36-238 (8) BP-2023-0931
11 DIAMOND COURT COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
36-238-001 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-2023-0931 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
DAVE MINER EXT IOR HOME
Est. Cost: 8000 IMPROVEMENTS L C CSSL099953
Const.Class: Exp.Date: 10/20/202
Use Group: Owner: KARE FASZCZA GERALD &
Lot Size (sq.ft.)
DAVE INER EXTERIOR HOME IMPROVEMENTS
Zoning: WSP Applicant: LLC
Applicant Address Phone: Insurance:
264 SOUTHAMPTON RD (413)374-0720 6ZZUB9F45112621
HOLYOKE, MA 01040
ISSUED ON: 07/17/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF
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 NO THAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
.„2 7-1
• t � •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fa :(413)587-1272
Office of the Building Commiss oner
RECEIVED
:� The Commonwealth of Massach - c. jut 1 4 2)23
w IWIEBoard of Building Regulations and S . :ids OR
Massachusetts State Building Code,780 I MR II Y
Building Permit Application To Construct,Repair,Rens ate gr*� ra"IV sP FCT1op$E
:‘ 0//
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. 8 -3 - t.3/ Date d:
ii
Key Jo/ J -7- 17 2623
Building Official(PriatName) Signature Date
SECTION 1:SITE INFORMATION
1.1 Prop Address: �✓r b L2 Assessors Map&Parcel Numbers
r' l qt Mai•-t
1.l 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 0 Zone: _ Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP1
2.1 Ownert of Rord:
17 rry t—o S c Z ef't r-''o a t.. 1J--v' eit fr,
Name(Print) City,State,ZIP ''
/t Qf 4frt.A./� Co rrL 32 a'- e30 G Pfczc zt► a. /TarYI. Cow,
No.and Stmdt Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:
,1-r ' t'l Aer,-, G.F Ae'r� 0rr
/ fc r- /,syrr c a
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs. Official Use Only
(Labor and Materials)
1.Building $ hi qcg — 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
0 Total Project Cost;(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No.aoaL,,Check Amount: `t 0 Cash Amount
6.Total Project Cost: I(o,qr / 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Oggq 2 i O �i
6 e M i n e-r License�yNumberr Expiration to
Name of CSL Holder �y
g(o Snatilaunp4on Pad List CSL Type(see below)No.and Stree Type Description
HO O H 1J /� 0 Lto U Unrestricted(Buildings up to 35,000 cu.ft)
City/To State,ZIP 1 (�•l R Restricted 1&2 Family Dwelling
M Masonry
RC Roofing Covering
WS Window and Siding
2 �y t� �/ /�(� A,, • SF Solid Fuel Burning Appliances
1 i3 3/! I0 ` q V c ai e)date v tv r I le, eovyi I Insulation
Telephone Rmail address D Demolition
5.2 Registered Home ImprovementContractor(HIC) '
Dave Mir h- to or Home u4 Iowa/0045HIC Registration Number ExpuatiL do Date
HEC Co N ol!r HIC Re scant) e
•
' o I v Die VAC( Q 10 40 13374 31 ) %nil address
City/Tos'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 lc 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 {� X I Sl puvut1)e
to act on my behalf,in all matters relative to work authorized by this building permit application. �y ��3
ertV Fs zc2A-
Print Owner's Nne(Electronic Signature) Date
SECTION 7b:OWNER1 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.
74/2 '.
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 nag 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
wwwmass.gov/oca Information on the Construction Supervisor License can be found at ww w.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"
: .:, The Commonwealth of Massachusetts
Department of Industrial Accidents
P ---
.;� �,` Office of Investigations
' Lafayette City Center
L
�_% 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 vier �,xfer i o r lio n e pro vev e.vv s 4 t 0---
Address: atdi60(iiin avvt Rot)
City/State/Zip: jl.......y._...46t0Re. 1illGL OUD'-lO Phone#: S.13...,3` Li-DVgO
e you an employer?Check the appropriate box: Type of project(required):
1. ' I am a employer with 4. ❑ I am a general contractor and I 6. El New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. El Demolition
workingfor me in anyemployees and have workers'
capacity. 9. ❑Building addition
[No workers' comp.insurance comp.insurance.: 10.0Electrical repairs or additions
required.] 5. ❑ We are a corporation and its P
3.❑ 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.Insurance Company Name: ZUr t C.\
Policy#or Self-ins. Lic.#: (o Z U "I F 4 1 1 (V o g a Expiration Date: ) O i a i 10_3
Job Site Address: // 0 I a M 64-44 d-e,,,rcl— City/State/Zip: f 'e'f f t "001<t-,--
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 cert fy under the pains and penalties of perjury that the information provided above
is true and correct
Signature: Date: 7/
`{ f 2
Phone#: 413 i - Oea.O
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):
?❑Board of Health 2❑Building Department 3IJCity/Town Clerk 4.0 Electrical Inspector 5.0'lumbing
Inspector 6.0Other
Contact Person: Phone#:
City of Northampton
i'[' ' .'� Massachusetts 4 �s — s,��`
l DEPARTMENT OF BUILDING INSPECTIONS 2 jd ,z
w i aw 212 Main Street • Municipal Building v, `, {� s
` Northampton, MA 01060 s 0Cs'Ny
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: U 6 U,-el r C)°L 1 ►."7
The debris will be transported by:
Name of Hauler:
-mac ►vtr,
Signature of Applicant: Date:
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
S _ :�. �+.... _
•
Type: LLC
- _; Registration: 186552
DAVE MINER EXTERIOR HOME IMPROVEMENTS, LLC ' Expiration: 02/04/2025
264 SOUTHAMPTON ROAD
HOLYOKE, MA 01040 .:.;:t; _..
-- :
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
DAVE MINER
264 SOUTHAMPTON ROAD ,1a_(a/Z ie,4
HOLYOKE,MA 01040 Undersecretary Not valid without signature
,r Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Re ulations and Standards
Constructs upe r Specialty
CSSL-099953 ti ;'' scpires:10/20/2023
f =k DAVID MINE? i t ..
'� .1f264 SOUTHAMPTON RI)' m
OLYOKE MA,01040 . 4 s
i sO
It f 33- _
b/J,�Ss1's
Commissioner
daiG fi. i'7��ixJ_ i.
a'
s
DAVE MINER
Date: /949 ig-3
Exterior Home Improvements
(413) 533-0481
www.DaveMinerRoofing.com
264 Southampton Road,Holyoke,MA 01040
MA Registration#186552
FOS 10,7- Telephone Number 6 O 6306
Customer Name: Y' f- p
Address, City/Town, State: � ' �)I Q 1M( 0,(?U o r oce- to(pps,
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 X Landmark PRO Landmark Premium
Other shingles to manufacturers specifications. Color:
• Install SwiftStart starter strip along eaves X" 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 I
• Other: �,. . ., b. \-e. (R r)
,
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 sa`isfactory 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 y reason as detailed in the accompanying Notice
of Cancellation Customer's Initials