39A-016 (2) 15 WRIGHT AVE BP-2021-1416
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A-016 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-2021-1416
Project# JS-2021-002354
Est.Cost: $5815.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVE MINER 186522
Lot Size(sq.ft.): 5924.16 Owner: SPERRY LEE D
Zoning: URC(100)/ Applicant: DAVE MINER
AT: 15 WRIGHT AVE
Applicant Address: Phone: Insurance:
347 NEWTON ST (413) 533-0481 WC
SOUTH HADLEYMA01075 ISSUED ON:6/1/2021 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.
t
Certificate of Occupancy Signature i • r • -
FeeType: Date Paid: Amount:
Building 6/1/2021 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
•
The Commonwealth of Massachusetts b /�
Board of Building Regulations and'Stan., ds"r0 �✓
W Massachusetts State Building Code, 786L R < ? IA_ CS ALITY
WeE
Building Permit Application To Construct,Repair,Re Qt. 01 !i -molish a Revis d Mar 2011
One-or Two-Family Dwelling 4M40 r 1/4
r,7
This Section For Official Use Only 4 oie/o,
Buildin Permit Number: 1 --oZ t `(N at D e A lied:
Ev,N ' ) c53 IZ / 6,-1• ZOZI
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Proerty Address; 1.2 Assessors Map&Parcel Numbers
wr l f f l- IVf q4 o 1(
1.1a Is this an accepted street?yes no Map IN umber Parcel Num
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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWN/E►RSHIP1
2.1 Lee-
rt of C t( tic,i-h ( .1 /r 14'
�r; /
Name(Print) City,State,ZIP
b" o ve c/- 5)- 3( - '
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': S"0%1 f^ iLe r #- " 'r' lh of c,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $QQ
�+- Check No. tl30Check Amount: No Cash Amount:
J
6.Total Project Cost: $ gl.- -- 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
aWgf3 I ofAvl3-(
v( I II.Yi License Number Expiration Date
Name of CSL Holder L ,�(
3 k 7 Ne'L+'f c� S List CSL Type(see below) / t
No.and Street Type Description
O. Welf 04^ O I 0 7 ,f" U ; Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
5 71(—6720 Pill/C@ pAvc ,Arr L . c. (e,m. I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
Av !►tip 6 �t/I G i r l/' HIC Registration ati Number Expiration�/io
7-2/
DDate
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/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 .......... No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize /g U ✓4_ / `ei
to act on my behalf,in all matters relative to work authorized y this building permit application.
tee 5ee f fy c/p-4-/2
Print Owner's Name( lectronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
(C7A ✓z ✓'t of-,f s/-,rb l
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. 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"
City of Northampton
S!C
Massachusetts
r t�
DEPARTMENT OF BUILDING INSPECTIONS may;
w' ;V 'fJ 212 Main Street • Municipal Building Jb CDC
..,., tea" Northampton, MA 01060 ss ,• `��
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: li 6 s°7 A6.6yc t l�`
The debris will be transported by:
4 rt /7 0 4.- I rt-i
Name of Hauler:
Signature of Applicant: Date:
_ The Common h•�ealth of Massachusetts
�" "'.' Department of Industrial Accidents
, h=- r, 1 Congress Street,Suite 100
=,_ V?h_= Boston.MA 02114-2017
;•. wwii:mast.gov/dia
Stokers'('ompensation Insurance Affidavit:Builders'('ontractors(I lectricianst'Plumbers.
TO BE FILED l5 fill lIIE PEKMfITI1(;.11'11lU Rffl_
Annilcant Information (� Please Print LenIMs'
Name(disc re::s<)rpanwatten Individual): C)1� A-kit ✓`'t t t( e.X h/i v✓ f evt.e
Address: ? 41 7 t,"G-4-a- S k--'
City/State/Tp:_ _ � __`Ac170 // Phone#: 3 7 Y 'O 7 2 0
Are yea as employer?('heck the appropriate but:
Type of project(required):
I.0im r a employer arch 7 employees dull and in parr-here 1.' 7. 0 New construction
2r3 I am a snk propre na-n tor or purthtp and have no employer si c t rig for nee m S. al-Remodeling
y an capaciiv-psi.aorkcrs comp.Insurance iiquired] ■�• od
9. 0 Demolition
t.p I ant 4 INrrtetYare9 doing all atxk myself-11tr aurkus-cumin.enunaree required.]'
1.®I am a humerus tier and urll Ire hiring eon iraciurs to conduct all u oak on my prupcvty. I a ill 10 o Building addition
ensure that all etniracion either have undress'Comrpuas:rlrura atsuranci:Of an sole 11.O Electrical repairs or additions
proprietors u tth no employees_
12.0 Plumbing repairs or additions
i.1=1 I am a general contractor and I have hired the sob-contractors It t�d on the attached,heel.. 1 Roof repairs
These sub-contractors have C.nghloyecs and have%tickers'comp. in,urance.'^
14.0Other
b.®We arc a curpu abase and its ut icrm have CNC7t.'is A lieu'relit tit exemption per 14161_c.
132.C 1t 1ti.and ae have no unployacs.(y'°winker.'comp.hirsute once rcyuned.(
'Any applicant that clack%taus al must also fall not ea%cairn beta%skewing their nrxkcrx compensation policy ilfhnmhan.
'Itomeownrn abut submit dm attwkavit indicting dray err doing ale as'rk and then hurt tntsi&ctmtractors moo submit a new affidavit irdicatinc such..
'Contractors that check this box roust attached an adifitiond thee shoat an c tire name of the sub-contractors and one whether or mot those%.nieces itavc
employees. It"the sul*ctxdraetsas have einployocs.these maaa mmridetreu aurkcrs'comp.potley number..
— r yes
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: - _ r I,C.
Policy#or Self`ins_Lic_#: 6 2 V i / -Ks-CI %(r 20 Expiration Date: 70 1 ./
lob Site Address: / S Aid/'rc/Y 14- C_ City/Statc'Zip: ./tfr-,_/t+ r✓
Attach a copy of the workers'compensation policy declaration page(showing the policy number and Lion date).
Failure to secure coverage as required under MGL c. 152. §25A is a criminal violation punishable by a fine up to SI.5O0.00
atdior ore-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250_O0 a
day against the violator.A copy of this statement may be firrwardcd to the Office of Insestigatlons of the DIA for insurance
coterat'e verification.
I do hereby certify under the lain,and penalties of perjury that the information provided above is true and correct.
.�3� 1 a-J
aimature: Dale: /
Phone Al.: 3 7' - G? N o
Official use only_ Do not write in this area.to be completed by city or town official
City or Town: Permitil.icense#
—
Issuing authority (circle one►:
1. Board of Health 2.Building Department 3.('ityll'own Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
bAVE MINER Date:
Exterior Home Improvements
(413) 533-0481
www.DaveMinerRoofing.com
347 Newton Street,South Hadley,MA 01075
MA Registration#186552
•
/ 70',r e ,,
Customer Name: /�y Telephone Number
Address, City/Town, State: F I .y `r
CertainTeed Roof System
• Strip off existing roof and remove all debris from worksite
• Line all edges with 8" aluminum drip edge
• Install_feet of WinterGuard ice & water barrier along eaves and up any valleys
• Install Roof Runner Diamond Deck synthetic water resistant underlayment
• Install CertainTeed Landmark Landmark PRO Landmark Premium
Other shingles to manufacturers specifications. Color:
• Install SwiftStart starter strip along eaves!eaves and rakes
• Install using 4 nails 6 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. Install Cricket at chimney.
• Plywood
Install 1/2" CDX plywood
Install 1/2" CDX plywood as needed @ per sheet
• CertainTeed SureStart Plus_4-Star 5 Star Warranty Coverage
• All workmanship is guaranteed for 10 years unless otherwise specified.
• 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:
/6 "7 //0
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 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: 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 a y .
Signature: Signature: CV\A.,)
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