24A-068 TOTAL COST $7,555.75
SEVEN THOUSAND FIVE HUNDRED AND FIFTYFIVE DOLLARS AND SEVENTY FIVE
CENTS
NO'1'E:CONIRACTOR WILL INSTALL HALF INCH CDX PLYWOOD OVER EXISTING
SHEATHING AFTER ALL ASPHALT SHINGLES ARE REMOVED FOR AN ADDITIONAL
$2,600.00 WHICH IS 52 -4'X 8' SHEETS OF PLYWOOD AT $50.00 DOLLARS PER SHEET
INSTALLED.
FROM WHAT CONTRACTOR VIEWED FROM LOOKING IN ATTIC AT THE
UNDERSIDE OF ROOF SHEATHING CONTRACTOR DOES NOT BELIEVE IT WILL
NEED TO BE GONE OVER.
CONTRACTOR TO SUPPLY ALL MATERIALS,LABOR AND EQUIPMENT TO DO JOB.
CONTRACTOR TO PULL BUILDING PERMIT AND TO CARRY LIABILITY
INSURANCE.JOB WILL TAKE BETWEEN FIVE AND SEVEN DAYS TO COMPLE l'E.
CONTRACTOR TO DISPOSE OF ALL DEBRIS ASSOCLAIED WITH THIS PROJECT.
CONTRACTOR TO SUPPLY AN ON SI'Z'E DUMPS'I'ER.
PERMS OF PAYMENT ARE ONR THIRD OF THE TOTAL AMOUNT OF JOB DOWN
AT START OF JOB THIRD AFTER ALL EXISTING SHINGLES ARE TORE OFF
AND DISPOSED OF AND ROOF IS DRIED IN FROM THE WEATHER WITH WATER &
ICE SHIELD AND ROOF GUARD UNDERLAYMENT.THE FINAL PAYMENT TO BE
PAYED AT COMPLETION OF JOB.
THOMAS L. CHAISSON
GENERAL CONTRACTOR
H.I.C. #131023 C.S.L. #074671
/2/2-/ 7(
TRI- COUNTY CONSTRUCTION
1- 413- 522 - 4939
P.O. BOX # 1013
WENDELL,MA.01379
12/20/2010
MIKE STILES
63 RIDGEWOOD 'TERRACE
NORTHAMPTON, MA.01062
BID PROPOSAL
1.TAREOFF ALL EXISTING ASPHALT SHINGLES FROM ENTIRE HOUSE 1,645 SQ.
FT. WHICH INCLUDES 1,008 SQ. FT. FROM MAIN ROOF,247 SQ. FT. FROM FRONT
PORCH,193 SQ.FT. FROM REAR LEFT ROOF,188 SQ,FT. FROM REAR PORCH
ROOF AND ONE 9 SQ. FT. SIDE ENTRY ROOF.
2.INSTALL (GRACE) WATER & ICE SHIELD TO BOTTOM THREE FEET OF MAIN
ROOF AND THE ENTIRE ROOFS OF FRONT PORCH,BOTH REAR ROOFS AND
SIDE ENTRY ROOF 638 SQ. FT.
3.INSTALL (BERGER) ROOF GUARD UNDERLAYMENT FROM TOP EDGE OF
WATER AND ICE SHIELD TO PEAK.
4.INSTALL NEW ALUMINUM DRIP EDGE TO ALL EDGES OF ROOFS.214 LIN. FT.
5.REPLACE TWO FOUR VENT STACK BOOTS.
6.INSTALL (IKO) THIRTY YEAR ARCHITECTURAL SHINGLES TO ALL ROOFS.
7.INSTALL NEW RIDGE VENT (CORE VENT) AT PEAK.
8.CAP ROOFS UP HIPS AND AT PEAK USING (IKO)THREE TAB SHINGLES.70 LIN. FT.
TOTAL COST OF THIS PROJECT IS 1,645 SQ.FT. x $4.00 PER SQ. FT. $6,580.00
EXTRA LAYER OF SHINGLES $35.00 PER 100 SQ. FT. $575.75
ADDITIONAL WATER & ICE FOR PORCH ROOFS.2 -TWO SQ.ROLLS $400.00
City of Northampton 4
$
Massachusetts .;
DEPARTMENT OF BUILDING INSPECTIONS g ,.
212 Main Street • Municipal Building r ob
Northampton, MA 01060 , N ,
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 backfili), 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
•
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
=an= 600 Washington Street
tl� Boston, MA 02111
=_ www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business / Organization /Individual): /6:im-J Ci ,1J 0'1
Address: 2 j Loch 14
City /State /Zip: /Veldt, Phone #: / c 7Y' S i 2
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. El New construction
2,;] I am a sole proprietor or partner - listed on the attached sheet. 7. ❑ Remodeling
These sub- contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. [I Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 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. ® Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
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.
t Homeowners 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 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.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date: S
Job Site Address: City /State /Zip:
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 pains and penalties of perjury that the information provided above is true and correct.
Signature: Date : /2 /,'Q c1
Phone #: 1 S 7/'
- 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):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 CONSTRUCTION SERVICES
ft.
8.1 Licensed Construction Supervisor: //'' Not Appl ❑
Name of License Holder : Uk 4 l (:4 fn i S S 0 7 n? 4/4 7 f
License Number
10c). t,/e -+I c /1 - 01 7 01/d s i
Address �� Expiration Date
Signature Telephone
1° a •is ere •i � m.rrovertien 'Contractei ' -'71 A /e _ . u R,'. , �., . _ Not Applicable ❑
7 C L , + JJu� 'LAX. �..7. - 6, $ C6,431104141- /31 N1
Registration
Company Name / , ( Number
//
Address Expiration Date
L-46.41/ 4 o l.y j i. Telephone /`TN -S.V.1 4U yZ
SECTION 10- WORKERS COMPENSATIO
s _
N INSURANCE AI= PIDA1fIT {MG L � 152, § 25c(s))
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 ❑
.� s1
i rt iv ox tg � 6
The cm-rent 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
•
SECTION 5 DESCRIPTION OF:PROPOSED WORK (check 'all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors E
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C7 Siding [0] Other [0]
Brief Description of Propos d / /
Work: /4�� r� j( Et/W 1i ,S�`j;?�5te.ii/ t.,/c�r ,t,c, Situ aercc/ f Ar�ii k���ci'K
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
aaa l ew °ta+ouse and or addition o.eii tin'Q, ousrnq; c'o hey ollowin'
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? rti
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
t_ SECTION 7 OWNER.AU 7O BE COMPLETED WHEN .
MWNE 2S AGENT OR CONTRACTOR APPLIES FOR BUILDING PEFO
I, , 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
(. ( Ae; ),(J amt . , 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 under the pains and penalties of perjury.
,�<,(ivy4s C �� ssG et
Print Name 74
Signature of Owner /Agent Date
•
1r 0
r
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Inffrniation
Existing Proposed Required b}rZoning
This column to be ed i1, «
Building Dartm t Mi.) '
F
Lot Size 1 t 1 I '4 *., +
i 1 t.° , t
Frontage i
Setbacks Front I 1 —# TT
Side L: R:' , L:' . i R:P i
I
Rear = I-1 i I
Building Height 1
I j p
Bldg. Square Footage i- I 1 % 1 #
3 ,
Open Space Footage
(Lot area minus bldg & paved s i
parking)
# of Parking Spaces i I 1
Fill: _ _ _ _
(volume & Location) i.
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:!
£ t
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
I IF YES: enter Book Pagel and /or Document #1
E
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
0 , Date Issued: 1 E
C. Do any signs exist on the property? YES 0 NO 14
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO r4
IF YES, describe size, type and location
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
-t ' p y
[ F N'$ '�De ®a A e''" e 8 h v
vE p City of Northampton S u �i rse ii :4
R ��E.O B uilding Department .
,` 212 Main Street 4 e fi - 'aep -are
�� ZZO Room 100
rthampton, MA 01060 m
<.,, a e • X87 -1240 Fax 413- 587 -1272 ' � �
of derpeol �_
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE •INFORM
5 x ` Thissection t o b comp leted.b ; y•office t ,
1 W � Y �� i S'. SE �� >
1.1 Property Address: o z; • . * *', " � t x u `�+s , , i
, /G ' on @i �'x : i i ii : s *�v`:e a�'C+ k "( O v erl y District " ' .-" x ' s ' �!"+T� y s� u^,
1m S t D ,,._ : .; CB Di rz
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
r
2.1 Owner of Record:
Name (Print) Current Mailing Address.
Telephone /
Signature 1 _1 �0 S , C!
2.2 Authorized Agent: // ,, e 11
�n �f()( f bk" /d Q tom��" Gil) l 14/'141 o)37�i
Name (Print) Current Mailing Address:
� -
/ -5 S f� [ �l I s 21- �1�,3�I
Signature Telephone
SECTION 3 � ESTIMATED CONSTRUCTION COST
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
r
1. Building, s �tt ti �� .� (a) Building Permit Fee'
h
5 frt
2. Electrical I (b) s tima t e d Total Cos# of
b onstruction.frorr (6) i,
3. Plumbing Bulling Permit Fee` ,
4. Mechanical (HVAC) 7: `� A
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) Check Number
. • ., .. Th Sec tion For Official Use ;Only .,, . .
Bull
g PermitNumber
Date
.
i
Sig ,�• ,,.
B uildi ng Ir''";t%
of, Buildings', Date