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17A-275 (2) 154 OAK ST BP-2019-1357 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma ,.Block: 17A-275 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category. ROOF BUILDING PERMIT Permit# BP-2019-1357 Project# JS-2019-002187 Est.Cost: $11200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: DICKY MATOS 105917 Lot Siae(sm. ft.), 10715.76 Owner. GOLDSTEIN SUZIE Zoning:URB(100)/ Applicant: DICKY MATOS AT: 154 OAK ST Applicant Address: Phone: Insurance: 3 GLEN ST (413) 530-5335 WC HOLYOKEMA01040 ISSUED ON.512912019 0:00:00 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/Chimmey: 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 Signature: FeeTyoe: Date Paid: Amount: Building 5/2920190:00:00 540.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 6L Gr= p II--�� Department use only City of North mptflR EC BIltus of ermit: Building Dap rtm nt jTSeL C riveway Permit 212 Main trey Ber/S plic Availability Room 1 0 MAY 2 9 2019 r/W II Availability Northampton, 0 060 of Structural Plans phone 413-587-1240 ax 4#8i 12 INSrFc tte >Ians 12 _ NORTHAMPTON.IAA O' plfy APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH ONE ORTWOFAMILY DWELLING SECTIONI -SITE INFORMATION GCtM "C b� lqJ)2 'v7 1.1 Property Address. Thle......—be wmptMed by office 1 54 VIS 1/ L Map (7 Lot a�� Unit -N I\ (�1no !Y-1I�-I'T Zone Overlay District V� ` •a ( 1 'c1 Elm SL gisMct CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 1-7 ie .6D Idel 15L) CP L St FIaaa( Mo Name(PdM) Current M1peo Address: Telephone Signature 2.2 Authorized Acent: Name(Pd Current Mailing Address—� U1255:205)15 Slgnat I Telephone SECTION 3-ESTIMA ED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by Permit applicant 1. Building I I O'J (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) ACDI Check Number This Section For Official Use Only Building Permit Number Date Issued: 44z 1 Signature: 5-z8-zl Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING An Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Vus column in be filled in by r—� Building Deyarunenr Lot Size Frontage r�`� 0 --- Setbacks Front O Side L:0 R:= L:= R:= Rear 0 Building Height �. Bldg.Square Footage Open Space Footage O O % ,] Qur area minus bldg&paved Parlors) #of Parking Spaces Fill: volume&L ius ion A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES O IF YES, date issued:=— IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page' i 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 additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: F— E. WIII the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pan 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 5-DESCRIPTION OF PROPOSED WORK(check all applicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [(] Siding=] Other(CO wo rlkDo1C�tl(nhf PS8 120 mi Cod rr.shingk - SPV flf}Ll_-in. jd PYjnP :t Alteration of existing bedroom_Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.If New house and or addition to exlatinahousing, complete the following: 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? I. 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 fl. of wetlands?_Yes No. Is construction within 100 yr. floodplain_Yee No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. 1, 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, 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 y ( Lr jis as Owner/Authorized Agent hereby d cla a that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed or the pains andipenaltie of perjury. IU Print Na 8 60 I sign er/ApeV Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable [3 � Name of License Holder: I 1 CS- I05Q I^�1 License Number AddneL Expl Det Si 1 re (i Telephone R Istore me maroverl Contractor, Not Applicable 13—I - I�Ja I f a 112,�Q- Company Noft Regis tion umber (4n S& 51 lP l lc n A dre a }�/� '� �{. II�r , 1 ��r- [ Expire ipn� D t�e 7 1 Il A (,J�'1..HC) Telephone`1���,167 4 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.L.C.152,§25C(0)) 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 •'� +� Massachusetts L9.'PEftTDfEHT OF BDILDIBO IBSP£CTIOBS 212 Mein 9teaat •Municipal Building C� Northampton, MA 01060 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: X ,94 FVxfnd , No (Please print house number and street name) Is to be disposed of at: C09I10 - MglnS ] ) IUT • (Please pnnt name and location of face it ) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) lag-11 Si re o-r1P I it Apt)IiEanf 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 of Industrial Accidents I Congress Street,Suite 100 Boston,MA 01114-1017 www.mass.gov/dia Ulkirkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumben. TO BE FILED WITH'ITIE PERMITTING AUTHORITY. Applicant Inform ion Please Print Legiblv Name(Business/Orgmintion/Individual): Address:. I (-)k o tit City/State/Zip: hone #: Am......pin,,r'.'Gkkth pprovrtatr box: Type of project(required): I.�eemploy«with _ emrkwoesoullmWorpan-time}• 7. ❑New construction ].❑l am a sole proprietor or partnership and have no employees working for me in 9. ❑Remodeling any capacity.[No workers'comp.nevion« requhed.] 3❑I am a homeowner doing all work myself[No workers'mmp.immense required.i' 9. ❑Demolition 4.1:11 ran o hameoxner and will be hiring emi rsetors to condan all work on my property. [will 10❑Building addition nown,dn all csairre s,either have workers'esswenorion imwma or are sole 11.❑Electrical repairs or additions proprietors with no employee:. 1FB2.E]Plumbing repairs or additions 55.[]1 am a general contractor and I have hired the sub-tuntracmrs listed on the aneched sheet ]3. of repairs These sub-contracmrs have employees and hon workers'comp.i omwee. 6 We mea co and its outer,have exercised thew night of MGL c. 14.❑Other .❑ corporationm,tion l 152,§1(a),and we hme res employees.Mo workers'camp.immance raluired.i •Any applicant then ch«ks box#I roma also oil out the se tion below showing their workers'compemation policy innomil on. t Homeowners who submit this audsvit indicating they are doing all work it then have outside tommnnra nmst submit a nev atlidmit inti..oiu; .odh. enwhomore that checkthis box mmt anacbed an additional sh«t showing Ne name of the subiwv nomm .and male svhclher ar nm�ho.c ominc.ha.c e�loy«s. If nhe sub-mmaztors have emplq�ees,ase}mush proviJe Iheir workers'comb_policy numh�r 1 am an employer that is providing workers'compensation insurancefor my employees. Below is the po&y and job site information. Insurance Company Name: / AMPIjUn :165. OD, ` ,' I Policy#or Self-ins.Lit.#:uI'�hi II/\k�,p11,t�`4_:i M Expiration Date: Job Site Address: I� DR LSt�'A.11.1 l P ,M n _City/State/Zip: Attach a copy of the workers'compensation policyo0cy declaration (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 fore 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 certifyer th urns an�dy�d¢,maItt' of perjury that the information provided above is true and correct Sipaanne: h 4 Date j �G Phone#: 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/To"Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: --_.-- ' �mism�. 0%aalessiana. _. 2oarc a'Bsmnq ReOWauans dndr S:.' - Conatruellon,3upen;�ao� DICKY PAATOS 3 GLEN STREET HOLYOKE MA 01040 Ccm.�lasioner Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Individual DICKY MATOS ReglaMw: 188207 3 GLEN ST. E)prad 0' 05108(2U20 HOLYOKE,MA 01040 tlp0ste Andress and Ra Caro. mlu W Comumdr Matra A Sumneas Reauld ion HOU E JIM MOVEMENT CONTRACTOR ReO.st adon valid for lrMiviCual use my TYPE:IrtlMhlel b 1.Me almiration data. H faurtl return to: 9s01�n AWLINUm (Nace.d Canaumar Attairsand Buslneea R,ula0on 18 7 05gSY2020 One Aehbun0n Race-S.R.1301 DICKY M TOS Boatw.MA 02100 DICKYTOS S 3 GLEN ST. HOLYOKE,MA 01040 Undereecretaty Not valid M hhout elgn9dlR coi¢d' CERTIFICATE OF LIABILITY INSURANCE 02112l201B TES OWtTl4MTE m MMID AS A WITnM OF DDORmAT10N ONLY AND COMM NO MMM WON THI OpRHCATG FIOIDR T CETTTICATE DONN NOT ARMINIMIVY.Y OR NEGATNdY MES06 ESTYp OR ALTYf THE OOVEIAOB APPORD® BY TIN POLICY BELOW. THIS CERTIFICATE OP pDNMNOE DOES NOT OONBTPUU A OONIAACT 8811X®1 THE ISSUING INSURER( t AUMORM RFFRESETfATNE OR PRODUOR AND THE GIMM IDATE HOLDER. WMRTANr: SEN ae1lMore heldm N an ADDrnouL EUIR1®,9,pokyllm)nYt mm ADM=&NSW M pwbbns of be coda• N SUBROGAIM 0 KAM w*JW to IIs Ores OW andIM M of Its poft,•w bdn pololm m1G rogdm an•ndwe ft A SUW m t tlia oerUn•Rbds nefawdw btlw awESorllleNm b Nuafash rle>dL� msffi YFY CHI beumnce A9enq,Ino 419 696.2885 FAR 419 592-0889 416 Nen SI mrunAardynoy.awn _ U9YeRAeE MIJCe MIA 01040 NBmB1A ACE ALMOCAN INSURANCE CO 72667 rml® MrReR a: Dicky Morro dba DMR Rwing c: —L_—— 9 Glen Street MA 01M0 OOVEMON CERTIPICATE KNEW REVISION NU ' THIS N TO CWnfT THAT THE POLICIES OF INSURANCE UBTED BEIM HAVE BEEN I8SUED TO THE INSURED NAI®ABOVE POR THE POLICY PERK INDICATED. NOTWTHsTANDINC ANY REQUIRomm,TEST OR Comm OF ANY cowmA)T OR OTHER LV]mmeff YIHI R89 wT TO MCH TH CERRFIOATE MAY BE IBSL ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.U IRS GHOPH MAY HAVE BEEN REDUCED BY PND CLAIMS. TrwnrrwAlm Arm eemsu9�wPaRLUAwtm �� 14A•BY1eE �acclR , IEOW ar PBie0NIL6Aw WIRY ®ILA9016�TEppnWnppf.Af�iBt 6OSIN.A98REMlE PG1CY❑FfT �JIOC i RIOOIWRa-CgP.CP,10B e IIIIIOeOdelMmllY e MR AM EMILY ll I OYe•W e tlLY AI�� � i � '. aGnLYMMtY W'•�IrO e ANYRnILY A9 my e t ImmnALIN 9COIR 1 E1B1106me•mri _ BIW CUJRWDE ABBFL\lE ruuwl•l I nEIvllrl xowwulwrurnr A0 1100,00D wa m� nI■IAI U371O88409 OW12=19 1 021122020 DESCRIPTIONo"F` e+A beUr WDAW aEef�IgX ar oruasaMenw uwn..J�fuwxn�w.amw,.� ardw,rrrwYrf•sw��wrer1� Celtllxale Issue0 as eWtlenre of insolence. CERTIFICATE HOIDER THE WARE I M DA70 THEISM. ED TILE B E GAIIfe L M B6ORE ACC NMMM10N DATB =PVA NOTICE Vml e6 OElR19t® IN � AODDIOAN�MIM TIE PmDY R/OYm10M8. NmIR®1!I®BRATNB OTSI61078 ACOIfDaDRPORATTwL AIREIIb I••elYwl. ACORD 26(2018109) ThbAOOMnNs••ndbE•m splOrM mmbolAOORD 3 Glen sl CONTRAC Holyoke, Me 01040 413-530-5335 Fitt . CS105917 ' HIC-166207 Date May 28.2019 t (;f'.,�,. '.. t ' �• CT-0639705 P.O. Terms Bill To Suzie Goldstein Ship Via 413-250-3801 Ship Date 154 Oak St Florence,ma suziebgoldstein@gmail.com aY Description Unit E. 23 NEW ROOF 450.00 10,350.00 Tear of entire roof Inspect plywood(if any damage will be and additional cost of 60.00 per sheet 12 inch and 75.00 3/4 plywood. Install ice water barrier 6 It and valleys Install syntectic underpayment to rest of the roof Install limited lifetime warranty architectural shingles Seel all pipes and vents Install e'drip edge Remove all trash and debris Install a Tan-to Rapid Ridge Vent Building Permit included Color selected:dynasty glacier 1 Iko dynasty shingles 850.00 850.00 1 NOTES 0.00 0.00 Deposit given.5,600 5/28/2019 balance is due immediately after job completion. This job is expected to start in 7 days after the contract is signed. Total(25) $11,200.00