18C-068 (4) 3 GLEASON RD COMMONWEALTH OF MASSACHUSETTS BP-2021-1908
Map:Block:Lot: 18C-068-
001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-1908 PERMISSION IS HEREBY GRANTED TO:
Project# 2021 ROOF Contractor: License:
STOSZ CONSTRUCTION &
Est. Cost: 11400 PROPERTY SERVICES INC CS002209
Const.Class: Exp.Date:03/29/2022
Use Group: Owner: GIANESIN JUSTIN L&JORDAN A ABBOTT
Lot Size (sq.ft.)
STOSZ CONSTRUCTION &PROPERTY SERVICES
Zoning: URB Applicant: INC
Applicant Address Phone: Insurance:
115 MARKET HILL RD (413)374-4715 7PJUB-2E29014-9-21
AMHERST,MA 01002
ISSUED ON:09/21/2021
TO PERFORM THE FOLLOWING WORK:
REMOVE ROOF MATERIALS, INSTALL WATER/ICE BARRIERS,REPLACE WITH METAL ROOF ON HOUSE &
ASPHALT ON BREEZEWAY &GARAGE
•
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.
Signature:
2 .
Fees Paid: $78.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
[l 1 1
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ri'OI
NThe Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
'fit I USE
a- Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
rn One-or Two-Family Dwelling
_-- _ This Section For Official Use Only
' :Bu}I Iin i4ermit ben3e•ZDz1 - lei 03 Date Applied: 09/Zo(Zo yl
1411)0 r frssJ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addr s: 1.2 Assessors Map&Parcel Numbers
3 G�ieason Road l$G-00?-00 t
1.la Is this an accepted street?yes .x no _ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
ORB
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 I 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 OWNERSHIP'
2.1 °Mel qiN i &Jordan Abbott
northampton ma 01060
Name(Print) City,State,ZIP
3 Gleason Road 415 367 5216 jordangelabbott@yahoo.com
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) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work': remove existing roof materials,install 6'of ice Snow&water barrier on eaves of house,install synthetic felts on
reminder of roof decks,install standing seam metal panels on house root,install architectural asphalt shingles
on breezeway and garage roofs
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 11,400_ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $ --
Suppression) Total All Fees: $ o0
_
11,400 Check No.157( Check Amount: jg Cash Amount: _
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:_,___
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 002209 3/22
License Number Expiration Date
Name of CSL Holder [�
Michael Stosz List CSL Type(see below)
No.and Street Type Description
115 market hill road U Unrestricted(Buildings up to 35,000 cu.It.)
City/Town,State,ZIP R Restricted 1&2 Family Dwelling
M Masonry
Amherst Ma 01002 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413 374 4715 stosz@pm.me I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 171421 3/22
Stosz Construction&Property Services Inc
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
115 market hill road stosz@pm.me
No.and Street Amherst Ma 01002 Email address
413 374 4715
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 . LF 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 Michael Stosz
to act on my behalf,in all matters relative to work authorized by this building permit application.
Jordan Abbott 9/14/2021
Print Owner's Name(Electronic 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.
michael j stosz 9/14/2021
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.govloca 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
,_r.1vrj
tojr. Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
m�� Off:"
212 Main Street • Municipal Building
Northampton, MA 01060
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 Be-2421-I ti og 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:
on site dumpster
Location of Facility:
The debris will be transported by:
Name of Hauler: Aarons Towing Easthampton Ma
Signature of Applicant: Michael J Stosz Date: 9/14/2021
.. .,, The Commonwealth of.tlassachusetts
Department of Industrial Accidents
1 Congress Sired,Suite 100
Boston, .$11 02114-2017
wr www.m..,..ydi.
11 takers't'ompensation Insurance kffidas it: BuildersiContractortiElectricians'Plumbers.
to 111.FILED Vi I I I( 1 III. 11.R5II I-I INt:.it I HMI I 1.
Applicant Information Please Print Lettish
Name o . , , •. ... ,,t,.,til.. . ALL,Ir Stosz Construction&Property Services Inc
Address: 115 Market Hill Road
City/State/Zip: Amherst Ma 01002 Phone#: 413 374 4715
1 %rt.'you au employ tr?t Ito;k the appropriatt hot: i" pr of project(required).
„.-a 4,..4.:.,:. ...... .,„:
tr. LI iketiwytiviiite,
any capacity 1Ne worktrk'comp,insurance rcuintred-)
i 9. 0 Demolition
10 I an a horucowno doing all work.myself 11S,./A 4okers'cutup %mutant e requaul 1' 1
i 0 0 Building addition
4 0 1 aro a Ivornoe w no and will bt hiring..tottracton to condoct all work,.in nil% popeny 1 A ill 1
.i.at--thaf,Ail.....7•Tiff_...t.,.,'e-,,_1:1;,-.--r 1,-..1.,,,:-,,,'A,---'
Fittypnctor,with r..,.nipt,t,y4:4.!,
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L... ' 1 3 R 3. oot repairs
These sub-ccutirsciors haye erriployees stud have waiters'eurrip,insurance..
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i am an employer that is providing worAers'compensation in:surto:le for my employees. Befote is the polity and job site
information.
travelers
la,uramst:C'..nuran), \ans::
Policy tt"or Sell-ins. I_tc 7": 7Pjub2e29014921 Exlm rat son Illte: 6/27/2022
3 Gleason Road Northampton Mass 01060
Job Site Address: City"State,!Zip:
Attach a cop) of the viarktrs"compensation polies declaration page(thouing the pont) number and expiration date).
Failure to secure coverage as required under Nit.1 ,. ';12. .-J2c% z,a criminal otolatton punishable by a tine op to S1,500.00
and or one-year imprisonmeni as weed as co i! r•,..'7:.(01,, in the tomtit a sit li' 1k t IRK t tRDFR and a tine ot up to S250 MI a
kiiik Against tio: tt,iatot A ti.ix, ,i :in, NIAttant:In MO 1-h: 0.1"4-141tX1 iu tii,:(lilac k4 hi%,..."N4044110(01+.4 iht; DI.\ to[ itizriiiiitMX
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/do herelfi certify under the pains et 1 etta '• f pe ury that the injOrmation provided above is true and correct
Michael Stosz 9/14/2021
Stnattm: Dalt'
413 374 4715
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Official HNC only. be.,not write in this area.to he completed by city or town official
( its or'toren:
,1Pertnitlicente
Issuing Authority (circ one):
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1 I. Hoard of Health 2_ Building Department 3.4 ittrlottn Clerk 4. Hectrical Inspector 5. Plumbing Inspector 11
a.Other
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6.: Contact Person: Phone#:
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