36-043 (1) P -3
homeowners' agent: Building Permit
We Steve & Jessica Lacroix authorize Local Building and Remodeling to act as my agent to secure all necessary permits
to carry out all work stated in this contract.
09
WARRANTY
The GAF/ELK shingles include a 30 year "Systems Plus" Warranty. The 30 year warranty has 100%
coverage for the first 20 years on all labor and materials, after 20 years it prorates still covering all
labor and materials.
NOTE: Extra care will be taken to protect shrubbery and plants but we cannot guarantee against damage due to
the nature of the work performed.
NOTE: Property is to be swept with commercial grade magnets to remove any excess debris.
• Install new ridge vent along the entire ridge including dormer
• InstalI 2 new pipe boot flashings
• Grind out existing aluminum and install new lead flashing on the upper chimney
• If a rain diverter is needed above any doors or windows it will be installed free of charge
• Clean and haul away debris
Note: The above price does not include the cost to re- plywood the roof.
Re- plywood the entire roof: $3,170.00
Blown -in Cellulose Insulation: $1,300.00
• To be blow -in throughout the entire attic @ 12in. thick (Will bring to an R -value of 38)
• This will be in addition to what is already in the attic (approx. 3in.)
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The contractor agrees to perform the work, furnish the material and labor specified above for the
SUM of: $9,920.00 (Nine Thousand Nine Hundred Twenty Dollars)
Payments will be made according to the following SCHEDULE:
$4,035.00 upon the start date ($1800.00 -roof+ $1585.00- plywood+ $650.00- insulation)
$5,885.00 upon completion of the work
The following schedule will be adhered to unless circumstances beyond the contractors control arise including weather
or unexpected problems with other jobs.
r , _
fi
Work Scheduled to Begin: u V Expected Date of Completion: b V
(Date Contractor will begin contracted work) (Date when work will be substantially completed)
DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES
Ll L�� piU�/
Homeowner's signature Contractor's signature
Date Date
Required Permits
The following building permits are required. It is the obligation of the contractor to secure such permits as the
P
Local
Building and Remodeling
Anthony Robitaille 413.626.5296 MA. License # 102453
Fax4132899611 MA. Reg. # 138144
HOME TIE O RMA M �T INFORMATION
15780
PCJ. i�� ,c- Fi92''7'1��,�- ��1Xr1LZ�C1 CONTRACTOR
Name Company Name
Steve & Jessica Lacroix Local Building & Remodeling
Mailing Address Contractor /Owner Name
27 Winchester Street Anthony Robitaille
City/Town State Zip Code Business Street Address
Florence MA 01062 P.O. Box 892, 4212 Church St.
Contact Number City/Town State Zip Code
(413)586 -5514 Thorndike, MA 01079
Business Phone
1- 413 - 626 -5296
Contractor Registration #:
138144 - Expiration Date: 2 -25 -2010
WORK TO BE PERFORMED
Roof Work: $5,450.00
• Remove existing shingles (approx. 18 squares)
• Remove all plywood
• Clean down any framing appearing to have mold on it with bleach and water mix
• If more soffit vents are needed they will be cut in while the plywood is off of the roof
• Install new 5/8 in. plywood on entire roof
• Install 30 year GAF/ELK architectural shingles
• Install GAF ice and water barrier around the eaves, valleys, and chimneys
• Install synthetic underlayment paper
• Install new drip edge
• Install new step flashing
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
It- . 1 - ' • o .. - • es 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
-------- --pern its- in- conjunction..to_ 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
fi Office of Investigations
® '
p 600 Washington Street
•
• " Boston, MA 02111
,;" . www.mass.gov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Lif3cR11 IkL /ML wJi t FN Over C tf ilfT(A; t. Please Print Legibly
Name ( Business /Organization/Individual):
Address:
City /State/Zip: Phone. #:
Are you an employer? Check the appropriate box: Type of project (required): 1
1. P I am a employer with 3 4. 0 I am a general contractor and I
employees (full and/or part-time).*
have hired the sub- contractors 6. ❑New construction
listed on the attached sheet. 7. 0 Remodeling
2. ❑ I am a sole proprietor or partner-
ship mid have no employees These sub - contractors have. 8. ❑ Demolon
for me in any capacity. employees and have workers' t
working
Y ty. 9. Q Bulldin • addition
[No workers' comp. insurance _ comp._ ;nsurance
required ] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. C I am-a- hemeo-wner- deing- work o c_e� s ave xercise.. _• - — 13 1 Oth1 l_ P� er mg repairs or additions
myself [No workers' comp. right of exemption per MGL 12.Q Roof repairs
insurance required] t c. 152, 1 , and we have no
4 O
employees. [No workers'
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.. 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: WALL _ _13 F ' t .
•
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 nninber 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 yiolatar. ge advised that a copy of this statement may be forwarded to the Offi .: of
Investigations of the DIA for insurance coverage verification.
_ I do hereby certi under the pains and penoltiPs ofperjury that the information provided above_ astruemuLcorrea____ - .
$! f' / Pate. 1 � 2 UQ
Signa ,, , '
� . I- G •
Phone #: L i 13 - (, 5 216
Official use only. DO write in thts area leted by city or town officiaL
City or Town: Permit/License #_ - -- -_ - _
Issuing Authority (circle one):
I: Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Ins. ector 5. Plumbing Ins. ector _ _ __ 6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: (� T Not Applicable ❑
Name of License Holder:!" Ii I NvIV ' ( `( V-1 i4 lGk ic Z' 3
License Number
('c ft`t 'c72 '' ' r'I ta Mn 0:67g
Address ji/c/2ci3
ratibn Date
q1361 -6 52
i ✓, ` w r ✓�
Signaturd Telephone
9. Registecctf;klome.Impro� cement ° C. nti ctor• , >,, ..<.. ; ,ate .,.. >, _... f Not Applicable ❑
be-E,4"--6 . • . 4 ii WI 1413f747t1t 13 5% Li if
Company Name Registration Number
• (fi:f D. f 4 1Lah G �fLSf
Address c Expiration Date
G ,5'1 ,''Ci Z j f -�Gj t rt �ui� CJI C Telephone L EI "
(—
_.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 ❑
it tt X I..
The_current_exemption for "honmeowners "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, ui is intended to be, a one or two family dwelling, attached or detached structures accessory to snrh nse 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 ampton a r. tnance , " a e • •
.:. to . — , ®. eneralT;a =ws - Annotated. _
Homeowner Signature
/\
ti
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House D Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 14
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [p]
Brief Description of Proposed
Work: SrFzP t I'itituL RUci r P`1 We O RrPi w C A PL1 n wD Si - it�uL +� 3 c ' G4.F 4fK.
Alteration of existing bedroom Yes I' No Adding new bedroom Yes V No
Attached Narrative . Renovating unfinished basement Yes x No
Plans Attached Roll - Sheet
6aiflieW, house ands radditionkoecistinf tiousincL amp a it ie f011ov liiq:
a. Use of building : One Family Two Family Other
it
it
b. Number of rooms in each family unit: Number of Bathrooms �..;
v'
+
c. Is there a garage attached? I
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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR DUILDING PERMIT
i, C t L G �'TI` - ,fi T as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by t building permit application.
Signature of Owner Date
I, , as Owner /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.
S t Z CcOif/
Print Name
Signature of Owner /Agent Date
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
Frontage '_._._.__Y..._ m .... _ _ ,
Setbacks Front
Side L:__ R.. L: R::,_____, _ __,
Rear. ____: .
Building Height
Bldg. Square Footage l�_ % r
Open Space Footage
(Lot area minus bldg & paved L._ __
parking)
# of Parking Spaces
Fill: i 11
(volume & Location) ?.__ . .__._._. ; .___ ................__
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES
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 Page! i and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES
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:
______ ._ D: ire tthiee a any proposed c anges to or a rtions o signs inten d-T t e property ? YES 0 NO 0
e
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 lea
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton Stemut�
Building Department
212 Main Street S��uue /S � a ; s
Room 100
ob, Northampton, MA 01060 a 3���
phone 413- 587 -1240 Fax 413 - 587 -1272 �' �0 `
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: �� I
This section to be completed by office
L
27 IAJ v gcsi P. 5r �'1- vitr �Ull" Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Add ss:
1 03 - 51t, 51`i
- 1-1 ,' clef) Telephone
Signature
2.2 Authorized Agent: Per] LIfii nn
Name (Print) Current Mailing Address:
/ a • " 1
/ 1 '1 /6 / �I / 3 - C ( - 5 2 �, 6
�
Signatur6 Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS •
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building *Permit Fee
q �
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
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of ° Buildings ' Date
27 WINCHESTER TERR BP- 2010 -0471
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 043 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 -0471
Project # JS- 2010 - 000649
Est. Cost: $9920.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ANTHONY ROBITAILLE 102453
Lot Size(sq. ft.): 10018.80 Owner: LACROIX STEVEN E & JESSICA S
zgrnnx_tIR 1100)//WSP II Applicant: ANTHONY ROBITAILLE
AT: 27 WINCHES [ER TERR
Applicant Address: Phone: Insurance:
P 0 BOX 892 (413) 626 -5296
ThorndikeMA01079 ISSUED ON :10/29/2009 0 :00 :00
TO PERFORM THE FOLLOWING WORK :STRIP,PLY & 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: OK. 11 1 I3 107
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAI N OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu p anc /7 - ,_/ Signature:
FeeType: Date Paid: Amount:
Building 10/29/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo