30A-083 BP-2024-0700
11 HIGH MEADOW RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
30A-083-001 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-2024-0700 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF 2024 Contractor: License:
Est.Cost: 35350 SPAETH PROPERTY SERVICE 103632
Const.Class: Exp.Date: 10/28/2025
Use Group: Owner: KAREN KSIENIEWICZ CHARLES&
Lot Size (sq.ft.)
Zoning: SR/WSP Applicant: SPAETH PROPERTY SERVICE
Applicant Address Phone: Jnsurance:
117 NORMAN ST (413)781-8683 UB885906262314G
WEST SPRINGFIELD, MA 01089
ISSUED ON: 06/04/2024
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: 172._
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
E q/ ifildriTif
1.- 9._.E--.---- -C—ETc/;-E7:-11:,- )
IZ, The Commonwealth of Massa usetts
' Vt '
Board of Building Regulations an Stall&Nds- FOR
Massachusetts State Building Code, 780 CMR 3 202d UN[CIPA ITY
201
USE
Building Permit Application To Construct,Repaint;, np, ,�, ^ lis a i Revised Mar 2011
One-or Two-Family Dwelling f , ,,,";aPEwr DNS
This Section For Official Use Only
Buildingi`Permit Number:a,�i 2'/. 70D Date Applied:
/C-Vi� 725 // -- 6-/1-26z9
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro rty Address: 1.2 Assessors Map&Parcel Numbers
rl ,h JV 4Joti Road FheitL(i Aix( 104 -083-(x,/
l.la Is this an accepted street?yes i/- no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
15,E/5U
Zoning District Proposed Use Lot Aran(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 done? Municipal 0 On site disposal system 0
Check if yesEl
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
6 rl n i' o raid', Ftuyij(e , 4 (2(O l 2
Name(Print) , ( City,State,ZIP
J' t � !r),n G°a(l�t) y/3-6-76= 4000- �7r,h Ic/& /Id r adl i,Gcyh
o.an S Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Eivi Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: TA 5 tr,P 4. 5t kwk /a,tf if q xJ fevp/ems e
u' ,141 iit to o Cif fa,h l tred gill n /
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ ,S5 36 U 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. 17)))9�heck Amount: +LP Cash Amount:
6.Total Project Cost: $ Jf� Jo Paid in Full El Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
L (51a/4,U .(2 ate —
A r- /16o r h License Number Expiration Date
Name of CS Holder I
17 n �roi4n 5�re 1 List CSL Type(see below)
No.and/Street T T Description
2Jes f (?, i'4i 'l4 Q(Q� Unrestricted(Buildings up to 35,000 Cu.ft.)
9 Restricted 18z2 Family Dwelling
City/Town,Stan,ZIPO' M Masonry
RC Roofing Covering
WS Window and Siding
// ,{�%/ SF Solid Fuel Burning Appliances
�� I 7/3- 7- 6 5 / � oteptie//tlg#it( 4'► D Demolition
Telephone Emairaddfess
5.2 Registered Home Improvement Contractor(HIC)
19 FfgF -?-,toy
ETea 'p'ir h HIC Registration Number Expiration Date
HIC Com�any Na$re or I C Registrant ame
/77 h/oimat 5ffrer fie%e ,5�ethg/ ,r. ,4ymf,e wn
No.and Streeeett Erna a
City/Town,State,ZIPP H /A 15/ I ' gli-7/ Obi
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 fa No 0
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 f1 6 Q,e
tt
to act on my behalf,in all matters relative to work authoriz by this building'permit application.
► lea K ienzeu,,/ri 55=31-,Ir„qy
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.
S� A Imo' 5 cc1 aJa�
Printgel'alrAuthorized Agent's Nam ectroni Sig lure) 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"may be substituted for"Total Project Cost"
•
The Commonwealth of Massachusetts
•
Department oflndusfrialAee dents
tali 1 Congress Street,Suite 100
=74Boston,MA 02114-2017
www.mass.gov/din
Workers'Compensation Insurance Affidavit:Builders/Contractors/Llectrielans/PIumbers.
TO BE FILED WITH THE PERMIT '.ING AUTHORTTY.
Applicant Information Please Print Lei ib1V
Name(Business/Organizationffndividuwt): Spaeth Pf cc¢(J(/ ,j ee_roG _
Address: /1/7 �A/i4/ett'I 6& t
City/State/Zip: Y,�`(16 I �j n4� �i Le/ M4 CIIO Phone#: 4//'_ 71/
Ara you an employer?Cherlrthe appropriate bow
- Type of project(required):
1.[I I am a employer with , L employees(full and/or parbdime).* 7. ❑New construction
2.a lam a solo proprietor or partnership and have no employees working forme in 8. El ReniDdnling
any capacity.[No workers'comp.insurance required.)
• 9. ❑Demolition
3.0 I am a homeowner doing all work myself[No wogs'comp.insurance regrmed.]t 10 Q Building addition
4.0 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 ILO Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance? 13.F(Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1`i-❑Other
152,§1(4),and we have no employees.[No workers'comp,insurance rekprhedj
*,(say applicant that checks box#1 must also fill out the section below showing theirworcent'compensation policy information.
t Homeowners who submit this affidavit indicating they are•doing hll work and then hire outside cdritractots most sabr nit a new affidavit indicating such.
CContractnts 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. Ii'elaw is the policy anrljob site
information.
Insurance Company Name: /l-jtreie f5_ _____ .g7C._te
Policy#or Self--ins.Lie.#:: 1)0 8? i90 6p„ a 3/+r -- Expiration Date: (Q
Job Site Address: // /Moak/art j Rehl Q/ City/state/zip: F/0veoef//14 ()/d4 A
Attach a copy of the workers compensation policy declaration page(showing the policy number and e:Epiration 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 fame 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 certify r thepubis d pen . ofperjury that the information provided above is true and correct
Signature: ` Date:
Phone#: •
Official use only. Do not write in this area,to be completed by city or town official
City or Town: .Permit/License#
IssningAuthority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ID
ACG L CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYW)
�� 09/18/2023
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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and condittone 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 endorsoment(s).
PRODUCER CONTACT Wendy Mane Gelinas
NAME:
Brown&Brown of MA LLC DBA Berkshire Ins Group PHONE (413)447-7376 FAX
(A/C No.Eat): (AlC.Nei:
P.O.Box 4889 E-MAIL Wendy.Gelinas@bbrown.com
ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC N
Pittsfield MA 01202 INSURER A: Travelers Property Casualty Company of America 25674
INSURED INSURER B: The Travelers Indemnity Company of America 25666
Spaeth Property Services,Inc. INSURER C: The Travelers Indemnity Company of Connecticut 25682
177 Norman Street INSURER 0: Travelers Casualty and Surety Company of America 31194
INSURER E:
West Springfield MA 01089 INSURER F:
COVERAGES CERTIFICATE NUMBER: 23-24 Master 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 AUUL SUBH POLICY EFF POLICY EXP
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY), _ LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 1.000.000
DAMAGE TO RENTED —
CLAIMS-MACE XI OCCUR PREMISES Ea occurrence) S 300,000
MED EXP(Any one person) 5 5.000
A Y6605N503257TIL23 06/24/2023 06/24/2024 PERSONAL BADVINJURY S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE 5 2,000,000
POLICY n XPRO- n _ 2.000,000 +
I
JECT LOC PRODUCTS-COMP/OP AGG S
5 OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000
(Ea actidenl) I
ANY AUTO BODILY INJURY(Per parson) 5
B OWNED X SCHEDULED 6A8N8764122314G 06/24/2023 06/24/2024 BODILY INJURY(Per accident) $ ,
AUTOS ONLY
XHIRED NON-OWNED PROPERTY DAMAGE 5
AUTOS ONLY X AUTOS ONLY (Per acc:dont)
S
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAB CLAIMS-MADE CUP5N5594502314 06/24/2023 06/24/2024 AGGREGATE S 1,000,000
DED X RETENTIONS 10,000 S
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
C
OFFICERRAEMBER EXCLUDED ANY PROPRIETOR/PARTNEWE ECUT WE ❑ N I UB8P5906262314G 06/24/2023 06/24/2024 E.L EACH ACCIDENT S 1000000
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 5 1000000
If yes,descr be under 1000000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
Employee Dishonesty 250,000
Crime D 107112208 06/05/2023 06/05/2026
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached ft more space Is required)
Project: Roof
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
. • • '
L•,-,
till Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building R,, ulations and Standards
C o nst,(Ai7 tkilko9rvisor
CS-103632
qpires: 10/28/2023
AF
GARY SPAi N'.14.,;. •
177 NORMAWS
WEST SPRff4 -17 ;1 7
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer AffauliA Business Regulation
HOME IMPROV , ONTRACTOR
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SPAETH PROPER1V
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• GARY SPAETH 1 .4
• 177 NORMAN STREET ,S,„, *-4.47,1'N,i.t4;, il/2erearA.
•i
WEST SPRINGFIELD, MAaltdr, •"-7
Undersecretary
. •'''-''7:--117:7,71. .71-?:' , c,....,.:H...;,.v,Y4"'" 777.77•77:77 -7 .°777;.rf :
City of Northampton
s.
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building -c;
Northampton, MA 01060 SHW WO`:°
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: f /(A� 014-6((OXb
Location of Facility: � I (�\ M I . V8 , t��'f n G�,l AU O,'
1 v
The debris will be transported by:
Name of Hauler: 41x (.1,on.6/-ir1)7 Mal
Signature of Applicant: Date:
Spaeth Property Services
Gary Spaeth MA CS# 103632
Karen Ksieniewicz
KrinKcK@hotmail.com
413-575-6298
11 High Meadow Road
Florence, MA 01062
Roof Replacements
To Strip a Single layer of shingles from roof
To inspect and replace sheathing where needed @$110/sheet with 5/8" plywood
To install 6' of CertainTeed ice and water on eave and valleys
To install CertainTeed synthetic roof paper to all other areas
To install new F8 white drip edge at all eaves and rakes
To install all CertainTeed Landmark shingles and roof components to assure full warranties
To install all new pipe flanges, boots and bathroom vents
To seal all skylights, vents, and nails
To remove any awnings from the roof and reinstall and seal when complete
To make sure paper for CertainTeed sure start/warranty protection is complete
Total estimate of roof procedures $35,350
iiiiehit
SOAETH
PROPS 1
177 Norman Street West Springfield, MA 01089 (413)781-8683
Spaeth Property Services
Gary Spaeth MA CS# 103632
Total Down payment is equal to 40% of total $14,140
Balance to be paid upon completion of job $21,210 4(2o 660
Or a06 c1J
al
Quote good for 30 days of receipt j"1} Opp
7 t\
Dater13d<46 ignature:
Date.> JC'01. / Estimators ignature:
SQAET11
p, pppE RT-/
\\\ 177 Norman Street West Springfield, MA 01089(413)781-8683