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38B-161 (3)
12 FORT ST BP-2018-1024 GIS a: COMMONWEALTH OF MASSACHUSETTS Map.Block: 38B- 161 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv� ROOF BUILDING PERMIT Permit a BP-2018-1024 Project JS-2018-001853 Est Cost S8800.0 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: A & J HOME IMPROVEMENT INC 101017 Lot Size(sc.ft.T 5575.68 Owner: DOLINGER ABIGAIL Zonine: URB(100)/ Applicant: A & J HOME IMPROVEMENT INC AT: 12 FORT ST ApplicantAddress.- Phone: Insurance: 60 WASHINGTON AVE (413)467-1500 (1 WC SOUTH HADLEYMA01075 ISSUED ON.•4/1112018 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 sienature: FeeType: Date Paid: Amount: Building 4/11/20180:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner LAO " F DeparVnent use only ---� City of Northampton Status of Permit ` - Building Department Curb Cut/Ddveway Permit 212 Main Street Se"r/Septic Availability Room 100 WaterNtlell Availability Northampton, MAO 1060 Two Sets of Structural Plans \ .:A phone 413-587-1240 Fax 413-587-1272 Plotf$de Plans Other Specify APPLICATION TO CONSTRUCT, ALTER REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION g/�c 8 -io A-L/ 1.1 ProoertvAtltlres This section to be completed by office `s:' y �j a FOC} Q12 1 Map '5P f Lot wt Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Ovmer of Record Ab 17 I n ,aQ la. Fo€+ 3r MoaiFam fin, MA Name(Pr t Current Mailing Address: Telephone L113 'ALJ. Leto Signature 2.2 Authorized Agent: O'U m/1 m " w +,+ I.. 1 0 11 h A. RA 16.) M QI07S Name(Pmt / Current Mailing ress'. i!G� �� 4r3 N47 isoo nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed brimitapplicant 1. Building $ ASO OU (a)Building Permit Fee 2. Electrical U V (b)Estimated Total Cost of Construction from 6 3, Plumbing Building Permit Fee 4. Mechanical(HVAC) 7 5. Fire Protection 6. Total= (1 +2+3+4+5) 00 oB Check Number This Section For Official Use Only Date Building Permit Number. Issued. r Signa Building Coioncrllmpector of Buildings Data EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Co,npleted. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This..loan to be filled in 1, Building Department Lot Size Frontage Setbacks Font Side L: k 1, R: Rear Building 1b,ght Bldg_Square Footage °o (men Space Footage % (l.ot encu minus bldg&pasta parkin') 4 of Parkmig S ages 1'111. volume&Lowtiov A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO (D DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES O IF YES: enter Book Page and/or Document at B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW () YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs W be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES © NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,orfilling)over t acre or is it part of a common plan thatwill disturb over 1 acre? YES 0 NO O IF YES,then a Northampton Storm Water Management Permit from the DPW S required, SECTION 5-DESCRIPTION OF PROPOSED WORK(cheek all applicable) New House ❑ Addldon ❑ Replacement W9ntlows Afteratlon(s) Q Roofing EVr Dr Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [OJ Decks [M Siding[p] 01 Brief Descd bon of Proposed Work . +nap f R c'N hyla Rnnt WA, p4m iso Sil 1 s Alteration of existing bedroom,Yes_No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes __No Plans Attached Roll -Sheet 5a.If New house and or addition to existing housing, complete the following. Use of building '. One Family Tvm Family Oilier b. Number of rooms in each family unit. Number of Bathrooms a Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Medved of heating? Fireplaces or Woodstovesi Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? I. 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. L Septic Tank_ CitySewer_ Private well City water Supply_ SECTION Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. I�OUK �O' gt}U� as Owner of the subject property hereby authorize uthorize toactonmybehalf, m aAmTJ ers eTal tivep to +I fY109D1YN'ter��s work Inuthorized by this building permit application. a DIS Signaturef owner J Data L A n A ) L Qrl- ,as Owner/Authorized Agent hereby declare tat the statements and information on fire foregoing application are true and accurate,to the best of my knowledge and belief. Sign//e��d under the pains and penalties of perjury. 1�Oun Print Name //5;—jz 3�9 -Jog re 610 erlAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:j� Not Applicable ❑ Name of License Holder Pil"AR2uJ Q19,er, jo(t)17 License Number 0107s- ll-IL-aZolq Address Expiration Date Signatu a Telephone 9 Registered Home lmurovementContractor: Not Applicable ❑ A+S }�- I mpg 'i' In 13x399 Commnv Name Registm5on Number 1\ CHIC» L,)_ I-,ZOlfi ACdress �� Expiration used Telephone V13 ZKe71J_&� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.154,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Faiiue to provide Nis affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes._ _ 0 No...... ❑ City of Northampton ss Massachvaetts V ; 1�. ra;PARIT1ENT OF BUILDING INSPECTIONS m` 212 Rain Street a lCorcipal 010 Building C< Nort➢a�tan, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR") regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four handy homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owneioccupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building'be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that ental must be registered Type of Work: Est. Cost: Address of Work. Date of Permit Application: I hereby cenify that Registration is not required for the following reason(s): _Work excluded by law(explain): _lob under$1,000 00 _Owner obtaining own permit(explain): _Building not owner-occupied Other(specifN): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L. Chapter 142A. SUCH OWNERS ALSO ASSUME THE RESPONSIBH.ITES FOR ALL WORK PERFORMED TINDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building peril as the agent of the owner. Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice. I hereby apply for a building permit as the owner of the above property. Date Owner Name and Signature City of Northampton Massachusetts m� J z 1 DEPARTMENT OF BUILDING INSPECTIONS 2 ,� 212 Myin Street Municipal Buildi� C� NoikLav¢[on, MA 01060 Massachusetts Residential Building Code Section 110 R5.1 2 Homeowners 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. Section I IO.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR l 10.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. 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. City of Northampton (t Massachusetts F ; DEPARTMENT OF BUILDING INSPECTIONS ;t 212 Main Street *M.u�i 01 Building � NoitTm¢ton, MA 01060 Fh. yn Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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. The debris from construction work being performed at: I a, &A &,, (Please print house number and street name) Is to be disposed of at: co" (Please print manne and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) l/�2 Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated,the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The ColuntonlVealth of Massachusetts DepartnteutoflndustrialAccidenis ICongress Street,Suite 100 7 = Boston,MA 02114-2017 { - rvrvshounr agolddia NA others' Compensation Insurance Affidavit: Builders/Contra,tors/Eleetricians/Plumben. TO BE FILED NCITH THE PERIDITM;AlTHORI f1'. Applicant Information Please Print Legibly Name(Ilosbmss final A&J Home Improvements, Inc. Address:60 Washington Ave.. Cite/Stale/Zip: South Hadley, Ma, 01075 Phone#:(413)467-1500 a.yon an empmcnr I Checkflm.pprnprmo mn: Type of project(required) I Mlamacmplo}'err,:@8__ _cmplo�ces(Inland'm partum') Z O Nuty coustNctid, 2.❑Iam a.olepmpriemr orpnrtnenbip andlems no mplo,ees vatk'me for in,in R. E]Remodeling ame,."maty.IN.arms," comp inmnn,e rcarried 1 9, ❑fire tno1al.ar iOl 1 men d ' II k If l\ '. Arepair.' . - e -' dl ❑I homes d 'Il be trot 't dmet ll - I p Po', 1-11 IOQI3nllditlg uddllion 4- that all cont,actovdlherh rodeo compensation ¢+manors or are aide ll.❑Electoral repairs or additions pmparmn marc andn's , 12.r1Plmnbingrepair or additions 5[3I amp ecneralcormcpa and l lmv,hired the sulecontmcton linadmt lhconad,edshcct- 13.2]Roofmpous Th bus I _1 wnPl d h rood p.-untrance.' 6n%%r gory ri 1'teolll, 1 'i.cd,h hlI mplionper�IGI,c. 14-QOlhct _ - 152.§10),and-have na empinrem.Isro..'kers'comp.insurance rrldrap t I sans-iliphorttht esters on,-I m-tal,'fll—1 h. h her.,'afo insthe" ke - lap toon poics''rd r I dome.•nun sn—cl nd tl',atFdmil-mchrome cc%arc done all work and open hire outside isincractme must:ubmita missaffidavitirucomeeach - ;Contradon tbar dmckthis hos must.1malicd an additional sheet shmdae the name of the sub-con rromrs and slate x[rather or not those cautias has mark,ees lflhoaub<undmcwn M1aw wPWpers,Wel a,,coca id,their'cukem- amp.Police romiluen. I an,an e..piolrr that is prosdding n'a,iln'emtipensation insurance for ory empic reel. Heloae is the policyand job site information. Insurance Conipam Name'.Charlis Policy#or self-ins-Lic-#:WC003796174 Espimtion Date:05/11/2018 Job Site Address Q FQa+ &IiC8y/Smtelzil, 11A Attach a cops of the porkers' compensation policy declaration page(showing the policy number an expiration date). Failure to secure.",'crag,,as required under MGL c. 152,§25A is it criminal violation punishable by a line up to$1,500,00 and/or one-vcur imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and It lint of up to$25200 is do, against the violator. A cops of this statement ndav be Iorparded to dile:Office oftmcsaga ntim of the DIA for insuranw overngc I enfirutlon. I do hereby certify under th•pains anrt penaia'es ofperjaq,that the lnfortnaum provided above is true and corren. Siguotoce l f->� D t 3 9-�Otfr T Phone#'(413)467-1500 Official use only. Do not wine in this area,to be completed by chy or lotrn officfai Cit'an Topn: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.Cityrrop'n Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: �fo A & J Home Improvements, Inc. _ 60 Washington Avenue • South Hadley, MA 01075 , ,.�' Office / Fax: (413) 467-1500 • Cell: (413) 575-1290 _ AJHomelmprovements@yahoo.com HIC Lic# 135399 • GAF-ELK ID# CE17267 • CT Lic#600705 /CS, SL, RF, WS# 101017 Proposal Submitted To: Phone k's: )98 131 IJ/i ✓ Home. Cell: / Street City, State, Zip Code: No^1 hu kid 0 � U'House ❑ Garage ❑ Other Proposal to furnish and install the following: ❑ Re-Roof ear-off O Gutter -) -1 , C^ Op Poi C4, Complete Roof Preparation Home exterior to be protected by tarps and plywood I ° c I cs c W�Shrubs, landscaping, trees to be protected U'Roofers buggy shall be used where accessible with permission from owner a"Entire existing roofing material to be removed to existing decking, including flashing, etc. 'Site to be cleaned everyday with roll magnes debris removed at project completion (included in price) UDeteriorated existing decking replaced at ,75 per sheet plywood (only if needed) hite/ rown 8 inch meta drip edge installed at eaves and rakes J White/Brown 5 inch for re-roof only New Flashing will be installed where necessary / ' stall lead to chimney Y/0 stall new pipe boot flashing We shall acquire all appropriate permits etc, for all roofing work Complete Roof System -J 3 x We propose hereby to furnish maty IaIs and labor - complete n accordance with above specifications for the sum of: SOCA SSc[� Total Sale Price $ Down Payment $ -3 ,5(iG Upon Completion $ (jO(" ACCEPTANCE OF PROPOSAL: The above prices, s tons and conditions are satisfactory am are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion. Unpaid balances shall accrue with interest at 16% per annum. Purchasers) will pay for all costs, expenses and reasonable attorney's fees incurred by A & J Home Improvements, Inc. to recover an(ysums due under this contract. Data% mL.2 ) 6 Signature: �4i Phone # y13 Date: Estimator's Signature: ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage ® Commmoomvealth of -0assarhusdfs Divi n of Pmfessonal Licensure Board of Building Regulations and Standards CSSL-101017 Expires. 11;1612019 ANDREW J DEREN 60 WASHINGTON AVENUE SOUTH NAOLEY/MSA 01076 04 Commissioner Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration[ 135399 Type: DBA Expiration: 4/1/2018 Tilt 419291 A & J HOME IMPROVEMENT ANDREW DEREN 60 WASHINGTON AVE. - - - - - - -- -- SO. HADLEY, MA 01075 Update Address and redo..card.Mark reason for change. Address Renewal Employment - Lost Card OtPee o[Coosnmer Affairs&Buslaess Reguladan License or registration valid for indi return to:only HOME IMPROVEMENT CONTRACTOR before of Consthe umer Affairation if found rens Reg: Registration: 135399 Type: 10 Pec of Consumer Affairs and Business Regulation Expiration: 411/2018 DBA B Park P MA va 5170 Boston,b1A 01116 A&J HOME IMPROVEMENT ANDREW DEREN 60 WASHINGTON AVE. SO. HADLEY, MA 01075 Vm1 ,a,,rd rp Not valid without signature AIE �^�H CERTIFICATE OF LIABILITY INSURANCE D5/11 2017 ' 5/17/2.17 THIS CERTIFICATE IS ISSUED AS A MATTER OF NOFORMATION ONLY AND CONFERS NO, RIGHTS UIRCN THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE FOLLOWS BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cer ifiCale holder IB an ADDITIONAL INSURED,the polHadles)..at be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an eadorsemaa A stMeTlrerM on this ce UiwM does rpt. r .r rloht6 to the certificate holder In lieu of such endorsements). PROOUCER qM E:G Mine £dgett Webber 6 Grinnell rz?.lla cul (413)SBfi 0111 :faG NHP 1913)5eE-6991 E-MAIL aed ett@webberandgrinnell.am 8 North Hing Street AODaBss _4. _ _ . _ INSURSIONAFFORDINGCOVERAGE _ _ _.MAIC• Northampton MA 01060_ Neu..RAEnduranoa(XS Brokers INSURED INSURERO$a$ety Iib. Co- CAR AEJ Home Improvement, Inc. NOURERC Chant./Claett _ Attn: Andy J. D¢ren INauREe.g.fety Indemnity 3_3618 _ . 60 Washington Avenue _ IN6URFR E. South Hadley MA 01075 IxsuRER F: COVERAGES CERTIFICATE NUMBERExp 11/17 REVISIONNUMBER: THIS 15 TO CERTIFY THAT THE R'kIC1E5 Q=INSIMZPNCE LISTED BELOW HAVE OEPN ISSUED TO THE INSURED NAAfED ABDVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REGUIRE:SENT, TER„ OR CONDITION OF ANY CONTRACT OR OTHER DOCpNENT WITH RESPECT TO WHICH THIS CERTIFICATE ',TAY HE ISSUED OR TAY PPRTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TER6!5. EXCLUSIONS AM1DCONOITIO%S OF SUCH POLICIES.OUTS SHOWN';AY HAVE BEENREDUCED BY PAIDCLARdS. _ WNi:_ rypEOFIN..NANCE POOL WBR Paula...IS IMMI Y Y % OMl6 VA, XCOMMERc1ALOENERALLIASI111Y EACNIX:CURRENCC 1,000,000 'OP AGEYO RELut 5 100,000 CBce.....oi500 9/22/203'1 9/22/2019 p. DE% ( / IX':mn) 5,000 i --- - - - Kn.p..ADVI,WURY 1,000,000 G %L AGORECATE L'.IT A°P_UES PER PR%ERALACCITTGATA a 2,000,000 X FC_ICY' PNa LW I. CTS Cc'AFCP nGG 5 _ 2,000,000 OILER AUTOMOBILE LIABILITY �(E , ,All ATHA 'VG 5 1,000,000 ea]ILV INJVi2V(Pe,persenl B A1IRL3 JEO X S'1VFLJLEO 6244816 11/29/2036 11/29/2017 `m'FR LflVIPe,W.Yt'h 1 Al1TO5 AUL.NCCJ;\ED I Lgr_ n AGE -- 5 X H•flEDPUT05 IX 'AVTOS ,IP 'Goll _ P,P-ease3 e,o.o UMBRELLALIAB .,IF F'ACN CGCURRERCE. a E%cies LIAE O.A"'S!IA!i NGREG9iE 5 050 R-TE iC,S 5 WORKERS CCOAMMATION WC00PH`Iil9 X $TATVTE ERN ANDEMPLOYERS'UASILITY .ANY PROPRIETORRAT R'ESECVTIVc YyN.NIA 'An$'ma'.. lc e%c lutleE E EAL4 ALe C5N1 $ 5001000 CII-EVIIER E%CW.-D? g®{prsarx crasaacaan. 15/11/2017 6/11/2018 E L C EVER EA E'.IPLOYEG S 5001000 C (Man0zlay N ch IOlcS�RPiIO.V GOi'EflAtiC:J 6 Fe'an EL 0STAFF-POLICY LIMIT S 500 000 D AuiOmllblle Liability 6291093 33/29/2016'31/29/2017'Comtinatl 611 A 1.1 E $1,000,000 Andy or. c $8,000 OEECRIPTON OF OPERATIONS I LOCATORS I VEHICLES (ACORO IDI.AdINI.-1 u1NN.S-AN.H1e,may r-ANS-SPI-1 npe[e b Ie'R"'l CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OUCR19E0 POLICIES BE CANCELLW BEFORE THE E%PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOW3EDREPREBENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INH026✓menn