32A-243 •
•
•
HOME IMPROVEMENT
September 17, 2012
Elizabeth Patrie
131 Bridge Street
Northampton, Ma
Appendix A
- Strip roof of existing shingles and dispose of debris except for area already done
- Strip and dispose of slate shingles
- Supply and install new osb sheathing on front part of home where slate is stripped from
- Supply and install f8 drip edge
Supply and install ice and water barrier to code however full ice and water barrier on low slope
portion of roof
- Supply and install Synthetic underlayment on remaining decking
- Flash all valleys and roof penetrations with ice and water barrier and aluminum step flashing
- Supply and install new pipe boots and seal with geocel sealant
- Supply and install led on both chimneys
- Supply and install cobra rolled ridge vent. Seal cap nails with geocel
- Supply and install Certainteed Landmark architectural shingles
- Total Job Clean Up
LIFETIME WARRANTY ON MATERIAL AND LABOR
Includes labor material disposal (dumpster on site ) permits and taxes
$11,645 less $375 angies discount total of $11,270.00
Terms are $500 down, 1/3 on start, and balance on completion
1346 Elm Street, West Springfield MA 01089 - Phone: (413) 382 -0249 Fax: (413) 382 -0241
Page No. of Pages
rop01ar
CT. REG. NO. 0621848 COLOR WIDTH
VISTA HOME IMPROVEMENT
MA REG. NO. 162058 1346 Elm Street
West Springfield, MA 01089 INSULATION
Toll Free: 1- 888 - 597 -2323 • Local: 413- 382 -0249
FAX: 413- 382 -0241
Proposal Submitted To Homeowner Work To Be Performed At
Name et ( (1 L Street
ubt
Street C it y �JN� State
City rh t State i' y� 0 _ Date of Plans
Date s A " Z" Telephone j
We hereby submit specifications and esti tes for:
` 1 ppeA
t �►"^ -� s VIA& £ LAv r r M.; ri � 4-04,3te
Date work will start � S _ Date work will be completed - y - _
I
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from the
above specifications must be made in writing on an Add - on/Modification of Contract form and may become an extra charge over and above the amount stated herein.
This agreement is contingent upon delay;: beyond our control. Owners to carry fire, tornado and other necessary insurance. Our workers are fully covered by
Workmen's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults, homeowner agrees to pay all costs of col-
lection, Including reasonable attomeys fens, in addition to other damages incurred by contractor. An 18% per month service charge will be assessed for all payments
not made within 10 days of due date per he schedule below:
a proper hereby to jyrnish material nd labor - complete, accordance with the above ecifi tions, f•1 the sum of:
'91)/1 e/,
Said amount shall be paid as follow;: (i✓ � 4
Note: This proposal may be withdrawn by us if not accepted within days.
YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE
DAY OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. (SATURDAY
IS A LEGAL BUSINESS DAY IN CONNECTICUT.) THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES
ACT AND THE HOME IMPROVEMENT ACT. THIS INSIRIJMENT IS NEGOTTIBLE.
Signature of Contractor or authorized representative:
*(I/We) have read the terms state herein, they have been explained to (me/us), and (I/We) find them to be satisfactory and hereby
accept them.
Signature of Homeowner(s): _ i X
itZk The Commonwealth of Massachusetts
=. -z. — Department of Industrial Accidents
. --.---
Office of Investigations
600 Washington Street
- --- -
Boston, MA 02111
www mass govidia
Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Businessiorgantiatiotondivictuao: \11 scy) 7 *It
City/State/Zip t ,) - ) ea_c:\__Adlil___
— Phone #: L\ \ 3 -3D---c
Are you an employer? Check the appropriate box: Type of project (required):
I am a employer with
4. 0 I am a general contractor and 1 6. 0 New construction 1
I. k.
have hired the sub-contractors
employees (full andiorptrt-time) * 7., 0 Remode I ing
0 1 am a sole proprietor or partner-
listed on the attached sheet
1 ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity.
workers' corn
[No workers' comp_ insurance p insurance. 9. 0 Building addition
5. 0 We are a corporation and its
I 10.0 Electrical repairs or additions
recpiired,1 officers have exercised their
1,0 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 12.0 Roof repairs
insurance required.] + employees. [No workers'
13.1.0ther COC,
comp. insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
1r 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 cheek 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:_U.,..) I \ \ \ 0. Da.) \NA \. aTh. 5 Li 1 no-e
C), r,
Policy # or Self-ins. Lic. tit: 1,C,1 0.7.1. 3 ‘c; " 3 aA 3 () I. t Expiration Date: 5/s) i :-:
-
Job Site Address: to \ & ,.. 5 City/State/Zip:floy---Mi
Attach a copy of the workers' compen, tion policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGI, 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 hereby certify under the pains and nahie.s of perjury that the information provided above is true and correct
ce
Si.grIatur iilL
q: ...41/ .,
Date: 9/ I e
. ,
Phone #: 1_ — • ----..)''-
_ C
t Official use only. Do not write in this area, to be completed by city or town official
city .
1 City or Town: PermitiLicense # 1
_ 1
issuing Authority (circle one):
1. Board of Health 2. Build Department 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing inspector
I 6. Other
•
1 ____________ .. _ .
Contact Person: Phone #:
______
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
0
Name of License Holder : k \etd i, DO C q9 - 7 3
License Number
iy E � m 5A•- w . 5pcl A 0(1 S a-3/1 3
Address Expir tion Date'
nat Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
I A \' - iY y o U t y vv e v'0- I (9 C.O c
Company Name Registration Number
(3 E �)�s ° ' 1 ofl Q1-1.3
Address Expirat on Datt
g e..ckt J -`� ,(�.z� , , Telephone ` 13 °�"4
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 La
wss and l State of Massachusetts General Laws Annotated.
Homeowner Signature ---- i 't-- kre„e.+
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) n Roofing ❑
Or Doors El
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [0] ,other [ �11
akelo
Brief Description of Proposed
Work:'J �l �Y1`��f ��.A `t \( ,A- WAY V E' c' ICS' (L j r;
Alteration of existing bedroom Yes , No Adding new bedroom Yes )C Not
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 V ---C '
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? V 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
�- --OC N O-eA - - \ +_ , as Owner of the subject
property J 1 —
hereby authorize 1y )'C 1 C \ rYl(`P Vv
to act on my behalf, in all matters relative to work authorized by this building permit application.
'\ c Sl ?/! a-
Signature of Owner Date
I, ? c \CO J ( U l� Jrn_ _ nV rcLerf -' N T , 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.
Print Name
A.dusrt d 9/ 14 I
Si ure 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 0 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 O YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO . 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0 :r
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
--RECEIVED Department use only
ity of Northampton Status of Permit
SEP 2 2012 u ilding Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
WEPT. OF BUILDING INSPECTIONS
NORTHAMPTON, MA 01060 No hampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
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
I `J - e Map Lot Unit
‘00C \—ii1 C'ti l� , `� vrn
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) /* _ �Sr nga Iipg,A re s�! lkb
C9 '� Ct t - - Teleeephone
Signature
2.2 Authorized Agent: 0A-01*
I
,c..`n Zv AI-\ -- �j �� >i k4 �tm r � I 3q e l wt 5 -, t Spy l
Name (Print) Current Mailing Address:
17C/CC
ure 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) L. 3--7(-) Check Number 00 7/ 3�
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
131 BRIDGE ST BP- 2013 -0320
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 243 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2013 -0320
Project # JS- 2013- 000517
Est. Cost: $11270.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VISTA HOME IMPROVEMENT 99472
Lot Size(sq. ft.): 26179.56 Owner: PATRIE ELIZABETH S & ELAINE T KEYES
Zoning: URC(52) /SC(48)/ Applicant: VISTA HOME IMPROVEMENT
AT: 131 BRIDGE ST
Applicant Address: Phone: Insurance:
1346 ELM ST (413) 382 -0249 WC
WEST SPRINGFIELDMA01089 ISSUED ON:9/20/2012 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 9/20/2012 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner