38B-179 (5) BP-2023-1137
13 FORT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-179-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1137 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 8000 ROBERT J WALKER 034783
Const.Class: Exp.Date: 10/18/2023
SAMUEL E WALKER TRUSTEE OF THE WALKER
Use Group: Owner: FAMILY TRUST
Lot Size (sq.ft.)
Zoning: URB Applicant: JUST WALKER
Applicant Address Phone: Insurance:
36 Service Center (413)584-1224 0
NORTHAMPTON, MA 01060
ISSUED ON: 08/22/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i
, • +,
I
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://north,y itonma.gov/DocumentCenterNiew/15553/Residegtia...
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The Commonwealth of Massa• use c
°l''44,!,� Board of Building Regulations a•0 St �0 IC•'ALITY
\ Massachusetts State Building Code, - :1 ii� SE
Building Permit Application To Construct,Repair,Renova - 16'(" , Revis:,Mar 2011
One-or Two-Family Dwelling .MAo,eoio
This Section For Official Use Only
Building ermit Number: gy2—y3 //37 / Date Applied:
EUI+.s�I<Q,s li/-/Z S-zI-zoz.
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
JJ Fa'R'T Sm.*
1.1 a Is this an accepted street?yes f no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) Il/112t— f7On�1,3`(0
Front Yard Side Yards" Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage
posal System:
Public lY Private❑ Zone: Outside Flood pa Municipal WrOn site disposal system ❑
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
'r2-D6ce-z S Lo AL-v f2._ N o (2 -j- w`- P11)1J KR- o Lo&O
Name(Print) City,State,ZIP t�.10W4-4.✓
13 CO'17-7r Sr tN 5 C8 to 40-1-7 _Ft rv►c.+e a +c c 66-«;—e c , 6-c31%.,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED ORK2(check all that apply)
New Construction CI Existing Building p/Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other Specify: 1?-m:a0 c tJ L
Brief Description of Proposed Work': .r. .Vv...Q V St'-A., r0 C c.„t- (.
cow ` ) e► 0\40-1— s1^^ PIPS
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
O Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:�$,
6.Total Project Cost: $ Check No. \K� Check Amo O
❑Paid in Full 0 Outstanding Balance Due:
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia...
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City of Northampton
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r �, ,A Massachusetts � 5 " '�
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i DEPARTMENT OF BUILDING INSPECTIONSSi
. 212 Main Street • Municipal Building y�,
" Northampton, MA 01060 a ,„,,,,..4A
4
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new/replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable).
9. Energy Code-all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residentia...
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City of Northampton
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Massachusetts rya.
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building :mot
Northampton, MA 01060 sl=yy ")1���
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Itprt-
The debris will be transported by:
Name of Hauler: Ccm Co-v-vpet-n.)1
Signature of Applicant: Date: Cd2 I
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND... https://northamptonma.gov/DocumentCenterNiew/15553/Residectia...
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City of Northampton
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Massachusetts 1"
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} r DEPARTMENT OF BUILDING INSPECTIONS !
212 Main Street • Municipal Building a3�,
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Northampton, MA 01060 S'PV \�
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detached structures
accessory to such use and/or farm structures.A person who constructs more than one home in
a two-year period shall not be considered a home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pains and penalties of perjury on this day of , 20 .
(Signature)
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/
SECTION 5: CONSTRUCTION SERVICES
5.1�Construction Supervisor License(CSL) S,� p 3 -7 1 cA l 2,1
�'p g ircstr S (-A-a-N LAe-A-(t License Number Expiration Dat
Name of CSL Holder
List CSL Type(see below) U
3(o Se.e-v I v 60..
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Nb'ed•t"IalA-i.A, 7TCt-> *A— O vDC() R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding a f
/� /,'
SF Solid Fuel Burning Appliances
d'3 6`sl, 4v 77 Q.C .c-k r ±c+sc ac e4 fc'v` I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1124::. 5/121
' >6.4i.e (,,¢, 0.12 t-v"* HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name k yyV--• AJJ
No.and Street Email address Cpnl
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes 0 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
X'lit Owner's or Authorized Agent s Name lectronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
4
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The Commonovealth of Afassachusetts
=6-71 Department of Industrial Accidents
—ra 12 1 Congress Street,Suite 100
7 q Boston. MA 02114-2017
7' Al
www.mass.goildia
-.1,---
- 11 orkers'Compensation Insurance Affidas it: Buiklers/Contractors/Electricianv Plumbers.
in BF.FILED NS I in I II I:.PE10111-11ING At.41101(1111.
Applicant Information Please Print Levi his
Name(Business,OrganizationindiNiitual):
Address: l' --t>so--/----
City/State/Zip: 19,0trctrt,,,, 'Wt.— Phone#: 1--11r- rc-Is,-- 4-o 7-7
Arefor in ensphore!t bo:k the appropriate hot: Type of project(required):
1.0 I am a einplo7.,cr with eptines tfull tdar part-timer' 7. 0 New construction
I am a sole pruprsetur ur partnership and base nu enapkrwes working for me in K. 0 Remodeling
.ins capacitv.[N4.1*urkers'cump insurance requins.1.]
9.-7 IN:n2olition
3.[J 1 im a lairmasvirscr doing all work myself,[No wortisas`curry,insurance moiled"'
4. lam a huirk.saumm and will be hiring ountractora to conduct all work on my',weeny. I Will Ed : 10 j Building addition
citsun:that all contracturs either have skuiters cuirrapensaiivin insurance or are stale 1 la Electrical repairs or ailditions
prupneturs With no rinplul..cis...
12.0 P gibing repairs or additions
5 I am a INitt.731 cuntructur and I have hired the aub-cuntracturs listed un the attached shed.
13 Roof repairs
These aub-curstncturs haw Lmpluyed and twit:winters'comp.insurance.:
I 4..°Other
6.0 We are a ourporataun and sts;Akers has r exercised their nght of exemption per MGL c.
152.tj li it,and We have nu kanpluyed.[Nu*LAMY.rump.insurance required.]
i
°Any applicant that chucks box al most also rd]out the section below showing their workers'compensation win.)information..
'ilurncow nen,who submit this atrida6t indicating they are doing all work and then hire outside contracted must submit a new affulati.it Indic:lung sis:h.
:Contracturs tlist cheek this EbOX Inns,attached an Additional sheet shut.era the name attic sula-cinaractues am!lune*further or not Oho .:cniitic,haw
eniplo ce., If the sub-eurar-talt.iN 1121',:ilur i,,,,,CO,tiLi4 KIU.51 ply,id e r;:i..i: w inked-mis polie'y number.
I am an employer that is providing worker.*'compensation insurance for my employees. Below is the policy and job site
information. 4.
Insurance Company Name: _
Policy 4 or Self-ins.Lic. 4: Expiration Date:
Job Site Address: City/State/Zip:
Attach*copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under:MI_c. 152, *25A is a criminal violation punishable by a tine up to$1,500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Oftloe of Investigations of the DIA for insurance
,.:(Y,cra,.!::S erilleation.
I rho hereby certify under the pains urn!pen(thie Of periary theft the infOrtnatiott provided above is true and correct.
Signature: (26.1..,—*-- W7---14...._ _ Date: Z)( 2-1 I 7-7
Phone 4: 41 5 S'S tf ei 0 1'1
Official use only. Do lJr Ft ii rite in this area.to/u cornpleteil by city or town officiaL
City or Town: Permit/License 4
Issuing Authorit), (circle one):
° 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspet lot-
h.Other
1
! ('ontitet Person: Phone#:
...
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