38B-021 Reade Roofing
Derrick Reade
429 Deerfield Street
Greenfield, Ma.
01301
H.I.C. 154731
V1r2-E4-; t ‘1 /1. 1
David Karcut f � /�
58 South Mill River Rd
South Deerfield, Ma.
01373
re: Contract
28/30 Fort Hill Terrace
Northampton, Ma.
Reade Roofing has spoken with you in depth as to what is the best way to deal with your roof and
what we have decided is to remove present roof material from the upper dormer and lower garage sections
and then install a .060 rubber roof in the following manner.
Reade Roofing will:
1. Tarp off the entire grounds below work area
2. Remove the present roof material
3. Inspect deck making minor repairs as needed
4. Install ' /z" fiber board
5. Adhere rubber
6. Wrap the roof edges in brown metal similar to other areas
7. Install 5" self stick over all nails
8. Clean the entire grounds around work area
9. Properly dispose of all debris
Reade Roofing can accomplish this work for $4,150.00 and we require 30 %, $1,300.00 upfront
and the remaining $2,850.00 due upon completion.
Thank you for the interest in Reade Roofing and we look forward to servicing you soon.
Do Not Sign This Contract If There Are Any Blank Spaces
All home improvement contractors and contractors shall be registered and that inquiries about a
contractor or subcontractor should be directed to:
Registration Division, Program Coordinator
One Ashburton Place Room 1301
Boston, Ma. 02108
Tel (617) 727 -3200
The home owner has a three day cancellation time in any contract under MGL c 93 s 48: MGL c 140D s 10
or MGL c 255D s 14 as may be applicable
Home Owner's ign ture Date Reade Roofing Owner's Signature Date
, / C<
A 1
C ,
The Commonwealth of Massachusetts
—�----�— Department of Industrial Accidents
y
i►.=.. �` Office of Investigations
'a��= 600 Washington Street
.µ t. Boston, MA 02111
..e www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 1.4,. � L.- I
Address: /6 9 6i v' Ck.� a
City /State /Zip: C_QJ 0 Phone. #: 1j/' -(col ki-gS77 0
Are you an employer? Check the appropriate box: Type of project (required):
1.0 I am a employer with 4. 0 I am a general contractor and I
employees (full and/or part- time).* have hired the sub- contractors 6. ❑New construction
2.'p am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. Building addition
[No workers' comp. insurance comp. insurance.$ g
required.) 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work officers have exercised their 11.0 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' 13.0 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:
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 c • under the pain and penalties of perjury that the information provided above correct.
� is true and correc
Signature: ! ' ' Date: 7 -' a-t 'Q-0 —
W
Phone #: tub - (e ), 4 ^ 79R
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 Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone #:
,, �_ p 1�i'i a�3ac �1i5crs (J I-
� ' ' y ✓EP.' TM =tiT Gc EUILDLNG INSPECTIONS c
■�, = �i
INSP�CTCR 212 Main Street • Municipal Building `�Q c ,
Northampton, MA 01060 .
HOLM OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as ;.is /her construction sup:. or. 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 bacldill).
so- notube holes (before pour). a rough building inspection (before work is
concealed). insulation - inspection (if required) and_a final buildinq.ins:nection. 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. .
lithe 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
1, 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. y V
Date
Address of work
location
s ` The Commonwealth of Massachusetts
o.a .
E Department of Industrial Accidents
- � � ` - Office of Investigations • } ' "— 1 " C 600 Washington Street
_
Boston, MA 02111
% www.mass.a ov /dia
Workers' Compensation Insurance Afidati Builders/ Contractors /Electricians/PIumbers
Applicant Information Please Legibly
Name business 'Orzanization/Indivi��Iai)• i _erf t cK- Qe ck K. 2�,1 i
Address: 9 fao(t /// Aria
City /State/Zip: f f , 0 10Q Phone #: 74 77 &)7/
Are you an employer? Check the appropriate box:
Type of project (required):
1. re' am a employer with 'z
4. I am a general contractor and I 6. ❑ New construction
employees (foil and/or part-time).* have hired the sub- contractors *?'
I Q listed on the art ched sheet_ 7_ Q Remodeling
2. I am a sore proprietor or partner-
shi' and have no employees These sub - contactors have g. Q Demolition
j working for me in any capacity. employees and have workers' 9. Q Buildins addition
[No workers' co:,.i Ms-..�ance comb. insurance.: 11 r—i •
required.] 5. Q We e are a corporation and its 10.1_1 Electrical repairs or additions
3. ❑ I am a lioraeownei doing all work officers have exercised their 11.❑ Plumbing repairs or ar'�itions
myself [No workers' comp. rift of exemption per MGL 12.Q Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 1'•Q Other
Comp. insurance required-]
- 'Xmi applicant mat =emu oox rI roust a:so nil oat me section oe:ow snowing then workers' compensation.poiicy information.
Homeowners who submt this affidavit indicating they are doing all work and thei hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box =stomached an additional sheet showing the name of the sub - contractors and s=ate whether or not those entities have
empIoves_ If the sub- ccncactars have c:,,pioyees, they rnvst 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: I ra( tiff.../.e6 s c i : n e _
Policy # or Self-ins. Lic. #: (t% X U/ ' 0 77 81- A /6 `i ' (+ Expiration Date: 8
Job Site address: (9 ( H /l l 7eisdc t(A„ Cit f v a ( : 0 40 / / r/ i � )
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required render Sec*son 25A of MGL c. 152 can lead to the imposition of penalties of a
fine up to S1,500_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 3250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Invesdsation: of the DL4 for insurance covera_e verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
— _isna Sr e -�.,/ _ 7 — Date: VOr
Phone #: 11J ! 5 On
f� ii Officiai use oniy. Do not write in this area, to be completed by city or town official
City or Town: Permit/License it
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone .-:
Annommor
1
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : 14rAr-f\li \CUto%Z 7 lo b
License Number
I s-t - R : r f k A l _ . 4 2 y 5 - .G - ! I
Addres Expiration Date
( -� ( j 1 b- foal -7?q
Signatu Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
D'erricL a tt /5Y , . 1
Com any Name Registration mber e r
‹ istra on 2 ;2011
Address c� /✓C.�`, j . Expiration Date
` C(f7 to L c Telephone //J 775_60/
, —
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 ❑
11. - Home Owner Exemption
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. CIVIR 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 -vear 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
f.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing u
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding [0] Other [0]
Brief Description of Proposed r / Z)
Work: eMolt. prey 41 {a':ti7 1Cr iet as 74(i✓1 / ISIS I 11 ( &t '
JCL'
Alteration of existing bedroom Yes No Adding new bedroom Yes No r1 `,I�
Attached Narrative Renovating unfinished basement Yes No Y �, 1 or 'ei/ty'
Plans Attached Roll - Sheet
6a: If New house and or-addition to existing housing, 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?
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 7a -- OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
•
, 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
, 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.
Pri ame
itiata.atidL ViciT
Signature of Owner /Agent D
N
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
Side L: R: L: R:
Rear
Duilding Ilcight
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
oarkine)
# of Parking Spaces
Fill:
(volume & Location) . ,„ __. , .._.,.. . ___
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW (g YES
IF YES: enter Book Page and /or Document #
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 Obtained C.) , Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES C) NO GV
IF YES, describe size, type and location:
E. WII the construction activity disturb (clearing, grading, exca ion, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES () NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
N
• Department) use only
City of Northampton Status of. Permit:
Building Department Curb GutlDriveway Permit
,,t,,,'(1 -212' Main Street SewerlSepticAvailability
cb t R6, m 100 WaterlWell Availabil
(- Nor n, M 01060 Two Sets of Struc tural Plans ;
phone 413 -5$7 fi Fax 413 -_ 5$7 -1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
,
( -I- 14111 �L�' o t Map Lot Unit
N J'+' ==VHF 6, r
Zone Overlay District
Eim St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
_ vx )c6.rk-r te �,II J� Y
Name (Pr Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building , `; j) ° (a) Building Permit Fee
2. Electrical / / ' 4✓ (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection • �., �
6. Total = (1 + 2 + 3 + 4 + 5) _ g Check Number �
This Section For Official Use Only
I
Date
Building Permit Number' Issued:
Signature:
Date
Building Commissioner /Inspector ofBuildmgs
*.I. BP- 2010 -0274
GIS #: COMMONWEALTH OF MASSACHUSETTS
e ,. . k: 38B 0 1 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0274
Proiect # JS- 2010 - 000352
Est. Cost: $4150.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: READE ROOFING 87965
Lot Size(sq. ft.): 9147.60 Owner: KARKUT DAVID A & PATRICIA M
Zoning: URC(100)/ Applicant: READE ROOFING
AT: 28 FORT HILL TERR
Applicant Address: Phone: Insurance:
429 DEERFIELD ST (413) 775 -0071
GREENFIELDMA01301 ISSUED ON:9/10/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW RUBBER 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 9/10/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo