Loading...
05-015 (5) 77 GROVE AVE BP-2019-1062 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma : lock:05 -015 CITY OF NORTHAMPTON Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) CateguryROOF BUILDING PERMIT Permit# BP-2019-1062 Project# JS-2019-001729 Est.Cost:$7765.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: DAVE MINER 99953 Lot size(s#.IF): 21387.96 Owner: ZALTA NISA&ELAN BARNEHAMA Zoning: URA(I Ill Applicant. DAVE MINER AT: 77 GROVE AVE Applicant Address: Phone: Insurance: 347 NEWTON ST (413) 533-0481 WC SOUTH HADLEYMA01075 ISSUED OM3/27/10190:00:00 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: pit: 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 Shmature: FeeTvpe: Date Paid: Amount: Building 3/27/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner loops City of Northampton perml Building Department Curb CutID.A W'N Y_ 212 Main Street Room 100 A vallidoll Ityd11;j1j;j: "7 % Northampton, MA 01060 ` Sete4structurvt Fill phone 413-587-1240 Fax 413-587-1272 Sere (til „lli l.0 at APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOL14H A CH h���LLIN� SECTION i-SITE INFORMATION 1 � MA9 27 2019 1 1 1.1 Property Address: Tpislivectl4n to b*completed by off1pe Map---G5 annm, ncacr.T1OrBnd �THWPTON.MA 01000 77 QroJr- dl)G Zone_Ownay District El.Sit District— CE District� SECTION 2-PROPERTY OVINERSHIPIAUTHORIZEDRGENT 2.1 Owner of Record: tv I s� 74 77 A U Z! ^4 Name Fnnt) Current Mailing Address 5-84- 3842 e,A4 Telephone Signature 2.2 Authorized Anent: DNv if 317 Name(print) Currant Mailing Address -7.2 0 /j57 Y Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 7 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6, Total=(1 +2+3+4+5) 1 776J-- Check Number Tilde Section,For Official Use Only Building Permit Number: Date m z Issued Signature 3-:77 ZQ R Building Commissionerfli-spector of Buildings Date EMAIL ADDRESS (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 m by Building Department Lot Size —_ Frontage Setbacks Front Side L R L:._ R:— Rea,Rear Building Height Bldg.Square Footage ""' % — — --- - -- Open Space Footage % ILm arca minus bldg&paved Mixing) #ofPwking Spaces -- - Fill: ..._ .... valumc B Lee..) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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 O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION&DESCRIPTION OF PROPOSED WORK(clack all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors O Accessory Bldg. ❑ Demolition ElNew Signs [0) Deeks jp Siding j[3] Other[M Brief Description of Proposed NLw Work: Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes _No Plans Attached Roll -Sheet ea.If Newhouse and or addition to eAsthm housing corm the followinot a. Use of building One Family_ Two Family Other It. Number of roams 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 Wocdstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of we0ands?_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 CONTRACTOR APPLIES FOR BUILDING PERMIT I, IU 1 S A 7c +E as Owner of the subject property (� .p hereby authorize II✓ f"gc MnPt+- to act on my behalf, in all matters relative to work authorized by this building permit application. (o Signature of Owner Date I, Ill IR J'P /'� I✓•>°rL . as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed /nundr the pains and penalties of perjury. ^e Print Name Signature of OwnerlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder'. IDAyiD MIde-,- 9q! �F.S 1' l License Number 347 /UQWlfN /S Address Expiration Date �- - 37Lf Signature Telephone 9.Realstared Home Impro-i Conttaetor. Not Applicable ❑ f)&-JZ! V" frg,,L r/Io/ �{ z An �eiw �s LGC / ar, f» Company Name Registration Number j ✓e w�" 51- 50„�, �1�,11�. /rA- /J I/ I7O Addresa Expiration Date Telephone 179-O71n SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provitle this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yea.......p yNo...... ❑ r City of Northampton Massachusetts i x DEPARTnENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building Jig �✓ 'JC aorrsa ton, a 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration,renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Est.Cost: Address of Work Date of Permit Application: I hereby certify that Registration is not required for the following reason(s): Work excluded by law(explain): —Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed render the penalties of perjury: I hereby apply for a building permit as the agent of the owner: ala) lm -Oavo-t fttru"f l8u5�C a Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton �' ....- 1 Massachusetts DEPARTMENT OF BNIIDING INSPECTIONS 212 Mein 9treat • H icipal Ruiltling Northampton, 1 01060 Massachusetts Residential Building Code Section I IO R5.1.2 Homeowner: Person (s) who own 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 homeowner. Section I I O R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton i Massachusetts i44444gg�fJJ'�f11 s DEPBNTNENT OF BUILDING INSPECTIONS 9 '7 212 Hain 8ttBBt •Hunicipal Building y pb Northampton, !a olOfiO 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 150X The debris from construction work being performed at: 77 6,-., 4v-- /.= A (Please print house number and street name) Is to be disposed of at: Urilkte r�ecya�i.7j (Please print ame and I anon of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Z� 3/a f/ Signature of Permit Applicant or Owner 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 oflndustrialAceidents I Congress Street,Suite 100 Boston,MA 02174-20177 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumben. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information 1 PILegibly P ' t Namd-� /ye(Business/Organizat,.Wlndividual): N -JC ^17Iye n. Address: 33-7 tie v4,,,,­ 3A- City/State/Zip: So v j� 14,b, , 1-m Phone#: t//,' 7N ^ ell e Are you an employer?Check the appropriate box: Type of project(required): 1 lamaee'lo,orwith 7employees(fulloud/ceparttime).* 7. ❑New eim,tmcti,in 2.❑1 am a sole pmpr coor or parmossup and have no employees working for me in any capacity.[No workers'comp.insurance requmea.] 9.8. �Demolition ng 1 em a homeowner doing all wink myself[No workers'comp.imautavice mqunedj t ❑ emolition 3❑ 4.❑lamahomwwnermdwillbehirmgconma rsmconductallworkonm prop ty ]will 10❑Building addition me mat an cnntmcmrs other have workers'=nmcensaunn insman=e or arc ante 11.❑Electrical repairs or additions proprietors withnn empbyees_ 12.❑Plumbing repairs or additions 5 1 Thtoense subcronuc ewmtohrvaenedm1 hlaovyeeehseendd theavsue bwcoken comp en smonanNceeat nached sheet. 13 ROOF re airs 5.❑We area coulomtion and its officers have exercised then right of exemption per MGt.c. 14.❑Other 152,41(4),and we have re employees_(No workers'comp.neuron=e requited_] "Any applicant thaKheek,box#I must also fill out the se[ion below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they are doing all work and men hire outside contractors most submit a new atbdnvit indicating such. :Contractors that check$is box most attv:hed an additional sheet showing the name suits,subconanetors and it,.,,whether or not those entities have employees. Ifthe sub contractors have employees,they must provide their workers'camp.policy number. L am an employer that isproviding workem'compensation insurance for my employees. Below is the policy and jab site information -II Insurance CompanyName'. z"i I fh Policy#or Self-ins Lic. #: 2 Z I-L 13 9 F' 45112 6 i 6 Expiration Date: 7 6 - (/Lri Job 5ite Address: 77 (1Ro-C 4-- L- City/State/Zip: J1ecr�s 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, g25A 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. 1 do hereby certify under Lhe pains and penalties ofperjury that the information provided above is hue and correct Sienaaturc ~-- Date Phone 4: 2�T `7 1:4-672 6 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/Lieense# 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service ofanother under any contract of lure, express or implied,oral or written" .An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence ofcompliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be remmed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should entertheir self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitrlicense number which will be used as a reference number. In addition,m applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NIASSAFE Fax# 617-727-7749 Revised 02-23-15 vvww.mass.gov/dia Date: v Estsrlor Homs Improvsmsnes (413) 533-0481 www•DaveMirwrRoofing.com 347 Newton Street, South Hedley, IIIA 01070 MA Relletratlon #111204 Customer Name: J✓: , , Telephone Number Address,City/Town, State: ' STANDARD ROOF SYSTEM Landmark • Strip off existing roof • Line all edges with 8" aluminum drip edge • Install feet of ice&water barrier along eaves and up any valleys • Install Roofers Select underlayment • Install CertainTeed Landmark architectural shingles to manufacturers specifications • Install starter strip along eaves • Install using 4 nails per shingle • Install a ridge vent along the length of house approx. 15"in from edge of roof • Install new vent stack collars • Replace step Dashing as needed along walls and chimney • Re-Dash chimney with lead Dashing as needed. Plywood / Install 1/2"CDX plywood Install 1/2"CDX plywood as needed @ per sheet • CertainTeed SureStart Plus 3-Star Extended Transferable Coverage (20 year non pro-rated full coverage warranty for material defects) • All Workmanship is guaranteed for 10 years unless otherwise specified • 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 We Propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of: A deposit of 113,$ ,? .`+ F ,is to be paid before materials are ordered. y s due at the halfway A Payment of$ � y point,and the balance of$ 7— 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. r. Authorized Signature:_ Note: This Proposal may be withdrawn by as ifnot accepted within 30 days Acceptance of ProposalTheabove 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. _s Signature: Signature: ' Date of Acceptance: S 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