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18C-103 (4) Kowal General Contracting 13 Redden Road Springfield, MA.01119-2631 We are Fully Insured& Licensed (413-)782-2656 (413)-575-1105 Hic Lic#124626& CSL 100833 We hereby submits specifications for: Roof Igor Miroshnichenko Date: 11/10/2013 45 Gleason Rd. Northampton, MA. 330-5128 Re:Above Address We will strip the roof of the house and dispose of the material. (This does not include the garage or the flat roof in the back of the house.) We will apply Ice Guard 6 feet up and in the valleys. We will apply a synthetic felt paper on the rest of the roof. We will install new drip edge. We will apply the appropriate length of ridge vent on the house. We will install new boot for the vent pipe. We will install CertainTeed architect shingle. Any step flashing that is damage I will replace. I will straighten out the gable ends. I will apply for a permit We propose hereby to furnish material and labor complete in accordance to above specifications for the sum of $ 6,750.00 Any unforeseen damaged wood will be the cost of material, labor, removal and application will be $35.00 per sheet. All material is guaranteed to be as specified. All work to be completed in a work man like manner according to standards practices. Any alteration or deviation from the above specification involving extra costs will be done only upon a written change order. The costs will become an extra charge over and above the estimate. This is to include, but is not to limited to, hidden damages that are uncovered during the course of the job and additional work required by local building inspectors. All elements of this agreement are contingent upon delays beyond our control. The estimate does not include material price increases, or additional labor and materials which may be required should unforeseen problems arise after the work has started. You, the buyer, may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made half down when material is delivered and the labor is started,quarter payment due when half way through and remaining balance due when job is completed. (Make check payable to Walt Kowal) (please do not hesitate to call me if you have any questions at the above number Please sign on the above line&return it back so a permit can be pulled City of Northampton r � w Massachusetts , ft/ * 9 .� DEPARTMENT OF BUILDING INSPECTIONS g 212 Main Street • Municipal Building JG Northampton, MA 01060 � d sf ti M._.,..,.°.li� -✓ 3Y1.,.= N';vr 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 • The Commonwealth of Massachusetts • , Department of Industrial Accidents ®t` p® L Office of Investigations M 0 600 Washington Street p® Boston, MA 02111 N. . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4 G; G °'—'--(.._ Address: /4y /rti-',,,7•77 1 yy Ar 59 r7 1-4,7/- City/State/Zip: . T'/,� /1P Phone#: f-7,6 J/:),S' Are you an employer? Check the appropriate box: Type of project(required): 1.[f I am a employer with j• 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions 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. tHo meowners 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. Insurance Company Name: 7:i7 d V r AP.,5 __� Policy#or Self-ins. Lic.#: C/4 11/.s '''' 90 9'42 Y-/-73 Expiration Date: ? / ?' • Job Site Address: ,5----../4/e v11 /r6t? City/State/Zip: / j ' /�,j 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 certify under the pains and penalties of perjuty that the information provided above is true and correct. Signature: „ -Ve- ' c?'%?` `.�' `1----.-- Date: 14P'°-`li '_"/Y Phone#: 1- r' // 72. -- 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//Sup�� /ervissor: Not Applicable £ t Name of License Holder: i l /7 e�Czi'A' / /mo 'j 1h License Number /37 "rri/a4/-, i#Z11 .1.5;€ 7/7 7417e4' fiCr Address Q///p Expiration Date c1 Signature elephone 9.:Registered Home.Improvement Contractor:;_ Not Applicable £ Company Name ,p Registration Number /7 e` :e ,/ / 42,i�� Address /// Ex iration Date /) _ f P Telephone 2 7,//C/r, 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 ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing X Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [[] Siding[D] Other[D] Brief Description of Pja,p9sedi Work: 2r/7 MOO' a /y �4t ° ctliC/7it4 r �f7i�f`7. 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 existtnq 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 Ze/t? jZ ©L�/� / , 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. te/eC Print Name Signature of Owner/Agent Date 44, , 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 r- ( i : f I Frontage I.__._. ._.-^__� ___________-____._J I ___ Setbacks Front TI I r—--� r---1 Side L:` i R: L:E j R:t... I i t Rear a.____.__I I I Building Height 1---�' E l_.__± Bldg.Square Footage —.i r--1 % 1- i I Open Space Footage % (Lot area minus bldg&paved i______j ET-I _y_wi ,__„_J parking) #of Parking Spaces (�� I l i Fill: .. ._..._....,.� �..�.._..m.....,...y..�..._. ., _.�� ...__.��,_,...__..,._..� €_ ..__.f (volume&Location) E i i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:'~ IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES 0 IF YES: enter Book Page and/or Document#1 ------ 1 •B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: b i C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: I 1 D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: L 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. .,y er' 4 O WSif t.O ue o � 1 • ▪r▪ l , ag k- 1 ; a 7F E City of Northampton . r '�l Building Department Gurla CuUDrteurayPerrrti# , is h 1 212 Main Street SewerlSep��el��a�lailyM1} v'V 5 2o'3 il'i Room 100 Water/Ut ttAvailab lit .% Northampton, MA 01060 Two sets of Structural Plans` y E/eciri. {71 1;RI 4 a yr vT r IL4 N cr�r, ,? 1 & ph ne 413-587-1240 Fax 413-587-1272 Plof/Site Plans I Icr C 's MS -i. �'fv1� �V Y 4 'f ' .ct �i91_ ''"5.,3 , lL-,�C.)1060 echons Dter Specify fl 1 C. ..u.��.t _..... ... ...... ...._i. � ............_�i. �!�..:.�. _....:._: 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 `Z 7 /~C4Sd,"7 ii4 Map Lot Unit Zone Overlay District Elm St=District CB-District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: h /iti' ,44, 6/1 d r,,p Nam Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: / p U,A s' , je/4,/� / L /4/; / Name(Print) Current Mailing Address: O'//y? "ti c c 17e2 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) Estima7 Construction ted Total from Cost(6)of 44, 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection r O 3 6. Total=(1 +2+3+4+5) Check Number 7�7/ This Section For OfficialUse Only Date .. Building Permit Number: Issued: Signature: Building Commissioner/inspector`of Buildings Date 45 GLEASON RD BP-2014-0616 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C- 103 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-2014-0616 Project# JS-2014-001041 Est.Cost: $6750.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WALT KOWAL 100833 Lot Size(sq. ft.): 7143.84 Owner: MIROSHNICHENKO IGOR A Zoning: URB(100)/ Applicant: WALT KOWAL AT: 45 GLEASON RD Applicant Address: Phone: Insurance: 13 REDDEN RD (413) 575-1105 () Workers Compensation SPRINGFIELDMA01119 ISSUED ON:11/14/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:STRI P & 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 11/14/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner