17C-114 (7) BP-2024-0385
50 STILSON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17C-114-001 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-2024-0385 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 4000 JAMES ROBERTS 099404
Const.Class: Exp.Date:01/21/2026
Use Group: Owner: M. RICE,SUSAN
Lot Size (sq.ft.)
Zoning: URB Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
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:
le‘ "“
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
tom. Y� \
The Commonwealth of Massachusetts ., `°
Board of Building Regulations and Standar �'-/6s FOR
Massachusetts State BuildingC6de, 780 C •" ,�. CIPALITY
V/ Board
` ., '` ...USE
Building Permit Application To Construct,Repair,lt> ' ate Or Dtir ish a ',Revise/1 Mar 2011
One-or Two-Family Dwellin ,,/?„, ce, .{� {!
t This Section For Official Use C)nj '>,'1'nl ^
/
Building Permit Number: 6A 7 4 3 95- Date Applied: o�6 �`
o S 4.,.._, ��, ��i� .,._` y.��az,
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erty 1:77.64,11.../ 1.2 Assessors Map&Parcel Numbers
d-
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 CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 O Red: v- fl(.'.7i7T2
Name( City,State,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Zj4" C_Q ---- ,:„.,......"
SECTION 4:ESTIMATED CONSTRU i ION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building � 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical ,d 4s(/ 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $ Total All F e : $
Suppression)
Check No Check Amount:
6.Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
"? >
Massachusetts .�
DEPARTMENT OF BUILDING INSPECTIONS
,0 212 Main Street • Municipal Building v� y 5
Northampton, MA 01060 44-h' i, lti
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR WINDOWS,
DOORS,ROOFS,RENOVATIONS,ROOF MOUNTED SOLAR,ETC.
1. Building Permit Application signed by legal owner and filled out
by owner or authorized agent.
2. One set of plans and specifications of proposed work(Digital and hard copy).
3. Construction Debris Affidavit filled out and signed by applicant.
4. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
5. Contractors must supply a copy CSL, HIC, and proof of Liability Insurance.
6. Energy Conservation Compliance Certificate (new /replacement windows).
7. Home owner's License Exemption Form (if applicable).
8. Note any Special Permit requirements(if applicable).
9. Energy Code—all new construction (Gut/Rehab) requires a HERS Rater Affidavit
10. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor ce a(CSL)
License Number Expiration Date
Name L Ho er
List CSL Type(see below)
�4 7,� CD Type Description
No.and Street
7_7 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/ o V'tate,ZIP Masonry
Roofing Covering
S Window and Siding
Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Ho mprovcmcnt Contractor(HIC) /7/5-4k 3102 t
FIIC Registration Number Expiration Date
HIC Company N e or a istrant Na
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 !. - 1/,��/ •4
to act on my behalf,in all matters relative to work auth.V; by this building permit application.
c c:„,ci
Prin Owner'§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.
Print 's or Authorize 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
Department of industrial Accidents
1
1 Congress Street,Suite 100
14,64itz.
Boston. MA 02114-2017
wpie.w.mass.goridia
%linkers'Compensation Insurance Affidas it:Builders/ContractorstElectricians/Plumbers.
TO HI.1 ILL D XX I Ill"I 111..PLRMIETINC;ArTHORIIY.
Annlic ant Information Please Print Levi bil
Name tlitiainicss,'Organtzation:Individual K._
Address: d
City/State/Zip: ‘41'/Z--)7----L., Phone P: 47417 —.47/1(/ "--0,.._? d-
Are you an cniploytr?t heck the apprnpriat r Nix: Type of project(required):
I.. I am a toyer A ith .. . ._employees(full anilor part.tiniei..* 7. 0 New construction
, a iwk arupnehat in partracrallup and have no employees working tut me in K. 0 Remodeling
inc.%capacity.(Nu workers'comp.insurance roomed)
9. El Demolition
Tii am a hunsoowner dump all work myself[No iloorktax"comp.mourance moaned.]
10 0 Building addition
4.0 I am a Itinnarwrian•and skill be hiring eentrachms to conduct all sii ink on my ptoperty. 1 will
imatirr that all corm-sours eith..T bare warritem*cormiamaation rinitirance or an:sole I I Het °cal repairs or additions
proprietors with no erripluyees,
IllIP 4 .mg repairs or additions
I am a emeriti contractor and I ha..c hired the sub-contrachns.listed on the attached sheet
13 edr Roof repairs
Them:lob-tuntratun.haw employees and Lune'workers'emnp.insurance)
14.0 Other
ha w'e are a camp/mum and its of t44.1.7%have exercised then nsbt of e.tenspiion per MCA_c.
151,§114t,and wc haw nu erniployoes.[No workers comp.insurance minutia I
'Any applicant that checks box=I must also till out the section below show ine their,i.or Ler, compensation policy crilverninton
1`Flomiama nen who submit this affnhoot radscatir/H they are doing all work and then hoc outside:emir-actors mint sahnut a new-a(fidaY it indicating such
tuniraciora that cheek this box moat attached an addational sheet shoo.Mg the name of the sub-cenamictots and state V./Miser or riot doom:arlitte:s haw
employees. If the sub-tioniractors haw.LitiriV.01.1.!%.they must provide their worker,',,,,,tir r.,1,...1.manlier
I am an employer that is providing ovorAers'compensation insurance for nry employees. Below is the policy and job site
Information. j „,...." ,--
bisurance Company Name: 6/ e'-(--"1-- _
Policy#or Self-ins.Lie.#: Expiration Date: Z-#
Job Site Address: Cityistmeizip: ...." z --------
Attach a copy of the workers'compensation policy declaration page 1 showing the pair, number and expiration date).
Failure to secure coverage as required under MGL c. 152, *25A is a criminal N tolation punishable by a fine up to SI.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 5250.00 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.
Ida hereby cern*fr under the pains run wnolties ofperfitty that the Information provided above is true and correct.
Siimature D.N A11/1400
le..11---/—
- t. 9
Phone.4'. i.--1 Ty— 4-714{(—V, 3,..,__er--
Official use only. Do not write in this area.to be completed by city or town official
city or Toss n: PermitiLicense P
Issuing Authority teirele one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts
. •
1\ � s DEPARTMENT OF BUILDING INSPECTIONS 3
' -;>. 212 Main Street • Municipal Building
Northampton, MA 01060
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:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: rr-1.7 %r✓� 4 Date: J
City of Northampton
)0 Li-i
Massachusetts , . .... re
DEPARTMENT OF BUILDING INSPECTIONS
1121 yam= 212 Main Street • Municipal Building xil ..
Y► "' Northampton, MA 01060 4:1'} +^-;'‘`N4
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (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'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.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 am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"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 dwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in
a two-year period shall not be considered a home owner.
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 Building 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, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts 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 under the pains and penalties of perjury on this day of ,20 .
(Signature)