24C-014 BP- 2011 -0335
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP- 2011 -0335
Project # JS- 2011- 000550
Est. Cost: $8200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(s4. ft.): 5793.48 Owner: PAPPALARDO THOMAS J & SARAH E SMITH
Zoning: URB(100)/ Applicant. NRB EXTERIORS INC
AT. 254 PROSPECT ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563 -6354 WC
GRANBYMA01033 ISSUED ON. 1011312010 0:00:00
TO PERFORM THE FOLLOWING WORK.- & 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:
FeeType: Date Paid: Amount:
Building 10/13/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
City of Northampton
Building Department
212 Main Street
Room 100 X54
Nort ampton, MA 01060
phone 413 -587 -1240 Fax 413 - 587 -1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 7 - SITE INFORMATION
This section to be completed by office
1.1 Property Address
Lot Unit
E
Zone Qverlay District
Emit St District CBDistrict
SECTION '2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Current Mailing Addr ss:
J i T'ti C�c �I � �`�t � ". __ Tel p
Q1 e t �e
Signature
2.2 Authorized Anent:
13 1
AP i
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building 1 (a7 Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit t=ee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) L1C� C� L> Check Number '
This Section For Official Use Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
. . ^
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
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage 010
Open Space Footage %
(Lot area minus bldg & paved
# of Parking Spaces
(volume & Location)
A. Has aSpecial ever been issued for/on dnesite7
�� �� ��
NO «_/ DONTKNOV� �~� YES ^��
IF YES, date issued:
IF YES: Was the permit recorded at the Reg ofDeeds
0 NO DON7kNOW 0 YES
IF YES: enter Book f Page and/or Document#
��
B. Does the �tecontain a brook, body nf water orvvetiands? NO «_ �� � DON7KNOVV «~� YES �~/
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tnbembtained � �btained »�� ���e Issued: — — --
«�� «�� ' 'L__-_________�
C. Do any signs exist on the property? �� �� � YES «�� NO x��
|F YES, describe size, type and location: |
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
|F YES, describe size, type and location:
E. Will the construction activity disturb (clearing, gradingexcavation, or filling) over 1 acre orinit part ufa common plan
that will disturb over 1acre? YESKl NO K l
�� ��
|F YES, then o Northampton Storm Water Management Ponnit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all avolicable)
New House ❑ Addition E] Replacement Windows Alterations) El Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other [a
Brief Description of Propose
Work: -z.�., � [ �, h "1 Q, k ; !` �,� w [ 1 �� —�/ ;v 'y r c?�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
" her i' d' 'rQ _ �"iv`
6 ar ,i�.�teirr� ai�t�t��ealt;��ac� 7� � r_rib���
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.
I. Septic Tank City Sewer Private well City water Supply
SECTION Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES F.OR BUILDING PERMIT
I, i -'� °I /�� G'. Ca as Owner of the subject
property �/ a
hereby authorize [J
to act on my behalf, in all matters relative to work authorized by this Iluilding permit application.
Signature of Owner Date
I, V`�� �' ��' �' '� 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 u e pains and pepalties of perjury.
Print Name i
Signature of Owner /Agent Date
SECTION 8 - CONSTRUCTION'' SERVICES
8.1 Licensed Construction Supervisor Not Applica ❑
Name of license Holder 1 v -\ �1 i k \ I r l� r `( C, �
License Number
Address Expiration Date
Signa�rire Telephone
Realstercttrttte lrii'ter`iiiement.+tra>rta��t, y F 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...... ❑
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 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
T
The Commonwealth of Massachusetts
Department oflndustrial Accidents -
Office oflnvestigations
600 Washington Street
Boston, MA 02111
www.mass gov1Wa
- Workers' Compensation Insurance Affidavit: Builders/ Contractors /Elect- neians/Plumb.ers
Applicant Information Please Print Legibly
Name (Business/Orgmization /Individual):
Address:' s
G�(Ci Phone. #:
City /State/Zip: � � 4- ,, -
k kr e you an employer?. Check the appropriate'box: Type of project (required):,
1. am a employer with 4.. [] I am a general contractor and I 6. New construction
employees (fall and/or part-time).* have hired the sub- contractors
2..0 I am a sole proprietor or partner- listed on the sheet 7. ❑ Remodeling
ship and have na employees These sub -contractors have. .8. Demolition
working for me is any capacity. employees - and have work='
9ut3 ' _ ad$on
[No workers' comp. instance incnrarrP �_..
cep• - ' --
r aqua edl ] 5. We are a corporation and. its 10 .0 Electrical repairs or additions
officers havexercised their 11. PIUmbin 3. El I am a homeowner doing all work F ❑ g repairs or additions
myself o workczs' co of exemption per MGL
Y comp. 12: []. Roof repairs
insurance required.] t c: 152, § 1(4); and we have no
amp to [N
o workers' 13.0 Other
.. y ees.
comp. msuraace required. ].
'Any applicant that checks boX #1 must also fill out the section below showing theirworl='. comp easatia 1 poficy'formation:
t Homeowners who submit this a$idavit.indicatmg they are doing all work and the hire outside contractors must submit a new affidavit indicating such.
TConuactors that check this box must. attached an additional sheet showing the name of the sub - contractors and states whether or not those entities have
employees. 'If the sub - contractors have employees, they must provide their workers' comp..policy number
lam an employer that isproviding workers' compensation insurance for my employees Below is thepolicy andjob site
information.
Insurance Company Name:
Policy # or Self-ins. Lic #: / L) Expiration Date: li
J ob S ite Addr t / S r L 1 ' 1 5 City /Sta&zip: �+ � � c, -- ;'',�✓ ='1 /`
Attach a copy of the workers' compensation policy declaration page'(showing the policy number. and eairation date).
Failure. to secure coverage. as required biid&.Se6tioa`25A '6f MGL'c: 152 sari Iead'to 8ie 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 fire
of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
IiNest satibns of the DIA for insurance` coverage verification
I do hereby certify.. _ the p ; and penaUes ofperjury thafthe uformation provuded�bavE is�riiE_andcnrrect___
Snature. - .._.. - Date: F ,�
Phone #:
Official use only. Do not write in this area, to be completed by city or town e7cle
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2_ Building Department 3. City/Town Clerk .4. Electrical Inspector 5. Plumbina Inspector
6. Other
Contact Person: Phone #:
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 person(s) who seek to use
the home owner exemption, - to act as their own construction supervisor, 16 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 occunancv
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
�ermits 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
Date
Address of work
location
n�er tt�e C01
Fully Licensed and Insured e; t'e�zr��� 7 Philip Cir Granby, MA 01033
-----------�
MA Reg #: 20= 2015718 ' a Phone: 413- 563 -6354
MA Lic #: 147961A Specializing Fax #• 467 -9748
MA CSL #: 99565
Authorized GAF/ELK Roofing NICHOLAS BERNIER
(Owner)
Contractors
www.nrbexteriors.com EXTERIOR HOME IMPROVEMENTS, Inc. www•nrbexteriors.com
ROOFING & SEAMLESS GUTTERS
Windows - Siding - Decks
Residential - Commercial
Pro sal submitted to: Phone# h: �-1 �� c:
� PC4O Ai5
Special requirements
Street
City, state,zipcode \
Proposal to furnish and install the following
❑ Re -roof i' Tear -off utters
Complete Roof Preparation
, ff - Home exterior to be protected by tarps and plywood
.2- Shrubs, landscaping, trees to be protected, roofers buggy used
,2 Entire existing roofing material to be removed to existing decking, including flashing, ect
Site to be cleaned on a daily basis with roll magnet, debris to be removed at project completion by dumpster
0' Deteriorated existing decking to be replaced at $50.00 per sheet of plywood
9"" New flashing installed where necessary
Install new pipe flashing to waste vent stacks
Complete roofing system
41' Install ice & water barrier along bottom 3$ of all roofs
,.0' Install ice & water barrier around penetration, in valley's, and all critical areas
�-- Install 151b reinforced saturated felt paper to entire decking
�P - Install breathable synthetic deck protection to entire decking
- P-' Install 8" perimeter flashing to all edges of all roofs W white ❑ brown
-9- Install pre cut starter shingle to bottom and rake edges of all roofs
-B° Install GAF Prestigue High Def Shingles to manufactures specs Fusing six nails ❑ using four nails
fr'� Install Cobra snow country ridged pvc ridge vent to all peaks in heated areas
-1-' Install GAF ridge caps to hips and over ridge vent
,B'' Install new lead counter flashing to chimney
Warranty options
We guarantee our labor for 15 years GOOD
❑ GAF -ELK 10 yr smart choice roofing system warranty for 100.00 BETTER
❑ Upgrade GAF -ELK 15 yr weather stopper roofing system plus warranty for 200.00 BEST
El GAF-ELK Prestigue High Definition - color: w ✓ r � 30 year ❑ 50 year
Acceptance of Proposal:
The above prices, specifications, and conditions are satisfactory and hereby accepted. Payment will
be'' /z down upon signing and balance due upon completion.
Total sale price: do yment: � C.) upon completion:
Customer signature: date: ,¢4, ) 0 phone #:
J
Authorized signature: date: