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36-158 (4) 1 120 BURTS PIT RD BP-2020-1227 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 158 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: replacement windows/siding; BUILDING PERMIT Permit# BP-2020-1227 Project# JS-2020-002069 Est. Cost: $34800.00 Fee: $140.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: DAVE MINER 99953 Lot Size(scl.ft.): 11630.52 Owner: DZULINSKY KATHERINE Zoning: Applicant. DAVE MINER AT. 1120 BURTS PIT RD Applicant Address: Phone: Insitranc•e: 347 NEWTON ST (413) 533-0481 WC SOUTH HADLEYMA01075 ISSUED ON:61II12020 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF, NEW SIDING, 2 REPLACEMENT WINDOWS 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 Si nature: F_eeType: Date Paid: Amount: Building 6/11/20200:00:00 $140.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 VVater/VVell Availability ;0Northampton, MA 01060 Two Sets of Structural Plans r' :. phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map L Lot /I Unit j3v 5 Zone Overlay District/ �t Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �� 0 13,r4s ;t' �� ;*I-r Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Ne(Print) Current Mailing Address: 37 y- a» Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building t, g 6 (a)Building Permit Fee 2. Electrical L (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) j�� 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only 16p- .��� 17 Date Building Permit Number: Issued: Signature: (O'vil-Z0W 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 Setbacks Front Side L: R.L_J L:Q P'= Rear L� Building Height r--1 Bldg. Square Footage % 1—_1 C� Open Space Footage % rr (Lot area minus bldg&paved 7 1. parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T 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 additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. VIII 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? YE: O 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) ff— Rooting El Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs per] Decks ❑ Siding[]] Other EM Brief Description of Prpsed 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_ s' 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, ,j.� it, ✓ " I Nt '0Z U 1 ." ,' !�7 as Owner of the subject property /) hereby authorize /1/ �— to act on my behalf,in rI matters relative to work authorized by this building permit application. Ce�3-Cec-� d .L Signature of Owner Date as Owner/Authorized Agenf hereby declare that 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. M f Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder: /T L �` ►�2'< 77 F La �{ �j �y� License Number 0 l r��t /' Cit C ;� ? cs b Address Expiration Date ? 7Y6-23o Signature Telephone 9. Roistered Home Improvement Contractor: Not Applicable ❑ A-JC /K C h 7' r rel keA -r r Ze6 "Z - ,--�.j Company Name Registration Number lir / ) f Address w 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 • s� Massachusetts F r°' A._ i DEPARTMENT OF BUILDING INSPECTIONS g Iia 212 Main street •Municipal Building 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: (Please print house number and street name) Is to be disposed of at: V C.,r �\ r 4 G_� (Please print name andel I catition of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Q� a 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 of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia NN orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Awlicant Information Please Print Legibly Name (Business/Organization/Individual): (° /77/4r-( 6�7��t!•r z" L L Address: 3 L?? �— City/State/Zip: 30-- lo'e l(f Phone#: 3 �7 Are you an employer?Check the appropriate box: Type of project(required): 1 a employer with employees(full arid/or pad-time)." 7. []New construction 2 I am a sole proprietor or partnership and have no employees working for me in g ]Eat IT10del1Tlg any capacity.[No workers'comp.insurance required.] 3❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t Demolition 10 D Building addition 4F]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❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 513 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13F]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6F]We are a corporation and its offrcees 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#I must also fell out the section below showing their workers'compensation policy inforniation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: / ;?t"�(t G � / Policy#or Self-ins.Lic.#: 6 Z 7V 1-3F��.7�7 1� (q Expiration Date: XQ Job Site Address: �j d l-�U��S 0 "� �t" City/State/Zip: �lb yw&a- 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,§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. I do hereby certify under t e pains and penalties of perjury that the information provided above true a correct. Sienature: Date: Phone#: �� -7 Oftieial use only. Do not write in this area,to be completed by city or town of lciaL 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#: Customer Name: ,KE�T+lffZ I W D60( 1NSLq Telephone Number(`�13) 314 - �S_ Address, City/Town,State: 112-0 gUaT5 f)T` f2.0,4f) . FL-o1&t,166 , I VIA 01 O(C:1 Z_ BETTERROOF SYSTEM Landmark Pro • Strip off existing roof • Line all edges with 8" aluminum drip edge • Installer 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 as needed along walls and chimney • Re-flash chimney with lead flashing as needed. • Plywood �/ _Install 1/2"CDX plywood 0'1/1 t N Pt _Install 1/2"CDX plywood as needed @J4;_ 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 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,$ y7 cc , is to be paid before materials are ordered. A Payment of$ dy is due at the halfway point,and the balance of$ aid 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 work as specified.Payment will be made as outlined abov . IAA�� z- -/-+4 Signature: Signature: - . I U Date of Acceptance: 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 Customer Name:f:&IJ61L INC Telephone Number ( 3 ���� - S`S OS ty112� ��►rCTS�i r r2<��� Address, Ci /Town, State: � Ft~J 12-(--NC f � YY'1l�, � y i v (72 Siding: Recover over existing siding Strip off existing siding Reside house using Lifetime Premium Siding Install House wrap or insulation backerboard: Tyvek House Wrap 3/8" Backerboard,approximate R Value 1 1/2"Backerboard,approximate R Value 3 x_1/4"House Wrap R Value 4.17 Trim: Color: 1,,r 1< Wrap all wooden trim with aluminum coil Door and Window Trim: V Standard Bend `✓ Built in J-Channels Corner Posts: Matching corners Other Soffits: Color �- �' Cut open soffits nd use vented material __,__Use Soffit material on all ceilings and overhangs Accessories: (Those checked will be needed) Gable Vents r Exhaust Vents t Light Blocks " Split Blocks Siding Accents: Other: Shutters: fairs Louvered Raised Panel Other Gutters: �( _Install new gutters and downspouts k" Complete Partial Y Gutter Guard Protection All Workmanship is guaranteed for 10 years unless otherwise specified All debris removed from work site Magnet ground for loose nails See below for any additional work or comments Oth- Conwork starts We Propose hereby to furnish material and labor-complete in accordance with the above specifications for the sum of: r-C dollars(SL e- .dcv ) A deposit of 1/3,$ 74-e , is to be paid before materials are ordered. A Payment of$ -7-91u— is due at the halfway point,and the balance of$ 4J cc 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. Authorized Signature: �Y Note: This Proposal may be withdrawn F f Proposal—The above prices,specifications and conditions are satisfactory and we hereby accepted. rized to do the work as specified.Payment will be made as outlined above Gam- - Signature: �jDate of Acceptance: :L4 a„ ,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