35-061 Kowal
General Contracting
13 Redden Road
Springfield, MA.
We are Fully Insured & Licensed
(413 -) 782 -2656 (413)- 575 -1105
Hic Lic # CS SL 100833
We hereby submits specifications and estimates for: Roof 3/21/2011
Name: Eagle Crest Property Management
Address 1: 73 Main St.
City, State, Zip,: Amherst, MA. 01002
413 - 256 -3442
Re: 918 Ryan Rd., Florence, MA.
• We will strip the roof on the garage.
• We will apply 1/2 inch plywood on to the roof
• We will level off some of the dips.
We will apply felt paper.
• We will install new drip edge.
• We will apply Many perma ply 28 glas base.
• We will apply GAF Ruberoid torch smooth.
• We will apply remove part of the overhang on the garage.
• We will finish off the trim with finish board.
I will apply for a permit.
Labor $ 1,715.00
Material List:
7 squares of GAF Ruberoid Torch Smooth
3 Rolls of felt paper
3 Rolls of fire retardant paper.
1 roll of brown coil stock
2 bundles 3 tab brown shingles.
5 gallons of tar.
1 box nails for plywood that will fit Bostitch
5 lbs of bulk tin button
40 feet 1x8 trim board.
40 feet of 1x3 trim board
4 -2x6x8
/' /':
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. The inspection 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 (it 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
permits in conjunction to the building permit issued, and that 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
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
Date
Address of work
location
,
The Commonwealth opfassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.govidia . _...
•
- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly r
Name (Business/Organization/Indivirinal): //6:4 / , 7
- Address: / F "ert ,1 ,. . .
..._
City/State/Zip: 5;'."..777 fi/‘-( GY/tr Phone.#: 75//" .f
Are you an employer? Check tkr(appropriate box: ' Type Of projec t (required): /".
1. 2 I am a empioyer with 42 4.. [J I am a general contractor and I
6. 0 New construction
employees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet. 7• 0 Remodeling
2. 0 I am a sole proprietor or partner-
ship and have no ealoyees These sub-contractors have -8. 0 Dernalidon
• working for me in any capacity. en:ployees and have workers
9 Er Builditi a
[No workers' comp-. insurance
.0irs or additions
5. 0 We are a corporation and its 10 Electrical repairs
3.0 I am a homeowner doing all work officers haveGercised their . 11.0 Plumbing repairs or additions
r •
right Of exemption per MGL
nayself [No workers' comp. 12.0 Roof repair' s •
insurance required.] t • c. 152, § 1(4), and we have no
employees. No work'. 13.0 Other
• • ccuIP- insurance reciffired-J
*My applicant -that checks box #1 must also fill out the section below showing their workers' compensation policy information-
t Homeowners who submit this affidaVit inclicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
1 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 pnsvide their workers' comp policy number.
I am an employer that is providin' g workers' C ompensation insurance for my einployees. Below is the policy andjob site
information.
Insurance Company Name: 7/-7, C--/ r /1` 5 . • .
i
Policy # or Self-ins. Lic. #: 6 A'afi — ft‘ '?" 4 // -- /
47 Date: - g v*--- 7 F --//
Job Site Address: Pirli *7 1 LC cityistafrizip:*
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure ceverage required tinder Secti5il'25A ofMGL c 152 can lead to the in:position of criminal penalties of a
fine up to 51,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WOXIC.-ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
• areitigitions the Da fiii ihS111 - -ailci - coviiiii -
I d' o hereby: certify under the pains and penalties ofpeljztry that the information provided_above_istrue_iiniLcorrect.L_____ _
Signature: , .'•,2'Irr'er "-- - / ::. ..'. D
Phone it: 1 d' ,5" ''' - - . •
- 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 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : v4' ,® / / ,? ( / " 9
License Number
1'7 , ,f� -/A-/2 /fie � � / 9 ref o ///7
Address Expiration Date
5
Signature Telephone
�cRegister�d. .Efaim�lmpfovemeri�ttrifractrtr _. ,� . ",i., Not Applicable ❑
Company Name Registration Number
/ 7 ,slice /7 f ,1i4 / a 0/1/
Address Expiration Date
Telephone .W/
9".
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL. 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 qt. 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
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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing J
Or Doors D
Accessory Bldg. ❑ Demolition El New Signs [0] Decks [0 Siding [0] Other [0]
Brief Description of Proposed �•
Vk 17
/"/p `l f7Ct' �6Yr�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa .C"�e�nr.�otrise�>rld �I�ic1�o��tc��ex�s�l�iq�a Enq� �rr���t��ir�.��c�[lo���t:
a. Use of building : One Family x 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
, 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.
S ignature of Owner Date
OV /7 /KO) 4i l� / , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
OG€./.er
Print Name
Signature of Owner /Agent Date
1.
'. .
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information . + J" ,...
Existing Proposed Required by Zoning /f; r
This colurnk to befilled in by
Building`Department
LL
Lot Size I :_ l 1 y
Frontage ` _ i
Setbacks Front , L 9
Side L: - R:' . I. ; R:
Rear
Building Height 7-1
Bldg. Square Footage % I i a
Open Space Footage ,a %
(Lot area minus bldg & paved , i
parking)
# of Parking Spaces '
Fill: i £
(volume & Location) i
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 1 I I Page ' and /or Document # _ y
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ,Date Issued
C. Do any signs exist on the property? YES 0 NO 0
__
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the 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 Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
�,� City of Northampton ,' frtzt'vt
'frol%
f
. uilding Department <
„
1%\ 212 Main Street ,.. }
' . 0 .0 ` Room 100 '
y ,
• rtham ton, MA 01060
P g � g � �
e 413 -587 -1240 Fax 413 - 587 -1272
1PLICATION 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
2ei fig K>1 / r Map Lot Unit
Zone Overlay District
EIm St District" `' CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
9/Y C.i rs t
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
q tf.I mar / 7 -e, 44", -, , ,f%C' /
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /7/ r 7 / � (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) Check Number )11
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
918 RYAN RD BP- 2011 -0760
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 061 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 -0760
Project # JS- 2011- 001256
Est. Cost: $1715.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WALT KOWAL 100833
Lot Size(sq. ft.): 19994.04 Owner: BEEDE ROBERT H
Zoning: SR(100) / /WSP II Applicant: WALT KOWAL
AT: 918 RYAN RD
Applicant Address: Phone: Insurance:
13 REDDEN RD (413) 575 -1105 0 Workers
Compensation
SPRINGFIELDMA01119 ISSUED ON:3/24/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE RUBBER 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 3/24/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner