36-058 (4) D Local
� ��,
2010
Building and Remodeling
$ Anthony Robitaille Contact Information: MA License #102453
P.O. Box 892 Cell: (413)626 -5296 MA Reg. #138144
Thorndike, MA 01079 Fax: (413)289 -9611 CT Reg. #615780
*If you agree to the work and pricing listed above, please initial here 1 /( k 1 and sign at the designated spots below*
Customer Signature:
, .,� - . Date: 12 t . 01 / d
/� � �,( /, � - ���.��
/ .
Contractor Signature: `,�jn f; „Kte Date:
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: Expected Date of Completion:
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 Kevin Aste authorize Local Building and Remodeling to act as my agent to secure all necessary permits to carry out
all work stated in this contract.
ra /
l e,61�tti- C��-t� l /3d 10
WARRANTY
There is a 10 year warranty on all labor and materials.
NOTES:
- Extra care will be taken to protect shrubbery and plants but we cannot guarantee against damage due
to the nature of the work performed.
- Property is to be swept with commercial grade magnets to remove any excess debris.
-Local Building will remove and reinstall any satellite dish, however, the homeowner is responsible for
any fine tuning needed, or any charges that come along with it.
- Local Building will provide a dumpster for this job; this is included in the total cost. Proper
precautions will be taken, i.e. planks under dumpster to prevent damage but we cannot guarantee against any
damage caused due to the weather and materials composing the driveway. Please initial below stating you've
read and understand the conditions shown in this contract.
(Initial Here -- -- ) / . )
* *If you agree to the work and pricing listed above, please sign and initial the original
copy of the contract in the designated spots and send back to Local Building in the
enclosed return envelope. **
o Ina*
December 2 � Local
a Building and Remodeling
Anthony Robitaille Contact Information: MA License #102453
P.O. Box 892 Cell: (413)626 -5296 MA Reg. #138144
Thorndike, MA 01079 Fax: (413)289 -9611 CT Reg. #615780
HOMEOWNER INFORMATION CONTRACTOR INFORMATION
Name Company Name
Kevin Aste Local Building and Remodeling
Address Contractor /Owner Name
25 Redford Drive Anthony Robitaille
City/Town State Zip Business Street Address
Florence MA 01062 P.O. Box 892, 4212 Church Street
Contact Number City/Town State Zip
(413)586 -0439 Thorndike MA 01"079
Business Phone
1(413)626-5296
Contractor Registration #
138144
MACSL#
102453
Work To Be Performed
Roof Work:
• Strip existing 2 layers of existing roofing
• Install .060 EPDM Rubber Roof (Fully Adhered)
• Install new white C6 drip edge on 3 sides
• R &R,the gutter if necessary
• Clean up and haul away debris
NOTE:
-If the roof needs plywood this will increase the total cost listed below by $400.00. (We will not know this
until it's stripped.)
-If the trash is removed by the homeowner, the total cost will reduce by $100.00.
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The contractor agrees to perform the work specified above for the
SUM of: $900.00 (Nine Hundred Dollars)
The total cost is due upon completion of the work listed above
If NO plywood is needed, homeowner is to initial here I {< A I to accept the total cost of $900.00.
*Contractor is to write VOID above if plywood is needed*
If plywood is needed, homeowner is to initial here I I to accept the new total cost of $1,300.00.
*Contractor is to write VOID above if NO plywood is needed.*
If trash will be removed by homeowner, contractor is to initial here I I to reduce the total cost by $100.00.
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 owir 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
iermits 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
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.
Date
Address of work
location
,
. ,
- .■ The Commonwealth ofMassachusetts
--Ar.z.--r--- Department of Industrial ACcidents
Office of Investig,ations •
600 Washington Street
Boston, MA 02111
www.mass.gov/dia . ...,-
-:.
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
,..
Name (BusinesilOrganilationandividunl.): .. ..
.. . ,
.
• Address: . , •
City/State/Zip: - Phone.#:
Are you an employer? Check the appropriate box: • Type of project (required): i
1. Ja I am a employer with 3 4. 0 I am a general contractor and I
6. 0 New construction
have hired the sub-contractors
employees (full and/or part-time).*
listed on theattached sheet: 7. 0 Remodeling
ship
2.0 I aril a sole proprietor or partner-
These sub-contractors have
md.. have no, -21oyees 8. 0 Deinaliiion
enAgoyees anaer' . s•
working for me m any capacity. d hve warks 9 D Winding aAdition
[N .... comp..nsurance.T.: _ , .
o workers' comp. insurance
required:I • .
5. 0 We are a corporation and its 10.11 Electrical repairs or additions
3.0 I am a homeowner daing ill work officers haVettercised their . 11.0 Plumbing repairs or additions
I
myself [No workers' comp. lien of exemption per MGL s —
12. Roof repairs
insurance required.] t ' c. 152, §1(4), and we have no
, employees. [No 13.
comp Other
comp. insurance regiiireil. •
*My applicant -that checks box Al must also fin out the section below showing their workers compensation policy information:
1. Homeowner* who submit this affidavit incHcaiini they are doingall work and then bite outside contraCtots trout submit a new affidavit indicating sucb.
Contractor s that cbivq this box must attached an additional sheet showing the name of the subcontractors and state whether or not-those entities have
employees. If the sub-contractorshave employees', they must provide their wciriceis' comp. poliey number. .
• 1 am an employer that is providin' g workers' compensation insurance for my ethplOyees. Below is the policy erndjob site
&formation. - .
Insurance Company Name: L 1 0 44)1 ' '1 ! (<1/IL
. - .
• - a - , ( ,-- , -.) c , r „,.„ ' Policy # or Self-Ms L . Lic. #: w c- - ." ' J - 1 ' t i / 4 b - v i I Expiration Date: - l O ' ' 11
,„ , „ ,,, I
„, A c- <1 ( i
Job Site Address: 2 5 1( ' I / I'''' l' ll' r t- u r ' ' t j ' City/SIate/Zip:' t id /
.
Attach a copy of - the workers' compensation policy declaration page(showing the policy number antiexpiration date).
. . ...
. .
Failure to secure coverage . as requited nit SeCtiiiir25A - C. 152 can lead to the inipOsitiOn of Ciitainal Pcnaiu -41 'es of a
fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the formi of a STOP WORK- ORDER. and a ae
of up to $250.00 a day against the yiolator. Be advised That a copy of this statement may be forwarded to the Office of
EtVeitiiiitiOnliif the for insmnce 6tiiiii-ai" - '' .----- :''-' - ' 7--
- ,,,, - _ • - ,. __ ..
herebyceriz), under the papts•and penalties ofperjray that the infonnationprovided_idroverintliorrect_______
• .
Signature: CZ "1/;/, &1 ,117/1 • . . - . . Da.te; 0 ( 3 i . .
. , . .
Phone it: - . _
. - Official use only Do not write in this area, to be completed by city or town afficial
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 /J Supervisor: g , Q Not Applicable ❑
Name of License Holder : /'7 it' i f I ci 16 1 �� tit-4 i 1 10 i. 5'
License Number
Pc PLO( 1WWC f OtKt mail 01C 3
Address Expiration Date
. , &F `„ C2 5 2 q 6
Signature Telephone
x.•. y.:F - r aP s 7 y b'f � .
B Regi�te" it���oi� +elnte�rortert�ier�'�a��tp�"` ���- � �. �w�.�N �� Not Applicable ❑
'
Company Name Registration Number
LGC /IL ebiii,!J f (,• fi[ EliI( Z j- f 1
Address Expiration Date
Telephone -(16'6 z (_ 5
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 Et No ❑
i1 MOml.+ '
The current exemption for "homeowners" was extended to include Owner occupied Dwellines 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 1083.5.1.
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 buildine 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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing cEl
Or Doors 0
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [E] Siding [D] Other [o]
Brief Desc ' ti of Proposed i 4 in
Work: j1�T Re,� ofTlV6 f X [✓S14tt l: Pohl fiv1�13F2 4fficy Z
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
F C C o i f f? j 1 T , 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, ivt If (;� ib �� o �� �� �� L//i, � �17� / as Owner /Authorized
Agent hereby declare that the statements and informatiesn on t the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
j4 (1 Wiji1 ii i.'
Print Name
o t 0 3 - 14
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 I
Setbacks Front
Side L:1 1 R:1 1 L: R:1 ' 4
Rear
Building Height s I
1
Bldg. Square Footage [T 1 1% 1 ( 1 r
•
Open Space Footage 3 %
(Lot area minus bldg & paved t
parking)
# of Parking Spaces — _.
Fill: � ' �-
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW Q YES 0
IF YES, date issued:;
a
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
I F YES: enter Book P age l I and /or Document #,,
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q
, Date Issued:
C. Do any signs exist on the property? YES Q 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 Q NO Q
IF YES, describe size, type and location: f
s
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 Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
il. ��� City of Northampton ° n = - '`
y Building Department
J 212 Main Street _
�� s
a
Room 100
Northampton, MA 01060
phone 413- 587 -1240 Fax 413- 587 -1272 �� ` '', �,:
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by - office
1.1 Property Address: 00114 - Ma p L ot:
(= j v /{ lu` r ILL/1_, G 4 6 2 Zone OverlayDistrlct
IM St'bistrict CB District �'
SECTION 2,- PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
(C�� ,J sir 2s Rfpi' Dry
Name (Print) Current Mailing ddres�s:
-II 3- 5,6.._ CI -1
Telephone
Signature
2.2 Authorized Agent:
/�ii�i +Ic f�c�t3 T'7 t(C I0 1 `t f
Name (Print) Current Mailing Address:
, ',• i y � 1-113-1-113-6:/e. iqt
li /, i / w v
Signature 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
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 44.7o S
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building i Commissioner/Inspector of Buildings Date
......... .
BP- 2011 -0602
GIS #: COMMONWEALTH OF MASSACHUSETTS
458. 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 -0602
Project # JS- 2011- 000966
Est. Cost: $800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ANTHONY ROBITAILLE 102453
Lot Size(sq. ft.): 12501.72 Owner: ASTE ESTHER P
Zoning: URA(100) //WSP II Applicant: ANTHONY ROBITAILLE
AT: 25 REDFORD DR
Applicant Address: Phone: Insurance:
P 0 BOX 892 (413) 626 -5296 WC
ThorndikeMA01079 ISSUED ON:1/3/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2 SQ EPDM RUBBER ROOFING
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 1/3/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner