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36-220 (5) BP-2024-1002 77 WINTERBERRY LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-220-001 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-2024-1002 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: DAVE MINER EXTERIOR HOME Est. Cost: 28603 IMPROVEMENTS LLC CSSL099953 Const.Class: Exp.Date: 10/20/2024 FERGUSON, JEAN E. &DAVID B.THOMAS Use Group: Owner: TRUSTEES Lot Size (sq.ft.) DAVE MINER EXTERIOR HOME IMPROVEMENTS Zoning: WSP Applicant: LLC Applicant Address Phone: Insurance: 264 SOUTHAMPTON RD (413)374-0720 6ZZUB9F45112622 HOLYOKE, MA 01040 ISSUED ON: 08/12/2024 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: 7 2_ Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner I�^^ / j. The Commonwealth of Massachusetts�o qG.(° ` r'p? �k Board of Building Regulations and Standards ''Dr ti0 I FOR �� Massachusetts State Building Code,780 CMR oti�9o.e. i 3EALTTY Building Permit Application To Construct,Repair,Renovate Or '.,'1 a ;t cgs Rev' ed Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: , ',Life r, Date Applied: 5rei/& ill iG- < 1 f / e_12- ay Building Official(PrintName) , Signature Date SECTION 1:SITE E INFORMATION Li rty Address: 1.2 Assessors Map&Parcel Numbers 7T Lit/r It 17T -I,7 i- 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.$ Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required T Provided Required Provided 1.6 Water Suppty:(M.G.L c.40,§54) 1.9 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal❑ Ou site disposal system 0 Check if yesC] SECTION 2: PROPERTY OWNERSHIP1 2.1 Ownert of Record: j—e-( :., rely S✓5a.--. F/are.A r Wit,- (�106-2 Name(Print) City,State,ZIP 77 I,' IHhriDryir i. rt 9/'icc3/}57 T'.-7., , r-rrfvs.,J f' d' .' 4R- , No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ (Alteration(s) 0 J Addition ❑ Demolition El Accessory Bldg.O Number of Units Other ❑ Specify: Brief Description of Proposed Work2: O. r, f 4 f L- L:.,At 1 W r✓ i •�.r 10- 1 r � ' �•;�1 �r SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Omelal Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee CI Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees:$ Suppression) /,�) 6.Total Project Cost: $ G e3 CheckNoQ)310 Check Amount: (,CCashAmount: 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Q3 40 jgo I e �► 61 El r License Number Expiration Date 7 � Namen of CSL Holder cX iJ Q_ rj-V t(w i p1 l/l� ;'? 1 List CSL Type(see below) No.and Street b� Type Description U Unrestricted Buildings up to 35,000 cu.ft.) ©�7/ 't e i a- ln�`(} U R Restricted 1&2 Family Dwelling City/Town,,State,ZIP M Masonry RC Roofing Covering WS Window and Siding u SF Solid Fuel Burning Appliances 11 37+G 7lav dove (neon I V1er -L c I Insulation Telephone Email address PhVI/ D Demolition 5.2 Registered Home Improvement Contractor(RIC) V�' Vi'11�2�'t (40 1,1, .- cry) , it c. Registration l01' 5� o2i HIC Registrr ation Number Expiration Date HIC Company Name or HI Registrant Name dove )P1 No.and Street 5li Email address City/Town.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 Da tie 1",,i Vl e to act on my behalf,in all matters relative to work authorized by this building permit application. (i Pridiwner's Name(Electrons gnatu e) Dane 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. DC14 e. V . 1/)ef- 8 3/2 Y Print Owner's or Authorized Agent's Name(Electronic Signature) Dam 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 Horns 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.gpv/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 City of Northampton • • 'c Massachusetts �'t� DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Buildings Northampton, MA 01060 • frki ;`r.1° . • 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: �, c I �6Y tlr c�� � i"'t , ` /J1��° `'�t� The debris will be transported by: Name of Hauler: (;)J ‘,/e 4/ 7 / y Signature of Applicant: -' _ .- �- - Date: / `',^ The Commonwealth of Massachusetts gip' Department of Industrial Accidents ��G --� Office of Investigations ci f1 Lafayette City Center r: �� 2Avenue de Lafayette, Boston,NIA 02111-1750 c`'- ., www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Legibly Name (Business/Organization/Individual): Dave_ Mier E "er{or 4to1Me Timprovew\e}'lfs fr-L-P- Address: 62679 9jpotti aVn i. Rot City/State/Zip: t 01 OR e 1 r lL 010go_ Phone#: L{13 aj` L-( 7 A e you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 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 working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp.insurance.x required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 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.(g-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. f 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: ,[_.ue 1 cif) Policy#or Self-ins.Lic.#: to ZZ 0 e)at li I'�' �j l l p� d tA Expiration Date: ) ( a I 1 of Job Site Address: 7 2 ii'r it,i-tr 1 tr Z,^ City/State/Zip: t/e -.,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 certify under the ains and penalties of petjury that the information provided above is true and correct. Signature: _---�_____________> Date: 14/ `t Phone#: 413 Cj I LT " Oki o2v 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): 1f:Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 5Elumbing Inspector 6.0Other Contact Person: Phone it DAVE mINERi Date: _ I Exterior Home Improvements (413) 533-0481 www.faveMinerRoofing.com 264 Southampton Road,Holyoke,MA 01040 MA Registration#186552 Customer Name: y; 61- ne,in Telephone Number CO 1 Address, City/Town, State: '77 t!ti ��s e' t^t' La r a Fl(',r 're 0106D. y 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 ,k Roof Runner_ Diamond Deck synthetic water resistant underlayment • Install CertainTeed Landmark N Landmark PRO Landmark Premium Other shingles to manufacturers specifications. Color: ! • Install SwiftStart starter strip along eaves \ eaves and rakes • Install using 4 nails Z 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 1 Install 1/2" CDX plywood as needed @ per sheet • CertainTeed SureStart Plus k 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: v • l 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: Iw;• f dollars($ A deposit of 1/3,$ I ) 3 ,is to be paid before materials are ordered. A Payment of$ / t t ' is due at the nalfway point,and the balance of$ ' S 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 'thin 3 days of acceptance for any reason as detailed in the accompanying Notice of Cancellation Customer's Initials