17A-088 • amm-01�VORK ORDER
CUSTOMER NAME ]t1d-N s AMOUNT TO BE COLLECTED ON COMPLETION: S 7, rO y
INSTALLATION ADDRESS: A) �'-f' TELEPHONE(PM-Y�U � 7� ti S S�
CITY/STATE: L D r 6rj C 6 , ' ZIP CODE CID 6 bL-
CHE LIST DIAGRAM
✓ PICTURES EdYES ❑ NO -
Fascia Board �flS
Fascia Cover Color
Roof T ype j313 S
�r L d
Roof Color 1'3 L/Q Ge SL a i x x X k jc'
Pitch of Roof
Q Present Roof
VA/No.of Layers "Z_
i
Air Vents 1 i CIA) /I`"
(�Ridge Vents
�p LL
❑No.of Skylights
U No.of Chimneys { 3 Z
Ice&Water
Snow Guards
Q Valley Footage SPECIAL INSTRUCTIONS:
(a Endwall Footage 70 —'
U eight 1-2-3 Storey n�
Si for Job —
E�� I ®�+ r �, ,�Vkk �,4 Sir%� �i c X01
ei1r1f En sib�s`st ro' f. i p
Agreement Between
0001$ INTERLOCK INDUSTRIES, INC.
Unit 7, 25 Walpole Park South 1 1 6 7 5
Walpole, MA 02081
Registered as a Massachusetts Home Improvement Contractor Registration#139640
Registered as a Rhode Island Residential Contractor# 18345
Customer Service: 866.588.ROOF(7663)
Name ���#�`A,N f Egg c,c _ ("Buyer") Date
Job Address 3 1144 t,tam t�j
City/Town *FAO pErve , Zip Code
Buyer's Home
Address Zip Code
Work Phone (40 '6 7 00'9 s Home Phone 0) 29(-3040 Cell Pho(V/F)S:r/p
, /7Sj.�-
The Buyer is the registered owner of the land and premises described in the job address above (the"Premises")and hereby contracts with
Interlock Industries, Inc. (the"Contractor")and authorizes the Contractor to furnish all necessary materials and labor to install,construct and
place the improvements according to the following specifications,terms and conditions(the"Specifications")at the PrgmWises.
Icir�ie one>: SHINGLE SLATE
SPECIFICATIONS
YES NO ROOFING MATERIAL YES NO OWNER WILL
✓ Supply adequate electrical power.
Shingle -Color: �L�c1C 1R� G✓n� ► k4W"90Td llbasi
/ IB Low Slope Roofing-Color: V/ Be responsi'�1ee for all rot damage and other necessary
V Flash Skylights - Number roof repairs. (ie) Roof decking, fascia boards, etc.
Flash Vents Roof repair work will be undertaken by Interlock
Underlayment -� Industries, Inc. at a cost to be mutually agreed upon in
Snow Guards VF To 2-T pcs. advance between the parties.
F/7.iM Cs K-,J A r 13,46e T)otg dw fikr
ROOF REMOVAL y LNy LOCATION OF SHIPMENT:
_ Strip existing roof layers. t _ �Z
_ Haul away roof debris d pay refuse feel Ue�� START DATE: _ u,;cf i-'S bj�
_ Note location for bin ' 0 COMPLETION ►TE ar *6 f��Ifi1N '-
_ Sta and sub ec Chan I
>�n ln�Cu 4 a V taS5 l`P of 6r �rv5 -
✓�
�I`� d' �Ci�i ' �l L l` t 161^, l/ TO � .lj4G(6'l�S D� �•1C05'f/12(.r A;1JNad!��- �t�trS�dS /.S�iGI./
iGv jvGGvDISS .b i 6eaw �il�srf� lYl�at.�3" /qi4, A�A51210'4 A4 ,��f►vrb-1►/
6 ouroo� JO(, ✓�lr iKllisr~6c�G14 °,ullc r sxtGa'' Td
iAJrs��Tj �/'�� /�N�/' AQ�)bkAL Gu1�G �aST /,s0611; Al"k e.
� AP20 rsrN62 ROf' t -rt✓E h/0�'1^6bu $ jib�g�u,�l; �f�-
THIS CONTRACT INCLUDES: S-0975144- tC Tro 6�A;AAP b 5t'IW p�WWL�R 67-00
LIFETIME LIMITED WARRANTY,TRANSFERABLE,NON-PRORATED FOR MATERIALS MANUFACTURED BY INTERLOCK ROOFING LTD.
PLUS 10-YEAR LIMITED LABOR WARRANTY P OVIDED BY INTERLOCK INDUSTRIES,INC.
LIFETIME LIMITED MATERIAL WARRA TY IB ROOFING,PROVIDED BY IB ROOFING SYSTEMS
Financing Requested Yes No Sales Price $
&a06.v�
Sales Tax $
Interast Rat:.: " a OSb Total $
Down Payment $ 0
Payment not to exceed $ Total Balance on Completion $ J'f � � 0.
O.A.C.(on approved credit)
MAKE ALL CHECKS PAYABLE TO: INTERLOCK INDUSTRIES, INC.
IN WITNESS WHEREOF, the Buyer and Contractor have hereunto signed their names this day of fL'920 0
The contractor and the homeowner hereby mutually agree in advance that in the event that 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 Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as
provided in MGL c 142A. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
INTERLOCK IND TRI S, I
Signed
Per: uyl
(Print name) tJ Signed
c/o Unit 7, 25 Walpole P rk South Buyer
Walpole, MA 02081 Witness
HIC.# 139640 Print Name
Relationship to homeowner
This Agreement is a binding agreement and contract between the parties. This is not a credit transaction and will not be financed by the Contractor. If
financing is required,the Buyer hereby authorizes the Contractor to obtain credit information and the Buyer hereby agrees to provide and sign all necessary
documents required by any third party financial institution to complete the financing,immediately on request. The Buyer hereby acknowledges receipt of this
Agreement. See reverse of Agreement for additional terms and conditions.
All surplus material is the property of the Contractor.
MASC CR0707
✓/ze 10Q/y�iy/ypryytUP�� o�'✓��aaaacluael�a
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registra}ion: 139640
Expiration: 7/ 812009
Type; Supplement Card
INTERLOCK INDUSTRIES INC
PAUL MCALLISTE'R;
#7-26 WALPOLE PARK SOUTH
WALPOLE,MA 02081
2 42
CORD, CERTIFICATE OF LIABILITY INSURANCE D"�°"�""°° '"I
"tomicm THIS CERTNICATE(S ISSUED AS A MATTER OF MWORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTi
mr" commomw Its"" ceat= HOLDER. THIS CERTjP=,m DOIS NOT Mime, offm OR
"30 C010twacte J vd. /400 ALTER THE COVERAGE AFFORDED BY THE POLlCN?S BELOW.
ro Ht 659520
A VAURERS AFFORDING COVERAGE NAICi
Interlock Industries, Inc.- r,RKMA.- ANBRICIM HOES ASSUME= CD
a Massachusetts Corporation 1111161im e
Unit E7, 25 Walpole Park South 1111111.11m e
s D:
Walvoi MA 02061 smarm ft
COVERAMM
THE POLICIES OF INSURANCE L15TED WOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PM=PERIDO INDICATED.NOTWI HSTANDW
ANY REOUIREMENT,TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'WITH RESPECT TO WHICH THIS CERnRCATE MAY BE 9MM OR
MAY PERTABN,THE INSURANCE AFFOW0 BY THE PODS DESCRIBED HEREIN E SCI T TO ALL THE TERMS,OCCI.! IONS AND CONDITIONS OF SUCH
PODS.AQCARESATE Li SHOYM MAY HAVE BEEN-FATIUCED BY PAS CLARAS.
ewt PotICY tRnlvm Potter SHM WE POLICY i1t1uA $
A r NONAI UAINIM 3LS836199 /01/2008 /01/2009 FAGN O +
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PeRS«ar.s AM NAMY + Roo am
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900 A1f8RE6ATE LOW APPLIES PER PAODIfC7s-COMPMAGO +
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CERTIFICATE HOLDER LANCE"'nON
>ResLD AUY oP nu AsovE ossamEU POLICIE+ss OIIt10EtLED!lfplE tI1E®IPIRA11oq
To tiltom it May cmce= m-m mmw.me mm umiimit w"mmval TO wft m„_MYS ww"m
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ACORD2512001 B) eACORD.CORPOMMN 1988
DS#4087279
CBITIF"TE NUMBER. .
025
y,pp, TM CERTIFICATE E 9WUW AS A MATTER OF BNFORNATION ONLY AND CONFERS NO"WM UPON
THE CERTIFICATE MOLDER OTHER THAN THOSE PROVIDED BY THIS POLICY.TM C'ERTRFTCAIE DOES
MARSH CANADA LIMITED NOT AWEND.EXTEND OR ALTER THE COVERAGE AFFORDED,BY THE POLICE'S OESCR M HU4ML
70 UNIVERS"AVENUE,SUITE 800
TORONTO ON M5J 2M4 coRIrANIES AFFORDING GvvERAC
BNSLRIBC , COMPANY LIBERTY MUTUAL INSURANCE COMPANY
A
I
INTERLOCK INDUSTRIES,INC., COMPANY -
A MASSACHUSETTS CORPORATION B '
UNIT#7,25 WALPOLE PARK SOUTH COWANV
'WALPOLE,.MA 02081 H.
C
COMPANY
a
'TMt8TOGERTRYTH&'F THE POUCWX,OFHVSURAP#;E1.157Ea_tiEREjN%AVfi-KEN.=ED-TO.TNE.tK"EO.NA#IED-F I.P.OR.THEPERIOO.OfUISUAA=l10lcAm...NOTRVITNSTANpB4G.ANY
REOLVWANT.TERM OR CONDITION OF ANY CONTMCT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTFICATE MAY BE ISSUED OR NAY PERTAIN.THE NMRANCE ARWOED BY THE
POLICIES L WW HEREIN IS SUBJECT TO ALL THE TERMS.CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.LMDTS SHOWN MAY HAVE BEEN REDUCED BY PYUD CLAIr L
co TYPE WSRARANCE POLICY IR um POLICY EFFEGTRVE POLICY EKPMAI N LAM
LTR DATERMMRRLTTT DATE W MTK YYT
tLCTEAAL UAWRITY - GENERAL AGGREGATE i
COMMERCIAL GENERAL LIA am PRODUCTS-COWIOP AGO i -
CLAN4 MADE a OCCUR PERSONAL S AM RLIUIY i
OWNS S 8 CONTRACTOR'S PROT EACH OCCURRENCE i
FIRE DAMAGE PAW 494*A i
WO M PAW 4M PW3094 $
I
AUTOYOBBPLABJLRTY COMBINED WAmE LlWT >)
ANY AUTO
ALL DINNED AUTOS BODILY ULRNRY >}
IPar pNawo
SCHEDULED AUTOS
HIREDAUTM somy BNJURL' i
Ws acck%W
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PROPERTY DAFMGE 4
GARIMELIANLITY AUTO,ONLY-EA ACCIDENT i
AN AUTO OTHER THAN JUftO ONLY
• EACH ACCIDENT i
AGGREGATE- t
Excm upim TY EACH OCCURRENCE i
UN BRELI A FORRLR AGGREGATE i
OTHER THAN UMBRELLA FORM i
VMKX NW UAWAM EL EACH Acclo T i 1,000.000
THE PROPRIFTOW X BNCL- WCI-871-072231-OW 2/1/200$ 2/1/2008 EL DISEASE-POLICY LOW i 1,000,000
PARTNEIM EXECl1TTVE
OFHCVk�ARE. EXCL EL DISEASE EACH EMPLOYEE g 1,000.000
OTNHI.
otscw.wm OFOPEIULTRWNSAaTJL no= .
RE.-PROOF OF COVERAGI_.
`SHOAL ANY op THE MCLICES msc MW HEREIN K CAHICRLEO W ONE THE R7tPIMTHON CATE
TO WHOM IT MAY CONCERN: THEREOF.THE i1fSWF M AFNHRCM coVVWM Watt 0"AVOM TO MAIL 20 RAYS YMYTIEN NOACE
TO THE CUmRCA79 MOLDER NAMED HEFAM OUT FAILURE TO MAIL SUCH NOTICE SHALL"POSE NO
OOUGATION RNI LMBLWV OF ANY KIND WON THE IHSURE1k5I AFPDROM ODVEBAGE.THEE AGNRS oR
NEPRESENTATTMES OR THE tBMRA OF THIS CBCTWICAW-
IIJUSH/CA)NADA IWTFA
• � +Jk�i
w"(m) DATE 113112008
z
2
12l' IN/L= S Lnt=l u-nicHnal
51
C'L�-NnVYLEDGEMEN'T
r-l-VA"r T*AlUD TI 0 A
n
01F�AO-Cszch-Ts,-Vts aEo'ws Le I orneo,�wmer Le right under 780CNER to
L; "wn " as e Soil 5
a C, Z E tf C 0 a S-_7 U ca 0 r, 5'a T_-i Th e el
intends to be, a ore or two ni�
on which he/she resides Or ML
zwelz;-2 zacLed or datachef struct.1res acc ssary
to such use and/or la= A
persoj�w�o coast-a=more than cae home in a penod SLau l not be considered a
I 'horse owner.-
pton-;�azzts any perscm(s)who -seek to
T-he&uEdiagr:�,deppaz:�--ment far he Ci,.y oft-Nor-121zmr,
to be a7wa—e
tLzt by doLing sc-v-ou become r--pcasible for compliance wifu state buEdinz codes
and reguLticns- The inspecoon process-re'77res tLal the building deppwent be ca-Iled-I
VA
to =-,Cz-0e--t Work-at-Y-anous stages, Whiclb- include foundation/footings rb Alre bacldD
SC-notube holes (before vour). a roug-h bu-ildin--jimectiou(before work-is
ar-C L- man ecti-an (if rec u I-ed)and 2-fma LIbizEdiagg i=n ectle n- The
bT-,;2d-;n2 depm requires theSa i=-- pe-c-tons before the-work is (::Cncealed; failure to
s---cnre these I=Vections can result fn failure to obtiin a cerdEcate ato' c'cunancv
UF tLe hc=i e-o-w-mer hires.over trades to pef:OrM-Work 7, plur-abinng gas) tLe
ho=ea war er-WE.' b -bl e to e:---e Lhieir prayer-
Je Sure tHe L-azes hEr-_--q s
their rewired
Z erm--,ts La, cf-mjuzct�om to the buillding pe=t issued, 1--d that they gel.
Lispections-FaElure clFzLe Lmd:L-1/16 T-I trades to secze the Pe='ZS and inzpe,--Eozs as
caz DET AY tLe prcji—u--:-1 such ti as the proper pen its and inspections are
made
T the above_
(Home m-owne.-Iresident's signature requesting exemption)
irg
I wi.71 cail to scLedul.-aTIT recl:iiedd building inspectors ne--C--Szry for tLe build
issued to me-
Addres(z nFV11in
Icczrlon
- Office of Investi;ations
600 Tf'irs.•'~'ing ton Street
1 = Bosion, AL-1 02III
nww.mass.1 ov/,disc
Workers' Compensation Insurance Affidavit: Builders/Co ntractors/Electridans/P1 Limb ers
nolicant Information Please Print Lee-lbl
Name (Business/orzarizationilndividual): _
A 4A
L1uui�.JJ.
Clfy/StatZ/Zlp: Phone #:
-.re you an employer? Check the appropriate box: Type of project(required):
.❑ I am a employer with 4. [7 I am a General contractor and I 6. ❑ -New construction
employees (ful3 and/or part-time). have hired the sub-contractors
2.C] I am a sole proprietor or partner- listed on the attached sheet. %. ❑ Remodelin`
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. insurance comp. insurance.i
required_] 5. ❑ We are a coral oration and its 10.❑ Electrical repairs or additions
3.❑ I am a iiomeowrer doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.F7 Roafrepairs
insurance required.] _ c. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
`Any applicant that checks bcx#1 must also fill out the section below showing their workers'compensation policy information.
Ho meowners who submit this afndavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Coiaractors 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.
Jam an employer that is providing workers'compensation insurance for uty employees. Below is the policy and job site
information.
Insurance Company Name:
Policy -=or Self-ins. Lie. ;r: _.Expiration Date:
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 51,500.00 and/or one-year imprisonment, as w-eIl as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investi`ations of the DIA for insurance coverage verification.
I do hereby-cerrij_,,--unite,—theprr ins-rzjrtl care.1.4e5-of-perjztry4hat the information provided above is true and correct.
Si--nature: Date; . .
Pl i one
� d bv.city or town of cial
City or Town: Permit/License;r"
Issuing Authority (circle one):
i. Board of Heslth _. Bulidln_ Deparrment _. City;1r owr, Cle`li 1.Electrical ,aspect; P.uinti'_i? inspector
j 6. Other
Ciiit:ii:i Pi'.r5t)?-i' phone r ��
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 Improvement Contractor: �" :.� Not Applicable ❑
Company Name Registration Number
Address G Expiration Date
lJ�^S>� �� �� ZG� 0 Telephone�C� G'��t?�c7�� -7
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 buildin ennit.
Signed Affidavit Attached Yes....... No...... ❑
Owner' gemtion
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
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[0]
Brief Description of Proposed
Work: -Tf-+!P- C PF Z L-Lily
Alteration of existing bedroom Yes_ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ N' No
Plans Attached Roll -Sheet
6a. If NeW house and or addition to existing housingr'coinpiel.e 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? 1 5
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 BE2 COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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
0 x l as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing applicatio re true and accurate, to the best of my knowledge
and belief.
Sign,et nder th pain 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
Side L: R.,,_.__ L . ._._.:._ R .........
w_
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 0 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#. Mry m
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 Q
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 anM gemenf Permit from the DPW is required.
1 Department use only
City of Northampton Status of Permit.
Building Department CurbCut(DfiuewayPermit
212 Main Street Sewer/Septic Availability
Room 100 WaterW'61l Availability
Northampton, MA 01060 Two Sets of Structural Plana
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR(DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
This section to be completed by office
1.1 Property Address:
4 Map_ Lot Unit
Zone Overlay District
b CB District
Elri%St District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: n
p'o V,
Name(Print) Current Mailing Address:
G��� i��
Telephone
Signature
2.2 A4thorized Mek
Aa 01
Name(Pri Current Mailing Address: GLrzSjt''��d2�_
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only'
completed by ermit applicant
1. (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) Check Number
This Section For Official Use.Onl
Date
Building Permit Number. Issued:
Signature:
_ _. ------ -- —...------d ---_
Building Commissionelse
npctor—
o w mgs - Date
BP-2008-0770
GIS#: COMMONWEALTH OF MASSACHUSETTS
11, ir CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: roofing BUILDING PERMIT
Permit# BP-2008-0770
Project# JS-2008-000672
Iat. Cost: $17500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: INTERLOCK INDUSTRIES, INC 129369
Lot Size(sq. ft.): 14810.40 Owner: PEASE SARAH A&LINIDA SHARKEY
Zonin4:URA Applicant: INTERLOCK INDUSTRIES, INC
AT. 3 MOUNTAIN ST
Applicant Address: Phone: Insurance:
UNIT 7 25 WALPOLE PARK SOUTH (508) 660-6665 0
Workers Compensation
WALPOLEMA02081 ISSUED ON:311112008 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST TI IS 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 3/11/2008 0:00:00 $50.002224
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo