16D-033 BP4022-1405
52 LILLY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
16D-033-001 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-2022-1405 PERMISSION IS HEREBY GRANT, D TO:
Project# ROOF Contractor: License:
DAVE MINER EXTERIOR HOME
Est. Cost: 25200 IMPROVEMENTS LLC CSSL09995g
Const.Class: Exp.Date: 10/20/2024
Use Group: Owner: FREY CHARLES G(L/E)JILLIAN E F'EY
Lot Size (sq.ft.)
DAVE MINER EXTERIOR HOME IMP'OVEMENTS
Zoning: URB/WP Applicant: LLC
Applicant Address Phone: Insurance:
264 SOUTHAMPTON RD 6ZZUB9F45112621
HOLYOKE, MA 01040
ISSUED ON:10/31/2022 •
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
I t ECE VL1_ )
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR.11) Massachusetts State Building Code,T80 CMR CT 2 7 2022 MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mizr 2011
One-or Two-Family Dwelling °[P ORTBaMrTnN'SPmCno NS
This Section For Official Use My
Building 't Number:a05.5
. ,x. /`!05 Date Applied:
T' 10 � �r�, / _ '26_20z Z
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 rs Map&Parcel Numb
5 2- lilt 0— ( � 3 1
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❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Char I t} t=r'er F l bf z ec.t /Y(2-
Name(Print) City,State,ZIP 1
52. L, t y 'd- 2yo 7 s'c y C►Aclit//Z/r7 f / el od. c c,—
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition Cl Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 1
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 $ CIStandard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Feeh$
Check No. heck Amount: Cash Amount:
6.Total Project Cost: $ ?S/ 9-uu-- ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) oqqqb.3
O
p(�j f M 6 1�)er License Number Expiration to
Name of CSL Holder
Noq S ± 4o in Pad List CSL Type(see below) i"`l�
No.and Street Type Description
1101 y o H e Q V i V lJ U Unrestricted(Buildings up to 35,000 cu_ft.)
City/Tow State,Zlp R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
e SF Solid Fuel Burning Appliances
413 31'101,90 daedwievyht'er 1 lb coon I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvem nt Con ractor(HIC)
tl{e I1 r I IOr[-tome i��- �-i-e— l R �-
FRegistrant
_ � HIC Registration Number Expua�i n Date
( p' Chino l a� 8 e_
N .and Street
f and( o lie, W . o 1040 l3 37140'i go Email address
City/To n, 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 tic No ❑
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_ Da I)P Vij ti e(—
to act on my behalf,in all matters relative to work authorized by this building permit application
Print s Name(Electronic Signature's Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
enteringmyname below,I herebyattest under the
By
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.
Ci Z_ ` o /}1 I ,
MUST BE SIGNED by Owner or Authorized Agent 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 aa 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 Cosf'
The Commonwealth of Massachusetts
t �, = 1 Department of Industrial Accidents
ae
g = �_ 1 Congress Street,Suite 100
4
1 f Boston,MA 02114-2017
��E w ww mass gov/dia
«eerkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organi7ation/Individual): D - E 1Qr ovP"Tvyypr( p ei b
Address: a9 SoA000-01k LOac(
City/State/Zip: HOtyOeh N,ct
( t,040 Phone#: 4 ,J ;3#114 ' 13 ti 20
Are you an employer?Check the appropriate box: Type of project(required):
1.[(3 am a employer with 3 employees(full and/or part-time).' 7. 0 New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ,Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 ❑Building addition
4.❑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
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§I(4),and we have no employees.[No workers'comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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: 2 l)I'1 C-h
Policy#or Self-ins.Lic.#: ()Z1 V 661 4 b I I (&(O 2± Expiration Date: 4 01 0 t t _
Job Site Address: S`-1 L t 1 cl S 1- City/State/Zip: Fie/r nc
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 the 'is and penalties of perjury that the information provided above is ct.true and co*e
Signature: ff rrt Date: / '' /(lu,4.�'
Phone#: 1'4 1. ) ..SI" 01 a�0
Official use only. Do not write in this area,to be completed by city or town official
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#:
City of Northampton
•oaYMP>o.
'' Massachusetts hie s:_ c'<e
i. I *
(c DEPARTMENT OF BUILDING INSPECTIONS
5 212 Main Street • Municipal Building 3L C�•
ti' Northampton, MA 01060 fS6 ; rjN
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, 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: e6 c 1( Ay_
Y
The debris will be transported by:
Name of Hauler: Ue
Signature of Applicant: Date:
DAVE MINER Date: 93 aal
Exterior Home Improvements
(413) 533-0481
www.DaveMinerRoofing.com
264 Southampton Road,Holyoke,MA 01040
MA Registration#186552
Customer Name: l b EE.S l " ,V Telephone Number
Address, City/Town, State: � �-. y Sr 1 reoci
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:
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 comp etion.
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to stand d 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 I surance 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 above.
Signature: Signature: • /
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 ,