17A-287 (4) 344 BRIDGE RD BP-2019-0577
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-287 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:ROOF BUILDING PERMIT
Permit# BP-2019-0577
Proiect# JS-2019-000937
Est.Cost: $7090.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor: License:
Use Group: DICKY MATOS 105917
Lot Size(sq ft.): 90604.80 Owner: FITZGERALD HAROLD RICHARD JR C/O ALICE FITZGERALD
Zoninpz:RI(100)/RR(86)/URA(14)/ Applicant. DICKY MATOS
AT. 344 BRIDGE RD
Applicant Address: Phone: Insurance:
3 GLEN ST (413) 530-5335 WC
HOLYOKEMA01040 ISSUED ON.11/14/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeType: Date Paid: Amount:
Building 11/14/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
R 5e- 14-577 9COF
City of Northampton
%7777777 7 77
Building Department
212 Main Street
s! Room 100 � � t
t
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 � � t } k
F
APPLICATION TO CONSTRUCT,ALTE RE IR, RENOVATE OR DE OLIS 4 A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION NOV - S 2015
1.1 Property Address: This 6eeldn to be completed'by office
n DEPT.OF BUILDING YtdSPECT10N5
�-.,n � NORTHAMPTi�A�At}1fl6� Lit knit
lc)-c(Ice , ci. O(ou azone Overlay rilstrictt
Elm St t)istrfct C$District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
a e(Print) �yr1 1")_ kq res
rtj
Telephone
Signature
2.2 Authorized A ent: p C-}-
cIle n J
Name(Pri Current Mailing Address:
q13 5_, 5-3-35
Sig,ha e Telephone
SECTIQN 3-§STIMATED CONSTRI CTIOA'COSTS
Item Estimated Cost(Dollars)to be Official Use Only,
completed by permit applicant
1. Building Oq 0 G (a)Building Permit Fee
� v
2. Electrical (b)Estimated Total Cost of
Construction from. 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= 0 +2+3+4+5) nqn Check Number
This Section For Official Use Only
Building Permit Number. Elate
Issued:
Signature:
Building Commissionedinspector of Buildings Date
@ i C ��1 � C o rYl
EMAIL ADDRESS (REQUIR D; EITHER HOMEOWNER OR CONTRACTOR)
i
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L.'_ R._., s L:L V,A Ram_..,, .._ .i
Rear
Building Height
Bldg. Square Footage % IT
Open Space Footage w s.
(Lot area minus bldg&paved N_,f
arkin
#of Parking Spaces
Fill: l
E
F
volume&Location _ n a
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES U
IF YES, date issued V
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ® YES
IF YES: enter Book = Pageiand/or Document#;
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained U Obtained Q , Date Issued
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO
IF YES, describe size, type and location: i
R
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 6-D6XIBIPTION OF PROPOSED WORK(check all agglicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing d
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [❑] Other[l7]
Brief Descri do of Prop sed.le ( O]T-eaI ,111S eC W , in S ( t (_Q._W� P" rva(U,1,�5}
Work: Il S l i (1tilt 1' 1
i(1546 11/e ,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
944011
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION Ta OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, JO( HCA k)J as Owner/Authorized
Agent hereby dezi-aih that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
ned under the pains and penalties of perjury.
I
Print Nam
A/I C tLiiLD (( I -11 Oct
Sig at f Owner/Age Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name of License Holder: off) 1 1
3:�
License Number
3
No n S+
Address Expiration Date
4 &1 dia
Si na a 6 Telephone
l 5 30 5 3 3,,b
�, , Not Applicable ❑
Com aiv N m Registration Number
-5111 jc'�Qr�)AQ
0� LJO QI Q40
Address Expiration Da e
Telephoneq(3 '5. 5335
SECTION 10-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...... ❑
City of Northampton
Massachusetts
t�
DEPARTMENT OF BUILDING INSPECTIONS 7F
212 Main Street • Municipal Building ��-<§ Cam
Northampton, MA 0106010
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Rvy _
Type of Work: ( � Est. Cost:
Address of Work: Lam- t`—I 01tr UU br Lif
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
- t� I 1jualm
Date Contracidr Name HIC Registration No.
OR:
Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS4 s
212 Main Street •Municipal Building Jbf �yC`
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
3- -TI q R)1'1 id a la V d
(Please print house numb-dr and street name)
Is to be disposed of at:
C� I
(Please print name and location of f cility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
I A— q rf�kp I I
to4re of P it Ap 'cant or caner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: t v 2 ,() S+
City/State/Zip: HDLIouPhone#: 9 t: 530 -5 a��
Are you an employer?Check he appropriate box:
Type of project(required):
1.�I am a employer with employees(full and/or part-time).* 7. []New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.F1 I am a homeowner doing all work myself. [No workers'comp.insurance required.]'
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.E]Plumbing repairs or additions
5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�oof repairs
These sub-contractors have employees and have workers'comp.insurance.*-
6.F�We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(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.
*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. nn
Insurance Company Name: l� Q n CA_ Ta,::
Policy#or Self-ins.Lic. #: 1 41a9,2 9,2 D Expiration Date: Q CA
Job Site Address: � ae st City/State/Zip:Fk)rCacfH0 of uQ
Attach a copy of the workers' compensdtion 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 certi nderlo a pains a d pe Ities of perjury that the information provided above is true and correct.
Signature: 2 Date:
Phone#: J
Offcialuse 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#:
3 Glen St ' s
Holyoke, Ma 01040
413-530-5335 Number f
CS105917
HIC-166207 Date Jun 19,2018
LE
P.O.
Terms
Bill To
Rick Fitzgerald Ship Via
344 Bridge Rd
Ship Date
Florence, Ma 01062
4132970840
Description Unit Ext
NEW ROOF 360.00 6,840.00
Tear off entire roof
Inspect plywood (if any damage will be and additional cost of 60.00 per sheet 1/2 inch and
75.00 3/4 plywood.
Install ice water barrier 6 ft and valleys
Install syntectic underlayment to rest of the roof
Install limited lifetime warranty architectural shingles
Seal all pipes and vents
Install 8"drip edge
Remove all trash and debris
Install a Tamko Rapid Ridge Vent
Building Permit included
Iko dynasty shingles 650.00 650.00
Add for premium shingles
Subtotal $7,490.00
Si rnrature. Discount $400.00
Total $7,090.00