32C-009 U.S. METAL A
740 High Street • Suite 2 • Holyoke, MA 01040
1 -800- 232 -0399. 1- 413 -536 -5474 • Fax 1- 413 - 533 -8166 DATE PROPOSED TO BE DONE ON
www.usmetalroofing.net ")i ,, ,1 <
SUBMITTED TO PHONE NUMBERS
STREET JOB LOCATION
C. c\ ���1 ;1 Vii
CITY, STATE AND ZIP CODE
t i r (t 1 E i - i P " 1C - (y "1i)
DIRECTIONS
We will furnish and install new Englert standing seam metal snap lock system, 24 gauge as listed below.
Work is guaranteed for five years and the manufacturer warranties the finish on the metal for 35 years.
COLOR: C t „ — ± Hc7 2, i � t;`ij SPECIAL INSTRUCTIONS / COMMENTS
ROOF: 1 t ` PORCH: 4`'1 t (C i
SOFFIT: ADDITION: �); -r l 444 �-
FASC{A: GARAGE: f '
PLYWOOD: GUTTERS `j '= `-� t Ca rt'T7T / 1t_ i fr If 67 -4
RIP /REMOVE: DOWNSPOUTS: Lrf = °, � l?
OTHER: `" P_PA!R. 1� ,
III 1 riTi 1 1 1 1 1 I 1 1 1 1 1 1 1 1 1 1 1 1 1' I I I t I' I t T t I f
Contractor will begin work on or about (date). Barring delay caused by circumstances beyond Contractor's control, the
work will be completed by (date).
All roofing panels are custom fabricated on -site with state -of- the -art rollforming equipment.
*As with any rollform steel panels, a certain amount of waviness or oil canning may become evident at certain times of the day when
sunlight hits them. This is standard in the industry and does not affect the integrity of the metal. This shall not be construed as a product
defect and shall not be cause for rejection.
Contractor does not perform or assume any responsibility for any painting, staining or wood or wall finishing on interior or exterior.
The contractor does further agree with the owner that (a) he will begin work within a reasonable time after the execution thereof, and will
prosecute it diligently and with due care, and in a good and workmanlike manner; (b) in doing the work, he will comply with all statutes,
rules, regulations and ordinances applicable thereto:
Contractor to procure all permits required by law. Contractor shall provide public liability insurances.
Owner warrants that he is the owner of the property on which tne work is to be performed or that he is otherwise authorized on behalf of the
owners to enter into this agreement.
We Propose hereby to furnish material and labor - complete in accordance with above specifications for the sum of:
) (' t�s'k C:� =t` � �{ Ci. , ,`� - ----- dollars (S L - : )•
Payment to be made as follows:
/.
Name of Contractor/Designated Registrant
($ - � ) upon signing Contract; U.S. METAL. ROOFING DISTRIBUTORS, INC.
Street Address
% ($ ) upon start of job: 740 High Street, Suite 2, Holyoke, MA 01040
Phone
1- 800 - 232 -0399
($ ) upon 1/2 job completion; Registration No.
i C' MA# 134740 CT# 602546
I % ($ 5 i /S C' ) shall be made forthwith upon completion Name of Salesmen
work under this contract
Notice: No agreement for home improvement contracting work shall require a down payment Authorized Signature )
� 1
(advance deposit) of more than one -third of the total contract price or the total amount of all " 7 ? � L/ _ r�7 7
deposits or payments which the contractor must make, in advance, to order and/or otherwise ) 7 7
obtain delivery of special order materials and equipment, whichever amount is greater. To be approved by Office
Acceptance of Proposal 1 have read both sides of this document and accept the prices, specifications and conditions stated.
I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be
made as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of
this transaction. Cancellation must be done in writing. See accompanying,cancellation.
/ ; DO NOT SIGN THIS CONTRACT IF THERE AREANY BLANK SPACES
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Signature . .4` L % - - w ' -�w. P, .• Date , / Signature v Date -r ,. �I. '
IMPORTANT INFORMATION ON BACK I
COMMONWEALTH OF MASSACHUSETTS --
DIVISION OF PRO ESSIONAL LICENSURE - BOARD 0
SHEET METAL WORK RS
AS A MASTER-UNRESTRICTED
ISSUES THE ABOVE LICENSE TO:
KEITH A REHBEIN
740 HIGH STREET
HOLYOKE MA 01040-4764
6108 12/28/12 975042
LICENSE. NO EXPIRATION DATE SERIAL NO
The Commonwealth of Massachusetts
-- Department of Industrial Accidents
} ,
, Office of Investigations
, =Ira= 600 Washington Street
°.
' A Boston, MA 02111
� y"r�. www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):/ ,/. , 5, /pi. T4 �_ V' / s 7 g m „ , o, J Do
Address: 7' 4/6 f7 57k4 E 7 — 57 <d'
City/State/Zip: a , , 0 ( a Phone #: — 53/ -74.Si
re you an employer? C i eck the appropriate box: Type of project (required):
1. I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. # L ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4), and we have no 12. Roof repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13. Other
*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 their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ems , ()ft L.7 l 4- 3 t.lAe., / y
f
Policy # or Self -ins. Lic. #: i `� p . ' 0 5 / (1) Expiration Date: /o 1 l/1
Job Site Address: ( .1—.J - /7 k, ,17Rt4 1 City/State /Zip: , , 01 1,11 dItj 4 , 0 J0,d,
Attach a copy of the workers' compensation policy declaration page (showing the policy number and exp ration I ate).
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 insurance coverage verification.
I do hereb .,, - the pains a ties of perjury that the information provided above is true and correct.
Signature. / Iir ie!al-) "
Q �(,Cr- mot,- ----- Date: 5 (1/1
Phone #: .€ 3 _ :5 -' -
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 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Lu& &4/ A g� � 0 1J AlOtu✓iiu ,4 , , /774 0 --
Name (Print) . No. and Street City/Town Zip
Property Owner Contact Information:
____ -_
Oww,v /-3 063 - 5? 7- - -
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the prop rty owner hereby authorizes
C/. s. ine -74i LL- o i7 f de , 7 ' iU - 11(r / ' ' A - v /a0)
Name Street Addri.s City/ own State Zip
to act on the property owne s behalf, in all matters relative to work authorized by this building permit application.
SECTION 10: CONSTRUCTION CONTROL (Please fill out Appendix 2)
(If building is less than 35,000 cu. ft. of enclosed space and /or not under Construction Control then check here ❑ and skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
I JA a/7 &J-14E ;/Ai 53t 5 41 ( 10k
Name (Re t) elephone No. a -mail a dr ss Registration Number
7i4 ' S�Qr!E7 1 E 4 Al .. 11/ di/ 5I 7 ( 11t L, I- J- Y l .—
Street Acker ty/T.wn State Zip Discipline Expirati n Date
10.2 General Contractor
a 5, //14 , TAL. O(i / A/6 - (Q /51k / g(.i oiJ d 1'4('. .
Co pany Name
/ 71-1 l a. /, /347.4 07n ( lit ..loll II 1 acifok
Name of Person Responsible for Construction License No. and Type if A..licable
'7 U it� ! 5712(6 7 /hi_ /u 1�F . - (,/
Street Address t/ I City/ T State Zip
1 13 53,ri_ - --
Telephone No. ( bus' ess Telephone No. (cell) e-mail address
SECTION 11: WORKERS' COMPENSATION INSURANCE AITII)AVII (M.G.L. c. 152. § 25C(6))
A Workers' Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes ❑ No ❑
SECTION 12: CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost (from Item 6) = $
1. Building $ 744 e-o a)' Building Permit Fee = Total Construction Cost x (Insert here
2. Electrical $ / �— appropriate municipal factor) = $ .
3. Plumbing $
4. Mechanical (HVAC) $ -- Note: Minimum fee = $�.{�_.__ (contact municipality)
5. Mechanical (Other) $ - Enclose check payable to ( T d 7 A( 0 # '/l1 70A,
t
6. Total Cost $ ��. �'CI '` (contact municipality) and write clieck number here f
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of m owledge and understanding.
. '
A4MIKE‘A)WC.1-1 46in )2 tat-, itt..9.-- name / Title Telephone Please print an ign � hone No. Date p
/ 37 s _ -Iloilo i'F 6/ �
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
rtr ,rte
'P t: WED
r trt
L4, mmonwea1th of Massachusetts - 6
D of Pu S afety g ;e
�i• _ . u_ _ chusetts State Building Code (780 CMR)
1 . mg Permit Application for any Building other than a One- or Two -Family Dwelling
(This Section For Official Use Only)
Building Permit Number: _ Date Applied: Building Official:
SECTION 1: LOCATION (Please indicate Block # and Lot # for locations for which a street address is not available)
/3-J- MArt) S 7k' 1 Ei /q' g71 lid �'✓i 6/6
No. and Street City /Town i Zip Code Name of Building (if applicable)
SECTION 2 PROPOSED WORK
Edition of MA State Code used If New Construction check here ❑ or check all that apply in the two rows below
Existing Building Repair ❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other Specify: 1{Oa� /nI �, �tiE
Are building plans and /or construction documents being supplied as part of this permit apph Yes ❑ No
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ,
Brief Description of Proposed Work: / r14. i, }i ANi? /ASV/ n(G • (0 0 rh ,
/77F n'14R.i . fl! I Wl AN' £a,.t) a. ,4 D 11Qt4i • , / isb t-
1 u s / .11.4o E.#J � ' o Ns
tter JztA) AAin no,tIIILI - Oaf/624 frets
SECTION 3: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION, ADDITION, OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No. of Floors /Stories (include basement levels) & Area Per Floor (sq. ft.)
Total Area (sq. ft.) and Total Height (ft.)
SECTION 5: USE GROUP (Check as applicable)
A: Assembly A -1 ❑ A -2 ❑ Nightclub ❑ A -3 ❑ A-4 ❑ A -5 ❑ I B: Business E: Educational ❑
F: Factory F -1 ❑ F2 ❑ H: High Hazard H -1 ❑ H -2 ❑ H -3 ❑ H-4 ❑ H -5 ❑
I: Institutional I -1 ❑ I -2 ❑ 1 -3 ❑ I-4 ❑ M: Mercantile ❑ I R: Residential R -10 R -2 ❑ R -3 ❑ R-4 ❑
S: Storage S-1 ❑ S -2 ❑ U: Utility ❑ Special Use ❑ and please describe below:
Special Use:
SECTION 6: CONSTRUCTION TYPE (Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7: SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
Water S pp1y: Flood Zone Information: Sewage Disposal Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site ❑
PublicX Check if outside Flood Zone Indicate municipal ❑ required ❑ or trench or specify:
Private ❑ or indentify Zone: or on site system ❑ permit is enclosed ❑
Railroad right -of way: Hazards to Air Navigation: MA i listoric Commission Review Process:
Not Applicabl Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed ❑ Yes ❑ or No Yes ❑ No ❑
SECTION 8: CONTENT OF CER E OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: _ Occupant Load per Floor:
Does the building contain an Sprinkler System ?: Special Stipulations:
File # BP- 2011 -0988
APPLICANT /CONTACT PERSON U S METAL ROOFING DISTRIBUTORS, INC ' = - 1 . !�
ADDRESS/PHONE 740 HIGH ST, SUITE 2 HOLYOKE (413) 536 -5474 i
PROPERTY LOCATION 122 MAIN ST
MAP 32C PARCEL 009 001 ZONE CB(100)/ , = r ,
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Q��L� , GO r
Fee Paid o J
Tvpeof Construction: INSTALL NEW MEMBRANE ROOF & INSTALL GUTTERS & DOWNSPOUTS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 031003
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
6 3 1
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
122 MAIN ST BP- 2011 -0988
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit# BP- 2011 -0988
Project # JS- 2011- 001615
Est. Cost: $7400.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003
Lot Size(sq. ft.): 1045.44 Owner: FIGARO REALTY CO LLC
Zoning: CB(100)/ Applicant: U S METAL ROOFING DISTRIBUTORS, INC
AT: 122 MAIN ST
Applicant Address: Phone: Insurance:
740 HIGH ST, SUITE 2 (413) 536 -5474 WC
HOLYOKEMA01040 ISSUED ON:6/6/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW MEMBRANE ROOF & INSTALL
GUTTERS & DOWNSPOUTS
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 6/6/2011 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner