07-059 (7) 381 NORTH FARMS RD BP-2021-1057
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 07-059 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-1057
Project# JS-2021-001794
Est.Cost: $5000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: TIMOTHY LUCE 100515
Lot Size(sq. ft.): 54014.40 Owner: RINGEY DAVID C
Zoning: RR(100)/WSP(100)/ Applicant: TIMOTHY LUCE
AT: 381 NORTH FARMS RD
Applicant Address: Phone: Insurance:
PO BOX14 (413) 387-9800
LEEDSMA01053 ISSUED ON:3/24/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. I r
Certificate of Occupancy signati< e: r • i l
FeeType: Date Paid: Amount:
Building 3/24/20210:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)'587-1272
Louis Hasbrouck—Building Commissioner
I RECEIVED/
1
MAR 2 4 2021 I ,
W
The Commonwealth of 'assachusetts
Board of Building Regulationsiand ltl? PECTIONS FOR
Massachusetts State Building�0 ;�)14'C"Mft o106o MUNICIPALITY
----_ __.._; USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
BuildingPermit Number: i P'Q(� (US 7 Applied:
euiP /, 3 y1;77ate
3-2/4-ZOz1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 P o erty A es • 1.2 Assessors Map&Parcel Numbers
. s i uv ..rr".s Ra a-i Q5 1
I.la 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 It) Frontage(II)
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❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' J�/
Na2.1
eOwnn ' rdI 4 -A O(VU7 i( ` City,State,ZIP j
�j1� 7� a �r^i ii
GO'�
Ntfad�tTelephone Email A e
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building l Owner-Occupied 0 Repairs(s) 131 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Wor l�2►n,,,%/i Q,k,teD1-,� 460 ''(//��V v Si I@ I . ?45},,,,i'
Az.) c cL4 2 ,«,( not-A �✓1,i J o vt Silo eit(y •
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
l. Building $ '<-t700 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:y,$
6.Total Project Cost: $ ' Check No.,Y1 Check Amount: V Cash Amount:
5 1vV— 0 Paid in Full 0 Outstanding lance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
I'htv , I a (p Li nse Number Expiration Date
Name of CSL Holder J�
�1 J� J ,� !/ List CSL Type(see below)
No.and S ect (,`J Type Description
S) )ice
J /! f v/v7� U Unrestricted(Buildings to 35,000 cu.ft.)
City/Town,State,ZIP 1 Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 (� 38/ resod 1f'/U5m ��Q � I Insulation
Telephone Email address J D Demolition
5.2 Registered Home Improvement Contractor(HIC) /jay 2
Ti ems— rr /2- is 2
E 1�� J HIC Registration Numbe Expiration to
HI Co parry a or HIC Registrant Name
Arc
N .andet � 411-)62— Email ad ess
/to o/O Y(3 3g7 �gtx� s
City own,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 .❑
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 i► LILA
to act on my behalf,in all matters relative to work utho ized bis building permit application.
M NZ114Ct'elf4777,11 -
Print Owner's Name(Electronic Si Date
SECTION 7b:OWNER' OR AUTHO ED 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.
Print Owner's o 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.govidps
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.) I-labitable 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
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
rig..
s'
Massachusetts �k �'!�.
r . c.
DEPARTMENT OF BUILDING INSPECTIONS r ,
212 Main Street • Municipal Building
Northampton, MA 01060 ssFh7C�`*`
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: \j�I 10,
The debris will be transported by:
Name of Hauler: N
Signature of Applicant Date: 2
The Commonwealth of Massachusetts
rDepartment of Industrial Accidents
:. , I Congress Street,Suite 100
: Boston.MA 02114-2017
^�,.. ` 14ww. aass.gor/dia
11 of kern"('onipeasation Insurance Af idas it:BuildersiContraetorsF kctricirnsJPlumbers.
10 RI.FILED %1111 11111 PERM(,I I l's(At I I ORE( .
Applicant Information Pleast_triaLlideilth
Name tHusincsstirganitanoi dtttfu ) rr_
Address: 1 O c _ I
(it'. State/Zip: Laci3 / 6/053 Pau>ne ::' //3 3A 7 7?oD
are von an employee t hick the appropriate but:
Ty It.of project(required).
1.0 i Sat a-:r .Cr%tall cn>ph!v.^es(lull out or patt.ttn,a.` 7. a New construction
ant a tote peoprw^tur or paAncrstop and have tar empluyct'working g for Inc m $, I C Remodeling
soy ease((! [No tucker.'comp insurance. reoulivii.1 tee
9. 0Demolition
30 I ant a hs cruvin er donne;all nuri myself.(lrio*token'moo.nsutiaica region: r
100 Building addition
A.C3 I am a laim.utie ta-r and will be hiring auntraaarn to eventful all Si cal on Inv property.. I will
ensure that all co:mac-tun tither hats%viten'eonfg ensatioet tn.'auranse.v arc Mlle I i D Electrical repairs or additions
pruptxiurs with flu ctnpluyecx
i2.0 Plun rot',repairs or additions
5 I ant a general eurtuaetor and l lute hired the stab-contracta:rs listed on the attached*beet
thew cutot ntra.turs have enrptuyces and hav a*taker,'.imp.ttauranse,
13 uof repairs
•
o
6.t f WC are a l`rc.Ypueairtn and its officer.have vim lied then right ut ve tripttun pet Wit s 1 4.c--+�� - --
■. I`,!..S i(4t.and vie have no employees.(Ne.Aorken'comp nuns zinc e rsyutred I
'An,appti.ant that sh..ks Isis a t cast at,.fill out the>'e.ttun Klux.eu..s n.then%cakes, cotnpensaiiun gvriies utt.Kn atwas
r lt.vtaustnen'Abu sut•init this&frialts it indicating the,are doing ad x elk and then Pure outsiek:contraettrri taunt sutnnat a nex affulav at indicating such
4.._unt:actvn that cheek tfit,hot must attached an nhlonrrul sheet shun mg'the name of the nth-contractor,and stale w(tether iv nut thus calitts,ha c
cmpto.ec. It the soh,untractors base enq,Iote ,.the!,must ptt.t id,tar.is .vutler3'snip tt het i.uintw't t am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self--gas. Lie.#: Expiration Date:
•
Job Site Address: City State Zip: ___
Attach a cope of the srarkers'compensation putt,declaration page(showing the policy number and expiration date).
facture to secure coterage as required under MOE c. 152. 25A is a criminal violation punishable by a fine up to SI.5.00.00
and or one-year imprisonment.as well as civil penalties in the form()fa STOP WORK ORDER and a line of up to S250.00 a
dal against the t iulator. A copy of this statement macs be turwarded to the Office of lot cstigations of the DIA for inrurnnce
.utera_e teriticatioli.
I do hereby certify under the pains and penalties of perjury that the information provided above is true unit rrtrrecr.
Signature. Date 3 —21 Q. /
Phone#: / 3 lob
Official use only. Do not write in this area,to be completed by city or town official
( its or Town: Permit,License#
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3.(its• t own Clerk 4.Electrical Inspector 5. Plumbing Inspector
(►.Other
( ontact Person: Phone#: