36-056 (6) +$ (100-”0 for the plywood ($50.00 per sheet x t 2 -"' T° 1 S sheets)
$ S - S AC° will be the total cost 1 57 0 0 JS 7T Cc 7
a } �
Payments will be made according to the following SCHEDULE:
$1,800.00 upon signing the contract
$ 31'0 upon completion of the work
F 3
The following schedule will be adhered to unless circumstances beyond the contractors control arise including weather
or unexpected problems with other jobs.
Work Scheduled to Begin: 08/17/2009 Expected Date of Completion: 08/19/2009
(Date Contractor will begin contracted work) (Date when work will be substantially completed)
DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES
x /d
Homeowner's signature Contractor's signature
PS/ zoa5 (3$ -i5 2009
Date Date
Required Permits
The following building permits are required. It is the obligation of the contractor to secure such permits as the
homeowners' agent: Building Permit
I Don Bruno authorize Local Building and Remodeling to act as my agent to secure all necessary permits to carry out all
work stated in this contract.
( � - i FA uv,
WARRANTY
The contractor will warranty workmanship for Five years. This warranty is transferrable 1 time.
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.
Local
Building and Remodeling
Anthony Robitaille 413.626.5296 MA. License # 1 02453
Fax4132899611 MA. Reg. # 138144
CT. Rea. # 0615780
P.O. Box 892 Thorndike MA 01079
HOMEQW R N) RMATION CONTRACTOR INFORMATION
Nance Company Name
Don Bruno Local Building & Remodeling
Street Address Contractor /Owner Name
41 Red Ford Drive Anthony Robitaille
City/Town State Zip Code Business Street Address
Florence MA 01062 P.O. Box 892, 4212 Church St.
Home Number City/Town State Zip Code
(413)335 -5960 Thorndike, MA 01079
Cell Number Business Phone
(413)584 -0617 1- 413 - 626 -5296
Contractor Registration #:
138144 - Expiration Date: 2 -25 -2010
WORK TO BE PERFORMED
• Strip 1 layer of existing shingles on the front and back of the roof
• Install 30 year GAF/ELK architectural shingles
• Install ice and water along the eaves and valleys
• Install synthetic felt underlayment
• Install new COBRA ridge vent along the entire ridge
• Install new hoot stack flashing
• Install new drip edge
• Install new step flashing where needed
• Replace r 2-/ S" sheets of 1 /2in. 4 ply plywood (Any moldy plywood will be replaced) (Each sheet of plywood
replaced will cost an extra $50.00 on top of the total cost)
• Clean and haul away debris
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The contractor agrees to perform the work, furnish the material and labor specified above for the
SUM of: $ 500 ` 5$ C for the roof work
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
. 11 ' g • - ... ocess 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
T -- —pe ts_in- conjunctionto- the_building_permitissued, 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.
lte-
Address of work
location
Y • • _
1.
The Commonwealth of Massachusetts
Department of Industrial Accidents
A" = 1. _ F Office of Investigations
tc 600 Washington Street
'� i Boston, MA 02111
_� . www. mass gov /dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): ( CA I - iCRC
Address: Po` B 92 -
City /State /Zip: 7 f /a ?Q,/7(E f + Uj077 Phone. #: 6 6 ` 52 ? 6
�
Are you an employer? Check the appropriate box: Type of project (required): i'
1. I am a employer with 2 4. ❑ I am a general contractor and I
6. ❑ New construction
employees (full and/or part- time).* have hired the sub- contractors
listed on the attached sheet 7. 14
2. ❑ I am a sole proprietor or partner- Remodeling
ship and have. no. — nployees These sub - contractors have 8. ❑ Demolition
worlring for me in any capacity. employees and'have workers' 9. ❑ Building addition
[No workers' comp. insurance C.Omp.,ir]SULanrp #
d. uire
re 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
required.] ce_rs�aave exercis iL_._ i-1 Plurnbin 3. ❑ � -am a- liemeo-whomeowner ai��vorlc - - - - -- — - - - -- ❑ g 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 affidauit: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: L. T 8t14 \. 114(/1/1 L
Policy # or Self-ins. Lic. #: ? 7 3 5( Expiration Date: - 6__ 2 5 " I 0
Job Site Address: t( / - At°Fad'0 9f. f LOR 4tcC r City /State/Zip: 414I4 - 01 0 E1-
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required tinder Section - 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51 and/or one :year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
.Edo hereby certify under the pains and penalties of perjury that the information provided _abaveeisirue- and_carrect~__ _ .
Signature: Date:
Phone #:
Official use only. Do not write in tfiig area, to be completed by city or town
City or Town: Permit/License #
Issuing Authority (circle one):
I.- Board of Health 2. Building Department 3. City/Town - CIerk 4. Electrical_ Inspector 5. Plumbing Inspector
6. Other r
Contact Person: Phone #: -
• •
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable ❑
1 [
Name of License Holder : �l � I l / G , 1 , f p �1& / 7/ 6 f a z- C(5 3
License Number
f O)C, q j ( {oPNVK( (r/04 0(07? o3_lG• 2013
Addres Expiration Date
q( -C;` 6- 5/Tq W',j
Signature Telephone
. Req-istered Note lriiprxiveitieritCtiittractor £„' •" i ; ... . Not Applicable ❑
LO C4L 13 t DPP$' 118 i `l y
Company Name Registration Number
Address Expiration Date
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 ❑
.. tQ
The_current_exemption for." homeosuners" was extended to include Qwner 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 buildin • 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 "O r. tnances
e andI t. i - - . - ®-= - - ral - L aws Annotated.
Homeowner Signature
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors CI
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] Other [0]
Brief Description of Proposed
Work: S'( I 141\0 Of sapuu t,S uPI;Aeu 12_ 9 kfis car yP'-'i PL`i
Alteration of existing bedroom Yes No Adding new bedroom Yes 4( No
Attached Narrative Renovating unfinished basement Yes y No
Plans Attached Roll - Sheet
sa If. Nerii'house and'ar aci ii cart to e�ciSfi nA bouslnct corm fete ti a •foilo nA:
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
I, iii/4,14 b.1. it L.
as Owner /Authorized
Agen 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 paine and penalties of perjury.
A to (1
Print Name
Signature of Owner /Agent 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
Lot Size
Frontage
Setbacks Front
Side L. __.. R. J._ _. L ° .__ R:_.
Rear
Building Height
Bldg. Square Footage ; %
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume &Location) _.3
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES
IF YES, date issued:t
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES 0
IF YES: enter Book ` Pagel I and /or Document #'
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 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 0
IF YES, describe size, type and location:
D ` - Are th re an Fo p osed c an es o or a t Ions o si n intended fb� thie ro ert ? YES 0 NO
YP P g g� s P P Y•
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 Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
4 -1
City of Northampton Status f t?e j x ;
q\ $ uilding Department Cu Cu Drive
♦ r
t\ ` r% 212 Main Street S tialil
oom 100
Ngrtha MA 01060 vi eS3fiaeti Plans �a
0 phons44 587- 9:,240 Fax 413- 587 -1272 Po 61P s r i° °
b er S
AP i1c ATION —T-ti ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTI(1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
IL / EOFOR ii Map Lot Unit
Zone Overlay District
F Lup,clvu
EIm St,District CB District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
(hi At' --eR -- -- — 1_160- FoRa__ t FIPAIlvcr (1 f► CIO C 2 -
Name (Print) Current Mailin Add ss:
Ltt3 51 6c
Telephone
Signature
2.2 Authorized Agent:
4rt ( . o Pa8,'7AJGGC Pa 60)( x2- r t(GIRpfi ,I ltit4 0/079
Name (Print) ,, Current Mailing Address:
0 .1 P ,, lj t{13 5291
Signature/ Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building f 7o C ( 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) s ?Uo Check Number
This Section ForOfficial ' se Only
•
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
MEDFORD DR 1 11 BP- 2010 -0180
GIS #: COMMONWEALTH OF MASSACHUSETTS
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 -0180
Proiect # JS- 2010 - 000224
Est. Cost: $5700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ANTHONY ROBITAILLE 102453
Lot Size(sq. ft.): 12501.72 Owner: BRUNO DONALD R & PATRICIA A
Zoning: URA(100) //WSP II Applicant: ANTHONY ROBITAILLE
AT: 41 REDFORD DR
Applicant Address: Phone: Insurance:
P O BOX 892 (413) 626 -5296 WC
ThorndikeMA01079 ISSUED ON:8/17/2009 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:
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 8/17/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo