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31B-256 (2) 50 STATE ST BP-2019-1386 GIS 4: COMMONWEALTH OF MASSACHUSETTS a :Block:31B-256 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-1366 Project# JS-2019-002228 Est.Cost:$15875.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. .License. Use Group: DICKY MATOS 105917 Lot Size(sp.R.): 5357.88 Owner: CARSWELL CAMERON zoning:CB(100 Applicant.- DICKY MATOS AT. 50 STATE ST AaalicantAddress: Phone: Insurance: 3 GLEN ST (413) 530-5335 WC HOLYOKEMA01040 ISSUED ON.61412019 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/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 Occuoancv Sienature: FeeTvve: Date Paid: Amount: Building 6/420190:00:00 $40.00 212 Main Street,Phone(413)587-1240,In:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: .>r . . . Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability '.I Room 100 Water/Well Availability Northampton, MA 01080 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plana APPLICATION TO CONSTRUCT,ALTER, REPA OR TWO FAMILY DWELLING SECTIONI -SITE INFORMATION JUN 3 pplg 3U'� --) !5'V 1.1 Prooertv Address: This to to be completed by office SO �alQ �y Elrcr .Ply WngB apBlme ,lJ_ 1C`�(,, A.rt�MR �.^(gyp of Unit Nv4ham,phyn , Ma, Oil0Q Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT (,I 30 1 ST �,6f� Yy1�7Vlt��)0 O Name(Print) C1rrpgt Nlgy ngQitd(e�_4 I o Telephone 1 Signature 2.2 en � M G,le n sfi /-{ol�aKe /ria _6161(0 N e Print) &rd railing Atltlreae: r 06 933 C n re Telephone SECTION 3-EST ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit apiplicant 1. Building C (a)Building Permit Fee 2. Electrical ✓ (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) W ryr. L10' oU 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number 1-( This Section For Official Use Only Building Permit Number. Date Issued Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRE EQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 777 Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he find in by Building Mpamnem Lot Size Frontage Setbacks Front C ,� Side L:r�-�-.�'� R: L:= R.= Rear u O u Building Height Bldg.Square Footage Open Space Footage (lot area minus bldg&Paved pad,i-g) At of Puking Spaces -- Fill: values&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW © YES 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#i 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 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(cleating,grading,excavation,or filling)over 1 acre or is it part of a common pian that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all noollcabla) New House ❑ Addition Replacement Windows Alteratlon(s) E] Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [Oj Decks [M Siding M] Other[(:j Brief Degch ion Pro T?_A( GR t I PAIA r171 1 i a Q itgQ .S Work: Alteration of existing bedroom_Yes -No Adding new bedroom Yes � No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea,It Now house and or addition to existina h m I e the} Ilowin a. Use of building One Family Two Family _Other It. 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 stones? 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_Yea 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, 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. Signatureof Owner Date ENnu- I, 'I e/i[ ,t/NA A !1 �� as Owner/Authorized Agent hereby declare t at 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 Na Sign of DNMr/ t Dab SECTION 8-CONSTRUCTION SERVICES .1 Licensed C n tru tl Su r: Not ceApplicable 13 MAIT)F Name or Llnae Holder 1 l- ' U.1 r 12 License Number clip in s+ wZ10 03- 30-W Ad T, 13 5-36 X33 S Eapindlon Data T pnature Telephone 9. ftaistered Home Im v m t r ct r Not placable ❑ 6r) Comoany Registration Number pis+ 6�-- 6) (o- 209n AM—a},(L�' ,", �I//►►��� /�l ' Q Expiration Dale hil f� / / l a U t o`T U Telephone SECTION 10.WORKERS'COMPENSATION INSURANCE AFRDAVIT(M.G.L a 152,$25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this efidevk will result in the denial of the issuance of the build' g permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Massachuaetta s" Iffil OS a LDLIYG L SYECTZMS 212 Nein etr t *Municipal aullanq North ton, Me 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: ,50 SA OA-e Sf N 6Hh a 610c () (Please print house number and street name) Is to be disposed of at: 5j 111ab (Please pnnt name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 4 &-4 j4dEL� gnature of P d Appl cant 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 Commonweahh of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.mass govIdia WWorkers'Compensation Insurance Affidavit:Builders/Controctors/Electricians/Plumben. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Bwiness/Organintion/Individual): Address: n 5 City/State/Zip: fik4b4Cl'l a- 6) 0`1V Phone#: 13 5-30 J j 3 A.7", .employer?Check t e apprnpriatebas: Type of project(required): 1. __ employees(fidl mtd/orpart-time).+ 7. ❑New construction 2. 1 stn a sole proprietor o partnership and have no employees working for me in ❑ 8. ❑Remodeling my capacity.[No workers'comp.insurance requied.l 9. ❑Demolition 3.01 em a homeowmr doing all work myself.[No workers'comp.ivsmance inquired]' 4.❑1 am a homeowner and will he tiring eons om w emMuo all wok on mY propertyI will 10❑Building addition ire that all conaaGon either have workers'compensation inswance or me sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑PI bing repairs or additions 5.E]1 an a general commissar most I have hired the subcnntracmrs listed ou the attached sheet. ]3, oaf repays These s sb�convactors have employees end We workers'comp.insiumbe,t 6.❑We are a enrpoation and its.11i have exercised their right ofexeseption per MGL c. 14.❑Other 152,§1(4),and we have tin stories us.IN.workerscomp,am..required.) "Any wheret that chinks box k l must dsu fdl out the section below showing their werkers'ems,smation policy iM tion. I fhmsmmners who submit this affidavit iWimang they are doin,all work and then hie outside contractors most submit a new afFdaril mmd ming such. :Contractors that check this box must attached an ndditional sheet showing the more ofthe sub-emanon....and,tme whethor or not thou entities have mol. Ifm,sub-ootomer,hove employees,in,must provide their —doss wmp.pilin numhcr. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ((l' Insurance Company Name: RE Aftll� (y {� UyI VQ,�'I �.� d2-12-70 { (76 Policy#or Self-ins.Lic.4:� 1 /�r n 3 0 qq3 Expiration Date: f12—I Z—Z nrf� ��e Job Site Address: sfi=* S7 City/State/Zip: Ny#w 4-616UK1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and eflnation 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 offs STOP WORK ORDER and a fuse of up to$250.00 a day against the violator.A copy of this statement may he forwarded to the Office ol'huvestigations of the DIA for insurance coverage verification. 1 do hereby c ti under the poi d aloes atria that the information provided bone '}hue and correct. Si �-C Date, (Q 1_��`�(� Phone#: � O 533 Official use only. Do not write in this area,to be camplyded by city or town official. City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#; 3 Glen St CONTRACT Holyoke, Me 01040 413-530-5335 Number 62 CS105917 Date May 28,2019 HIC-166207 CT- 0639705 P.O. Terms Bill To Cameron Carswell Ship Via 18022724102 Ship Date 50 State St Northampton, Me 01060 cameroncarswell®yahco.com Qty Dawnptbn Unit Ext 33 NEW ROOF 400.00 13,200.00 Tear off entire roof Inspect plywood (if any damage will be and additional cost of 60.00 per sheet 1/2 inch and 75.00 3/4 plywood. Install ice water barrier 6 ft and valleys Install syntectic underlayment to rest of the root Install limited lifetime warranty architectural shingles Seal all pipes and vents Install 8"drip edge Remove all trash and debris Install a Tamko Rapid Ridge Vent Building Permit included 1 Chimney 450.00 450.00 Install lead flashing to waterproof 1 Wo dynasty shingles - 950.00 950.00 300 Gutters 4.25 1,275.00 Replace all gutters and down spouts Total (335) $15,875.00 nature ._ Convnonwea ar Ol Uaasacnusem - i Drvunn of° °IassmMl Lkensure 'aoem of awl.ny aequmaens srw f[annares (JpnalrJ410II anxn.130/ CiS-105917 DICKY MATOS 3 GLEN STREET HOLYOKE MA 010410 �cm.^usswner -� ' Office of Consumer Affairs and Business Regulation One Ashburtor Place- Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: IndMuel DICKY MATOS Regetre0on: 1&&207 S GLEN ST. E)Oreoon: O5/08/2020 HOLYOKE,MA 01040 Uptlato Md.arM ROW.Card. l>1Ms ME IUffl ar Mels!C Mows gs0uletlon HOMEIMPfTY%:lnMCONtgACTOR geyat U,. I for lr Ifel uOe oNy TYPE. E,r ENare the orowrnwr tleta. I bunt raw.to gealNre7 M g On.c - Um.R. Affects 1131H ass RegulNlon 16b20T Crrtl02020 One<:OCAWRaee-SUM 1ffiI DICKY MATO& eeefrr,MA 02100 DICKY MATOS 3 GLEN ST. HOLYOKE,MA 01040 Undersecrerery Not valid without Signature C®rra CERTIFICATE OF LIABILITY INSURANCE 02=0x" 19 DanarzDls THIS CERTIFICATE Is ISSUED AS A MATTER OF INPORMMAT1Oa ONLY AND OO PSKS NO MOM UPON THE CER WWATE HOLUM 1 CERTIFICATE DOES NOT AFFINVATNELY OR NEGATIVELY ANWID, MIND OR ALTER THE COVERAGE AFFORDED BY THE PO" BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT ODNSNTUTE A CONTRACT BOTVI®4 THE ISSUING INSURERS), AUTHOR[ REPRESENTATIVE OR PRODUCER,AND THE CHYIWDAIR HOLDER IMPORTANT: N the QW05cata hoklor Is an ADDRIONAL RMUMV.GIM P WeyP-)must hM ADDITIONAL INSURED pWINGum a be aMal R SUBROGATION 13 WANE],sublwt W tlW arlm And!owwwons at an pa",aalRNn Policies nr7 n fft an sMIRs1RINA. A SWANWN tlae asrtlAwte saoE nal aanlAr tIW fo Iha aartlBaaY I101sar N Isu dash a EIIm000tI Haalb,Fbun CHI Inure AgenW,Inc. 419 BW*M J 419 -OS% 418 Main Street "Wrycompnoy.Oat HoWlas MA 01040 ILNII®IA ACE AMERICAN INISURA=CE 1000 9287, MNIII� Ye1aast : ._ Dhary Maim ma DLR Roo@O c: S Gbn Sweet a; N8111a31 E: IAA 01040 _ P: COVERAGES OERTUgQATENUYMW: REVNI MNUIIEO THIS W TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BFLDW HAVE BFM ISSUED TO THE INSURED NAMED AWA FOR THE POUCY PERK INDICATED. NOTAITH8'TANDING ANY REQUIREMENT,TERN OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VAHI RESPECT 70 WHOM TH CERTIFICATE MAY BE WNW OR MAY PERTAIN,7HE INSURANCE AFFORDED BY THE POLICIES DISIMSED HER13N W SUBIE.T TO ALL THE TDM SIDUADONS AND CONDITIONS OF SUCH POKES LUTE 8HOVA1 MAY HAVE BEEN REDUCED BY PND CINNs rllaoaoAlRa IJ♦n saaaawsaLasasulArllr (i1fH OCCIIHRBMEI a aAaBIMOE Is MMEW ar n i PBRDNaLAADV ILIIRY ®ILM0f6GOBRIGMpRp.NTIHIBt '. 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