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31B-208 (2) BP-2024-0386 97 STATE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-208-001 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-2024-0386 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 11000 RICHARD PALMISANO CSL89485 Const.Class: Exp.Date: 03/05/2026 Use Group: Owner: LLC KILERINE PROPERTIES Lot Size (sq.ft.) Zoning: URC Applicant: BAYSTATE EXTERIOR RESTORATION INC Applicant Address Phone: Insurance: 87 SHATTUCK RD (413)374-2719 6HUB-6B21339-4 HADLEY, MA 01035 ISSUED ON: 04/05/2024 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: Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner • The Comnyvealth ot`>rgassachusetts`' FOR Board of Building,R sulations and Standards MUNICIPALITY Massachusetts State Code, 78U CMR USE• Building Permit Application To Cons ct air,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: !3i A" 39 Date Applied: 41/...• 4Z, // 11-5-26zq Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers q 7- 11S�/'-_ 1.Ia 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'ofecord: U , A ©lC�.� N216 e(Pri t) City,State,ZIP 00- 3649 (tfMaas i ins Val PM4is 9AutAZ ecnk No.and Street Telephone kEmail Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alterat• n(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Otherpecify: tef Description of Proposed Work'-: S p p .3-- t AJApki,i4- SlAm.p /gee.J clucl�, ° .r- to` s t. - • 01-dmk., (a-L►e>m( C i +J a/E" -4- pt_4 Pta1 Ji , ((14.1 .4-42-c..+- stA%►yt.r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ t`t oU-o 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 Fee : Check N1.)-1A 1 Check Amount: Cash Amount: 6.Total Project Cost: $ l U ji ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5. onstruction S rv'sor License(CSL) 89,1 C /.51.0 .0 C,-‘44Q3 Q " -c License Number Expiration Date Name of CSL Holder / 'Erl S IA4,iauek tl , ' List CSL Type(see below) t,/� No.a d Str a �(� Type Description CYV�1A I 01 U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State, R Restricted 1&2 Family Dwelling y M Masonry RC Roofing Covering _ WS Window and Siding �l \ SF Solid Fuel Burning Appliances 4/33'%�a-7/3 (,t�W jheirQ.Afg"T` I Insulation Telephone Email address D Demolition .2 RegisteredLt.�HomeIImppro�veme i Contractor(HIC) / 0 ,105 c9--3/b4 ` Ek-( � - 1-Ac._ HIC Registration Number Expiration Date HIC C mpany Name or H1C Registrant Name No.and Street Email address City/Town,State,ZI 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 Iss-uance of the building permit. Signed Affidavit Attached? Yes �.�C7J No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRAC OR APPLIES F UILDING PERMIT I,as Owner of the subject property,hereby authorize r',L`�-412 6 q\NotA, o to act on my behalf,in all matters relative to work authorized by this building permit application. A-tO'a_ 1 ' 4.itt( 3-44 Print Owner's Name lectronic 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 con ' ed in this applic t ' true and accurate to the best of my knowledge and understanding.. 611 JAKIeb 4&°1 el it Prin 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 H1C 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 Q A,,o� s s.�.... ,�',. Massachusetts ?S �'<< wi V t ' '' 'l 1.( 1, t 0 DEPARTMENT OF BUILDING INSPECTIONS S r �°wr'"'' ���°.r ` 212 Main Street • Municipal Building � r, i- Northampton, MA 01060 4",e' `.`OC` PA, ,.y0 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: qetlikt The debris will be transported by: r Name of Hauler: - ` Signature of Applicant: - Date: q(14. (74 The Commonwealth of Massachusetts Department of industrial Accidents z, 1 Congress Street,Suite 100 Boston, MA 02114-2017 ' ' .,,,,,.., .-i: WIVIV.mass.gov/dia ..r-",- 41tkers'('oni pensation Insurance AMdavit:Builders/Contractors/Eltetricians/Plumbers. 10 HE 1:11.1.1)WITH TII Pk:HMIll'INC AUTHORITY. Annlieunt Information Please Pritil Lettihly Name(Business,"Oraanization/Individual) Address: 17 ,C4ACtroArk.-- Var.:t.. CityiStatelZip: t-tetri laA- 6,03, Phone#: 6-4,) 74,/ d--7/, Are.ruil an employer?Cheek the appro Late boa: Type of project(required): a employ's with___a_einpiloyees(full antkor parne).* 7_ 0 New construction 2C]lam a sole proprietor or punnenhip and have no employees working forme in K. 0 Remodeling any capacity.[Nu workers comp.insurano: req tared.) 9. El Demolition 301am a hunsusencr doing all work myself.IN o workers'comp_irtsurance nsquireik)' 100 Building addition 4.0 I am a homeowner und will be hiring contractors w conduct all work on my property_ I will LIMUte that all contractors either have workers"compensation insurance or are sole 1 1.{:1 Electrical repairs or additions proprietors with no employees_ I ID Plumbing repairs or additions 50 I am a urneral contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: I 1211Mrepairs 14.0 Other 6.0 We are&corporation and its officers have ex acised their right of exemption per A1GL c.. 152,11(4),and we haw no arapluyiees.[No 1.1 mice&coinp.insurance required.] *Any applicant that liccks box al must also fill out the section below show in their uorkers'compensation pulley information. *I tornearicsen who submit dits affida%it indicating they are doing all work and then hue outside contractors mist subnut a new affidavit intik-Anna such. tCuntracturs that check this box must attached an additional sheet shwa ing the name of the sub-contractors and state whether or nut those...whim have employees_ If the sub-contractor%haw employees.they isms]provide their workers'comp.pokey number. s I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. — Insurance Company Name..(C-46ks ,z-p„s _ Policy#or Self-ins.Lie.#: Idt-It46 lettg-i 33i-14 Expiration Date: V/3// I Job Site Address: ,7-4 7 Sfetit_. SA CityiStateiZip:A.V_A-4-40.4.-- kt._ M A--. 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 imprisonment,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 veri' : ' n. I do hereby c py •: , .. Ithin e ,...:• . of perjury that the information provided°bur i.% Ire and correct. tew:M Sire: ' 1 4 11 . ,. • Date: (( ('' (Yel Phone 4: ) ?Li —a7/et Official use only. Do not write in this area,to be completed by city or town official ('its or Tovin: Permit/License# Issuing Authurit) (circle one): 1. Board of llealth 2. Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 1 6.Other Contact Person: Phone#: