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16D-019 (2)
BP-2023-1009 165 NORTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16D-019-001 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-2023-1009 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 14885 Const.Class: Exp.Date: Use Group: Owner: WILLARD BETH A&ROBERT G DELISLE Lot Size (sq.ft.) Zoning: URB Applicant: WILLARD BETH A & ROBERT G DELISLE Applicant Address Phone: Insurance: 165 NORTH MAIN ST FLORENCE, MA 01062 ISSUED ON: 07/28/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 2 SMALL ROOFS -ALCOVE AND BACK PORCH 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 RECEIVED J1 L 28 2023 The Commonwealt)i of Massachusetts FOR w Rnard of Rnildinb Regulations and Standards �{I bE NTRT iw� c Bu lding Code, 780 CMR MUNIUSE CIPALITY Building Permit Application To Construct,Repair,Reno''ate Or Demolish a Revised Mar 2011 One-or-Two--Family Dwelling This Section For Official Use Only Building Permit Number: 30- A.3- J crP I Date Applied: ii\c'& 1 t ' . • ' ' 'eti, 748/a..a Building Official(Print Name) Signature i . Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers /(o51 JbrM 'n9.n S?- /4,b - D/I—Do! 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 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 CI Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' ...a Owner ili Recor Gd� �l�oG 7 imcihi 1a 10s76rie_A.-/ 106 2 Name Print , Si- City,State,ZIP 65 oi*i�air S . 443 3- -88K 1bcafllar-M/ rite mom.fa.V No. and Street Telephone Email Addres SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied VI Repairs(s) CII Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: _ Brief Description of Proposed Work2:B7.g ,,- re reel2 2 s-�,al",ergs -2icipvt. -I- beek. -.J 3fr lb 74664 brd6 a5 ylcze-6,5tri 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 $ 0 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 $ Total All Fees: ��/ Suppression) (� h r 6.Total Project Cost: $ Check No. 1 D heck Amount: `� ��j � 5 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address 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 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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 containe• this application is true and accurate to the best of my knowledge and understanding. I/►C;(/01/ 07/Z-7/20223 P P. t • er's or Authorized Agent'same(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" City of Northampton Jµ\ti ;'4f, -.�.- / Massachusetts r :G / _ DEPARTMENT OF BUILDING INSPECTIONS rf 212 Main Street • Municipal Building )i �y 4 �y Northampton, MA 01060 �3V N. N10 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: V a ii c-C,a The debris will be transported by: Name of Hauler: /,w, Signature of Applicant: ,� �C Date: C— The Commonwealth of Massachusetts Department of Industrial Accidents r..arl_ 1 Congress Street,Suite 100 'zali Boston, MA 02114-2017 - www.mass.gov/dia Hinters'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING MINORITY. Applicant Information // l Please Print Leeibly Name(Busit�esxUrganizatior `Individual):3ele-7 1 N ll�� Address: / . Aicyjh Moir) r`- City/State/Zip: ' 4_ ffl14-' 0/062 Phone#: 4k', $ s-s Are you an employer?Cheek the appropriate boa: Type of project(required): la I am a employer with______ employes(tuft and/or part-time)-• 7. 0 New construction 20 lam a sale proprietor-or partnership and have no employe.x avatttiang for rase in 8. 0 Remodeling any capacity.[No workers'comp.insurance required] 3 lam a homeowner all work self. o workers'comp.insurance 9. ❑bemolition d°"�� '� ter " tetra-1 10 Q Building addition 451 t am a homeowner and will be hiring contractors to conduct all welt on my moperty. I will tare that all contractors either have written'co nation insurance ix ast sole I I 4:3 Electrical repairs or additions proprietors with no employees_ 12.0 Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the another]sheet. 13 Roof repairs These set -contsactots have employees and have workers'comp.insurance.: 6.0 We are a corporation and its offtcerr have exercised their right[of exemption per MGL c. 14. Othc-r 1 S2.$1(4 and we have no employees.[No waiters'romp.inatranee required.] "Any applicant that cheeks boat rI must also fill out the section below showing their workers'compensation paliey information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors roust submit a new affidavit iodicatioss such_ :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors base employees.they noes:provide their workers comp.policy.nunber. I am an employer that is providing workers'compensation insurance for my employees. Below Is the policy and job site information. Insurance Company Naar:-- —_— — Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 fine 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 verification. I do hereby tify under t e pains and penalties of perjury that the information provided above is true and correct. Sign ,[ 6 Date: 07/2-1/2-023 Phone#: 3--. 5 —& Official use only. Do not write in this area.to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northam-ton Massachusetts40, "+!� t, ft DEPARTMENT OF BUILDING INSPE IONS I 212 Main Street • Municipal Eu'lding Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBI ITY AFFIDAVIT 11' ve4/i$1i9S2_ I, I W I.44'0 (insert full legal name), born_ (insert month, day,year), hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners' emption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 111.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I a seeking the aforementioned homeowners' exemption, does not involve the field erection of manufacture, buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"home. ner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dw•lling, attached or detached structures accessory to such use and/or farm structures. A person ho constructs more than one home in a two-year period shall not be considered a home owne . 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Buildin: Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, 'iteration, repair, removal or demolition involving any activity regulated by any provision of the Mas•'chusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed der the pains and penalties of perjury on this 27 day of . , 2023 OA, (Signature) Google Maps 150 MA-9 INorthampton,Massachusetts G Google Street View Oct 2018 See latest date P _., 1 ei lac , iiii, ,.,,,_ '' IL ri , .. ., it....... • , io ♦. it 1. I• ` R Jr . Google . Image capture:Oct 2018 ©2023 Google li 205 - --Al ., _ i rt o L Timothy J. Luce PO Box 14 Leeds, MA 01053 Phone: 413-387-9800 H I C # 149288 CSL # 100515 SM# 13395 Proposal 7/13/2023 Bob Delisle & Beth Willard 165 North Main St. Florence, MA 01062 Asked to estimate the cost of roof work 165 North Main St.; I offer the following proposed scope of work limited to only the following: • Remove existing flat seam metal roof panels from bay window and rear porch roof areas down to wood roof deck. • Remove siding at rising walls, as needed, to accommodate new flashing install. • Remove and replace fascia trim. Prime, and paint to match existing. • Furnish and install new '/2" plywood overlay over existing roof boards. • Furnish and install full coverage high temp ice and water shield in both of these roof areas. • Furnish and install 16oz. copper dri edge in these areas. • Furnish and install 160z. copper flat earn roofs and flashing on these two roofs. • Reinstall/replace siding at rising wall . • Prime and paint any new siding to m tch adjacent materials. • Includes the cleanup, removal and d sposal of all construction related debris from building exterior to rake/ room clean condition. The cost of the above-described labor and materials is $14,885.00 ero-v C`.. ' a' 7 A down payment of$5,000. is required at proposal acceptance. The remaining balance is due and payable upon completion. Work to be substantially complete on or before 9/30/2023. 4 Accepted b ? LL. ( d h Date �7 13�2 �- �._..7 This proposal is valid for 30 Days Any work not specifically included in the above written proposal will only be performed upon written change order agreement and for an additional fee. The homeowner has the right to cancel this agreement with 72 hours of signing at no penalty.