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35-160 (7) ALL EXTERIORS ROOFING-FLAT ROOFING-SIDING-WINDOWS WE ARE LICENSED REPAIRS-SNOW PLOWING FULLYINSURED (413) 478-1536 FACTORYTRAINED OSHA CERTIFIED Jeremy Sawyer,President/Owner MA Registration#174528 HONEST&RELIABLE 21 Rolf Ave.Chicopee,MA 01020 CT Registration#0636067 Allexteriorsl @gmail.com MA Construction Supervisor Lic.#106836 Proposal Submitted To: Date Phone#'s C: `ems "7 7 L H: -�� 'L/O-2 , W: Street Email: 770 City,State,Zip Code Special Requirements: l / /Ore 192'4;? 0 /aC /Yl�.,, ��GC7 G•1 �7C 'iti G�c^ 7GC� /Jn ❑ Recover Strip Gy00 -g f+) Complete Roof System [R We shall acquire all appropriate permits for all work © Home exterior and landscaping to be protected Do not Do.Fl.f 0 c rte+e- << 5 ® Strip existing roofing to the decking and dispose of it in a proper landfill ® Deteriorated existing decking will be replaced at$75 per sheet of plywood after a full inspection. © Install Ice&Water Barrier at all eaves,valleys, chimneys, pipes and skylights(6'min.on all eaves) [� Insta (151b.felt)Synthetic) underlayment over remaining decking area ❑c Instal!meta!drip edge at eaves and rakes 0,'5") whi} /brown/copper) ® Install manufacturer's starter shingle on all eaves Install new pipe boot standar opper) ® Install new vent ridge ve Rol /Rigid) ❑ Install proper soffit ventilation Shingles: (6 nails per shingle) A F-- Shingles [NJ HD Lifetime ❑ Ultra HD Lifetime Color a)/ S l..4e 14 F Ridge cap shingles Warranty Options: Z7we guarantee our workmanship for 10 full years (see our warranty coverage) ® Estimated Start Date /1 -% / S— Estimated Completion Date a Chimney Options: [� Lead Counter Flashing [:14"Box Vents (Black/Silver) [:112"Box Vents(Black/Silver) P, 41, Ch,m r s We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: Total Due ($ f ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment ($ satisfactory and are hereby accepted.You are authorized to do work as specified. Payment will be 1/3 down at start of job,and balance due upon completion. Balance Due Upon Completion ($ 3,5 G ) Do not sign unless all sections are filled out Date: Signature: Date: Estimator:(Print Name) S Ie S v (Sign Name — Estimates are honored for sixty(60)days from above date ATTENTION HOMEOWNERS: Please cover all personal belongs in the attic,garage or storage due to the possibility of roofing debris or dust coming in through cracks of the wood.All Exteriors will not be responsible for debris or dust in the attic or storage areas. 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: The debris will be transported by: C The debris will be received by: /'V0 Building permit number: Name of Permit Applicant �e-t-f 2 Se7 Date Signature of Permit Applicant City of Northampton Massachusetts �:• lr-" OW DEPARTMENT OF BUILDING INSPECTIONS xli 212 Main Street • Municipal Building '�:_-n•� : Northampton, MA 01060 ss -•7•••1�'� 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 I The Commonwealth of Massachusetts Department of Industrial Accidents ti ® ace o Investi ations . - .ff f g 600 Washington Street ' f Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -3-l°rC g�-2 �C, c✓��✓ e Address: cR I 0�'p /',C- oOYv City/State/Zip: c c, ✓o Phone#: 4 7'7 Are you an employer? Check the appropriate box: Type of project(required): 1.XI 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) ❑ I 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 ve workers' and ha 9 ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ 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. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.® Other �� r n 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. $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 mustprovide 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: /7'�1 -ry r-&f C!,1411c,-1i'1�1f("-r .�A --S 4 Policy#or Self-ins.Lic. #: 29— Expiration Date: 6 Job Site Address: 7� S � �.-� � City/State/Zip: F/ /d6 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 par an penalties of perjury that the information provided above is true and correct. Si afar Date: Phone# Of use only. Do not write in this area, to be completed by city or town official City or Town: PermitUcense# 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 87 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ s- Name of License Holder: Q ere r T License Number Address Expiration Date Sign Telephone Not Applicable £ Registered`.Homeambve nt rome Contractor PP Company Name �^ -Registration ^fNumber h"C C,4J-e-e ffo/5, 9 Address Expiration Date /� Telephone /74-1.5-3 C 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 4yvner.Egemptori 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, i i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [0 Siding [❑] Other[❑] Brief Des=tion of Proposed Work: et-r 4e w_ e 670 t) f LT e7 //o.ls e G c L orC Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa_' If New house aind or.additka-rrto exisdi—io "ousing .corn �ete_fF a follow�nr : 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? U 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 IJ c v "t 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 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 I, �Pr{r"i� /0�q/z �x r l rn/ S' as Owner/Authorized Agent hereby declar6 that the stat ments 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. Print Name e7- Signa Owner/Xgent Date - I Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Tbis column to be filled in by Building Department Lot Size Frontage t --- --� Setbacks Front Side L:" { R:= L:= R:= Rear Building Height Bldg. Square Footage t Open Space Footage ,— (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW � YES Q IF YES, date issued:! J IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW /1*,A YES Q IF YES: enter Book j Page, ? and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size,'type and location: S D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing, grading, excavation, or fifling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. RECEIVED - ' Llepartment use only:: �,. �i NOV ' 4 MIS a ol Northampton rrnit B Idin Department ;Ctrrh CutfDri+teway Perrnit t Ik DE 7 C "^ ' ca� i212 ain Street SewerlSepticAvatlty 4 >, �—_ oom 100 a/Vater/U1fa7�AvUabthty i.:.. Northampton, MA 01060 TwaSefls of5tructrJral Plans -�•.i=_Ji;+3 phone 413-587-1240 Fax 413-587-1272 PIof/Slte Plans APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfion fo be compleffed U office 1.1 Property Address: "_= = 779 RYAN RD BP-2016-0625 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 35- 160 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-2016-0625 Project# JS-2016-001042 Est. Cost: $5250.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO Const. Class: Contractor: License: Use Group: JEREMY SAWYER 106836 Lot Size(sq.ft.): 43385.76 Owner: RICE BETH M&JAMES W zonine: Applicant: JEREMY SAWYER AT. 779 RYAN RD Applicant Address: Phone: Insurance: 21 ROLF AVE (413) 478-1536 Liability CHICOPEEMA01020 ISSUED ON.111412015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE HOUSE & PORCH 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 11/4/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner