43-097 (5) BP-2024-0333
31 WHITTIER ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-097-001 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-2024-0333 PERMISSION IS HEREBY GRANTED TO:
Project# roof 2024 Contractor: License:
Est. Cost: 40 DL WEST ROOFING CONTRACTOR 106007
Const.Class: Exp.Date: 07/08/2025
Use Group: Owner: LAMSON IRENE M TRUSTEE
Lot Size (sq.ft.)
Zoning: WSP Applicant: DL WEST ROOFING CONTRACTOR
Applicant Address Phone: Insurance:
11 PLYMOUTH AVE AWC4007036390
FLORENCE, MA 01062
ISSUED ON: 03/27/2024
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:
17:17
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts _ ,
re Board of Building Regulations and Standards FOI,.
+BAR 2 6 MU'�IICI?ALITY
3� Massachusetts State Building Code, 78�0 CMR 202q USE
Building Permit Application To Construct,Repair, R`novate Or:D mulish a Revised Mar 2011
One- or Two-Family Dwellin
This Section For Official Use Only :,r_°"'
.
Building/Permit Number: 6 ')-` ' 3 > Date Applied:
K i.I‘..) / , —/Z, ? S-Z7 ZOZy
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
11 i, 41-c(' -'-
1.1 a Is this an accepted street?yes- no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot :\rea(sq II) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1,,Dwner'of Record:
Name(Print) City,State,ZIP
31 (Pk i.c.r 4t3),S$y—4(e-N ‘`c ims..-.42(-60 4 . Ok-
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 FRepairs(s) 0 Alteration(s) Oh Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Ether 0 Specify: ('Ley.
Brief Description of Proposed Work': o t 1
lY</oa SQ. 0.m k c c.ir[s c�ln A t tit c.,
i
'36. e P cti� Q Ire,"•1YIL.CZ?` Q 41a 4._ '� �b. c •SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ It 3 --- 1. Building Permit Fee: $ Indicate how fee is determined:
I — 0 Standard City/Town Application Fee
2.Electrical $ 0 Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fee ,�(�
Check No.11 Check Amount: �� Cash Amount:
6.Total Project Cost: $ 1 11�j 0 Paid in Full 0 Outstanding Balance Due:
•
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
(551 - Jo o ?- s taz
L, �,� - License Number Ex Ira on Date
Name of CSL Holder
List CSL Type(see below) RC.
1 t Q 1,4 rum,) CtJ.9 -
No.and Street ` Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
epoTCity/Town,State,AZIP Masonry
6(c)• b( Ce t R Restricted 1&2 Family Dwelling
M Masonry
Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
elephone Email adans D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number xpi lion Date
H11 CoConwpny Name or C Registfant Name GLs�C C�
Es (,ccCYM\No. d Stree tLess
°' 40.r ) - 060•7 .)615'43l (
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 O
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 O.(.. (}�,¢=.d-fiegnsfat,c otA 4Cobr —
to act on my behalf,in all matters relative to work authorized by this building perm application.
SiV4n.0 ��..�of/ -- fi/iiZI
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By enterin my name below, I hereby attest under the pains and penalties of perjury that all of the information
containe this a p "cation is true and accurate to the best of my knowledge and understanding.
4 **it,
Pri er's or Aut rized Agent's Name(Electronic Signature) Dat
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
'' Massachusetts QS� r��
* � fG
'I DEPARTMENT OF BUILDING INSPECTIONS �'-
l
ti 212 Main Street • Municipal Building �� �e
'1 41 Northampton, MA 01060 nsH� ����
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: U l (i 2 /mr 4,1
The debris will be transported by:
Name of Hauler: D.L. L-'-c4 Aa� cS
Signature of Applicant: 1.' / Date: zL(l1- 7y
.4.
, The Commonwealth of Massachusetts
=-.341=ii ie
wira4
Department of Industrial Accidents
I Congress Street,Suite 100
Boston, MA 02114=2017
1„,..
www.ntoss.goiserdia
Workers'(7umpensation Insurance Affidavit:BuiblersiContractorstElectriciansirlumbers.
TO HE FILED WITH no:PERMITTING AUTHORITY,
Annlicant Information Please Print Legibls
Name(nusines,VOrganiaationfindduat):_ CA(...f• _Lk.,-`,4-lar,447 flitaiftiS.S_. CiSdjr4- Lb("-
Address' t t P . . _...„_. .. __.,......,.
City/State/Zip:_r fivA . ex0o:7_ Phone#: (1-44 ,) UK_'4.3 t t
A.re yen an employer?Cheek th 11 ppZpriate boa:
Type of project(required):
I.Eg ant a employer with ,.. -,__employees and and'or part-time I.* 7. 0 New construction
20 I am a laile.proprietor or partnership and Lime nu employers working for me in i 8. 0 Remodeling
any capacity..[No workers`claim.insuriunv required.)
9. 0 Demolition
30 t am a humeownin doing all work myself(No*mkt&comp.insurance rentrired.1'
i 0 0. Building addition
4.0 I am a hintionwher and will he hitins wintranson to ounduct all work on ms propetry. I will
emote that all contraimars either have mitten"compensation insurance LW an Mak I I 0 Electrical repairs or additions
proptietons*ids no erriployem.
12.0 Plumbing repairs or additions
501 ant a gcmciral nontractor and I bane hired the suli•earittactorti listed on the attached JIM.
l 342koorrepain
These sub-contractioni ha employees and have workers"comp.insurance
14.Nbther ft&g...)
w,,am a comeration And Its:Lacers have exercised their right of exemption per belfil c.
1$2,$101,and we havie no employees.[No workers'comp.in an required.]
. .
*Any applicant that chinks box til must also fill out the amtion below showing their workers'cortipensation policy information.
i Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new aftidav it indicating mink
Seormactors that check this bias must attaelsed an additional skeet showing tfai name of the a ltntcr.emea and state Or liether or not those,mities hate
employees If die sub-coraractors ham employees they mum pro.,isle their workers'nomp.policy number_
I OM an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she
infOrmation.
linsuroo,:c Company
Policy t or Self-ins. L .#: PP( 40,0 3--03Q 3 areoz3 4- Expiration Date: 5 r -7071
Job Site Addrtn,s: ( _6 44 =51_,_CitylState/Zip: OCCerf.-)
Attach a copy of the workers'compensation policy declaration page(showing the policy number a d expiiation date).
Failure to secure coverage as required under ME c. 152. §25A is a criminal violation punishable by a line up to 51.500.00
anikor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of op to S250.00 a
day against the violator.A copy of tin, ,tateirient may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification
. . , . . . .
I do hereby cer ,underth pi iila and penalties ofperfury that the information providediove is true and correct.
Signature: ,------
I
/-4. Date:
Phone#:6ti.3.) Ca q's--- 7,.3)1 I
Official use only. Do not write in this area,to be completed by city or town official
City or Towni Permit/License it
Issuing Authority(circle one):
' I.Board of Health 2.Building Department 3.Cityriown Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#: