24C-045 Gat
page 2of2
12. ripe Staging will be used during this project.
1 3. A rented lift will be used during this project.
1 4. Job site will be cleaned up at the end of each work da
All material is guaranteed to be as specified, and the above work to be preformed in accordance with the drawin and specifications
submitted for above work and completed in a substantial workmanlike manner for the sum of:
Twenty Seven Thousand and 00/I 00
Dollars $ 27,000.00 )
Pa to be made as follows:
Any alteration or deviation from above specifications Involving extra costs will be /'
executed only upon written order, and will become an extra charge over and above Kespectklly submitted
the esti mate. All agreements contingent upon strikes, accidents, or delays beyond
our control. Owner to carry fire and other necessary Insurance.Ail accounts not paid brian L. Young owner
within 30 clays are subject to a late charge of 1.5% per month.ln the event that legal
action is instituted to coiled any sums due under this agreement, the undersigned
agrees to pay all costs moored including attorneys fees. NOTE: This proposal is valid for 15 (fifteen) days and may be
withdrawn, if not accepted within this time.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereb accep You are autho . • to do the work as
specified. Pa will be made as outlined above. `/
Signature /
Date r — c
f Signature - jO
( k1gehne Design DATE: 12 -13 -0 C
Brian L.Young Owner Customer: Larry Whalen
PO box i 0 i + Address: 337 Elm Street
Northfield MA01 360
Northampton MA 01060
Cell 413.522.7287 — MA C5 Lic. # 102575
MA HIC Reg_ # 141479 Job Location: `fame/ Top roof - slate
Specifications: page 1 of 2
1. Kemove the existing slate and dispose. Owner to provide area for a roll off t
dumpster.
2. Install pol to the complete roof area. (approximatel 1,850
sduare feet)
3. Kemove the existing bottom J- channel and siding on sides of dormers to receive
new aluminum step flashing. (save and re- install)
4. Install new slate to the complete roof area using a 3" bead lap. Slate to be
semi weathering, Vermont sea green(see samples), 2." x 1 ", prepunched nail
holes, palleted and delivered to the above job site.
5. fabricate and install .032 aluminum valle and step flashings.
6. rabricate and install 16 oz copper chimne flashings and lead counter flashings.
7. Install new plumbing vent pipe flashing.
8. rabricate and install .032 aluminum ridge cap.
9. Kemove all of Ridgeline Design's debris from the job site.
10. Ridgeline Design will hold 40 pieces of slate after the job is complete, and in
the event that an slate fail within twelve months of installation, Ridgeline
Desi will replace the slate at no charge to the owner.
1 1 . Landscaping and other structures (flat roofs) will be protected during the
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 processrequires 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 _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.
Address of work
location
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
w ._ p=
+�= ; 600 Washington Street
■_at_ Boston, MA 02111
,,. www.massgov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individnai) L, Xi> : �� `I i- l t ' J fit? "Des, i ;'�
Address: t C' v LA 1G / `i AL; •�'1�t e(( J✓ Ci /3 (ce.) •
J
City /State/Zip: Phone. #: x / f 3 - ` l % _ G 1 / / / 3 - S. 7 `7
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 6. ❑New construction
employees (full and/or part- time).* have hired the sub - contractors
2.3. I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have. no •- ^ployees
These sub - contractors have . 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers' comp. insurance _ coup..insurance #
required.] 5. 0 We are a corporation and its
10.0 Electrical repairs or additions
3.0 T arms - iomeowaer -deice _ __ _ _ __ officers xxercised their i L.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.
1 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' cornp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
f ormation
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 51,500.00 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. to advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coveraee verification.
I do hereby certify under the pains and penalties of perjury that the information provided above_islrue andcorrect
r . _ . l 1
Si. . , tore: ~ �. gate• cg _. 0
Phone ##: /- >, f .5 :),2
Official use only. Do not virile fir this area,, to be completed bycity or town offciaL
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
8.1 Licensed Construction Supervisor: J i� Not Applicable ❑
PA
- jet of License Holder : v\. L.- . xC.l,t j i ti i4S J "3
License Number
o, :3 C G 1 l 3
Address Expiration Date
/,3 (y)-/4 =7 -7. 7
Signa ure Telephone
9..,Reastered Horne- mproverrientecint rzi. .. a f, ..._, Not Applicable ❑
I ti l
(pi
Company Name Registration Number
/
Address Expiration Date
1 ?-)c1( 1C /? r 4 t 1 d / 3 6 Cl Telephone
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 ❑
ilt4116iiito
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
o i amp on •r•tnances; a -
-rat - Laws - Annotated.
Homeowner Signature
r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House [D Addition ❑ Replacement Windows Alteration(s) LJ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [D] Other [0]
Brief Description of Proposed
Work: Behar'::, o €XlS'lle + � , � 5 +t1 Tea;
Alteration of existing bedroom Yes 4 No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes .X No
Plans Attached Roll - Sheet
sa�:t� [ ���c > cif: ��isfiticr�ausrnq :��o�nplete�th�..fi+r���orq:
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
et v1 1 � (J J 0, , as Owner /Authorized
Agent hereby declare that the statements and ihformationn the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
-� ,
Signature ofowwner /Agen) 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
1
Lot Size , ___ _ _.___(
i _
Frontage _ ..M . mm .� ' _ _._.___. _._. _._
Setbacks Front I € ? I j
Side L . R _....mj Lam.._._ R:l a
_,. ...1 __ _ F
R ear ._.. ,
Building Height m -- .- .- -..._.
Bldg. Square Footage r i F % s
Open Space Footage % ... _
(Lot area minus bldg & paved
.eb. _m!
parking)
,
# of Parking Spaces , J . --
Fi1L• 1
(volume & Location) L.. -_ .._ .-
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW * 4 4 YES 0
Y
IF YES, date issued:;
i
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES 0
IF YES: enter Book i Pagel and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO V` " DONT KNOW 0 YES Q
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 II)
IF YES, describe size, type and location:
" -` D: --- kre there any proposed changes to-or additions o signs intended for the a property ? YES 0 NO
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 pi
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton
Building
_
g Department . �fl
212 Main Street Se - -
Room 100
„,(�11 Northampton, MA 01060
n 1 7 pl he 413- 587 -1240 Fax 413- 587 -1272 s ,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1i -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
r r AI � � r-te4
Map Lot Unit
t Zone ' Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
r
��1un
L . �c�.'� ��''�� b ,''1/:;; " - ie(J v 4 O(3(ye
Name (Print) Current Mailing Address:
-----,
-y/3 y 2 ' (>r' l r r a y / - ' - 7 7
Sign - attire Telephone
SECTION 3 ESTIMATED ONSTRUCTION'COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building It 2 > C)c) r. > (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) Check Number 7,0/ g3��
This Section For ' Offcial'U s e Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -0741
APPLICANT /CONTACT PERSON RIDGELINE DESIGN
ADDRESS/PHONE P O BOX 1014 NORTHFIELD (413) 498 -0121
PROPERTY LOCATION 337 ELM ST
MAP 24C PARCEL 045 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �,(�
Fee Paid l K� r- `
Typeof Construction: INSTALL NEW SLATE ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 102573
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO AVIATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
/
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
33IILM ST ( BP- 2010 -0741
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map :Block: 24C ='045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2010 -0741
Project # JS -2010- 000714
Est. Cost: $27000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RIDGELINE DESIGN 102573
Lot Size(sq. ft.): 12850.20 Owner: WHALEN JAMES J & CONSTANCE V
Zoning: URA(100)/ Applicant: RIDGELINE DESIGN
AT: 337 ELM ST
Applicant Address: Phone: Insurance:
P O BOX 1014 (413) 498 -0121
NORTH FI ELDMA01360 ISSUED ON :2/23/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL NEW 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 2/23/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
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10. ,,i)o any signs exist on the property? YES NO
IF YES, describe size, type and location:,
Are there any proposed changes to or additions of signs intended for the property YES NO
{
IF YES, describe size, type and location:
11. plan of development that wilt disturb over 1 acre? YES NO X
IF YES, then a Northampton Storm Water Management Permit from the W acre is required.
12_ ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMA
rids, column res erv ed
DP
for use by the Building
EXISTING PROPOSED . a
i 1 iiiiiMil
a 3 rr
O.
Frontage
Setbacks Front
5 '° So
Side L• Zv R. �f L �} R. 4'
Rear
Building Height ,
Building Square Footage
p
% Op Spa (tot area x
m inus en buildin g Et paved 7 � �
• p�rkvig ' —_ .__
# of Parking Spaces ::7,:ii- Of Loading D cks /] €a,s" .. ,a r d.s '
::,,,z,' ma; - L .� _ Fill: - � f ;= ",- ,
(volume a location) 00
�� ,,
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. 1
Date: ! ! ' Applicant's Signature : -C 0
NOTE: Issuance of a zoning permi does not r e iiev an applicant's burden to comply with ail zoning
requ and obtain all requi per mits from the Board of Health, Conse Commission,
Histo Architectural Boa Department of Public Work and othe app licable permit granting
auth orities. —
W :\Documents\FORMS\o �ginaJ ,Buildino- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004
�'. -File No. 1_ 10 d
��..�....w; rx '��������_ .:. .�- : ..,>_ ... ...__,.,..«...ma s:�. �
Please e - or p�r tall information and return form to the Building
Inspector's Office with the $15 fil fee (check or money order) payable to the
// i City ofNorthampton /
1. Name of Applicant: i` re . W d ' / / eit -a C
Address: 33 7 C LP2 Telephone: 5 gq
2. Owner of Property: C Ci1S 0, L � WA.Lt �/� - �'�d G f�1 � 1J7
Address: .35 1 -604 Telephone: Sg 7 •
3. Status of Applicant: Owner /" Contract Purchaser Lessee Other (explain)
4. Job Location: ,:) 61-0 51
5. Existing Use of Structure /Property:
7.wt y' ,r A4
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan 9, Site Plan Engineered /Surveyed Plans
•
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW YES IF YES date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: , enter Book Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO X, DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , , date issued:
(Form Centimes On Other - Side)
W:\Documenu\ FORMS \original\BuiIding Inspector \Zoning- Permit - Application- passive.doc 8/4/2004
File # MP- 2010 -0028
APPLICANT /CONTACT PERSON WHALEN SARA & LAWRENCE WHALEN
ADDRESS/PHONE 337 ELM ST (413) 584 -2228 0
3373 ELM SI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
1"61 ING FORM LLED OUT i/ 77
ENCLOSED REQUIRED DATE
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - NEW ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACT N HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRES TED:
Approved f Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : §
Intermediate Project : Site Plan AND /OR Special Permit with Site Plan
Major Project: Site Plan AND /OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
V Permit from Elm Str Commission Permit DPW Storm Water Management
/4/ C-
Signature of Building Official Date
Note: Issuance of a 7..,;,,g p ermit does net relieve a applicant's hiurden to comply with all zoning
rr comply
and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.