29-371 (9) BP-2023-1216
15 AUSTIN CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-371-001 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-2023-1216 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2023 Contractor: License:
Est. Cost: 5850 WALTER MAREK III 055201
Const.Class: Exp.Date: 06/23/2024
Use Group: Owner: HOOVER GAIL E TRUSTEE
Lot Size (sq.ft.)
Zoning: WSP Applicant: W MAREK INC
Applicant Address Phone: Insurance:
73 SOUTHAMPTON RD (413)977-9539 WCC-500-5014290
WESTHAMPTON, MA 01027
ISSUED ON: 09/07/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND REROOF GARAGE AND PORCH 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:
c • . I.�
I
av
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVED
The Commonwealth of Massachus tts SIT — 6 20
WBoard of Building Regulations and St dar s M IC ALITY
Massachusetts State Building Code, 7 C T OF BUILDING INSPECTIONS U E
Building Permit Application To Construct, Repair, Renova NOR A'�'nr oio6Ikevised ar 2011
One-or Two-Family Dwelling
�/��� 3 This Section ForOfficial Use Only
n.__i dc._ n_...__'..�.r._.__t__.. ✓� ,s04 .. /d/0 1 Date
e._._i'_d.
tsutiamg rermtt/iJvumoer. �.!/ j Laatte-tippiteu:
ii
Kev4-V �, //12 9-7_Zd2�
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1 I C ropy f—tllINNet•ieAc.,
1.2 Assessors Map& Parcel Numbers
1.1 I this an accepted street?yes 0'( no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq fl) 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 ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 r , I ofi core V Fidff,e.C'Q, A 0 f di.
Name(Print , city state 71
I S AO G idi t- Y3 .53-‘
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing BuildingQl Owner-Occupied Cgi Repairs(s) 01 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Prop sed ork2:
i --- ram ir- t,lt' ( c4
& e 1 p
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ J i 53 I. Building Permit Fee: $ Indicate how fee is determined:
1 " ❑ Standard City/lown Application tree
2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ o
Co
Check Nor 7 [Check Amount: "l Cash Amount:
6. Total Project Cost: $ i :A:„i.,11 n n..«..«,.„,1:..,. ..i.,..,..,n.....
1 S v J�
r n..
I u ralu ul run LJ VUWCaIIUlllg DQ10.UGG LUG.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Sup rvisor License(CSL) çca. I 03419'
Y v a � Mara( License Number Expiration Date
Name of CSL Holde
3 SAA- ,, p, V List CSL Type(see below) (.4
No. d S et Type Description
1-0'r /144 V 1 `W/`[,vU unresdicteu(Buildings up to»,vou Cu.u.1
R Restricted 1&2 Family Dwelling
City/Town,State,' M Masonry
RC Roofing Covering
WS Window and Siding
9 \ C;91 SF Solid Fuel Burning Appliances
1(� 11`i J l 1 C3 eCi)ivflert I Insulation
Telephone Email address D Demolition
5.2 ReOstered Home Improyement Contractor(HIC) I ( 4 g L/
! 1AkrticEyc• HIC Registration Number Expir io ! /,miln Date
HIC Company Name or HIC Registrant Name
o. d t etiffiii7
J 14\ Email address
City/Town, Stat ,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 A THORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR UI ING PERMIT
I,as Owner of the subject property,hereby authorize 0"V
to act on my behalf,in all matters relative to work authorized by this building permit applicatio .
C
\ l \/'r( gn afore) a a..)Priwner's Name Electronic Si 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
containe in this applica' and accurate to the best of my knowledge and understan ll
-d)
Pri er'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
3. "Total Project Square Footage"maybe substituted for"Total Project Cost"
The Commonwealth of Massachusetts
1•Lioi. s. iii:wje.t�t Department of Industrial Accidents
1 Congress Street,Suite 100
10 MA 02114-2017
.. ,, www:mass gov/dia
mi
11'uiicers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leelbly
Name(BusinesVOrganitatioirflndivi,ival) Cfl�► ` '
Address: 35/L:N.10.• �oC
City/State/ZipkA r\-1'► J4� Phone #: q)"?
r ! t 1
Are!ma as employee ayee Cheek the appropriate tat:
Type of project(required):
1441 am a employer with _9___.employeea(flit!aadint partxime)." 7. 0 New construction
20 I am a sok proprietor or partnership and have no employees working for me in $. Q Remodeling
any capacity.(No workers'ems.insurance required.]
9.
3 I am a homeowner doingall auk myself. o wodce*ra'co insrum El Demolition
40 I am a homeowner and will be hiring garters to condoet all work on my property. I will IO D Building addition
ensure that all contractors either have workers'compensation insurance or arse sole 110 Electrical repairs or additions
raaarieton with no enu►iovees. . .
12.0 Plumbing repairs or additions
50 I am a general contractor and I have hired the tub-conttactom hated on the attacked sheet 13E1Roof repairs
These sub•cantta tors have employees and have workers'comp.insurance.;
6.0 We are a corporation and its officers have exercised their right of ex on per hltiL c. 14. Other
152.Ij 1(4).and we have no employees.[No workers'emnp.insurance required.'
"Any applicant that checks boa el must also fill out the section below showing their worktats"compensation policy inleimatiori.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mush submit a new affidavit indicating such.
+Contractors that check this box must attached an additional sheet showing the name of the audr meturrs and state whether or not thosce entities has.
nn4r+r.wa If the cul►rr.it-eirrra ltriv.*rtwtlnv e, the,mi..t rrorsiA..tl+air wcsrtor 'nano rdiet,mm`h•r
1 ails an employer that Lc providing workers'compensation insurance for my employees. Below is the policy and job site
information. 103
Insurance Company Name: ��
Policy#or Self-ins.Lie.#: IM`-'SOU" � Expiration Bate: c)-
Job Site Address: 'SAA'51V'% C CitylStatel2 ip•• ria . uplb
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 S1,500.00
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 certif"under the pains s ofperjury that the information provide a ye is true and correct.
Signature: - Date: �� 0
. .-
Phone#: -I13 ) 9 s3 1
Official use only. Do not write in this area,to be completed by city'or town official
('its or Town: Permit/License a
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone SS:
City of Northampton
oft NAM/j\ 5 `': S
I
0" ' ti Massachusetts Q*5 , c'z
I A.,
' ;:,. _ DEPARTMENT OF BUILDING INSPECTIONS y, 5;
212 Main Street • Municipal Building Jb Ca
N N. 2' '--' * Northampton, MA 01060 Psyy�, ox
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
nrnnprIv lirencerl ‘Aiacte rlicnncal farility ac rlpfinprl by Mf;I r 111 c 1 S(lA
The debris will be disposed of in:
j I 1 C %\
Location of Facility: ��, i.‘S
The debris will be transported by:
6(- .1Y)C.
Name of Hauler: �A�a'�
Z-v/
Signature of Applicant: Date: h)
g pp
08/23/23
W: Mark Inc:
General Contractors
73 Southampton Rd.
Westhampton, MA.
(413) 977-9539
WIHMO' €0fmt:fl t
Proposal
CS #055201
HIC # 159488
Gail Hoover
15 Austin Circle
Florence ,Ma 01062
The,following is a proposal re-roofing of Garage & Porch area
Strip and Shingle: Remove all shingles down to roof deck, re-nail boards where
1,70POPQnr1J nntptr !MU rnttod hnnrrlc /yin to ?2 cn ftl cnvor rnnf WWith if.° X u'ntor hnrrior
I LL.L.L.JJLAL}',�/uel.LL tilt}' 1 VLLL.IA VVI.,NO 11A// LV JL. `311 JL), 1.V VL.L I VVJ IV LLLL &I . Vl. YV L.LLI./ VLAL I L,I,
install new metal drip edge, new vent boots, install Owens Corning or GAF Brand
laminated asphalt shingles, shingles having a limited lifetime warranty and install
shingle-over venting on ridges.
Proposed Cost$5,850.00
Balance due upon completion of roof project.
Acceptance uj rrupusui —li we accept we prices, spectp petitions anti curtuittuns
stated. I/we understand that upon signing, this proposal becomes a binding
contract. Due to the nature of a remodeling project hidden and unforeseen costs
may arise, if additional work is needed to complete this project you will be
contacted before the work is performed. You are authorized to do the work as
specified and payment will be made as outlined above.
SignatureGkbyvv.„ %' t f
Date I
W/1/a eer Marek /// 2/,23/,23
W Marek Construction
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2Y CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
AC
09/06/2023
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 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:
K.S.K.INSURANCE AGENCY,INC. PHONE
N,Fxt)•(413)527-7859 C.No):(413)527-8314
203 Northampton St. ADDRESS: travissias@ksk-insurance.com
P.O.Box 597 INSURER(S)AFFORDING COVERAGE NAIC#
Easthampton MA 01027 INSURER A: REPUBLIC FRANKLIN INSURANCE CO
INSURED INSURER B: ASSOCIATED EMPLOYERS INSURANCE CO
W.Marek Incorporated INSURER C:
73 Southampton Rd INSURER D:
Westhampton MA 01027 INSURER E: I
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 ADDL SUER POLICY EFF POLICY EXP LIMITS
LTR INSn wvn POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY)
•
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000
I 1-7 OAMAOF TO RFNTFn __ -__
A I CLAIMS-MADE I X I OCCUR PREMISFS(Fa occurrence/ $50,000
5406031 11/01/2022 11/01/2023 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 PRO-
JECT LOC PRODUCTS-COMP/OP AGG $1,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO
BODILY INJURY(Per person) $
ALL OWNED F—I SCHEDULED onn„v In,,l lov/o.........1.L...., S
AUTOS AUTOS DVU,L, Indunr Ire/dbUUeuy 0
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per accident)
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESSCE LIAB CLAIMS-MADE AGGREGATE _ $
DED ISS RETENTION$ $
WORKERS COMPENSATION x PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
B ANY PROPRIETORPARTNER/EX OFFICER/MEMBER(EXCLUDED?ECUTIVE YYN N/A WCC-500-5014290-2023A 02/10/2023 02/10/2024 E.L.EACH ACCIDENT $100,000
a„.....h.....,r.,uut - I ,- c inn nnn
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If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
GENERAL CONTRACTOR
CERTIFICATE HOLDER CANCELLATION
CITY OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
210 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS.
NORTHAMPTON MA 01060
AUTHORIZED REPRESENTATIVE 4.4.4 DA>