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17A-263
BP-2023-0606 56 OAK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-263-001 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-2023-0606 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: DAVE MINER EXT RIOR HOME Est. Cost: 17928 IMPROVEMENTS LLC CSSL099953 Const.Class: Exp.Date: 10/20/20 4 Use Group: Owner: W CL P DEBORAH A& MICHAEL Lot Size (sq.ft.) DAVE MINER EXTERIOR HOME IMPROVEMENTS Zoning: URB Applicant: LLC AnDlicant Address Phone: Insurance: 264 SOUTHAMPTON RD 6ZZUB9F45112621 HOLYOKE, MA 01040 ISSUED ON: 05/09/2023 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I I OTi •II Fees Paid: S40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-I 272 Office of the Building Commissioner The Commonwealth of Massachusetts W Board of Building Regulations and Stands %. 9 FOR Massachusetts State Building Code,780 C `�� FOR USE Building Permit Application To Construct,Repair,Renovate Or )Q!nolish a Revised Mar 2011 One-or Two-Family Dwelling ' , This Section For Official Use Only 5�' ''s Building Permit Number: _P.'3"00(, Date Applied: i->1.Z //t 6-C,2025 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 5-6 O c tc Sk 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❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Recopt Pe bofQ (Lk4pi Fyorrec e. iv4-4/2 Name(Print) City,State,ZIP .6 oc(. 5--- a ct. Peb cfc1 6 (am c�i No.and Street Telephone Emaii Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify: Brief Description of Proposed Work2: S'k X' f /'r /e D A tin f (Ibe 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 $ 0 Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:r$, 6.Total Project Cost: $ 1 Cl g— Check No. 010 to Check Amount: Cash Amount: 7 ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) gg9153 0jgbla-2) Ua u e miner License Number Expiration Date Name //o of CSL Holder HoQ CX lP LJDU lce.t1 , List CSL Type(see below) ,n\ L No.and Street D�(� Type Description I o Ke M Q �,4 Unrestricted(Buildings up to 35,000 Cu.ft.) F ►$ R Restricted l&2 Family Dwelling City/Town, tate,ZIP M Masonry RC Roofing Covering WS Window and Siding 11 y SF Solid Fuel Burning Appliances /�J X 1iia'7(26 dc1w Q drive wit V1Cr1-1L I I Insulation Telephone Email address tT D Demolition 5.2 Registered Home Improvement Contractor(HIC) t,, 549. aI a P A M twG� v-ocr, 14 ..,-te r/ L 1 C HIC Registration Number Expiration Date HI Company Name or HIC Registrant Name delve eve IMl vier l(e.LC,01 No.and Street 7 /4 C4165-- 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 .❑ 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 )e M"1,!vier-- to act on my behalf,in all matters relative to work authorized by this building permit application. �q Fmk C k rio J-/?/13 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. Dove_ M► Inc(' 517 4) 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 _, The Commonwealth of Massachusetts Department of Industrial Accidents 9 ,,,___,_,9 Office of Investigations :1 A Lafayette City Center o i 2 Avenue de Lafayette, Boston,MA 02111-1750 `<=. = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): OW)e M i U►e°r E 6 er j or Lto► i e pro veme✓1c�-(-L Address: p°r!lob'{ Spotinavytrii-oK Poi City/State/Zip: 61 O t 1/Ok e i Ma_ o t&y 6 Phone#: Lt 13 3`] -©/7 g0 r e you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 3 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' p �' 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. -Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. :Contractors 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. I_ Insurance Company Name: ZU►" 1 C_vl Policy#or Self-ins. Lic.#: (ZZ U V F q' N l 1 (9 (o g t Expiration Date: ) Q 1 a l I a3 Job Site Address: r lz G c ' f'- City/State/Zip: Ha,'4e.4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 above is true and correct. Signature: 7)....„„,-- Date: 5'77 A 3 Phone#: L 1 3 )1L - Oil020 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 21:3 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5J'lumbing Inspector 6.0Other Contact Person: Phone#: City of Northampton o. !girl,. �! ; 0-- A.Massachusetts A 4I W, , DEPARTMENT OF BUILDING INSPECTIONS� � �" 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 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: Vet ry AF yL II�; The debris will be transported by: Name of Hauler: 01,1...)-- toe(1— Signature of Applicant: Date: .5-/7/a3 THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration zt Type: LLC DAVE MINER EXTERIOR HOME IMPROVEMENTS, LLC:-- Re 12 264 SOUTHAMPTON ROAD Expiration:pration: 02/00 52 4/24/2 025 HOLYOKE, MA 01040 *.!• ,`'. .. Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 186552 02/04/2025 Boston,MA 02118 DAVE MINER EXTERIOR HOME IMPROVEMENTS,LLC ' 1 DAVE MINER .• 264 SOUTHAMPTON ROAD (�.��/sue HOLYOKE,MA 01040 Undersecretary Not valid without signature 11) Commonwealth of Massachusetts Division of Occupational Licensure • Board of Building Reca ulations and Standards Construct` uste: r Specialty w CSSL-099953 I pires:l0/20/2023 -4 DAVID MINEF,I 11264 SOUTHAMPTON RD OLYOKE M4,01040,. 44, 1` rL, - Commissioner da ACORD 0025 2016-03 Acroform-Certificate-52.pdf file:///C:/Users/emc/Downloads/Certificate-52.pdf A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)10/19/2022 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: Beth Carballo PHO FINCK&PERRAS INSURANCE AGENCY INC (NC. o xt1: (413)527-3000 LAIC,No): EMAIL ADDRESS: bcarballo@finckandperras.com 6 CAMPUS LANE INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURERA: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: DAVE MINER EXTERIOR HOME IMPROVEMENTS LLC INSURERC: INSURER D: 264 SOUTHAMPTON RD INSURER E: HOLYOKE MA 01040 INSURER F: COVERAGES CERTIFICATE NUMBER: 826487 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 ADDL SUBR POLICY EFF POLICY EXP MD LTRINSD D POLICY NUMBER (MM/DDIYYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS-MADE OCCUR PREMISESO(EaENTED occurrence) $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1 POLICY 7EciLOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY A OFFICER/MEMBER EXCI DED��VE E.L.EACH ACCIDENT $ 1,000,000 N/A NIA NIA 6ZZUB9F45112622 10/21/2022 10/21/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationrnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 eI` I Daniel M.Crowjey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 of 1 10/19/2022,4:55 PM DAVE MINE& Date: 41 3 Exterior Home Improvements (413) 533-0481 www.DaveMinerRoofing.com 264 Southampton Road,Holyoke,MA 01040 MA Registration#186552 Customer Name: 1}e..b0r0 h L\o.pp Tel phone Number �t1 5 saki g i Address, City/Town, State: S� Qa 10( CertainTeed Roof System ° 1f Y J`s • 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 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 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