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18C-133 (2) Ka wal General Contracting 1:3 Redden Road Springfield, MA.01119-2631 Afe are Fully Insured & Licensed Email: WaltKowal @yahoo.com Cell: (413)-575-1105 Hic Lic#124626& CSL 100833 Are hereby submits specifications for: Roof J Russell Date: 8/13/2014 80 Blackbury Ln Northampton, MA. 586-0033 Re: Above Address VVe will strip the whole roof of the house. We will dispose all the material. VVe will apply Ice Guard 6 feet up. We will apply a synthetic felt paper on the rest of the roof. We will install new drip edge. We will apply the appropriate length of ridge vent on the house. We will install new boots for the vent pipes. We will install def ion architect shingle If the house nee�ye et�ii n plywood will be price of material and $25.00 per sheet for labor. I will apply for a permit Ale propose hereby to furnish material and labor complete in accordance to above specifications for the sum of: $ 9,750.00 Additional cost of applying aluminum snow guards front, back & on the garage will be an additional cost of 10.00 All material is guaranteed to be as specified. All work to be completed in a work man like manner according to standards practices. , Any alteration or deviation from the above specification involving extra costs will be done only upon a written change order. The costs will become an extra charge over and above the estimate. This is to include, but is not to limited to, hidden damages that are uncovered during the course of the job and additional work required by local building inspectors. All elements of this agreement are contingent upon delays beyond our control. The estimate does not include material price increases, or additional labor and materials which may be required should unforeseen problems arise after the work has started. You,the buyer, may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made half down when material is delivered and the labor is started,quarter payment due when half way through and remaining balance due when job is completed. (Make check payable to Walt Kowal) (please do not hesitate to call me if you have any questions at the above tuber) P, - Y,, aK-- P ease sign on the above line&return i back so a permit can be pulled City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: �a �i°�� *�x lw The debris will be transported by: AG(�5 Paf/ The debris will be received by: Building permit number: Name of Permit Applicant Date Signature of Permit Applicant City of Northampton A S r Massachusetts DEPARTMENT OF BUILDING INSPECTIONS l , 212 Main Street • Municipal Buildingvi r Northampton, MA 01060 ss� •• �1t� 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/footinqs (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 1, 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 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: rnleAe r City/State/Zip: ! M/4 Phone Are you an employer? Chec he appropriate box: Type of project(required): 1.P I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 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. Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance. 9. [] Building addition required.] 5. F] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself o workers comp. right of exemption� ' per MGL p 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. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Conb•actors 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: /'/a C /?0:07 Policy#or Self-ins. Lie. #: 6 ��, e ��y/"j Expiration Date: 9—/� Job Site Address: City/State/Zip: !/ I 'o 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: L�`—" `i%' Date: T Phone M ✓ 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 Appplica�bblleQ£ Name of License Holder: (s�� /L ©Gt/�/ �f/'o D J 7 License Number XW Address Expiration Date Signature -Telephone 9.Re istered Home Im' Fovement Contractor: Not Applicable £ Company Name Registration Number --/�'�- Address ' Expiration Date 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 E"gemption' 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 lie/she shall be responsible for all such work performed under the buildine 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 Or Doors 17-1 Accessory Bldg. ❑ Demolition ❑ New Signs [[--3] Decks Siding[0] Other[p] Brief Description of Proposeda., r ell -top- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a,_If New house and or'adtl, ion lb exist[ng hausing;:complete the foltowmg: 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. 1. Septic Tank City Sewer Private well City water Supply S-ECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 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. 17 9Yo c�Ja Print Name /// 3ignature of Owner/Agent Date f 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 Setbacks Front Rear Building Height Bldg. Square Footage 0110 Open Space Footage % #of Parking Spaces (volume&Location) IL A. Has a Special. Permit/Variance/Finding ever been issued for/on the site? x~� x-� NO �~v=\� DONTKNOYY �~� YES �~� |F YES, date ioued1 � IF YES: Was the permit recorded at the Registry ofDeeds? NO �=�� DON7KNOYY 0 YES 0 IF YES: enter Book Page I and/or Document# i �� B. Does the site contain a brook' body nf water orwetlands? NO �~�� DON7 KNOW �~� YES k�� IF YES, has a permit been or need tobe obtained from the Conservation Commission? Needstobeubtained �- � Obta|ned «-� Date ' �_� t_� ' C. Do any signs oxi ��exist on the YES �~� NO �~�� IF YES, describe size' type and iocation: 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, gradingexcavation,or filling)over 1 acre orisit part ofa 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. ^ — j �1'`^- r adepartment use only k K Iii ty of Northampton Status of Permit �, " uilding Department Cirrb Gut/Dnvevvay Permit SEp 9 F i r LEP 16 ZQ14 212 Main Street Sewer/septicava�ra`bitity ' ' ' ,; -/ Room 100 Water/V1Ce1iAVailabihty Hect►fc,P►urnbin N rthampton, MA 01060 Twa Sets of Structural Plans aortharr ton, MA�ell -587-1240 Fax 413-587-1272 Pfof/Site Plans ! " Other Specify � ,_r3 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 off►ce Unit Zone ': Overlay D►str�ct ' Eim St D�stnct CB District . SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent:y Name(Print) CurreriLMaifin g ddrer Signature Telephone lj SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (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 of 6. Total=(1 +2+3+4+5) ftly.7,r"o Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector'of Buildings Date 80 BLACKBERRY LN BP-2015-0305 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 133 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-2015-0305 Project# JS-2015-000573 Est. Cost: $9750.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WALT KOWAL 100833 Lot Size(sq.ft.): 17119.08 Owner: RUSSELL JOE W JR&MARGARET H zoning URB(100)/ Applicant: WALT KOWAL AT: 80 BLACKBERRY LN Applicant Address: Phone: Insurance: 13 REDDEN RD (413) 575-1105 Workers Compensation SPRINGFIELDMA01119 ISSUED ON.911612019 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: FeeTyipe: Date Paid: Amount: Building 9/16/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner