25A-135 (4) BP-2023-1779
17 GLENWOOD AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25A-135-001 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-2023-1779 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF/WINDOWS 2023 Contractor: License:esc ' z6
Est. Cost: 20000 ROBERT OBEAR
Const.Class: Exp.Date:
Use Group: Owner: WILMINGTON TRUST, NATIONAL ASSOCIATION
Lot Size (sq.ft.)
Zoning: URB Applicant: OBEAR CONSTRUCTION COMPANY INC
Applicant Address Phone: Insurance:
34 A EAST MAIN ST (413)537-5953 5X67382
MILLERS FALLS, MA 01349
ISSUED ON: 12/26/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF, REPLACEMENT WINDOWS
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:
coliktfitlx.)
44 ut
Fees Paid: $105.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
DEC 20
Xi23
The Commonwealth of MassaJhuse FOR
inOt Board of Building Regulations anii Starid4W run ow �iSa MUNICIPALITY
Massachusetts State Building Code, 7800E k` a"'"Tnr.rya osoONs_ ( 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: 0• A 0,-1 7 7 Date Applied:
4164
Building Official(Print Name) Signature / Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
17 Glenwood Avenue,Northampton 25A-135-001
1.la Is this an accepted street?yes X 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 CI Private 0 Zone: Outside Flood Zone? Municipal 13 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
EDS Enterprises, Inc. Millers Falls,MA. 01349
Name(Print) City, State,ZIP
34 A East Main Street 413-537-5953 obearconstruction@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building[3 Owner-Occupied 0 Repairs(s) [3 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units 1 Other 0 Specify:
Brief Description of Proposed Work': Replacement of existing asphalt shingle roofing with new
30-year architectual grade asphalt roofing replace 4 windows
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 20,000 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: ''// ��11h
Check No.541,1 'Check Amount I V l Cash Amount:
6.Total Project Cost: $ 20,000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS086260 07/24
Robert Obear License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
47 W. Chestnut Hill Road
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
MA. 01351 Montague, R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonr
y
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-537-5953 obearconstruction@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 152593 09/2024
Obear Construction Company, Inc. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
o34aA Easstt Main Street obearconstruction@gmail.com
NMlllers calls,MA. 01349 413-537-5953 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 ❑ 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 ,of �. ow, I hereby attest under the pains and penalties of perjury that all of the information
00,0
contained ' ' ation is true and accurate to the best of my knowledge and understanding.
///L
-icilif 12/18/2023
Print • -j': horized Agent's Name(Electronic Signature) Date
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"
City of Northampton
SNs - ..SIC
Massachusetts
• ° DEPARTMENT OF BUILDING INSPECTIONS �• ,
212 Main Street • Municipal Building
'�� Northampton, MA 01060 J:f!%•— yjN�
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: Greenfield
The debris will be transported by:
Name of Hauler: Afforable Dumpster Service
I/A,
Signature of Applicant: t/'I��� Date: 12/18/2023
_ The Commonwealth of Massachusetts
I`W_ _ii Department of Industrial Accidents
!ai
1 Congress Street.Suite 100
ir ' 1: Boston,MA 02114-2017
. wwiv mass.gov/din
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERstirriM.AtTHOWTV.
Applicant Information Please Print Le ibh
Name(Business.'tlrganizztionlnd.%idual): Obear Construction Company, Inc.
Address: 34 A East Main Street
City/State/Zip: Millers Falls,MA. 01349 phone#: 413-537-5953
Are yea as eahptayer!(.'leek the appropriate boa: Type of project(required):
I.Q i am a employer will, 10 catpkiyeca(full and ur part-craw).• 7. 0 New construction
21::)I am a auk proprietor or partionlip and have nu employees working for me in 8. ® Remodeling
any capacity^.[!No workers'coop.insurance ngrnnd-1
30 I am a hointonner doing all work myself.[No wuhm'cutup.rostrum a nyrired.)' 9. ❑ Demolition
10 0 Building addition
40 1 am a lei mowrwt and will be hiring contractors to conduct all work on my property. I w ill
arum that all contractor.either have winters'compensation uuurance or are sole 11.0 Electrical repairs or additions
proprietor with nu employees.
ILO Plumbing repairs or additions
SO I am a general contractor and I has c hied the sub-contractors listed on the attached sleet_ 13 nROOF repairs
Thesesubconttactorshave -mployeesand hesew oilers' ms comp. urancc.• z--■
h.Q We arc a corporation and its of twos have exenised their right of exemption per MGL c. 14•0Uthet
IS!.¢1(4).and we have no cmpiwti^ea.[No w mien'comp.insurance rcyuueml.)
'Any applicant that chucks box a1 must also fill out the section below showing their nutters'comptanYa paw'y irtarmtieo.
*Homeowners who submit this afrrdayit=beating they are doing all work and then hire outside eurinacasis oral admit a m w of tides it inik.ntmg such.
:Contractors that cheek this box must attached an additional sheet showing the name of the subcontractors and male whaler or not those entitle.have
empluyees. If the subcontractor have ernployeas.they roust provide their worker'curio-polies 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: Employers Mutual Casulty
Policy#or Self-ins.Lie.#: 5X67382 Expiration Date: 04/2024
job site Address: 17 Glenwood Avenue city state/zip: Northampton,MA
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to SI.5(H).(0
aniVor one-year impris . tee _as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.(X)a
day against the viol- �� tiof this statement may be forss wiled to the Office of Investigations of the DIA for insurance
coverage verificat'
I do hereby cer i �'"• ,, • , • ', ay that the information provided above is true and correct.
Signature: ''P' Date: 12/18/2023
i.
Phone#: • 13-537-5953
Ofcial use only. Do not write in this area,to be completed by city or town official
('itv or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City frost n Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: