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25A-017 06/17/2004 15:43 FAX 413 585 0787 FIERST - PUCCI U 009 NOTICE OF CANCELLATION ,2004 You may cancel this transaction,without any penalty or obligation,within three(3)business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be retumed within ten(10)business days following receipt by the seller of your cancellation notice,and any security interest arising out the transaction will be canceled. If you cancel,you must make available to the seller at your residence,in substantially as good condition as when received, any goods delivered to you under this agreement,or you may if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's experience and risk. if you do make the goods available to the seller and the seller does not pick them up within twenty(20)days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller,or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to Joseph J.Narkawicz,President,Tech Roofing Service,Inc.,at 267 Page Boulevard,P.O.Boa 948, Springfield,MA 01101 not later than midnight of tbird business day after the signing of this.contract. I hereby cancel this transaction. Date: Buyer's Signature: Buyer's Signature: I hereby acknowledge receipt of two(2)copies of this Notice of Cancellation which have been given to me- Date, Buyer's Signature: Buyer's Signature: Merst Residencel Cl.wpd 06/17/2004 15:43 FAX 413 585 0787 FIERST - PUCCI 10008 NOTICE OF CANCELLATION .2004 You may cancel this transaction,without any penalty or obligation,within three(3)business days from the above date. If you cancel,any property traded in,any payments made by you under the agreement,and any negotiable instrument executed by you will be returned within ten(10)business days following receipt by the seller of your cancellation notice,and any security interest arising out the transaction will be canceled_ If you cancel,you utust make available to the seller at your residence,in substantially as good condition as when received, any goods delivered to you under this agreement;or you may if you wish,comply with the instructions of the seller regarding the return shipment of the goods at the seller's experience and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty(20)days of the date of your notice of cancellation,you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller,or if you agree to return the goods to the seller and fail to do so,then you remain liable for performance of all obligations under the contract. To cancel this transaction,mail or deliver a signed and dated copy of this cancellation notice or any other written notice,or send a telegram to Joseph L Narkawicz,President,Tech Roofing Service,Inc.,at 267 page Boulevard,P.O.Box 948, Springfield,MA 01101 not later than midnight of the third business day after the signing of this contract. I hereby cancel this transaction. Date_ Buyer's Signature: Buyer's Signature: I hereby acknowledge receipt of two(2)copies of this Notice of Cancellation which have been given to me_ Date: Buyer's Signature: Buyer's Signature: Fiel'mt Residences C1_wpd 06/17/2004 15:43 FAX 413 5850787 FIERST - PUCCI 10007 SCOPE OF WORK for property located at 10 Park Street,Florence,Massachusetts Description of work to be performed by Tech Roofing Service,Inc. Removing the railings and wood Platforms and setting them aside. Removing all existing roofing,insulation and flashings clean to the deck and properly disposing of these materials off the job site. as manufactured b Furnishing and installing a five(5)year labor and material warranted EPDM roofing system y Firestone Building Products Company. This system will rords consist attached to the deck over the existing 1. One(1)layer of%1v Dens-Deck Prime reinforcing surface. 2. One(1)ply of.060EPDM roofing membranewith tape adhered seams,fully adhered over the reinforcing board. 3. Gravelstops constructed of.032 aluminum,designed as required by existing conditions and as detailed by Firestone Building Products Company. 4. Base flashings constructed of.060 EPDM membrane. 5. Flashing the rail posts with EPDM membrane and capping with 16-ounce copper counter flashing. 6. Reinstalling the railings and wood platforms. 7. Installing 5/4 11x 6"1pe wood deck on 1"x 4" polyearbonate synthetic sleepers. 8. Applying Messner's UVPlus finish/preservative prior to installing the wood. PLEASE NOTE: Removal and replacement of any rotted decking will be charged on a time plus material basis and is not included in the contract price. Materials and/or Equipment Tech Roofing Service will supply. Materials and/or equipment necessary to complete the above work. Materials and/or Equipment you will supply: 110 volt electrical supply Water source Materials not to be used: N/A Initials: Fierst ResldencelC1_wpd 06/17/2004 15:43 FAX 413 585 0787 FIERST - PUCCI Q006 being performed. Tech Roofing Service presently has or intends to enter into a written contract with the following subcontracts: N/A N/A Tech Roofing Service will give you the name of all subcontractors with whom a written contract has been entered_ You sbould also be away that any person who performs work on your properly may also obtain a lien upon your property under Chapter 254 without a written contract. AGREEMENT WITHDRAWAL DATE Tech Roofing Service,Inc.reserves the right to withdraw this offer if not accepted within 60 days of the Submittal Date contained on the front page of this agreement_ RIGHT TO CANCEL CONTRACT YOU MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER,WI-RCH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF,PROVIDING YOU NOTIFY THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY MAXI.POSTED,By TELEGRAM SENT OR BY DELIVERY,NOT LATER THAN MIDNIGHT OF THE TIHRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS AGREEMI NT_ SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT_ By signing this Agreement,you acimowledge that you have received a complete and original signed copy of the entire Agreement and attached Exhibits. Tech Roofing Service may not start work until after this Agreement has been signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A LEGALLY BINDING AGREEMENT. IF THERE ARE ANY PROVISIONS WHICH YOU DO NOT UNDERSTAND,YOU SHOULD CONSULT WITH AN A'T'TORNEY BEFORE SIGNING. This Agreement is signed and sealed on l 20 k` . ',Tech Roofing Service,Inc. o e By h w Preside C . Fierst ResidencelCl.wpd �5- 06/17/2004 15:42 FAX 413 585 0787 FIERST - PUCCI 10005 on the front page of this Agreement. WARRANTIES Tech Roofing Service will grant you,as part of the Total Price,a Limited Warranty. Tech Roofing will use materials that are currently acceptable for their intended use in perfonn'ing the work. You should be aware that it may be determined that Some of these materials may cause health problems. If there are any materials that you do not want used in the work,list them on the attached Scope of Work forme. EXHIBITS The following Exhibits have been attached to this Agreement: ■ Scope of Work ❑ Limited Warranty ■ Notice of Cancellation ❑ Other ❑ ARBITRATION THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROV ED IN MGL C.142A. Tech Roofing Service,Inc eowner By: Josep�JNarkawicz,Pr t D e Date Date NOTICE:THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES. THE RIGHT TO R4MATE ALTERNATIVE DISPUTE RESOLUTION SHALL END TWO(2)YEARS AFTER THE DATE OF THIS AGREEMENT- MISCELLANEOUS This Agreement is a Massachusetts contract, contains the entire agreement between Tech Roofing Service and you, any representatives or warranties not expressly contained in it are not a part of the Agreement,and it is binding upon our heirs, executors,successors and assigns. This Agreement may be modified only by an instrument in writing signed by other Tech Roofing Service and yourself This Agreement is subjectto and is intended to comply with the provisions of Chapter 142A of the Massachusetts General Laws and its corresponding regulations. LIENS Under Chapter 254 of the Massachusetts General Laws,Tech Roofing Service,and any subcontractor that Tech Roofing Service has a written contract with,may obtain a lien,commonly known as a"mechanic's lien",against the property where the work is -4- 06/17/2004 15:42 FAX 413 585 0787 FIERST - PUCCI 19004 Tech Roofing Service intends to hire the following subcontractors to assist in the work: Name Registration Number N/A NJA NlA N/A These may not be all the subcontractors that Tech Roofing Service may hire,and Tech Roofing may decide not to hire any one or all of the above subcontractors,which decision shall be at the sole discretion of Tech Roofing Service. If you ask any subcontractor to make any changes or substitute materials without first obtaining written agreement from Tech Roofing Service,these changes may adversely affect another part of the work that you are not aware of and may create additional delays and costs. If you make such changes or substitutions, you will pay Tech Roofing Service the additional cost any subcontractor charges Tech Roofing for such changes and substitutions and for any extra work and material related to your request,plus Fifty(500/6)percent. INSURANCE Tech Roofing Service shall purchase and maintain liability insurance or protection of all claims wider worker compensation acts and other employee benefit acts,claims for damages because of bodily injury,including death and from claims for damages,other than to the work itself, to the property which may arise out of or result from Tech Roofing Service operations under this Agreement_ You shall purchase and maintain property insurance in a form acceptable to Tech Roofing Service upon the entire work and materials for the full cost of replacement as of the time of loss. The insurance shall include Tech Roofing Service as a named insured and shall insure against loss from perils of fire,extended coverage and shall include"all risV insurance for physical loss or damage, including, without duplication of coverage,at least theft,vandalism,malicious mischief transit,collapse,flood, earthquake,testing and damage resulting from defective design,workmanship or material. You will increase the limit of coverage, if necessary,to reflect the estimated replacement cost. You will be responsible for any co-insurance penalties or deductibles. If the work covers an addition to or is adjacent to an existing building,Tech Roofing Service shall be named as additional insured under your property insurance covering such building and its contents. You and Tech Roofing Service agree to waive all rights against each other for damages caused by fire or other perils to the extent covered by insurance. RIGHT TO TERMINATE CONTRACT If the.work is stopped or delayed,either in whole or substantial part,for a period of thirty(30)days under an order of any court or other public authority having jurisdiction,or as a result of any act of government and due to your fault or negligence or as a result of an act within your control;or if the work shall be stopped or delayed either in whole or substantial part,for a period of thirty(30)days due to your failure to make a payment on time or make Tech Roofing Service feel secure,or,if you should commit a material breach of any of your responsibilities or obligations under this Agreement,then Tech Roofing Service may, upon giving you seven(7)days written notice,terminate this Agreement and recover from you payment for an work performed; for any unpaid costs of and fees for the work;for any liability,obligations,damages,commitments,and/or claims that Tech Roofing Service may have incurred or might incur in good faith in connection with this Agreement;as well as receiving payment for the Tech Roofing Service attorney's fees and legal feels and all lost anticipated gross profits on the work not performed as of the date of the termination_ NOTICE Notice will be deemed to be given if delivered in hand or if sent by certified mail,return receipt requested,to the address listed -3- 06/17/2004 15:41 FAX 413 585 0787 FIERST - PUCCI 16003 If Tech Roofing Service is delayed at any time in the progress of completing the work due to acts of God,war,civil commotions, accident,governmental regulations or policies,any act or neglect of yours or by any separate contractor,or by change orders, or by labor disputes,fire,delay in transportation,unavailability of materials,adverse weather conditions,unavoidable casualties, difficulty in obtaining fuel,electricity,services or supplies from the sources from which they are normally obtained, or other causes reasonable beyond the control of Tech Roofing Service,then Tech Roofing Service may reasonably extend the date for substantial completion- If the work is not substantially complete by the ending date,as extended,Tech Roofimg Service will not be liable to you for any incidental or consequential damages you may incur due to such delay. If you are supplying any materials or equipment to be used in the work,you shall have such materials and equipment delivered to the work site not less than N/A days before they are needed for the work. If they are not delivered on a timely basis,Tech Roofing Service will not be able to schedule work dependent upon them and the date of substantial completion will be extended due to such delay. TOTAL PRICE AND PAYMENT SCHEDULE The total price for performing the work and supplying the materials under this Agreement is:S 5,800,00 FTVE THOUSAND,EIGHT HUNDRED DOLLARS. Payments against work completed and materials delivered will be made within fifteen(15)days from when Tech Roofing Service notifies you that the different completion stages have been reached.Payment will be made in the amounts as set forth below- A deposit of$1,800.00 before work begins or material is ordered/delivered- Balance paid at the completion of the project. All sums not paid before substantial completion of the work will be due and payable upon substantial completion. Payments due and unpaid under this agreement shall bear interest from the date payment is due at the annual rate of 18%or the maximum legal rate,whichever is less. In the event that Tech Roofing Service incurs costs or expenses in collecting payment due and unpaid under this Agreement,you shall pay such costs and expenses including reasonable attorneys' fees. If you fail to make any payments when they are due,then Tech Roofing Service may immediately stop work. Tech Roofing Service may choose to not start work again until you are current with the payments and Tech Roofing Service feels secure in obtaining the remaining payments- If there is any stoppage in work due to your failure to pay on time or to make Tech Roofing Service fwl secure that the remaining payments will be made, such delay shall automatically extend the date of substantial completion. ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN ADVANCE OF THE COMMENCEMENT OF WORK SHALL NOT EXCEED TIM GREATER OF ONE-14ALF OF THE TOTAL CONTRACT PRICE OR THE ACTUAL COST OF ANY MATERIAL OR EQUIPMENT WHICH HAS TO BE SPECIAL ORDERED OR CUSTOM MADE,WHICH MUST BE ORDERED IN ADVANCE OF TEE COMMENCEMENT OF THE WORK, 1N ORDER TO ASSURE THE PROJECT WILL PROCEED ON SCHEDULE.NO FINAL PAYMENT MAY BEDEMANDED UNTIL THE AGREEMENT IS COMPLETED TO TIM SATISFACTION OF BOTH TECH ROOFING SERVICE AND YOU. TECH ROOFING SERVICE MAY NOT REQUIRE YOU TO PAY PART OR ALL OF THE BALANCE NOT YET DUE UNDER THIS AGREEMENT BECAUSE TEC1I ROOFING SERVICE DEEMS ITSELF TO BE INSECURE. HOWEVER, IF TECH ROOFING SERVICE DEEMS ITSELF TO BE INSECURE, IT MAY REQUIRE AS A PREREQUISITE TO CONTINUING ANY WORK THAT THE BALANCE OF FUNDS DUE UNDER THIS AGREEMENT,WHICH ARE IN YOURPOSSESSION,SHALL BE PLACED IN A JOINT ESCROW ACCOUNT REQUIRING BOTHYOUR SIGNATURE AND THE SIGNATURE OFAN AUTHORIZED EMPLOYEE OFTECHROOFING SERVICE FORANY WITHDRAWAL. SUBCONTRACTORS -2- 06/17/2004 15:41 FAX 413 585 0787 FIERST _ PUCCI 19 002 AGREEMENT BETWEEN TECH ROOFING SERVICE,INC. AND FREDERICK& EVA FIERST Tech Roofing Service,Inc.,267 Page Boulevard,Springfield,MA 01104,Federal Tax Identification Number: 04-2730706 and Registration Number. 124864,is entering into this Agreement with you,Frederick&Eva Fierst of 10 Park Street,Florence,Massachusetts, Joseph J.Narkawicz,President,acted as salesperson for Tech Roofing Service in arranging this Agreement. ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS,UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION_ INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION,ONE ASHBURTON PLACE.ROOM 1301,BOSTON,MA 02018. TELEPHONE:617-727-8598 SUBMITTAL DATE:June 14,2004 SCOPE OF WORK Tech Roofing Service,Inc.will perform the work set forth in the attached SCOPE OF WORK on your home or the property located at 10 Park Street,Florence,Massachusetts. If you would like to change any work to be performed or materials used, such eh2mges would have to be made through a Change Work Order. This may also change the total price and extend the date for completion- Tech Roofing Service reserves the right to make minor changes in any plans and to substitute materials of equal or better quality. Should Tech Roofing Service encounter any unknown conditions below the surface of the ground or concealed or unknown conditions in any existing structure you will agree to make an equitable adjustment with Tech Roofing Service under a Change Work Order which shall increase the total price and extend the date for substantial completion of the work. PERMITS To perform this work,Tech Roofing Service,or subcontractors hired by Tech Roofing Service,will obtain on your behalf the following permits: ■ Building Permit U Demolition Permit 0 Electrical Permit 0 Plumbing Permit 13 Certificate of Occupancy D Other IT IS THE OBLIGATION OF TECH ROOFING SERVICE TO OBTAIN THESE PERMITS AS YOUR AGENT. IN THE EVENT THAT TECH ROOFING SERVICE DOES NOT OBTAIN THESE PERMITS AND YOU OBTAIN TH13M,OR IF TECH ROOFING SERVICE IS NOT REGISTERED WITHTHE BOARD OF BUILDING REGULATIONS,YOU WILL NOT BE ENTITLED TO OBTAIN ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 142A. The obligation of Tech Roofing Service to obtain permits is limited to those permits directly related to performing the work that Tech Roofing Service agrees to perform. To the extent that other permits or governmental or regulatory agency approvals,such as but not limited to zone changes,variances,special permits,site plan approvals,or approvals of conservation commissions, are required to be obtained before Tech Roofing Service can obtain the necessary permits,it is your obligation to satisfy such requirements and you shall meet those requirements at your cost. STARTING AND ENDING DATES Tech Roofing Service will apply for the permits within seven(7)days of the signing of this Agreement by both parties or your satisfying any conditions required to be met prior to the permits being issued,which ever date is later. Tech Roofing will begin work withinfifteen(1 S)days of obtaining theneeessary permits and Tech Roofing Service expects to have the work substantially completed within thirty(30)days of starting. -1- 06/17/2004 15:41 FAX 413 585 0787 FIERST - PUCCI f�001 FIERST, F-UCCI & KINDER L1.P ATTORNEYS AT LAW 64 GOTHIC STREET FREDERICK U. FIER=Tx NORTHAMPTON, MASSACHUSETT5 01060-3042 JOHN P. PUGGI C.JEFFREY KINDI%R** w JONATHAN J. KANE'tx (413) 594-6007 OF COUNSEL TELEcOPIER (413) 585-0787 EMAIL; (reclplent'd namQa e� fierstOuccl-com WALTER C. 90MOL w6B51T1;:www.fi®rstpucci.com IQ FACSIMILE COVER SHEET J I Client:N/A Date: June 17, 2-�O Please transmit the attached pages to: Facsimile Telephone Addressee (s) Number (s) Number s) TECH ROOFING 413-739-4537 413-737-5546 Total Pages (Including Cover Sheet) : 9 please note the total number of pages to be transmitted. If you do not receive the amount indicated, please call us as soon as possible at (413) 584-8067 . Fred has asked that I fax to you the enclosed agreement with signatures. He asks that you please deposit the $1800.00 check you are holding. We will be sending the original document today VIA U.S. Mail. Please feel free to call if you have any questions. Janet for Frederick U. Fierst wwxk*******wwwwvrk**** CONFIDENTIALITY NOTICE **xxxx********wwwwwwx*x THE DOCUMENTS ACCOMPANYING THIS TELECOPY TRANSMISSION CONTAIN INFORMATION FROM THE LAW FIRM OF FIERST PUCCI & KINDER THAT MAY BE CONFIDENTIAL OR LEGALLY PRIVILEGED, THIS INFORMATION IS INTENDED SOLELY FOR THE USE OF THE ADDRESSEES NAMED ABOVE. IF YOU ARE NOT AN INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED TFAT DISCLOSING, COPYING, DISTRIBUTING OR TAKING ANY ACTION IN RELIANCE ON THXS INFORMATION IS STRICTLY PROHIBITED, AND THAT THESE DOCUMENTS SHOULD BE RETURNED TO THE SENDER IMMEDIATELY. IF YOU HAVE RECEIVED THESE DOCUMENTS IN ERROR, PLEASE TELEPHONE US IMMEDIATELY SO THAT WE CAN ARRANGE FOR THEIR RETURN AT NO COST TO YOU_ x ALSO ADMITTED IN NEW YORK • ALPO ADMITTED IN COLORADO •••ALSO ADMITTED IN NEW HAMPSHIRA AND CONNECTICUT � �.tttAMP20 f � a9 (rziI of �\Tcrr llampfoli r B - 6 �I[DDNCht16CIlD — DEPARTMENT OF LtUILDII\G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 , WORICER'S COMPENSATION INSURANCE AFFMAVIT _ C (l i censed�e.nni(lee) with a principal place of businesshesidence at: --- --� � (Stree-t/ci ty/Scatc.w p) do hereby certify, under the pains and penalties of perjury, ,that xI am an employer providing the followivt •.vorker's compensation coverage for lily employees wol�ns� on this job: aas mrtce Compauy) (Pelic;Number) (F�-pi ,-tion Date) O I am a sole proprietor, general contrac-Lor or homeowner (circle one) and have hired the contractors listed beiow who have the folio•Ping workers compensation policies: (Name of Contactor) (Insurance Cornoan7"Poticf Number) (Exp,rmtien Date) (Name of Contractor) (Insurance Comra;iy(Pohc}, Numb,--r) (E xr�ir tioa Dzte) (Name of Contractor) -- (Insurances Compan),/Policy Nmnbcr)_ (l x:iradon Date) (Name of Contactor) (Insurance, Compaiay/Pohcy Numbrs) (Expi uoa Date) (attac3t adr±ition2l 9lxet ifncre:vr::n i�!:c?<i:�cxmiiec:�tnin_rr,:�ell crc:-n�tv,•) i ( ) I am a sole propriuoi- and have no olic for file. ( ) I al a home 0\r,'fler perforlTltn2, all Ole V'.Orr; niyself. NOTE:plc:"e be ft%Wc till:t a ilk he<rc Ni)-r3 rtt>o a ploy rrs .;stn(:)mauiicn-mcc,eorr n:ct�,n cr irpau lot IIKYC tILD lhtuo 1rLLf In%%i-,di lY la.tiroslrFS[C1:dam U oo the .:x�zpPtitttcn rri thereto e c uc<GcrxrillV c rte:i ca cmployc3 under the tvork&l oc%rPc_s_tim Art(GLI5?ss 1(5)),nppt;_anen by n homco%mcr for D Bess":.c cc pera:i:—v legit 9,211"of an cmployor under ilia Workoet convpa tion Acc I underhand that i copy of thi,"xixn�mt nay ba forwnniod to tbo Pctxirtmcnl of Indusfrinl A,,i6c%&OfG of I�uvao�o for tln oova-agc va-ificatioa and that Eliurc to_<auc covm&O under section 25A of Mai,152 can Icsd to the imposition of cri.�nin-1 Pcrslr'a oomiAing of a floc of up to S 1,500.00 tutd'cx L-uprisonuu-It of up to on.yz`r n.-A civil perultics in tfx Conn of a Stcp --d Wcrk Oni= d D fim 0(51W.00[dsy[Fiinst rn- - Q For dq:utlr>�tel u—only f� � 2..a'� Permit Ntuntx:r ------------ F -------------- U` (( Map,',_ _I,ot ;•' ---- ignatum of Liccn_ccJPcnnittr_e -- n_` r y E`S'T�ONB�'b�NSir• U�C��'�ION SERVICES ' �_ 8 1 Licensed Construction Supervisor: h ` Not Applicable ❑ Name of License Holder �4: \VCirL `w��L c--s �� l n ` License Number Address Expiration Date Sign Telephone ement °ontr cto Not Applicable ❑ Company Name Registration Number Address Expiration at S . Telephoney\-�, `� �1'��k4(o .., T f� 0 mNORKERSCOMPENSATION INSU3RANCE AFFIDaAVIT(M:G.L. c 152, § 25C(6j) 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...... ❑ The current exe tion for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such ho er to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. CMR 780 i Edition Section 108.3.5.1. Definition of Homeowner: Person 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 fame welling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more th one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building O 'al,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the b ' din permit. As acting Construction Supervisor your presence on the jo ite 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'Compe ation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts Gene 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 complian with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts eral Laws Annotated. Homeowner Signature r ��SEC~�TI�.ON - D S.'R' �T® PkROPOSED�ORK cf�"eek" 19l hcai le ' MA New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing X Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signsn[ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: R c4AN Q%_ \��'^^"� ��rL44 Alteration of existing bedroom Yes Q< No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet❑ If Ne hod" e a d o d Lion t0 existing ho- s-infY, compile. a th fol,l inR: 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? VOd d, Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fi laces r Woodstoves Number of each g. Energy Conservation Compliance. M check 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? —f Yes No . I. Septic Tank City Sewer Private well City water Supply a u» ax a x: SSECT10N7 a�OW�NER UTI OF2IZATION PTO BE COMPLETED; WREN: OWNERS�AGENT!D�t CONTRACTOR APPI_IESOEOR BUhLDING PER Tti- ��.. =ri Naas I, �e'� Sl�`..^.�. 1 'f'"`�� 1 `"L• 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 `S�ry:..� 3�wt Ncv I �u+wL C � vjK as Owner/Authorized Agent hereby declare that the s atements 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 N e Signatu f Owne g Date e Section 4. - ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 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 NO IF YES, describe size, type and location: D. Ar there any proposed changes to or additions of signs intended for the property?YES N o IF--YES, describe size, type and location: City of Northampton ., a t Building Department r 212 Main Street efi a a Room 100 Northampton, MA 01060 phone 413.587.1240 Fax 413.587.1272 ' °s rm r APPLICATION TO CONSTRUCT, ALTER, ( EA I 4 ONE OR TWO FAMILY DWELLING 2 2004 1 i SECTION 1 - SITE INFORMATION 'his s ti'on tobe comp.3�e�ci'ti offrce 1.1 Proaerty Address: f Map .. l Qt It t� ' LJ'C ` tom Zone Overlay Des n°ct s hIm St`District CB ds nct s - SECTION 2 -PROPERTY OWNERSHIP%AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: \ `t'' Telephone Signature --- 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signa 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 !� l 2. Electrical (b) E:aimated Total Cost of Construction_from 6 3. Plumbing Building Permit Fee d. Mechanical (HVAC) 5. Fire Protection _ 6. Total = 0 + 2 + 3 + 4 + 5) � {� �=' Check Number This Section For Official Use Only Building Permit Number: Date Issued:- Signature: - -- - — — Building Commissioner/Inspector of Buildings Date 14 PARK ST BP-2005-0004 GIS#: COMMONWEALTH OF MASSACHUSETTS g :B©ch:23A-017 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0004 Project# JS-2005-0004 Est.Cost: $5800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TECH ROOFING SERVICE INC 124864 Lot Size(sg.ft.): 33497.64 Owner: FIERST FREDERICK U&EVA C Zoning:URB Applicant. TECH ROOFING SERVICE INC AT. 10 PARK ST Applicant Address: Phone: Insurance: P O BOX 948 (413) 737-5546 SPRINGFIELDMA01101 ISSUED ON:712104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE PORCH 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• Receipt No: Date Paid: Check No: Amount: Building 7/2/04 0:00:00 26544 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo