38B-099 (2) BP-2022-0300
42 MUNROE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38B-099-001 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-2022-0300 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 28500 SAM LAKAS 103997
Const.Class: Exp.Date:05/23/2023
Use Group: Owner: ANDERSON MILGRIM DAVID J &KYRA
Lot Size (sq.ft.)
Zoning: URB Applicant: SAM LAKAS
Applicant Address Phone: Insurance:
5C SOUTH ST (413)230-6699
WILLIAMSBURG, MA 01096
ISSUED ON:03/25/2022
TO PERFORM THE FOLLOWING WORK:
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:
Gas: Final: Final: Rough Frame:
Rough: Fire Department Driveway Final: Fireplace/Chimney:
Final: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: i .
+ '/ ♦
Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fa x:(413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
ut Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One- or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: A. a-- Date Applied:
K,-„,.,..., &)-55
//42._. "3-25-ZO2Z
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Prope Ad ress: V--_ M c/`••• >'>2 -51-- 1.2 Assessors Map& Parcel Numbers,a
1.1a Is this an accepted street?yes 1/ 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 Owne 'of Record:
i.7U M.i HrNV-, No! k-o„ ,� Al { Glb6O
Name(Print) City, State,ZIP
(-la R0tvna e S+ , u(2) -1 -5 - gC56
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building P& Owner-Occupied pc Repairs(s) >B Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other R Specify: Ag o F
Brief Description of Proposed Work': 'ci„-{Ne 0 I 41 1 ark ra a F a" C e S L. k,( .. l nS .1-1,,((�/a-�t CQ7' LI�Sc-V , t A %. ,l( V V11 30 V�ec„ ow (.4- ✓'o o-C; Ice_ 4+- w
(^ cry, Le-4 P-ce�e 4 U l J e t't,n 7 `) . 5 y frt l� z tA.- v( Q-4- /c�- it-
e- -
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1,(, 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (I-VAC) $ List:
5. Mechanical (Fire $ Total All Fees:
Suppression) ��1 ,f�
/ Check No.1U'I t7 Check Amount: "�v
6. Total Project Cost: $ ?-p7d 0 0 Paid in Full 0 Outstanding Balance Due:
City of Northampton
" ~ Massachusetts 4a,$S
/ VA ,
*
DEPARTMENT OF BUILDING INSPECTIONSe:44'*'NN'''O '
212 Main Street • Municipal Buildin ,,((
Northampton, MA 01060 �9� g sN 1t�
64
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1, ����
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PROCEDURE FOR OBTAINING A BUILDING PERM tdik WINDOWS
DOORS, ROOFS, RENOVATIONS, ROOF MOUNTED SOLAR, ETC.
I. 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 Construction Supervisora License(CSL) , l 0 3 q,Ctl )a?)/X-5
S'64,,f eA — �"�-C"'� License Number Expiration Date
Name of CSL Holder
S� S a✓dam S�-,
List CSL Type(see below) (J
No.and Street Type Description
W l V U 3 )4 t Y 61 C' C,( 6 U Unrestricted(Buildings up to 35,000 cu.ft.)
City/Town,State,ZIP Restricted 1&2 Family Dwelling
M Masonry
RC 'Roofing Covering
WS Window and Siding
y(2) V70 Flo 00 f 1� 0., CA SF Solid Fuel Burning Appliances
E1 4, Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) (9 31 Z�-- a tq /
n^ HIC Registration Number Exp ation Date
HTCompany is,NaLne or I Registrant Name SD
50
e L.1 11,,n( .No
3m� o1o't Email address
City/Town, State,ZI `1 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 1 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 authorize S/LA- 14A,` S
to act on my behalf,in all matters relative to work authorized by this building permit application.
ow M,� avN `31 a u 2�
Print Owner's Name(Elect onic Signature) ate
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.
37aS/ .7
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 Accidents
I Congress Street,Suite 100
Boston, MA 02114-201
t
.,., . soostinass.gottilli a
Workers'C'empensation Insurance Affidavit:Budder ('ontractorsiElectriciansfPlumbers.
TO SE FILED%till THE PERMITTING AUTII()RITV.
Applicant Information Please Print I.egibb,
Name tRusiness'Organizationibufividualy: S 07.^^- L.--e,,1//..40. ..S (6-1".. ct„Vevt404,--
Address: 5 C C4(..A\/\ S1 -
,—
C. il,City/State W ----k^A's `I a I VZ — X3 o, -•A
Phone #: L', 1 }
• .
Are yea an empisier?:'heck the appropriate box: Ty pe of project(required):
lain a employ in-with crieplo:•ees OWL:chive pan-time t.' ' 7.. 0 New construction
2 01.1 I it a*ale propisnor or psoniership and have no employees workow for me in - 8. 0 Remodeling
any L-apar.ity.[No workers,'e.oitip.insurarivv wipured]
Demo
3SJ .a I homeowner doing all wort m (mil yself[No workers' li_imuranee rui eqred.]' 9. ci litioci
i i 0 Cl Building addition
4.C1 1 am a luMX:AW•tlet and will he hiring contraisaurs co vsnidtiet all work on my property.. I will
erasure that all CUTutracturs either have workers'COrrVelevallurt umurancr or are Note 1 1 i a Electrical repairs or additions
pmprietors with no erriployevN..
1.2.E]Plumbing repairs or addition.,
.5.0 1 am a,generni comtracior and I hate hired the Alb-cunt:actors hated on the attatdiett sheet
These sub-eeiiiraezels ha‘v employees and ha . I3a Rout repairs
workers'comp.insurance,:
14.LI°the]
6.E:1 We are a onporation and its offieess have exercised their right of exemption per MOL c.-.
ill§1t4l.,and we have no ernployees.[No workers 'comp.insurariee rammed.]
An applicant that checks bolt 41 must also fill out the we:ion below Allowing their workers'eompensarion policy infecznation.
+Homeowners who strismit this affidavit indreautig they Ate doing all work and then hire outside contractors roust iabrnil a new affida..it inctiLating u,.:.11..
t-Contraelots that check this bus must arucbed an additional aheet showing the name oldie mtb,:untractors and,tatc.4 helher or nut thly:c entatieN
employe-el. if the ihb-contracISTShav ernpluvev,....iitcy triust provide their workers.'eomp policy notriber
I am an employer that is providing worAers'compensation insurance for my employees. Below i8 the policy and job site
information.
Insurance Company Name: _
Policy 4 or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/StatetZip:
Attach a copy of the workers'conipensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage a' required under MGL c. 152. §25A is a criminal violation punishable by a tine up to$1,500.00
andor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator_A copy of this statement may be forwarded to the Office or investigations or the DIA for insurance
co%era,4e verification.
I do hereby certift under tit ins and penalties of perjury that the information provided above is true and correct.
ate: /?•V
Phone 4: q 1 22 - (9•.30
.. _
',.. Official use only. Do not write in this area, to be completed ky city or town official.
. City or Town: PermitiLicenat#
Issuing Authority(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
Massachusetts w -
* *
DEPARTMENT OF BUILDING INSPECTIONS 7 �
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:
Location of Facility: p, n g.01C 363 i DeLd .7 mil Q 10 6‘
The debris will be transported by:
Name of Hauler: ''v, S t c/ d1,�
J
Signature of Applicant: �.G� Date: ,J! d-�
City of Northampton
' Massachusetts !tf
DEPARTMENT OF BUILDING INSPECTIONS
a e 212 Main Street • Municipal Building 3
Northampton, MA 01060 r
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)
Sam Lakas Construction
South@o SI%ii �a�t
Williamsburg,
MA 01096 S�
413.230.6699
CONTRACT ::: lCA
Date:3/24/22
David Milgrim
42 Munroe St.
Northampton,MA 01060 e_,1 r`/"-e-
413.923.8556
Project:Roof
Proposed Wort/Notes
Strip and Install Roof
The job consists of the main house roof and all additional roofs except the garage and small roof over generator.There is an
extra dumpster charge for the slate which is included in the price.Price includes stripping two layers of roofing.New 30 year
warranty architectural asphalt shingles to be installed, .Chimneys to have new step flashing installed.
Ice and water shield will be used 6 feet up from bottom of the lead edges,valleys as well as around the chimneys.Synthetic
underlayment used everywhere else.Main ridges will be vented.New white drip edge installed,as well.Price of new/CDX
plywood is included below.The price does not include any additional carpentry work.Any additional work outside this scope
will be billed at$100/hr plus any materials bought.
The two small skylights will be replaced with Velux C04 manual venting.units,This is not included in the price and will be billed
at$100/hr plus materials including any inside finishing work that is needed to be done.Price of skylight units is around$750
each.If new lead flashing is required on the chimney,that will also be bitted at this time and material rate.
The payment will be scheduled as follows:one third due on signing of this contract,one third on the first day of job starting and
one third on completion of the job.
By signing this contract,I,the contractor promise to deliver in a timely manner a quality,finished project as described above.
You,as the customer,agree to pay all money owed as described in this contract.
Materials and Labor$20300
Plywood 0 ) j
Dempsterr$1$1500 Permit$200 v 3/9-g I
Total due$28500 -l Cc 0
Home owner
ntractor