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17C-266 (2) Sep 05 07 10: 10a p, 2 SPECIFICATION GUARANTEE: installation shall be made in accordance with:a)Each manufacturer's-recommended design and procedures.b)The construction manufacturers detail handbook.c)The SMACNA Architectural Sheet Metal Manual.d)The NRCA Roofing and Waterproofing Manual.e)The Handbook of roofing Knowledge.These guides have been used to determine the correct personnel,products, procedures,and specifications for every phase of this project. LONG TERM MANUFACTURERS WARRANTY: TLC EXTERIORS LLC is a certified roofing installer and is qualified to prepare manufacturers warranties upon completion of the job for the specified material.chosen.TLC EXTERIORS LLC also warrants the job for labor according to A1A(American Institute of Architects). CONTRACTORS LABOR WARRANTY: 5 years by TLC MANUFACTURERS WARRANTY:30 years by manufacturer PROJECT SCOPE AND CONDTTTONS; TLC EXTERIORS LLC proposes to furnish and install material in accordance with the above specifications for the sum of THREE THOUSAND, FOUR HUNDRED FIFTY DOLLARS --- - ------ - -- - - $3,450.00 TERMS: Standard industry cash terms;One half deposit with contract,balance due upon completion.TLC EXTERIORS LLC reserves the right to withdraw this proposal if not accepted within thirty(30)days. ACCEPTANCE: Upon acceptance of contract,work will begin within(30)thirty days and be completed within one week(weather permitting).The above prices,specifications,and conditions are satisfactory and accepted TLC EXTERIORS LLC is authorized to do the work as specified.Payment will be made as follows: Total Price: $3,450.00 Deposit: $ 1.725.00 Balance Due: $ 1,725.00 Total remaining balance due upon completion of specified work r117 4 S/13/07 TLC EXTER10 LLC-295 EAST STRE UTH HADLEY,MA 01075 DATE Z?ZA—, 1.?qld -7 A �` PLEASE L ALL CHECKS PAYABLE,To:TLC EXTERIORS LLC Sep 05 07 10: 10a p. 1 295 East Street L c South Hadley,MA 01075 I� -Tel: 413-539-5837 Fag: 413-534-0755 A Division Of TIC Exteriors LLC DATE: 9113107 NAME: Giardina ADDRESS: 112 North Main St. CITY,STATE,ZIP: Florence,Ma.01062 RE:JOB SITE: same Dear. Tony, TLC ROOFING Is pleased to submit the following solutions: PROPOSAL: I REMOVE ALL EXISTING ROOFING FROM REAR ADDITION AND DISPOSE OF.(durnp fee inc,) 2 FURNISH AND INSTALL NEW ALUMINUM DRTP EDGE. 3 FURNISH AND INSTALL NEW ARRI ON ALL EVES,VA EYS,AND LOW SLOPES. 4 FURNISH AND INSTALL NEW 15 I B.FELT PAPER. ��// 5 FLJRN1SH AND INSTALL NEW 3D YEAR ARCHITECTURAL SHIN" FS. 6 FURNISH AND INSTALL ALL ASSOCIATED STEP FLASHINGS NEEDED. 7 FURNISH AND INSTALL NEW VENT PIPE FLASHINGS, 8 FURNISH AND INSTALL NEW LEAD COUNTER FLASH TN ON CHIMNEY. 9 FURNISH AND INSTALL NEW ROLL RIDGE VENT. 10 FURNISH OWNER WITH MANUFACTURERS WARRANTY. *any deteriorated wood decking or fascia will be replaced at an additional cost of $55.00 per 4x8 sheet,or$6.50 per board fl. NOTE: This project has been specified in accordance with roofing industry standards,as well as,each manufacturers specification requirements.All work will be done by craftsmen certified in the application of every product used in this proposal.This assures your qualification for all long term warranties available and your"peace of mind that the job was done right the first time. INSURANCE: All work involved within the following proposal is covered by Worker Compensation,Public Liability,Property Damage, Product Liability. An insurance certificate will be supplied upon request. PROPERTY PROTECTION: To minimize inconvenience and damage to the property,plywood protection sheds,tarpaulins,and safety warning lines will be installed as needed_Debris will be disposed of promptly in accordance with local Iaws and ordinances. 1995 FALL PROTECTION SAFETY COMPLIANCE: In February 1995,OSHA substantially changed the fall protection requirements for roofing contractors and property owners. Noncompliance can result in forced project stop and fines.All of our employees have been specially trained and equipped in order to comply with these new regulations. ACOR©,. CERTIFICATE OF LIABILITY INSURANCE 07�24�2 0 PRODUCER (413) 536-1491 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Metras Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2030 Memorial Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chicopee MA 01020- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:National Grange Mutual Thomas Leonard dba TLC Exteriors INSURERB:AIM Mutual Insurance 295 East Street INSURER C: INSURER D: South Hadley MA 01075- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NS RD TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE MM/DDIYY) A GENERAL LIABILITY MPB49531 04/21/2007 04/21/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ CLAIMS MADE a OCCUR MED EXP(Any one on) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JRe LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR r_1 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND VWC6008801012004 05/21/2007 05/21/2008 TORY LIMITS ER EMPLOYERS'LIABILITY 500 000 ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ r OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under 500 000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ r OTHER SL DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPLCIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE / p! ,,`,�,{me/ ACORD 25(2001/08) ©ACORD CORPORATION 1988 T,INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 �StSAAfPT O O �� ?$ LEI zfy of Xarf4ttiitvton Z $.. � j�riassac�usetfa 5i DEPARTMENT OF BUILDING INSPECTIONS /: INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to act as iris/her construction sup,.: .-isor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before your), a rough building inspection (before work is _concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupanev until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing&gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 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/Individual): --FL-C k /t)(�S Z— L Address: 2 S 4- S4 , City/State/Zip: So , t Phone 2 9 Are you an employer?Check the appropriate box: Type of project(required): 1.91 I am a employer with 3 4. F� I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. E]Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. $ 9. �Building addition 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.Q Roof repairs insurance required]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any app—tican t Tiat c ec ox ill 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. *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 sub-contractors 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: 1'T_M ]-/� . Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address:_J I a NN' Jq "IV S f , r()'&J(e , City/State/Zip: �Jy2rit/� �� 0/0 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 fie 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 9- 3 - O 7 Phone#: S� 3 7 Of 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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t ry SECTION-8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 9 Registered Home.lmpcoveiiientContracfor .. u ;'+ Not Applicable ❑ 13y81 6 Company Name Registration Number `PL (— k OR / 1�S" -0 8 Address Expiration Date 19 Y E4 S� S Telephone SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1"52,§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 building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ i` ✓t`y 11--"- 6tA6.Q , ner;Exetft 611 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-vear 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 Y SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[o] Brief Description of Proposed. Work: LiLzt D 1 i RvUF Alteration of existing bedroom Yes No Adding newtedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New.house-and©r:additior`.to ex stitt4 housi g,Campiete fhe fotlowinci: 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 o. s cons ruc ion wi i 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, 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 ----------------------- I, `�•�/11Q S (}r\}/� �C 'c(0 L�C as Owner/Authorized Agent he e y 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 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 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) V A Has a Special Perm it/Variance/Fi nding ever been issued for/on the site? NO G DON'T —'.— ..' IF YES, data issued:' / ' IF YES: Was the permit recorded at the Registry ufDeeds? NO x�� DON / xmum' 0 ,co IF YES: enter Book / Page / and/or Donumont#| O. Does the site contain obrook, body uf water orwetlands? NO 0 DON 7KNOV 0 YES 0 IF YES, has a permit been ur need to be obtained from the Conservation Commission? Needs tobeobtained v~~\ Obtained v�v�� Date�~� ' ` C. Do any signs exist on the property? YES »~-\ NO 0 IF YES, describe size, type and location: | D. Are there any proposed changes to or additi-ans-of-signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: i ) E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre nrisd part ofa common plan that will disturb over 1 acne? YES �� l NO ��l IF YES,then a Northampton Storm Water Management Permit from the DPW is required. µ i Department use only City of Northampton Statusof;Qemut « x rl�ding Department Gu tx CuV09 Away f?er u ,212 Main Street SewerfSepttcAvatlabrlEty � Room 100 iGlf`aterNtLell AvatfabtCity° �^ Northampton, MA 01060 FwaSets'o€StrucfuraTPCans =� r � ho13-5.8.7-1240 Fax 413-587-1272 PtoGSite Plans Others acl P.- fY APP{_I.CATION.TO CON'S7�IZUCT,�'QLTER,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 I A/ 2(1-+ "J AJ S �' Nlap= Lot Unit F l o Rho Zone Overlay District •EIM,St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: 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) �Q d, 00 Check Number This Section For Official°Use Only Date Building Permit Number_ Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2008-0217 GIS#: COMMONWEALTH OF MASSACHUSETTS 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-2008-0217 Project# JS-2008-000339 Est. Cost: $3000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: T L C EXTERIORS LLC 134816 Lot Size(sq. ft.): 5052.96 Owner: GIARDINA ANTHONY&EILEEN Zoning URB Applicant: T L C EXTERIORS LLC AT. 112 NORTH MAIN ST Applicant Address: Phone: Insurance: 295 EAST ST (413) 539-5837 WC SOUTH HADLEYMA01075 ISSUED ON.91512007 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 9/5/2007 0:00:00 $25.001473 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo