10B-032 (6) 42 GROVE AVE BP-2021-0133
GIs#: COMMONWEALTH OF MASSACHUSETTS
MW:Block: 1013-032 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-2021-0133
Project# JS-2021-000212
Est.Cost: $40000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: APOLLO CONTRACTING 104705
Lot Size(sq 1): 25351.92 Owner: HENRY CANBY
Zoning: URA(105)/ Applicant: APOLLO CONTRACTING
AT: 42 GROVE AVE
Applicant Address: Phone: Insurance:
88 CAVE HILL RD (413) 835-1336
LEVERETTMA01054 ISSUED ON.8/4/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 2 LAYERS ROOF AND 1
LAYER OF SLATE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. l3uiiding 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:
FeeTvpe: Date Paid: Amount:
Building 8/4/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
ILI The Commonwealth of Massachusetts , �? FO
Board of Building Regulations and Sta ���0
Massachusetts State Building Code, 780', C ALITY
E
Building Permit Application To Construct,Repair,Reno, evise Alar 2011
One-or Two-Family Dwelling n7.
This Section For Official Use Only
it Number:Perate lied:
FMN /Z-5s
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assess s Map& Parcel Nu s
1.1a Is this an accepted street'?yes no Map Armber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Henry Canby Leeds, Ma 01053
Name(Print) City,State,ZIP
42 Grove Ave 413 320 1472 hcanby@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied C3Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify:Standing Seam Roof
Brief Description of Proposed Work':Remove existing 2 layers of asphalt shingles and 1 layer of slate,install 24 gauge standing
seam roofing
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $40,000 1. Building Permit Fee: $ Indicate how fee is detennined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Total All FeeSuppression) {(,
Check No.�_ .heck Amount: 4�
6.Total Project Cost: $40,000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-104705 8/16/20
Neal Bannon License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
88 Cave Hill Rd
No.and Street Type Description
U Unrestricted(Buildings u to 35,000 cu.ft.)
Leverett Ma 01054 _ R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413 835 1336 mail.apollocontracting@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1657564 3/30/21
Neal Bannon Dba Apollo Contracting HIC Registration Numbcr Expiration Date
HIC Company Name or HIC Registrant Name
88 Cave Hill Rd _ mail.apollocontracbng@gmail.com
No.and Street Email address
Leverett Ma 01054 413-835-1336
Cit /Town,State,ZIP Telephone
SECTION 6: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 .......... 0 No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize Neal Bannon
to act on y behalf,in all matters relative to work authorized by this building permit application.
Ca4m
Print 0,,mir s Namc( ectronic Signature) Date
ECTION 7b:O NEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
co i it s application is true and accurate to the best of my knowledge and understanding.
rint 6wn /s or Authorized Agents Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Comm oil wealth oJ'Alassachusells
r--! Department of Industrial Accidents
Congress Street, Suite 100
r '
Boston, .11.4 02114-201
WIVIC.M rss.gol-If is
11t►ri:ers'
Compensation Insurance Affidat it: Builders.('ontriciamit:lectrici:rm.'Plutrthrr%.
Mat.I.711:q M lift 1 IIF_PI!.N.11111'1'I\(:.lt i ll(1N1 l l.
Vottlicaut Information Pleaw Print I.V.-W)h
Mame iBusln,,t►rganurtton Indtt,ctuull: Neal Bannon Dba Apollo Contracting _
Address: 88 Cave Hill Rd
Cim"State.21p: Leverett, Ma 01054 (r]tc�nr -- 413 835 1336
Arr!tnn an emphthrr:'(hRk the appnuprinte(rut: I t 1X of IirU1l'cl(required):
I (.r19 a atlpltfYcT+Vitt 6 enrrioctes ttult and et part-lintel' T. tett construction
_.:.J I aro a w1c txupnetrn yr p:tatacrshrp and!rale no cnrpla>yee;e-Aorktng aur ern to 14. Remodeling
:uta capacity [Nu uurker>':utnp.utswunee rcyuued;
9. Dctttulttuln
1 fj I atn a lumwvoncr dvint all nor;,mv,wL f.[No A utk 7%'cunp.tnsuran.:.mqunctd_l
10 I3wltltnFt adtittaut
3 0 1 ant a Itlwoonc7 and will be hLung tcmtra yurs tv conduct all catnk on my pterlt-H . 1 to M !—�
cnsurt taut all corttractcon cidxr ltatc 5�utktn':+xrgattwu,m insl:mancr of an sole 1 I.:J Lle reread reylatts or additions
prupnet,oN a nth no crrtpluyrcv
l?.[j Plumbing repairs ut attdtUurty
5�1 stn a uentral contractor and 1 hs+c hued the suh-cvntr:utvn lmw-d un the atta�iwd fact
!3yD Roof rt�.ur.
1 hem!wb-ctmtractut,Iue ti crnplut cc,.and hsr+c u oiler,' uctiurrcKc.
h.Q14-[( ] ?diciStanding Seam installation 41'c are a c,�tj*.Irntrun atilt it,vlrl:crs hr+c,:tcrctxd Flnu nE,I>t a+l etcn�utm pa•r*tEi1.c _.___
I51,�It 41_and we Las:no cntplcttecs.I Vu++turkcrs'comp.in,tuancc Icyuucd_I
i,r: appluaatl that ch:ck. Kt.% 1 rtlu>t stat All Wt dle Section SAM shoat Ing Char t4Utkcra':untpenl.atltln Furl!: m14111 IM
Ikmje w nem into sutnna Club atTtd4+u tndacatmg tory are d.nng all Mork and dxn kurc uulmdc tnu l,uhnnt a nex aftida+It rndtwttnlr swh.
;Cuntsactum dial check thr,ixrx must attazlxd an additional sheet stwm mg the name 0 the bub:+mtraetor.4110,tate w hiXhLr,n nvl thusc vnUdc>hs'e
employees. Itthe,uh-cowracuns lu--c cmpluyec,.titcc ntust pt %0%;thor uvrkc-rn'cvtnp.It,lt:a number
I um an emplr{t e•r shpt A pruridim;i,iwrAert'tw vrpens t1iun initerunce f►r nir emplorees. gehow ix the Iwliel•rend jab.site
irefurrrrutiart.
Insurance Company Name. American Zurich
Polus 9 or Self iris. Lic. 6ZZUB5B29496 I_xpiratton Date: 3127/21
Job Sitc Address: 42 Grove Ave t:'tt•. State Z.i Leeds, Ma 01053
:attach a cup) of the storkers'coni pen%ation policy deciarativa page(shots int:the policy number and expiration date).
t dttuty to wv:urQ i;ot crage as resume!under NI iL C. 152. �ti5r\i,a cnrntnal c rotation puttt,itahtc bt .t line tip to S1_5000)
and-or one-year imprrsonnient.a %ell as chit penalties In lite ki nt of a STOP WORK ORDER and a lint ul,up to 5-150.00 a
dj%, agatnst the t tulatur_A wpy of this statement ntaN he turctartlyd to lite Office tit llmesugalions of the DIA lar insurance
c0leratze verification.
I ria hereatn ruler the!.►neer%dart pend trek of perjurr their rhe•information provided rtbore it ttrrfltEe ane!c'(rrrc•c•f
t+�tt:tttlt:: Data:.
Phone 413 835 1336
UJjcYu!utr r.,nlr. Du put lt•rirr in ilei.nein.to br•c•urrep/c•te•rl hi•c•ih•err roan uJrrial_
('it► or Tuan: 1'erntidLiceusc tt
Issuing;Authority (circle one):
1. Huard of licxlth 2.Building Department 3.Ci1l� fottn('lerl, 4.Electrical Inspector 5. Plumbing, Inspector
h.(ither
Conlact Person: Phony k:
City of Northampton
"ttom Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS 9
212 Main Street • Municipal Building
Northampton, MA 01060 �SNW 3
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Valley Recycling
The debris will be transported by:
Name of Hauler: Apollo Contracting
l
Signature of Applicant: _ Date: