29-567 BP-2024-0334
57 BIRCH HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-567-001 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-2024-0334 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 18645 DL WEST ROOFING CONTRACTOR 106007
Const.Class: Exp.Date: 07/08/2025
Use Group: Owner: DEBRA DION MICHAEL&
Lot Size (sq.ft.)
Zoning: WSP Applicant: DEBRA DION MICHAEL&
Applicant Address Phone: Insurance:
57 BIRCH HILL RD
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:
/e7?
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts NI? 2 r
r
tBoard of Building Regulations and Standards J02� R
M1lJNICOPALITY
- Massachusetts State Building Code, 7�80 C1VIT '� / U5E
,(7 .
Building Permit Application To Construct, Repair,Renovate Or Demol i 4lr a Revised Mar 2011
One- or Two-Family Dwelling °"�S
This ection For Official Use Only
Building Permit Number: J P-AI_ 3 Date Applied:
l/� 7/Z5 i/f7- 3 2 7-ZoZ/
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
5� (? r drs iklK 4 _
1.1a Is this an accepted street?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 Owner'of Record:
1K-2 0+bv1 glotru..z< 1'1.44. 6(o 2-
Name(Pant) City,State,ZIP `
S5 a►rc-h tit tk 64A. 6i3)Sg€— H WPDi 611dre ('c�w�
No.and Street Telephone EmaiAddress
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 6( Addition 0
Demolition 0 Accessory Bldg..1❑ Number of Units Other li�Specify: AL E c -
Brief Description of Proposed Work2: (e -,e eoci'4<tu .�reQ� k(- �c) cl .k lv‘s-{q l� c, VA4�
4.,ek4.L— rJ 05lvt� I «✓ 1yrizr-(-_ vrt( Irk S i,sl .
y P J
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ /2 4t45. I. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2.Electrical $ 0 Total Project Cost3 (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) _ Total All Fees:,$
Check No.�V Check Amount: t/ Cash Amount:
6. Total Project Cost: $ /4(etas. 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 55 _I6� m g -re"
`}`ld if License Number Ex ra on Date
Name of CSL Holder n
l91.
9� �c � � List CSL Type(see below) QC—
No.and Street Type Description
QJ�-Q b Z U Unrestricted(Buildings up to 35,000 cu. ft.)
R Restricted 1&2 Family Dwelling
City/Town, State,ZII' �S✓ Masonry
Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
tit3.4-q-C(5-r3 it A lcg-›`f87$e yvv,, • Cb Insulation
Telephone Email ad ss D Demolition
5.2 Registered Home Improvement Contractor(HIC)
0.L. f �'c� (ecAarc c r \�3Zo *aiOnDaHICRegistraonNumber te
HIC Company Name or HIC Registrapit Name
9k V -t„ cALI,E 0I431815— mei ,C,cwk
No,.and Stre t Emat ess
1'1c e .2/ wVq- 6(o(Z & � —43I 1
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 r 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 O.L., ( .- V•gbaS-,t--i. c (�or-
to act on my behalf,in all matters relative to work authorized by this building permit 4plication.
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
contai d n this ap i tion is true and accurate to the best of my knowledge and understanding.
oativaeA (pe -3/vil-tozy
Prin wner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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"
1
City of Northampton
oyS s,[,
Massachusetts Q� '<<
ji
, , • c DEPARTMENT OF BUILDING INSPECTIONS a`. ��� x?
212 Main Street • Municipal Building v,. ,a;'.
;m ' Northampton, MA 01060 sr�{ �ArD 's
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: `fCI ec-a-rc(tv5 23e(e_� U jil 62 4 fiprA pq,1
J �
The debris will be transported by:
Name of Hauler: k). L. U Rpoji' t te5A/0-4//_./1
Signature of Applicant: —1 Date: 3/iq/ UrZ
, •
The Commonwealth of Massachusetts
--(0 Department of Industrial Accidents
- $ I Congress Street Suite 100
4) Boston, ,Iffl 02114-2017
.k,
www.nrass.goWdia
%Valuers Compensation Insurance Affidavit:Builders/Contractorsinectricians/Plumbers.
TO RE FILED wati TIIE PERMITTING AUTHORITY.
Applicant Information Please Print Legit&
Name(ausincsvOrganintiotvindividual I: -c_s_
Address: \ 0 e-
City/State/Zip: -.4,‘. , ft,k1L4:3,t6(et_ Phone#: 8(3) &I'S- -3 1 L
Art yens an employer?['heck the Amax:pH:Ay hot:
-11-)Ile of project(required):
togi I ant a employer with .,..Z--__ employees(lull unid'or part-timer,• 7. a New construction
21:1 I arn a wile tyrupnetor or partnemhip and have nu employees%ratans for me 7n K. 0 Remodeling
any capaciry„(No worker;comp.:normalcy required.)
9. E 3E]I am a homeowner doing all wort myself.(Ni‘workias'comp.smormu.-e required Dcniolition.).
1 0 0 Building addition
4.E3 I inn a hunieowiter and till he hiring ninlitlidIJIN in L'1741d7114:i all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Eltxtrical repairs or additions
plupriair.Th Vigil no employees.
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the sub-contractors holed on tlit attadied sheet.
These sub-euntractors have employees and h 13.ErRoof repairsave Worker.'emirs insurance.;
. A941
6.0 We tire a OkirpfltalbUt3 and its officers hat e exervised t6M right of eAeniption per MGL e. 14 11f0 ther al 04_,
151.§1141.and we Irate no employees.(No workers'comp.insurance required.]
*Any applicant that checks but a I mutt also fill out the seetron below shoo ins their workers'compensaii,i pokey or tormation,
I.I loirreowmers veho submit dus affidavit indicating they are doing all work and then hire outside eontr.w.tots eared submit a new a flidsk it Ind riming sueh,
"Contractors that check this hit must attached an additional sheet show ins the name oldie suls-contractors and state w hoher or not those odities have
employees If die!Lib-contractor%tune CltrIllyCI:7.,TICS, !LIU!l pro',ide their workers'comp pulley number_
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob site
information.
A
Insurance Company Name: j4-....1--, 1
A1. 141-5. 6 .
Policy#or Self-iris. Lic. #: AP.-t tt ?-03c..32/0 f.rre.34_ Expiration Date:
Job Site Address: Sq-- (36,-e.)& IL_.‘k kk (2,c),. City/StateiZip: 0,15_10$44_1 10.N4 ,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a tine up to 51,500.00
andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violitor.A copy of this statement may be forwarded to the Office of investigations of the DIA ibr insurance
coverage verificar.loti.
I do hereby certi under il,,p fin+ owl fleflalties of perja r-).that the J nformaiion provided above is true and i'orreci.
Signature: - Dille. .317'(
(a/
Phone : 6t -2)) C,2.5 --- -( i
Official use only. Do not write in this area.to be completed by city or town official
City or Torn: PermitiLicense 4
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.('ii flown Clerk 4. Electrical Inspector 5. Plumbing Inspector
G.Other
Contact Person: Phone 4: