17B-022 (8) 453 BRIDGE RD BP-2019-0679
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mak.Blogk: 17B-022 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOFING/REPLACE WINDOWS BUILDING PERMIT
Permit# BP-2019-0679
Proiect# JS-2019-001111
Est Cost: $11125.00
Fee:$72.00 PERMISSION IS HEREB Y GRANTED TO:
Cgnst.Class: Contractor: License:
r u DICKY MATOS 105917
Lot Size(sa.ft.): 17641.$0 Ow ewer: SANABgIA DIANE
zoning_URB(1oo)/ Applicant: DICKY MATQS
AT: 453 BRIDGE RD
Applicant Address: Fh_„ one: Insurance:
3 GLEN ST (413)530-5335 WC
HOLYOKEMA01040 ISSUED ON:12/10/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF, REPLACE 2
WINDOWS, PATIO DOOR
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 12opartm nt Fireplace/Chimney:
Rough: (�(i:, 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 Signature:
FeeTyae: Date Paid: Amount:
Building 12/10/2018 0:00:00 $72.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck--Building Commissioner
k
City of Northam ton E C E
Fes: Building Depart ent — 3
212 Main Stre t �
Room 100 DEC 6 �-
Northampton, MA 0106
phone 413-587-1240 Fax413
O DING IN
NORTHAMPTON,P
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION "t/,� 61 7f
1.1 Property Address: This section to'be completed byofftce
MapLot •` .•' - Unit
y53 5A
V�I J I Ia� ► 1 C,{ done t}verlay Dlstri+tyt
n, H
Elm St uistrict G8 llatriot
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
C)il � 453 �YA/F- Rd
np-
Name(Print) Curf fa rgA`d�dres
Telephone `t
Signature
2.2 Authorized Aaent:
]))(-Jj �l (-a
Name(Prin Current Mailing Address:
Sign Telephone
ETION 3-ESTIMATED CQNSTRUCTION COSTS,
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building OO (a)'Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee `
4. Mechanical (HVAC) + p Q
5. Fire Protection 1
6. Total = 0 +2+3+4+ 5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: ` 6
Building Commissioner/Inspector of Buildings Date
M @ d
W
EMAIL A RESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front —s '
l . ma
Side L R.
Rear
Building Height '
Bldg. Square Footage °o
Open Space Footage , , % ,.
of area minus bldg&paved i
parking)
#of Parking Spaces
Fill: ^. .,.._ ... ._.
volume&Location .
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW U YES U
IF YES, date issued:fi
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES U
IF YES: enter Book e T T „f PageE and/or Document#:
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued FJ _ rx
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ICS NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROEOSED WQRK jcheck all applicable)
New House ❑ Addition ❑ Replacement W' dows Alteration(s) Roofing
Or Doors Q
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [Cl] Other[D]
Brief Des n tion of Pro os d 0
WorkGnGQrYn��Sirind, s, .il�►orrts,�ns �s
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No Z r�, la U
Plans Attached Roll -Sheet lilt nV�s
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, as Owner/Authorized
Agent hereby dec re that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print am
ig a of Owner/Ag nt Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ ]_
Name of License Holder:. r,( 10` 9 1'T
Lice se Number
3 3D
Addre Expi ation Date
11 t),rL .tflo Ii� q .5 - 5 -35
ign a Telephone
Not Applicable ❑
Corrivany Nam I Registr ion Number
L-P L)DDc)
,-3 hVn 4�4-,fo , w4 C)
Address Expirati n Date
Telephone L49
SECTION 10-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...... ❑
City of Northampton
sr
Massachusetts ���„,`... •{�
,c
DEPARTMENT OF BUILDING INSPECTIONS a
212 Main Street •Municipal Building �� x
' Northampton, MA 010601
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
- g 15 3 j3n M(�
(Please print house num r and street name)
Is to be disposed of at:
ffv ( 16-1
P ease print name and loca n of fa ility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
r )�;ro
Si of P mit AolicanYor pcarer Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of IndustrialAccidents
o l Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Le ibl
Name (Business/Organization/Individual):
--Drf�-I Hat)s
Address: � �
City/State/Zip: 4_ Phone #: .5.3 �
Are you an employer?Check the appropriate box:
Type of project(required):
L I am a employer with employees(full and/or part-time).* 7. []New construction
2.aI am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling
any capacity.[No workers'comp.insurance required.]
9. (7 Demolition
3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Q Building addition
4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees.
12.Q P umbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOf repairs
These sub-contractors have employees and have workers'comp.insurance.+
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'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: A QR :TA) `
Policy#or Self-ins.Lic. #: I Kq�O Expiration Date: J U d�NI
Job Site Address: 5 3f�ndM_ '9--" , L�-f"1'�ity/State/ ip:t
Attach a copy of the workers' compensation policy declaration page(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.
I do hereby cert' nder the pain d alties of perjury that the information provided above is true and correct.
Signature: Date: I
Phone#: 3
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 Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
4 ,
Program Name Northampton CDBG Fiscal Year 2016
Funding: CDF HPG CPA Other(describe) CDBG
Housing Rehabilitation XX Septic Installation
OWNER-CONTRACTOR CONSTRUCTION AGREEMENT
THIS AGREEMENT is made effective this 7th day of December, 2018
between the "Owner" Diane Sanabria , for work to be performed at 453
Bridge Road, Northampton MA 01062 and the "Contractor" Dicky Matos GC
having a principal place of business at 3 Glen Street, Holyoke MA 01040.
Article 1. CONTRACT AMOUNT:
The Owner shall pay the Contractor, in whole or in part using CDF, HPG, CPA or other
funds, for the completion of the contract work, the sum of Twelve Thousand One
Hundred Twenty Five dollars and no cents ( 12 125).
Article 2. NOTICE TO PROCEED:
The Community Development Office (CDO) shall issue a written Notice to Proceed to
the Contractor within fifteen (15) calendar days of the execution of this Agreement. If
said Notice to Proceed is not issued within this fifteen day period, the Contractor shall
have the option of withdrawing the bid proposal, and this Agreement shall thereupon
terminate, without liability on the part of either party.
Article 3. TIME OF COMMENCEMENT AND COMPLETION:
The Contractor shall contact the Owner within ten (10) calendar days from the date of
the Notice to Proceed to schedule a time to commence the work to be performed under
this Contract. The Contractor shall agree to diligently pursue, execute, and substantially
complete all work by March 7, 2019 . Work may not begin until both
parties have received a fully executed copy of the contract and the three day rescission
period has expired.
Article 4. OCCUPANCY OF PREMISES:
It is agreed betweeContractor and Owner that the work shall be performed while
the premises arerocn'uph o/vacant (circle one).
Article 5. THE CONTRACT DOCUMENT:
The Contract documents consist of this Agreement, the Contractor's bid proposal,
Contractor's insurance certificate, and the work specifications prepared by PVPC
Housing Rehabilitation Specialist Richard J. Barus. These elements form the Contract
w and are hereby incorporated and provided as Attachments.
Page 1 of 13
The parties have executed this Agreement as of the date above so noted.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I!!!
Three identical copies of the contract must be completed, signed and returned. One fully executed copy goes to
the homeowner, one fully executed copy goes to the contractor, and one fully executed copy goes to the CDO
(PVPC).
You may cancel this agreement if it has been signed at a place other than the contractor's
normal place of business, provided you notify the contractor in writing at his/her main office
or branch office by ordinary mail posted, by telegram sent or by delivery, not later than
midnight of the third business day following the signing of this agreement. ,
CONTRACTOR OWNER
4#
6t
Sig
Y
gh4rySignature
l
Diane Sanabria ,
Printed Name Printed Name
1 44
Date Date :
Signature
Printed Name
Date
General Information
Dicky Matos GC 453 Bridge Road
Firm Name Address (Street)
3 Glen Street Northampton, MA 01062
Address (Street) Address (Municipality, State, Zip Code)
Holyoke, MA 01040 631-289-3846 (Dolores-sister)
Address (Municipality, State, Zip Code) Telephone Number
413-530-5335
Telephone Number
Page 2 of 13
Energy Star Certification
Any applicable products that will be installed in the below listed rehabilitation project will
be required to meet the "Energy Star" certification as required by the CDBG guidelines.
The products to be installed must be approved by the Housing Rehabilitation Specialist
before ordering or installation. Proof of"Energy Star" certification must be presented to
the Housing Rehabilitation Specialist before payments for those products are made.
LEAD PAINT— NONE— Home Built in 1991
REHABILITATION— EXTE R
foo
Strip is ing Shingles 1 —I&eo and Install New Roofing in e .
Materials: Synthetic roof underlayment by Palisades or equal. Grace ice &water
barrier or alternate approved by Rehab Specialist. In stock, 240 Ib. 30 year guaranteed
(ASTM certified)Architectural fiberglass/asphalt roofing shingles by Tamko or equal.
Sheet metal vent pipe collars, lead chimney flashing, step flashing and aluminum drip
edge. Continuous roof ridge ventilator with louvered side openings by Palisades or
equal.
If plywood is required for repairs, an allowance of up to $50/sheet installed is
allowed for 4 ply %11 CDX plywood — including nails.
Execution: Owner to select shingle color from Contractor's normal source of supply.
Strip and remove from job site all existing roofing shingles. Inspect for rotted or
deteriorated sheathing. Inspect for insect infestation. Back nail all existing sheathing.
Install new shingles in a fully workmanlike manner according to standard practices of
the trade and manufacturer's specifications. Install aluminum drip edge at gutter and
rake edges. Replace chimney counter-flashing with new lead flashing; vent pipe collars
and step flashing. Install ice &water barrier at gutter edges, valleys, and dormer
windows up 6 feet onto roof from house wall. Install synthetic roof underlayment
over remaining roof surface before installing shingles. Do not use staples. Install ridge
vent according to manufacturer's specifications.
LOCATIONS: Front& rear roofs on house.
COST:
� C)
Clean House Gutters Upon Completion of Roof Job.
LOCATIONS: Front& rear gutters on house.
4
,a
a:
COST: /
Install New Patio Door Screening.
Re-wire existing patio door screen with animal proof screening. Re-install screen and
latch to operate smoothly.
LOCATION: Rear of house.
COST: J�
Install Reglacement Exterior GFCI Electrical Outlets. (2—outlets)
Provide for new watertight covers. Provide for proper grounding as required.
Nota: These outlets are not working at the time of the inspection.
LOCATIONS: Front— 1, rear- 1
COST: 3 00
�} c (0�s
place Broken Insulated Glass in Windows. �2—sashes
Remove existing sashes from windows. Dismantle sashes; measure for new glass, and
order glass. Re-assemble sashes and re-install in windows. When new glass arrives,
install as per manufacturer's specifications.
LOCATIONS: Rear basement slider window— 1
Rear kitchen window- 1
COST:
Replace Damaged Stair Treads. Q treads)
Remove existing stair treads and dispose. Install new 5/4"thick pressure-treated treads
to match existing stair treads in size and thickness.
LOCATION: Front exterior stairs of house.
5
F �
r
COST:
REHABILITATION – INTERIOR
Install Resilient Vinyl Floorina. (3 –rooms)
Materials: Resilient "floating" plank type flooring as manufactured by Allure Ultra or
equal. Baseboard trim, shoe molding or equal.
Execution: Prep old floor covering and install new floor covering as per manufacturer's
specifications. Dispose of any related materials from the floor project upon completion
of the work. Leave Owner with any left over flooring material. An allowance of up to
$23/sq. yd. is allowed for the purchase price of the materials, not including installation.
Install small baseboard trim to cover edges of new flooring. Trim to be painted or
stained & sealed, Owner's choice.
LOCATIONS: Kitchen–21' x 10
Bathroom–7' x 7'
Rear bedroom –13' x 10'
COST: 3 a oo
Install New Lithium Battery Operated Smoke/CO Detectors.(2 – units)
Kiddie" or alternate approved by Rehab Specialist. Install according to manufacturer's
specifications. At least one detector to be placed on the highest habitable level and on
each floor below, including basement. Photoelectric detectors are required in all-areas
of the home.
LOCATIONS: Basement– 1
11 floor hallway - 1
COST: —
Repair Existing Light Fixtures and Electrical Outlets•to Make Operational.
6