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24A-019
Oct 18 13 08:23a Czelusniak Funeral Home 413-586-2019 p.1 J.D. Rivet & Co., Inc. ROOFING •SHEETMETAL 1635 PAGE BOULEVARD SPRINGFIELD,MA P.O.BOX 51063 INDIAN ORCHARD,MA 01151 TEL.1413)543-5660 FAX(413)543-3373 October 14,2013 * - Robert Czelizsni i3. 4s1 2 135 Prospect St. Northampton, MA 01060 - RE: 135 PROSPECT ST.—SHINGLE ROOF 1,800 SQ. FT. Scope of Work: 1. Remove and properly dispose of 2 layers of existing asphalt shingles down to the wood deck. 2. Furnish and install 1 row of ice and water shield at roof eaves, valleys and flashings. 3. Furnish and install synthetic underlayrnent over the wood deck. 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 jobsite of all roofing debris. 7. Furnish owner with the shingle manufacturer's lifetime warranty. PRICE.--$9,500.00 (NIr4E THOUSAND FIVE DOLLARS) ALL COSTS RFI ATED T OBTAINING A BUILDING PERMIT ARE EXCLUDED FROM TI-TIS PROPOSAL. I ael Schepps, Sales& Customer Service Acceptance of Proposal—The above prices,specifications and conditions are satisfactory and are hereby accepted. You are autherired to do the work as specified. Payment terms are net 30 days unless otherwise agreed in writing.All material is guaranteed to be as specified. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire and other necessary insurance. All accounts not paid within 30 days are subject to a late charge of I Va'N.per month on the unpaid balance. In the event that legal action is instituted to collect any sums due under this agreement,the undersigned agrees to pay all costs incurred including reasonable attorney's Fees. PAYMENT TERMS;25%DUE UPON PROPOSAL ACCEPTANCE,25%DUE UPON MATERIAL DELIVER.BALANCE (50%)DUE UPON COMPLETION. NOTE:THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT ACCEPTED WITHIN 60 DAYS. ' Signatur e 14" ./ Date: g703 ��wr�rcrin, burr- trace 4960 A°RO CERTIFICATE OF LIABILITY INSURANCE D04/30fDD/Y3 04/30/2013 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(les)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 NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE FAX 312-803-7443 (WIC.No.Est): IAIC.No): 300 South Riverside Plaza E-MAIL Chi Certificatee®AJG.corn Suite 1900 ADDRESS: Chicago, IL 60606 INSURER(SLAFFORDING 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. INSURER D: Springfield, MA 01104-1752 INSURERS: 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 ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR -INSR WVD POLICY NUMBER IMMIDDIYYYYI (MM/DO/YYYYI LIMITS A GENERAL LIABILITY ZAGLB9168500 05/01/13 05/01/14 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,000 PfiEMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 X 5,000,000 All Projects 1,000,000 PERSONAL E.ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 -GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGO S 2,000,000 POLICY X I PIFRCT ri LOC S A AUTOMOBILE LIABILITY ZACAT9150200 05/01/13 05/01/14 COMBINED SINGLE LIMIT 1,000,000 _(Ea accident) j X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE A (Per accident) $ HIRED AUTOS AUTOS_ Physical Damage S 1,000 Comp/Col'. B X UMBRELLA LIAB X OCCUR HAU773723/01/2013 05/01/13 05/01/14 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DOD X I RETENTIONS 10,000 S A WORKERS COMPENSATION ZAWCI9295000 05/01/13 05/01/14 X OYI RIMITS OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/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 Ilyes,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,II 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 • ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Vimalachi 33380733 8 Details http://elicense.chs.state.ma.usNerification/Details.aspx?agency id=1&... The Official Website of the Executive Office of Public Safety and Security(EOPSS) Mass.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 ' I The Commonwealth of Massachusetts • Department of Industrial Accidents t ,. Office of Investigations • 1 f' c� 600 Washington Street • c Boston, MA 02111 • •�•��' 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#: (413)543-5660 • Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 50 4. ❑I am a general contractor and I 6. [J New construction employees(full and/or part-time).* have hired the sub-contractors 2.1-1 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. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ['Building addition • [No workers'comp.insurance 5. n We are a corporation and its • required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 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 12.19 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. =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: Arch Insurance Company Policy#or Self-ins.Lic.#: ZAWCI9295000 Expiration Date: 5-1'14 1 Pros ec Job Site Address: Ave_AJL City/State/Zip: t`lc".i-11, 14(x• (t7l°G 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 nder to pain and penalties of perjury that the information provided above is true and correct. Signature: Date: j 0 ' )-3 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/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: ...r M - s OSC'. 3 o {fit t License Number r 635 Pc. L 1� d∎ � c. ittIA /1/4-k G-. Address Expiration Date 3- 5,-(3- 5660 It ur:., Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address 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 build. g permit. Signed Affidavit Attached Yes FJ 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[O] Other[0] Rt.ove_ �tsgoo CF a..-(c-S o ekc * cc'el Brief Description of Proposed - Work: li r ,S .. ]-1 c w SIcS „a case c el-et/LS-6"r te s 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 , 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, M__ ' ' .‘c I'`i-PP S , as Gwner/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. 5i+-e,1 4c Ivy 5 Print Na Signature of 8wnertAgent 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 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 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES IF YES: enter Book Page and/or Document# 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 ® Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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 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 (1) NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: � , Building Department Curb cut/Driveway Permit 212 Main Street Sewer/Septic Availability (j: ' Room 100 Water/Well Availability td' 2 Lul3 - Northampton, MA 0411036_5087_ Two Sets of Structural Plans phone 413-587-1240 Fax 1272 Plot/Site Plans Electric, Plumbing& as Inspections Northam ton MA 01060 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 13 5" Pros pec )- A e. Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Reco rd: 2 b v A 6lb(L C/z.e-t L '- � 1 or a,-y,3 S f(r Se@C.h A e Name(Print) Current Mailing Address: NI� '-I W `.i 17 104, P 3 'r Telephone Signature 2.2 Authorized Agent: 10..0 aox_ 51 oc.Q a, tZ■v t - : Co sc.. , ©U 1 Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 3 9,500 (a) Building Permit Fee 3 3 tp tf S�'/vclv�L 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) ', s�'0 Check Number L 3�a y This Section For Official Use Only Building Permit Number: I sssuu ed: Signature: Building Commissioner/Inspector of Buildings Date 135 PROSPECT AVE BP-2014-0502 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A-019 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-2014-0502 Project# JS-2014-000854 Est. Cost: $9500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq. ft.): 20560.32 Owner: CZELUSNIAK ROBERT F&ABBIE Zoning:URB(100)/ Applicant: J D RIVET & CO INC AT: 135 PROSPECT AVE Applicant Address: Phone: Insurance: P 0 BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:10/23/2013 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 10/23/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner