25-021 (3) BP-2024-1483
145 RIVERBANK RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25-021-001 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-2024-1483 PERMISSION IS HEREBY GRANTED TO:
Project# REPAIRS 2024 Contractor: License:
Est.Cost: 18500
Const.Class: Exp.Date:
Use Group: Owner: WATLING SHERYL V& RACHEL B PERRY
Lot Size (sq.ft.)
Zoning: SC Applicant: WATLING SHERYL V&RACHEL B PERRY
Applicant Address Phone: Insurance:
145 RIVERBANK RD
NORTHAMPTON, MA 01060
ISSUED ON: 11/13/2024
TO PERFORM THE FOLLOWING WORK:
REPAIRS TO ROOF AND WALLS
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: &Z.
Fees Paid: $138.75
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
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The Commonwealth of Mass usetts `S \\':"�
Board of Building Regulations and ' ny#' �J OR
Vt Massachusetts State Building Code, 78 # ,^o � , Q U EAL[TY
Building Permit Application To Construct,Repair,Renovat .f, olish R ised Mar 2011
One-or Two-Family Dwelling 90 c>.
This Section For Official Use Only
Building Permit Number: •a'" f ff3 Date Applied: I I— s'2 Z
4,,..., /�Zs /C at 2 11- 13-2O241
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
1.la Is this an accepted street?yes ii 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 Wate Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Publi Private❑ Zone: — Outside Fl Z e? Municipal 0 On site disposal system
Check if yes►'
SECTION 2: PROPERT OWNERSHIP1
2.1 Owner of ecor : I 1 , ,�^d
S h cr y/ A)Ai-I 1 n� /�/�� f 4-1*elto � /" 4 O 10 Co O
Name(Print)' City, tate,ZIP
{ ,S" g't.,tri•AN6( R A ylskP-13r7 f,e.4ol•4S3S0c'oMc Aft;Ale s
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(chec all that apply)
New Construction 0 xisting Building Owner-Occupied Repairs(s) Alteration(s) 0 Addition 0
Demolition ccessory Bldg. 0 Number of Units 1 Other 0 Specify:
Brief Description of Pro O 'Work2: D e r ft(IA c 1 Sh iea 'i* i t 4 vi /eJ 4-
' e/LJ o e -t on e c�-‘o n t r G J c b e Jt rtz o M _ 7/4 s . . -R rytd ii
Vb
s� re . '� lns,J A -lo� fio e'(fJit%1S eyI-cr.or ',JAW
`c/Aria G oc port
e ,,QQ
SECTION 4:ESTIMATED CONSFRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official}] Only
1.Building $ /' O a O 1. Building Permit Fee:$ 13% / Indicate how fee is determined:
i '(Standard City/Town Application Fee
2.Electrical $ S'O 0 0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 0 2. Other Fees: $
4.Mechanical (HVAC) $ d List:
5.Mechanical (Fire A
Suppression) $ 0 Total All Fees: 1,�(�`J
Check No. heck Amount i L •
6.Total Project Cost: S I X 5 o O ❑Paid in Full 0 Outstanding Balance Due:
City of Northampton
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Massachusetts
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4''•• DEPARTMENT OF BUILDING INSPECTIONS `
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212 Main Street • Municipal Building Ca
,. Northampton, MA 01060 44 --%
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 Affi. .vit
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 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
tYM 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
CTION 7a:OWNER AUTHORIZATION TO BE COM D WHEN
0 'S AGENT OR CONTRACTOR APPLIE UILDING PERMIT
I,as Owner of the subject property, autho ' t C- NC
to act on my behalf,in all matters rela' w orized by this building permit application.
P owner sctrontc Signature� V Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATI
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.
Arj 1-1 )-I ,r. ///s/Z°17
Print Owner's or Authorized Agent's ame( ectronic 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"
,
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The Commonwealth of Massachusetts
p lit, ' _ Department of Industrial Accidents
'" 1 Congress Street,Suite 100
':mac ill'
l_ Boston,MA 02114-2017
tez;, �' ' wwn:mass.gov/dia
u 11 r ker ' Compensation Insurance Affidavit:Builders/Contractors!ElectriciansfPlumbers.
TO DE FILED WITH THE mitt 'F1'ING AUTHORITY.
Applicant Information Please Print Leeibty
Name i llu tness ore nnrtatioty ndividual l: S 4 dry f Jis)rt 1_
A i
Address: LI ., cr,..nu ail
City/State/Zip: d'2t.f 44.A Mr ''"/V A OI b(Phone#: 9/3 58$' 13 c
i
Are you flu ctuployer?Cheek the appropriate bore
Type of project(required):
l.❑l am a cmpiwer with__ impluyeea(Pull anther part-time I.' 7. O New construction
2E11 am a sole propricke or lxermenhip and have nu employees working fur roe in K. i .emodeling
capacity.(Nu workers'comp.tnsunrntx required]
9. . Demolition i
.1 1 am a homeowner doing all work myself.(No waukas'comp_rrnurance required./'
4.0 lam a homeowner and will be herb contractors conduct all work on myIQ Building addition
luring property. I will enure that all contractors either have%orkers'corn .naataon insurance or urc aol¢ I I.n J Electrical repairs or additions
proprietors with no tutpluyrc_ ILO Plutnbmg repairs or additions
S,I I am a general contractor and 1 lone hired the sub-contractors listed on the attached sheet I Roof rep:tin
These sub-contractors lac employees and have workers'comp.insurance.;
6.❑we are a corporation and its officers have exercised their nght of exemption per MGL c. 14.0 Other
152.i 1(4 1.and we lose nu employees.(No workers'comp.insurance required.)
'Any applicant that clerks bus 71 must also fill out the section below ahuw'ing their w'urkees'compensation pulley information
t Homeowners who aubnut this aft"rdaa it indicating they arc doing all work and then hire outside a edractec mint atibnut a new aliidas it indicating such
:Contractors that cheek this bor.must atta bed an additional sheet showing the name of the sub-contractors and state wheal r or nut thiu,e Amities base
employees If the sub-contractor,has employees.they must proside their %takers comp pulley number
I am an employer that Ls providing workers'compensation insurance for my employees. Below is the policy td 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 MMGL c. 152. S25A 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 fort ofa STOP WORK ORDER and a tine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjuty that the information provided chore i% true and correct.
Signature: �� h( Daie //.613/
Phone#: Yi,3' f��-/357
Official use only. Do nut ir'rite in this area.to he completed by city or town ofcial
City or Town: Permit'License#I
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton
Massachusetts
1 tt
DEPARTMENT OF BUILDING INSPECTIONS ,
212 Main Street • Municipal Building
Northampton, MA 01060 'rs'N4
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in: V A Q f le e C"/ C I I 1 S
Location of Facility: 2 3 c/ eas Fir)Hr►eiN A) gj / 0 14 -,4,7
The debris will be transported by:
Name of Hauler: c�^'p��` A- 1•^S
Signature of Applicant: Date: ///-
City of Northampton
. i`��`s`iY `s 'K,..$ip
Massachusetts �4? �` - 'e
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DEPARTMENT OF BUILDING INSPECTIONS Di 1 )A
1; ,ice
212 Main Street • Municipal Building J� Ca
Northampton, MA 01060 Ps• 410,;�o
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, 5 c e r y/ &{iN A-1 ' S (insert full legal name), bo n_(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 requi ements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection wit 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 ac,ordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 C ' 110.R5.1.2:
Person(s) who owns a parcel of land on which he/she resides or intends to resi•e, on which
there is, or is intended to be, a one-or two-family dwelling, attached or detach • structures
accessory to such use and/or farm structures.A person who constructs more than •ne 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 upervision of
the project or work on my parcel, I am not engaged in construction supervision in connec 'on with any
project or work involving construction, reconstruction, alteration, repair, removal •r demolition
involving any activity regulated by any provision of the Massachusetts State Building Cod:.
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 projec or work.
Signed under the pains and penalties of perjury on thi•
s S 4-( day of A10)evullef 20 Z 6
Signature)