23B-046 (120) 62/25/E002 12:17 413-585-6226 YUUNG ROOFING INC/-. PAGE 02
FEB-22-2002 13:57 COGLE�' D t CK l NSON 413 582 2959 r P_02/03
i
Ccntr.Lie.No, 1 01723 Proposal CAQ. 0 a- a 3
_ �-
OUNG Tel. 413-584.1367
figfl. �. 413-586-9167
Fax 4I3-S85-0226
t
Roofing
j FEB 2 F ���'2 P.O. Boa 56
_.� Florence, MA 01062-0056
Ga. r,� ,yt� t ^iS tta Date, 2/8!02
Hospital
a: 31 Locust Ott.Northamption,MA.01060
Job Location Boiler Roam Roof area thst has asbestos panels
SPECIFICATION'S:
1. Install galvanized metal decking and anchor to the existing steel perlins.
2. Initall 26'gauW-Max-Rib"galvalume Kynar finish metal roofing.
3. Fabricate and install flashing for walls and roof edges.
4. Owner to choose standard color. Custom colors will be extra.
5. Owner will have the asbestos panels removed before roofing scans.
IN3c�7C
WE PROPOSE TO FURMSH MATERIAL AND L50R 1N ACCORDANCE WTTH THE ABOVE
SPBCMCAMONS,FOR TM SUM OF.
Twenty,roux Thouesad Fow Htn&ed&00/100 24,400.00
Pollan{3,_ - �•
THE ABOVE PRICE IS GOOD FOR THIRTY(30)DAYS ,PAYN04 T TO BE MADE AS FOLLOWS:
In full upon connpleaon.
110 M�l.eY1 r t•tx� Art r,erae�r selOtle��4�
lenAee M l�r�t aw era�rYr16 pl yin rnrMeSt upa�
MM&n aw wr•ft""O a•� w" «r AttthoriZeQ ttat+d Ptesidei►i
rt reM w eM ww0 Odd.M eft w�OW am @Won M IM OMO-0-0—
way am—6. �e �r ANOW" o�n r�+.l�ur+s �a Signatum
Aec"tmat of Proposal- The above g °
priccc,apeaifications tad eeadidams are satisfactory 4" arc lgiut
hereby toeapted. You en eathortud to do the work u
1peeifled: Peymsor aria be made u autlhWd above.
Date of AccarAma al^o�'-0 � �a
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 _
Expiration Date. -- ---
Signature Telephone
92 Registered Professional Engineer(s):
Name ii Area of Responsibility
Address Registration Number
Signature i 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
Address If /� ,
1b C"1Ci tG 584-1367
Signature T Telephone
04_(t�t plO
8� °g Cr laf wart 11aillpf oil z
6 �asat:rhnsrtts'
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORETR'S COMPENSATTON INSURANCE + + AVTT
I,
(licenserJpermittec}
with a principal place of business/residence at:
(phonet#)
(sti r�.t/city/stairJrip)
do hereby certify, under the pains and penalties of perjury, that:
(4am an employer providing the following worker's compensation coverage for lily
employees woring on this job:
(Ins-umnce Corapmy) (Policy Ivrumber) (Expiration Datc)
( 1 I am a sole proprietor, general contractor or homeowner (circle one) and have hire
the contractors listed below who have the following worker's compensation policies'.
(Name of Contractor) (Insurance Company/Policy Numbcr) (Expiration Date)
,f
(Name of Contractor) (Insurance Company/Poiicy Number) (Expiration Date)
(Name of Contractor) (Insmancrr Compary/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(attach additioml shect ifnoo=.vy to include informarioa pataining to aIl ooCjtractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that vihile hooxxAvo a who employ persons w do maiatcnancq consirctioa or repay work on a dwelling of
not ntoce than throo unit in which the hoes»owner resides or oa the p-otitxli appurtenant lhercto tiro not ctn=ny ooandercd to be
employcr3 under the waakr's ration Act(GL152,m 1(5)�application by a homcoww for a liarru a pelmd may evidence the
legal datua of an employer under the Workeet Compensation Act
I understand that a copy of this rtalemcat may be forwended to the Deputaxai of Industrial Ao6d=&Offioo of Imivanoo for the
covmge vcrificatioa and that failure to seam ooverngo under soctioa 25A of MGL 152 can lead to the imposition of criminal penalties
ooasisiiag of a Sac of up to S 1,500.00 and/or imprisonnxut of up to one year and avil pcnaltia in the form of a Stop Work Ord-and a
firm of 3100.00 a day agpinst tile_
For dq=W3- till uao only
/ Permit Number
17, ---L40t#
s . Signature of Li ermit tce e
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
1, as Owner of the subject property
hereby authorize to act or
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
_J as Owner/Authorized Agent
hereby declare t t th tateme 'ts d 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
11, o, a-:5 10.;
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
Address i Expiration Date
66 �.I
�C-Z 413-584-1 367
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. d. 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....... El No...... ❑
Versionl.7 Commercial Building Permit May 15,2000
17. Water Supply(M.G.L. c.40, § 54) 17.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public Q Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
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:
(vo}ume&Location)
A. Has a Special Permit/Variance/Finding/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 Z 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 NO
IF YES, describe size, type and location:
D. Are t re any proposed changes to or additions of signs intended for the property ?YES —
No
IF YES, describe size, type and location:
Version 1.7 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 [ ]
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ( ❑
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 F 1 - OFFICE GEtN P
y Ns
Floor Area per Floor(sf) St
r y s 4
1st 2nd
3rd >
4tn y,
3rd
4tha s
Total Area (sf) Total Proposed New Construction (sf) f
a u. >;
Total Height(ft) $'
y i / 8
Total Height ft-------------------- �� I
Versionl.7 Commercial Building Permit May 15,2000
�n City.of Northampton f e
uilding Department
212 Main Street
'4 Z Room 100
202 e
No thampton, MA 01060 Two es fEc .
1 413- 87-1240 Fax 413-587-1272 P1 , ePia .a
It herSpe�i
ymp
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
This section to be completed by office
1.1 Property Address:
i1 Map. Lot Unit'
F i ���r� I yA`Et LEI
s
"Zone Overlay District
Elm St. District CB District
SECTION 2 -'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(Prial) Current Mailing Address:
413-584-1367
Signature Ll Telephone
SECTION 3 -'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building, Ck (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction.from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
r
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) I �. .).f1 Check Number v
This'Settion For Official Use Onl
Building Permit'Number: Date Issued:
Signature:
Building'Commissioner/Inspector of',Buildings Date
f
39 LOCUST ST BP-2002-0728
GIS#: COMMONWEALTH OF MASSACHUSETTS
� a :Block:23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2002-0728
Project# JS-2002-1198
Est.Cost: $18500.00
Fee: $92.00 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 INC
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 OIV:2125102 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW METAL ROOF OVER BOILER
ROOM AREA
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 2/25/02 0:00:00 12917 $92.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo