30A-045 (4) BP-2024-1471
31 LEXINGTON AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-045-001 CITY OF NORTHAM PTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-1471 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est. Cost: 4250 JAMES ROBERTS 099404
Const.Class: Exp.Date: 01/21/2026
Use Group: Owner: SWEENEY DARCY K
Lot Size(sq.ft.)
Zoning: URB Applicant: JAMES ROBERTS
Applicant Address Phone: Insurance:
30 Edwards Rd (413)527-6078
WESTHAMPTON, MA 01027
ISSUED ON: 11/04/2024
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF REAR SECTION
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:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: 6/2_
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massac sett-
{n Board of Building Regulations and `tang. ds 14\1 - 4 ��2� CR
tt ALITY
Massachusetts State Building Code, :0 C R
US
Building Permit ApplicationOne-or Two Family Dwellin To Construct,Repair,g-now DF7a��TMA�}to��A'c�°vlsed�.��r 2011
This S ction For Official Use
Building Permit Number: 11", 1'' / Date Applied:
S,yen, -zy
Building Official(Print Name) Si re Date
SECTION 1:SITE INFORMATION
1.1 ProPe�r Add ess: Q . , 1.2 Assessors Map&Parcel Numbers
6Fifref
1.1a Is this an accepted stye . yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownpf Record:
Name(Print) City,State,ZIP
3
No.and�S et Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': &ery..444-.-C 011.121
4°-e - -1b7(-1-1-(
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item ( Estimated Costs: Official Use Only
r and Materials)
1.Building IA-
1. Building Permit Fee:$ 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 Fein , fl9
Check No. Check Amount:
6.Total Project Cost: $ 0 Paid in Full ❑Outstanding Balance Due:
City of Northampton
Massachusetts • ,.
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fi, ';
'�' �'" DEPARTMENT OF BUILDING INSPECTIONS 7 14
`:.
212 Main Street • Municipal Building ��' fay
is•1' ,. Northampton, MA 01060 ;ti,.,wo%
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 Const u ion Supervisor L' s (CS ti 9'9 c-0 ' / i (
License Number Expiration Date
Name o L Hold
List CSL Type(see below)
No.and et •-ram Type Description
�/ 21/- 1 v /0 ( U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP ` R Restricted 1&2 Family Dwelling
M Masonry
Roofing Covering
gt u ,5 SF
and Siding
SF Solid Fuel Burning Appliances
Cf Q 3 I Insulation
Telephone Email address D Demolition
5.2 Registered H me Improvement Contractor(HIC) � _
HIC�Registr�atton.Number Expiration
HIC Compa me or C Registrant ame
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 .❑
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 this building permi 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.
grea,spolFry //—/ ‘-(
Print Owners or Authorized Agent's Name(Electronic Signature) Date 1
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 Congress Street,Suite 100
- .. +:� Boston,MA 02114-2017
ww►s.mass.gor/din
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
to Bk I BLk i)WITN illI PERMUTING'AliTHORlTV.
.-Annlic:ant Information Please Print Legibly
Name(Bus Lncss Organization.Individual):
Address: 62, de (f/
City/State/Zip: L . ,G eq Phone #: ` 13`Lit G{/1 3 37---- 1
Areyar as employer?Cheek the appropriate hat: Type of project(required):
1.0 I inn a employer with employee's(full aul or part-time I' 7. [)New construction
' am a sole proprietor or partnership and have no exaploycx3 working for me in $. O Remodeling
any capacity.(No workers'comp.uraunrnce respired]
301 am a Ik.laseowner doing.all work myself.(No wodtaa'cum_uruurnncc required.['
9. ❑ Demolition
4.E3 Lam a his neown►-r and well be hiring coatrooms to conduct all work on my property. I will 10 Q Building addition
censure that all contractors either)arse workers'corrrp.-nsa1iun uwurance or an sole 1 I a Electrical trical repairs or additions
proprietors with no ezuployeva-
12.0 Plumbing repairs or additions
50 Ism a general contractor and I hare lured the sub-contractors listed on the attached sheet 13 Kt)oI repairs
These sob-contractors have employees and to%e workers'comp.insurance.;
6.0 We an:a c ration and its officers have exercised then n ht of ex taunn14. Other -
wix S �P per 1iGL c.
152.$1141.and w e has c no cmpluyces.[No workers'comp.insurance required.]
'Any applicant that chucks box a1 must also till out the section hclo%%.how nag their workers'compensation pokey information.
s Itomeow•ners who subunit this atYidavit indicating they are doing all ss ork and then hire outside contractors mustsubnrit a new affidavit indicating sock.
:Contractors that cheek this box must attached an additional sheet stowing the name of the subcontractors ctors and state is!tether or not those entities have
cmplusee, If the sub-contractors have employees.they must prosidc their workers'camp.policy 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: �9
Policy#or Self-ins. Lic.#: Expiration Date: �v� « r
Job Site Address: City/State/Zip: .
Attach a copy of the workers'compensationpolicy declaration page(showing thepolicy num e and expiration date).
pe P g ;� P
Failure to secure coverage as requires under MMGL c. 152,*25A is a criminal violation punishable by a fine up to S1.500.00
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 Of3ioe of Investigations of the DIA for insurance
coverage vcritication.
I do hereby certify under the pains and ties of per'ury that the information provided above is true and correct.
Signature: G Date. /7 ---/-----c.Phone#: J / 3 _ GY' U O .<-- a'
Official use only. Du not write In this area.to be completed by city or town official
City or Town: Permit/License fr
Issuing Authorith(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
,,,,,- HAM, 04. 4`, SIn
-.. Massachusetts "';
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DEPARTMENT OF BUILDING INSPECTIONS ''
,.��. r 212 Main Street • Municipal Building I-,
*ate
_,, Northampton, MA 01060 ssFh' .i?��
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: 10i�
The debris will be transported by:
Name of Hauler: (' '
Signature of Applicant: `Date: /�j-- /
City of Northampton
Q•,f. OM`
�,/` .:� Massachusetts
It
'
i ` ' !7 DEPARTMENT OF BUILDING INSPECTIONS
1 ,
171 _r �� 212 Main Street • Municipal Building
VV Northampton, MA 01060
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)