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38B-037
A &J Home Improvement Inc MA Reg# 135399 60 Washington Ave Conn Reg# 600705 South Hadley, MA 01075 Phone: (413) 467 -1500 Customer Address Fred Wessel 4 Edgewood Terrace Northampton MA Description of Duties: Roof Replacement on studio 1. Remove existing shingles from studio roof 2. Protect studio and landscaping with tarps and plywood 3. Install 3' of Ice and water barrier at all eves as well as in all valleys and around penetrations 4. Install 151b over rest of roofing deck 5. Install new 8" drip edge (white) on all eves and rakes 6. Install new GAFELK starter shingles at eves 7. Install new GAFELK (lifetime) asphalt shingles to roof (color of choice) /1 r c 8. Install new GAFELK Ridge vent 9. Install new GAFELK Cap shingles 10. Clean up all debris (removal fee included) 11. Pull permit for all work Agreement bonded to M • • - . .. •I labor according to the description above. Entire Roof R-. - • •• - • . 11 00 ?ront and Back t . • 000.00 Skylight Replacements $ 450.00 each ' 9 0 0 -- )00 / This quote guaranteed for 60 days. Signature Brian Cauley Date 8 -31 -2011 Accepted: I hereby authorize A &J Home Improvement to perform work to the above specifications. Payment is agreed or 1/3 down deposit and balance to be due upon completion. Please sign and retur one c and retur o the above address. Thank Y 1 u. f Date N ` Signature A / � Phone r � . The Commonwealth of Massachusetts Sr . - l Department of Industrial Accidents %� v _- Office of Investigations >i1 600 Washington Street Boston, MA 02111 r-, www.nrassgov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly, Name (BusinessiOrganizatian /Individual): { `� ° ire.• 1 ryT tc,o, tme r1} S -I-AL Address: 60 We into •-ic N Aveil . N City /State /Zip: Sta>.: �rN + -# t ) °I°1-) Phone #: L i) 3 1:16, ? 6 t; Are ou an employer? Check ttje appropriate box: Type of project (required): 1.1g I am a employer with n 4. ❑ 1 am a general contractor and 1 6 ❑ New construction employees (full and /or part- time).'" have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 1 ; ?• ❑ Remodeling ship and have no employees These sub contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9, ❑ wilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Pl9tbing repairs or additions myself No workers' comp. c. 152, § 1(4), and we have no l2. oof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] . -------- Any applicant that checks box ie 1 must also fill out the section below showing their workers' compensation policy information. ' 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 1 - C Insurance Company Name:t,�1 i1,;,S�J1C� _ :Y),Ji ' __— --- Policy # or Self -ins. Lic. 4 : _ WC-- () j j {/ 1 t `1 \ Expiration Date : 5 - i f 3 c a Job Site Address: _I m • ' _ Goa City/State/Zip: Ntls.. + to 144— 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 ofcritninal penalties of 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 $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. 1 do hereby certify under the s and penalties of perjury that the information provided above Is true and correct. g � e- Signature: . ' - -- - y - Date: 1 '.49"'d t! Phone #: ' ' ? l`OO Official use 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 #: ., SECTION 8 - CONSTRUCTION SERVICES 8.1 ._i ens . C • n - t tion ' ryas �, n , - - Not Applicable ❑ Na Ltc of enet older : - A Ai J Tinme Tmprrwweg pn i V i O 1 l � 60 Washington Avenue License Number fff! C1� South Hadley, MA 01073 J 1— aot Address ± Expiration Date gig. A Signature Telephone 9, Registered Home Improvement Contractor: Not Applicable ❑ 3S3 Company Name . A & J Home Improvement Registration Number 60 Washington Avenue � — I -ate) Address South Hadiey, MA 01075 ; Expiration Date Telephone e 7 /30 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 rmit. Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [l Addition ❑ Replacement Windows Alterations) [J Roofing Zr Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[Z1 Siding [O] Other (0] Brief Description of Proposed ` (- Work: cravat (S k� � � &i x4io eoct eoue J4E-! s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet $a. If New house and or addition to existing housing, complete the following: 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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , 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 * l._ .- M 44) ru , as Owner /Au , orized Agent hereby declare that the statement and information on the foregoing application are true and accurate, to the best of edge and belief. Signed under the pains nd penalties of perjury. A VV;1 1 2.2A1'; Print Narhe 'coif Signature of Owner /Agent Date 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: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO © DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained ® ,Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO O IF YES, describe size, type and location: 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. { sap s C t Department use only J City of Northampton Status of Permit: � ilding Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability ; Northampton, MA 01060 Two Sets of Structural Plans d � >'�'' phone 413 -587 -1240 Fax 413 - 587 -1272 Piot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office C Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: C _ t RI We SSA Name (Print) Current Mailt, Address: Telephone Signature 2.2 Authorized Agent: A & J Home Improvement 60 Washington Avenue Name (Print) South H MA 0107 a nt Mailing Address: t r Sign e Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 5100 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) 51 CO Check Number o/ 74 0,5 This Section For Official Use Only Budding Permit Number: IIsssued: Signature: Building Commissioner /Inspector of Buildings ; x' Date ;•i • • • 4 EDGEWOOD TER BP- 2012 -0338 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B - 037 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit # BP- 2012 -0338 Project # JS- 2012- 000551 Est. Cost: $5900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: A & J HOME IMPROVEMENT INC 101017 Lot Size(sq ft.): 6534.00 Owner: WESSEL FREDERICK JR & LEE ANN Zoning: URB(100)/ Applicant: A & J HOME IMPROVEMENT INC AT: 4 EDGEWOOD TER Applicant Address: Phone: Insurance: 60 WASHINGTON AVE (413) 323 - 7847 WC SOUTH HADLEYMA01075 ISSUED ON:10/6/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & REPLACE 2 SKYLIGHTS 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 10/6/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner