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29-366 • All Types Of Roofs Proposal No. • Quality Siding & Trim r �` t�IC KELL 4 Westfield, MA Sheet No. �� • FREE Estimates (413) 568 -9513 Date • Fully Insured riOOFING & SIDING Proposai Submitted To Work To Be Performed At Name p t k ed+ t 6 Street L 9 flv 5 t i'ni Gia, Street City FLflrteii e. City State State MP. Date of Plans Telephone Number S 0 r — 5 D 2 - 9 Architect We hereby propose to furnish all the materials and perform all the labor necessary for the completion of S t a r . J1 q j&ocF to e.Gk S e-Ciit9IJ �/ d add A �i ��� �� P 14 t.3. ` (14-orel Wor 01 aZ; p e.� 5 /s(Zo.4 peat"ir►ne ta Ice- A-rsh:1 X141 -eel iv,a_m6LLrltie- r J Figs& 2 1t, VA)le. cll. ►d ' 5 i4.i1I Ir.; s t 41-Li 11 q &AF Q 4 tAy rne.t Oni ge.s.fr o r (4,,,,f- - I- IniskA :',n AF 5ihi4ka - © c ... - , `~ SedA Lin AL(. P 5 Nei Re- -FLh Shier � 44. or .:tom ifOs R L.r`rr1 ' JVe,1 �►J pipe- t�04f, .c ®n1 'toil pipes f` ernoV: ri 3 ii Li, de t4R.$` 4a fit 010 2R.gN bJi -.qerR All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of For plywood repair $!9 per sheet, includes labor and material. q s � - 41:VA Artchi c itru, 60 5t4-iN Ak p r N ..l� Dollars ($ �O, °c) s s'-i e L;NG with payments to be made as follows: T3 C ' ' @ q q® CC L+ a ` P Any alternation or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra change over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. It is the home owner's job to cover any items of importance in the attic from the time the contract is signed and dated. Any damage caused by not covering items in the attic is not the contractor's responsibility. 1 -C iatt uPaoei,a'f+✓£ 1O °Dfc-id / z2 �1 0 2 C-CA7rreAc-i�ic1'v-5i , - riarure2 5 -,p Respectfully submitted fp ,, 4 3. Co w. ; e.-r-o 4. 'To F -r arJ rort.N. r Note - This proposal may be withdrawn by us if not accepted within days ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Pay- ment will be made as outlined above. root,+ - ri is C t. 0.v ATTAc e b L- £ k. - r t _ 5 r 6.i' ,rte Accepted Signature 4 /_ / II Date Signature A � o INSURANCE BINDER OP ID SH ° 07 ` /20i 0 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON T_ HE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER# 8231 Nautilus Insurance Company Neill & Neill Insurance Agency -- — 662 Riverdale Street TIME D ATE EFFECTIVE DATE XPIRATION TIME _ West Springfield MA 01089 X AM I l X J12:01 AM David W 13 732 -4137 , (A/C, 413 731 -6629 07 THIS BINDER /20 /09 ISSUED ? o Ol END COVERAGE I 08/20/09 j NOON PHONE FAX _ -- (NC, NO,Ext): IN THE ABOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY #. NC 643312 CUSTOM : P D ESCRIPTION OF OPERATIONSNEHICLES /PROPERTY (Including Location CUSTOMER ID: ( 9 ) INSURED Roofing and Siding Patrick Kelly Roofing & Siding 12 Old Feeding Hills Road Westfield MA 01085 COVERAGES LIMITS TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS % AMOUNT PROPERTY CAUSES OF LOSS BASIC L I BROAD I SPEC ■ GENERAL LIABILITY EACH OCCURRENCE • $ 1 , 000 , 000 X COMMERCIAL GENERAL LIABILITY R ENTE • - ._. __ R ENTED • PREMISES $50,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $5,000 X ; Nautilus Insurance Co PERSONAL ERSONAL & ADV INJURY $1,000,000 -- GENERAL AGGREGATE $2,000,000 RETRO DATE FOR CLAIMS MADE: PRODUCTS - COMP /OP AGG $ 2 , 000 , 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS - BODILY INJURY (Per accident) $ —I SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS MEDICAL PAYMENTS $ NON -OWNED AUTOS PERSONAL INJURY PROT $ UNINSURED MOTORIST $ $ AUTO PHYSICAL DAMAGE ��� — 1 DEDUCTIBLE ALL VEHICLES ;SCHEDULED VEHICLES I ACTUAL CASH VALUE COLLISION: - _ — j STATED AMOUNT $ OTHER THAN COL: E I OTHER I GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ - AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ I UMBRELLA FORM AGGREGATE $ I OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF - INSURED RETENTION $ X WC STATUTORY LIMITS WORKER'S COMPENSATION E.L. EACH ACCIDENT $100,000 EMPLOYER'S LIABILITY E.L. DISEASE - EA EMPLOYEE $500,000 E.L. DISEASE - POLICY LIMIT $ 100,000 SPECIAL General liability policy period: 03/30/2009 - 03/30/2010 FEES $ • CONDITIONS/ OTHER TAXES $ COVERAGES Workman's Compensation policy period: 05/31/2009 05/31/2010 ESTIMATED TOTAL PREMIUM $ NAME & ADDRESS 1 MORTGAGEE 4 ADDITIONAL INSURED LOSS PAYEE i � _ __ LOAN # AUTHORIZED REPRESENTATIVE David W Neill ,� :../... � ... ACORD 75 (2004/09) NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE ©ACORD 6'0 RPORATION 1993 -2004 • 1 i 4_'f4 Boars o . uilding egulat(ons any tans ars s One Ashburton Pla - 13 � - O Place Room 1301 0 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 128749 Type: DBA Expiration: 5/11/2011 Tr# 284626 PATRICK KELLY ROOFING & SIDING PATRICK KELLY 12 OLD FEEDING HILLS RD WESTFIELD, MA 01085 • - Update Address and return card. Mark reason for change. L Address Renewal Employment 1 Lost Card DPS -cal C' 40M- 08/08- DBSLIFORMCA108212008 Massachusetts - Department of Public Safet /; Board of Building Regulations and Standards Construction Supervisor License License: CS 102344 Restricted to: 00 PATRICK KELLY 12 OLD FEEDING HILLS ROAD 1 WESTFIELD, MA 01085 Expiration: 10/29/2012 t,'un3missiuncr Tr4: 102344 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations T_ he inspe ion process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure - these - inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper __penmits-in-conjunction..to- the - building ..permitissued,_ they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1 , understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date- - ��..._._ _. Address of work location ' The Commonwealth of Massachusetts Department of Industrial Accidents ►� z Office of Investigations • , = . c 'I 600 Washington Street Z Boston, MA 02111 ,: 'S. www.massgov /dia -Workers' Compensation Insurance davit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): k ke... ( ) ' oC� - .4 � , a Address: J2.. de.) Fe.e4;no 11A-LS Rei City /State/Zip: We-st P,'eJJ me- o lo4s Phone. #: 41 — S6 g - gs Are you an employer? Check the appropriate box: Type of project (required): " 1.0 I am a emplo with 4. Q I am a general contractor and I 6. 0 New construction gmployees (full and/or part-time).* have hired the sub - contractors 2. I am a sole proprietor or partner- listed on the attached sheet 7. Q RemodehnQ ship and have. no eloyees These sub - contractors have. 8. ❑ Demotion for mein any capacity. employees and have workers' working Y p tY- 9. Q Building addition [No workers' comp. insurance com�.3uSUrance # , re ed 5. 0 We are a corporation and its 10.0 Electrical repairs or additions q ] 3.0 I am- a-homeo net -d ing_an vo k- - - - - __ - - - _oL _e sila excised their _ 11.0 Plumbing repairs or additions myself No workers' comp. right of exemption per MGL 12.0 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. . t Homeowners who submit this affidavit: indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors 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 _ormation. Insurance Company Name: NI �-t- !9/)C� fv iL'' Policy # or Self-ins. Lic. #: iJ C. ‘4-33/ a Expiration Date: - 3- 30 2 -0/0 Job Site Address: Z. q 5 -� C i P.. City /State/Zip :' FLo K. es. 1 ba- p Q Attach a copy of the workers' compensation policy declaration page (showing the policy nu 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 and/or one -year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and afire of up to $250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of Investigations of the ID f or insurance coverage verification I lo_kereby certify under the pains and penoltiPs ofper icry :that the information provi ded.above is true_attdcorrect ____ _ _ vr Signature: / b /2 Date: ■ —' - 0 9 Phone #: Official use oiily. Do not write in tlic`area, to be completed by city or town officiaL • City or Town: Permit/License # _ Y 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 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder : iY n T i f � t L ke.. f (t ( 02. 3 *A' J License Number 1 Z o141 Fie -J;n9 1- K11-s 12.4 W e-S6c,' (d 1 0./21 2;02_ Address Expiration Date T 4 - g Signature Telephone 9.; Registered ;.Home;'irriprovementContraetor A .: I ,,xi A . ,. ., Not Applicable ❑ e 4TA;(it i< 24odin ✓ J S ac � ic1; n I2 7 4 - el Company Name / Registration Number Z o 1G1 F e e . — J ; r - s id W es i f i Address Expiration Date Telephone 413 -568 — 01 5+3 11 2.O )i SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M-G.L. c. 152, § 25C(6)) J- 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 buildi permit. Signed Affidavit Attached Yes No ❑ 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 `i o ampton "e I mances, a e - - . - .4 tt - 6eneral< -- Laws - Annotated. Homeowner Signature _ _ - SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing LIQ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed _ Work: STR4.f 1 200.C, EN.stAj1 4 /c�e ad ice_ And w&z., Feat` PAPA. Sh;nij i ;4 Vep+ Alteration of existing bedroom Yes Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa.Tf,Netni fiouse and ezistnicrhdi sing; complete fh4 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 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 P 4fA.;Cic- key/ , as Owner /Authorized Agent hereby declare that the statements and inform on on the foregoing application are true and accurate, to the best of my knowledge and_beliaf. Signed under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date , 0 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 LotSize ._ ..._.____._._.�.., ;_.,____,,_._____._,.._ ...._,...__ ' .._. ___ ........ ...._.r' Frontage _ v_... ._. ..... _, fi _.. _ __ _. __ _.. _ Setbacks Front Side L. >_.._�_.., R.',._._....._.._, L : __.._.__. R:',„....__ ,_ . .. Rear Building Height Bldg. Square Footage is > % Open Space Footage (Lot area minus bldg & paved ....,_— f parking) # of Parking Spaces „____: _. _. . Fill: .� w �. �._ „. v (volume & Location) ..._.,.,....„... .....,.Ai _____ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 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 j Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: x_ DTTare t ere any propos c to or a loons o signs intended oFff i property ? YES 0 NO 0 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department CtrCttiD�e �x 212 Main Street 5 �� x a Room 100 Northampton, MA 01060 f� ��« �� phone 413 - 587 -1240 Fax 413-587-1272 P1; � 0 , eott ie. *, . 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 Map Lot Unit c i 'USciaJ ci2 Zone Overlay District FL o eo/ Efm°St`Distrlct CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ORn►o Ke;fh ib _._ v.5_±. 1.) r 1 - 6 2a ¢ Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Pfi k4Ij 12 olci .Fe.ecl;ny Ifrus voe-stfie Name (Print) Current Mailing Address: � • ' t rl,; 4 ) 3 3 - 6 4 1 ' . " Signature Telephone SECTION 3 -ESTIMATED COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (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) 10 g Check Number This Section For Official Use Orir'y Date Building Permit Number. issued' Signature: Building Commissioner /Inspector of Bu Date R 4 ;u< BP- 2010 -0154 # COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0154 Project # JS- 2010- 000190 Est. Cost: $10490.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PATRICK KELLY 102344 Lot Size(sq. ft.): 16988.40 Owner: POWER JANE M & DANIEL T KEITH Zoning: URA(100) //WSP Applicant: PATRICK KELLY AT: 69 AUSTIN CIR Applicant Address: Phone: Insurance: 12 OLD FEEDING HILLS RD (413) 568 -9513 WESTFIELDMA01085 ISSUED ON:8/10/2009 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 8/10/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo