29-587 (2) BP-2024-0102
85 WOODS RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-587-001 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-2024-0102 PERMISSION IS HEREBY GRANTED TO:
Project# 2024 ROOF Contractor: License:
Est. Cost: 700 0 SAM'S RENOVATIONS LLC CS-112866
Const.Class: Exp.Date: 08/11/2024
Use Group: Owner: KRISTEN JOYCE
Lot Size (sq.ft.)
Zoning: SR Applicant: SAM'S RENOVATIONS LLC
Applicant Address Phone: Insurance:
61 LAMB ST 413-535-8910 MPP 4663G
SOUTH HADLEY, MA 01075
ISSUED ON: 01/31/2024
TO PERFORM THE FOLLOWING WORK:
STRIP&REPLACE ROOF SHINGLES
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.VV. 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:
I`
Fees Paid: $80.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
i! ♦
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
MUNTY
Massachusetts State Building Code, 780 CMRIUSE`M I
�3uilding Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
tir 3'eEt-tit Number$p_202,t4-O I p Date Applied:
i
I 31
Building Official(Print Name) Signature ate
SECTION 1:SITE INFORMATION
1.1 Property Address: t 1.2 Assessors Map&Parcel Numbers
?5 W 0od S l L 2_1-15-87--do I
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
6g- 1 • 154. atrL
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:
Kits 3o4 6 Nn 14LQ.k evo ►M p oin to o
Name(Print) City,State,ZIP
WD0h, A.—e_ ci 19•IA7.3903 Vcis4-eApyce 0 gAA ,c
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 ❑ Specify:
Brief Description of Proposed Work': 1 O o - 'G.10.4f. - 5�2 L,P f'po - it Sh 1 k
N � SlnsA A ( d
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 000 ,no 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 Fees: $ B D c
o Check Nie/353Check Amount: OD
6.Total Project Cost: $ boo 0 Paid in Full 0 Outstanding Balance Due:
Ic tc,,k)tt - c,. -rk he r,w/o far r rn i t-
City of Northampton
Massachusetts
p
y'`,' DEPARTMENT OF BUILDING INSPECTIONS (
212 Main Street • Municipal Building
,,..- Northampton, MA 01060 {5`l'4 I' 0a
•
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.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
SG„.v1,&&v W License Number Expiration Date
Name of CSL Holder l L`
t �� l L List CSL Type(see below) ( lk 1�S r7 ‘L
No.and Street �j 1 Type Description
SOv l Unrestricted(Buildings up to 35,000 cu. ti.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
INA O t o7C- RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
M\3 c3 S S- °l ID clANAAcloAgl I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) ' ?3 Z 144
SG,A.A c .I in o'Iti�c n+�S �.L L HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
c , (� t (,c v s�- S h c.w,d ave_cq @ yeatov i
No.and Street ^Uti 1 t'I—G 913 � 1 O Email address
City/Town,State,ZIP 1 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 accurate to the best of my knowledge and understanding.
S Ct.w.cAAA.-+tea G(A) - C-11 - 2_
Print Owner's or Authorized 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"
•
The Commonwealth of Afassaehusetts
ri 71.T Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.govidia
‘Vatkers'Compensation Insurance Affidavit:Builders/ContractorsfEleariciansiPltimbers.
IC)HL PULED W11-14"I IlL PERMirrING A1.11401411Y.
Applicant Information Please Print Leeihis
Name Ili usubess:Organkzation: ay./
Address: I Si--
city/state/zip: 5. (4r„cie.41_,— Phone : CP-3 cl (0
Art you an milk"re?Check the appropriate bok
pr of project(required):
10 I am a erriptoya with employees( and,cir part-ti t.• 0 New coristruction
tr:/ I am M sole pauprictor or pionerslup and bflI fluerriployee%work try tut nw li) Vt. 0 Remodeling
any capacity..(Nu workers'comp,insurance ceituiredi
3.0 I am a hurrazowner doing all WW1'IllyYdr.{No worktIt°rump,IltilltlirtAX nal aired]* 9. El Demolition
Building addition
4.0 I arn horneowita and sill i,c huin connartues to conduct all wurk on my property, I
motire that all contractors either hat r xorkers'conmensalitni imarnmer or am sole 11.0 Electrical repairs or additions
propnetors ith nu employees
12.0 Phpibtng repairs or additions
s.0 I am a general contractor and I lu.e hued the sub-runtracturs Listed on tbr artakhed sheet_
13 out repairs
Tbrse sub-contractors haw employees and hair workers'comp.insurance) f
14_I:1 Other
6.0 We arc a corporation and its officers have rat:retard their ngls of eacrripliun per MCaLk
1,12,t (41.,and we ha..-enoatliplu)ves.[Nu wutterr comp,insurance regal:W.1
°Any apptionti that chkvIcs box al Mail also fill out the section below show ins!their w Luker,'eunmensation pula.-y information.
Homeowner%who subsrut this affidavit indicating they are doing all work and their hire outside eminactire4 mint submit a new arlid.ar it indicating such
:.{...tiritracturs that rhea this laa.k itiust attached an Jelditiuruti dteet show ins the name c.kf the sah-euntraewes and trite w hotter in not Ilium:atones haw
if the sub-cuntractur,Its,,e pride orkerh'comp.)7olic±.number
1 am an etnployer Mai iS providitn,,workers'compensation insUrartee,Thr my employees. Below is the policy and job site
information.
Insurance Company Name: frt t-VG-
Policy#or Self-ins.Lic.#: V\k_ Lj C3 L (4, .3 L- Expiration Date: 1—t '2. 2-`k
Job Site Address: V1/4)floAS City'State.?Zip: N.104 Att6simps I-Pok Mir 0({)Lat)
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCiL e. 152,§25A is a criminal iolatiun punishable by a fine up to S1.500.00
ani.tor 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 [MA for insurance
coverage verification.
1 du hereby certify tiller the pains and penalties of perjury that the infOrtnation provided above is true and carrect
Signature: "— 0-v Date: f- 3 1 - '1
[Mom. 5-3 ei I
tylicial use only. Do not write in this area,to he completed by city or town officiaL
City or Town: PermitiLicense#
Issuing Amlioriki (circle one):
1. Board of I lealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6,Other
Contact Person: Phone#:
City of Northampton
Massachusetts
,,.
.10
DEPARTMENT OF BUILDING INSPECTIONS
wwip 212 Main Street • Municipal Building
-- '{' Northampton, MA 01060 15'1- \
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: 1. C, S-e_ 11 64a. ri.A.t
The debris will be transported by:
Ct im S r
Name of Hauler: �v,/�-I� ons
Signature of Applicant: O1/S Date: 1 • ?I"2Y_
City of Northampton
Massachusetts + .., j •.
�P DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building ''.3k ,fir
3 Northampton, MA 01060
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)