30B-036 Buyer will:
• Supply adequate electrical power for the Specifications.
• Be responsible for all rot damage and any other necessary sub roof repairs not stated in
the Specifications.
• Agree to compensate the Contractor for any additional work perfornned by the Contractor
at a cost that is mutually agreed upon by the Buyer and the Contractor before the work is
started.
Special t strpctions:
It 1' F ck <f fL -t . n_s - c J. y
-i'vl .; .-1 r - 77( 4-P x 47044_6e 4
c_._
1 of _A-e--01 1-41 / 7 z-- 1 ? del(' 1714-Lx4-: -e- -,z5 J t-r-4(
nl s /c,s .0x4 zd sir ...
t c.).e ,. 1 ! t 7-4 e i - j /24.4.-P--4... ,
e- tZ) ,vim - -
A - 11 4 .01 J /J/ be bi PAPr" 7 r `
-4 ,Pe-f...) e Az- e' d 7"c `^a! &a GI . Mx rzso t `z.s70
# Contract Price $ /7 7,0( .--
Sales Tax $ —
Sub-Total S 7 r e
Down Payment (1/3) $ . - ---
When Work Begins Payment (1/3) $ 47 0
Balance On Completion (1/3) $ 5; 100
Make all checks payable to Classic Metal Roofs, LLC
Do not sign this agreement if there are any blank spaces
In witnessAhereo£ the Buyer and Contractor have hereinto freely signed their names this
V ``'_ day of_ �_of201,x/
The Contractor and the Buyer hereby mutually agree in advance that in the event that the
Contractor has a dispute concerning the contract, the Contractor may submit such dispute to a
private arbitrati • 1 service which has been approved by the Office of Consumer Affairs and
Business ' - y : + an • • e Buyer shall be required to submit to such arb
oo
Signed: S igned
Oa c Met. Roofs, LI .0 l YifYer --
} ij C 6 Signed: ---
Buyer
This is a binding agreement between the Buyer and the Contractor. This is not a credit transaction and will not be financed by the
Contractor. If financing is required, the Buyer hereby authorizes the Contractor to obtain credit information and the Buyer hereby
agrees to provide and sign all necessary documents required by any third party financial institution to complete the financing
immediately upon request The Buyer hereby acknowledges an original copy of this agreement and to the teens and conditions
attached.
All surplus material is the property of the Contractor
This is an agreement between For Office Use Only
Classic Metal Roofs, LLC
264 Gleasondale Rd. (Rte 62)
Stow, Massachusetts 01775
Registered as a Massachusetts Home Improvement Contractor
Registration # 144235
Toll free 1 -866- 660 -6668
And
Name �✓ %jI `c4- C .
Hereinafter will to as the `Buyer".
A d d r e s s , 3 / 4 s t a4 27
o _
City/Town Pr‘ r ►h State 6 A � ' `` Zip f d 1—
Phone # Home % / 5 --- 3q/-g4.83/ Cell W3
Job Site
Address (if different):
jutvi fit tut) on (toile). ) i f ' T/
The Buyer is the recorded owner of the property described in the Job Site address above, and hereby
contracts with Classic Metal Roofs, LLC (hereinafter the "Contractor") and authorizes the Contractor to
supply all necessary materials and labor to install, construct, and place the improvements according to the
following specifications, terms, and conditions (hereinafter the "Specifications ") at the Job Site.
Specifications: ei j tr d
Classic Metal Roof Shin Rus + Color: SG MB DC CB BS FG SB TR BK
• xfor I Color: RW TR MB JG SG
Premium Color: WW AB CP CU
Finish: Standard Thermobond
Yes No Roofing accessories
Flashing skylights — number
Underlayment type r
�' Vent pipes, size & number 0r //
y Snow Guards # / 5,'dte•3 c >� )
\) Sheathing 4'x8'x5/8"
Existing Roof material removal & dis I al
X Strip existing Roof # layers s _ / d 4 ti 17 41
R emove and dispose Note: Place 1 1 era e1ii feztl
City of Northampton
r ". .
Massachusetts ,t.
'i S tZ lft DEPARTMENT OF BUILDING INSPECTIONS
110
212 Main Street • Municipal Building . � , v �
Northampton, MA 01060 fi .ai'D't
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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 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
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.
Date
Address of work location
•
The Commonwealth of Massachusetts
@-.. Department of Industrial Accidents
Office of Investigations
r.r
a 600 Washington Street
am.. •� mew M Boston, MA 02111
'
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization/Individual): t � mss / t - A,/ ,/ t, / ne'e L-C. c1
Address: Y /fi//f
City /State /Zip: '5 0 !2l1/ 7 75 rnone #: 2rr52e — 777
Are you an employer? Check thlappropriate box: Type of project (required):
1.1, f-am a employer with 4. ❑ I am a general contractor and I ❑
employees (full and/or p - time).* have hired the sub - contractors 6. New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 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.
$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. poiicy 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: 1", i 4
Policy # or Self -ins. Lic. #: ¥'9 11 P/9 Expiration Date: / Z 2-2/ 'z_
Job Site Address: 2 7 )2 ,1✓r- City/State /Zip: �L1 -L d �
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 insur• ' - - overage verification.
I do hereby certify nder epains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone #: '
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 #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder : A'71.- G`? 2 y7 '4
License Number
C ( 645 - / f' w 44 /- Oe -y�i
Address Expiration Date
/ � l 7, 0)-
Signature Telephone
9 e'• rsteted om�` a i`m rovement :Contractor
., . "�" � t SOgr:. Not A pplicable ❑
Company Name Registration Number
Address Expiration fl ate /
Telephone w J _ - 777• 11J
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 ❑
11 omeUwner ET emnptio
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
•
I .l
SECTION 5- DESCRIPTION OF PROPOSED WORK (check alt appticable): 4 , .
New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors D
Accessory Bldg. ❑ Demolition ❑ w Signs D] Deck [D Siding [El] Other [D]
BFief Description of Proposed , / '1 Jam {� y�
Work: �" &e l S r e k›P' e 1 (/
AAA-0 fie /` :c) •I
Alteration of existing bedroom Yes >< No Adding new bedroom Yes • No
Attached Narrative Renovating unfinished basement Yes ____&No
Plans Attached Roll - Sheet
sa AIL ew ho use4a nd or addit onto ezistin • - housin • 4com" a lete,lth - fol ■ine ®':
a. Use of building e - Family Two Family Other
b. Number of rooms in each family • • Number • z athrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. _ Dimensions
e. Number of stones?
f. Method of heating? /
£ Fireplace •r Woodstoves Number of each '
g. Energy Conservation Compliance. Masscheck Ener, Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 10d "yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade N
k. Will building conform to the Building and Zoning regulations'? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7 T_OWNERAUTH ORIZATION TO BE-COMPLETED WHEN
' OWNERS AGENTTOR' CONTRACTORAPPLIES FOR BUILDING P
1, , 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
1, j� `" r' 1CrG2a e ( O it (7 ( s1/ c- Act -a /:,2e.).
e.) , as Owner /Authorized
A gent hereby declare that the statements and infor ation on the foregoing application are true and accurate, to the best of my knowledge
a nd belief.
Signed under the pains and pe altie of perjury.
41 1 / - 4 - ( "I 7
Print Name
e47
Signature of Ow "Tr. - Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
b
Existing Proposed Required by'Zoni>
This column to be five m ty
Building Department
Lot Size
1 ?4 i
1
r
i 1 { !
Frontage
Setbacks Front _ F
l ? r`` i
Side L: °` i R:'F i L:1 9 R:'; r '
a
Rear I !
/
Building Height I 1 /
/
Bldg. Square Footage j 1 1 , 1 % ! i V
Open Space Footage % 7 F___ (Lot area minus bldg & paved 1
parking)
Spaces E I `—"" L---
# of Parking p
Fill: I _ — I
(volume & Location)
v
A. Has a Special Permit /Variance /Finding ever be; is ed for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the '--gistry of Deeds? \\
NO 0 DONT KNOW 0 YES 0 \
IF YES: enter Book 1 - _
Page; s and /or Document # i
B. Does the site contain a brook, •ody of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit bee or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained , Date Issued:
C. Do any signs exist on t 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 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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
�,. . - __ _ _ .. __w.._ , k � Departmei u my ' n
RECD - ' G of Northampton St o f Pe mi t r . t'
(Building Department •: v,ra�
_ 28 ' 2 Main Street Se er ear al a � �
Room 100 UCI e - eC -A v;�
f ,
DePT..oFSUJ�a , -+ orthampton, MA 0106 w® 5e s fr. a u . . ar,i e Iry z
INSPE S
NORTHAMPTON MA i 41c- 587 -1240 Fax 413- 1272 P!• a lasx "
® her ecif s
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SFGTI 1 SITE INFORMATION
Thi s s e ction to be completedby office ,
1.1 Property Address: , k ,°, hk $- ; t i T'qq� o
P P 13'f'' IIllap * « Y L ot a , :� , �t� Unit r , ■ ?' 7- -Ul 14-/(-4--- Zone m ix v�is � .� ks Ove D s' .a., ra'kR
l "` -, a fi y . e " a +�, 'a ?m^q - x ° . 4 �„ '` •,u+'.
7s
, St District - - .. - ,i:� " "� CB Distric r
SECTION 2 . PROPERTYOWNERSHIP /AUTHORIZED AG
2.1 Owner of Record:
/
Current Mailing Address:
Name (Print)
e- _3 . " Y /- 3 Y1
Telephone
Signature .
2.2 Authorized Agent: / �� ,
1 sS �1. ` L-- d4 y ( Ze -1- .5Ar -t / �/ '.1, �`^' `p—
Name (Print) Current Mailing Address:
6,/ 7C7
17J 5a .'- '?7
Signature Telephone
SECTION 3 = ESTIM ATED CONSTRUCTION CO
Item Estimated Cost (Dollars) to be O fficial Use Only
completed by permit applicant
1. Building - ' / 7 (a)Buiiding` 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) Ch Number /�, / #' : .3,C -
This Section For Official Use OnIy
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
237 RIVERSIDE DR BP- 2012 -1095
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30B - 036 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- 2012 -1095
Project # JS- 2012- 001882
Est. Cost: $17700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: _ CLASSIC METAL ROOFS LLC 100240
Lot Size(sq. ft.): 12501.72 Owner: SABADOSA LINDSAY N
Zoning: URB(100)/ Applicant: CLASSIC METAL ROOFS LLC
AT: 237 RIVERSIDE DR
Applicant Address: Phone: Insurance:
264 GLEASONDALE RD (978) 562 -7770 WC
STOW MA01775 ISSUED ON: 6/11/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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 6/11/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner