17A-171 2 PROPOSAL AND CONTRACT
DATE:_
Home Depot
�\,-` SIORE If, 2 '_117-G KvI.,L.
(, ��3� Tamp,,I lurid,33619
,61 Ben JOB If '1�- �i Ilom,tmpro-ni-t Contractor
�j Cunsmnei Affairs Dept:1-888-68I-722 1
-7
t LEAD 4. / ( / -3 2 Z- NIA Li,.#128471 Cl Li,.14566155
Y
PURCHASER'S ME HOMF PHONE OEI-.CL N!r:BE7
C,�.-r c c �L� ro„i ---- yes s� �zs- /3 _�;jil,
ADDRESS // // Clll' - STATE //11 /IP ---
�t7 ��lOWt'S .S 1 M /I
NEAREST CROSS STREET IVSIALLATON AIXJR[S� DIFFERENT CTV STATE ]IP
SALESPERSON TO CHECK ITEMS TO BF. -I PR[.-PARATI ON 1ROOF INC SHEET[CflAt _ISOF6IT&FASCIA I .'I'J-UP
BID AND SPECIFY ON PROPOSAL , tJ LEAR CFF _'CARPENTRY V Fn ILATION ;_r GUTTER WORK
INSPECTION REVEALS THE FOLLOWING PROBLEM AREAS: L NAIL OVER EXISTING SHINGLES(Go over).
C-hingies ❑Decking ❑Chimney Flashing CI Shakes,Tile=_.t,Ietal Apply over existing shingles.CAUTION:New materials wilf conform
to unevenness of existing deck and/or shingles.
❑Vent Pipe Flashing ❑Dormer Flashing C;Ventilation i.]Cit;anng
INSTALL:
❑Valley Flashing Cl Overhang&Trim❑Exposed Ceiling FI Wind/V,uer/Ice Underlayment __- �] Ln.f t.
❑Other _ _ ___ ___ ____. _._.____ _-_.. FLASHINC;i install or Rework. ❑Donner/Wall Fla3nin,l
HOME DEPOT agrees to arrange installation of the follows .pe of :�Chlmnu-Flashing LI/Step Flashing 4cnt Flashing
_ __ ____ -
roofrno material with limited material warranty by the Manw er Other Flashing ---- _ --
VEIyTILATION TO BE INSTALLED:
Material Name 5 Years Celc- Ridge Vents ❑Static Vents Lave Venn
CITurbine Vents LI Power Vents _ Gable End Vents
(see limited warranty for details) STACK COVERS:Replace n Size:
Note:No warranty is given for leaks caused backup of n s. - - -
Note:Blends show less variation in shade due e to light raflec ^n,ran LX)RIP EDGE TO BE INSTALL ED:
solid colors.Black normally has some shade variation. Install--_____-_-____--. __ )y_U_ _.__ LF.
GUTTERING(Color and Description):
To be installed on a 2- story house.Rise /-G. per 12- - --_---
f rxttached Garage ❑Free-Standing Garage t owSlope OVERHANG AND TRIM(Color and Description-lie ,icii,,iioiy I f:uh
Other: exlsung):-
TYPE OF EXISTING ROOF. CLEAN-UP AND REMOVAL: Job site will h v,, a noa, c!ezn
appearance after the job is completed.
hingles able ❑Hip ;_]Mansard -Shakers
Note.'Home Depot is not responsible for any existing nssonry,wooer
❑Tile ❑Low-Slope ❑Slate LJ Other ____. _ _.-. or other materials, nor any items above the roor line_ Any nrdden
Note: Home Depot takes no responsibility for idenrirc:E: ^ nor conditions which require additional work or any extras requested by
removal nor disturbance of existing environmental or purchaser will be billed separately and purchaser agree-tc h y for
__ `F _ Initials.
hazards.If it is determined that any of the material or/obsites=re an the work as an extra
Additional Layers:It is possible during the course of insta11a0on that
environmental hazard, the purchaser most arrange (at pi,,craser's additional layers of material could be found. If additional layers era
sole additional expense) for removal, haul-away, dump r_ and found purchaser agrees to pay$�,�- -”per square per layr:r as
replacement of materials according tc existing local, s:a:e ano an extra._]) e,_Initials.
Federal law. _ initials. Installation Dates:The current estimated start date should be,,:h n
❑Valley type-Existing New Ln.Ft. the next_ -weeks.Subsequently,based on the: frnaleo
work it)this contract,the current estimated completion der shoud
MAIN ROOF has ,_._1.__layers of--A_SF h`j f � _.._ .
-- _ within i_-S _.days of the actual start dat
_ y
ADJACENT ROOF has 1 layers of ���- 11 w-1 I Note: I These estimates are subject to the DEIYS IN INSIALLAIIOIv
EMOVE existing _woofing to the dec,- cover condition on the reverse.
with a new felt and then apply roofing materials. Special Instructions:
DECK: Plywood Thickness T&G_ x
Other:
ROTTEN OR DETERIORATED DECKING: Home Depot v„!. :nstall
approved sheathing where needed.No charge or estimate has been - -- - _ _ -- _-- -
made for replacing such rotten or deteriorated wood. such ------_--- - - --
conditions are found,purchaser will be billed separately and agrees ---
to pay for the work as an extra.�'4 e e Initials_ ------ - ---------- - -
CASH PRICE:$_S,7.7 S _Approximate Monthly Payment:$ (may vary or not be applicable basea upon credit appro-,
METHOD OF PAYMENT:(The credit terms and conditions are provided on a separate document.)Price valid for thirty(30)days.
O Cash:payments as follows:$ U .cown,balance due upon completion.
If payment by check:BANK REFERENCE:.__- _ -CONTA T NAME _—_PHONE#
L1' redit Card:Circle One: &D l
MC VISA AMEX DISCOVER Card# (� 0f
Downpayment Amount(If Any): -
Authorized Cardholder's Signature:7_ "?^ =- --_. Exp Date:
❑Home Depot Extended Credit - -
SUBMITTED BY v //�/ APPROVED BY
REPRESENTATIVE _ cz✓'^`� MANAGER__
I/We,the owner(s)of the emises describe above(hereina^er referred to as"Purchaser(s)")offer to contract with The Home Depot to furnish
deliver and arrange for installation of all materials necessary according to the above specifications.THE TERMS AND CONDITIONS OF THIS
AGREEMENT ARE CONTAINED ON BOTH SIDES OF THIS FORM.Do not sign this contract if there are any blank spaces.
PURCHASER'S SIGNATURE ✓ t-' ' SPOUSE'S SIGNATURE: DATE:
-t- - - -__.._----
YOU,THE BUYER,MAY C NCE_L_THIS-TRANSrA TION AT.ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DAI E
OF THE TRANSACTION.SEE-THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT
Note:The following construction related permits are necessary before the contracted work begins:
It is the Home Improvement Contractor's obligation to obtarr,such permits as the owner's agent.Owners who secure their own permits or dual
with unregistered contractors will be excluded from the guaranty fund provisions of M.G.L.c.142A.
HDAS-f3F002 0800-1�1:.
4.tt1MlP�O
�O
9 4 Grxt� of Nart4aillpf oll
9 B �lasartcllnsrtta'
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORK-ER'S COMPENSATION INSURANCE AT,MAYIT
(licenserJpermittee)
with a principal place of business/residence at:
'7 Co- �,; (phone#)_
(streei/ci /stafeJzip)
do hereby certify, under the pains and penalties of penury, that
(�j I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(I.ns =Cr Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensatiorl policies:
(Name of Contractor) (Insuran(-- Company/Poticy Number) (F-pimtioa Date)
�r
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance- Company/Policy Number) (Fxpiradon Date)
(Name of Contractor) (Insul-nnce Compairy/Poky number) (Expiration Dade)
(attach acki6oasl L+xci ifnc---rr,'r,i-,chu iaI-ocmatiou pertn ing Wall ooc ad4rs)
O I am a sole propnetor and have no one working for me.
O I am a home owner perforrning all the work myself
NOTE:please be awarc that while hcarowjrcra wbo crnploy pc zom to do m.jn j�co s7uctioa or rc air work on a dwelling of
not moce than lhrco units in whica the h=n touvcr r,=dcs oc oa tso p ouads appurtcmnt thereto a,not gcocri y oomidcred to be
eatployexs under the Wort s cox�cn Act(GL152,n 1(5)),application by a homeoavcr for a Lccwc or permd may evidence the
legal stzftu of an amployoc under the Woci of a Compcmation AcL
I understand thst x copy of this ctat-1 may bo forwarded to tbo Dcp"tmmt of rndir,%t�ial A,(x-i&o&Ofhoo of La--wa for tba
coverage vaiticition and that&di c to static covcmV under suction 25A of MGL 152 can Icad to tho imposition of criminal penalties
eomiatin of a fine'of up to S1,300-00 and/or itnpriso� of tip to one year and civil penalties in the form of a Stop W ofk Order and a
fins o f S 100.00 a day ag;in.A me
Poc&p-tmc� —only
Permit Number
( gyp;{ Lot#
ttna iccnscclpermittee e
SECTION 8-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
M Re BT- re&llnme meomn ` Not Applicable ❑Cn' o
Company Name 7� Registration Number
TA
Address Expiration Date
Telephone t C �
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 building permit.
Signed Affidavit Attached Yes....... No...... ❑
11. �H.om ner�Exempt�on=
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
SECTION 5 DESCRIPTION OF:PROPOSED:WORK fch'eck allapalicable)
::h a,A, i<WS#f+AT.aYH4fi9r, -sus
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
i
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
sa:°IfNewhois"e: doad':dition o"`ezistin"=hou"sin com lete the';.fola"owin
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
I c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
I
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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
as Owner of the subject property
hereby authorize ___ to ac'; on
my behalf, in all matters relative to work authorized by this :D�jilding permit application.
Signature of Owner Date
as-Grrner/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.
j G G
Print Na
Signature of r/Ag Date
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. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
Northampton
I �g Department
21 Main Street
,R 2 0 2002 !' om 100
Northam ton, MA 01060
Rhone-4.13,.587 240 Fax 413.587-1272
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: r
Map �� �Lot
s5 Zone ;Overlay Districts'
A)
Elm St. District CB District°
SECTION 2 -'PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
i
1 irk �6 � A1a,�nv�r� /1f
Name P(int) —T� ! Current Mailing Address,
( ?
Telephone
Signature
2.2 Authorized Agent:
Name(Pri 1l __�o Current Mailing Address: 3
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) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
i
,,
26 HOWES ST BP-2002-0788
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mo:Bloel<: 17A- 171 CITY OF NORTHAMPTON
Lot:-001.
Pe-mw: Building
Cateernv:roofing BUIL ING P
Permit# BP-2042.0788
gw ect# JS-2002-1312.
Est.Cost:$5275 ao
Fce:$25 aQ PERMISSION IS HEREBY GRANTED TO.
Ciins� Class: Contractor: Lkense
yse Group: GEORGE TARANOWSKI 128471
I of size(W.it): 78$_4.3.6 Owner: >CLAYTON ROBERT C&IANE C
Zonin URl3 Aoft4atz- GEC3RGE TARANO SK{
AT 26 HQWES ST
Agnikant Address: Phon : _insurance_.,
130 OP RD UITE 11 888 533-71 4
Workers Compensation
MANCHESTERGT06,040 LgLLED ON.-NW142`U:Ot111t1
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST THIS CARD"SO IT IS VISIBLE FROM THE STREET
Inspector of I'lumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter;
Footings:
Rough: Rough; House# Foundation:
Driveway Final:
Final:. Final:
Rough Frames
Gas: Fireplace/Ch nner
Rough: Oib Insulation:
Final: e: Final: !lC -;Z e0 '� ..
THIS PERMIT MAY BE REVOKED BY THE CITY O OR'T`HAMPTON UPON VIOLATION F
ANY OF ITS RULES AND REGULATIONS.
Qprtificate of Ocggpancy a
Fee T
Rkpipt o: Rgft Paid: Q 4,No: Amount:
Building 3/20/02 0:00:00 230 $25.00
212 Main Street,Phone(413)`587-1240,Fax.(413)587-1272
Building Commissioner Anthony Patillo