39A-058 (2) George Koeber
PO Box 507
Whately, MA 01093
(413) 665 -9576
Email: georgenmary @comcast.net
Construction Supervisor: CS063492 MC License Number 120754
Sheet Metal Workers License Number 2016
Lead Safe Certificate Number R -I- 18867 -10 -00336
Addendum to proposal for Richard Wagner and Ruth Folchman re. insulation and venting.
48 Lyman Rd.
Northampton, MA 01060
We propose to:
Add 2" poly iso foam insulation. Add furring and upgrade plywood to 5/8" for venting.
Purchase blue metal coil stock to match as closely as possible existing standing seam porch
roofs. Process and custom bend metal to cover plywood and foam insulation.
Project Addendum Cost *: $ 8,000.00
Original Roofing Proposal $43,000.00
Combined Project Total $51,000.00
*Project addendum cost does not include any application of cellulose insulation to be blown into
any probable air space as indicated in diagram prepared by Jim Vannetta. Any application of
cellulose would be done based on time and material. ($50 per man hour).
Gutters and downspouts are not included in this proposal. (Any handling of existing gutters and
downspouts is included. Installation of new will be time and material.)
Any additional carpentry due to unforeseen rot or decay or other circumstances revealed after
stripping the existing roof will be charged as time and material ($50 per hour per worker plus
material as required.)
The terms tit' proposal will expire if not accepted by April 30, 2011
y7-2./ / o 11
Propo •Asubmitted by George oeber Date
Accepted b :
2 2 G
Date
Date
•
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 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 hone 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
iermits 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 tome .
Date
Address of work
location
• 7
. , • 1 ,
. The Commonwealth of Massachuse
Department oflndustrietli4ccidents
Office ofinVestigationg
600 Washington Street •
Boston, MA 02111 . •
r: • • : : L...= r. • .c.,.., - .
www.mass.gov/dia .
::,--,.---
•
: .....
-Workers' Compensation Insurance Affidavit Buililers/Contractors/ElectriciansfPlumbers
Applicant Information . Please Print Legibly
Name (Busines.i/Orgarifiationfindividual): G t /".6, t •-•.) e ..
. . ..,...., ..
• - Address: / 2 ,------ ( f __ ss ji t i
City/State/Zip: akl A - O/6 T q Phone.#: g(3 ecrys---7,c -
. .1
Are you an employer? Chmi the appropriatebox: . •T .
. ype of project (required): /
• 1.0 I am a employer with 4• 0 I am a general contractor and I 6 , . . .
. Lj NCNV construction
have hired the sub-contractors
employees (ill and/or part-time).
listed on theattached sheet: 7- 0 Remodeling
235.1 I am a sole proprietor or partner-
These sub-contractors have .8. 0 Demolition
ship ancl have no 1,loyees
working forme in any capacity. eingc2.3 Woricets'
laili.ildpigbalittifai
; #.*
[No wOrkepY comp-. ipsuiance . - car- - • 1 : : ..
requirect] .- 5. 0 We are a corporation and its u t4ectncal repairs or additions
• 3. 0 I am a homeowner doing all work officers baire‘roised their . 11.n Pluiabing repairs or additions
1
myself [No workers' COIDp. . lied Of exemption per MGL
120 Roof repairs .. -
insurance required.] t ' - . p. 152, §1(4); and we have no • , , . .
. employees: [No workers'. 13.11 Other
-
' .. .
. ' comp. insurance reqtiired.1. - . • . -:
•Any applicant that cheeks box #1 also fill out the section belowshowing theirWodcess compensation policy inforroatioz•
I Homeowneri who submit this afEda;rit.incrtdating they arc doing all work and theii hire outside contraetora must submit anew affidavit indicating such.
C..ontractors that chick this box must attached an adcfitional sheet showing the name of the sulcontractors and state wiettierornotthoselattitim have . •
employees. lithe stih-contraitnrshaVe employeeS, they mnstprovide their works' comp. poNey number. : . , : . -• : •
an employer that is p roviding workers' compensation insurance for my einplOyees. Below is the policyandjob site
information.
. .
. , • • Insurance Company Name: .
' .
. - • - . .
Policy # of Self-ins. Lic. #: • Expiration Date: - • :
Job Site Address: • : " . '• City/StafeiZip:'. • ' - ' - r • - .-
Attach a copy of the workers' compensation policy declaration page (showing the policy nundier. and espiratiort date).
Failure to secure cover-A a:S rebilife iinikif Sedibiit 152 can lead to the iiiq' 3 iiiiiitil iifaillitiiiiieizitlies of a
fine up to $ 1,500.00 and/or one-year imprisomn* as well as civil penalties in the form of a STOP woluc_op,mat. and a fine
of up to $250.00 a day against the violator Be advised:t4ai a copy:Oft-ES statement may be forwarded inthe:CotriC:e
- ffve — sliitiliOris - oftliEDIA. -- fol k iiiiiii6e' EiiiiiiiEECarti - ' 7 - - --1.- . '7.T.:, C..,...
_ _______
, fird heribyTCiTrilhiiidir th e4 -7.-- .an il pen iikieloliirjuryi I u ri thelnfirmationprOvideliniiiiiteluid_Cai-rett.
4i...e
Signatirre: Seiejt • - ' . Dili: 't .?-// • . _ ' , .
Phone ii: 1 ‘_6 C g S" - 0 - . • .
1 - OffiCial use only. Do not write in this area to be Completed by cio ;ii ioWii"afficial
. .
City or Town:
I Authority (circle one):
.- Permit/License # • , - .
:1. Beard of Health 2. Building Department 3. City/Town Clerk 4. ElectricalInspector 5. Plumbing Inspector
6. Other ,
-
Contact Person:
Phone #:
. .
• •
SECTION 8 =- CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : C S (� i 3 Uj' CS C t 9 i-
1 g(/
License Number
Address / Expiration Date
iAytyc /y llq oia3� Q_ /7adi3
Signature Telephone
4 (L366S9S76 ` /3 16 Tys)
tit Home _im rd t =tr ent o ra or <. ., Not Applicable ❑
/ G 1075
Company Name Registration Number
CCOR5e � � e 2 /-2z) 75
Address 1 x/13 �� S7 � Expiration Date
(7Q
la ,g5j, // /ei r Telephone S IC / ,'y 9S/ Q q' a
SECTION 10- WORKERS' CQMPENSATION'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 0_ No ❑
1
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 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 J
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [[] Siding [0] Other [0]
Brief Description of Proposed
Work: 57eiP t'/re- - roof Wvase_
Alteration of existing bedroom Yes V No Adding new bedroom Yes K No
Attached Narrative Renovating unfinished basement Yes ,( No
Plans Attached Roll - Sheet
Ga 1#��ev�r�us��ri �rsait��di�i��t+� -+�1� "tiara hausi�la ;�r�ria�e�e�he °foilr�r`n�na:
41 / 4
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
I, U t02 t<' a �-L e C , as Owner /Authorized
Agent here 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.
le t e . '
Print Name
'4 1e. 1�r1_/ <2/ X24 /
ignature o r /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required byZoning
This column to be filled in by
Building Dep ent l ,-,,,'-,4' S A i
9
Lot Size t 1
Frontage 1 1 , o-
Setbacks Front
Side L: . R:1 i L: — I R: . _ _ I 1
Rear { 1 =
Building Height r i � {�
Bldg. Square Footage % 1-1 =I i I
Open Space Footage %
(Lot area minus bldg & paved E 7 _,,1 = m s
parking)
# of Parking Spaces 1 i
Fill: ( ____If...___ S
(volume & Location) ` i .. - s
1
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
I
IF YES, date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0, DONT KNOW 0 YES 0
IF YES: enter Book 1 l Pagel ? and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO / 0 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 ,Date Issued: i _ _ a
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO
i
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 el
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton 1 Q
RELi V Li : uilding Department ` �
�
212 Main Street s
Room
APR
z 6 N . rthampton, MA 01060 ffi _
• I • i 41 - 587 -1240 Fax 413 - 587 -1272 8 g
t kT
SEPT. OF BUILDING . -
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 completedl by office
Map Lot Unit
96 7 / ymgi e isle
,///f.
Zone Ov rlay P ri t
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: Vr' c4i¢ea' it / ayh e ' ri- &A le4 m,4
yS 4/i;i4Ii ,&
Name (Print) Current Mailing Address:
Telephone 9/3 3 - 7
Signature
2.2 Authorized Agent:
Ge, e v l" ,� e �' O 1 5b 7 U�Sj /e ' //1 o/O `�5
Name (Print) v Current Mailing Address:
y /3id5 95 `/ /38 - d' 7y5)
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS, 4 9 pc 6?, d Q d
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 1 /j�
6. Total= (1 +2 +3 +4 + 5) Check Number o` (!!/
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
■
48 LYMAN RD BP- 2011 -0873
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A - 058 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP- 2011 -0873
Project # JS-2011-001432
Est. Cost: $51000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: GEORGE KOEBER 063492
Lot Size(sq. ft.): 19209.96 Owner: WAGNER RICHARD & RUTH FOLCHMAN
Zoning: URB(100)/ Applicant: GEORGE KOEBER
AT: 48 LYMAN RD
Applicant Address: Phone: Insurance:
P 0 BOX 507 (413) 665 - 9576
WHATELYMA01093 ISSUED ON:4/29/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & RE - ROOF HOUSE
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 V][OLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 4/29/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner