12C-099 65 MORNINGSIDE DR BP-2019-1380
GIs s: COMMONWEALTH OF MASSACHUSETTS
Man:BIOCk: 12C-099 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ROOF BUILDING PERMIT
Permit a BP-2019-1380
Project is JS-2019-002220
Est.Cost:$16388.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVE MINER 99953
Lot Size(su.R.): 22651.20 Owner: NEWSOME BARRETT
Zoning:SR(124VWSP(124V Applicant: DAVE MINER
AT. 65 MORNINGSIDE DR
Applicant Address: Phone. Insurance:
347 NEWTON ST (413) 533-0481 WC
SOUTH HADLEYMA01075 ISSUED ON.6/312019 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP &SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspectorof Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House k 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 Sieaature:
FeeType: Date Paid: Amount:
Building 6/3/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Zoo F
BoPI3yo
Deperbnent use only
City of Northampton Status of Permit
Building Department Curb CuVDnvew y Pemut
212 Main Street SewadSepbc Awilabilily
Room 100 WaftrAN.11 Availabildy
Northampton, NIA,01060 Two Sets of Structural Plane
phone 413587-1240 Fax 413587-1272 PloUSift Plans
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOV TE O W6&AVM1QYX6WfO F4MILY DWELLING
SECTION I -SITE INFORMATION spy 31 2019 td C' •C9g1
1.1 Progeny Address This section W be mpla ad byotTlae
6 nr4J ft.7G MA. pgEKt OCBIr^�Nn M91EC110" Unk NORTHAMPTON,MPO
one Overlay Dili
Elm St District Ca VADw
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
r3P,rt * WcW f•rr, C ,)- /✓Morn ,nr ffJe D/t- F/em-< r^'d-
Neme(Pdnk) Current MMIYg Addran:
e<'k"cp Telaphone
Signature
2.2 Au0norized Ageat
t�kx ✓RrAr� 3,f7nz ! . sF so. 11 lilyyr4
Nemo(Phe) Cunenf Mailiry Addnwi
C 37 y —o-7iL�
si,numnr Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
m lelad by pennitapplicant
1. Building /6/ 3 y (a)Building Permit Fee
2. Electrical (b)Estimaftd Total Cost of
Construction from 6
3. Plumbing Building PermN Fee
4. Mechanical(HVAC) `�•
5.Fine Protection
S. Total= I +2 t 3 t 44 5) Check Number
I LN IS-
This Section For Official Use Only
Building Permit Nu DaftIssued'.
Signature: 5 -31 209
Building CommleeionenInspeclor of Bui c,,r pare
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
I C AHI lfl ':J �-1
.��__ N �LON@
1 � dry � ; �oia J�
L .. r... . .w... _.e L __�.�
1'
Section 4. ZONING All Infatuation Was[Be Completed.Perm[Can Be berried flue To Ircomplele In(ormal"an
Existing Proposed Required by Zoning
This column m be Ned in by
building Depelmeol
t.ol Size
Frontage
Setbacks Front
Side L: R 1,:_---LRI
R
Building Height
Bldg, Square Footage '4 O
Open Space Footage % ..
(lal,m.miuue bWa a yed _
rti.
#of Parking Spaces
Fill:
volume a Inrauo.
A. Has a Special Permit/Vanance/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 O 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 O 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 ado)tions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. VAII the construction activity disturb(clearing,goading,excavation,or filling)over 1 acre or is it pert or a common plan
that mil dish rb over l acre? YE: 0 NO O
IF YES,then a Northampton Storm Will Management Permit from the DPW is required.
SECTION S DESCRIPTION OF PROPOSED Check all tupplicabb
New Nouse ❑ Addition ❑ I Replaceent Wlndowa ANeretlon(a) ElRooflrg ❑
Or Doorsm ❑
Accessory Bldg. ❑ DernolNlou ❑ New Signs ®] Decks ❑ Siding O] Other EM
Bnef Description of proposed
Work'
�� go
Aneration of existing bedroom Yes.No Adding new bedroom Yes No
Attached Narrative Renovabng unfinished basement Yes _No
Plans Atteched Roll -Sheat
ea.If New house and or addition to mdgdM housing, complete the following
a. Use of building One Family Two Family Other
b. Number of rooms in each family unit: Number of Bedrooms
c. is dere a garage attached?
d. Proposed Square footage of new consbuchon. Dimensions
e. Numberofsbries?
f. Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Massdteck Energy Compliance fon affached?
h. Type of construction
I. Is construction within 100 fl.of wetlands? Yes No. Is construction within 100 yr. floodplain_Vas_No
j. Depth of basement or cellar floor below finished grade
IL Will building candor to the Building and Zoning regulations? Ves_No.
I. Septic Tank_ City Sewer Private well City water Supply
SECTION 7e-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPUES FOR BUILDING PERMIT
1, Owe {"e W3 s,! ,as Owner of ft sublet[
property
hereby authorize �-ligir"'e ^^ly.y r
to act on my behalf,in all matters dative te work authorized by this building permit application.
e« �ye J- C—,/-
Swesers
^or oris, DSM
I, ] JA uP `-"I my .as Owner/Audonzed
Ayer reby declare that the statements and information on the foregoing application ars true and accurate,ti,the beet of my,knowledge
and belief.
Signed under the pains and penalles of perjury.
]� at /^71 PPA-
Phos No.
Z K--Jw A i
Signature of CansdAgent Oate
;. i .
SECTION 8-CONSTRUCTION SERVICES
B.1 Llcerleed ComtruMlonSuoervbor: Not Applicable 0
No=a License Holder V Y(��RA C tM IA F1 5 94 .r3
Licaw Nlnber
7 k f • s S. 1R .1[ry inli /19/2e119
Address Evprrodoo DeN
7Y70.> 0
Signature TeMpwr
Not Applioble O
�R � rtAt� G,-Y4410,1v� /a,.t �� /Scrs=
Commem Nam Regisbalim Nlanbar
Nf_ 2 /4 b
Address 5L4 Expimbon Date
Telephone
SECTION 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8))
Workers Compensation Inwlance affidavit must be completed and wbmitted with this application.Failure to provide Me affidavit will resuN
in Bre denial of Ore isecance of the buikhrkg pairmt.
Signed Affidavit Attached Yea...... No...... 11
City of Northampton
Massachusetts
i
DIPXR aT OF art W]Nc arapacMOW R
zlz Hain S's . l4nietYl Bu11dLg =\�
Horn+aptm, eas 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 162A requires that the"reconstruction,aaeration,renovation,repair,modamization,conversion.
improvement,removal, demolition,or construction of an saation to any pre-existing own erb upied building containing
at least one but not more then lour dwelling unds....o to strudunes which are adjacent to such residence or building'be
done by registered contractors.
Note.Lf the homemvner has contracted with a corporadm 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 remoo(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 W17H 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 1I3A.SUCH OWNERS ALSO ASSUME THE RESPONSIBUMS FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building pemrit as the agent of the owner:
;.:aN-e " ( � I' CP 5S Z
Date ntractor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owncr Name and Signature
_ City of Northampton
Massachusetts �94�
s
DBPda1TffiM." OF BUILDING INBa W1B Y.
212 YSvt . DlUo
Nhpm, M olos
•r.—'o
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 110.115.1.3.1
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
Maesachu etts
s
D212a niT OS BUILD SNS ldl ,
212 Main sthM &Munlnlpal Bu11GLp
�. ew�m�tm, ea. ovoco
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 r /)7 0 t r,,� r. j� e'IL
(Please print house number and street name)
Is to be disposed of at:
V.. Lkry krey,L+,
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
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.
a
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-1017
UW www.massgoy/dia
1\orken' Compensation Insurance Affidavit:BuBders/Contndon/Ele riciem/Plumben.
TO BE FILED WTFH THE PERMITTING AUTHORITY.
Aonlicanl Information Please Print Leuibh
Name (Ousires.40,mi.atiodlndividua0: Q pr. c. 1MtwC/ tf)`krv"'r 14�—,- ..('wX
Add=,:-7'4 'y P--417v Se"
City/State/Zip: Se-Ndiex pitta Phone#: ? ^u7td
Anym an mpbyvTOmk ie appropdre hoc Type of project(required):
1 .amp1,aviN-2—_mnployeeffoustaompatt-tine)' 7. []New construction
a sole pmpridorapatthmhip mdlwenomployea watkimg fcanin 8. emodelfng
my capacity.INo robs,'carp.ins.ns,unnsil
3�[am abmmwnaaoimg dl wek my.ea Mowm4m amp.wumureatdtealr 9. Demolition
<❑I m a M1mmwne W will h hi^me mNracbrt W mdmt all work m my prolzdy. I wJl 10❑Building addition
m thr allmwadaa athehave woKas'eampemadon msmmamre sale I 1 Electrical repairs or additions
poplars with an mploysm. 12.[3 Plumbing repairs or additions
5❑1m a,medcon..and 1 have hired the,u nottadm land an themaild dsd. 13❑Roof
Thee�ub mntramn ha-mPloyrea and have annex'emmp.wumee.t repairs
6❑We one,a cmpotalion ad in Officers haw exercised their night ofassaption t#Man, 14.�OIher
15Z 51(4),and we have m employee.[No warkm'cenp.ieaufew.e"hand,I
*My applicant and checkv bon nil mut also Minna the seed.Wnw showing their—do.-canpematinn policy information.
t Hmmwnm oho submit this affidavit indicting tbny arc doing all work and thrn hhe mbidc mntncWm count mbmit a new affidavit ndi.nnp—h
l'ontracWrs that clwck do,box must amcAd an additional shod showing thc nave of Ne aub+m rdn&n.and sole.ft,M1er or not thorn cont'has
amrlorea. If the subsuntracWr hose employee,Weir it pmvidn thci works, romp.policy numhu
1 am an employer that if providing arorhers'rnmpeneation losunnce for my employees. Brhtw is the policy and job site
information.
Insurance Company Name: 2c,t 1
Policy#or Self-ins.Lic.#: 2-z v0 St 14 S L 1 1 1 11, Expiration Date: I t
Job Site Address: ba' Mel Ar i al/L JW/ Ciry/State/Zip:
Attach a copy of the nonhen'compemafbn policy declantion page(showing the policy number and expiration date).
Failure in secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a free up in$1,500.00
anal/or one-year imprisonment,as well as civil Inanities in the farm of STOP WORK ORDER and a fine of up 0$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 cetrffy under thepabs andpataMes o(pedury that the Information provided above Is true and carred.
S „ansa� Date' .�/� 6/r 4
I'hane4 7Y'-074n
O)Jieial are only. Do not mite in the area,to be completed by city rrr man tJlaia[
City or To": Permit/Licensc#
Issuing Authority(deals one):
I. Board of Health 2.Building Department 3.CUyffown Clerk 4. Electrical Inspector S Plumbing Inspector
6. Other
("Matt Penon Marva
Information and Instructions
Massachusetts General LAW chapter 152 requires all employersto provide workers'compensation for their employees.
Purmann to this stande,m anpiayee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An empbyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or die
receiver or hunce ofan individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more it=three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons m do mamuncence,construction or repair wait on such dwelling house
or on the grounds or building apportioned thereto shall not because of such employment be deemed in 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 at to construct buildings in the commonwealth for any
appfiramt who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor my of its political subdivisions shall
enter into my contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fi0 oro the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
maxs nary,supply sub-conuactor(s)riame(s),address(es)and phone numbers)along with their cerlifrcate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with on employces other the the
members m perbe ,are mtmgwred w teary workers'compensation inwuaece. If anLLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Amuknts fm confumatim of insurance coverage. Also be sure to sign and date the affidavit The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Acsiderrts. 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-maiued companies should enter then
self-insurance hcense number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and pointed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office ofluvestigations hes to contact you regarding the applicant.
Please be sure to fill in the permittlicame numberwhich will be used as a reference number. In addition,m applicant
that most submit multiple pemut/liceme applications in my given year,need only submit ore affidavit indicating csment
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 mwn may be provided to the
applicant m proofthat a valid affidavit is on file f c forme permits or licenses. A new affidavit must be filled our each
year.Where a home owner or citizen is obtaining a teens,or peanut not related to my business or commercial vacuum
(ioe a dog license or permit to burn leaves em.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax ember:
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-MASSAFE
Fax#617-727-7749
Revised 02-2115 www.mass.gov/ilia
kit
DAVE MINER,. Date:
Exterior Nome Improvements
(413) 533-0481
www.DaveMineraoofng.com
347 Newton Street,South Hadley,MA 01075
MA Registration 0186552
Customer Name: &71 L- - Telephone Number 7 , 7 - 3 ,
Address,City/Town,State: l M t / F 1 r - a 1 „E
fL1G7 W�^,FG'
BETTER ROOF SYSTEM S .I
Landmark Pro
• Strip off existing roof
• Line all edges with 8"aluminum drip edge
• Install I 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
• 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 m needed along walls and chimney
• Re-flash chimney with lead flashing as needed.
• Plywood
Install 1/2"CDX plywood
)L_Instaa 112"CDX plywood as needed *_.5 r 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 / / S '
. Other s 1 - � '
S / -
Contractor is not responsible for any damage to interior of home.Any loose articles on walls/shelves;should be removed before work stares
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,$ S s/ ' ,is to be paid before materials are ordered.
A Payment of$ 10/1 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. /1
Authorized Signature: Note: This Proposal may be withdrawn
by as iif nol accepted within 30 days
Acceptance of Pmposal--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: Signattne:
Date of Acceptance: // /3 7 / t R
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