22D-011 06/17/2014 11:18 4135867239 MURPHY REALTORS PAGE 04
o. $
TOTAL OTHER: 3 D.00
GRAND TOTAI,FOR ALL REPAIRS(P%aae awbis check your addllion) 2790.00
Date Bid 3ubmillaq: 05/27/2014
Date Bid Approved; 05/2812014
Data of HomeSteps Requested Completlon: 06/08/2014
'ontractor Signature
nstructions to Brokers and Contractors:
rhea is your authorizmn to contract on behalf of Frame Mac rpr the IbNowing services and repairs to the property_Costa to
2erform each Nom may not exceed the amount confirmed below without prior authorization.
(ow must submit the following documents to Homesteps Accounts Payable within three,(8)days of completion of the
approved serwtces or repairs:
L The original demised invoke.
L This form with the Brom6rgntractur CertNlcats of Completion signed.
1.If the wont was completed by a third party(such as a subcontractor or suppliel),then the attached
WppliedgubComraftr Csrlillcats of Completion,
L Photos attached or submitted online,
2AYMENT WILL NOT BE MADE UNTIL THE DOCUMENTS ARE RECEIVED IN THE HOMESTEPS AP DEPARTMENT FOR REVIEW,
:reddlo Mac reserves the right to verily completed repair(s)via third party Inapactlon(s)prior to final payment
�4-vy-
f/4-�
06/17/2014 11:18 4135867239 MURPHY REALTORS PAGE 03
A,3 Tap Asphalt Shingles
B,Aluminum Shingles
C.Concrete Tlles $
0.Corrugated ❑ L�..! $
E.Dimensional Asphalt Shingles ❑
F.Edging&Vents ❑
1.Uneer POM &prfee/Ln.Ft, "Inniallod" §
G.Flat Hot MoppedlRubber f ❑
1.S"M Fast &priolno.Ft. "Inalallaq 3
H.Guitars&DDwnepauts ❑
1.Linear Feel &prlaal✓„n.Ft. _ "Inotallod" §
I.Metal Roof F1 [I D $
J.Missioniclay Tile ❑ F� n $
remove and replace root sheathing
K.Roof Sheeihtng/Roo}Decking 0 a 66 $2790.00
L.Slate Roof ❑ $
M.Wood Shingla&shake $
TOTAL ROOFING: $2790-00
Make sure you follow HOA requlromonm and loyal requirements.Specify location of stairs and stops,
aY.
A.eelustef8 6,Railings n M
1,Linear Feet ♦t prlos&n.Fr_ � "Infdallod" $
S.Folding Attic Steps 0 F� ❑ $ _
C.Stairways ❑ n F] $
D.&tape 0 0 ❑ $
06/17/2014 11:18 4135867239 MURPHY REALTORS
PAGE 01
Date:
File Name lurpWataYtor#
Property 413 584-5700
Facsimile Cover Letter
To
Fax# 44 Con}Ot.
. nrtbanvtan, 02 01060
Message _fax: 566-7239
SL4 eortb4MVtan, :MZt 01060
,rax: 582.7199
From mail�srturfjgreattor .crt
06/17/2014 11:18 4135867239 MURPHY REALTORS PAGE 02
Broker Inspection/Contractor Bid Form (rorm4.0115peg")
doBrokers-use this form to mark recommended repair Poems,Fallow the current repair bidding quidellneq,
Contractors-Bid on the scope of work as determined by the broker or field W.Communlcats any
► 21 oversights to the broker ibr consideration.All materlais,equipment,appliances,at,must be new.
Obtain permits as required. General Contractors are to take before,during and Aftarptmtos of repairs,
Freddie Mao HOMes These photos should be uploaded to HSC when applicable or retained in the General Contractor's nle
and be provided to HomeSteps upon request.
Contracor Company Name: Home City Roofing A smi#: 1078568
Contractor Name: Ken Pooler Jr 1 IS RYAN RD,FLORENCE,
Contractor Offloe phone Number: 4133636958 Property AddreBg: FIAMPSHIRE,MA,01082
GOntractar Cell Phone Number: 4133836958
Contractor Email Address: KaP166iRverizon,net Loan ft: 384630628
Contr$ctcrAddrese: 64 Grandview Street Usting Broker. DAVID MURPHY
Contractor City: Sprinoeld 9roker Phone: (413)582-7190
Contractor stotelzip: MA 1 0111 B
Freddle Mac supplier 9(if applicable): Hap Company Name:
1020465 Phone Number-, •
Momeebapp Address:
5000 Plano Partway Carrollton,TX 75010
Appllonces must be Energy star qualKed and ba tonsistentwith the quality level of the hump.Appllanco cofarq are to match gntl match
'rand when possible.State reason for replacement(missing, Inopprable,agedl. Appliencq replacement must Include the model,color
LngLtypdl. Bid to include Installation and CIS opal.Repair Describe repair needed.
4.bisnNra9tter LO M N
1 Garbage Disposal 0 0 ❑
:.Microwave Oven 0 D $
D,Oven ❑ 3
Range ❑ ❑ 0 y
Range Hood F1 � ^
3.Refrigerator n g
i,Trash Compactor ❑ ❑ y_�
Vent Hood ❑ ❑ ❑ Ste_
Washer&Dryer � � F 8
Water PurlMer D L._.I F] a �
TOTAL APPLIANCES: $0,00
06/17/2014 11:16 4135867239 MURPHY REALTORS PAGE 03
Replacei Lo not overlay more than one existing roof.So conslatom with nolghborhoodl chock with WON vcrlfy local mquirsmantn,Prlca Includos
tear-oft and parmits,Specify ue tit and Noe o rca !g g oU MASO For 1 t® ant.
Replacs 04th 25 yr shingles. If shathing Is cwnpmmitrad$10.100.0010 repistm vAh
Nt—_ l4wood•
A.a Tab Aaphatt Shlttglett E 1..,_I $7310.00
B.Aluminum Shingles $
C.Conorate Tilas
D,Corrugated $
E.Clmenalorlai Asphalt Shingles ❑ 11 El $
F.Edging&Vents ❑ ❑
1.Unear Foot A prloKn.Fl $
G.Flat Hot Mopped/Rubber
t.Square Feet. Q priceraq.Ft. °rAMd0^ $
H.Gutters&Downspouts 1
1.linear Feet &prlae&n.Ft. "Inefelletl" $
I.Metal Roof Ll ❑ $
J.MlasionlClay Tile a ❑ 11 $
K.Roof SheathinglRoof Docking f� F1 0 $
l,.slate Roof 0 0 1:1
M,vvood Shingle&Shake 0 F1 0
7'30.00
TOTAL ROOFING: y
Make sure you follow HOA roquirernants and local requlremonts,Specify location of stair»and stood.
�.
A.Balusters&Railings
1.Unear F&O &pricelln,
B.Folding Attic Stops � 0 LJ a
n " n
06/17/2014 11:16 4135867239 MURPHY REALTORS PAGE 02
Broker InapectionlContrasctor Bid Form (F0tm4.D115papaq
arokete-Use this form to mark recommended repair Items.Follow the current repair bidding guldellnes.
Coetractom-Bid on the$Woe of work as determined by the broker or field rep.Communicate any
Hom s ovemIgMe to the broker for cornklerallon.All maMNats,equlpment,appliances,eta must be new.
Obtain pemilts as requited. General Contractors are to take before,during and after photos of repairs.
F-mid[e Mac Homes Tbas6 photos should be uploaded to HSC when applieabfa or retained In the General Contractors file
and be provided to HorneStepe upon request.
Contractor Comparry Name: Home Ctty 222tirtg Asset s.; 1078568
Contractor Name; ICen Pooler Jr 115 RYAN RD,FLORENCE,
prvp"Address: HAMPSHIRE,MA,01062
Contractor Office phone Number, 4133838958
Contractor Cell Phone Number: 4133836958 Loan y; 384630826
Contractor Email Address: lKsA66 @verfzon.rlet
ContracWrAddress: 64 Grandview Street Lleting Broker. DAVID MURPHY
Contreowt City: Springfield Broker Phone_ (413)582-7190
Contractor StNWZlp: AAA 101118
Freddie Mac Supplier*(If applicable): HOA Company Name:
1020485 phone Number, EXL
Honw8liam Address:
$000 Plano Parkway Carrollton,TX 75010
4ppl1ancea moat be Energy Star qualified and be eonsUtont with the quailty level o1 the home.Appliance colors are to match antl match
srnnd when possible.State reason ror reptacerner,t(mis31no. inoperable,aged). Appliance replacement must Includo tho modal,Color
Ind Upe. Bid to Include Inetenation sntl tlla a41.Ro air,Describe repair needed,
k.Dishwasher 0 $
B.Garbage Disposal ❑ $
C.It erowave oven 11 0 S-
b,Oven Q ❑ 11 3��
E,Range $
F,Range Hood $
0,Refrigerator
H.Trash Compactor $
L Vent Hood
J.Washer&Dryer 0 n F S
K.Water PuriAer [I F1 0
TOTAL APPLIANCES: y 0.00
06/17/2014 11:16 4135867239 MURPHY REALTORS PAGE 04
E. $
TOTAL OTHER: 1$0.00
GRAND TOTAL FOR ALL REPAIRS(Pieria daLiN* t**01Mur oddltlon) $7310.02
Data Bid Submitted= 05/08/2014
Data aid Approved; 05/15/2014
Date of HomaStaps Requested Completion: 06101/2014
Contractor Signature
lrtatructlana to Brokers and Contractors:
This is your authorization to contract on behalf of Freddie Mac for the foikming serviooe and repairs to the property.Coats to
perform Oath Poem may not wined the amount continued below Whout prior authorization.
You must submit the following documanta to Homesbepc Accounts Payable within three(S)days of completion of the
approved services or repairs:
1.The original itamlaed Imroles.
2.This form with the BrokoNCordractor Certificate of Complation signed.
b.If the work was cornplateil by a third party(such as a subconbactor or suppllso,then the amchad
SuppiledSubContractor CartMcats of Completion.
e.Photos attached or submitted online.
PAYMENT VALL NOT BE MADE UNTIL THE DOCUMENTS ARE RECEIVED IN THE HOMESTEPS AP DEPARTMENT FOR REVIEW.
Freddie Mae reseives the right to vaft completed repslr(s)vas third party Inspoctton(s)prior to final payment
LPIO
The Commonwealth of Massachusetts
Department of Industrial Accidents
W
Office of Investigations
n I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
__Name (Business/Organization/Individual): 1Il
Address: e g L7� ///f
City/State/Zip: s`C.v 1¢ Phone #:
Are you an employer? Check t e appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
�mployees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.N� 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.1
required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑�oof ' repairs or additions
myself. No workers' com right of exemption per MGL
y [ p. 12. irs
ins urance required.] c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
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 der the pains and penalties of perjury that the information provided above is true and correct.
Siizna ture: // Date:
Phone
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 7
8.1 Licensed Construction Supervisor: / I Not Applicable ❑ /
Name of License Holder:. `-"7�r�,IX.5 � .� a ca 0 a61
License Number
a2 S" 8 -ode- t o A .� zf >` X
Address IV Expirati n Date
Signature , Telephone J 0/
Al -
9.Renistered Home improvement Contractor; Not Applicable ❑
Company Name Registration umber
Address 1 ,/f r� Exp�rfion ate
1'1,4 ZY6,-G� Telephone
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...... ❑
11. - Home Owner Exemption
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 amlicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [O] Other[p]
Brief Description of Proposed —
Work: S 4- �.
Alteration of existing bedroom Yes o �~ Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes y No
Plans Attached Roll -Sheet
6a.If New house and or addition to existing housing, complete the 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, f ,as Owner of the subject
property
hereby authorize j12'
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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.
�- 'kle-d' ,--
Print Nam
y
Sigirature of caner/Agent Date
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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location
A. Has a Sp vial Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW l YES l
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 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO
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,exca$ation,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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Out/Driveway Permit
EE' 212 Main Street Sewer/Septic availability20M ' Room 100 Water/Well Availability
orthampton, MA 01060 Two Sets of Structural Plans
_.phoxie 4 3-587-1240 Fax 413-587-1272 P dt/Site Plans
Electric, Plumbing&C,a ,r c icir Other Specify
Ncrthanir or KA
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
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
J i le— 111 q
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Printl Current Mailing Address:
Signafure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
C>
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=0 +2+3+415) Check Number
''j� ,[ / )F�This Section For Official Use Only
ate
Building Permit Number: �,O P-f`� -/ I Qc9 IIssued:
Signature:
Building Commissioner/inspector of Buildings Date
115 RYAN RD BP-2014-1290
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D-011 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-2014-1290
Project# JS-2014-002167
Est. Cost: $7310.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TOM KELLIHER IMPROVEMENT 88261
Lot Size(sq. ft.): 13677.84 Owner: TENHOVE JOHN W
Zoning. URA(100)//WSP(100)/ Applicant: TOM KELLIHER IMPROVEMENT
AT. 115 RYAN RD
Applicant Address: Phone: Insurance:
25 BEAUDRY AVE (413) 575-8428
CHICOPEEMA01020 ISSUED ON.611712014 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 6/17/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner