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18C-065
1 J.D. Rivet & Co., Inc, ROOFING-SHEETMETAL 1635 PAGE BOULEVARD SPRINGFIELD,MA P.O.BOX 51068 INDIAN ORCHARD,MA 01151 TEL.(413)5435660 FAX(413)543-3373 October 1, 2014 R Alan Black 189 Prospect Ave. ' Northampton,MA 01060 RE: SHINGLE ROOFS,INCLUDING GARAGE—1,800 SQ.FT. Scope of Work: 1. Remove and properly dispose of(2)layers of existing asphalt shingles down to the wood deck. 2. Furnish and install (1)row of ice and water shield at roof eaves,valleys and flashings. 3. Furnish and install synthetic underlayment over the wood deck. 4. Furnish and install new aluminum drip edge. 5. Furnish and install lifetime architectural asphalt shingle roof system complete with all associated flashings. 6. Clean jobsite of all roofing debris. 7. Furnish owner with the shingle manufacturer's lifetime warranty. Note: Re-use existing gutters and downspouts. PRICE=$$,750.00 (EIGHT THOUSAND SEVEN HUNDRED AND FIFTY DOLLARS) ALL COSTS RELATED T OBTAINING A BUILDING PERMIT ARE EXCLUDED FROM THIS PROPOSAL(IF APPLICABLE) Israel Schepps,Service Manager Acceptance of Proposal—The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment terms are net 30 days unless otherwise agreed in writing.All material is guaranteed to be as specified. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire and other necessary insurance. All accounts nof'paid within 30 days are subject to a late charge of I %:%per month on the unpaid balance. In the event that legal action is instituted to coVct y ms due under this agreement,the undersigned agrees to pay all costs incurred including reasonable attorney's fees. PAYMENT TER.XIS 3 00.00 DOWN,SI,750.00 AT COMPLETION AND THEN S1,000.00 PER MONTH FOR 4 MONTHS. NOTE:THIS PR 0"6S Y E WITHDRAWN BY US IF NOT ACCEPTED WrfH1N_60_DAYS. Signature: Date: � /W -/960 The Commonwealth of.Massachusetts Department-of Industrial Accidents 1 Office ofrnvestigations 500 Washington Street .Boston,MA 02111 wwiv mass govldia Workers' Compensation Insurance Affidavit: Builders/ContractorsfFIectricians/Plumbers Applicant Information Please Print Iaeaibly Name(Businesstotganizationadividual): J.D.Rivet & Go . , Inc . Address: 1635 Page Blvd. City/St4te/Zip: Springfield, MA 01104 Phone#: 413-543-5560 Are you an employer?Check the appropriate box: Type of project(required): 1.n 1 am a employer with 5 0 4. ❑ I ant a general contractor and I employees(full and/or part-time).* have hired 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 S. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition (No workers'comp.inmzance 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.E]Roof repairs insurance required.]t 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContructors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose entities have employees. Ifthe sub-contractors bave employees,they must provide their workers'comp.policy number_ I am an employer that is providing workers'compensation insurance for nW employees. Below Is the policy and job site information. Insurance Company Name: Arch Insurance Corlpany Policy#or Self-ins.Lic.#: Z AWC 19 2 9 5 0 0 0 Expiration Date: 5/1/15 Job Site Address: $ �os, cc. AFL erA w, �o,� �9a . P City/StatelZip: � P 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 WORD 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. 1 do hereby certify n epY6 and penalties of perjury that the informaQdion provided above is true and correct Si tore: Date: Phone#: 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.Cityfrown 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: T`^ t)l e I e CS— d 5-f?,-3 b License Number r 3� 6(,)c� Sp!��. � roc a�'��, . Address ' Expiration Date L+(3--54 4,6 Signature Telephone S.Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number IG35- P c, (,Ick io 1S 3 Address Expiration Date Pill t f el t N( c Telephone 4 1 3- 543 Moat D 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 buildi 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 ❑ Addition ❑ Replacement Windows Alteration{s} ❑ Roofing EIK Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[C3] Other[lam] Brief Description of Proposed fLa�oJc cv.� ot;Sioore, Work: .,51xr43A4 COOL ":f( ct� G-CCC 5 E.� Alteration of existing bedroom Yes No Adding new bedroom Yes No QjW61.fAL Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa,If New house and or addition to`existincl housincl. comtolete the foffowing: 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 1, �� [ �L_ - ,as Owner of the subject propeq t here yf t rize J .�, kl ✓C� �n t to half, in all matter elative to work authorized by this building permit appI* atio . /� g t r ner Date 1 ,1$fs.r St. t�f1 S -:y. r) 2%'J t-�- Co V. 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 e Sig atur of OwnerrAgent 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 ° m--- (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 DON'T KNOW 0 YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES Q IF YES: enter Book Page and/or Document #; B. Does the site contain a brook, body of water or wetlands? NO 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 , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 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 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Deb a&► ent use only l City of Northampton st s ►f � a Puilding Department t:rt x uttUrltie I?'e€mtL 212 Main Street �ISepticvA rway"" Nd� 5 Room 100 �a Availabililk v' & i0o hampton, MA 01060 ti cs is rrl s plans k Electric,o hm'pgn, - 87-1240 Fax 413-587-1272 Rtotl te-Plans � N APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION'I -SITE INFORMATION 1.1 Property Address: This section to be completed by office ( 8 9 Pros me i.- A v Map Lot Unit a r MPS Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name Current Mailing Afldrebs: Telephone SAW thorized Anent: DA .; c 6C, =etc , (�(�rl ��;�c�s(� , f`'� a Name(9EZ Current Mailing Address: T� uti3 _Gt43-5W V Signs re 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 j✓ 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) $ '? S^C� Check.Number J 6 This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissionerlinspector of Buildings Date 189 PROSPECT AVE BP-2015-0528 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C-065 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-2015-0528 Project# JS-2015-000992 Est. Cost: Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: J D RIVET & CO INC 050230 Lot Size(sq. ft.): 16988.40 Owner: BLACK ALAN&GAIL STERN BLACK Zoning: URB(100)/ Applicant: J D RIVET & CO INC AT: 189 PROSPECT AVE Applicant Address: Phone: Insurance: P O BOX 51068 (413) 543-5660 Workers Compensation INDIAN ORCHARDMA01151 ISSUED ON:111512014 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 11/5/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner