43-125 (3) B -2022-1057
11 GREENLEAF DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
43-125-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1057 PERMISSIONIS HEREBY GRANT4D TO:
Project# ROOF Contractor: License:
Est. Cost: 11050 A&J HOME IMPROVEMENT INC 101017
Const.Class: Exp.Date: 11/16/2023
Use Group: Owner: C. KELTING-DIAS, DEVON L&JAC*UELINE
Lot Size (sq.ft.)
Zoning: WSP Applicant: A&J HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
60 WASHINGTON AVE 413-575-1290 WC531S621875010
SOUTH HADLEY, MA 01075
ISSUED ON:08/26/2022
TO PERFORM THE FOL LO WING WORK:
STRIP AND RE-SHINGLE
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
tli/lAtAA .y9 . e •
I(r
Fees Paid: $40.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Office of the Building Commissioner
REc�
IL. The Commonwealth of Massachus s � '!.f
Board of Building Regulations and S dar aUG 2 FOR
Wit Massachusetts State Building Code, 7 0 o R 5 (-0 9 US 2TY
Building Permit Application To Construct,Repair, ate ' a R ised ar 2011
One-or Two-Family Dwelling HAMPr7N INsp�C_
This Section For Official Use Only ^�q°l os°'' ;
Building Permit Number: C, )-J ' ,�t/ Date Applied:
4)0 100.55 ' ' 6-as-2 2
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property,Addrgss:, - 1.2 Assessors Map&Parcel Numbers‹
13ton u �+5
1.1a Is this an accepted street?yes no Map Number Parc'et umber
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) • Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 pr'er'of Record:
brim) haRRl( 3von Flocs , c{ PA
Name rin, � � City,State,ZIP
13 M 'tn ?Q MA&
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other IVSpecify: Roo{
Brief Description of Proposed Work': & iP Pi4S+n As Oak Sh nEr kis Ce lJ� ),n'e''l
new Tarn Kb 3Inn3Lt O(r t aceiso,w5
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1 I i O513,0, 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:14
Check No n /Check Amount: Cash Amount:
6.Total Project Cost: $ 1
0jo.ot, 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) WW1 1 l 1• 8
33
AInd , Dt>u, Expiration�-� to
Y'� License Number Date
Name of CSL Holder
(AD W asl' t tc 1 List CSL Type(see below) lk
No.and Street V�I fJr1 Type Description
C`O .A'1 ('F 11 l p U Unrestricted(Buildings up to 35,000 cu.ft.)
J ' R Restricted 1&2 Family Dwelling
City/Town,State,ZIP A Masonry
tORoofing Covering
Window and Siding
r',co SF Solid Fuel Burning Appliances
43 �75 Iala0 l6\,o 't impttovetn a s(�Y c,,,, I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) L
[ I �� i �I✓ 2 3 a F- (O
SHIC Registration Number Expiration Date
HIC Company yNNaame or�gistrant Name _[,��_ `
No.and Street i J7 & �'��eirnpaw-ey4 ev4-5 e.MC 02-CP h
Qct Hai 1(4- a107E &/?3 S2S!�g0 1 Email address
City/Town,State,ZI Telephone
SECTION 6: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 Issuanc f the building permit.
Signed Affidavit Attached? Yes No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Pi (Tu MA Yt1
to act on my behalf,in all matters relative to work authorized by this building permit application.
Sec. egitx him t,- $'d2 -a()1 A
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or A onze srt's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches _
Type of cooling system Enclosed Open _
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
ri< Mr>oti `S • s c
y 'i. Massachusetts ��� x- 4C.
;c c
g �.F t 6. DEPARTMENT OF BUILDING INSPECTIONS
�'y''+: r •l" 212 Main Street • Municipal Building vti Ca
:: Northampton, MA 01060 sSi , ar3 %
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Co..Si1c( 4-6Yt0t,
The debris will be transported by:
Name of Hauler: CC€ 1 )
NN
Signature of Applicant: A Date: S''d)-A),
�
The Commonwealth of Massachusetts
■ * ' 3 Department of Industrial Accidents
Office of Investigations
600 Washington Street
kit
..R Boston,Mass. 02111
wiirw.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians%Plumbers
Applicant Information n Please Print Legibly
Name(Business/Organization/Individual): ' 11J 1 J€ 1✓Y1(J!"..Dxmeti'lis- I AL
Address: £l) L)424)i t1G ,� )
City/State/Zip: S D A `•J Nod Li MA 01075 Phone#: f 13 L/6 7-
Are you an employer?Check the appropriate box: Type of project(required):
1. I am an employer with 3 4. 0 I am a general contractor and I 6. 0 New construction
employees(full and/or part time).* have hired the sub-contractors7. 0 Remodeling
2. 0 I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have S. 0 Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers'comp.insurance comp.insurance.#
required] 5.0 We are a corporation and its 10. 0 Electrical repairs!or additions
3. 0 I am a homeowner doing all work officers have exercised their 1 I ❑plumbing repairs or additions
myself [No workers'comp. right of exemption perm MGL
insurance required)t c. 152,§ 1(4),and we have no 12. [t .00f repairs
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.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contactors that check this box must attach 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. / 11 1��U RO t
InsuranceCL Company Name:
Policy#or Self-ins.Lic.#: �A.C. 5 3(I^5 0 t 7 D O I t Expiration Date: .5/1l/ )j.)3
Job Site Address: t Ll Gt�h L�} `4J4 City/State/Zip: f V-e• }-('i&
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 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
$250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certi /nder th ' s and penalties of perjury that the information provided above is true aid correct.
Signature: /L ' -4-4_ Date: S ^a
Print Name: skew d )p kit Phone II: '1i3 5-75 i 19 6
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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone#:
Commonwealth of Massachusetts
Division of Occupational Licensure
Board of Building Regulations and Standards
ConstructiqiitigupeiNk9rSpecialty
CSSL-101017 y FJcpires: 11116/2023
ANDREW J OREN
60 WASHINGtON AVENUE
SOUTH HADL'FY MA 01075
r1 •
1 l�
nO1.J,v�L'l
Commissioner d)r'ad.2a f;. 51c1-0?tl'.ta..
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
A&J HOME IMPROVEMENTS INC Registration: 034862
60 WASHINGTON AVE. Exxpipi ration: 03/29/2024
SOUTH HADLEY, MA 01075
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS'
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
204862 03/29/2024 Boston,MA 02118
A&J HOME IMPROVEMENTS INC
ANDREW J.DEREN
60 WASHINGTON AVE. 1/ Gholz'
SOUTH HADLEY,MA 01075
Undersecretary Not valid without signature
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"Y"Y)
`..� 05/20/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
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 certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: JoAnn Casa9randa
FOLEY INSURANCE GROUP INC.No, (413)214-7474 a No:
E-MAIL Casa rands ole Insurance rou com _ADDRESS: ) 5/ Lf y g P
37 ELM ST INSURER(S)AFFORDING COVERAGE NAIC 0
WEST SPRINGFIELD MA 01089 INSURERA: LM INS CORP 33600
INSURED INSURER B
A&J HOME IMPROVEMENTS INC INSURER C:
INSURER D:
60 WASHINGTON AVE INSURER E:
SOUTH HADLEY MA 01075 INSURERF:
COVERAGES CERTIFICATE NUMBER: 776924 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE INSD SUBR POLICY NUMBER POUCY EFF POLICY EXP LIMITS
tMMiUDlY1rYY1 (MMlpDIYYYY)
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS MADE OCCUR DAMAGE TO ETCITED
PREMISES(Ea occurrence) S
MED EXP(Any one person) $
N/A PERSONAL d ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S
POLICY JECT LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $_
ALL OWNED SCHEDULED AUTOS AUTOS N/A INJURY(Per sodden)) S
HIRED AUTOS — NON-OWNEDtUT PROPERTY DAMAGE
$
t)
UMBRELLA LIAB _ OCCUR , EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE N/A AGGREGATE S
DED RETENTIONS $
WORKERS COMPENSATION X RER 11TE ERH
AND EMPLOYERS'LIABILITY Y/N
ANYPROPRIETOR/PARTNER/EXA OFF CEO/MEMBER EXCLUDED? N/A
WA WA WC531S621875012 05/11/2022 05/11/2023 E.L.EACH ACCIDENT $ 500,000
(Mandatory In NH) E.L.DISEASE-EA EMP.OYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000
N/A '
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the abve policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/Iwd/workers-compensation/investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Battistoni Contracting Inc ACCORDANCE WITH THE POLICY PROVISIONS.
534 Market Hill Road
AUTHORIZED REPRESENTATIVE
Amherst MA 01002 Daniel C�
M.Cro9ey,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
A & J Home Improvements, Inc.
'� 60 Washington Avenue • South Hadley, MA 01075
%� TAMKO Pro f' r
\ Office / Fax: (413) 467-1500 •• Cell: (413) 575-1290 CERTIIIED CONTR CTOR ,
�- t AJHomelmprovements@yahoo.com +'�`` 'r,
HIC Lic# 135399 • CT Lic# 600705/CS, SL, RF, WS# 101017
Proposal Submitted To: Phone#'s:
GF--; Cti 6 \ hc, r f`14^ 'L ,1 Home: Cell:
Street: J
t +l&NO1j �C er1 t7 cc �"`� �� r"` i C� Ga1-1 lfcn
City, State;Zip Co
A.--
t'l C
C 1 Cl /n ( e tVlL'( f. S
C Q g CI Garage Other
Proposal to furnish and install the following:
❑ Re-Roof ❑ Tear-off ❑ Gutter
Complete Roof Preparation
&Home exterior to be protected by tarps and plywood
IA Shrubs, landscaping, trees to be protected
0-
i Roofers buggy shall be used where accessible with permission from owner
-Entire existing roofing material to be removed to existing decking, including flashing, etc.
0 Site to be cleaned everyday with roll magne ebris removed at project completion (included in price)
el Deteriorated existing decking replaced at per sheet plywood (only if needed)
Jj hite row 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only
6 Vew flashing will be installed where necessary / install lead to chimney
Vipstall new pipe boot flashing
tU We shall acquire all appropriate permits etc. for all roofing work
Co plete Roof System ❑ 3 ft.
rW ce & Water Barrier installed at the eaves to protect from ice dams (and meet code in they north) 19.6 ft.
& Water Barrier installed at all valleys, around penetrations, and ch�s to protect critical areas
Y 15 pd. Reinforced underlayment installed over entire deckin / Synthetic roof underlaym nD
'install Ridge Vent
S,h/ingles:
m"Tamko Series ifetime 50 Color
C/famko Ridge Cap Shingles '0
t
War my G07.)__14- L. n
Re We guarantee our workmanship for 10 full years ❑ Quote go d for 30 days
We propose hereby to furnish materials and labor - complete ' dance with above specifications for
the sum of:
,.J Site to be cleaned everyday with roll magne ebris removed at project completion (included in price)
61 Deteriorated existing decking replaced a per sheet plywood (only if ne ded)
Zi`�-hite Brown 8 inch metal drip edge installed at eaves and rakes CI White/Brown 5 inch for re-roof c
a/e-w flashing will be installed where necessary / install lead to chimney
O'I s tall new pipe boot flashing
g
e shall acquire all appropriate permits etc. for all roofing work
Corr�plete Roof System ❑ 3
ce & Water Barrier installed at the eaves to protect from ice dams (and meet code in the north) -6
& Water Barrier installed at all valleys, around penetrations, and chimneys to_prbtect critical areas
id 15 pd. Reinforced underlayment installed over entire d eckin Synthetic roof underlayment
install Ridge Vent
Shingles:
/
0"Tamko Series _ ifetime 50 Color
4V amko Ridge Cap Shingles f
Warranty �eli,� ��t
YWe guarantee our workmanship for 10 full years ❑ Quote 11
o d for 0 days
s
g p ys
We propose hereby to furnish materials and labor - complete _. eQr ance with above specifications for
the sum of: \
Total Sale Price $ /4 ['),5-4) Down Payment $ (%) 3 Upon Completion $ e),3
ACCEPTANCE OF PROPOSAL: The above prices, sp'cifications d conditions re satisfactory a
are hereby accepted. You are authorized to do work as . Payment will b0 40% down upon
signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per
annum. Purchaser(s) will pay for all costs, expenses and reasonable attorney's fees incurred by
A & J Home Improvements, Inc. to recover any sums due under this contract.
/
Date: r '�� �--
c J`� Signature: `� Phone #
Date: 5.-/t) -,l 1. Estimator's Signature: � ., ,�
ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage areas due to the
possibility of roofing debris or dust coming through cracks of the wood. A& J Home Improvements, Inc. will not be
responsible for debris or dust in the attic or storage areas.
Mas;tc-aid VISA ..r�cRiuw DiS(
EXPRESS