24D-325 (4) BP-2024-0358
3 PROSPECT CT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
24D-325-001 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-2024-0358 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2024 Contractor: License:
Est. Cost: 1800 MATTHEW FABRY 118003
Const.Class: Exp.Date: 12/20/2026
Use Group: Owner: MARY CONNOR,
Lot Size (sq.ft.)
Zoning: URC Applicant: ROOTS CONSTRUCTION LLC
Applicant Address Phone: Insurance:
98 PLAIN ST (413)667-7424 ROWC405015
EASTHAMPTON, MA 01027
ISSUED ON: 04/01/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE ROTTED TRIM BOARDS AND RAILING POSTS
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:
41"7.2
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
/ CNN
The Commonwealth of Massachusetts
0:/e/,
: `9 Board of Building Regulations and Standards FOR
c�c9Q Massachusetts State Building Code, 780 CMR MUNICIPALITYUSE
riding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
\60 tis This Section For Official Use Only
Building Permit N ;�
umbVV'oifyi"' g Date Applied:
J�t)r� �7 / 3-29-20zy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3 I9T2f fieCT C0 r74"
1.1a Is this an accepted street?yes t,rno 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 Owner1 of Record:
M 'I 'fey (fin ems` Mr1 ^, 'MA v id 6 a
Name( C V City,State,ZIP
3 Prvs a-ef Co vr1" 410 - 60?-5s46 /YvviC vei3h7 941 41.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(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': /./4-C �d j
/addi kyi 0,/‘ (t c r ' c O� 1 f-c>Jk t?efl -Ce it,e0( //I'2,
pos-tor , frirn/--5f-irS)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 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 $ u
Suppression) Total All Fees: $ /P.S--
O Check No./03 Check Amount: Cash Amount:
6.Total Project Cost: $ ` ��, 0U 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) / /g j o 3 /Z/Z o/Z 6
tick 13/Zy- License Number Expiration Date
Name of CSL Holder
�8 �(� S 1 List CSL Type(see below)
No.and Street T Type Description
tnf`t l r/14.4 v 10 2 7 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State,ZIP M Masonry
('/7 G�7 ?Lt/ZZ I( RC Roofing Covering
` 7 WS Window and Siding
RcvstsC /1 SkrtlC7104 4//3 jj SF Solid Fuel Burning Appliances
�/M.4►/.Gc)1 I Insulation
Telephone Email address D Demolition
5.2
Registered Home Improvement Contractor(HIC) $v 4-1-6 /Z Z!r
-C 'e S ro.S fr\C (L)A HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
C'1" IPA ^ St (� -�5(ontitiAat{/3 ) !. tar+
No.and Street 7 Email address
c '� �AS? 1ZIA, vJ O L7 U 13-66 7 4r �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 El/. No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR, APPLIEES FOR BUILDIING PERMIT
I,as Owner of the subject property,hereby authorize , Q C)lc (UPI c) ,z,e N-1 [i,c
to act on my behalf, in all matters relative to work authorized by this building permit application.
.may Ale(Mkt, Cdivi tr 3IZ8/2-y
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.
.4Wy "'Werg67 Cov.er 7/Z5/0
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 Massachusetts
M Department of Industrial.Accidents
• •I=- 1 Congress Street,Suite 100
Boston, MA 02114-201
wWwmass.gov/dia
' 11 urkers'( ompensation Insurance.lf idas it:Builders/('ontractors/EkctriciansiPlumbers.
It)131. 111.1..1)N1 l i It I III:rF K1,nrrI1G AI-1 N )Rl I s
Applicant information � / Please Print Levibh
MIMIC(Nwtncss,Organv$t�m�ndividual): oc!g 3 C/c,„S"1- \J(tj ch L L .
Address: R R pl +C' .54
City/State/Zip: E4$ ir/J a, 44A c C'L 7 Phone#:.Li(3-- 6 6 7— 7 y. Z 41
Are you an eatpkycr?('hrek the appropriate boa:
Type of project(required):
. m a employer with 3 employees tint'and or part-tnte'l.• r. D het% construction
". 1 am a who ptoprkior or purtntnhrp and haw no employ oes workmp for nee in
8. 0 Remodeling
an capacity.[No workers'comp).insurance n.qurrtat.l
9. D DeIllolition
30 I:nn a homeowner doing all work myself_(No workers'comp.nn.nrarce required]'
10❑ Building addition
4.❑I am a humans nor and will be hiring contractors to conduct all work on my property. I wilt
ensure that all contractors either hate%C/tire compensation insurance or are sale 11.0 Electrical repairs or additions
proprietlNY w uh no employees.
loyees.
12.0 Plumbing repairs or additions
30 I am a general contractor and I have hind the srb-rrntractuts honed an the atiachcd sheet. 13 Roof repairs
These subcontractors hate employees and tote 111orI cis t.rop.inowsnoe.:
14. Other 12O1' l CAI(✓`
6.0 Vie an:a eurparalion and its officers hone cxerciseJ their nrlu ut exemption peT 111(:L c.
t`_ti It 4).and we hate no cn 'koyees.[No workers'comp insurance required]
•Any applicant that cheeks box#1 must also fill out the section below.bow in their workers'eutnpcnsarinn policy information.
t Ile mooesncrs who submit this afludavit indicating they are dorm all work and then hire outside contractors must sob nut a new atrndas it indicating suek
Contractors that check this box must arttat6edan adi itioaal sheet show me the mums of the wt.cunttaetAtis and state whether or not those entities tote
cmpluctes. It the sub-contractors lave employees.they amtpunrde their workers"tvrnrp.policy nuont'ci
annur
I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name: --C(`SII /
Pokey#or Self=its.Lie.#: ! +C3(A1 C 440 c—d 1) 5" Expiration Date: /43/
Job Site Address: .3 C't (751)Pc1 Cck1 r`l 7 CityState?Zip:r/1j 43440 rt/1/144 d)06 0
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. 151#25A is a criminal violation punishable by a fine up to S1.500.00
an&or one-year imprisotmnent,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
coverage verification.
I do hereby seer 'i•under the pains and penalties al perjury that the information provided abase is true and correct
Signature: Date: 3/Z�/2
Phone (--/l3—
Official use only' Do not write in this area,to be completed by city or town official
City or 1"oo n: Permitil ieensr tt
Issuing.tuthority(circle one):
I. Board of Ilealth 2.Building Department 3.(dish own Clerk 4.Electrical Inspector 5. Plumbing Inspector
b.Other
( intact Person: Phone#:
City of Northampton
ri:rT-r�r�, 5�5,...'w' S1tt; ,),fk
Massachusetts Aq�'% >c
DEPARTMENT OF BUILDING INSPECTIONS G
...„0„)
o �- 212 Main Street • Municipal Building yv6;, D�
Northampton, MA 01060 sfy wo,^'�
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: J4))e y I CyCfi '77
Location of Facility: Z 314 gi 1 4740A lezi 14,./4466,, of d6e
The debris will be transported by:
Name of Hauler: eC} T- (ci ' L L. c
Signature of Applicant / Date: 3/2-4 S 2/°-li