38B-260 Job Description
Remove asphalt shingles fromentire house roof and dispose of.Install Gold shield on eaves and vally's
install berger underlayment on remaining sections. Install IKO cambridge asphalt shingles.The flat roofs
will receive poly lass roofing, Color will be chos n by customer.
��� � f lylvocc i 5 o,ca 00-C
Materials Contractor Will Supply
Contractor will supply all materials needed.
Materials Home Owner Will Supply
Home owner needs to supply electricity.
Page five
NOTICE OF CANCELLATION
Date of transaction
You may cancel this transaction,without any penalty or obligation,within three days of the above
date.
If you cancel,any property traded in,any payments made by you under the agreement,and
negotiable instrument executed by you will be returned within ten business days following receipt by the
seller of your cancellation notice,and any security interest arising out of transaction will be cancelled.
If you cancel,you must make avaible to the seller at your residence,in substantially as good
condition as when received,and goods delivered to you under this agreement;or you may if you wish,
comply with the instructions of the seller regarding the return shipment of goods at the seller's expense and
risk.
If you do make the goods available to the seller and the seller does not pick them up within twenty
days of the date of your notice of cancellation,you may retain or dispose of the goods without further
obligation.If you fail to make the goods avialable to the seller,or if you agree to return the goods to the
seller and fail to do so,then you remain liable for performance of all obligation under the contract.
To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any
other written notice,or send a telegram to(Doug's Carpentry)
Seller seller )at(address of
Seller's place of business
not later than midnight of(date ).
I hereby cancel this transaction (date)
Buyer's signature
Page four
CANCELLATION RIGHT
You may cancel this agreement if it has been signed by a party thereto at a place other than the address of
the seller,which may be his main office or a branch thereof,provided that you notify the seller in writing at
his main office or branch thereof by ordinary mail posted,by telegram or delivery,not later than midnight
of the third business day following the signing of this agreement. See attached notice of cancellation form
for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPACES.
Homeowners) )2,. .( //6 ;(.1)' tea e- (9-0/3
Date
y p
Contractor / � Date �//2�J/I 3
Witness
NOTE:IN ADDITION TO THE HOMEOWNER'S RIGHTS BY THE LAWS,THE CONTRACTOR
CAN REQUEST ARBITRATION TO RESOLVE DISPUTES WITH THE HOMEOWNER IF THAT IS
AGREED TO BY BOTH PARTIES IN THE CONTRACT.IF THE CONTRACTOR APPLIES FOR
ARBITRATION,THE HOMEOWNER MUST DELAY COURT ACTION UNTIL AFTER THE
ARBITRATION HEARING.
OPTIONAL CONTRACTOR ARBITRATION AGREEMENT
The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor
has a dispute concerning this contract,the contractor may submit such dispute to a private service which
has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations
and the consumer shall be required to submit to such arbitration as approved in MGL C. 142A.
Contractor rf ' Homeowners / {
Notice:The signatures of the parties above apply only to the agreement of the parties to alternate dispute
settlement initiated by the contractor.The owner may initiate alternative dispute resolution even when this
section is not signed by the parties.
Page three
IF THE CONTRACTOR IS DOING WORK FOR WHICH CONSTRUCTION-RELATED PERMITS
ARE REQUIRED,THE CONTRACTOR MUST OBTAIN THOSE PERMITS FOR THE HOMEOWNER.
HOMEOWNERS WHO OBTAIN THEIR OWN PERMITS FOR THAT WORK CANNOT MAKE
CLAIMS TO THE GUARANTY FUND OR BE ABLE TO OBLIGE THE CONTRACTOR TO GO TO
ARBITRATION.THE HOMEOWNER IS RESPONSIBLE FOR OBTAINING ANY SPECIAL
PERMITS THAT MAY BE REQUIRED UNDER THE ZONING BY-LAWS,CONSERVATION
COMMISSION ORDERS,ETC.
Contractor will obtain the following permits:
Building Demolition
Plumbing Electrical
Gas Other(Describe)
Total Contract Price(in dollars and written out in words)$10,400.00
Ten Thousand Four Hundred dollars
Downpayment of$3,500.00
Must be paid at contract signing
THE CONTRACTOR MAY NOT TAKE PAYMENT OF MORE THAN ONE-THRD OF THE
CONTRACT PRICE BEFORE THE WORK STARTS UNLESS A GREATER AMOUNT IS NEEDED
FOR ACTUAL COST OF ANY SPECIAL ORDER OR CUSTOM MADE MATERIAL OR EQUIPMENT
WHICH MUST BE PAID FOR IN ADVANCE.DO NOT PAY IN FULL UNTIL THE WORK IS
COMPLETED AND INSPECTED.PAYMENTS DUE WITHIN 5 CALENDER DAYS OR ALL WORK
STOPS UNTILL PAID,A$10 LATE FEE WILL BE ACCESSED. 1 V2%INTEREST AFTER 30 DAYS
ON UNPAID BALANCE.
Schedule of remaining Payments:
Amount:$3,450.00 At 50%complete
Amount$3,450.00 At completion
HOME OWNERS WHO DEAL WITH REGISTERED CONTRACTORS FOR WORK COVERED BY
THE HOME IMPROVEMENT LAW,MGL C. 142A,HAVE THE RIGHT TO REQUEST
ARBITRATION OR TO SUE TO RESOLVE DISPUTES WITH THOSE CONTRACTORS.THEY MAY
ALSO MAKE CLAIMS TO THE CONTRACTOR GUARANTY FUND FOR ACTUAL LOSES UP TO
$10,000 IF THEY ARE UNABLE TO COLLECT THOSE LOSES FROM THEIR CONTRACTORS.FOR
INFORMATION ABOUT ARBITRATION AND THE GUARANTY FUND,CONTACT THE
EXECUTIVE OFFICE OF CONSUMER AFFAIRS(617)-727-7780
Page two
HOME IMPROVEMENT CONTRACT
This is the complete agreement between the contractor and the homeowner.
Name of Contractor: Doug's Carpentry&Roofing
Address:205 South Warger Road
Shelburne Falls, Ma 01370
Phone:(413)625-0152
Fax: (413)625-8347
Contractor's Registration Number: HIC 125427
Construction Supervisor License: CS 060375
Name(s)of Homeowner(s):Cynthia and Todd Di Geronimo
Address:54 Revell Ave
Northampton,MA 01060
Address of Job:54 Revell Ave
Date Work Will Begin:10/3/13
Date Work Will Be Completed: 11/3/13
These dates may change because of delays in getting material,permits,inspections,weather conditions,
subcontractors' schedules or other problems beyond the contractor's control.The contractor agrees to let
the homeowner know about any delays immediately.Changes to dates,the work to be done,materials or
price will be written and then initialed by the contractor and the homeowner(s),and attached to this
contract.
AS OF JULY 1,1992 ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS
COVERED BY MGL CHAPTER 142A MUST BE REGISTERED WITH THE STATE.TO CHECK ON
A REGISTRATION CONTACT THE DIRECTOR,HOME IMPROVEMENT CONTRACTOR
REGISTRATION,ONE ASHBURTON PLACE,ROOM 1301,BOSTON,MA 021008,(617)-727-8598.
HOMEOWNERS WHO DEAL WITH UNREGIS 1'ERED CONTRACTORS CANNOT OBLIGE THEM
TO GO TO ARBITRATION AND CANNOT MAKE CLAIMS TO THE GUARANTY FUND UNDER
THE-HOME-IMPROVEMENTT LAW.
Description Of Work By Contractor(see attached sheet(s).
Materials Contractor Will Supply(see attached Sheet(s).
Materials To Be Supplied by Homeowner With Approval Of contractor(see attached sheet(s).
Page one
• City of Northampton •
zS -«» 4,
I: A a°
Massachusetts
Vic,
, 4 DEPARTMENT OF BUILDING INSPECTIONS Pc
212 Main Street • Municipal Building .6b �
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
I, 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
E= Office of Investigations
1= 600 Washington Street a
Boston,MA 02111
°"$ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): po,,y1 5 ojo q n e _
Address: f--() y 5, "-A rr or- ILL
City/State/Zip: 5 7-e )Id H 9 L S //S/,if�2i 3'`Phone#: 62 ‘ "°/-5-
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
have hired the sub-contractors 6. ['New construction
employees(full and/or part-time).*
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
- These sub-contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. El Building addition
[No workers' comp. insurance comp.insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their i 1.El Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.7111'oof repairs
insurance required.] t c. 152,§1(4),and we have no
employees. [No workers' 1 .❑ 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.
1Contractors 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 penalties of perjury that the information provided above is true and correct
- -
Signature: Date: /0/11/7
Phone#: 6 q--
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#:
4
SECTION 8 CONSTRUCTION SERVICES:
a
8.1 Licensed Construction Supervisor: Not Applicaple ❑
Name of License Holder: j QL /0 S l°rg -, CS CC/077j
License Numb
(2-001) S, 1✓�a -e k Rd UJ! /5�I
Address Expiration Date
6y, /0/S2-
Sign re 7/ Telephone
.egie c d- ':"-rA 22proVenten 7Contracto., :,°` , . 3 ,v,„ i ;a . Not Applicable ❑
�619/c ' c' 12 5 I-0 7
Company Name Registrati n Nu ber
Z c S, l.s,-a,�; ,,- ill 121/5/i 7
Addres ., Expiration Date
�J1 7 1/4✓■4 f A' /04--
Telephone `, �f -051-
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIbAViT(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 ❑
gp .
>;, s 'ner xe p on
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) n Roofing le
Or Doors Cl �`�
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[2] Siding[D] Other[D]
Brief Description of Proposedc /�
Work: 11✓► �Dp-� / 7 �6G�
Alteration of existing bedroom Yes X No Adding new bedroom Yes X. No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
¢a Mee ouser-an addition:tarexistincN ousing idOmp a edn heFfiollow�nct:
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 AUTHORIZATION-TO BE COMPLETED,'WHEN`{
OWNERS AGENT OR CONTRACTOR APPLIES FOIZ BUILDING PERM1T
,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
D014As P�y h j , 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.
046,9/0 /"4 /
Print Nam / / //
Signatur Owner/A nt Date
a
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
e
Existing Proposed Required by'zoning
This column to be filled in by
Building Department
Lot Size I I I I
Frontage ; [ l ! i
Setbacks Front = 1-1 t_____
Side L:' R:i I L:i t R:I 1 s___ j
I
Rear
Building Height = = I i
Bldg.Square Footage % L____
- Open Space Footage �^ % _
(Lot area minus bldg&paved !__i
parking)
#of Parking Spaces I--'
_
Fill: . _ ._..I i _ _
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 14 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 I Page; and/or Document#1 E
B. Does the site contain a brook, body of water or wetlands? NO ��I DONT KNOW 0 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:
i
C. Do any signs exist on the property? YES 0 NO !Avit,
IF YES,describe size, type and location: ?
0.
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: 1 I
r i
E. Will the construction activity disturb(clearing,grading,a cavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
• .,'
City of Northampton us.�o ;et= � � .
- 3 2d` ' : •uilding Department lien.` e'er 1, ! ,� i.
j 1. ons 212 Main Street • e ed a " . � � �
sou
bin9 , MAG,O o Room 100 P x a® I , ,
ctric,t'w amPton. s, � ^ x � v;
ele North -- Northampton, MA 01060 •� a 4 � ., � 'tom
• phone 413-587-1240 Fax 413-587-1272 ''. „' t ., "" " '4 "1 htx �•
f u �,,a,.,_.. ...: ,w „ > ,, 'fix
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 `SITE'INFORMATION .„
M 4 ; r : x
�;s�. �� .�,� Th�ssectron to be completed by offices �� 4
3 ,.0�r ' }„ 't�11 p, V -'4 414,-,,.� yyfk�y tei ;,s*�ta b.5 -
1.1 Property Address: �:�. � w� r `� � ''''''-'44,:;-,:'':',,,'7
-1-1 k' // 4174, Y_ �g ,t,¢ ,.-4„I40-- k- Lod ,., � ,ni :
?$ ., ,r* ,a c a L., i �:,.sISIkt. ..-„,„;....7,s•-;',•,,,,1„.,,,i.,, nl mlo '� `its'
one 3'4, Overla "District -$ �,rye. ' - .,
E'Im St.C1lstr ct � te- Cg District ' :'�,,i '
SECTION 2 PROPERTY OWNERSHIPJAUTHORIZED AGENT ...
Y
2.1 Owner of Record: /�
Cln i); -17 aa.1 O; o TOgiMO' Sy f 71. ii/ /JVZ
Name(Print) Current Mailing Add : _77
Telephone r}
Signature
2.2 Authorized Agent:
0o`9/ s De°911 e a0-5-s, 14'g is 54 kty#14//5
/ f9
Name(Punt) Current Mailing Address:
/ 6 a �o/s�
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS s
Item Estimated Cost(Dollars)to be ” Official Use Only
completed by permit applicant '
1. Building i ii�� (a)Building Permit Fee
2. Electrical V/ (b)EstimateYd Total Cost of x
Construction from.(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection -
6. Total=(1 +2+3+4+5) (0 1100 Check Number
- , ..j. ,This Section For Official Use Only
Building Permit Number IIssued
.
Signature ;
Building Commissioner/Inspector of Buildings bate
54 REVELL AVE BP-2014-0412
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-260 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-2014-0412
Project# JS-2014-000705
Est. Cost: $10400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DOUGLAS DEANE 060375
Lot Size(sq. ft.): 8058.60 Owner: DIGERONIMO TODD&CYNTHIA C SIGDA-DIGERONIMO
Zoning:URB(100)/ Applicant: DOUGLAS DEANE
AT: 54 REVELL AVE
Applicant Address: Phone: Insurance:
205 S. WARGER RD (413) 625-0152
ASHFIELDMA01330 ISSUED ON:10/4/2013 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 10/4/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner