37-015 (4) 11/03/2006 22:28 , 4,135355073 BOB TROMBLEY JR PAGE 01/01
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SEAMLESS GUTTERS
• CARPENTRY •
• WINDOWS
- . ... -
Contract
To: Ingrid Tobin
Adders= 669 Florence Road,-Florence,MA
•Date May 8,2007
We propose to*wash all narterlal and perform all labor necessary to completelbe • . -
tollowlnip
Remove and dispose of existing siding. Close in gable vents on ends of house Cover exterior of house with
318"backettoard insulation, 'DM holes in soffit area to allow for adequate attic ventilation. Instal Mastic/Alcoa
Carvedwood series white vinyl siding. Cover all facia board with white aluminum.trim. Install white vinyl soffit to
all overhangs vented where necessanr. Wrap trim wound all windows and doors with white aluminum trim.
Install white vinyl fight blocks for all exterior lights and receptacle boxes. Install Alcoa white Seartlie:a heavy duty
aluminum(O32 gauge)gutters and downspouts_ Install11 pairs of black vinyl louvered shutters. Remove and
dispose of all trash.
We popesa to honk*material and labor for the sum oh Swum thousand four hundred dollms,
($7,400.00) '
Payments to made as%Moms Half down,balance duo upon conipletlen.
Contractor's 917.10611014jAllit V/x,ir."41,14_
• Aceeptsweva of Proposal
The above pdce and opechlautions are aceopted. You we amthodzed to do the work as spec:lilted.
Xis
Payments will ha . a*acerriredi above. t------"--
Owner's signedune • • 1111 . Datesel2,2•___
. .
Phone# (413)535-5073 Hitt 130371 .
. . Mating addiees: 614 8m Skeet, Chicopee,MA 01020
1
,
The Commonwealth of Massachusetts
Department of IndustrialAccidents
` .' Office of Investigations
=D- 600 Washington Street
'_='' �' Boston,MA 02111 -
,'{..*s' www.mass.govldia •
-Workers' Compensation Insurance Aida- it:Builders/Contractors/Electricians/Plumbers
An i licant Information • Please Print Legibly
Name(Business/erg. ization/JndividuaI): l3()-b `T TI r I t...�(_ sJ it• S 1 d i 1 1
• Address_ 1(l/ j r S# . J J-
citylState/Zzp: Cj)ri p e c I Y1)ii Phone.#:-_ 3 5 -503
Are yon an employer?.Clseck the appropriate box: Type of project(required):,
1.El I am a employer with 4- [] I am a general contractor and I •
employees(full and/or par ttrine).'
Nava lamed the sub contractors b- ❑ ew in n-,,�t on
2. I am a sole proprietor or partner- . listed cm the attached sheet 7. Er R rx odeling S i l ru)
. .he sb-conctors have have s m o ees a. ❑
Der±lolidon
worm for me in y capacity, employees and have workers' 9. Building addition
[No workers'comp,insurance • CO .mp itlsurance
tetpitxeci-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their
3.171 I am a homeowner doing all work 11.0 plumbing repairs or additions
myself[No worms'comp. right Of exemption per MGL . L2.EJ Roof repairs
insurance required•]t - -c- 152,§1(4),and we have no
employees_[No workers' 13.0 Other
. comp.insurance required.] •
Any appijeaus iba cli=ks imx#1 must also fill•out the aeetiaii below showing their works•Via,policy information_
1 lloracowncs,who submit this affidavit ind o:ding,they are doing all woes awl etc bite outside eonri cots must submit a new.affidavit indicating sttehr .
tContranmrs that at talc this box must winched an additional sbcct showing the name ofthe-sin-cotttractots and state what=or not those entities have •
. ,employees. If the sub-aciPtmctars lave eato1oyees,they must.ptsvidt t r'worlacs`comp:policy ausster. •
lent an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
•
Insurance Company Name:
Policy#or Self-ins.Lie.#: -- Expiration Date_
Job Sitz Address: • • City/State/Zip!. - - .
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 Oa
fine up to 5I,500.00 and/or one-year imprison ear,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 he forwarded to the Office of
Iuvestiffations of the DIA for iristmuce coveraee verification.
I do hereby certify under the pains.and p '*�- of,- '• - that the fmformation provided above is true and correct
' •
S" ture: ' I J4i 4 1 - Dater • .
-_ P'one#: e" _ -
Official use only.Do not write in this mar to be completed or town officiaL
•
•
...__ ity or sown: —---.... ..._.-.._. permitlbcense g
• —
Issuing Authority(circle one):
.1.Board of ld'ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing;Inspector
6.Other .
Contact Person: Phone 0:
00 T] ZLZILMTI, Did et:90 LOOZ/TO/IT
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder;
License Number
Address -�- Eacpiration Date
Signature Telephone
—....
9.Registered Horne 0
e Improvement Contractor: Not Applicable
;.or it ' J. � e. 1 , ;y X18
CompanyName Registration Numb
IH lf- 1 +.foA S , . q / .;)o03
Address Expiration Da e
C ,` I Lope_ 01 Telephone 53,5-- 5O/J
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.( c.152,§25C(5))
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 EY
1,X. Dome Owner exemption
The current exemption for"homeowners"was extended to include Clwner-urfupied 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 co utructs moreamene home in a two-year period shall not he 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 gueh work performed under the bulidin8 t:ermit.
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,von 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 .
•
•
600( l ZLZTL85cTt' %V,1 et:80 LOOZJTO_
SECTION 5-DESCRIPTION OF mOP9_SE,O WQRK fchecJui applicable)
New House 7 Addition n Replacement Windows Alteration(s) Roofing E
Or Doors fl •
Accessory Bldg. ❑ Demolition El New Signs [o] Decks [lam Siding i Other[CI]
�- .
Brief Description of Proposed �.�.-��� _. . _._ ._ /` ----W-
Work: Vir4 Stekina
Alteration of existing bedroom Yes . t - No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ✓ No
Plans Attached Roll -Sheet
6a"lf New house atd or addition to iOngfiputsino;calmplete the followln f:
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 la-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r , t f f
- W I ` r ( & I V b i n ,as Owner of the subject
property
hereby authorize o J Co I i ►b1-. . r •
to act on my behalf,in all matters relative to work authoriz= this building permit pplication,
St{ c n -r C -- ii ) j Or7
Signature of Owner Date
130.b ( rtr)r nb+ 1 .�r S t cLt..f1 ,as Owner/Authorized
Agent hereby declare that the statements and all formation on the foregoing applin are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
1 . . . Jam .
Print Name
I A1 .. 1
Sig tura of Owner/Agent bate
COQ ZLZTL$SCT6 XVd C7:90 LOOZ/TO/TT
Section 4. ZONING All information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to bc filled in by
Building Department
Lot Size . .
Frontage . -----
Setbacks Front
Side L. L:'
Rear
Building Height , •
Bldg.Square Footage
;
Open Space Footage
(Lot arca minus bldg&paved :
arkin . .
ti of Parkig Spaces ' .
.
Fill;
(volume&Locution) „ , „ „ , ,
—
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO er DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book ; Page and/or Document#.
B. Does the site contain a brook, body of water or wetlands? NO (...;r DONT KNOW 0 YES 0
1F 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 a
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(Gearing,grading,(yvation,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.
Z00[2] ZLZILSICIt XV1 Cf:90 LOOZ/TO/TT
,' �gpatYmen:t u�only , , t
City of Northampton Status.otsrllt,
Building Department 6',iiit'UtiCir1300S0 Perrtli!
212 Main Street SewertSiptic Availati;rty
Room 100 Wafer/Nfoll Availability
Northampton, MA 01060 Twa Sets ofStructurai;Plans
phone 413-587-1240 Fax 413-587-1272 PIoVSite Pleas
Uthi?r.Spedfy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
—
SECTION 1 -SITE INFORMATION
1.1 Property Address: (pug u�� '.��e �� This section to be completed by office
-I 'C Map Lot Unit,
F I r-ei'tce � 11 a
0 J u Zone Overlay District
Elm St.district_ CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
grid ' 1 i) I I (4-` .I obfn ij 1.9 /_/0('e n ce Rd• --
Name(Print) Current Mailing Address-
5 L/ -3 g3
Telephone
Signature
2,2 Authorized Anent
Bob Trom 121 ty _Jr. .13 n
Name(Print) Current Melling Address;
1;35-5613
Sign a Telephone
S TION 3-ESTIMATED CONSTIRUCTIO COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building _ I G y A 7 1-1 , co (a)Building Permit Fee
2. Electrical (b)Estimated.Total Cost of�^
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
"T C�.Fire Protection
6.
. Total W(1 +2+3+4+5) 1'i '' �N� 00 Check Number
This Section For Official Use On
Date
Building Permit Number;, _ Issued:
Signature: ,-,_
Building Commissionerllnspector of Buildings Date
IOOIj ZLZTLBgt;Tf XVd 190 LOOZ/TO/IT
BP-2008-0479
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0479
Project# JS-2008-000716
Est. Cost: $7400.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BOB TROMBLEY JR SIDING 149811
Lot Size(sq. ft.): 40859.28 Owner: TOBIN INGRID F&WILLIAM FX
Zoning: SR Applicant: BOB TROMBLEY JR SIDING
AT: 669 FLORENCE RD
Applicant Address: Phone: Insurance:
614 BRITTON ST (413) 535-5073
CHICOPEEMA01020 ISSUED ON:11/5/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
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 11/5/2007 0:00:00 $25.00150
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo