17C-034 (4) 101 NORTH MAPLE ST BP-2020-0367
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-034 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-2020-0367
Project# JS-2020-000611
Est. Cost: $8360.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DAVE MINER 99953
Lot Size(sq. ft.): 17380.44 Owner: EVANS-PEREZ ALBERT&KIMBERLY DAVID&MICHELLE R PEREZ
Zoning: URB(100)/ Applicant: DAVE MINER
AT: 101 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
347 NEWTON ST (413) 533-0481 WC
SOUTH HADLEYMA01075 ISSUED ON.9/20/2019 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 Occupancy Signature:
FeeType: Date Paid: Amount:
Building 9/20/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
`-` City of NOrtha GS tus o Permit:
Building part Cu Cut1priveway Permit
212 Mai Stre t ^ '
Sew rlSepc Availability
€ Room 00 cO�Q jVell availability
` Northampton, A 01060 \ T4n/q;ffets of Structural Plans
phone 413-587-1240 F4411 -5
� No Site Plans
VIE QNpA�N Other Specify
APPLICATION TO CONSTRUCT,ALTER, RE A]9—, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION &O—cV_.3 r�"" 7
1.1 Property Address. This section to be completed by office
J� Map Lot V) Unit
`
[ o� �6 r✓ r ����� 5+— Zone Overlay District
/ / &'!r#4 r-e' Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
l C vg vy ��z.z p( / c✓ 4r�h f �l e of4e
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
'71, 2'y ' D'7lp
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ?73 6 O (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=0 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: p�
Building Commissioner/Inspector 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 in by
Building Department
Lot Size
Frontage w_
Setbacks Front
Side L: R: L: �
R.
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
arkin _. m
#of Parking Spaces -------j
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#I c
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES l
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued: I
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 0 NO 0
_...... .. ...
.....
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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alteration(s) � Roofing
Or Doors E3 ff
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other[D]
Brief Description of Proposed Irl' e �k
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.if New house and or addition to existing housing,complete the following:
a. Use of building : One Family PAL 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 CONTRACTOR APPLIES FOR BUILDING PERMIT
I,
LVeAs ra f f t Z as Owner of the subject
property
hereby authorize /J ' 4 Y
to act on my behalf, in all matters relative to work authorized by this building permit application.
rs)�'/y K,- �p/,F/-�
Signature of Owner Date
I, 0 / as Owner/Authorized
Agent h6feby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under
tha pains and penalties
ssfof perjury.
Print Name � /J
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor:M Not Applicable
Name of License Holder: (rLY / ! n 'f
License Number/--,
//.�
e-1- 4y ��dl(� /u/'- v f O 7,L A0 /�o U 9
Address Expiration Date
Signa ure Telephone
9.Re ' tered Home':Improvement Contractor: Not Applicable ❑
A/d W-- /-0 1 4 t-e-, — /rb s--r t)t
Company Name Registration Number-
Q /q / ICI
Address Expiration Date
Telephone
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
`
Massachusetts �' 't�4
DEPARTMENT OF BUILDING INSPECTIONS �S
212 Main Street •Municipal Building
,r 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:
l p 4 /--'e,r)4 /'t AIe/?- ..5 V
(Please print house number and street name)
Is to be disposed of at:
tl - 1i '_7 Xle",C 16 IV e
(Pleasb print name and loon 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.
The Commonwealth of Massachusetts
4 Department of Industrial Accidents
a
1 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.
Applicant Information Please Print Le ibl
Name(Business/Organization/Individual): IM ( hal Y—r-
Address: _� 9 ? i''> ! ,t� a J!2
City/State/Zip; c_t V Z Phone#: 3 ? !J 7 7--n
Are you an employer?Check the appropriate box:
Type of project(required)'.
1jam a employer with employees(full and/or part-time).* 7. [:]New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. 1I odeling
any capacity.[No workers'comp.insurance required.]
9. Demolition
3.Fj I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10E]Building addition
4.❑I 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.n Plumbing repairs or additions
5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.� p
ROOf repairs
These sub-contractors have employees and have workers'comp.insurance.:
60 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.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site
information.
Insurance Company Name: y t i C
Policy#or Self-ins.Lic.#: `a 2 Zj AylFq 5/1 Xb I Expiration Date:
Job Site Address: /O/ /`'e,1A &,Vlt'S�— City/State/Zip:
Attach a copy of the workers'compensa 'on 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.
Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: 7 tt — r�7 ' 6'
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#:
%
nAVZL
WINE�a Date:
Exterior Home Improvements /
(413) 533-0481
www.DaveMinerRoofing.com
347 Newton Street,South Hadley,MA 01075
MA Registration#186552
• U.- +` S _ '' 4' _Telephone Number t' - °/
Customer Name.
Address, City/Town, State: /,0/
BETTER ROOF SYSTEM
Landmark Pro
• Strip off existing roof
• Line all edges with 8"aluminum drip edge
• Install 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 i 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 as needed along walls and chimney
• Re-flash chimney with lead flashing as needed.
• Plywood
Install 1/2"CDX plywood
Install 1/2"CDX plywood as needed @ 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
• Other
5 ILA
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:
_ dollars($ )
A deposit of 1/3,$ ,is to be paid before materials are ordered.
A Payment of$ 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 wil l
become an extra charge over and above the estimate.Our workers are fully covered by Workmen's Compensation Insurance and
Liability Insurance. __..... __,.
Authorized Signature: Note: This Proposal may be withdrawn
by us if not accepted within 30 days
Acceptance of Proposal—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 % !l - Y` i
Signature: -~ -- "- gn
f
cA
Date of Acceptance: , / (7
This agreement may be cancelled by Customer t i 3 days of acceptance for any reason as detailed in the accompanying Notice
of Cancellation Customer's Initials (. V