23A-061 Tom Masters
63 maple st
11 p Florence , ma
586 -7900
•
F S i s= ` 413/.563 -6354
ESTIMATE
Scope of work:
We will provide all the necessary insurance certificates, permits, supervision,
labor, materials, equipment, and supplies as required to complete the following. All
OSHA safety standards will be followed.
1.) Strip and remove existing roofing and dispose of in proper landfill.
2.) Clean/ inspect decking (rotted plywood or re sheathing replaced @ $ 50.00 per
sheet extra cost)
3.) Install new white aluminum drip edging to rakes and eaves of roof (8 ")
4.) Install ice and water shield 3 feet on eaves, 3 feet on valleys
5.) Install 151b tar paper to the remainder of the roof
6.) Install new pipe boot flashing and paint vent stacks black
7.) Flash all chimneys and minor re pointing if need
8.) Install Lifetime GAF 50 yr prestique HD timberline architectural style roofing
shingles to manufactures specifications using 6 nails
Color
9.) Install gaf ridge vent and cover with gaf ridge caps
10.) Clean gutters and excess roofing debris
11.) Install new flashing where necessary
12.) Roofers buggy will be used for clean up and keep job site in a safe manner
t' t) r■ F t ., a g,k, f- , tact c 4, (ct r
We will remove and properly dispose of all contract work related waste and debris
daily and maintain in a clean and safe manner.
We will guaranty this roof not to leak for 20 years under normal weather conditions.
We purpose to provide the material, labor, waste removal, and permitting to complete
the work to the above specifications for the sum of:
$9,200
$- 4000.00 down payment amount
$5,200.00 balance due upon completion
Authorized signature: date
Customer's signa e:1%�i e r/c� date
Please make check payable to N.R.B. Exteriors, Inc. and mail to N.R.B. Exteriors,
Inc. 7 Philip Cir Granby Ma 01033
=, The Commonwealth of Massachusetts
{_=� Department of Industrial Accidents .,
,� :�w Office of Investigations
' 600 Washington Street
Boston, MA 02111
K ` - � - ° R ' M www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
,
Name ( Business /Organization/Individual): N kci, t '(t'c (,p,) ✓s i ^ C.
Address: k ■ b C ( ✓
City /State /Zip: h 1 a- (1 0 101 - 3 Phone #: C ( �'(
Are you an employer? Check the a box: Type of project (required):
1. ► ' I am a employer with 4. n I am a general contractor and I
have hired the sub - contractors
employees (full and/or part- time). * 6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2. El I am a sole proprietor or partner-
ship and have no employees These sub - contractors have 8. ❑ Demolition
g for me in any capacity. employees and have workers'
working Y P tY• 9. ❑ Building addition
No workers' comp. insurance comp. insurance.$
required.] . 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
officers have exercised their 11. ❑ Plumbing re P.
airs or additions
3. ❑ I am a homeowner doing all work I�I'I
myself. [No workers' comp. right of exemption per MGL 12. 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: Arvi.// Lam-`
2 GA l t [,
Policy # or Self -ins. Lic. #: 6 t Z - Z. (1 0 9 -7 OS - ` ` ' ` Expiration Date: / ` 10 \,... Job Site Address: l0 3 /In 9 I-( ( f � 02 ! `4 City /State /Zip: r i o J < t t. c v /A --t
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 , e e pal, and pena ' ' • perjury that the information provided above is true and correct.
Signature: ` Date: / -1) ^ A_ i
Phone #: S^ (, 3 Cr 1
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 #:
p
Version1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) '.,
......
Independent Structural Engineering Structural Peer Review Required • Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
..----
I,
/ 0 is'N I \ tA. 3 _ _ . , as Owner of the subject property
hereby authorize liA to
act on my behalf, in all matters relative to work authorized by this building permit application.
4-
Signature of Owner Date
I, 4 f-. A_ 9 .44.__...{:2..i...s. ___J,... c ___ _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 uncle he p ' s and_oenalties_of oertury,_ .._ , „. _ _ _ . ....__ __._ . .
Print Name _________
.....--
lo-,-k-(-0, _
si .tfrl Owner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
--------
T - --- a-
Name of License Holder : ff
License Number
1___ --- '
7 IN, , i . _ ,,,, _ c:3 - __-
p --- ---- - ---- - AJ - 4 --
Address Expiration Date
Cil3 - ct 3c
-.nature Telephone
SECTION 13 -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 V No
f
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION'SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF EILOSEDSPACE)
9.1 Registered Architect:
_..._._.. .__._..._.._._.._._.._._._____ _ __. M_ Not Applicable ❑
Name (Registrant): ____
Registration Number
Address
_..r..... Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address __. Registration Number__ ___ _........._
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
✓ ` f f ._,._l"�L_ ._ _.., _ ....._........_._.._ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
AdAss 7
3 .3
Si cure Telephone
1
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side __._. m R:._...._.__. L _._._.. R.'_.._.___..'
Rear
Building Height
Bldg. Square Footage
Open Space Footage _ % . ,
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location) ..._w .,_,�..._... _ ._...,_._.._.,..,__,. _.._..._._.. _,.._
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
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (3 YES 0
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:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
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.
IA
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 t
CUBIC FEET OF ENCLOSED SPACE ,
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building C(
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofingjg Change of Use ❑ Other ❑
Brief Description Enter a brief description here. nn
Of Proposed Work R r
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B r ❑
F Factory ❑ F -1 0 F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
s Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑
U Utility ❑ Specify
M Mixed Use ❑ Specify
..'�..°'"
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: Proposed Use Group
Existing Hazard Index 780 CMR 34) _, ________ ,. Proposed Hazard Index 780 CMR 34): '_ _.____ _.__ .___.__ ._.
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 st ;
1 .__.
2nd 2 nd
... ... ,__ .................,. ,_.... w____ .._...m,......,_
...,,__, .._.._ _ ,,______ ._____ 3 rd +
3
4th _._..__.___,_..____�_..._.___. .. __ 4 th ""
Total Area (sf) Total Proposed New ConstructionSsf)______
Total Height (ft)
Total Height ft . ,_ ._. _.
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood_Zone 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone _ „_ _ ,,,,, Outside Flood Zone❑ Municipal ❑ On site disposal system I=]
f
Version1.7 Commercial Building Permit May 15, 2000
r-- EI Departmeht use # only � Y
�E ity of Northampton Status pf P it• i - i ,-,
uilding Department txrb�°GuflDnveay ert tr, s ��
OCT 2 2012 212 Main Street C 5ewerlSe star GVwa�lPablitjr . . s :t5,i,ft::r:'11:'::':'
Room 100 V a at er ik A t el ltA �a tta b iltt y r ` x s
1 Northampton, MA 01060 Two SeYsof StrttcttraC
a= NOPT "A" - _L :1 hone 413 587 - 1240 Fax 413- 587 -1272 Plot/Site Plans ::4 ::::::.::::
Other Spe
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
o3 n‘lI' ,-A-- Map Lot Unit
Zone Overlay District
� I0 / t » L. , l'1�
Elm St. District CB D
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: _______________ __ ,. ii _ ri ____ _„_....,„ ce
Name (Print) Current Mailing Addre
Signature. c.LJ CA Telephone
2.2 Authorized Agent:
R e ri Jr ..... — _ _ - . r_ ? .__S . _ !.. . .._I .... . . . � _ I 3
Name (Print) Current Mailing
Signature - /' ` Z �L;.� " Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 7 (a) Building Permit Fee
2. Electrical :-------- —_ .._. (b) Estimated Total Cost of
Construction from -(6)_ F..„_._ _ _ ._.. .._..
3. Plumbing ----------------- Building Permit Fee
4. Mechanical (HVAC) _. .__
5. Fire Protection
i 7 6. Total = (1 + 2 + 3 + 4 +5) Check Number Q/
This Section! For Official Use Only
Building Permit Number Date
Issued
I
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0497
APPLICANT /CONTACT PERSON NRB EXTERIORS INC
ADDRESS/PHONE 7 PHILIP CIRCLE GRANBY (413) 563 -6354
PROPERTY LOCATION 63 MAPLE ST
MAP 23A PARCEL 061 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out J
Fee Paid lip 6"
Typeof Construction: INSTALL NEW ROOF TO MANF SPECS _
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 99565
3 sets of Plans / Plot Plan
THE FOLL G ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved 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
As • '.n Relay
fi
�
Signature of 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.
63 MAPLE ST BP- 2013 -0497
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A - 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: ROOF BUILDING PERMIT
Permit # BP- 2013 -0497
Project # JS- 2013- 000786
Est. Cost: $9200.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq. ft.): 12458.16 Owner: MASTERS TOM
Zoning: GB(100)/ Applicant: NRB EXTERIORS INC
AT: 63 MAPLE ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563 -6354 WC
GRANBYMA01033 ISSUED ON:10/25/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW ROOF TO MANF SPECS
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 10/25/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner