22D-004 (3) U.S. METAL ROOFING
D I S T R I B U T O R S , I N C.
740 High Street • Suite 2 • Holyoke, MA 01040Q LL
1 -800- 232 - 0399.1- 413 - 536 -5474 • Fax 1- 413 - 533 -8166 DATE PROPOSED TO BE DONE CN
www.usmetalroofing.net `/� / fir /
SUBMITTED TO PHOVE NUMBERS I ,./
'_.:✓.� ?j .f a/, Xse - e F: - Y ' r. t nt` r.2 I € t✓ 'b j /!.
STREET JOB LOCATION E:
CITY, STATE AND ZIP CODE
DIRECTIONS
�✓/ We will furnish and install new Englert standing seam metal snap lock system, 24 gauge as listed below.
Work is guaranteed for five years and the manufacturer warranties the finish on the metal for 35 years.
COLOR: ' ' . HOUSE: ' I SPECIAL INSTRUCTIONS / COMMENTS
yy ,
ROOF: ('1 c PORCH: 4' b•-'7..:.4-4.3 1,1
SOFFIT: c���t f .'d 5 , C ADDITION: it <: .'r tr �. 1 c � sc
/1 47- ��
( /i!(� n A - , ' ,
FASCIA: t. / 4 , i GARAGE: ! a J .' i x i r,
r . x
PL'A DOD: GUTTERS: )/4:2, '
�' ` ! 9/ r t "' r � . r t
PA PEVOVE • . � - ...%` DOWNSPOUTS: . ti<.. - ,
t- i
OTrcP REPA
Contractor will begin work on or about 5 / 'tv 1i (date). Barring delay caused by circumstances beyond Contractor's control, the
:work will- be- eompleted-by -- -4 f' 9 / — t 1 (date).
All roofing panels are custom fabricated on -site with state -of- the -art rollforming equipment.
As with any rollform steel panels, a certain amount of waviness or oil canning may become evident at certain times of the day when
sunlight hits them. This is standard in the industry and does not affect the integrity of the metal. This shall not be construed as a product
defect and shall not be cause tor rejection.
Contractor does not perform or assume any responsibility for any painting, staining or wood or wall finishing on interior or exterior.
The contractor does further agree with the owner that (a) he will begin work within a reasonable time after the execution thereof, and will
prosecute it diligently and with due care, and in a good and workmanlike manner; (b) in doing the work, he will comply with all statutes,
rules, regulations and ordinances applicable thereto:
Contractor to procure all permits required by law. Contractor shall provide public liability insurances.
Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the
owners to enter into this agreement.
We Propose hereby to furnish material and labor - complete in accordance with above specifications for the sum of:
c,71-41. -r t z R - ir r'X ?{mod" f `- L ',- l� - / `: Y '. dollars ($ d /r ).
Payment to be made as follows:
Name of Contractor/Designated Registrant
2 1(.; % ($ - "L" ) upon signing Contract; 1 3 > U.S. METAL ROOFING DISTRIBUTORS, INC.
Street Address
($ fi' L (` )upon start of job; 740 High Street, Suite 2, Holyoke, MA 01040
% Phone
/ 1- 800 - 232 -0399
1 "s` % ($ { r �L' T _) upon 1/2 job completion; Registration No.
..' MA# 134740 CT# 602546
:" % (${- ._? s % ) shall be made forthwith upon completion pante of Salesman
work under this contract tit + /; ; a r ! q
Notice: No agreement for home improvement contracting work shall require a down payment \Authon Si tore
(advance deposit) of more than one - third of the total contract price or the total amount of all
deposits or payments which the contractor must make, in advance, to order and/or otherwise `
obtain delivery of special order materials and equipment, whichever. amount is greater. To be approved by Office
Acceptance of Proposal I have read both sides of this document "and ccept the prides; specifications and conditions stated.
I understand that upon signing, this proposal becomes a binding contract. You are aut to do the work as specified. Payment will be
made as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of
this transaction. Cancellation must be done in writing. See accompanying cancellation.
DO NOT SIGN THIS CONTRACT IF THERE AR ANY - ANK PACES 11
Signature °� z -�✓` Date / i / t f Signature / l Date /2
IMPORTANT INFORMATION ON BACIt
ch
COMMONWEALTH OF MASSACHUSETTS
DIVISION OF PROFESSIONAL LICENSURE - BOARD OF
SHEET METAL OVER
AS A MASTER- UNRESTRICTED
ISSUES THE ABOVE LICENSE TO:
KEITH A REHBEIN
740 HIGH STREET
HOLYOKE MA 01040 -4764
6108 12/28/12 975042
LICENSE NO. EXPIRATION DATE SERIAL NO.
Office of the Building(nspector
CONSTRUCTION DEBRIS AFFIDAVIT
(Required for all Demolition and Renovation Work)
In accordance with the provisions of MGL Chapter 40 § 54, a condition of demolition/renovation
permit is that the debris resulting from this work shall be disposed of in a properly licensed solid
waste disposal facility as defined by MGL Chapter 111 §150A.
The t debris will be disposed of in: /,,{ J 5 7672A -) / SS 4e ye4
(,),' f//'4 (If the debris will not be disposed as > ated, the holder
of the permit sha notify the
Location of Facility building official in writing , as to the location where the
debris will be disposed.)
The debr s will be transported by: /.�, 3 • /Wilt_ ROO 1)f 571/ , a e....1 a •
Name f auler 4,407,
, ..,4,a_ .," ,, iLe „ .. „ 0 , ____ - Signature of a ermit applicant Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
"1i11+ t Office of Investigations
= my v 600 Washington Street
_. Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): / s,
�- S I �E�T� �OU / /� ��. i (P l �W TOP.
Address: '7`1- 0 J ,ST16 -6 l - , �a
City /State /Zip th U E /7 I 4. Phone #: 473 —53.4 -5V-2 L-f
Are ou an employer? Clieck the appropriate box: Type of project (required):
C' � yP :
P J ( 9 )
1. I am a employer with ! 4. ❑ I am a general contractor and I 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. $ 7 • ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building 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 1 . ❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4), and we have no 12 Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.0 Other
*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 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. �f
Insurance Company Name: LJ 7 C' U,QE /L7 APO ,J06- l
/' , / - C
Policy # or Self-ins. Lic. #: �1 f ,� �j ,� $ Expiration Date: /�-/ d• if
Job Site Address: 1-0 ?')4o City /State /Zip OK6Ai '
Attach a copy of the workers compensation policy declaration page (showing the policy number and exj iration 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 her7 c- i der the pains nalties of perjury that the information provided above is true and correct.
p
Signa e:/ ll.��l�p� --;�- � 'l"tiC .- E' �- -'-'� Date: 5
Phone #: �' 3— ) — c1 7,, fll 561.
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 5: CONSTRUCTION SERVICES
5.1 Construction Supervis License (CSL)
� C' 'Sjir 3 S/ �� moo/ �--
l,"A��/ C., `�/ f'�E 7 License Number E pira on Date
Name of CSL Holder
// Q a 0'04
L 1 na List CSL Type (see below)
7lJ,�l'J it
d Street Type Description
1 ��r� U Unrestricted (Buildings up to 35,000 cu. ft.)
f; ., fr 0/) fi R Restricted 1 &2 Family Dwelling
City/Town, State, ' IP M Masonry
�/) RC Roofing Covering
M1 " " I �l WS Window and Siding
/ SF Solid Fuel Burning Appliances
, —6 I Insulation
Telephone Email address D Demolition
5.2 Registered Home Im veme Contractor (HIC)
_ Pt' L aonNurnber Cl 1 / Y 0, ) f1� 7i41 Q /l( '� /S /�( /:�/t g
Expiration Date
HIC Company Name,or HIC Regis nt Na e�
NO I t d Stre J ` T — 5/ • - -- /TV ali ILfa i�,ci- KJP /Y?di(. .L.W/t)
P 4 ° 0/0 �� . 3-5 � ,S Y 7 � Email address
To :Xl Sta Z I P 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 ssuance of the building permit.
Signed Affidavit Attached? Yes 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 ( , 6 . /riEJ7,`L j(/) /Air- DS C..
to act on my behalf, in all matters relative to work auth by this building permit applieat' n.
5 E eviv7L4r7 U
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 knowled and understanding.
.4 ' . /1414MITiligtoirtazh.—■,. ' 44 icte6. A/ , A, Vt" ---..". 5-
Print Owner's • Authorized Agent's ame llctronic Signature) i e / 4 h 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"
gm
RECEIVED
MAY -9 The Comm nw :alth of Massachusetts FOR
DEPT OF �ng legulations and Standards MUNICIPALITY
Nogromi iplasi er�ra Building Code, 780 CMR
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One- or Two - Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official (Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Prop Addre f : 1.2 Assessors Map & Parcel Numbers
♦ �s / '' .-
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)
1.5 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 ❑ Private ❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' of Record:
gio,.1- (4c.)42z i ✓Y1 [ luJ1 W6 - F/ 14
Name (Pr' City, State, ZIP
No. and Str- - Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building Owner - Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other fid Specify: • • n..)
Brief Description of Proposed Work k d b " . ♦ / ./ "E" _ X A : l �i 7 -
nf ftra ♦ i/�11�i . J( L f
/1 I) 7004 t.t ours* 171 :,N71 &
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)._ 1. Building $a v; 1 Building Permit Fee: $. Indicate how fee is determined:
2. Electrical $ 7 Standard City/Town Application Fee
❑ Total Project Cost (Item 6) x multiplier x
3. Plumbing $ - 2. Other Fees: $
4. Mechanical (HVAC) $ _.. List:
5. Mechanical (Fire $ Total All Fees: $ j / 9' 5
Suppression)
p Check No. Check Amount: Cash Amount:
6. Total Project Cost: $� 1 , /0 ❑ Paid in Full ❑ Outstanding Balance Due:
41 RYAN RD • BP- 2011 -0920
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D - 004 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- 2011 -0920
Project # JS- 2011- 001502
Est. Cost: $21703.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003
Lot Size(sq. ft.): 28314.00 Owner: HOWARD ERIC M & TIMOTHY DUCHESNE
Zoning: URA(100) //WP/WSP Applicant: U S METAL ROOFING DISTRIBUTORS, INC
AT: 41 RYAN RD
Applicant Address: Phone: Insurance:
740 HIGH ST, SUITE 2 (413) 536 -5474 WC
HOLYOKEMA01040 ISSUED ON:5/9/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & INSTALL METAL SEAM 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 5/9/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner