31A-235 BP-2023-1385
29 KENSINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-235-001 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-2023-1385 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 29500 JS CONTRACTORS INC 058968
Const.Class: Exp.Date: 08/28/2024
Use Group: Owner: COLLEGE SMITH
Lot Size (sq.ft.)
Zoning: URB Applicant: JS CONTRACTORS INC
Applicant Address Phone: Insurance:
126 SUMMIT ST (413)537-5379 6HUB-2E38599-8-23
BELCHERTOWN, MA 01007
ISSUED ON: 10/10/2023
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: • t • >2 • 3-1'I
I
Fees Paid: $192.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
----.....r" \\I P
5 tt3 The Commonwealth of Massachusetts
' :.ard of Building Regulations and Standards FOR
1, \o c•tir�spocjtOrt� ssachusetts State Building Code, 780 CMR MUNICIPALITYSE
' --.T r' Ilk
Uu oT':+ Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
roc'"''�` g PPp
One-or Two-Family Dwelling
This Se on For Official Use Only
Building Permit Number: & �'3'-f 3 75- Date Applied:
�t� a., f/& I61-0.7o23
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
29 kENs,,,,-)TQA-1 S-t'
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 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
A t4G,/Pla' � ,, 7` Cd%75e AnAry 'f
Name(Print) City,State,ZIP
02J2 44(4'4 a-tp 1 ''d 913-s57)6 rtidea-ite e,r1 'nd
No.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 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': L Trc:t-, Exs 7 s"i-i•.r Zo a-C To n&c.(�
TN-S N i A..oS L.LS c✓r"tal A.s pW s 2I A.._c_W 5-0..,7 Lam.s ' (j-Z, S 4)
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 ��`` b�
❑Total Project Costa(Item 6)x multiplierat 5�m) x 10
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
heck Check No.g5,3 Amount:_ �1,
6.Total Project Cost: $ :9-S 0 0 ❑Paid in Full 0 Outstanding balance Due:
City of Northampton
" Massachusetts
f{ 4
fe.M. DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
r.
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.
l
4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
5896$ 9 zs z y
"-t1 tE S Szc.z ci,t3 Q 'c License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) I.)
/76 Sc,",,,.,,-4 S7"- Type Description
No.and Street p
� � d`� U Unrestricted(Buildings up to 35,000 Cu. ft.)
4ECc��
it 7 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4//3 S s'5.5 Z 9 .Z E ir BA /e ( 6 j", i f I Insulation
Telephone Email address, D Demolition
5.2 Registered Home Improvement Contractor(HIC) I/s66/ ' 7
J•S CO#. ItA 'd"--S HIC Registration Number E pirat' n Date
HIC Company Name or HIC Registrant Name
1 ZG Su», dt- S t--- — Z as SA le 6P1A/4.—
No.and Street Email address
BELGL'‘sE/l-fawh+ p.,ia d/dd7 $l3 S37532.9
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 Z. 5 Coou"t'2r c-C'd 2
to act on my behalf,in all matters relative to work authorized by this building permit application.
G / oy�3
Print O is Name(Electronic Signature) l 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 mya knowledge► and understanding.
_� ;4,4".s s-z2z 1Sl3Ade � fr t _zs,_Z3
Print Owner's or Authorized Agent's Name lectronic Signatu ) 7 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/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"
ir
The Commonwealth of Massachusetts
==.
Department of Industrial,decidents
.
—MR..-... i Congress Street,Suite 100
Boston, MA 0211.1-201 7
www.mass.gotVdia
IA or kers' t.'Oittperisation Insurance Affidavit:BuilderVContractorserEketricia ns/Plit others,
Ili HE t ILI:II N4 I Ill THE PERMITTING AUTHOR!I V-
Applicant Information Please Prim t.,..IlihiN
Name ottusax..- Organization,Intitsidual): -T S f-rtts xi-tit A ‹,-t-Cr ft—N.
. ,
Address: rz G 5ti min it s-r"
C ity/State/Zip: -3/ f,1 c(.,-( A-1-6,...,jyp/ij,c,. Phone#: , Li/-3 5 g—r 57 2-9 .
. .
Art)oat on rnipluyed Cheek no appropriate nos: Type of project(required):
L.21.1 am a employer with Semployees(fall arlii,or partsiinel,* . 7.. 9 New construction
2.0 I am a sole proprietor or psevaership and have 113 etriployees workins, fur me na li. 3 Remodeling
aa3 Lapacify.CSio workers"comp:.insurance retpairedi
9: en Demolition
%.0 I am a lionsoumer-dump all weak myself Ilsio vimitcre comp.thatimace manned"
100 Building addition
4 C]I am a lintramwerier and 44,41.1 be haring oantractorts to conduct all ss ark on my property, I will
moire Mat all contractors either have workers"comptitatiOn,iltAltAttgX tlir 33V sole I 10 Electrical repairs or additions
ptuprienars with no employees,
1 ID Plumbing repairs or additions
1,0 I am a general euntraetor and I luxe fined the sultocontraetors hated 133 the aitasited sheet
I 3:N Roof repairs
Them atib-erantrachsra have employees and Moe workers'coals,latittrance,:
6,0 .0 Other We am a emparanion and it officers hese exervised their tight of eserraption per kit&e 14
152.,f 10),and we have no erryloyees.f No h takers camp,.insurance required:I
*Am appLiemst that checks box 0 I muo..11,w 611 out the Wal-0n beklit ibouing thee workers*compel-vex 1,Jo roiN.-:, tafolinanork„
' thPriarn nets who submit tins a flidto,a]adwa taw they are&wig all work and thew fine ortikaleentetradort MI24 Oth111.1t 3 he*affidiaa it traheatAwg stwh
Lora:aloft that tilt&tiffs 1,./..tA tta,:ct talw.1---d an whhtiuttal sheet Ansa in g the name ef the stdostontractors and-.LUC VOICIII-Ci"n not rheas ettfities haw
tr the,u6-..:,..1 ,,al,1°...1,,:.,!IT 1..,,,:,:e,,..iii,..A must ptswide their workers'sc trip.pJlw,),ntratiwt
- - _
lam an employer that is providing,worker cinnpensation insurance for my employees,. Below is the policy and job site
information_
Insurance Company Name'. re .
_
Policy#or Self-ins_ Etc.#'.. ‘.go a - z.E_acit 5947- 0-Z-1 Expiration Dine: Z. -z.Z. Z.y
Job Site Addrea : `-z9 IC-g ta itiq I 0-A-) 5'D City-StateZip: /tics rt-st-tinolp 71,7r-vi.....-
, Attach a cops of the et,orkers°compenaition policy declaration page(showing the policy number and exprratitm datej.
Failure to 801:4.11V coverage a required under N161.c. 152.§25A is a criminal violation punishable by a fine up to S1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 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/mins and man/ties ofperjury that the information proldded above is true and correct.
natureq. , - --kI
Date:
Phoneg: t 13 S
Official Ilse only. Do not write in this area to he completed by city or town official
1
City or Town: . Permii/Licettse It
Issuing_Authority(circle MIMI:
1. Board of licalth 2.Building Department 3.l'its/Tosits Clerk 4.Electrical his pector 5. Plumbing Inspector
6.Other
1 •
Contact Person: Phone*:
(
It
City of Northampton
0 i
'� t Massachusetts f r"
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building 4, y;,
s � i
.rye., Northampton, MA 01060 , A
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: /ALLy '-y cL,'w '1
The debris will be transported by:
Name of Hauler: -Z..S co)..)-Fet-A c—to�
Signature of Applicant: .��-� I Date: ` ' _Z _z3
i .
4,City of Northampton
Massachusetts
♦ DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building f,
Northampton, MA 01060 ��'a- . .i`
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)