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24D-075 \1assachusetts - Department of Public Safet■ Board of Buildint Regulations and Standards Construction Supervisor License License: CS 50230 JAN N DREYER 44 LAKESIDE DR I MONSON, MA 01057 • Expiration: 7/21/2012 ('onmisiuncr Tr#: 29504 • • • APP II OCT -13 -2010 09:32 From:123 Pa9e :1 /1 ‘ 00 c1 1 ~Tt� J.D. Rivet & Co. Inc. ROOFING • SHEETMETAL October 8, 2010 1635 PAGE BOULEVARD SPRINGFIELD, MA P.O, BOX 51066 Acme Automotive Z1IC. INDIAN ORCHARD, MA 01151 TEL. (413) 543 -5660 220 King Street FAX (413) 543 -3373 'Firestone Northampton, MA 01060 20M/ISTER 10 Attn: Don CONTRACTOR 16X.TILDLNG r'/ PRODUCTS RE: Replacement of Older Portion of Flat Roof — Approximately 8,100 Sq. FL V *Existing gutters to remain Scope of Work 1. Remove and properly dispose of the existing modified bitumen and double coverage roofing down to the wood deck, tIN v✓ + (t e tt- j e • 2. Furnish and install 1" polyisocyanurate insulation over the wood deck. T 3. Furnish and install Firestone 60mil TPO mechanically attached roofing system complete with all associated flashings. 4. Furnish and install new pressure treated wood hailers with height to match thickness of the new insulation. 5. Furnish and install new .040" painted aluminum edge metal in accordance with Firestone's requirements. 6. Remove and dispose of (6) pipes and (2) -2'x2' curbs, disconnected by•others. 7. Clean jobsite of all roofing debris. 8. Furnish owner with a Xyear Firestone labor and material warranty. Zb PvA, S Marg. P' = , 00.00 (Forty - Seven Thousand Five Hundred Dollars) OPTION: Up ade to .080 material due to P.V. System ADD= $2,500.00 mes L. Tras , President Acceptance of Proposal — The above prices, specifications and conditions are satisfactory and are hereby accepted. You arc authorized to do the work as specified. Payment terms are net 30 days unless otherwise agreed in writing. All material is guaranteed to be as specified. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire and other necessary insurance. Owner responsible for all building permit fees. All accounts not paid within 30 days arc subject to a late charge of I Vi% per month on the unpaid balance. In the event that legal action is instituted to collect any sums due under this agreement, the undersigned agrees to pay all costs incurred including reasonable attorney's fees. PAYMENT TERMS: 25% DUE UPON PROPOSAL ACCEPTANCE, 25% DUE UPON MATERIAL DELIVER, BALANCE (50 %) DUE UPON COMPLETI ON. NOTE: THIS PROPOSAL MAY BE WIT(- (DRAWN BY US IF NOT ACCEPTED WITHIN 60 DAYS signature: J/4, . .. _ (,l�i ()Maki A . 1 Date: /Df3 l�b ✓�"�`��/� 6144 6 jvitce 1960 .° CO it O 1-ss _ E 1 '- i f /1 - /", - -; j t - •� II 1 TV : 1 l '� /\ ^ = _ `:.— I \ _I 11 R_,, __ `.J' - i / I _ i I 1 I 1 \ ; '' _ `J ' \: 'L : '—, — - -- - O 1 --S2- c 1 7:-',iS - E iS S A - N OR TION - - Gal-Lecher - --- =_ e -- - ___ -- Y ,L_ \D CONFERS " NO .iC- ON — E _ _ J - r -_ _ lace - ., - AI . THE COV AFFORD ST TH.= _ POLICIES OW. or Pr c - =_ - B03 INSURERS AFFORDING DING CO`.• =0R �' ' =RAG= N,=,iC - i Sit ?EC - - — - - • INSURER ;, ? 3C"._- 11s CO 111150 1 . - _. }},..-- -._vav INSURER E 1 INSURE NATION 53;=010 115 CC 01 --ITS 119-=5 1_E_5 Pa_e Blvd .. _ + -- t t - INSURER C: i - ., INSUP.ER. u: I _ _ - _, 1_ I _ - ,INSURER c: I COVERAGES ' THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAID CLAIMS. ' • �1NSRIADD'Ll � -- - I FOUC EFFECTVE POLICY EXPIRATION - LTR INSRD. - TYP° OF :INSURANCE 9`' - - - -POLICY NUMBER � DATE IY MM /DD/YYII'Yl I PATE IMMlDDIYI'YYI I LIMITS A I LGENERAL LIABILITY I ZAGL39111900 I 05/01/10 05/01/11 EACHOCCURRENCE S 1,000,000 - -- X COMMERCIAL GEN RAL LIABILIT PREMI E Y DAMAGE SO S`cS(Ea REND i ° � .occurtence) $ 300, 000 I I I J CLAIMS MADE �- OCCUR MED EXP (Any one person) b 10,000 . I L 5,00.0,• .A? l P_o -eCtS - - -- PERSONAL &ADV INJURY b 1,000,000 -I_ - _ - - - - - - GENERAL AGGREGATE $ 2,000,000 ( GEN'L AGGREGATE E LIMIT FPPLI -S PSS PRODUCTS - COMP /OP AGG $ 2,000,000 - POLICY I -I PR - I L OC. -_ A -I I AUTOMOBILE LIABILITY ZACAT9 _. 05_/01/10 - 05/01/11 COMBINED SINGLE LIMB .�-I AN' AUTO -- - (Ea accident) - S 1,000,000 ALL OWNED AUTOS - - --- I ,. - BODILY INJURY 1 b - SCHEDULED AUTOS - (Per person) - u HIRED AUTOS ' BODILY INJURY $ - I NON -OWNED AUTOS (Per accident) • X I E'= vsical Damao - -- PROPERTY DAMAGE $ X I $1,000 Coup /Coil (Per accident) GARAGE LIABILITY 1 AUTO ONLY - E✓-, ACCIDENT I $ _ ANY AUTO O I OTHER THAN EA ACC I $ I , I I + I AUTO ONLY: AGG I S - B I I EY.CESS / UMBRELLA LIABILITY 9513288 05/01/10 05/01/11 EACH OCCURRENCE IS 5,000,000 I I - X OCCUR I I CLAIMS MADE AGGREGATE I $ 5,000,000 + IS 1 I DEDUCTIBLE I $ I I X. I RETENTION $ 10, 000 - I S A WORKERS OMPENSATION - - WC STAT- H - OAv7C192D53C0 05/01/10 05/01/11 X I I I I I RS AND EMPLOYERS' LIABILITY Y 1 N TORY 1 EMIUTS . ANY PROPRIETOR/PARTNERPD:ECUT1VE - E.L EACH ACCIDENT I $ 1,000,000 OFFICER/MEMBER EXCLUDED? I` I (Mandatory in NH) E.L DISEASE - EAEMPLOYEd $ 1,000,000 i If yes, describe under I 1 I SPECIALPROVISIONS below I - EL DISEASE - POLICY LIMIT I $ 1,000,000 OTHER I I I , DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES I EXCLUSIONS ADDED 'BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER • CANCELLATION 10 day notice of caacellat_an for non - payment - I SHOULD ANY OFTNEABOVEDESCRIB ED POLICIES BE CANC LED (EXPIRATION 3` t Certificate 'i cace I DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRi iT =N . _ - I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LE,- BUT FAILURE TO DO SO SHALL IO OS_ • NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER • ITS AGENTS OR - -- I REPRESENTATIVES_ I ' ' AUTHORIZED Z REPRESENTATIVE 'Ti- )t,Rl- � Rc. RtiT.ATiLc ■ ACORD 25 '1Q. 1) - - ©. X988 -2 O ACORD ed n:..viSi..i D i vv.,.`�i . _ bC ��:.: n�i�RJ ,=',Jl i 4 ^s rights reserved. R`.. - 15.4E54.10 The ACORD name and lo to are registeced marks of ACORD • The Commonwealth of Massachusetts Department of Industrial Accidents v1 Office of Investigations 1 600 Washington Street s Boston, MA 02111 -wow > www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -J - J CO 7 fig C__ . Address: CO . tax 5( 6 (G35 -P e &yam o(rs S 3 S .�O City /State /Zip: tivg_cf. Ei_t> mA- Phone #: (3 Are you an employer? Check the appropriate box: Type of project (required): 1.Fr I am a employer with 5Q 4. ❑ 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. I 7 . ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12K Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.0 Other_ *My 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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: K wA4 I tt .S. CO Policy # or Self -ins. Lic. #: 2.,\A/ C Z C S 300 Expiration Date: . ( f (2o ( I Job Site Address: 7..2") City /State /Zip: A✓ ' Mt G I 0‘'() 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 certify un' ' the pa' s and penalties of perjury that the information provided a ove is true and correct. - Si! ature: ./ Date: �1 110 Phone #: • ..5V-3 £6 60 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 #: Version 1.7 Commercial Building Permit May 15, 2000 • SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Don Muccino , as Owner of the subject property hereby authorize 2tv l 7 E V .h- /e/ V T 4- Co (11C . to act on my behalf, in all matters re ti e to work authorized by this building permit application. /2/0/ Signature of Owner_ Date Jan Dreyer , asr /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. Jan Dreyer Print Name /3 /0 /0 Signature of (r /Agen Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Jan N Dreyer CS 50230 License Number 44 Lakeside Dr., Monson, MA 01057 07/21/2012 Address dip Expiration Date (413) 543 -5660 .nat Telephone SECTION 13 - 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 0 No 0 Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor J. D. Rivet & Co., Inc Not Applicable ❑ Company Name: Jan Dreyer Responsible In Charge of Construction P.O. Box 51068, Indian Orchard MA 01151 Address (413) 543 -5660 Signatu Telephone Versionl.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be tilled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DON'T KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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 O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ '-oofin. 'J Change of Use ❑ Other ❑ Brief Description Replace partial roofing(8,00af) with same. R.19 insulation below roof deck + R.6 under Of Proposed Work: membrane = total roof R value is 25. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A -4 ❑ A -5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -i ❑ S -2 ❑ 5B ( ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1St 1 st 2nd 2 nd 3rd 3rd 4 th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone Municipal ❑ On site disposal system • Version1.7 Commercial Building Permit May 15, 2000 Department use only • . City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - DEC 1 0 2010 212 Main Street Sewer /Septic Availability Room 100 Water /Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone - 413 -5$7 -1240 Fax 413 - 587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 220 King St., Northampton, MA 10160 Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Don Muccino 220 King Street., Northampton, MA 01151 Name (Print) Current Mailing Address: (413) 584 -3710 / �^ Signature : r-Cs' v / Telephone ` -7/ 3 - 3d4 9 2.2 Authorized Agent: Jan Dreyer P. O. Box 51068, Indian Orchard, MA 01151 Name (Print) Current Mailing Address: (413) 543 -5660 Signatur- Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $50,000.00 (a) Building Permit Fee 2. Electrical $0.00 (b) Estimated Total Cost of Construction from (6) 3. Plumbing $0.00 Building Permit Fee 4. Mechanical (HVAC) $0.00 $300.00 5. Fire Protection (1 5) /9� 3� 6. Total = 1 + 2 + 3 + 4 + 5 � (� Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date BP-2011-0538 GIS #: COMMONWEALTH OF MASSACHUSETTS T i 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- 2011 -0538 Project # JS- 2011- 000890 Est. Cost: $50000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sg. ft.): 8755.56 Owner: MUCCINO DONALD J JR & LISA MUCCINO Zoning: HB(100)/ Applicant: J D RIVET & CO INC AT: 220 KING ST Applicant Address: Phone: Insurance: P O BOX 51068 (413) 543 -5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:12/14/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE PARTIAL 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 12/14/2010 0:00:00 $300.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner