36-058 (NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR II home im rovement contractors and subcontractors
All
MA License #103713 engaged in home improvement contracting, unless specifi-
148 Doty Circle • WEST SPRINGFIELD, MA 01089 cally exempt from registration by Provisions of Chapter 142A
1-888-NESCOR-1 1-888-637-2671 of the general laws, must be registered with the
413-739-4333 Commonwealth of Massachusetts. Inquiries about registra-
www.nescoronline.com tion and status should be made to the Director, Home
Improvement Contract Registration, One Ashburton Place,
Submitted Room 1301, Boston, MA 02108 (617)727-8598
To: 1-<, ""L =...t - F/ `-,r ."
3 f\W:-..11 r f 1. ,
a,' JOB NAME /'r ; 1
JOB LOCATION
PHONE 'DATE
e--/13- 5',, '
'°1 _,' y,=) (,:,f .7 < I l : ESTIMATOR
We hereby submit specifications and estimates for work to be performed and materials to be used: --
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Do not do:. Construction related permits:
tai .' t i;_, r i ? -- ,c. /i,P i - i r
WORK SCHEDULE L
Contractor will not.begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein.Contractor will begin the work on or about
C-,::/L."',i 15(date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by -7 I i"-+I i.date).The Owner hereby acknowledges
andagrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes,Acts of God,shortages of materi-
als,accidents,and all other delays beyond its control,shall not be considered as violations of this Agreement.
WARRANTY 7a,. 3 .c #r i., ri fir' , t.+r<...(; j,s .' ,t /1 s ,} ,,
The Contractor warrants that the work furnished hereunder shall be free fromdefects m materials and workmanship for a period of following completiorfand shall comply
with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,its subcontractors,employees or agents,is discovered
after completion of any job,including cleanup,the Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam-
age or such defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work.
labor-complete in accordance with above specifications,for the sum of:
p hereby _ .— _--i --
We Propose hereb to furnish material and a g¢
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.mac , i - ,,._ � i�,i.� f I-. '•_ i?. ;) _-a r- tL'r dollars($ �d Z / -', ,��),
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Payment to be made as follows: ,t
_%($ I` �r);)upon signing contract; NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR _
. _ Name of Contractor/Designated Registrant
($ + .)upon completion of°/. i + 148 DOTY CIRCLE
Street Address
($ --)upon completion of WEST SPRINGFIELD, MA 01089 413-739-4333
City/State Phone
103713
($ i ,/ )shall be made forthwith upon
completion of work under this contract. Registration No.
-
l
of Salesman " :' i} t'
Notice: No agreement for home improvement contracting work shall require a down Name o —
payment(advance deposit)of more than one-third of the total contract price or the i
total amount of all deposits or payments which the contractor must make,in advance, Authorized Signature
to order and/or otherwise obtain delivery of special order materials and equipment,
whichever amount is greater.
Acceptance of Proposal: I 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. See the separate notice of cancellation form
for an explanation of this right. Please refer to the Notice of Cancellation that accompanies this contract; contents of
which are referred to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
. _Signature . Date -- Signature Date
`
City of Northampton
// Massachusetts 'ect,.
tt / * 'c
" s DEPARTMENT OF BUILDING INSPECTIONS w �, 4
\. _, '•` 212 Main Street • Municipal Building 'i.)' y�. -"t.-7
�� .t.:;,'
Northampton, MA 01060 rp; ...: ,,,,.
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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 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 permits 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
•
is The Commonwealth of Massachusetts
Department of Industrial Accidents
.- :, Office of Investigations
__ '""""" 600 Washington Street w
° ! ; Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ? ..c)C:.0_
Address: t tW c ac-0\ .
City/State/Zip: V...),` it `c0( 1\ 016 Phone #: r3- -149I C2r)
Are you an employer? Check the appropriate box: Type of project(required):
a employer with Cr 4. n I am a general contractor and I ❑
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance.
$ 9. ❑ Building addition
required.] 5. [1 We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11. Plumbing repairs or additions
3. I am a homeowner doing all work ❑ g p
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 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 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. AZ'Insurance Company Name:
Policy#or Self-ins. Lic.#:V I 3 C-(c.c 3' 2.6- ( 2 Expiration Date: 7/7 rl'.�
- Job Site Address: 7 ReC 4 'D t(J City/State/Zip: `6„ecsce AAA O(0 ip
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
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 hereby cer ' under the pains and penalties ofperjury that the information provided above
r 3
is true rue and correct
(Si•iatu , Date: &
Phone#: p``"f --S- b -` � V I i ("?
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#:
J
SECTION 8 CONSTRUCTION SERVICES
b
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: '<QC* .- ,_\,�J X931
License N mber
`nom'_` •`f
�t3`k r" '(3- k-i av e\ t1: .5 €` - L-.--( 0(2 1 /4/4
Addres / r—�,.� Expiration Date
Signa ure Telephone —+�
9"Registerced Home Improvement Contractor r r,;;: , , ,s__- T;:2. _.,.,: Not Applicable ❑
KRD14-Ce CA 7k-)Q_C-;<!-\-L..tc Q_oc c) /be3 7/ 3
Company Name Registration Nu ber
f 8 CATC_t<c ( - , \c, t4-. t �ktif QT -7/(Lt 1
Address ,., Date
q ?,--c,‘6 (S
Telephone Xf C
SECTION 10-.WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G L c. 152;-§-25C(6)y -
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 b ing 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
•
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SECTION 5--DESCRIPTION OF PROPOSEDWORK`(check all applicable) a ,
New House n Addition ❑ Replacement Windows Alteration(s) n Roofing VC
Or Doors D
Accessory Bldg. ❑ Demolition El New Signs [E] Decks [[] Siding[C]] Other[0]
Brief Description Aozs d —LC��Wt
Work: JQ- E �S 4� � Z.` A y i T
( \ c ,“ .;,i,..,2t L c
�
Alteration of existing bedroom Yes No Adding new bedroom Yes No v
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
16 111 ew house and Oi iiciition to'existing aii in-Caimpiete thefoliowinq;
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-T.Q.BE COMPLETED WHEN r,-
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , 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, 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 of perjury.
Print Name
y
Signature f Owner/Agent Date
J
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 b -.
Building Department
Lot Size 7 _ _ , 1 I
Frontage ■ t i,
Setbacks Front = I I r i
Side L:' s R:I J L:i . _R:' J
Rear € 1
Building Height I j i I 1
i.
Bldg. Square Footage 7-1 I I % I Is-
1
--- Open Space Footage i I% -
(Lot area minus bldg&paved 1 i 1 ' i
parking)
#of Parking Spaces t
Fill: I: g
(volume&Location) t -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 404 YES 0
IF YES, date issued::
IF YES: Was the permit recorded at the Re istry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book Paget and/or Document#1
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 (3 Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 "a 0
IF YES, describe size, type and location: k 1
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size,type and location: i 7
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 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
E Department use only
ECENE f} 4 W p i 4
¢1 Ci of Northampton Status of Permit
CI d
'... Bu ding Department Curti~Cut/Driveway"Permits`` ' i' 3 ,
2c 2\12 Main Street Sewer/Septic Availability a
�\ Room 100 Wate/Well Availability. <<, .•_
r rthmpton, MA 01060 Two Sets of Structural Plans ,'}
pEFT•�F e'arjp of •a.=-1 -- .7-1240 Fax 413-587-1272 Plot/Site',Plan's ". }
Other Specify i`
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE:INFORMATION
1.1 Property Addre s:
This section to be completed by office'
R _
i�r
�� Re- J " _ -.Q(Z . Map Lot Urnt
f
F`oV r\ce A Zone Overlay District
O(C 1)Z r.s , .
,._Elm St,District CBDlstrlct
-SECTION I;PROPERTY OWNERSHIP/AUTHORIZED.AGENT
2.1 Owner�f/ofRecord:
6 r`e or -OSAe.--
Name(Print) Current Mailing Address:
Telephone
Signature ,
2.2 Authorized A ent:
Name Print) Current Mailing Address:
- �---�- 7.----.... y(3-1%--L I ')C( t
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)
7- "- Check Number/
)- This Section For.Official Use r Only -
Date
Building Permit Number Issued:
Building Commissioner/Inspector of Buildings? Date
25 REDFORD DR BP-2013-1246
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-058 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-2013-1246
Project# JS-2013-002055
Est.Cost:
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: KEITH DEVIN 99931
Lot Size(sq. ft.): 12501.72 Owner: ASTE ESTHER P
Zoning: Applicant: KEITH DEVIN
AT: 25 REDFORD DR
Applicant Address: Phone: Insurance:
148 DOTY CIRCLE (413) 846-4918 WC
WEST SPRINGFIELDMA01089 ISSUED ON:6/27/2013 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 6/27/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner