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22D-022
199 RYAN RD BP-2019-1396 GIS 4; COMMONWEALTH OF MASSACHUSETTS Mno:Blm :22D-022 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 Pennit# BP-2019-1396 Project# JS-2019-002245 Est.Cost:$8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JEREMY SAWYER 106636 Lot Size(sa. A.): 13634.28 Owner: HINDS RONALD E Zoning:URA(IOO)/WSP(100)/ Applicant: JEREMY SAWYER AT: 199 RYAN RD Applicant Address: Phone., Insurance: 121 WEST STATE STREET (413)478-1536 WC GRANBYMA01033 ISSUED ON.•6/612019 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: Drhv ..y 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 OccuoancY Sianeturc: FeeTYpe: Date Paid: Amount: Building 6/6/20190:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner Depa ment use only City Of N rthep on tato of Permit ..>� Building )epa tment curb uVonveway Permit �(.. 212 M in S eJUN - 5 2019 sew /Septic Availability Roc 10 Wate(Well Availability Northampt n, IN Iy$pEC 10 coo ets of Structural Plans phone 413-587-12 - w"Fa .To Ploy ite Plans Omer Specify 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 comp Nbd by am" � , Map 1br0 Lot 00, Unit F�o f!n c A 0106 .X Zane Overlay District Elm SL District CB DisMI% SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: moo - N, dr i� q /1� � dzoC Name(Print) Cumm Mailing AE rew: gay - 9�ssi TeleP ane Signature 2.2 Authorized Agent: /J / L7 Sfc-/c Sf (sr c.. 63 //190X3 ? Name(Pdra) Current Mailing Address'. eture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 8 3. Plumbing Building Permit Fee 6. Mechanical(HVAC) 5. Fire Protection ��, "'""" 6. Total=(1 +2t 3+4a5) DO Check Number This Secaon For OBkiai Use Only Building Permit Number Date Issued: 1- 4 -2611// A Signature: C- 4 -261!1 Building Commissioner/Inspector or Buildings Data EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information A4at Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This colunm to be nBed in by Building DVidur m Lot.Size Frontage Setbacks Front Side L R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage not area minus bldg @ paved #of Parking Spaces Fill: volume @Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW N' YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOWYES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW .® YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES Q NO V` 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 IF YES, describe size, type and location: E. Will the construction activity disturb(cl aring,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? VES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. I SECTION 5.DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ rRploacement Windows Alteration(*) ❑ Roofing orsDAccessory Bldg. ❑ Demolition ❑ Signs Iol Decks [0 Siding[0] Other[0] Brief Description of Proposed Work: L'n� /cr� 56.. . r�ouF Alteration of existing bedroom_Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement _Yes k No Plans Attached Roll -Sheet sa. If New house and or addition to existing housi 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? 4 f 3' d. Proposed Square footage of new construction. Dimensions e. Number of stones? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached? In Type of construction 1. 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_ Pnvate well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Qo , /I rn ds as Owner of the subject property hereby authorize elf�., sF u to act on my behalf,in all matters re 've to work itonzed by ;is building permit application. 5 Z//Zi P Signatuereeof-Owner D is I, \ t rf S as Owner/Authorized Agent hereby declare t at the statem sand 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. Prim Name S �f re of Qwwr/Agent D SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Nam.of License Hddar: .J pr r,.r �c ria.. — /068'36 License Number 0/0375� Address EMpi ion Dat ,SprFture Telephone 9._Reaistered Home Improvement Contractor: Not Applicable ❑ /9 /,7ysa � Company Name Registration Number /1r C.J S 'ia {e Soi- 0/02-7 a/ Sia / Address E%PI 'pn D Telephone yJt/S-.46 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.18T,s 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this applicator. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton j Massachusetts DSPARI4ffiir Or SDILDINO IN3PSOTION3 112 Mein atrwt a l icipal Build. ng MOrtA ton, rat 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 family homes.Prior to performing work on such homes,a contractor most 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 owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or buildin j'be done by registered contractors. Note.If the homeowner has contracted with a corporation or LLC,that entity must be registered. Type of Work: Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): 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 RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: 1 hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,l hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton t Massachusetts DEPARTMENT OF BUILDING INSPECTIONS /fI1 w 212 nein Street a Municipal Building J Y �• Northampton, M.N 01060 Massachusetts Residential Building Code Section I IO.R5.1.2 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. Section 110.85.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR I I O 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 Massachusetts s D212 M . S .. Mnici 36a illi.aBa 413 lYin rC mp •MuniciDBl Bvildiny aorNampton, w. 01060 Debris 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. The debris from construction work being performed at: /c/ 5 /�c, .c.. /lOt (Please print ho se number and street name) Is to be disposed of at: Alp r-4 k fay �,snwr� / �i 6 St Sor'nYp'eld r ,09 oiiey (Please print name a location of facility) Or will be disposed of in a dumpster onsite rented or leased from: " r4A S 1�- 1J, s/lelo/ (Company Name and A m ) Si ermitAcant or to 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 Commonwealth of Massachusetts WNI'orkers'Compensation Department of7ndustrialAccidents 1 Congress Suite 100Boston, MAA 021 02714-20777www.mass.gov/dia Insurance Affidavit:Budden/Contractors/6lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/OrgmizatioNlMividual): :::Sjrrrrs) Adilmss /> / G,1 S 74e -/ e S f City/State/Zip:nra, n65 dia o /so] Phone#: rr-/S76 Are you m employert Ch«k the appropriate box: Type of project(required): 1.®1 am a employer with .5 employees(full avNor pan-time)• 7. []New construction 2.❑lamasole pvpiearor pzrmehtp and have no nwkwan working for me in S. ❑Remodeling any capacity[No workers comp.ivsurmnt organist] 3 l am a hameowmr doing all work rrsdf(No workers'comp.imumnce required.]t 9. El Demolition 4.❑lam ahorneowneraMwill b<hvin gamorsmcovdumall work nom 10❑Building addition gwv conY.roopertY. Iwill me wrap aammseiwrhave workep'wmpensetion msmmmem In 1LE]Electrical repairs or additions pmptiemrs with no em,lo'no 12. Plumbing repairs or additions 5 1 am.gement comment and I have lines the subconaamots lists on the onached sheet. Th13.4 Roof r eo sub-conoacmrs M1ave employees and Mve workers'comp.wuren<e t eparra 6.❑We area wrpomuon and iu Motors have exercised wv right of exemption per MGL c. 14.❑Oth" 152,§1141.and we have.employees_(No workers comp.wwame acquired.] *"'ay applicant Wet checks box#1 mart also fin out w.secuou below showing Weir workers'compensation policy int tion. t IM"..-1w submit Wis affidavit InJicming Wcy are doing all work and Ww hire outside coneacmrs most submit a new affidavit indicating such. :Coovacmrs Wert eM k Wis box must mmched an additional sheet showing w name of the sub-conaacmrs and now woolia or not Wow entities have employes_ Ifthe subconhacbrs have emdoYces.an,,,must l o'uk Weu workers'comppolicy nomeno /am on employer that is providing workers'compensadon insurance for my emplayees Below is rhe policy andjab site information. r� Insurance Company Name: -)—AL /ye(-]I-'Fe r G1 . Policy#or Self-ins.Lic.#: 6SL 0 I A .2 /1G/R e-/! Expiration Date: Job Site Address: /9 S QSe.. /lob City/Slatc/Zip:>=y ren er ..rat 61o&.2 Attach a copy of the workers'compensadon policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required and"MGL c. 152,p25A is a criminal violation punishable by a fine up to$1,500.00 and/or ane-year imprisonment,as well ins civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby cerdfy under the dpenalties ofperjury that the information provided above is true and comet Signature: - Date, -/S`3 6 t Oficial 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?own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: , Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workcn compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contmMor(s)morels),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be rammed to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sum that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit ficense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town):'A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Corrunonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 Tel.#617.727-4900 ext. 7406 or 1-877-M4.SSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia Shingles 0 HD Lifetime El Ultra HD Lifetime CyolDr I / !1 Ridge cap shingles Warranty Options: ❑ We guarantee our workmanship for 10 full years (see our warranty coverage) © Estimated Start Date / / -19 © Estimated Completion Date - i Chimney Options: ❑ Lead Counter Flashing ❑ 4" Box Vents(Black/Silver) ❑ 12" Box Vents (Black/Silver) We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Duefit fl D CC) 1 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions ere Down Payment satisfactory and are hereby accepted.You are authorized to do work as specified Payment will be 113 down at start of job,and balance due upon completion. Balance Due Day of Completion(>i 5_ -% 51 1 Do not sign unless all sections are filled out ---�I If 1 on/A C V Ni.J 0—C. � Date: `f Owner: (Print) _ (Sign) , nL Date: /0- /( , Estimator: (Print) —Tv.. ,., t , . , (sign)G�._.�: Estimates are honored for sixty(60)days from above date c a ' 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.A)1 Exteriors will not be responsible for debris or dust in the attic or storage areas. ALL EXTERIORS ROOFING-FLAT ROOFING-SIDING-WINDOWS WEARELICENSED REPAIRS-SNOW PLOWING FULLYINSURED Phone # (413) 478-1536 FACTORYTRAINED Fax It (413) 255-0125 OSHA CERTIFIED Jeremy Sawyer, President/Owner MA Registration#174528 HONEST&RELIABLE 121 West State St.,Granby,MA 01433 - CT Registration#0636067 ABexteriorsIftmall.com MA C.S.G.#106836 Proposal Submitted To: Date /r !i r Phone#'s C: Street Email: ��i i r7�, � /�Oh4 Id `"I�/"O S•O/O�Z �GWI Cc:i (� /12 City, State,Zip ode Special Requirements: f /Ole \. Recover ® Strip Complete Roof System ® We shall acquire all appropriate permits for all work El Home exterior and landscaping to be protected Do Not Do EJ Strip existing roofing to the decking and dispose of it in a proper landfill Q Deteriorated existing decking will be replaced at$75 per sheet of plywood after a full inspection. C1 Install Ice&Water Barrier at all eaves, valleys, chimneys, pipes and skylights (6'min. on all eaves) i © Instal(1�51b�faJt�Synthetic) underlayment over remaining decking area Install metal drip edge at eaves and rakes Un 5") ("I jbrewn/copper) Install manufacturer s starter shingle on all eaves Install new pipe boots(sEandariVeopper) 0 Install new vent ridge vent: Rigid) - I Shinales: C✓`f6 nails oer shinalel