42-124 (5) BP-2023-1495
150 GLENDALE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
42-124-001 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-2023-1495 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 9000 JAMES ROBERTS 099404
Const.Class: Exp.Date: 01/21/2024
Use Group: Owner: STONE PETER A
Lot Size (sq.ft.)
Zoning: WSP Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 10/24/2023
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:
tr, • )ZR . 3-10•V
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildine Commissioner
IVED
OCT 24" ?n23
Th Commonwealth of Massachusetts
B and f Building Regulations and Standards FOR
OF GUI,.DIN(;INSPFCTI
/14RTHAmr,ToN,MA 0706Tp llssac setts State Building Code, 780 CMRNT! MUNICIPALITY
ITY
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 4, 01,3 I y9.7 Date Applied:
/Q"z z'z-
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
11 Property re ss: � 1.2 Assessors Map&Parcel Numbers
1.1a 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 0 Private 0 Zone: Outside Flood Zone?
_ Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 r'of Reco
Name(Print) /v"K k � City,State,ZIP
friNo.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Spec' :
Brief Description of Proposed Work2:
ioi
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Mat ials)
1.Building $ I.1. Building Permit Fee:$ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) $ Total All Fees/••$.
Check No3 7 Check Amounf:40
6.Total Project Cost: $ 0 Paid in Full ❑Outstanding Balance Due:
PP
City of Northampton
Massachusetts
tt
s .x'
DEPARTMENT OF BUILDING INSPECTIONS r'
212 Main Street • Municipal Building
Northampton, MA 01060 't!, F ,‘� �
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
I. 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.
SECTIN 5: CONSTRUCTION SERVICES
r.1 Construction Super ' r License SLO
J `11e'4) J 4.1
License Number Expiration Date
Name CSL Holdeer�j____� � /,/
e l/'��' ' 'IY6�Y� List CSL Type(see below)
No.and Street ._ Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/ own tate, IP Masonry
�/ / (/
X /� a al 7R Roofing Covering
Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) � _ '(
/,-,
� HIC Registratio// umber Expiration Date
HIC Compan . e or egistrant Nam
No.and /eet Email address
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 t/ / ,d
.X-170601------
to act on my behalf,in all matters relative to work authoriI by this building p rmit application.
�� i Tc N•
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./
_tr......„,..._/... 141-0-dilmre Jt/
Print O' 's or Authorize.Ag of s' ame( lectronic Signature) Date
NOTES:
I. 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/dns
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 halffbaths
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"
The Commonwealth of Massachusetts
— -
--- twamgfri, Department of Industrial Accidents
illiki,..= ,,,,,
I Congress Street,Suite 100
vottit-mr Boston, A/A 02114-2017
tt
wwwmass.gov/diu
‘1,w kers'Compensation Insurance AffitLavit:BuiklersiContractorsdElectricians/Plumhers.
10 DE FILED WITH THE PLAMITIFIN( AUTHORI1N.
Applicant Information Please Print Leeihls
Name iHusincss;organizatuntndividuair ' ..,,,4'il-*
Address: ?Or
City'Statelip: Phone : i 3-qii)
..... .
An you an 1,111(3101tr?Cluck the appropriate hot:
T)pr Of ptoject trctititred1
I, I am a employer*nth (fall ander part-time t.• 7. 0 Nest, edtt:Strticti ,11
2 Jaruk propnctur or pcuhataskup and base no employees*orking fur roc in S. 0 Remodeling
an capacirs, [No winters'coMp,insurance sexturrod I
9. D Demolition
I am a honsoawnet doing all work myself"No*orix.Ix'cump,inourance requsnair
i 0 Q Building addition
CO I ain a lurairsorkiter and will be homy cOutslcum to conduct all*urk on ray ptalk7ty I will
oisure that all contractors either have*wider;cumpensarrOn insurance or arr sole 11.0 Electrical repairs or additions
proprietors xsithi nu employees.
I 2.in 'tumbmg repairs or additions
50 I an,a g4:114:Tal contractor and I base tonal M acton.Listed on the anached sheet. _.
13 ii Roof repairs
These sub-eunoactors haw employees and has e workers'eamp,insurance,:
14_0 Other
era 94'e are a ourporahun and its officers has e exercised their oght of exemption per 111CIL,..
1:t2,§1(1),and wc lust no employees.[Nu workers cinnp.insurance required]
°Any applicant that cheeks box nl inwst also till out the section below shy*inn then workers'CtInkpermatkuti poliey information,
'tiorneowisers who submit this affislasn in/heating they arc&nog all*mi.and then hue outside contractors must siihnut it new affulas it indicating such
:Contractors that check rho box must UthieCia.A an eirldstkunal sheet show ing the name of the stib-x:crntrac-torx and.zate*hober or nut those aditio haw
employ ces II:lse sub-enstracturx base employ Ceti,they natal pm'.idv!heir w°dom.,"comp.p)i_:•• rucil,..1
I am an employer that is providing tvorA(-Ts'cu pensation insurance/Or my employees. Below is the policy and job site
information.
;: -
Insurance Company Name: ___
Policy 4 or Self-ins,Lie. ,t: Expiration Date: tii--, /,--. f
Job Site Address: City/StateiZip:
Attach a copy of the workers'compensation policy declaration page(showing the pone) number and expiration date).
Failure to secure coverage as required under MCiL e. 152.§25A is a criminal violation punishable hy it fine up to SI 300.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 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 pains penalties ofperjury that the information provided tthose is true and correct.
.
Signatum yfille77(% Date: /d — '—?
....-
Phone 4: -• 'i —41L/f-----
Official use only. Do not write in this area,to he completed by city or town official
City or Town: Pernik/License#
Issuing Authorit), (circle one):
1-Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6,Other
COUiliCI Person: Phone#:
. - ...,..,
Illir
City of Northampton
Massachusetts _
DEPARTMENT OF BUILDING INSPECTIONS S' IT
212 Main Street • Municipal Building '�6: 1;;.
Northampton, MA 01060 '' 0��
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:
The debris will be transported by:
Name of Hauler: ,2.,,v),(2
Signature of Applicant: Date: / 3 -3
City of Northampton
jd.A ratr,
' Massachusetts 4!�
T.
DEPARTMENT OF BUILDING INSPECTIONS
°`p> 212 Main Street • Municipal Building 1 ,•�:
Northampton, MA 01060 S, - ,y%
•
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)