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38B-111 (5) -.-------"— — ^ . 4411 — -- ------------ SEXTON ROOFING AND SIDING — ,------.."-- PrOp °fiat —____-------.-------, CO . A division of Saxton Home improvement Co. Tamko Roofing Systems ,.." -.eratiggibiNee- , 41, i a A c dr aeon I iiiirdlii 1 1111044 r Ouliiiii apt" (413) 534-1234 "raw Ark . "%ir atirfois bow P.O. Box 6327 FAX (413) 539-9906 MA HIC #113239 CT HIC #0605383 Holyoke, MA 01041 www.sextonroofing.com r ____ T _ ...,...__ SUBMITTED O f e ____*Acr_ _ k _ 2741SE 41_ enr4 . .;06 LOCATKA -- -- --- ...... Proposal to furnish and install the following u Re-Roof Illecar-Off ra Guts Complete Roof Preparation VHome exterior to be protecteo by t;ii ald plywood Ai/Shrubs, landscaping, trees to be protected entire existing roofing material to be removed to existing decklng, including flashing, etc p Site to be cleaned everyday with roll magnet debris romoued at project compleiioo 4/Deteriorated existing decking replaced at $2.50 per sq.ft hit Brown metal drip edge installed at eaves and rakes '' la/ ? New flashing will be instaled where necessary (see Special Requirements) 'stall new pipe boot flashing Le We shall acquire all appropriate permits etc for al! rooting work 9T-Olete Roofing System k Leak Barrier installed at all eaves to protect fn.)rn ice darns (and rftet codes in the v,orth) to * Barrier installed at valleys, around penetrations and chimneys to Protect ciritcal arers .._ Sif 15 lb. reinforced underlaymerit instalied over Andre decking Shingles ...,„ GAF Architectural i'< 50 year Coior °Li A' •-• (-; g 4: y VGAF ridge vent will be installed Wayanty Options 9 We guarantee our workmanship for 10 full years ---- ---1 ':.. *two* hereby to fur 1st) materi41and labor - complete in accordance with the above reifications, for the sum of: i l AY N ili MAD frs j -- [ ...... ji.k:.:_ik_ .. ,,.... 45,24/ dollars C - _ • ,i i All Makatea a guarenteec tr) be ais apeciliski All work to be completer, in a wow manned A eocording to litinden:l preca Any n:Won or deviation trom above speckdoetIone 'nweiAng , _ extra costs will be executed only opon voilftn vogra and will blooms art extra charge OW and biutleture i above the estimate. Al agreements contingent usexi strees, do:Wants or Mays beyond iliur core 01 Nni ,,, Thie r,r,,,,,„,,, ma Not responsible tor water damage during obrtsatintion, °yaw to pay , + 4.0„ legs, tees to' wi •- ,c with, 7, deo. , _ • '•,•--, ••• t• •• • .. 1 . : . 1 '', t .-..-.--------- ' A- . .- , _,.........-- r _____I_______.—!..": - - .. - ......:, - ., - z - , ---- .--.. -_:—.....„....___:._ ------- . — • --:'- , -- — . ,. --;.--..._---: ------- - - Ir. — ----:-------- N ( atttiginCt 01 yr ,,, . . The abov t ! , ' sp. t ,... e , . conditirxis sre 4A , 4.... :) .4.4........ , ( are satisfactory and are hereby , e ' .. - • iii "OP the 'r- ir. ignatu _ 11 work as specified. Payment will be made as outline( 7 irt VIII 1 ' , a sikawisnat 3.- * / 4 9 - 4, 1 k, 4._ ' ' . SIOnature -----•.: i - ,,,,, — - ATTENTION HOkAIFJERS; over eii wsdital beloiig gs in the Attic, barage or storege areas due to the possibility dr roofing debris ot dust , , , 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, 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 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 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_permitissued,_ 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 • 5 ■ . , The Commonwealth of Massachusetts Department of Industrial Accidents =W4ii� E Office of Investigations 'ssfi y 600 Washington Street __11_ l Boston, MA 02111 _ , _ www.mass gov /dia . -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business / Organization /Individual): �-E' f4Z�✓ i lid/. - , , Address: P�� e Co - 3 - City/State/Zip: / f ' o �c, /V o/ d y Phone. #: / 3- $ i f 3 t Are you an employer? Check the appropriate box: Type of project (required): / j , a 1. am a employer with - 4.. 0 I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub- contractors ' 2. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling ship and. have no employees These sub - contractors have g. 0 Deriiolon for me in any capacity. employees and have workers' working Y P ty. 9. Q Building addition [No workers' comp. insurance . comp. . insurance.t required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. 0 I am -a- homeowner- deing-all work - -- - - -- .- __9-ffi_cers -aye xereised -their 11-.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. f repairs oo c. 152, 1 4 r insurance required.] t � � § O• and we have no employees. [No workers' 13.0 Other comp. insurance required} *Any applicant that checks box #1 mast 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. 2 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 Co an Name: �� -e- C /-5 � C) Policy # or Self-ins. Lic. #: - . Expiration Date: -V -/G "1/ 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. 13e 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 ofperjury that the information provided _above is true tuu correct.__- ___ • Si. ,.. ture: Pa - • - 7 , 0 Phone #: v /1- S�‘,// 2 3' Official use only. Do not write in this dr to be- comp by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical II . ector 5. PIumbinQ Ins. ector _ _ _ 6. Other r Contact Person: Phone #: r SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Suupervisor. P Not Applicable ❑ v Name of License Holder : t. eft `J e � ri / l'‘� License Number 64 q Att /e- ply 176/ (Xdk , in* - ld - Addres' I Expiration Date Signature Telephone S.,Reinstered;H nine - pko ei ite ritra+ & x g _ , rgi i k;, Not Applicable ❑ 9 `? ( 1 C a //id 5 7 Company Name Registration Number co' bo,- c. 5 -7 AF / Yn/4 - 6 Address Expiration Date Telephone / Z 3 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 It-- No ❑ The_currentexemption 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 lo amp on fir. inane- s, a e : .1 • _ • General Laws-Annotated. Homeowner Signature 9 � 6 1 r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Etr Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ©/ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0] Brief Des ription of Pro osed Work: .. +e XSiS�'/�' 13A .r /PS h Sled/ /t'P42 A 3 ,a-eX CS. Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet f `W : h sett ar dtIi toe ci exists q hou sln q omnp ete thiI6i1o1i .n : a. Use of building : One Family Two Family r/ 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 art �-f' .�✓ -P aiJ P . 4 , 4 L , CC , as Owner /Authorized Agent hereby declare that the - tements 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. Print Na - r Signature of Owner /Agent 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 L _ _ i _. �� _ - Frontage 1 ? f ._ Setbacks Front i 1 Side L:1 R L: . _ ' R: _ Rear , Building Height '°M r 1 € `- Bldg. Square Footage i 1 ? 1 % r I €' i t Open Space Footage % l (Lot area minus bldg &paved _ s parking) # of Parking Spaces - -.. Fill: f (volume & Location) ---. .... �- m- � ----.. -- - -.j A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:= t f IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES 0 IF YES: enter Book Page= and /or Document # I $ ! B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q ,Date Issued: C. Do any signs exist on the preperty? YES 0 NO Q IF YES, describe size, type and location. f D. Are thieve any proposed c tinges o or a ifions oTsigns intended for tfie+property ? YES 0 NO 0 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department - ' ' `"4' rVU 212 Main Street k33-1',g11,443Rtta43,,NAriMiyealitatArli; e3,3. Room 100 Ndrthanpton, MA 01060 � � " e F phone 413 -587 -1240 Fax 413 - 587 -1272 off, Sp` 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 completed by office 7 (7't. CJi.120C. S, r` Map Lot Unit Zone Overlay District Elm St District CB <District SECTION 2:- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Pri t) Current Mailing Address: YI r t3 Telephone Signature 2.2 Authorized Agent: -/11 66 a., ,O, ec)-e 3 ,/,/ ./44 Name (Pri Current Mailing Address: cE /3 n3 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (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) O Check Number / This Section For official se Only Building Permit Number: Date Issued: Signature: Budding Commissioner /Inspector of Buildings Date 37 MEJ Q ' := BP - 2010 - 0816 GIS #: COMMONWEALTH OF MASSACHUSETTS 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 -0816 Project # JS- 2010- 001205 Est. Cost: $4700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SEXTON ROOFING CO 99689 Lot Size(sq. ft.): 8015.04 Owner: OUIMET JOHN C IRREVOCABLE TRUST Zoning: URB(100)/ Applicant: SEXTON ROOFING CO AT: 37 MUNROE ST Applicant Address: Phone: Insurance: P 0 BOX 6327 (413) 534 - 1234 HOLYOKEMA01041 ISSUED ON:3/18/2010 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: 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 3/18/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo