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18C-075 (2)
BP-2023-0821 781 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-075-001 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-2023-0821 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: DAVE MINER EXT RIOR HOME Est. Cost: 7650 IMPROVEMENTS L C CSSL099953 Const.Class: Exp.Date: 10/20/2024 Use Group: Owner: VAGET EREC Lot Size (sq.ft.) DAVE INER EXTERIOR HOME IMPROVEMENTS Zoning: URB Applicant: LLC Applicant Address Phone: Insurance: 264 SOUTHAMPTON RD 6ZZUB9F45112621 HOLYOKE, MA 01040 ISSUED ON: 06/21/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF GARAGE 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: (} o • • cy, • . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissiiiner chi The Commonwealth of ach k�i. �GN N ViTk:11 BBoard of Building Regulati•:i I+' M.: ,,ardsQFOR 'CIPALITY Massachusetts State Building Co I: ; $ ; it' USE Building Permit Application To Construct,Repair, ' . m° - ""*fish • ' ised Mar 2011 One-or Two Family Dwelling "ti sAF�, This Section For Official Use Only °so°tis Building Permit Number:/'-)-3 $...1/ Date Applied: ZaL Building Official(PrintName) Signature D to SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 7o / /3ri4c vl 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_IL c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private❑ Zone _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1irnerl of ecurd: QAdIKr, V fej- //ei/(.y /11/2- Name(Print) q City,State,ZIP 7 v �l/d s 3.ZU OS-O2 4 f yd ec . CGw No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2: I r p ry /'t 64 rsr d SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (FIVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fr ft (� Check No. ,((�yjj 77 Check Amount '" Cash Amount 6.Total Project Cost: $ 76 16 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) " QQ9K3 tb Igo l a3 00 J e {"I 1 Ul a r License Number Expiration Date Name of CSL Holder 4P`I Q ; 1 List CSL Type(see below) Dv' it�;"1 pit)VL i�CJ1 No.and Street Type Description }�I©i %,o K e (14D 16 D U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town/State,fate,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding �) �y SF Solid Fuel Burning Appliances t4 l3)19-0 7,26 t all to .0 d(A ve V1C1r�l: I Insulation Telephone Email address t.Cl D Demolition 5.2 Registered Home Improvemeent Contractor(HIC) (tJ�fl N'°� gt� 5a a`4 Gr Gi L HIC Registration Number Expiration Date C Company Name or HIC Registrant Name daljee CIO Ve1411 PW' lIE.jwi No.and Street 5rsrC-- 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 Dave M l net— to act on my behalf,in all matters relative to work authorized by this building permit application. i ,0'r J,„r- v 4 p a- /t6 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. Dave. ii6 /-)�. 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 ate, The Commonwealth of Massachusetts Department of Industrial Accidents `f- Office of Investigations (, ' l U• Lafayette City Center ,k. ^�'4 2 Avenue de Lafayette, Boston,MA 02111-1750 `' � www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p 1 Please Print Legibly Name (Business/Organization/Individual): Oc he'_ !�l Vle r �-(�Pr;or 6�oyV1e wt,�royevvlen (--L P Address: c (09 6ocith am1'I.p i�lit Rot City/State/Zip: h 0(yok e. 1fYlcu DI O I (0 Phone#: 413 3 r)L -1)Y go I.[e you an employer? Check the appropriate box: Type of project(required): I am a employer with ` 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. l Demolition workingfor me in anycapacity. employees and have workers' p h' 9. 0 Building addition [No workers' comp.insurance comp.insurance.I required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. 00f repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 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 hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.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: 2 U1r 1 C-_v} _ Policy#or Self-ins. Lic.#: 60�1.0 e)g F q 5 l i a (o g Expiration Date: ) O l a l I o23 Job Site Address: 7 Y ( /3.',c)f c f t- City/State/Zip: r)(-4 i°fie-- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 perjury that the information provided above is true and correct. Sitrnature: �' Date: I v /'V Phone#: L4N 3 1-1y " 0ilg-O Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3t]City/Town Clerk 4.0 Electrical Inspector 5E'lumbing Inspector 6.DOther Contact Person: Phone#: City of Northampton r°aY H�Pr° o Massachusetts �� _ '<111 yt DEPARTMENT OF BUILDING INSPECTIONS wr w '` 212 Main Street go Municipal Building y..,� Northampton, MA 01060 3't-h �'C' 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: VG- V\ 'e7 c Gr- I r N r The debris will be transported by: Name of Hauler: / oe vitt pP Signature of Applicant: ate: g THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor.Registration T_ !' _ _ Type: LLC r Registration: 186552 DAVE MINER EXTERIOR HOME IMPROVEMENTS,LLC - Expiration: 02/04/2025 264 SOUTHAMPTON ROAD HOLYOKE, MA 01040 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 186552 02/04/2025 Boston,MA 02118 DAVE MINER EXTERIOR HOME IMPROVEMENTS,LLC DAVE MINER 264 SOUTHAMPTON ROAD ,�,,��.�%�(N/ HOLYOKE,MA 01040 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Constructs uiT' per Specialty CSSL-099953 J *,i cpires:10/2012D23 DAVID MINE 264 SOUTHAMPTa OLYOKE Mt 01040 1 1 J - Commissioner da f 'artnihei r, 1t"y 4 DAVE MINER Date: I `f'\ a3 Exterior Home Improvements (413) 533-0481 www.DaveMinerRoofing.com 264 Southampton Road,Holyoke,MA 01040 MA Registration#186552 Customer Name: Telephone Number a() C J G Address, City/Town, State: & I b11( OOP Rd , V )( a V( )`t`G 1� CertainTeed Roof System • Strip off existing roof and remove all debris from worksite • Line all edges with 8" aluminum drip edge • Install feet of WinterGuard ice & water barrier along eaves and up any valleys • Install Roof Runner Diamond Deck synthetic water resistant underlayment • Install CertainTeed Landmark Landmark PRO Landmark Premium Other shingles to manufacturers specifications. Color: • Install SwiftStart starter strip along eaves eaves and rakes • Install using 4 nails 6 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. Install Cricket at chimney. • Plywood Install 1/2" CDX plywood Install 1/2" CDX plywood as needed @ per sheet • CertainTeed SureStart Plus 4-Star 5 Star Warranty Coverage • All workmanship is guaranteed for 10 years unless otherwise specified. • 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 We Propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of: dollars($ ) 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 Acceptance of Proposal—The above prices, specifications and conditions are satisfactory and we hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature: Signature: Date of Acceptance: 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