23B-046 (118) ContT. Lic. No. 101723
_ Proposal
OUNG Tel. 413-584-1367
I 413-586-9167
Roofing Co., lnc. Fax 413-585-0226
F.U. Box 56
Florence, MA 01062-0056 Date; 4/15/02
Customer : Cooley Dickinson Hospital
.Address: Locust St. South Hadley, MA. 01015
Job Locaiion The tar and gravel section of boiler room
SPECIFICATIONS:
I. Rip the tar and gravel roof down to the decking.
2. Apply 2 inch polyisocyanurate insulation. This insulation has a class a fire rating for your U.L.
requirements.
3. Install Carlisle's ballast roofing system. Tie the new roof into the existing Carlisle roof.
Flash all walls, edges, and roof penetrations with an approved Carlisle detail.
�! Fabricate a new 20 oz. lead coated gutter and tie into the existing gutter on ballast roof.
6. Fabricate 20 oz. lead coated copper edge metal locked to a kicker strip. New metal to match the
existing on the ballast goof.
7. Remove all roofing debris and dispose of in a legal land fill.
8. Upon completion of the work Carlisle will inspect the job an issue the owner a Ten (10)
yeAr warranty.
WE PROPOSE TO FURNISH MATERIAL AND LABOR IN ACCORDANCE WITH THE A13OVE
SPECIFICATIONS,FOR THE SUM OF:
_—Dollars($� )•
THE ABOVE PRICE IS OOOD FOR THIRTY(30)DAYS , PAYMENT TO BE MADE AS FOLLOWS:
In full upon completion.
N pttnrlY k purar�4od to be q poelltcQ. ay pterptletu ei dt•uuon fro,n atw+a ~+•.-•-—
apt rttkatletu IMroMn�etclN MMb Wlll st tdltgtaq only upon�^attta7 erden,t!d VnU
4aawMr N,tatnulogla wwaM obo a U,r artloW4, A.)rdnna,wd,ruutL,grntutron Authorized l Zd,e(7t
mrthn wetde+ts it deUyt b pea ow Mn rot. Owner to carry 111,and ether museary
Uvot A ee
All eeunb net paid aa1Nn 30 dtyt are alhlmt to a tale cher�e pf 110 K
per mw%*on the un[.atd Warm In thr event that W141 Kum is WituW to eolleet
lay Kou due undo this swami.the uhdtet vt ed tsrses to wY•u Costa Incurrm Signature
Incl"11V ramilaule aoarntys teed.
�..ceeptanee of Proposal— The above gnture
priees,speeifieations and Conditions are satisfactory and arc
herehy accepted. You are authorized to do the work as
specified. Payment will be made its outlined above. Acceptance
TOTAL P.02
mmmmmmmmmw
Costr.Lic.No. 101723
yOUNG Tel. 413-584-1367
Roofing Co., Inc. 413-586-9167
P.O. Box 56 Fax 413-585-0226
Florence, MA 01062-0056
Date; 6-25-02
Customer : Cooley Dickinson Hospital
Address: Locust S- t--N6rTha--m–pton–,--M- A. 01060
Roof over Kitchen
SPECIFICATIONS:
L Rip the complete roof down to the light weight concrete decking.
2. Apply 2 inch poly is ocyanurate insulation attached with Insta-Stik foam to the decking.
I Install Carlisle's .060 fully adhered roofing system.
4. flash all walls, edges, and roof penetrations with an approved Carlisle detail,
5. Install .032 gauge mill finish aluminum edge metal.
6. Install new roof drains and connect to the existing plumbing by a licensed plumber.
7. Remove all waste and dispose in a legal land rill.
8. Upon completion of the work Carlisle will inspect the job an issue the owner a Ten year
warranty.
WE PROPOSE TO FURNISH MATERIAL AND LABOR IN ACCORDANCE WITH THE ABOVE
SPECMICATIONS,FOR THE SUM OF:
-Dollars
THE ABOVE PRICE IS GOOD FOR THIRTY(30) DAYS PAYMENT TO BE MADE AS FOLLOWS:
In full upon completion.
a MOVAI is 00ranteW to bg as spvcINA Ary i1wrautm or dm4tlimn fron dw"
opowcauftp in"ow 004 wtu be ewtutad onty wan--en-4c".and 448
U406N=rt*tj�#r arA 004%1 OOUAAN� All IV com"14 OMUPW-t upon
strote. J,"Mof mit twira 00sa to"M an and neat naecaavy Authorized Richard Young President
Mxwmac. rJ sew ma to PW wuftn 00 do"are svlojaK In a Wx ehar&of 1 1/3%
W MWrh W the unp"botaft 1h lht ow that lfrl liellcm b►WWO LO eOned
am suxw&,w utuki tka weamt.the umirdsmw"a to ow au cmis iwrrgd Signature
w4uhro rVAWW**ttQMW$4ts,
fICUP18M Of VIOP0911- The above priceS,5 peci fi cations Witness
Signature
arid conditions are satittartary and are hereby accepted. —
You are authorized to do the work as opeeffied. Payment will
be made as outlincd above. Acceptant; Ide 40 pq A 2 191..
Date of Acceptance
Jp
G of 'Nod 11 all 1p!Lilt
I)I;PARTMENT OF BUIU)ING INSPECTIONS
212 Main Street * Municipal Building
Northampton, Mass. 01060
COMPIONSATION INSURANCY, AFFIDAVIT
with a principal place of busines-Ji-esidence a.t-.
cla [lei-Ql)y cer-til'Y, under tile- pains and penalties ol'peTify, that:
I aril an employer pi ovldlll�,, tile, fiflievvifli, %vol kel'.,; cojllpcl).Sa1101) c.ilverac,e for 111N.
I g on ibis job:
AL go
(Insumicc Company) (Polic-,,Nuolty-,r) (Expiration Date,)
am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have, the following work&s compensation policies'.
(Name of Contractor) (Wsumnce-Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company(Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Colnp.irlylpoficy Nu nbcr) (Expiration Date)
(Name of Contractor) (Im mmce Company/Policy Number) (Expiration Date)
(attach a6ditlooil sheet if n6ocTury to include informiLtion pertaining to all
O I am a sole proprietor and have no one working for me.
I am a home owner perforrating all the work myself.
NOTE:plczAc be aware that NNiiile lxxTYxwnx-r3 wIY3 efnplcry pcTunu to cio rjjAij-dcnjLncr
,cmtructloo or repair Nvutk on&dwcffing of
not more thin throo unit,in%xiiicli tlx honm-Amx rtiidns or w the gourA3 appkiritnud the do&m not ga)emfly oowi&rcd to be
=VlOyc"under the wQ+tc'%onmpcz licn Act(G1,152,"1(5)),nMticafion by a bcmoovacr for a uocnx or pffmil tray Cvi&=the
ItVI stabu of an employer under dLa workoeg Connmoution Ac
I understand dut a copy of this rtata-cut n-Y be forwarded to thx Dqsoj xrri of Industrial Ac6dcrAY01151oe of Trimirtrrce for the
coverage verification and t1ut failure to 6MUt—c"gn Inxkr stc6on 25A of h(Gl,152 can Icad to the iizvositi-of criminal PttWties
coalisting of a fim of up to S 1,500.00 anNor imprisotmxrst of up to one year&,d civil pcntWcs in the f(xm of eL Stop Work Or&—nod
film of 5100.00 a day tgtirzt m
FFordqmt,w-ere�0 use only
Pcmiit Numbe,
P4
7
7 M�JP4 Lot-#
Signature of Liccn tcc
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the ,uhject In opet tv
hereby authorize _
to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : Richard Young 011878
_ license Number
P.O. Box 56 Florence, MA. 01062 8/14/03
Addre Expiration Date
1� r 413-584-1367
Signature Telephone
SECTION 13 -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 affidavi-
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... K) No_.... ❑
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Fxpiration fate
---------------
Signature Telephone
92 Registered Professional Engineer(s):
Name ` Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Young Roofing Co. , Inc. Not Applicable ❑
Company Name: —
Richard Young President
Responsible In Charge of Construction
P.O. Box 56 Florence, MA. 01062
Addres,sn��
584-1.367
Signature Telephone
Version 1.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Fronta�c
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/Findin/g'ever been issued for/on the site?
NO DON'T KNOW ✓ YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 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 DON'T KNOW
YES
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 v`� NO
IF YES, describe size, type and location:
D. Are ere any proposed changes to or additions of signs intended for the property ?YES
Nc
IF YES, describe size, type and location:
r
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing M
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs ( ]
` � !���r w�i ��V�✓I�JVi'�flt t°,1Cl�R✓Y r'irJ^ r'1/ � it � f "� — �. � n �7 F ,�;I ' �o
t
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY,
Floor Area per Floor(sf) 1St ,
2nd
C
1st_— _.--_.—_
rd
2nd
3 Y 4 8h S}S
3 rd 4th a+ T 5tr z
4th
1
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft -----------------
..�..�.
i � 3 �� ��
,�,. . y.
�.. �V.yy�., • ..
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w 1.
r
Version 1.7 Commercial Building Permit May 15,2000
i of Northampton
JUL 2002 ding Department
12 Main Street
Room 100
G1NSPECT10ti I rth m ton, MA 01060
,MA 01060 P
one 587-1 240 Fax 413.587-1272
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1"" SITE. , INFORMATION
.-
section to bexurnplet, 6' offic ''s .
1.1 Property Address: � e#
Maps
l� ulst1 c. vw
ii
t strict �x��u, sue, B
o. B
SECTION -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
Young Roofing Co., Inc. P.O. Box 56 Florence, MA. 01062-0056
Name(Print) Current Mailing Address:
413-584-1367
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee " +
4. Mechanical (Ill
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) 3 Check Number
This Section For Official Use Only
,Building Permit'Number: Date Issued:
R
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2003-0022
GIS#: COMMONWEALTH OF MASSACHUSETTS
.. CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0022
Project# JS-2003-0069
Est. Cost: $23180.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Young Roofing Co Inc 011878
Lot Size(sq,ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL WC
Zoning:M Applicant: Young Roofing Co Inc
AT: 30 LOCUST ST
Applicant Address: Phone: Insurance:
P O Box 56 (413) 584-1367 Workers Compensation
FLORENCEMA01062 ISSUED ON.718102 0:00:00
TOPERFORM THE FOLLOWING WORK.-INSTALL MEMBRANE ROOFING TO BOILER
RM & KITCHEN ROOFS
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 7/8/02 0:00:00 13478 $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo