35-208 (10) BP-2023-1745
539 WESTHAMPTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-208-001 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-2023-1745 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 17000 MICHAEL LOW 060275
Const.Class: Exp.Date: 12/26/2024
Use Group: Owner: KEILLOR DAWSON JEFFREY &VANESSA
Lot Size (sq.ft.)
Zoning: WSP Applicant: AUTUMN BUILDERS LLC
Applicant Address Phone: Insurance:
6 LACKEY DAM RD AWC4007038268
SUTTON, MA 01590
ISSUED ON: 12/14/2023
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:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
s:),t ,.‘..i,---- \ le E.-011V--j
oEc 129-11
i • TEhe Commonwealth of Massachusetts
FCl'�ardof Building Regulations and Standards FOR
- j ,c�+\c''°'���^��P° `"ssachusetts State Building Code, 780 CMR MUNICIPALITY
FaT °,�NNvnc' USE
°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:a n— 3. 3— 17'l 5— Date Applied:
1, p I:161k_ 4 2, i Y
Building Official(Print Name) Signature I/
t
SEC ION 1:SITE INFORMATION
1.1 Pr erty Addres 1.2 Assessors Map&Parcel Numbers
1.1 a TeZan accepted stree . 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 Ow f Record: 4/CreACt°z // / 6/04
Name( t) Vel City,State,ZIP
63 (q' ) 71 ,),
No.and Street �� ( T phone mail Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Num r of Units Other 0 Sp cify:
Brief Description of Proposed Work': 74 J ' cIo/:
7
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 Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees
i AO
Check No.a Check Amoun : Cash Amount:
6.Total Project Cost: $ 17 s 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction S ervisor License(CSL) 06
pa7-s---
�� e.bit(
f C L2(4) License Number Exp. ation ate
Name oy C`SL oldt. ///
�, ,/� 1C1/ List CSL Type(see belov()
No.and Street I` Type Description
Si- �/ Unrestricted(Buildings up to 35,000 Cu.ft.)
T r , if t / R) Restricted 1&2 Family Dwelling
City/Town,State,ZIP (�• I Masonry
O J 5- 90 RC Roofing Covering
WS Window and Siding
5�9/3413a ' l� qi,r` 1 SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Hoyle Impr vement Contractor(HIC) 1,J 6 9/>/ 1 0 �
7k �`f7r
l�c't ,� C_Ce, HIC egis o Number x ation Date
HI omp� ml _ HIC ReC�Nti
"��1 side ?"® l,(��
No.a t t t m / D' d��5 Email addr�s
Q r �`/
City/Town,St e,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 accura to th st of my knowledge and understanding.
4if
Print Owner's or Authorized Age 's a ectron a ) irnc Date
NOTES:
1. An Owner who obtains a building permit to d is/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"
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE: LLC
Registration Expiration
146914 08/19/2025
AUTUMN BUILDERS, LLC. ,..
( i:-.:_,',. ..1 :7:4 '.;..s.,.
k:
MICHAEL R. LOW ^
6 LACKEY DAM ROAD ` 1 ,; ic0(a1' „. •
SUTTON, MA 01590 _ ,,A.. `./'
`` ` `` Undersecretary
Commonwealth of Massachusetts
9-..)- Division of Occupational Licensure
Board of Building Regulations and Standards
Constructio peniscs r 1 & 2 Family
fires: 12/26/2024 ~gti Wit. ,
CSFA-060275 p x ,.xs
MICHAEL R V3W . _ �. ,�
6 LACKEY DAM ROAD +�_ ems. 't =A
01-41,
SUTTON MA-91590 % • �' 1 tya>
4-0
l,‘
vv iV1�a.t (��lacljt wC /1•
r � ' ''
yy c , n W
City of Northampton
Oa'AMp' ,s . . S/C..
Massachusetts 44' '<<G
ee I DEPARTMENT OF BUILDING INSPECTIONS 6
4,4*' '1.r ' 212 Main Street • Municipal Building , �.�
• ra" Northampton, MA 01060 -..NW arp<'‘'
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: 37 ('.LIU2 cmf �c�- A oioz-`y
The debris will be transported by:
Name of Hauler: fed
&K.
Signature of Applicant: Date:
The Commonwealth of Massachusetts
et Department of Industrial Accidents
1 Congress Street,Suite 100
:.s .
Boston, MA 02114-2017
F www.mass.gor/dia
11'euiters'Compensation Insurance Affidavit:BuildersK_ontractarsfEketricians/Plumbers.
TO BE FILED WITH PERMITTING PERMITTING AUTHOWTY.
Applicant information , Please Print Leriblr
Name tBusiness-Organization Individual t: Aa Ioa)n put/dGrS LL C
Address: 6 2u<ke/� Ro&
City/State/Zip: Sir&v) /2 Phone r: 7-1
Are yor an rmptoyrr!Chock the appropriate lets:
Type of project(required):
1.a I am a employer with $ employees(full and'or part•tiitel.• 7. 0 New construction
21:1 I am a suk proprietor or partnership and hail:no employees loyees working for ne m fi. 0 Remodeling
any capacity.[No workers*comp.insurance rs4urrth.)
t nr
0 l am a ltocowncr dotniy all work myself [No isorkin,'curry.insurance r ipurial.)'
9. Q Demolition
10 a Building addition
4.Q I am a horrseowner and w ill Ise hiring a a fur w comhwi all work on my property. I will
ensure that all contractor tither lime worker'coirciensab mt insurance or are sole 110 Electrical repairs or additions
proprietor u ith nu rmplusec�.
1243 Plumbing repairs or additions
521 lam a general contractor and I hair hired the sob-contractors hoed on the attached sheet.
134Roof repairs
These Alb-contractors lime employees and hose workers'comp.insurance•
6.0 N`e are a carporoson and its oIfieers have taer ied their right of c.aernptron per M(.L c. 14. Other
152.4I(4).and we brie no employees.[No nutters'comp.insurance remitted.)
'Any applicant that checks box al must also till out the section below show my their workers'compensation putiey information.
Homeowners.who submit this affidavit indicatmg they are doing all work and then hire cwtside euritraeioxs must subnut a new afftdas it irxtiuoing such.
:Contractors that cheek this bus must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hate
cmpluyees. if the sub-contractors base cntiplosecs.they must preside their worker'ernnp.policy numiber,
1 am an employer that is providint', orAers'compensation insurance for nit`employees. Below is the polity and job►ire
information.
Insurance Company Name: Pbtn r c.ive.,.v.C_e eS`eN.0 —
f ins.Lie.#: £ ,1c N o o 1-02$2 cgs o p Expiration Date: (�./q/
Job Site Address: 53g Cr1-5.41 Krvt As led• erscC /14 cityistatelzip: d/p 26
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIG!.c, 152. §25A is a criminal violation punishable by a fine up to S1,5OO.00
and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.O0 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 under th (xtins and penalties of perjury that the information provided abate is true and correct
Signature: Date: it/lc, /.23
Phone 4: 19-4 ea�-- 6 5 3
Official use only. Do not write in this area.to he completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5. Plumbing Inspector
6.Other
I Contact Person: -- - Phone 4:—
1