24A-145 page 2. of 2
Notes:
— No painted surface will be disturbed during this project.
- The cost of testing for,or working with, lead paint, asbestos, etc. is not
included in this proposal.
- The cost for a building permit is included in this proposal.
All material is guaranteed to be as specified, and the above work to be preformed in accordance with the drawings and specifications
submitted for above work and completed in a substantial workmanlike manner for the sum of:
Twent Thousand Eight hundred and 00 /100 Doi6rs t $ 20,
f'aymentstobe made asfollows: $9,000.00 material deposit, balance due upon re9uest
My alteration or deviation from above specifications involving extra mats will be
executed only upon written order, and will become an extra charge over and above Respectfull submitted- .— •
the estimate. All agreements contingent upon strikes, accidents, or delays beyond
our control. Owner to carry fire and other necessary Insurance.An accounts not paid 5rian L. oun ow r
within 30 days are subject to a late charge of 1.5% per month.In the event that legal
action is instituted to collect any suns due under this agreement, the undersigned
agrees to pay all costs Incurred Including attorneys fee,. NOTE This proposal is valid for 15 (fifteen) days and may be
withdrawn, if not accepted within this time.
ACCEPTANT OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereb accepted. You are authorized to do the work as
specified. Pa will be made as outlined above.
Signature
Date f *� !_..
/C. ( C. / C Signature
Kk!geline Design DATE: /0 -6 -10
brian L.Young Owner Customer: Joan Juall
f'015 f 01+ Address: 1 5 Roe Ave.
Northfield MA o 1 56o
Northampton MAO 1060
Cell +13.522.7287
MACS Lie. # 1 0235
MA 1 Ke # 141479 Job Location: same
page 1 of 2
Specifications:
1. Remove the existing slate roof and dispose.
2. Kemove the existing chimne (lashings and dispose.
3. Rem ove the existing pipe flashing and dispose.
+. Install pol to the complete roof area. (approximatel 1 400 59.it.)
5. rabricate and install 1 oz. copper valle
6. rabricate and install 1 6 oz. copper chimne (lashings_
7. Install approximately 1 6 s of salvaged munson black 10" x 20" slate to the
complete roof area.
8. Install copper pipe flashings.
9. rabricate and install 16 oz. copper ridge cap to all ridges_
i 4. Kemove all of Ridgeline Design's debris from the job site.
Notes:
- Staging will be used for this project.
- a roll off t dumpster ma be used for this project
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
jermits 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
The Commonwealth opfassachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, M4 02111
• , www.mass.gov/dia •
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
r ,
Name (BusinesOrganizationandivirillnD: ctyl L 0 t i vt & • at t..
,
Address: 12 0 60 / IDA_ Fovr (qtit Nr,c46kR14 //11-4 i(k
City/State/Zip: /1/o (tt 414- 013100 Phone.#: Ill 3 -
Are you an employer? Check the appropriate box: Type of project (required):
1. 14 I am a employer with 0, 4.. 0 I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. D New construction
listed on the attached sheet 7. El Remodeling
2. 0 I ath a Sole proprietor or partner-
ship and have no .3.loyees These sub-contractors have .8. 0 Demolition
working for me in any c.apacity employees and have workers' 9
camp. intimince.;.: ' a
[No worker's' comp. insurance
10.0 Electrical repairs or additions 5. 0 We are a ccuperiation and its
required.]
3. 0 I am a homeowner doing all work officers have xercised their . 11.0 Plumbing repairs or additions
right of exemption per MGL
myself [No workers' comp. 12400ot
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance reqUiredj. •
*Any applicant that checks box #I must also fill out the section below showing their workers con pemmtion pohcy bfurmation.
t Homeownwi who submit this afftdaVit inciicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such.
1 C-ontractars that check this box must attached an additional sheet showing the name of the sub:-contractors and state whetheror not those entities have
employees If the sub-contractors have employees they must provide their workers' camp. policy number.
l am an employer that is providing workers' compensation insurance for my einployees. Below is the policy and job site
informatio• n. A
Insurance Company Name: 1-.119- / 4-titt,1 •
Policy # or Self-ins. Lic. #: W C-2 3 15 - 376, (o(o - 0 0 Expiration Date: - '3 -7 - If
•
Job Site Address: , 5 1 /1/0 (l City/Statz/Zip:' • 0 10 62 -
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failtrre to secure coverage as requited Under Seetiod'25K'OfMGL 152 can lead to the ii-bpinitiOn ofthin:dug penalties of a
fine up to S1,500.00 and/or one-year imprisonment as well as civil penalties in the form of STOP WORK .ORDER and a fine
of up to $25000 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
EVeilizations Of the DIAfor COVeriii viflctitTn.
_ /do certify under the pains and penalties ofperjury that the infornuttionprovidedibovaisince_and_correri
Si tine: • - S 7/ •
Phone t lig -L 117 -61 21 (/ 1 113 - 5 ••
• - 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,In.spector 5. Plumbing Inspector
6. Other ,
Contact Person: Phone #:
SECTION 8 -- CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: YOU Not Applicable ❑
Name of License Holder : T i l Q1/� -
) T2 .1//4-6134-6 License Number
)1)- a wr AIL r �C 'l / /l/ b 1 . kt d� , - ) 3
Address Expiration Date
•
_ • - 7 —o - -7 --
Si.fritre Telephone
9 'R• is _ "` ` .liotn >Im = r:vemnt Co ;, ,orate a n ., " �;,... �. Not Applicable ❑
T.;v,1 -1. l l� \ e t �l DU4 1
Compan ame Registration Number
I D' ct5Dk.- ?NA /YoC't 1 P�l AA 0 134 - a.
Address Expiration Date
"" Z,rC -v L, `/p J yt..1) Telephone Ni3 -qqt - - r9-1
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 X No ❑
esti
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing r"-±1
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [I= Siding [0] Other [D]
Brief Description of Propos d / I -
Work: _e 2 a c�t1 'Ke- yLo,fa;( o c�J�GlS�//vl 5144E -- 1 /4,S4 ,52 e, S ,
Alteration of existing bedroom Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes x No
.P- lansed -Rell She
- et
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
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
136 L . y 0 J D Z A �i � {l � r� , as Owner /Authorized
Agent hereby declare that t e state is and information on the fo going applicatio(t re true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
eil
Print Name (/
1 - 3 -10
Signature of Ow • gent / / 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 i Iiiiii e
Lot Size i
-.c., I 1 ' ` y°
Frontage 1
Setbacks Front 1 1 F-1
a.., w
Side L: I R:' Li
1 R:i a
I i
Rear `
Building Height 7-"--1 = i
Bldg. Square Footage —' —' '[ % I i
Open Space Footage %
(Lot area minus bldg & paved
parking)
# of Parking Spaces I 1 . _ .
Fill: i
(volume & Location) i t
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO (2) DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book 1 Pagel I 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 0 , Date Issued: „
C. Do any signs exist on the property? YES 0 NO 0
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 Q
IF YES, describe size, type and location: I
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.
m. s e
R
City of Northampton ��� >s
R ��E� - Building Department :� ��
212 Main Street _ s ' _ y .
�,�Q 2 V‘‘ Room 100 � n ,
!n` N • hampton, MA 01060 .. p ; j
r . "'- ' 87 -1240 Fax 413 - 587 -1272 , ,„ „ E` , ,,L „ , ' ° �
' dF 1Mi. � �
- APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
1.1 Property Address:
office
1 5 1-0e-,4 �/� Map This section Lot to be completed by of Unit •
yL Zone„ Overlay District
EIm St :District CB District
SECTION 2,- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Thc,vk Z'Jal
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
lac - Jai L. YoA)1 0 fox l of Lf NarJ oI ,//d4
Name (Print) Current Mailing Address:
NI3 - 4 9 go lal `�i Yl3 - 7 0' 7
------ Si ure T elephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building O 01) (a) Building Perm Fee
J
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) Check Number o rbs 4 3
This Section For Official Use Only
Permit Number:
Date
Building Issued:
Signature:
Building Commissioner /Inspector of Bu Date
15 ROE AVE BP- 2011 -0706
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A - 145 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-2011-0706
Project # JS- 2011- 001160
Est. Cost: $20800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BRIAN L YOUNG 102573
Lot Size(sq. ft.): 20908.80 Owner: JUALL JOAN M
Zoning: URA(100)/ Applicant: BRIAN L YOUNG
AT: 15 ROE AVE
Applicant Address: Phone: Insurance:
P O BOX 1014 (413) 498 -0121 WC
NORTHFIELDMA01360 ISSUED ON:3/2/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE SLATE 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 3/2/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner