36-146 A & J Home Improvements, Inc.
60 Washington Avenue • South Hadley, MA 01075 7''
Certified (413) c ) oz`
Office I Fax: 413 467-1500 Cell: 413 5 _�}
Weather StopperRoofing Contractor "1 IJ O
AJHomelmprovements @yahoo.com
HIC Lic# 135399 • GAF-ELK ID # CE17267 • CT Lic# 600705 / CS, SL, RF, WS # 101017
Proposal Submitted To: Phone#'s: t
S �'C�C✓l,{ Home: 6 20 0(14 1 Cell:
Street: 1 t�
g (-) t.-018\J cs)C04-.
City, State,Zip Code:
F
Louse L°1 Garage ❑ Other
Proposal to furnish and install the following:
❑ Re-Roof [�Tear-off ❑ Gutter
Complete Roof Preparation
dHome exterior to be protected by tarps and plywood
LiShrubs, landscaping, trees to be protected
'Roofers buggy shall be used where accessible with permission from owner
( Entire existing roofing material to be removed to existing decking, including flashing, etc.
[-Site to be cleaned everyday with roll magnet debris removed at project completion (included in price)
'Deteriorated existing decking replaced at $45.00 per sheet plywood (only if needed)
ihit /Brown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only
New flashing will be installed where necessary / ' y
'S/Install new pipe boot flashing
'/Ve shall acquire all appropriate permits etc. for all roofing work
Complete Roof System ❑ 3
We propose hereby to furnish materials and labor - complet- accordanc- ith above specifications for
the sum of: Pa CV Ng
41-3D
Total Sale Price $ �?�
�� o c Down Payment rabC3C} .oo Won Completion $ '3 3v, oc>
ACCEPTANCE OF PROPOSAL: The above prices, sp i !cations and conditions are satisfactory and
are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down upon
signing, and balance due upon com• etion. Unpaid balances shall accrue with interest at 18% per
annum. Purchaser(s) will pay for al •sts, expenses and reasonable attorney's fees incurred by
A & J Home Improvements, Inc. t• re over any sums due under this contract.
Date: Signature: Phone # 3-
Date: Q`_C 13 Estimator's Signature:
ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage
areas due to the nossibilitv of roofina debris or dust comina through cracks of the wood_ A & J
The Commonwealth of Massachusetts
Department of Industrial Accidents
a, rr Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ~� Please Print Legibly
k3
Name (Business/Organization/Individual): M m rflir„Utyf.ctt ,1%r.
Address: GO :49ntwjrr
th
City/State/Zip: Sc }'n 01 7)P O U)).a Phone#: Lft 3 ` L 7 • l Lj C'
Are you an employer?Check the aropriate box: Type of project(required):
1.21 I am a employer with 31 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have-tired the sub-contractors 6. New construction
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'
g Y p ty 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.["Roof repairs
insurance required.] c. 152, §1(4),and we have no
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.
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 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: Carat 5 —
Policy#or Self-ins.Lic.#: l� - G CJ.�7��4 71 Expiration Date: 6 - 11 - 1
Job Site Address: D. v t L_' City/State/Zip: 1` e4 flit-
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 gains and penalties of perjury that the information provided above is true and correct.
Signature: .� Date: JO_ �� 3
Phone#: "l,3 %L7 - / -0C)
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: 1)140)-0 40 / i
License Number
C o W S\ AV.( &A A 6
M Ar- 11-14
Address // Expiration Date
-' may U ) / $z.
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
IYme )VY,pL6' i3 leig
Company Name pp Registration Number
Address Expiration Date
/ Telephone L,& )is'
—
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 I i Addition ❑ Replacement Windows Alteration(s) n Roofing I r l
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [EJ Siding [0] Other[0]
Brief Description of Proposed� �± `` Q ''tom
Work: Sit 4 S Y�I> "u'
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, CieVti S S\H C k ,as Owner of the subject
property
hereby authorize A t J_ I r`'"'"—
to act on my beh If, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
4? J (4-orn.e 1 VV ) - " ,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.e
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 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO (3 DONT KNOW (3 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO (3 DON'T KNOW (3 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 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 0
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 Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
I r; ? Department use only
I
City of Northampton Status of Permit:
)1 Building Department Curb Cut/Driveway Permit
DEC 17 2013 l 212 Main Street Sewer/Septic Availability
Room 100 WateriWell Availability
L,ct orthampton, MA 01060 Two Sets of Structural Plans
`plane 1 3-587-1240 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
Map Lot Unit
LDf111I-LC� �(trwwe.
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: SA c )( 1 t� 1
atiS S1cj j( k1 t.,c,iw„icw
Name(Print) Current MailingvAddress:
C""��.��////'�` Telephone ,4;70
Signature
2.2 Authorized Agent: A,
Name(Prii Current Mailing Address:
VI 7/sot)
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 512° . (a)Building Permit Fee
2. Electrical J (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) Check Number ?�op)D
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
29 LONGVIEW DR BP-2014-0732
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 146 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-2014-0732
Project# JS-2014-001243
Est.Cost: $5830.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: A & J HOME IMPROVEMENT INC 101017
Lot Size(sq. ft.): 15638.04 Owner: SLACK CHRIS
Zoning: Applicant: A & J HOME IMPROVEMENT INC
AT: 29 LONGVIEW DR
Applicant Address: Phone: Insurance:
60 WASHINGTON AVE (413) 467-1500 O WC
SOUTH HADLEYMA01075 ISSUED ON:12/17/2013 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 12/17/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner