29-221 (9) BP-2023-1509
112 ACREBROOK DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-221-001 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-2023-1509 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 14000 SAM LAKAS 103997
Const.Class: Exp.Date: 05/23/2025
Use Group: Owner: PATRICIA HATHAWAY RAYMOND L&
Lot Size (sq.ft.)
Zoning: WSP Applicant: SAM LAKAS
Applicant Address Phone: Insurance:
5C SOUTH ST (413)230-6699
WILLIAMSBURG, MA 01096
ISSUED ON: 10/25/2023
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:
r • 16 9 Tit •
1 ! �
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVE
The Commonwealth of Massachusetts
j 2 4 2�� assac FOR
EI° r_ Bard of Building Regulations and Standards
M sachusetts State Building Code, 780 CMR MUNICIPALITY
USE
TS
FPT.-F GUILDIgK�-� eng4 emit plication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
NORTNAMPT
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number:mbbe 6/2"- -.3"t ice Date Applied:
1 �=Oi,) Kos, /// 2
/ lD Z5 wz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prope Address: � 1.2 Assessors Map&Parcel Numbers
119, . c r-e b roe — r
1.1 a Is this an accepted street?yes 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)
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 Disposal System:
Public❑ Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP1AA �
2.J``Own A of orr, c .0 n r�1 c.Q >7 YV`k'` O A 06
Name(Print) City,State,ZIP
l l - Acres 6 C 'r Pr , LW?-59,6 -e�6� ,1h9LictAaikAlo-y 0 y
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building VI Owner-Occupied 8D Repairs(s) ® Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units ptker 0 Specify:
Brief Description of Proposed Wor 2: S. (a CP(G' GAS _n 0 �Nl 0^ 14 n 'V
c WSWA i.R."/ CA.S IP cY S k.a .
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
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All FeesA ll tt y
Check No.,1jt4 'Check Amount: `mil 0
Total Project Cost: $ 1(.06 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
Massachusetts r a}�j •n !t=,
f "s; DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 0-
Northampton, MA 01060 'F'S),
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.
s L. c,ke /1-6
C i'4 cil/porl*
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) — !0 3 ctci7 S1-3/P-5
5-cum v t-C � �5 License Number Expiration Date
Name 6f CSL% �Holder
v, { ,
S /� A List CSL Type(see below) V
No.and Street v Type Description
W`I Y t 1hti. WO( / \ 0 17C( 6U Unrestricted(Buildings up to 35,000 Cu.ft.)
J Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
( � 3 30 - G,6-6ti-1 RC Roofing Covering
WS Window and Siding
5,1)0(7.3 C LO V may, • SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 isteerre Home Improvement Contr ctor(HIC) ! o/m/as-
5 l 6-NA HIC Registration Number Expiration Date
C HI orn any N e or egistrant Name
'� Spn(3d tx- I
No. ..V, SrO v C �/\ / 5;i'�j-�G Email address
City/Town,State,ZIP 0(Q,C(1 6 �ITelephone
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 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
t/jI,as Owner of the subject property,hereby authorize S 01""- '
to act on my behalf,in all matters relative to work authorized by this building permit application.
p.40.ti way k--0' (747-X-444:1-7 jo/ -07,1
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.
Se L-a/Le-1-'1" 1a7aa a-3
Print Owner's or Authorized Agent's Name(Electronic Signature) Da e
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"
L.., ,
.. The Commonwealth of Massachusetts
. ....."-.
Zailii=,tt Department of industrial Accidents
.......
l Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.govidia
m.oikers Compensation Insurance Affidavit:BuildersiContractorstElectricians/Pluinhers.
TO Bfr:I-11.ED WITH THE' PEILMITIING Al'THOltrlY.
Annlicant Information Please Print Legilals
Name 113us mess.—:Organization:Individual K, S.(A...-.P‘ ..---4,ic--00-s- Con4.r-c .4•C'Ivy
. ,(
0 Address: 5.--C- OA-
City/State/Zip: Vi 1 --1-)14-,.. b iiiii 0/04‘ Phone : LI i 2, -
Ate lonie*a ritipkryer?Cheek the Appropriate box:
Type of project(required):
it]I am a employft with ,,,,_ _._,,,.employee%(full and irr pars-tivaeL• 7. 0 Ness construction
.12rlarn a sole proprietor or partnership and have ILO employees working for me M a. E/Remodeling
any taimicity.[No workers"comp.insurance requiroJ]
9_ r] Demolition
Al u lionscownet doing all work irtysclf!No woakixs'corm,insurance required]
: 10 El Budding addition
I a I 3171 El homoowner arid vi all Ise ltumg calarso.ot-i•ta cuaduct ull work vtil My propert), 1
ensure that all coruracturs either have workers'conspensation insurance or are sole II a Electrical repairs or additions
FAUMWAM.4All employees,
1 2_E]Plumbing repairs or addition
.$0 I am a,i,vrierul contractor and I have hared the sub-contructink listed on the anavhed sku.,..:
These sub-contractors have employees itsti hat t*otters'comp.LAALMMIX 13.2(oof repairs)
14.0 Other
h.0 161'e are a eurponmon and its officers have exercised their righi of exemption per MU v
151.§I I'll,and we hove no ariployees.[No workers'comp.insurance filqUIX111
*An}applkant that c-luxig...i box g I must also fill out the.....%_zion I....low milit4 ate their A otliers'compensation policy mformution
' 1km...owners who submit this affidavit indicating they.nt doing all work arid then hoc outside contractor%mint subnut a MU'atfulav it inrJ h.-aung sua
;Contractor,that check this box must attached an aikbitiorud sheet show in g the name of the 5,u1:—.....ontractort and'gab:v.haber ot not thou:immix-%have
U.the sub-eorgractors have emplo.i 0.7%,the) most provide their v.urLera'COW..15-i il,..-..ntanbet
/ant an etnployer that is providing avorAers'clitnpensation insurance for my employees. Below is the policy and job site
infOrmation.
Insurawe Company Name: ______
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/StateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the polies number and expiration date.
Failure to secure coverage as required under MGL c. 152.§25A is a criminal s halation punish-able by a fine up to SI.500.00
aniVor one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 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.
I do hereby certify under the pain; penaides of perjury that the information provided above is true and eared.
...„.....- ,-----
-----....--- --- 1.,1 i 79 617d-3
Sltmature: „.-z 1..,.. ...' 0
nom:Z: 1 L-
' . 1 -2) - 2 30 — C G4 Ck
Osflicial use only. Do not write in this area.to be completed by city or town official
City or Tow n: Permit/License A
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plunthing Inspector
6.Other
Contact PeNfiri: l'11,11i.a:
City of Northampton
Massachusetts
Y
DEPARTMENT OF BUILDING INSPECTIONS
-* ,,,. . 212 Main Street • Municipal Building
—'',fM,„ Northampton, MA 01060
�
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:
oi[1,2,17 p_ex.Afc_Li) ).:5k4 ee4--44-4A-ip' i f4c" f))-
Location of Facility: v of A
The debris will be transported by:
Name of Hauler: S a-,,‘ L�� c
Signature of Applicant: �'��� '------- _ Date: 1 ° �/2 3
City of Northampton
MassachusettsF
14
DEPARTMENT OF BUILDING INSPECTIONS p'
'"" 212 Main Street • Municipal Building -''..
f'-" Northampton, MA 01060 $s'p. ��,N,,,
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)
•
Sam Lakas Construction
South W e�
Williamsburg,MA 01096
1""
413.230.6699
CONTRACT :::
Date: 10/20/23
Gail Hathaway
112 Acrebrook Dr.
Florence,MA 01062
413.586.0964
Project:Roof
Proposed Work/Notes
Strip and Install Roof
The job consists of the main house roof,the addition roof and the flat bathroom roof only.New 30 year warranty architectural
asphalt shingles to be installed,Certainteed Landmark Colonial Slate.The price includes stripping 1 layer of roofing and using
the existing sheathing on the addition roof.Stripping 2 layers of roofing and installing 1"cdx plywood to the main house and
bathroom roof.The bathroom roof will have torchdown roll roofing installed.Chimneys to have new step flashing installed.Ice
and water shield will be used 6 feet up from bottom of the lead edges,around the skylights,up the side walls,as well as around
the chimneys.Synthetic underlayment used everywhere else.Main ridges will be vented.New white drip edge installed,as well.
The price does not include any additional carpentry work.Removing siding on the side wall will be billed at$75/hr plus any
materials bought.This will be billed separately after the job is complete.The siding will be left off and new siding will be
reinstalled by home owner.
The payment will be scheduled as follows:one third due on signing of this contract,one third on the first day of job starting and
one third on completion of the job.
•
By signing this contract,I,the contractor promise to deliver in a timely manner a quality,finished project as described above.
You,as the customer,agree to pay all money owed as described in this contract.
Materials and Labor$14137.50
Dumpster$1000
Permit$500 J— C611/Y
Discount(-$163750) yj
Total due$14000
1a/ -0/9_3
Home o ner
ctor