24D-223 (2) Complete Asphalt, Slate, and Rubber Roofing Systems and
Repairs, Siding, Chimney Pointing and Gutters
Customer:
Joel Kaminsky (West side of main roof only)
252 Prospect St.
Northampton, MA 01060
(413) 586 -0021
Work to be done:
Complete shingled sections of west side of main roof only (right side of house) not r
recently shingled:
Inspect complete roof surface and replace damaged boards, where necessary. (
Remove and dispose of exterior layer of roofing material only, where necessary.
Install new white aluminum rake and drip edge.
Install Tamko ice and water barrier underlayment on complete eave edges and in valleys.
Re -roof over remaining layer of roofing shingles with Tamko Heritage 30 -year designer
architectural roofing shingles, color to match new Southeast section.
Re -flash and or re -seal along all walls, vents, and chimney.
l 0-year guaranty on labor, 30 -year Manufacturer's Warranty on material.
Joel — It's time to do this. If it's not leaking, there is no immediate rush. But it's
beyond patching. Everything is brittle and breaking apart. We're scheduling for
September. Any questions let me know. Todd
Total Cost $ 4,625
•
(Labor and material)
Deposit required pf $ 1,800 Homeowner: t
• Balance upon Completion: $ 2,825 Contractor r /.� /
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_'nspection process reviles 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 - conjunction_to ued,_ 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.
Dater
Address of work
location
r#
- . . a
The Commonwealth of Massachusetts
-_ Department of Industrial Accidents
- -41.� Office of Investig,ations
�
=:; 600 Washington Street
Boston, MA 02111
www.mass gov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/PIumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 7149 ,Cbit .1
Address: �3 S4/k
City /State /Zip: g/ee.fre4 ' ///ei-- a:34/ Phone. #: 77s =a7�
Are you an employer? Check the appropriate box: , of project (required): i
1. ❑ 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. I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling
ship and have no loyees These sub - contractors have. 8. ❑ Deao;on
working for me in any capacity. employees anZ-hhave workers'
Y aP ty 9. Q Building addition
[No workers' comp. insurance '
nsurance cam: _m , .
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. E I - am- a- bomeownerdoin -a -work — o -ers have exercise Jheir._ _44 �- 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. 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 affida 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 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 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 ofMGL 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 file
of up to $250.00 a day against the violator. De advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
_ /do hereby certify under the , ains and pen /rides of perjury that the information provided_ i _true_and.correct. _
Signature: • - Date; 7 R
Phone #: ` 775 W7-75 -
Official use only. Do not write r tl isIIrrert, to be completed by thy or town official
City or Town: Permit/License #—_
Issuing Authority (circle one):
I: Board of Health 2. Building Department 3. City/Town 4. Electrical_ Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone #:
w
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor
� / Not Applicable ❑
Name of License Holder : � LavTi1 � p
� d 7 / W /
License Numberr�/
l � --,4/12.r 7/s /� /
Address Expiration Date
6Qp 42 /1 e'(e /'
Signature
9 :Regist 6 me Improvement:Gontractor i„, . 4. ..4 ..: . �, N , . _ Not A
— 1.0P 4 rir s�f� N pplicable ❑
/ 11
Com pany Name Registration Number
--,-; c4A) - 744h
Address Expiration Date
:7 ( A ;�. / ! f (j Telephone 7 A
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 ik
The_current_exemption for "homeowners" was extended to include Owner 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
_.w . .. . c - tts-General Laws_Annotated.
___._. —.. - -° �; . - - - :
oft am r in nc ',- a n� .-- �` _-
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing T
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [D] Other [0]
Brief Description of Proposed / ,,� / 1x7 t Fje Work: � ` �'�T ( (R/�s
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa "- lf..Nevrr "house and.:or ad litiort'to= eicisfirtlq of srriq.-- eoinDiete the.fati&ving:
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 w TO SEC 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
z __
as Ow. u thorized
Agent h reby declare that the statements and information on the foregoing application are true and accurate, to the . -st of my kn. - -
belief.
Signed under the pains and penalties of perjury.
( 'lam6rn�
Print Name
Signature of 0 - ' Date
w
t
,
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 _ ._M
Frontage __._..__,__..w
Setbacks Front
Side L..__,,_ R :i._ ___:' L: R:_____;
Rear _ __, ,..,
Building Height __
Bldg. Square Footage
Open Space Footage __
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume &Location) _ _._____ , ___ ` L....._
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW '1 YES
IF YES, date issued: /
IF YES: Was the permit recorded at the Registry of Deeds?
NO _ DONT KNOW _O _ YES 0
IF YES: enter Book Page' l and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO GK DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued
C. Do any signs exist on the property? YES 0 NO ';,
IF YES, describe size, type and location:
-_ - - -- ._ p - 13: fro there any proposed c "anges o or a itlons o signs ii ten ed for t1ie property ? YES 0 NO T ,
W YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading,vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
L y
•
Qity of Northampton Stages. f1Perrnrt
.__ $ending Department c� 11WDn y..e
v rr it V l a i _ ,
212 Main Street s ewe r Sf�ratlebly� ��
s r P ' 2 2 2 Room 100 �uaTa
Northampton, MA 01060 es br . N 4 . .
phone 413 - 587 - 1240 Fax 413 587 - 1272 �1aft rued, � s
O er r Specf t 3 4 -16
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
Map Lot Unit
Zone Overlay District
`"iej St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of
-
Name (Print) Current Mailing Addr /� e70 /
Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
v G -> -
Signature Telephone
SECTION ..ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Buliding'Permit Fee
2. Electrical (b) Estimated Total Cost of
Constriction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6 Total (1 + 2 + 3 + 4 + 5) p( Check Number (p 5
•
This Section For Official Use Only '
-
Building Permit Number. Issued:
Signature:
Beading Commissionedtnspectar of Buildings Date
3
252 PRA ST ` BP-2010-0312
GIS #: COMMONWEALTH OF MASSACHUSETTS
r e „ 2 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 -0312
Project # JS- 2010- 000414
Est. Cost: $4625.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TODD BOYNTON 079221
Lot Size(sq. ft.): 7492.32 Owner: KAMINSKY JOEL STEVEN & JODY ANN ROSENBLOOM
Zoning: URB(100)/ Applicant: TODD BOYNTON
AT: 252 PROSPECT ST
Applicant Address: Phone: Insurance:
83 SILVER ST (413) 772 -8829
GREENFIELDMA01301 ISSUED ON:9/22/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: ROOF OVER 1 LAYER
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 9/22/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo