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30B-113
BP-2022-0230 97 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 30B-1 13-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0230 PERMISSIONISHEREBYGRANTED TO: Project# ROOF Contractor: License: Est. Cost: 14200 TIM DUBAY 100292 Const.Class: Exp.Date: 10/15/2022 Use Group: Owner: SORCINELLI ANTONIO R Lot Size (sq.ft.) Zoning: URB Applicant: DUBAY BROTHERS ROOFING INC Applicant Address Phone: Insurance: 35 EDENDALE ST (413)781-2533 UB1K82045722 SPRINGFIELD, MA 01 104 ISSUED ON:03/09/2022 TO PERFORM THE FOLLOWING WORK: ROOF POST THIS CARD SO IT IS VISIBLE FROM M THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: • Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I` 1, (� - Q1, • I • Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ,RECEIVE .. The Commonwealth of Massachusetts I Board of Building Regulations and Standards! MAR - 8 FO 2� �vIU)` CIP ITY 'I) Massachusetts State Building Code, 780 CMI1 US Building Permit Application To Construct,Repair,Ret}ovatn d M r 2011 ^,ORTHAMPT SPEC60 One-or Two-Family Dwelling one,MA otoso This Section For Official Use Only Buildin Permit Number: 8p` .1..1- as " , Date Applied: Et /,Kos _,L/ 23.9 26ZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.; �pe Address:_ , 1.2 Asom Map&Parcel Nu��sJ� G[ Mc" � f.1.1 a Is this an accepted street?yes no Map Number 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 0 Private ElZone: — Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name ) City,State,ZIP '7 -7 ' rede• / S74- SY? 2/91 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 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Sl -Lw 441 /eI41 "e 411 rnY&ehrq 1 ,/-d(f-- -Co ter.— i /-."c Ll _s y7 7/z 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: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No.40 /'/Check Amount: '! " Cash Amount: / 6.Total Project Cost: $ l2CO3.C 2 0 Paid in Full ❑Outstanding Balance Due: sN M City of Northampton Oa 041 S,... S, Massachusetts �� c'�` DEPARTMENT OF BUILDING INSPECTIONS Z; ` 7: x -, 212 Main Street • Municipal Building vy., OD Northampton, MA 01060 s� ,- 7‘1`� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 &2 FAMILY DWELLING, ADDITIONS, POOLS, DECKS, ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s)and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate (new/ replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner(if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit-public land by DPW/ private land by Building Dept. 13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /o p .� / License Number Expiration Date Name of CSL Holder .g3 /^2eit ? re_ List CSL Type(see below) No.and Street C ` Type Description S �' /� �� ow l U Unrestricted(Buildings up to 35,000 Cu.ft.) City/Town,State,ZIPR Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 791 .',_? I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ��' /57 7// V ZZ aU / / r ir7 2f 4- HIC Registration Number Expiration Date HIC Co an Name or ply' egistrant Name ( c/e,-z cr f i Nand Strept �/zs Email address 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 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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 ' applica' • true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized A 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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE -�� DUBABRO-01 WMCCLUREII ACC: RE) CERTIFICATE OF LIABILITY INSURANCE DATE 3/8/2 D/YYYY) /8/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McClure Insurance Agency,Inc. PHONE 413 781-8711 FAx 103 Van Deene Ave. (NC,No,Ext):( ) (A/C,No):(413)731-8548 West Springfield,MA 01089 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Penn-America Insurance Company 32859 INSURED INSURER B:Ace American Ins.Co. Dubay Brothers Roofing Inc. INSURER C: 35 Edendale Street INSURER D: Springfield,MA 01104 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADM SUBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS LTR INSD wVD (MM/DD/YYYY) IMMIDD/YYYY1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PAC7217537 7/22/2021 7/22/2022 pR MISESEaEoccurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X spa LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER: $ AUTOMOBILE LABILITY (Ea SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS E BODILY INJURYp (Per accident) $ AUTOS ONLY AUTOS ONLDY (Perr acEcident)SAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS ND EMPLOYERS VIABILITY SON TATUTE ERH UB1K82045722 2/1/2022 2/1/2023 100,000 A�FFICER/MEMBE LUED PROPRIETOR/PARTNER/EXECUTIVE N I A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof Of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE fif ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts n=�`=gri Department of Industrial Accidents 111 Ville / Congress S►reet,Suite 100 Boston,MA 02114-2017 4-1 wtvtt:mass.go►/dia — II takers*Compensation Insurance,Affidavit:Builders/Contractors/Electricians/Plumbers. "ill BE FILED'. ITN T11E PERSIILl 'GAUTNO1tf11 Applicant Information Please Print Legibly Name I Business Organization:individual►: / ,461 SA3P s ?cf e0 40 Address: City'State:'Zip: s/,7(/d p74-- o',lo y Phone#: Arr you an employer?t heck the appreprLNe hos: Type of project(required): I El 1 am a employer M ids I ..._trepluyccs(full and or part-time►' 7. 0 New construction 201 tin a sok proprietor or partnership aid Irate nu employers oinking for aft:in S. O Remodeling any capacity.(`a%ut►ers'comp.uaaearaan.r wWum:d_j 301 a a hu .vwner doing all work myself (So w1MkaYs'cusp_- hem noc pros►.]' 9. ❑Demolition m m 4.0 I am a ham►uttner and M ill be hiring atmfrao to conduct all Mark on my property, 1 M dI IO Q Building addition dn ro ensure that all c rgra.ton tither lute Muricn'clxtpau:athon insurance or an sole 1 1.0 Electrical repairs or additions proprietors"ieli O1 employees. "pl"ye 12.0 Plumbing repairs or additions 50 I am a general contractor and I hat a hind the sub a muactors Iist.J un the aitachcd shoat 13 Roof repairs These sub-euntractun Iu%c emplostcs and bate Marken'comp.insurance.: •L 6.�N c are a commaison and its utfit..s hate ctcrs:ucd them nrht of ctcnrp wn pal A(,L l'. 14. 011leI 132.t 1141.and as:hate nu employes.(No M milers'comp.insurance required.] *Any apphcatl that checks box al unst also fill out du sasisi n brkot shoo in their M orkt:s'compensation policy'information. Ilona's Iris M his minim this an-whoa Ma he:dim they arc dung all work and then hire outside contractors most submit a net atihdat It indicating such. :Contractors that check this hot must attached an additional shah showing the name of die sulrca tractoes and slate whether in not those.mastics[Late employees. If the sub—contractors hate employees.they must ptusidc then Mottos'wrap.policy number. I am an employer that is providing w orLers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Policy X or Self-tits.Lei. TM: Expiration Date: Job Site Addres 2 l / fe ci c�9 ( City/State2ip: F/0,19elL+e /am- 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided trove is true and cornet Signature: Date: Phone#: Official use only. Do not write in this area.to be cuttnlileted h►'city or town official ('into or Town: Permit/License# Issuing Authorit.(circle one): I. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector f. Plumbing Inspector 6.Other ('uttlaet Person: Phone#: City of Northampton t 4AMj ! �j Massachusetts /.4. �...'<< DEPARTMENT OF BUILDING INSPECTIONS ' '. 212 Main Street • Municipal Building Northampton, MA 01060 `'^•�:j�'�0 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 1/1/',��l'ct 4 1-✓'k S 7`?, a reap eny,t4 The debris will be transported by: Name of Hauler: Signature of Applicant: Date: Ste' �'—Zz DUBAY BROS. ROOFING INC. CONTRACT (413) 781-2533 Page No. of Pages DESCRIPTION OF JOB ARCHITECT DATE OF PLANS PROPOSAL SUBMIT"1 ED TO: JOB ADDRESS CITY STATE ZIP PHONE DATE tWE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR: N f We hereby propose to furnish material and labor, complete in accordance with above specifications, for the \ sum of dollars ($ I with payment to be made as follows: All material is guaranteed to be as specified.All work is to be completed in a workmanlike / manner according to standard practices. Any alteration or deviation from specifications Authorized involving extra costs will be executed upon written orders, and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note:This proposal may be withdrawn by us if not accepted insurance. Our workers are fully covered by Worker's Compensation Insurance. within days. J Acceptance of Proposal -The above prices, specifications and condi- tions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: Signature ,74 r0/2-4,2?,0_, 10/ a 4 4-a de e 4 e/4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual TIMOTHY DUBAY Registration: 181711 35 EDENDALE STREET Expiration: 04/22/2023 SPRINGFIELD,MA 01104 Update Address and Return Card. SCA 1 C' 20M-05/17��,�'� .7fe K/YIW,,,-vm•fYf%'V. /4--.14//7/1//4/V4 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration expiration Office of Consumer Affairs and Business Regulation 181711 04/22/2023 1000 Washington Street -Suite 710 TIMOTHY DUBAY Boston,MA 02118 TIMOTHY DUBAY � 35 EDENDALE STREET '�j' SPRINGFIELD,MA 01104 Undersecretary Not valid without signature • • ,. ' Commonwealth of Massachusetts . 1. Division of Professional Licensure • Board of Building Regulations and Standards - . - - Constructi\atip'S pl�fbispr Specialty if. - CSSL 100292cpires: 10/15/2022 _. i �. TIMOTHY J DUBAY. • - 35 EDENDALE-.STREETy j ,� • SPRINGFIEL MIAA 01104' if • �� • I�ti"L11�• �� - Commissioner (g,ie. K. Y&nd&. . . • - - -,- .