35-232 (8) BP-2024-0549
27 BAYBERRY LANE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
35-232-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0549 PERMISSION IS HEREBY GRANTED TO:
Project# REBUILD DECK 2024 Contractor: License:
Est.Cost: 20000 LEARY BUILDING COMPANY CSL104806
Const.Class: Exp.Date:02/17/2026
Use Group: Owner: JAMES HALE SUSAN &
Lot Size(sq.ft.)
Zoning: WSP Applicant: LEARY BUILDING COMPANY
Applicant Address Phone: Insurance:
13 GLENDALE WOODS DR (413)336-2611
SOUTHAMPTON, MA 01073
ISSUED ON: 05/08/2024
TO PERFORM THE FOLLOWING WORK:
REBUILD DECK
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: $130.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
r►.. io a,�t ,—
CMrN IL,--0 5-7 i"" c .
f MAY
The Commonwealth of Massachusetts 1 _ (-- 2024,
W
Board of Building Regulations and Standard ' Ot;
Massachusetts State Building Code, 780 CMt
MUNICIPALITY
!N' = USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a REvisec far 2011
One-or Two-Family Dwelling
This Section For Official Use Only
BuildingPermit Number: 60. .-�ft.s-q I' Date Applied:
dm/..) (25 ,�� 5 8 2oZy
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
21 c3Ay arm Licwe
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 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
1 M Jk) jkN 1,1--Atl.0 F I (-r r (ic I\m- 01 p 61--
Name(Print) City.State,ZIP
2 1�/�H'�r22y t✓rV j c-h 1 cv3 n 1,cbrrt(It1,net
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 11 Repairs(s) Ili Alteration(s) llif Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 20 iiy 1 ..t k IS-h1 Aev(t
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ .2_0 O 60 , 1. Building Permit Fee:$ Indicate how fee is determined:
i
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 $ Total All Fees:$
Suppression)
Check No.. Check AmotA I Cash Amount:
6.Total Project Cost: $ 2,b 0 b()— 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS—I oti Bob ti' 11• Z(
T11wc-j1+� La)(2y License Number Expiration Date
Name of CSL Holder
f
tn� List CSL Type(see below) 0
1Qn Alt�p " ""�No.and Street Type Description
�1 1 Mk G i' U Unrestricted(Buildings up to 35.000 Cu.ft.)
'Ivry ,r v R Restricted 1&2 Family Dwelling
City/Town.State.Z M Masonry
RC Roofing Covering
WS Window and Siding
L SF Solid Fuel Burning Appliances
►S• 11-1-3 -&S AlmOextv\\51.). AI„ \ bt,v\ I • Insulation
Telephone Emailjiddress J D Demolition
5.2 Registered Home Improvement Contractor(HIC)
19,106C 6.1 t4
1-(NW T1 h( L I 1 L (h tom . HIC Registration Number Expiration to
HIC CompanyName or HIC giant Na the
I, G\cd 1 D! 41t4 a U i ld l r(
No.and Stre Email a dress
City/Town,St IP 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
1,as Owner of the subject property,hereby authorize - U
to act on my behalf,in all matters relative to work authorized by thi uilding it applicati n.
Print Owner's Name `
(E ectronic 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.
Pn Owner's or Authorized Agent's Name(Electronic Signature) D�e
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.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
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Massachusetts �g40,.1.........
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t' ` _ )';' DEPARTMENT OF BUILDING INSPECTIONS 5: t`
+`` 212 Main Street • Municipal Building
,a.rF.i -.'u.F Northampton, MA 01060 sg_km-• ,�0
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: VALLE( Rc -t
The debris will be transported by:
Name of Hauler: t €-A \ b'o1L,'t\Nf; (br,,,,y
Signature of Applicant: Date: LI )2.6-1 -14-1
_� The Commonwealth of Massachusetts
d`_;— Department of Industrial Accidents
:- _e/1'_ 1 Congress Street,Suite 100
t_. Boston, MA 02114-2017
':,��,� www.rass.gov/dia
11 or1'ers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
to HE FILED WiTH THE PERMITTING AUTHORIT1.
:applicant Information /, n Please Print Legibly.
Name IBusirc organuauon.lndnzdualY ( '-tRLc CWI1-()'\A% 14 4�Am.1
Address: i l0 LC(''( I1.1 �'Ytifj v k- I
City/State/Zip: .cite IYtft 4 Cil_ Phone#: L1 I'll - -7j -3-1_- t
Are yea as employer?(heck the appropriate box:
Type of project(required):
I Cli I am a employer with _ _employees(full and or part-time 1• 7. El New construction
20 lam a sole proprietor or partnership and have nu employers work mg forme in 8. O Remodeling
any capacity_(No workers'camp.insurance regional]
9. ❑ Demolition
ICI I am a homeowner doing all wait myself.[No workers'comp.rmurance required]'
10 Q Building addition
4.a 1 am a homeowner and will be hiring w eir:tcaors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 110 Electrical repairs or additions
proprietors with nu employees.
12.0 Plumbing repairs or additions
t0 I am a general contractor and I have hired the subcontractors listed on the att:,a-hail+hret 130 ROOF repairs
These sob-contractors have employes and have workers'comp uuurune.•
6. Vie are a corporation and nb officers have exercised theft ngM of eaerripUun per NE IL c
152 §l(4),and we have no employees.[No workers'comp.insurance required.] 1f.(Other t.dtC 2,(A,, A
*Any applicant that checks bat al must also till out the sucoon below showing their workers'compensation policy information.
t llunnvrwners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating tacit.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those amitics have
employees If the sub-eontracturs leave employees.they must pro%ide their workers'cutup pull.'.number.
I 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-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 line 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 S250.00 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.
1 do hereby certify nder t"e 1 tins !ties of perjury that the information provided above is true and correct.
- o
Signature: Date: 1 i 19 i 2_1
Phone#: V I C 4-- 1 -1) ' �
Official use only. Do not write in this area. to be completed by city or town official
('ill or Town: Permit/license b
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3.CityfTown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
('ontact Person: Phone SI:
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