35-241 (4) 43 LADYSLIPPER LN BP-2021-0056
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-241 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2021-0056
' Proiect# JS-2021-000084
Est.Cost: $14960.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVE MINER 99953
LotSize(sq.ft.): 45302.40 Owner: HELLIWELL SANDRA N
Zoning: Applicant. DAVE MINER
AT. 43 LADYSLIPPER LN
Applicant Address: Phone: Insurance:
347 NEWTON ST (413) 533-0481 Nk'C
SOUTH HADLEYMA01075 LSSUED ON.7/20/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department 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.
Certificate of Occupancy Sip_nature:
FeeType: Date Paid: Amount:
Building 7/20/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNI�LI
ATY
Building Permit Application To Construct,Repair,Renovate Or Demolish a 'Revised Mar 2011
One-or Two-Family,Dwelling
This Section For Official Use Only
Building Permit Number: ,.31 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Gre;sy� �i 1.2 Assessors Map&Parcel Numbers yl
1.l a Is this an accepted street?yes no Map umber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(fl)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required ProAded
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.$Sewage Disposal System:
Zone. Outside Flood Zone?
Public❑ Private 13 . — Check ifyes0 Municipal O On site disposal system E3
SECTION 2: PROPERTY OWNERSHIP)
2.1wneyp Recgrd:
r� � d�•� l wG
Name(Print) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKa(check all that apply)
New Construction-0 Existing Building❑ Owner-Occupied ❑ RepZi s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify
Brief Description of Proposed Workz t
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1.Building $ 1. Building Permit Fee:S Indicate bow fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
O Total Project Costa(Item 6)x multiplier x
3.Plumbing S 2. Other Fees: $
4.Mechanical (HVAC) S List:
5.Mechanical (Fire $ ..
Suppression) Total All Fees:$ ip r
Check No. Check Amount: Cash Amount:
6.Total Project Cost: S ) c U paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
DAVC, !'•I rI X License Number Expiration Date
Name of CSL Holder (-� Tel �3 ✓"'L
7 1 7 id- List CSL Type(see below)
No.and Street Type Description
f, i J-lu C l o? S U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town.State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
J SF Solid Fuel Burning Appliances
0716 l� tJC�' 19 i le—✓ iAr0-L.L L:C<i' 1 Insulation
Telephone Email address D 1 Demolition
5.2 Registered Home Improvement Contractor(HIC)
24v- M Igor 1l j f�fi- - l ' LL c �/ A�
HI Registration Number Expiration Date
MC Company Name or HIC Registrant Name 5 _
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(NLG.L.G 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...........D
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 4 Arv-
to act on my behalf,in all matters relative to work authorized by this building permit application.
2eI'tAl:t �l�l �r t', /3Ab o
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.
Pritif 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/dos
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"
I
i
i
The City of Northampton
P
3 .
Building Department
, 212 Main Street
Northampton,Massachusetts 01060
Phone(413) 529-1402
Fax (413)529-1433
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance with the provisions of MGL c40, 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 FacilityV �l Kf
The debris will be transported by:
Name of Hauler_ _ _ _ _ V'4 I-r1 r - — — — — _ — — _ —
Signature.of Applicant: _ ___ ____ ___ _Date:_
i
The Coa monNeaM ofMassachusdis
Departmeni oflndus&WAccM=&
I Congress swg Suite 100
Boston,MA 0211¢1017
wwwmangovIdia
Workers'Compensation.humrance Affidavit:Bufldersl/Coagactors/Electricians/Plumbers.
TO BE FMW WITH THS PERN 117MG AUMORITY.
Antflicant Information Please Print LeQidbly
Name(Business/Organizatiodledividual): �e: I M Y/ ✓� :/ /7''•^ 2 �.Z,^t ` L
Address: / i;—A-e-
City/State/Zip: .�� l'Y . Phone#: J �/
Are you an employer?Check the appropriate bortr Type of project(required):
l.�am a employer with ` employees(full and/or part-time).' 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in $, emodeling
MY capacity.(No workers'comp.insurance required.)
3.r7I am a homeowner doing all work myself(No workers'comp.insurance requited.]t 9. riDemolition
4.❑1 am a homeowner and will be Kirin contractors to conduct all work on m 10❑Building addition
g y property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet .
These sub-contractors have employees and have workets'comp.insurance.: 13❑Roof repairs
6.nWe are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§I(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hair outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheer showing the name of the stub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: z�-t)f t C-
/
Policy#or Self-ins.Lic.#:_ / � �/� (3 ����i� Expiration Date: /y �:21
Job Site Address: L !f j/f 2�f City/State/Zip: /yn✓i' `�'�d� '� / �'
Attach a copy of the workers'cordpensation po'llcy declaration pace(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 fine 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$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.
Ido hereby certify under thepains and penalties of perjury that the information provided above iss true and correct
Signature: Date: �/ yj A,
Phone#: '7 7l�
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 CIerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
DOAOV'�ZMINERRe Date:
Exttsrlor Home Improvomont: 4,-) 0,;, 6
(413) 533-0481
www.DaveMinerRoofing.com
347 Newton Street,South Hadley,MA 01075
MA Registration#186552
Customer Name: ,�� ✓( �yc 1 ,,,c ( Telephone Number
Address, City/Town, State: �V
l/ Y �, ,✓ /�� ���/` ,, r,��w- �3/4(
BETTER ROOF SYSTEM
Landmark Pro
• Strip off existing roof
• Line all edges with 8"aluminum drip edge
• Install- - feet of WinterGuard ice&water barrier along eaves and up any valleys
• Install RoofRunner water resistant underlayment
• Install CertainTeed Landmark PRO architectural shingles to manufacturers specifications
• Install SwiftStart starter strip along eaves ��-e x oole_14
• Install using 4 nails for maximum wind coverage up to 130 mph
• Install a ridge vent along the length of house approx. 15" in from edge of roof
• Install new vent stack collars
• Replace step flashing as needed along walls and chimney
• Re-flash chimney with lead flashing as needed.
• Plywood
Install 1/2" CDX plywood
Install 1/2" CDX plywood as needed — per sheet
• CertainTeed SureStart Plus 4-Star Extended Transferable Coverage
(50 year non pro-rated full coverage warranty for material defects)
• All debris removed from work site
• Protect siding and exterior of house
• Protect trees and shrubs
• Magnet ground for loose nails
• See Other below for any additional work or comments
• Other
Contractor is not responsible for any damage to interior of home.Any loose articles on walls/shelves should be removed before work starts
WePr pose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of:
'v✓ G �rrA ti S n.l J,e r ►(11r '..._-`_dollars(S
A deposit of 1/3,$ , is to be paid before materials are ordered.
A Payment of$ is due at the halfway point,and the balance of$ paid upon completion.
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.
Any alteration or deviation from the above specifications involving extra costs will be executed upon written orders,and will
become an extra charge over and above the estimate. Our workers are fully covered by Workmen's Compensation Insurance and
Liability Insurance. _
Authorized Signature: Note: This Proposal may be withdrawn
by us if not accepted within 30 days
7Acceptancef Proposal—The above prices, specifications and conditions are satisfactory and we hereby accepted.
rized to do the work as specified. Payment will be made as outlined above.
Signature:
Date of Acceptance: 4 C
This agreement may be cancelled by Customer within 3 days of acceptance for any reason as detailed in the accompanying Notice
of Cancellation Customer's Initials