31A-074 (2) To: Louise Jeffway
225 Elm Street
Northampton, MA 01060
Date: October 10, 2012
Dear Ms. Jeffway:
Please see the following estimate for work at your 4 Washington Avenue residence in
Northampton, MA – details as follows:
- obtain building permit
re -roof over existing tin roof with new fully adhered EDPM rubber roof.
- re -pitch roof to drain properly
repair rotted wood on the eves on left -hand side of roof.
- repair loose step on porch
replace damaged shingles on bump -out roof on left -hand side
All work to be done in a professional manner in compliance with local
building code.
- Total Due: $2,200.00
❖ Terms: 50% down - payment, balance due upon completion.
Thank you for this opportunity,
Tom Schneeloch
Accepted By: _ s� I ,.,, — Date: /C� ,/,/ 1`•2
1
Thomas Schneeloch Construction
6 Duane Street
Westfield, Massachusetts 01085
413- 214 -9587
Note: please make all checks payable to — Tom Schneeloch
Massachusetts Construction Supervisor License #102549
Connecticut Construction License #0625832
IMPORTANT FEE NOTICE: CHANGE IN LAW ABOLISHES CSL's HIC REGISTRATION FEE
EXEMPTION. As a result of a recent change in the law (Section 80 of Chapter 27 of the Acts of 2009), the holders
of Construction Supervisors Licenses are no longer exempt from the HIC Registration fee. CONSEQUENTLY, ALL
CONTRACTORS, INCLUDING CSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A
REGISTRATION FEE OF $150.00, AND A GUARANTY FUND FEE. (See instructions for Guaranty Fund
fee schedule.)
100.00
16. REGISTRATION FEE ENCLOSED: $ 150.00 GUARANTY FUND FEE ENCLOSED: $
PLEASE INCLUDE TWO (2) SEPARATE CERTIFIED CHECKS OR MONEY ORDERS, ONE MARKED
"REGISTRATION FEE" AND ONE MARKED "GUARANTY FUND." ONLY CERTIFIED CHECKS OR MONEY
ORDERS CAN BE ACCEPTED. ANY OTHER FORM OF PAYMENT, INCLUDING BUT NOT LIMI 1'ED TO
PERSONAL OR BUSINESS CHECKS, WILL BE RETURNED AS INELIGIBLE. MAKE BOTH CHECKS PAYABLE
TO "COMMONWEALTH OF MASSACHUSETTS."
I hereby swear, under the pains and penalties of perjug, that all information set forth on this
application and submitted in support hereof is true and accurate to the best of my knowledge.
Further, I certify under G.L. c. 62C, §49A, that I am in compliance with all laws of the
Commonwealth relating to taxes, reporting of employees and contractors, and withholding
and r mitting of chil support.
lc / /S 2ci
Signature of Applicant If a corporation or partnership, position held. Date
THE COMMONWEALTH OF MASSACHUSETTS
OFFICE OF CONSUMER AFFAIRS AND For OCABR Use Only.
* BUSINESS REGULATION Registration No:
A. vi t 10 Park Plaza, Suite 5170
it 1 NO Boston, MA 02116 Effective Date:
t { Application for Registration as a Home Improvement
Contractor or Sub - Contractor Expiration Date:
" v (MGL c. 142A; 201 CMR 18.00)
C j \ 0
1. NAME OF APPLICANT: Thomas Schneeloch V \ /
(MUST BE EITHER AN INDIVIDUAL, CORPORATION, LLC, LIT, TRUST, OR OTHER LEGAL ENTfl Y)
2. NUMBER OF EMPLOYEES: 1 VVV `�
3. APPLICANT TYPE: XINDIVIDUAL _ CORPORATION _ PARTNERSHIP _ TRUST
(CHECK ONE - -- MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN #1)
4. SOCIAL SECURITY #: D I ' c1 5o1 FEDERAL TAX ID #: Ole 6'8 762/
5. APPLICANT PHONE #: 413- 214 -9587 APPLICANT EMAIL ADDRESS:
6. MAILING ADDRESS: 6 Duane Street Westfield MA 01085
STREET CITY STATE ZIP
7. PERMANENT ADDRESS: 6 Duane Street Westfield MA 01085
STREET CITY STATE ZIP
PLEASE NOTE THAT A P.O. BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS.
8. IF THE APPPLICANT IS A CORPORATION OR A PARTNERSHIP, PLEASE PROVIDE THE NAME, ADDRESS, SOCIAL
SECURITY # AND TITLE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE
TRUST'S OR THE PARTNERSHIP'S WORK (Please review the Instructions before answering this question):
LAST FIRST SOCIAL SECURITY # TITLE
9. IF APPLICANT IS DOING BUSINESS UNDER A DB /A, PLEASE STATE THAT DB/A, AND ATTACH A COPY OF THE
FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK:
DBA NAME: Tom Schneeloch Construction
10. (a) DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION - RELATED STATE,
CITY OR TOWN LICENSES OR REGISTRATIONS? x YES No
(b) IF YES, PLEASE FILL IN INFORMATION BELOW. ATTACH ADDITIONAL SHEETS IF NECESSARY.
LICENSE TYPE ISSUED BY LICENSE/REG. # EXP. DATE LICENSEE NAME
Construction
Supervisor CS- 102549 6/20/2014 Thomas Schneelocl-
•
City of Northampton
Massachusetts
*
d ` ^04 r + 0.
",a4 DEPARTMENT OF BUILDING INSPECTIONS r m.�
� 212 Main Street • Municipal Building r a y ti r
`t 5 ' Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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 (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 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 me.
Date
Address of work location
•
The Commonwealth of Massachusetts
~—=— Department of Industrial Accidents
Office of Investigations
-0 600 Washington Street
Weebiri sou.
....I -- Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 4 2_5 . $ 4 y Ge% ei _
Address: C S f-,r,e
City /State /Zip:l4kS� C'; c c L , Ol a g.5 Phone #: 9/ 3 2./ If C15 8 j
Are you an employer? Check the appropriate box: Type of project (required):
1. n I am a employer with 4. ❑ I am a general contractor and I
employees (full and /or part- time).* have hired the sub - contractors `o ❑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. C Demolition
working for me in any capacity. employees and have workers' 9. n Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. n 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.n Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.Z Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. ❑ 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.
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:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
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 pains and penaltie of per' that the information provided above is true and correct.
Si nature `, – — Date: /O // Z
Phone #: 4/3 2/‘ l
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 B o f NPalti 7 Rnilding DPpartrnPnt 1. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
. ,
SECTION 8 - CONSTRUCTION SERVICES'
1 Licensed Construction Supervisor: L N ot Applicablee ❑
Name of License Holder : '7 A j py cL ��/ ) , € OC h /0 2 5 T
g License Number
i A ir . 445 -F = . /40 0(0k5 6 tion 0 �'�
Address Expi ate
Signature Telephone
""----- :Registered Home., ImproVemenjCon actor :, V „ gz ,. ,,_` Not Applicable ❑
a $ oo Ca,, A
Company Name r � Registration Number
6 Y�f.�.� e_ Sire .L 5 + e— �t55 010 45
Address J 2 Expiration Date
593
Telephone Z/1 9V7
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 permit.
Signed Affidavit Attached Yes ❑ No ❑
`ome (3wn.er
11:E I emption
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
•
t •
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 1 Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [[l Siding [O] Other [o]
Brief Description of Proposed n ,
Work: r roo $') %tom prGh w c)
Alteration of existing bedroom Yes X No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X No
Plans Attached Roll - Sheet
�a If New house and or'taddition to ezistinq h uo s nq :complete ttie follow`inq:
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.AUTHORIZ.ATION -;TO BE COMPLETED WHEN
:OWNERS AGENT OR CONTRACTORAPPCIES FOR :BUILDING PERMIT
1, 41.- C4„,',/ - , as Owner of the subject
prop
hereby authorize / Ad)Y1 Cc.S
to act on my be alf, in all matters relative to work authorized by this building permit application.
, e t- 4,./ /0/451/0
Signatu f er 1 Date
I, �rv's)�.S 5C d7/1Qe c 'ih , as Owner /Authorized
Agent here y d eclare 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.
/----Ae:777741 ..-- IOC/J
Prin
/ /
Signature of Owner /Agent Date
• A
3
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 _. . : ...�._ n '
Frontage V _ _ .__ __
Setbacks Front
Side L: : R: L: R:
Rear
Building Height
Bldg. Square Footage T % —
Open Space Footage _ _
(Lot area minus bldg & paved parking)
I j p 1 i
# of Parking Spaces
Fill: I _,
(volume & Location)
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 Page: ' and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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 0
IF YES, describe size, type and location: 1
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: a
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.
Departmewt * use on r }y
City of Northampton St at us o Pecrni Z, }" ' t -
!� CEIVED Building Department l l C ut/t?rl v e a y , Permi t' :« , a k , t
212 Main Street Sewe fSep�ic`P labji t y� ) g 4 "�
Room 100 4tell A va i .,..,= ty . „, ��
orthampton, MA 01060 l''wo"# o ,Structural P las � '� , --
ti - ,r e 4 3- 587 -1240 Fax 413- 587 -1272 Plt�tiSe an
(YEPT. O BUIIDING INSP ''' - 3
,.arr+P nna o�osa Qther
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This se ction to be completed by office
1.1 Property Address: , ;
S Arel +or, Ma 3 4 Lot x ” ` Unit'
P
/1/ 7 a,vf / /114"5 S . �
. Zone Overlay pip t r , ct
0/O60 .
m St.�District
CB District
El
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
LOS. se_ e, 1 /„ - e .., 0i
Name (Print) Current Mailing Address:
S -6'
et /3 58'�i � 3
Q Telephone
Signal
2.2 Authorized A. ent: // e kolr/�j
/ - G. i y on � rr� S fr�c j K/s7L�, t -✓ c' /as
Name (' Int) Current Mailing Address:
��' cz/3 2 »'/ 9 52 7
Signature Telephone
SECTION 3 --'ESTIMATED CONSTRUCTION COSTS -
Item Estimated Cost (Dollars) to be Offici U
completed by permit applicant
1. Building \ 2 2 C' Q (a)'Bulldmg Permit Fee
�5 ., - .. 6
2. Electrical (b) Estimated Totai Cost of
Construction from (6)
3. Plumbing Bu ilding Per Fee
4. Mechanical (HVAC)
5. Fire Protection
6• Total = (1 + 2 + 3+4+ 5) Check Number se This Section For Official Use Only
Date
Building Permit Number.. I
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0456
APPLICANT /CONTACT PERSON THOMAS SCHNEELOCH
ADDRESS/PHONE 6 DUANE ST WESTFIELD (413) 214 -9587
PROPERTY LOCATION 4 WASHINGTON AVE
MAP 31A PARCEL 074 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out BO ��
Fee Paid
Typeof Construction: REROOF SIDE PORCH W/RUBBER ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102549
3 sets of Plans / Plot Plan
TH LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I R MATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Si I'' , 0,-/9-..../..---
: ature o Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
4 WASHINGTON AVE BP- 2013 -0456
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 074 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2013 -0456
Project # JS- 2013- 000728
Est. Cost: $2200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS SCHNEELOCH 102549
Lot Size(sq. ft.): 10628.64 Owner: FOUR WASHINGTON LLC
Zoning: URB(100)/ Applicant: THOMAS SCHNEELOCH
AT: 4 WASHINGTON AVE
Applicant Address: Phone: Insurance:
6 DUANE ST (413) 214 -9587
WESTFIELDMA01085 ISSUED ON:10/18/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:REROOF SIDE PORCH W /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:
FeeTvpe: Date Paid: Amount:
Building 10/18/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner