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31B-047 (4) June 26, 2013 Todd Boynton 83 Silver St. Greenfield, MA 01301 (413) 775-2775, tvalinetna,hotmail.com MA HIC#126807, MA Construction Supervisor#CS 079221 Complete Asphalt, Slate, and Rubber Roofing Systems and Repairs, Siding, Chimney Pointing and Gutters Customer: Gene Callahan (Soffit, fascia, and window casings) 9 Melinda Easthampton, MA 01027 Property @ 9 Summer St., Northampton Work to be done: All fascia and soffit on complete house, and all window casings with exposed wood trim: Cover all soffits under eaves with white Alcoa vinyl soffit panel. Cover all facias and exposed window trim with Alcoa white aluminum coil stock. 10 year guaranty on labor. Limited Lifetime Manufacturer's Warranty Gene— This is for all of the exposed wood on the complete house. I am about 3-4 weeks out right now. Any questions,feel free to call or e-mail. Todd Total Cost $ 5,325 (Labor and material) , Deposit required of: $ 2,300 Homeowner: Balance upon Completion: $ 3,025 Contractor: Top quality materials used — complete insurance c e rage,.-, References available. All trash removed by contrac' : . Visa, MC,AMEX and Discover accepted DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES MA HIC#126807, MA Construction Supervisor#CS 079221 The Commonwealth of Massachusetts Department of Industrial Accidents ; 1 1 ,,/ Office of Investigations ` � l__Eip —_ 600 Washington Street �� Boston,MA 02111 >:.�° www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Todd Boynton Roofing&siding 83 Silver St. Address: Greenfield,Ma 01301 413-775-2775 City/State/Zip: Phone#: Are ou an employer?Check,the appropriate box: Type of project(required): 1. I am a employer with 7 4. ❑ I am a general contractor and I 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. I 7 Remodeling ship and have no employees These sub-contractors have 8.All 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.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 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. tContractors 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. Acadia Insurance Acadia Insurance Insurance Company Name: Policy#or Self-ins.Lic.(#: W�C20 4319 11/16/2013 WC201 169n Datd1/16/2013 I , Avie' �� 7)?i /OF 010 Job Site Address: � U 7 l' City/State/Zip: 7)0�� 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/tiffyy under the pains a dpenalties of perjury that the information provided above i true and correct. Signature: ✓ f Date: `i /4' Phone#: y�3 -775 '' .775 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 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: UN Boynton Roofing&Siding License Number 83 Silver St. Greenfleld,Ma 01301 14,/7/6 Address 413-775-2775 Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ f� Company Name Registration Nu r Todd Repeon nRe &Slang I. Greenfield,Ma 01301 7%Numb Address '413-77;-2775 // Expiration Date Telephone 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 n Addition ❑ Replacement Windows Alteration(s) Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [El Siding[CI] Other[El Brief Description of Proposed /v ` I W, et-- ,0 (/e 6v,, ;l Work: 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 to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, P� /'`Ai ,as 0 er/Authorized Agent hereby'declare that the statements and information on the foregoing application are true and accurate,to the bes of my know=:.e and belief. Signed under the pains and ptEnatties of perjury. Print Name _____ -.//( /3 Signature of• � 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 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Cons ation Commission? Needs to be obtained i Obtained © , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES o NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, x nation,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. EC c', \L 4E' '' l i Department use only City of Northampton Status of Permit: AUG 2 8 2013 i; Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Electric, Plumbing&Gas Inspections Room 100 Water/Well Availability Northampton,MA 01060 Northampton, 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 67---/i �A1Me/5r Map Lot Unit •�v Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: f ,,* Name(Print Current Mailing Address: Signature "7-7......,— — 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) `)' ��j Check Number /6 13j This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner/Inspector of Buildings Date 11 SUMMER ST BP-2014-0247 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B-047 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2014-0247 Project# JS-2014-000405 Est. Cost: $5325.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TODD BOYNTON 079221 Lot Size(sq. ft.): 3702.60 Owner: CALLAHAN EUGENE Zoning:HB(100)/ Applicant: TODD BOYNTON AT: 11 SUMMER ST Applicant Address: Phone: Insurance: 83 SILVER ST (413) 772-8829 WC GREENFIELDMA01301 ISSUED ON:8/28/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE WINDOW CASINGS, FASCIA & SOFFITS 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 8/28/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner