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12C-029 A&J Home Improvement Inc MA Reg# 135399 60 Washington Ave Conn Reg# 600705 South Hadley, MA 01075 Phone: (413)467-1500 Customer Address Jay O'Sullivan 296 North Maple Street Northampton, MA Description of Duties: Roof Replacement 1. Remove existing layers of shingles from entire home 2. Protect home and landscaping with tarps and plywood 3. Any Bad decking will be replaced at $50 per sheet of plywood (if needed) 4. Install 3' of Ice and water barrier at all eves as well as in all valleys and around penetrations 5. Install synthetic over rest of roofing deck 6. Install new 8" drip edge (white) on all eves and rakes 7. Install new GAF starter shingles at eves 8. Install new GAF Timberline HD (lifetime) asphalt shingles to roof(color of choice) 9. Install new roll style Ridge vent 10. Install new GAF Cap shingles 11. Clean up all debris (removal fee included) 12. Pull permit for all work Agreement bonded to furnish materials and labor according to the description above. Roof Replacement $ 7,400.00 This quote guaranteed for 60 days. Signature Andrew Deren Date_11-22-2013 Accepted: I hereby authorize A&J Home Improvement to perform work to the above specifications. Payment is agreed for 1/3 down deposit and balance to be due upon completion. Please sign and re one copy and return to the above address. Thank You. Date 4-1-7-Pl Signature Phone W_ The Commonwealth of Massachusetts Department of Industrial Accidents !4 Office of Investigations r 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Ind ividual): 1 )m Address: t�U � tt:Yrnrc.vi�r City/State/Zip: Phone 4: Ll 1:3 LI4 7 Are you an employer?Check the aoOopriate box: Type of project(required): 1. I am a employer with 4. D I am a general contractor and I employees(full and/or part-time).* have fiired the sub-contractors ' 6 D 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 g. DemoIition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.> 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 1 I.❑ Plumbing repairs or additions myself. o workers' con tight of exemption per MGL Y � P� 12.EP400frepairs insurance required.] } c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#r 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 subcontractors 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: ,,, c� t Policy#or Self-ins.�Lic. #: (,i*- fl�,j�C> f�41 Expiration Date: ' tih °- 1 " d,I Job Site 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 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 tip 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 certi�ztttd er the Gains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: Vl!,j yG 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): I.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: �f)4tsj into 17 License Number uS ;v c;z i I — 1(�, — Address Expiration Date LAO Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 4iT J716mF Innp 13534 � Company Name Registration Number _(to C1 - ( -010) ( Address J Expiration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(ti)) 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 DweIIings of one(I) 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 fann 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 fornt 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 ammINEENEENM SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors C] Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks Siding[O] Other[pJ Brief Description of Proposed Work: Sfif_'P+ �y v 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, Lauo'l- feC Ak' as Owner of the subject property ( hereby authorize Pi-tj to act on my behalf, in all matters relative to work authorized by this building permit application. Z��_ Signature of Owner Date asOwne Authorized e hereby declare that the sta ements and information on the foregoing application are true and accurate,to the best o edge^ an belief. Signed under the pains and penalties of perjury. A"Lu 1— Print Name �s/ 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) #ofParking Spaces Fill: volume&Location 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 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 Q DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 35 Department use only D ity of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit 5 Z�l� 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans EMctrio,Plumbing 8, P -587-1240 Fax 413-587-1272 Plot/Site Plans Northampton,MA n,A.&A 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 r (qj voli� i n Map Lot Unit "Itc I y +C Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner wt ner of Record: ` ,�,{ A J2 ��ccn�C� ��� N / Cep Fja ,.tc-f Name(Print) Current Mailing Address: oC." `tl .. _ Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Addres . L-169 S-06 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(HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) 7'Yoo. c, Check Number 0 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspectorof Buildings Date 296 NORTH MAPLE ST BP-2014-1057 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C-029 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-2014-1057 Project# JS-2014-001815 Est.Cost: $7400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group. A & J HOME IMPROVEMENT INC 101017 Lot Size(sq.ft.): 24393.60 Owner: FRANKL LAURIE A Zoning: RI(100)/URA(100)/WSP(100)/ Applicant: A & J HOME IMPROVEMENT INC AT. 296 NORTH MAPLE ST Applicant Address: Phone: Insurance: 60 WASHINGTON AVE (413) 467-1500 () WC SOUTH HADLEYMA01075 ISSUED ON:411512014 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 SiEnature: FeeType: Date Paid: Amount: Building 4/15/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner