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24D-063 (2) II V . J.D. Rivet & Co., Inc. ROOFING•SHEETMETAL 1635 PAGE BOULEVARD SPRINGFIELD,MA P.O.BOX 51068 INDIAN ORCHARD,MA 01151 TEL.(413)543-5660 , , July 8;2013 FAX(413)543-3373 p ,, — . John Garber 18 Perkins Street , Northampton, MA 01060 RE: 18 PERKINS STREET—HOUSE ROOF—1,800 SQ. FT. Scope of Work: Note: Re-use existing gutters 1. Remove and properly dispose of(2) layers of existing asphalt shingles down to the wood deck. 2. Furnish and install synthetic underlayment over the wood deck. 3. Furnish and install (1)row of ice and water shield at roof eaves,valleys and flashings. 4. Furnish and install new aluminum drip edge. 5. Furnish and install Lifetime Architectural asphalt shingle roofing system complete with all associated flashings. 6. Clean j obsite of all roofing debris. 7. Furnish owner with the shingle manufacturer's Lifetime warranty. Option *Replace any rotted wood decking with 3/" CDX plywood at a price of$3.50/Sq. Ft. PRICE=$9,625.00 (NINE THOUSAND SIX HUNDRED TWENTY-FIVE DOLLARS) ALL COSTS RELATED TO OBTAINING A BUILDING PERMIT ARE EXCLUDED FROM THIS PROPOSAL Option: $5,365.00 Garage Roof—600 Sq. Ft. - Same scope of work as the house roof in addition to replacing the wood deck with new Y2" CDX plywood. Option *Replace any necessary framing at a unit cost of$7.00/Sq. Ft. iii /1"---.....-4"- Israel i hepps, Sales & Custom• Service Acceptance of Proposal—The above prices,spe tcations and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment terms are net 30.• 's unless otherwise agreed in writing.All material is guaranteed to be as specified. Any alteration or deviation from above specifications invo 'mg extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All a: -n ents conti gent upon strikes,accidents or delays beyond our control. Owner to carry fire and other necessary insurance. All accounts of paid ;,hi 0 days are subject to a late charge of 1 1/2%per month on the unpaid balance. In the event that legal action is instituted to e'lect any s 'due under this agreement,the undersigned agrees to pay all costs incurred including reasonable attorney's fees. NOTE:THIS P•a POSAL 1 AY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN_60,_„—DAYS. Signature: vrt,V C,"rn ,, Date: `7 g`'f/ /> , c. • , ice 1960 The Commonwealth of Massachusetts . _ Department of Industrial Accidents tt=,_�l�i=fl ,. Office of Investigations t._,-fl_ 600 Washington Street Boston,MA 02111 • ty''-=.sk' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/individual): J.D. Rivet& Co.,Inc. Address: 1635 Page Boulevard City/State/Zip: Springfield,MA 01104 Phone ti: (413) 543-5660 Are you an employer?Check the appropriate box: Type of project(required): 1.NI I am a employer with 50 4. ❑I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 t am a sole proprietor or partner- listed on the attached sheet.I 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g Y 9. ❑Building addition • [No workers' comp.insurance 5. ❑We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.n 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' 13.0 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 their workers'comp.policy information. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name: Arch Insurance Company • Policy#or Self-ins.Lic.#: ZAWCI9295000 Expiration Date: 5-1-14 - — i . Job Site Address: fg Pe'fk-"S sf, City/State/Zip: Fk ' Oh't, MA. 01°6° 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 certif nd the ains and penalties of perjury that the information provided above is true and correct. Signature: Date: 1"a Ci— 13 Phone#: (413) 543-5660 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/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: • Phone#: F A`°R°® CERTIFICATE OF LIABILITY INSURANCE DATE iMM/DD/TYYY) 04/30 04/30/x013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-312-704-0100 CONTACT Certificate Issuance Team Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX (A/C.No.EAU: (A/C,No): 312-803-7443 300 South Riverside Plaza ADDRESS: Chi CertificateaaAJG.com Suite 1900 Chicago, IL 60606 INSURER(S)AFFORDING COVERAGE NAIC INSURER A: ARCH INS CO 11150 INSURED INSURER B: AXIS SURPLUS INS CO 26620 J.D. Rivet & Co., Inc. INSURER C: 1635 Page Blvd. INSURERD: Springfield, MA 01104-1752 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 33380733 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL BUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER IMM/DD/YYYYI IMMIDDIYYYYI A GENERAL LIABILITY ZAGLB9168500 05/01/13 05/01/14 EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 300,000 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X 5,000,000 All Projects PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 —)POLICY l l JERCT LOC $ A AUTOMOBILE LIABILITY ZACAT9150200 05/01/13 05/01/14 COMBINED SINGLE LIMIT (Ea accident) t _. X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) Physical Damage $ 1,000 Comp/Col'. B X UMBRELLALIAB X OCCUR 8AU773723/01/2013 05/01/13 05/01/14 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$10,000 $ A WORKERS COMPENSATION ZAWCI9295000 0S/01/11 05/01/14 X STATU- TORY IMITS OTH- ER_ AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Master Certificate THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Vimalachi 33380733 Details http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&... The Official Website of the Executive Office of Public Safety and Security(EOPSS) Ntass.Gov Home State Agencies State Online Services Licensee Details Demographic Information Full Name: JAN N DREYER Gender. ,Owner Name: License Address Information • Address: 44 LAKESIDE DR Address 2: City: Monson State: MA Zipcode: 01057 • !Country: United States • License Information !License No: CS-050230 License Type: Construction Supervisor !Profession: Building Licenses Date of Last Renewal: 7/9/2012 'Issue Date: 7/21/2010 • Expiration Date: 7/21/2014 License Status: Active Today's Date: 8/6/2012 Secondary License: Doing Business As: Status Change: Prerequisite Information No Prerequisite Information Discipline No Discipline Information Documentum Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us Site Mar • • 1 of 1 8/6/2012 8:51 AM SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: -3 c`A Q1 t`(c License Number f is N et. � B k J S r-.5 F t\ct c -- c)Sc2 a 3 0 Address Expiration Date �(1 3- 5`s 3- ;,6v ig re Telephone i —AO 14 9.Registered Home Improvement Contractor: Not Applicable El r 0, (.1�c 1- G Co, —r Company Name Registration Number 1G 35 Pa)c eVick ��;nC I'ko. Address Expiration Date Telephone L(7- 5 -13° 5Gui 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 buil ng permit. Signed Affidavit Attached Yes No El 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) r +� New House [] Addition El Replacement Windows Alteration(s) El Roofing - Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs ID] Decks [p Siding[DI Other[O) Brief Description of Proposed ke.KO'c `"°� etc./ -(1r .t.'s�e. aF a tf ' o S ;nst&r do✓^ fv >�oeor VC(c�, Work: roiagtk e..et intl*l% '• v1-etA-j++tnk-, lit.i mat,-tist.;tlol, oe:p Grty c,.o_ 1-A..1'�'+^t SW-Alto-4', Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative • Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Tokn 40 d ,as Owner of the subject Property hereby auth. e , •a• 1ttNt.4- ¶ c.., -site._ to act on my behalf, II matters relative to work authorized by this building permit application. IIP 4da�`/3 Signature of• , ate I, ,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 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 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 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW © YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O 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 Q NO 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. .:. a S AUG 2 City of Northampton x l L 2013 Building Department 212 Main Street DEPT:OF BUILDING INSPECTIONS Room 100 ;` f '"#"Y "� NORTHAMPTON,MA 010&0 ` orthampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 7 F APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Progeny Address: This section to bs completed by office t Map Lot Unit M o e P1,�M 0 F o n C\a . Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY • RSHIPIAUTHOR1ZED AGENT 2.1 Owner of Record: 70 6, )mob S S 4-- f�feriet� L..fits, M w./01410 Name(Print) Current Mailing Address: 11000-- Si/-51 +9 11111k. Telephone Signature 2,2 Authorized Agent. Zr-i. VAT = Co. t c ■! Ad. 13.x 51o( �,nt;w, A-���d M Name(Print) Current Mailing Address: Oi If( Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 1 Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1y e1 4 0 (a)Building Permit Fee S 3 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) . 3 5.Fire Protection 6. Total=(1+2+3+4+5) IH,qgd Check Number 3Ote5 �5 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 18 PERKINS AVE BP-2014-0210 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-063 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-2014-0210 Project# JS-2014-000340 Est. Cost: $14990.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq. ft.): 4791.60 Owner: GARBER SANDRA Zoning:URB(100)/ Applicant: J D RIVET & CO INC AT: 18 PERKINS AVE Applicant Address: Phone: Insurance: P 0 BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:8/21/2013 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 8/21/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner