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24D-184 BP-2024-0487 129 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24D-184-001 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-2024-0487 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 9540 ROBERT THIBODO 65699 Const.Class: Exp.Date: 06/22/2025 Use Group: Owner: ORCUTT KAREN A&BRETT A TREGANOWAN Lot Size (sq.ft.) Zoning: URC Applicant: BOB THIBODO ROOFING AND SIDING Applicant Address Phone: Insurance: P O Box 201 (413)586-0391 65OUB-020N14 NORTHAMPTON, MA 01061 ISSUED ON: 04/23/2024 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: (:as: 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: 772. Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner [ ,__ _________ .......__ _ . . .., The Commonwealth of Massachusetts APR 2 2 2024 s ° FOR Board of Building Regulations and Standards MUNICIPALITY >° Massachusetts State Building Code, 780 MR :—,. USE rr:"T.OF StIli rnNr, NSP C 110w•Building Permit Application To Construct, Repair RenovaeteFfa lento t§4 p,n50 ised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building ermit Number: S° ".441 5/4,7 Date Applied: ev i a._.) arjs I/7/Z 4-2Z-Zaq Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 rrop� dre�S�C V S� 1.2 Assessors Map&Parcel Numbers 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco d: \( oY- tv-, U Y ( u N d Y*1.1 G.N...�t? -A-0 ✓-\ �('c i Name(Print) City,State,ZIP Y \ C. Q-�Sc-ft Sk— LI I3 '-q � cos-(.4- No.an Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(checic,All that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) l ' Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: rief Description of Proposed Wo 2: 1 � �v( "x-CS kAN, © , � yn CA\\ pa) S- _TAN 5k \\ ' 'LC Lr C•uY'6 - G`f`CIAiVR cvAl , .rI \is — ' t.Acl-( v-e.A �� 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 $ Suppression) `Total All Fe�ep, Q Check No. l Check Amoun 6.Total Project Cost: $ 9-'' S0 0 Paid in Full ❑Outstanding Balance Due: A r City of Northampton st Massachusetts 4„ r� * : • r DEPARTMENT OF BUILDING INSPECTIONS �g ' '^ 212 Main Street • Municipal Building Northampton, MA 01060 'Jrt� 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. j SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) a --11—,', b 4 ,s_c=. sT c p 11 �S License Number Expiration Date N5 of SL Holder 3 3 \^ c Q I-k List CSL Type(see below) No.and Street 1 `1 Type Description 1 ^ U Unrestricted(Buildings up to 35,000 cu.ft.) S 41 1 c"-�1,`.�'J 1'a— R Restricted 1&2 Family Dwelling City wn,Sttate,ZIP M Masonry CCIn,, RC Roofing Covering WS Window and Siding \ �+ SF Solid Fuel Burning Appliances Lill S-7 S' 1 I') 6-1 \bob�h`DO 6mr)o 1.*` _ I Insulation Telephone Email address Pb }b D D Demolition 5. Re0gisteredHom mprovemeut Contractor(HIC) 'eb"" 1 S ^�1 ` r`f,' �, �� ��ll HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name \ (� ` 3� �,A.S k�ckQ1'q S k /�e� do Yd o Zvi. ` Q �.�F�, o. Skeet Email address) w.. Li r3 S'1 S 1 Sco`l 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 Issu ce 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 authorized 1 h l 13 U 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 contained in this application is true and accurate to the best of my knowledge and understanding. fa—cC\.\ a & i -,;s4-' a CI 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 Department of Industrial Accident's 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.goWdia otters f'ompensation Insurance Affidav it:BuildemiContractorsiEketricians/Plumbers. 10 HU FILED Vk I III 1 IIE PERMITTLit;AUTHORITY, Annlicant Information Please Print Legibly Name of usaness;Organizatton:Individuai r 111\V) 0 a<3 Address: City/State/Zip: &S ‘1•1‘,.. i'llone LI 1'3 • Si .3 Iej GL-1 Art yaw SCI tunployar?Check the apprnpriatr hot: pe of project(required): it]I a employer with ,, employee%( arnior pnt-tinaci." 7. 0 New construction 20I am a sole proprietor or parineralup and[nese no erriployee-s,'A Pricing tin mc in g. 0 Remodeling cap.:way..No workers'ellerlp insurance regime-el 9. ri Demolition I df7/a IlUtlWilvincr&nag all work m)self.(No*mien'comp.111411/allt:ti reetainaLi' 10 Building addition 4.0 I sin a lionsoownar and will be kuring Oalgriclo../rb ha COrldlltd all Work on my property„ I wth moire that all COrtir31.30.1ri eldla have werrkers'compentsation intairance or alle I I CI Electrical repairs or additions proprietors with no employees, 12.0 P unibing repairs or additions ID I am a general contractor and I have hired the iwt,contractor%Ltd un the artaehed sheet_ 13 Roof repairs 1 hese.iiii:1-cuniracturs have employees and Liai workers'conm. 14_00thei 60 We an a curporimon and its officers h21-1:exercised thew nght ol eterriptaim iscr 1.11, and c have nu employees.[Su workeri'comp.Mat/ranee tcytinest 'Any applicant that checks bo):at mini Abu till out the sedum below%how inst then workers'convun1s:1'10u ,11,)tat 2tidltufl lionaeow niers who 61.1171416 ths affaiks‘it mdicattnE they are tawny all work rand then hire outeide contractor.TrIlrit,111111Ut a PL'11`ArrIALIV II 1116:31Ing Nik+ :Contractor%that duct this box inuta attic:bed an additional sheet show ing the name of the 5.11t*C(Mtractom and state whether in nut those.saddles e onployees, tr the nib-comm.-tins base employees,they rutisA provide their worker,'wrim.policy number last an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information_ Insurance Company Name-77- - . cOV- Policy#or Sdtms LIL #: u rap — 0)5 014 "ILj - L14 Expiration Date: 4-1 e- a 3 Job Site Address: \ 9\-b svcAs4 City'State:Zip: h(0441ovi 9 \ 114117 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirati n ate). Failure to secure coverage as required under MGL .. 152,§25A is a criminal] violation punishable by a tine up to S1.500.00 anikor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine sirup to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I du hereby rerrifr titrile.r the pain.%anti penoltie%of pi.rjury that the information provided above is true and correct Si nature- Date: t4 Phone#: 4 1 S i Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: City of Northampton Massachusetts I ' *it * DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building \- ' Northampton, MA 01060 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: c1s Location of Facility: N b YAkh o•wc)TO-Nr\ The debris will be transported by: Name of Hauler: C�/ \') d �? Signature of Applicant:-- Date: City of Northampton yi.it'J#g _ Massachusetts �aA DEPARTMENT OF BUILDING INSPECTIONSft 212 Main Street • Municipal Building Atli w` Northampton, MA 01060 rj$s'i JY 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)