32C-079 95:1712011 11:38 1 -413-E?2-667:1 C:ODESE,INSFEC 1 IONS F 1 1
■ ' .
.'\ The Commonwea/th of Mosachusett.:
:-._-.;.-- ;------ Department of IndAstrial A ceielena
I ' L ..,-10Tz---,, i Office of In liestigalions
......4e_ -
400 Wiz:Von Sam
Bostoig, MA 02111
`../ ' 11 * wwwatitstss.govldi4
Wo rkore Compen.:21.10r.1 restAr:ice Affidavit: ilnildersiC'entractorriElectricituisiPlumbers
Applieasist: _ 7/7 Please Print Legibly
Name i,sttrinesriorganitaticaladi-eidtrk: , . di. _ ---e!...c - .-i ,..C
-...,_2Z: --' "
Ci ly/StateiZ ,... jzd....
---
ip:____ - -...--Z-/J1 .
. Are you au employer? Ctwk sh):,a.mrepriate our,
i I ; 7)13e of project (required):
i 11;rfarn a employer with ___I___ 4. rl I tan a getwal mar-6.73or end I i i
. ,
, 1 6 0 New construction
I employees (fail andior part-firnc)-* have hired the s1.640nritttem 1 i •
2. 0 1 ata a tole proprietor f:Ir partner- hated ea tar 'attached start i i 7. 7 Remodeling .
i 1
1 alrlp and b..ave no esreleyeet; These alki-c.ontracters tame 1! S. D DeTekior,
employees and have wedats" i
wading for me in nay .-....apaz:ity 1 f ;. 0 Building addition
I ENTo vvotke;s' cop. issaarance comp. ipsurvnoe.; ' I .
f,. Li 74 we a oorporatiatiaad its i 10.0 Eiectri-4.1 =pain or addittor s
l regal:61 -
! 3-0 T arn a horneowaer doing eV. wed: officers have =seised brit i ; 1. !..0 Pitanbing repairs or az or.:
1 myseit (No WILMS' CA'.-!TIT_ ri.On of exemption per WiL i 1 .. .---1 -
. u Root TV=
'Llsutisee reqvatti.1 t r.. 152, f 1(4), ind voe bine tic, i
employom. NC workers' i nri ale:
i
i
1.nonnow..--
4 Aszy veeikrat ear elw.lx bcx. f I ramst siso 0100 tbc secd53 Now shairks dais %Wen' catiesaatiat vac" ttanatoci.
t Ititaggronsers !who =balk dds aldsit atets=kn %ay oe &iv ad *ark awl flu:MK pattik =Atom owsi. fault& neve &Tad:wit la/Ices:I; such.
loccesatexe dsstaixxic thk isaz soult seezbaa at adMaieulitlaxt 61106614 ft acre a( Ohs subossdmoiva We est *beta tstrutdou
stbcoloyams6 ribs settrxxixagass taw empleyees, they sesist pm* auk wedaavi 00111111PACY rartwx.
l am in getplayer that isproviary seenbarst" compitsdaiea InsweePoefor my etageyr.e.t. Belalf is Lie policy ani1015 sik
freformittitut.
I nsurancia c,..unpany Na_ /.... . ....._ —__________-_------,--:----•.--- - -.- ---•
o a • - ---/ ( 12_
Policy 0 r Selt-ins, tie. ir LW,.. • iixpirdict Dater. ..... -
- . pettc,4 .._. _
. .
Lob Site Addreat_ • . ' .4 /4/)/'
ilesnow.............ftws.■• - .--...----
Attach a (lunatic workers' eempentidna par, deelarteoli par Olsen* tbe ' . 01011bP,V mid twtratict:. dates
ha:110, WC= Colvecago as rercafted ander Vattica ISA efitill., a. 15 can kad in the imposition cfeduttid pamIttes of n
tip So ii,S00.00 *�r Etriatiosavaikwoisliss civil' pomades fa Oa tone aStOP WORK ORDElt awl a fiat
crop to $250.00 td alpha isc ifialtivat. Seetibiled tat * copotettis etnenintlaty be feetrenled to tit Ofte of
. __, ._ 1 ..._. ....i ',44.- • . l'-,;L, = '' 1 ' ' 4 2.-: -7!.. ..;_-.1,2;L:‘,::,- .,__„.•-___ -- - - „.. . ,... -....- ..-...,‘,..-=ers.....e.."-.----=----...^.=
, IA' kb e4 " past-satipeaskreistpdefurp time the beamistkatieaktai there Is eased corral.
-----------Jkt,:t.....: -. i i
Ettimpii______ 2 ......................,....................___________
...a==.,,,,,a........mr..w.
4.
- 7YAtai uses . tW14 men, . y se kw eitieti li
'
at er TOWM ____, • ParatItilAtente ili ...,_ . ..— i
fatting iiielherlOrteltele mu):
. P
,1„ Bnne41 of MAIM 2. Odd* Department 3. ciqtriteve Clerk 4. Metrical Lawlor . Plumbing trolled or 1!
ri, Other i
I!
Coittet ran' 111 •
. „.....,„,..,„,......................................; Mt* lik. -- 1
■••■•Ipara
■
Pr P �vosal
SEXTON ROOFING AND SIDING CO.
www.sextonroofing.com
VIKO t
GA P M C C.epsi.t IIMIb. C.elraclu
r Z
Setting the Standard '� �
Certified Roofing Contractors
P.O. Box 6327
p. 413334.1234 Holyoke, MA 01041
f. 413.539.9906
MA HIC # 118239 CT HIC #0605383
SUBMITTED TO Mike Barry PHONE 586 -8790 DATE 5 -12 -11
STREET 10 Wilson Ave. JOB NAME
CITY,STATE,ZIP Northampton, Ma. JOB LOCATION
1)Strip and remove exsisting roofs down to deck and dispose of in proper landfill.
2)Replace decking as needed. (Time and material cost)
3)Install 9' of ice and water shield on eaves, at intersecting roofs, around vent stacks, chimney and other
penatrations.
4)Install #15 roofing felt on remainder of roof.
5)Install IKO lifetime roof shingles as per manufactures specs.
6)Install /" high density board mechanically fastened with corrosion resistant fasteners, stainless steel
plates, install a full adherd .060 EPDM single ply EPDM roof on all flat roof sections.
7)Install new flanges over exsisting vent stacks.
8)Install new cap over ridgeevt,
9)Counter flash chimney.
10)Supply all manufactures warranties and SRC 15 yr. workmanship warranty.
We Propose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of:
Eight Thousand Four Hundred dollars ($8,400.00)Payment to be made as follows: (Due in full upon completion)
All Material is guaranteed to be as specified. All work to be completed in a Authorized
workmanlike manner according to standard practices. Any alteration or Signature .'""
deviation from above specifications involving extra costs will be executed
only upon written orders, and will become an extra charge over and above
the estimate. All agreements contingent upon strikes, accidents or delays Note: This proposal may be withdrawn by us if not accepted
beyond our control. Not responsible for water damage during construction. within (14) days.
Owner to pay responsible legal fees for non - payment, and applicable interest.
Acceptance of Proposal The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are Signature .44/f, r _ '.rt ..••■
authorized to the work as sp ified. ayment will be made as
outlined above. C Signature
Date of Acceptance. �
6 -4 1c r' bo•e h CtJ,1 cj US ti 6421- 1..cav r, -r,mi 1 WOt,1{Jl
(i 1t t '�C S C '< ,/d Zt `7C .c t c r O ' . t 1 �. 4 T �CC7 i
110,,,
SECTION 8 - CONSTRUCTION'SERVICES
8.1 Licensed Construction Supervisor: o Not Applicable ❑
/ 1
Name of License Holder : i e CJ-e 7C 4 ',ti• 796
License Number
o iS , Pa K 1) a. i-�-t� ty , (.4A4
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
r.., V
Company Name Registration Number
a)- >k c 3 'l 11 t y6 /
Address ! ' Expiration Da te l
Telephone, 3 V/.
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. - Home Owner Exemption
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Lt'
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [D Siding [0] Other [D]
Brief Description of Proposed
Work: Ui/E- E/s sh'.4._ 7 ' 4 .771r � ; ff 9el V ' few •S ;?
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. If New house and or addition � to ^ existing housing, complete the following:
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
I, , as Owner of the subject
property
hereby authorize ,& 4 Z1 avv ift (I/ •
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, L ft '/t � i `T� l ` ere 4 ` , as Owner /Authorized
AgeT hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
3 / - / ,
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: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW (3 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q ,Date Issued:
C. Do any signs exist on the 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 ® 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 ® NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
VT7T.
Department use only
' City of Northampton Status of Permit:
R EGE JEO Building Department Curb Cut/Driveway Permit
V 212 Main Street Sewer /Septic Availability
t Nti Room 100 Water/Well Availability
P Northampton, MA 01060 Two Sets of Structural Plans
cr•
o - 413- 587 -1240 Fax 413- 587 -1272 Plot/Site Plans
of . , to 0 1 p fi0 Other Specify
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
7 Z (ti
Map
r p Lot Unit
1‘.0 Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
PliK Zre4/ /6 wi " lso,1J Adrye X/64,74
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
/ kJ 1?C)CA ( H` tyal4 ;.,e44
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /t (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 6 ! Q/ %I
This Section For Official Use Only ��
y
Permit Number: Date
Building Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
10 WILSON AVE BP- 2012 -0221
GIS #: COMMONWEALTH OF ASSACHUSETTS
Map:Block: 32C - 079 CITY OF NORTH PTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CO T CTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (M L c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0221 (
Project # JS- 2012 - 000328
Est. Cost: $8400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq. ft.): 5096.52 Owner: BARRY MICHAEL S & REBECCA L
Zoning: URC(100)/ Applicant: SEXTON ROOFING CO
AT: 10 WILSON AVE
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534 - 1234 WC
HOLYOKEMA01041 ISSUED ON :9/1/2011 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 9/1/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner