31A-041 (4) BP-2024-0279
281 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
31A-041-001 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-2024-0279 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF REPAIR 2024 Contractor: License:
Est. Cost:. 10000 LEARY BUILDING COMPANY CSL104806
Const.Class: Exp.Date: 02/17/2026
Use Group: Owner: BURK LALE A
Lot Size (sq.ft.)
Zoning: URB Applicant: LEARY BUILDING COMPANY
Applicant Address Phone: Insurance:
13 GLENDALE WOODS DR (413)336-261 1
SOUTHAMPTON, MA 01073
ISSUED ON: 03/19/2024
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO ROOF
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: �,�r�;44
Atailt 114044
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
OW1 CO Will reacx '-1
R CE I &lcyzc
C
The Commonwealth of Massachusetts tl
Board of Building Regulations and StandardsMAR 1 4 2024 FOR
1 J Massachusetts State Building Code, 780 CMR �Ul`1�CIPALITY
USE
Building Permit Application To Construct,Repair,Ren tq)Qgji io,k-r10 isedMar 2011
One-or Two-Family Dwelling NORTHAMr1 oN,MA 01060
This Section For Official Use Only
Building Permit Number: --�y .3?9 Date Applied: /
1LL-0LA1S Tla b!'dUc,Ic_ l�zoAfr t--- ./ 42
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Ltd CRZ, J'C
1.1 a Is this an accepted street?yes k 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 12( Private El Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
l-AL.1: 03 )(&14, N0A114AN\ b ) MA b 1060
Name(Print) City,State,ZIP
Zit LgE5«N1-
<
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) [ ' Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': L4T (.O0 - (_ki{ick1(L
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ I O o D 0 9-D- 1. Building Permit Fee: $ Indicate how fee is determined:
- 0 Standard City/Town Application Fee
2. Electrical $ 0 Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: $ 41-
to Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ i 0J 0 b 0 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) G -1 a k1 a a 2' '
T►fy1 C'�4�� [.p R.1 License Number Expiration ate
Name of CSL Holder List CSL Type(see below)
No.and Street Type Description
b 1 A to rib
_ n a i 0 3 U Unrestricted(Buildings up to 35,000 Cu.ft.)
v1 r� �)/p I( !v 1!� I R Restricted 1&2 Family Dwelling
City/Town,State,Z M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4►�j"YMc-'?e;i 1 I -6/0 tzk 60 i 1 4 (.4I1v I Insulation
Telephone E 1 address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
(UiL-t) Ml1 (,Orel A 1$IObS �11)1._014-
LEAP-\-1xD`- HIC Registration NumberExpiration Date
HIC Company Name or HIC Registrant Na 1
I`� l: r,r�1t $k-r. l.,n' ffS VA ` '''f1 MO 11 V111IA 1 r IN\
No.and Street mail addrees
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 A HORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
//''
I,as Owner of the subject property,hereby authorize ' 1' / &j;t,OIN� C.Zr�Pau
to act on my behalf,in all matters relative to work authorized by this b ding permit plication. /
toll/ 640eAc 3•15- 2-i
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 inntth'is application is true and accurate to the best of my knowledge and understanding.
/ ,,1 ,,/
Print Owner's or 'uthorize. 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 Cummonts+eulth of Massachusetts
FL=_ Department of industrial Accidents
1 Congress Street,Suite 100
=�j Boston,MA 02114-2017
www.ntoss.gov/dia
Workers'('ompensatioa Insurance Affidavit:Builders Contrnctors/E:lcctricians/Plumbers.
TO tw FILED)wnirritc p*ILMrr-rr(;Ar enrolee[
Applicant lufirrmation Please Print Legibly
• p
Name(Businessiorwinizanoniindividual): .k.� ' P��►L.t)is fL' (tk,i,()TAN,' 1;\-�
Address: 1'S (1.,
6.1 .? 1 -
(icy�State/Zip: �D a}�-�M n r,� t �s' � Phone#: ��`��" ,�, ,,'+� /,l�r, .,
Are you an employ et?l hark the appropriate Iwo: pc of project(required):
I am a employer with ,,employees(full a dtor part-time i.* 7. 0 New construction
1 ant a ink proprietor ur isnmership and have hp employtxs wonting fur me in 8. 0 Remodeling
ally capacity.[No workers`comp.iatur'ancr requited.]
9. ❑ Demolition
.t 1 ant:1 hnirai)w nti dtling aU work myself.(No workers-comp.imunince mgwntL]"
a. I ant a homeowner and will be hiring cOaltiracittra to conduct all work on nay property. I will
IUD Building addition
[idiom that all contractors either have workers'compensation u►aurance or an:tole II.J Electrical repairs or additions
proprietors with no employees.
1 2_ Plumbing repairs or additions
3 1 am a primal commachtr and I hove hired the sub-contractutt listed on the:Mat:hcd ilwct
Them:sub-cunulo acrt bane employees and have workers'comp.nwuraticc. 13 I t Rllufrep:tirlr
6.i►tj We are a corporation and its officers have exercised then right of exemption per MCC c. 14. Oilier'
Oilier'
§I(4),and we have nu employees.(No workers'comp.insui;incc required.]
'Any applicant that check[box#1 nue.1:tiro till out the section tv:lovt slowint [licit ttol B.T cooilpeutation policy inli imatiuri.
I lomcuw nets tt h e subnni this attielat it indicating dur)arc doing all tcank and 11icn hire ouiwulc us tnAttractors must t new.ubtuit a affidavit indicating ttaeh.
II-otlar:aootm that check this lsos mutt attached an additional sheet Chow tar the italile of the Nub,contractor,and slate ii h.e hci en not Heise entitles have
etrloyees. If the tub-eandractors have employees.they mutt pt,+,ale ilueti u++[kci. cuntp,it+lic,nuntt eu
I am air employer that is providing worriers'Compensation insurance Pr my employees_ Below it the polite and job site
irrforntatiuir.
Insurance Company Name: _Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State.'Zip:
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$1,500.00
and'or one-year irnprisonmertt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
c+.n erzw crtfcatifin r ,i-o
I des/t ere/il c ertifj+ Miler in 'and [nett[ of perjury that the information provided above it true am!correct.
N.11,.1 tit. Date: 3.13 'Z y
4>i3 334 2tei I
Official ate rink. Do»IAt-rile ire this area.to be eontpkied hr city or tows official
(`its ur'km Permit ions#
Issuing.`titlioritr (circle one):
I. Board of Ileadth 2. Building Department 3.Citytfown(clerk 4. Electrical Inspector 5. Plumbing,Inspector
[;.Other
contact Person: Phone Zt:
City of Northampton
YH
Massachusetts ? - r .
I a ,Xi DEPARTMENT OF BUILDING INSPECTIONS ,
. s w;fr 212 Main Street • Municipal Building 0 is
1 x� Northampton, MA 01060 sHn ���
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: \ A f F,ELk'CLINIL, F� 1j-4.t^,Artr;; (-,I\ tnR_itf .,1pT�r,� MA o)G�OO
The debris will be transported by:
Name of Hauler: ifAN ermi.bNaG C' ( fANy INC
Signature of Applicant: Date: ' r3 -`Li