32A-102 (3) BP-2023-1338
26 MARKET ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-102-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1338 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 30000 FORREST DEVINE 095779U
Const.Class: Exp.Date: 07/07/2024
Use Group: Owner: LLC DDM PROPERTIES
Lot Size (sq.ft.)
Zoning: CB Applicant: DEVINE CONSTRUCTION INC
Applicant Address Phone: Insurance:
129 LOVERS LANE (413)478-9691 2001W89165
GRANVILLE, MA 01034
ISSUED ON: 09/26/2023
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:
tir
Fees Paid: $210.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac se s
I�w1 Office of Public Safety and Inspec 'ens O �S
t Massachusetts State Building Code(780 I ' 6:")l o�
Building Permit Application for any Building other than a One-o '• •• ily Dng
yn0it
' (This Section For Official Use Only) ro�>itiA�
Building Permit Number a3` I3.Y3'c Date Applied: Building Official: 491Fcl,
SECTION 1:LOCATION 6b0
4,
0
No.and Street City LTown Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2•PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building❑ Repaird 7 Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No
Is an Independent Structural Engineerin Peer Review required? Yes ❑ No C
Brief Description of Proposed Work: f e?lk C e t e 3 4-v o. S ive:u
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2❑ Nightclub 0 A-3 ❑ A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 ❑ H-4 0 H-5 0
I: Institutional I-I 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IBD IIAD IIBD IIIAD IIIBD IV VAD VBD
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal
Public[la'" Check if outside Flood Zon ' Indicate municipal A trench will not be Licensed Disposal Site❑
Private 0 or indentify Zone: or on site system 0 re permit id r trench or specify.
is enclosed 0 71-Q
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission RcviewT rocess:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes❑ No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
--S-fk',LA-- 6e ZC r IC Z 6 Kotf Le-e 9(€ — l.3d N-L-,a a tom- A g•&q- a LO6 0
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information
0c...w12—r III 3 ( -t23I 11(5_ 5777,57( r IrvC:S(,� tv.eico.,,i
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
;„, `DeJe %.0._ t2-S (,Ve-r$ 6 - t�rc;/co'tl�e r A:01 0( v 3 4(
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
U ,‘'-'11-- (Sct-f ' (o N
Company Name
;raS el—�e v 1...%..` 07S ? 7
Name of Person Responsible for Construction License No. and Type if Applicable
t 2 (c sex S ki c- 6i .t v &, (62 ,t--cf-- t )3 4-1Street Address City/Town State Zip
- - 417-Ct> r'q I c-acCe5 e 00-42_77- ( q-t (L c v„�
Telephone No.(business) Telephone No.(cell) e-mail addiess
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes CI No C l
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ ,. 0I CVO Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ _/Pl .
3.Plumbing $ �V
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to L � ��
6.Total Cost $ t (contact municipality)and write check number here l
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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 t of my kno e and understanding.
ILI
Please p ' t and sign meTitle Telephone No. Date
V..1 Z��5 nkv.€ 6--,..,<.„.(.<e PC AL DOS Li Ve. t'e-5*-ciev.-u_`Zl'a 6.c
Street Address City/Town State Zip Email Address J
Q 3
''l 1 [� _l c o
Municipal Inspector to fill out this section upon application approval: i ��� " • .. ``�
Name Da
City of Northampton
40-`--,,-.,*- Massachusetts kV c,�f
c.
i ( .':, DEPARTMENT OF BUILDING INSPECTIONS S:
212 Main Street • Municipal Building J, a
Northampton, MA 01060 syy o
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: iliklk,6-6 4— G1 (.
The debris will be transported by:
Name of Hauler: 4 herSa' 4-1`vGk
Signature of Applicant: Date: Z57Z3
•
_ The Commonwealth of Massachusetts
y l 1=1_!i Department of Industrial Accidents
—:.IIiI�:- 1 Congress Street,Suite 100
1s1 Boston,MA 02114 2017
•�•. w"ww.mas&goy fdia
Workers'Compensation Insurance Affidavit:Builders/ContraetorsfEleetriefans!Plumbers.
TO HE FILED WITH THE PERMITTING AUTHORITY.
Anolleant Information Please Print Legibly
Name(Business/Organization/Individual): �CC� w Ca-4 Star`cic i t n/V
Address: / L 0_,ze r,1
City/State/Zip:_�1 ((2 M'9 ()1t3C/ Phone#:, ?13. 47 g ? /
Are yea an eanpbpee?Check the appropriate box: Type of project(required):
1p1 am a employer with___emplo}sms(full andlor part-time).• 7. [3 New construction
?.D I am a sok proprietor or partnership and have no employees Working far ma in 8. 13 Remodeling
any capacity.[No workers'comp.insurance required.]
3.�I am a homeowner doting all work myself_[No workers'comp.neturanor required"« Demolition
4.01 am a homeowner and will he hiring a onn ctors to conduit all work on my property. I will 10 Building addition
enure that all contractors either have workers'compensation insurance or are sole I I Electrical repairs or additions
proprietors with no etoployeea.
12.0 Plumbing repairs or additions
sin l am a general contractor and I have hired the sub-contractors listed on the auacitedd sheet. 13. f repairs
These sub•crmtracto have ernploye+r and have workers'warp.insueance_t ,`^^,
6.0 We are a corporation and its officers have exercised their right of exemption per MGL 14.D Other
I s?(l(d).and we have no employees.[No workers'comp.insurance required.
t
*Any applicant that chocks box PI mi stt also fill out the.section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating des are doing all work and then hire outside ccenrecto s must submit a new affidavit indimikig such.
contractors that check this bra must attached an additional sheet showing the name of the sob-cmuractors and state whether or not those entities hays
employees. If the sub-contractors have employee's,they must pavtide their corkers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ik,NU t.t Jy/
Policy#or Self-ins-Ltc.#: TOO 1 It) $ [ 6 5 Expiration Date: 7/l 1 2-41
Job Site Address: 1,2.-- (6 M24// 1- sl-rP e d— City'SlateiZip: 1Jd t 44m iy �Ea
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1.500.00
and/or 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 Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify unde d penalties ofperjury that the information provided above is true and correct
Signature: Date: Z5/7- 3
Phone#: yt 3 7 e f 6
Official use only. Do not turite in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 1.Building Department 3.Cityftown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CONSTRUCTION CONTROL WAIVER
From: ,,/v`I AS_ ( 1 JY� c I()ci C o JU
a9 iebVf.f j Z;(eLE_
6ra'vA11e Miq 0 ( 03
To:
Jonathan Flagg
Building Commissioner
City of Northampton
212 Main Street
Northampton, MA 01060
The Massachusetts Building Code,section 107.1 allows for an exclusion from requirements for
construction control in certain situations.In accordance with code section 104.10,I request that you
grant a modification to waive the requirement for construction control of the project at
because the work is of a minor nature,will not affect structural elements,health,accessibility, life or fire
safety,and will be done in accordance with the prescriptive requirements of the code.
Thank you for your consideration.
Respectfully,