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17A-193 (7)
BP-2023-0929 30 POWELL ST COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 17A-193-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0929 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: DAVE MINER EXTEI'IOR HOME Est. Cost: 11888 IMPROVEMENTS L C CSSL099953 Const.Class: Exp.Date: 10/20/202 VANA.SE GERARD R&JEFFREY R& RENEE M Use Group: Owner: GRISE Lot Size (sq.ft.) DAVE INER EXTERIOR HOME IMPROVEMENTS Zoning: URB 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ,2 • TIT Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner FUzUtIVtU 5 Gil«,t. 14 JUL 2023 The Commonwealth of Massachusetts r " -Board of Building Regulations and Standards FOR r �' BUILDING INSPECTIONMaSS ichusetts State Building Code,780 CMR MUNICIPALITY Y -._ THAMPTON.MA 01050 USE l3uii ermit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: - ,.1 3-• Date Applied: //,/ 717-7673 Building Official(PrintName) Signature Date SECTION 1:SITE INFORMATION 1.1 Proper17.,Addrew 1.2 Assessors Map&Parcel Numbers 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 9s5nerl of Record: l 7r'C ! I 7/�r p z, T/6 r,ere /"(,— Name(Print) City,State,ZIP �/ • ?C.) Pm :.✓ —�4 .sJ- 2Gc 3�yS' ftf(�L 5f1,,4 e.Jv No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Wor : Jam'!i1 j te.: Zr C /3.m-rl 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 $ II Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) $ Total All Fees:${ OLJA Check No.9.0 Check Amount Cash Amount: 6.Total Project Cost: $ f yg - ❑Paid in Full ❑Outstanding Balance Due: SECTION S: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ogNq J j o 2.4 'Dave f e Miner License Number Expiration Date Name CSL Holder � /► g69- 9no±h .U17n 1 o n fo ad List CSL Type(see below) No.and Street I Type Description 1-101 V O iI L. IHa f v T R Restricted lea g dings up to 35,000 cu.ft.) Family Dwelling City/TowX State,ZIP M Masonry RC Roofing Covering t� �y /y(1� i WS Window and Siding 1 l3 3 1 t O !d(v e 0 date V1�11n c F IC?+ eov i SF Solid Fueln Burning Appliances I Insulation Telephone Email address D Demolition (5.2�Reegister�ed Home Improver t Co ctor(HIC) e JCiao&mber ter" Fk}ner ,or QwN�prot tit ^'"� E'JxpCirati nDae C o N or tt Ise Ottot0010 it ate_ Nffry oke, Oka oioLto 14133740716 F.mail address City/TosGn,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 'D OW Sj P tr1/44 ? to act on my behalf,in all matters relative to work authorized by this building permit application. s. sir 54 7 `r (3-2 Printer'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 'cation is true and accurate to the best of my knowledge and understanding. r7/9( o9 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 ant 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 wwiv.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 nt Massachusetts it DEPARTMENT OF BUILDING INSPECTIONS 1 rdrii, �;r y� 212 Main Street • Municipal Building ....e'0/4) - 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: (/' tit t 7 4LC L t� The debris will be transported by: Name of Hauler: A VC /Yi irtr,2 Signature of Applicant: Date: The Commonwealth of Massachusetts Department of Industrial Accidents ` . . Office of Investigations o A Lafayette City Center �� 2 Avenue de Lafayette, Boston,MA 02111-1750 1/4,5_,,, _-1 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): >CW M l tie l EXreY'1 or AA Tmprovetments Address: atoli 60vi aV 1.00K Rot City/State/Zip: NO[VOKe 1 VY cu ©l0'-O Phone#:_q13 ,3r p! -D Y go Ai e you an employer? Check the appropriate box: Type of project(required): 1 I am a employer with 3 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P tY 9. 0 Building addition [No workers' comp.insurance comp. insurance.x 10.0Electrical repairs or additions required.] 5. 0 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: Z Vt'1 C Y Policy#or Self-ins. Lic.#: (07_1.0eAr- 41186.gA Expiration Date: ) (dal 'o2. Job Site Address: 3 ° Pe" L.k $ City/State/Zip: 'r11-"y/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: Date: 7 ("lb'3 Phone#: 1413 !L7 - O 1 2.0 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3JJCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration .: #- • �: Type: LLC • . __" Registration: 186552 DAVE MINER EXTERIOR HOME IMPROVEMENTS, LLC Expiration: 02/04/2025 264 SOUTHAMPTON ROAD = - HOLYOKE, MA 01040 . •i-f?� y:-�:-.-�i... tee:. 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 fC.(�,/ � HOLYOKE,MA 01040 Undersecretary Not valid without signature Commonwealth of Massachusetts Division of Occupational Licensure • Board of Building Re ulations and Standards c� r. Constructs upier r Specialty CSSL-099953 :�; . * - 6ipires:10/20/2023 -k DAVID MINE% 264 SOUTHAMPTON R i .. .1i0LYOKE Mk 01040 L'r)/J,VdfiX3��' - Commissioner &g „n yi Customer Name: Telephone Number Address, City/Town, State: 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 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