Loading...
17A-257 (15) U.S. METAL ROOFING 1 ED I S T R I _E3 _U- _T-_0___ R S , 1____N_ -C 740 High Street•Suite 2•Holyoke,MA 01040 1-800-232-0399. 1-413-536-5474•Fax 1-413-533-8166 DATE PROPOSED T BE DONE ON www.usmetalroofing.net j r` <`� SUBMITTED TO PHONE NUMBERS STREET JOB LOCATION CITY/T/ATE AND ZIP CODE ry L DIRECTIONS f a We will furnish and install new Englert standing sead enal:Aft system,24 gauge as listed below. Work is guaranteed for five years and the manufacturer warranties the finish on the metal for 35 years. 7 COLOR: 're' � HOUSE: ESPECIAL INSTRUCTIONS/COMMENTS ROOF: PORCH: - �' / n SOFFIT: ADDITION: L, / l C'♦_. Ef [c .�i -f' �/Il�CY�y Cl r ' FASCIA: ` { GARAGE: ,/�— f�CIl 1C.:fr,• 1'ff<{t,, / '-(,^,,` - ,� y:.x r �'A"-t<' PLYWOOD: ' r 5���S GUTTERS:YP-iJ>P er RIP/REMOVE: `"''�f - 'frST�'f( DOWNSPOUTS: OTHER: REPAIR: "' fi .' < r `!„< !A fi-j-.7 / <�,- ',•;t✓_ F /h Contractor will begin work on or about �” ' (date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by G��* _(date). All roofing panels are custom fabricated on-site with state-of-the-art rollforming equipment. *As with any rollform steel panels,a certain amount of waviness or oil canning may become evident at certain times of the day when sunlight hits them.This is standard in the industry and does not affect the integrity of the metal.This shall not be construed as a product defect and shall not be cause for rejection. Contractor does not perform or assume any responsibility for any painting,staining or wood or wall finishing on interior or exterior. The contractor does further agree with the owner that(a)he will begin work within a reasonable time after the execution ffiereof,and will prosecute it diligently and with due care,and in a good and workmanlike manner;(b)in doing the work,he will comply with all statutes, rules,regulations and ordinances applicable thereto: Contractor to procure all permits required by law.Contractor shall provide public liability insurances. Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. We Propose hereby to furnish material and labor-complete in accordance with above specifications for the sum of: FJ�1, 9 5que n, -�A A �'.re� t�1*t c C/ry or f rt k fZ s r ar_ dollars($_0707-1 Payment to be made as follows: Name of Contractor/Designated Registrant 190 %($ -7 t�7 7 upon signing Contract;{p ? '', U.S.METAL ROOFING DISTRIBUTORS,INC. Street Address 3 k($ =)upon start of job; 740 High Street,Suite 2,Holyoke,MA 01040 Phone Q f© ft 1-600-232-0399 ($ upon 1!2 job completion; Registration 4 4 r ..z•��} 134 40 CT#602546 f O /($ 3 / )shall be made forthwith upon completion Name of an work under this contract ,'. Notice:No agreement for tame improvement contracting work shall require a down payment Author/ i ura n (advance deposit)of more than one-third of the total contract price or the total amount of all �. deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount i�greater. ! .. To be approved by Office Acceptance Of Proposal 1 have read both sides of this document and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this trans ction.Cancellation must be done in writing.See accompanying cancellation. 0 NOT SIGN THIS CO n RACT IF THERE ARE ANY BLANK SPACES /ant ` Signature_ 2L .. � '� � Data '✓ ��41 �'� Signature Date IMPORTANT INFORMATION ON BACK Ill, Office of the Building nspector CONSTRUCTION DEBRIS AFFIDAVIT (Required for all Demolition and Renovation Work) In accordance with the provisions of MGL Chapter 40 § 54,a condition of demolition/renovation permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter 111 §150A. The debri ill be disposed of in: 1\1(j'V Aa Vn1I AP, AX (If the debris will not be disposed as indicated,the holder of th permits all noti he Location of F ' ty building official in writing, as to the location where the debris will be disposed.) The debris will be transported by: ! YI i 7✓� Jj c< fo,' Name of Hauler Signature of pe it applicant Date The Commonwealth of Massachusetts Department of IndustrialAccidents = Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 N �•'• www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual) 4(4,06t, �e i Address: A! 1✓e.CJ 141'4 010)16 City/State/Zip: U Pho e#: re you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with �-- 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. p Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152,§1(4),and we have no 13. Other employees. [No workers' 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. tContractors 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: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: / / O'k �/ct t 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$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK 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. I do her y ify der the pains aloes of perjury that the information provided above is true and correct Si �' --P�_r--. Date: Phone#: Official use only. Do not write in this a ea,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#: DATE(MWDYYY) ACCC R°® D/Y CERTIFICATE OF LIABILITY INSURANCE 5/6/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michael Bonacorso Bonacorso Insurance Agency, Inc. PHONE (781)273-3200 A/CNo :(781)273-0600 83 Cambridge Street ADDRESS:mike @bonacorsoins.com P.O. Box 1502 PRODUCER 90003154 Burlington MA 01803 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:F1rst Mercury Insurance Company 10657 INSURERBNational Union Fire Ins Co PA 19445 US Metal Roofing Distributors, Inc. INSURERC:Star Insurance Co. 18023 740 High Street INSURERD: INSURER E: Holyoke MA, 01040 INSURER F: COVERAGES CERTIFICATE NUMBER:13/14 Master REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR 1 POLICY NUMBER MWD MWD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREM MIS EaEoccurrence $ 50,000 A CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 10,000 X Deductible: $2500 PERSONAL 8 ADV INJURY $ 1,000,000 -CGL-0000049334-01 11/7/2014 11/7/2015 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PR� LOC Per Project Aggregate $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DEDUCTIBLE $ RETENTION $ Q BE 023343774 11/7/2014 11/7/2015 $ L+ WORKERS COMPENSATION X WC1STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 500,000 OFFICERIME H)EXCLUDED? 0684560 7/26/2014 7/26/2015 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatory in NH) If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Bonacorso ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2009os) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen.isor License: CS-0310031.. , Gary C Rehbein 24 Cunningham Sfrcet Springfield MA 0-1107 ` ��,,,1lfc• '' "`` Expiration Commissioner 05/19/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 134740 Type: Private Corporation Expiration: 1/11/2016 Tr# 247372 U.S. METAL ROOFING DISTRIBUTION , IN GARY REHBEIN _-- 740 HIGH ST. SUITE 2 HOLYOKE, MA 01040 --- -- Update Address and return card.Mark reason for change. Address ( j Renewal ❑ Employment ❑ Lost Card SCA 1 0 20M-05/11 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only —__ ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 134740 Type: Office of Consumer Affairs and Business Regulation xpiration: 1/11/2016 Private Corporatior 10 Park Plaza-Suite 5170 Boston,MA 02116 U.S.METAL ROOFING DISTRIBUTION,INC. GARY REHBEIN 740 HIGH ST.SUITE 2 HOLYOKE,MA 01040 Undersecretary Aot valid without signature SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Muoervisor: Not Applicable ❑ Name of License Holder: -� L?7� License Number J � Addr ss > Expirati n D t l / / J Signatu k Telephone 9. Registered Home Im rovem nt Contractor: Not Applicable ❑ A r S / 3 -/ 10 Com piny Nrae Registration Number kUo -14 L_- 0 a /l 0' Add s Exp rati n Date Telephone "/i 3-5� SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insur nce affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of a building 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 buildine 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 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[dJ Brief Description of Proposed Work: i L- ,i I P X J .n too ✓h i ` .L / - c d; �- �u c �-fi' Jv�e u/� A��Cc1T Alteration of existing bedroom Yes No Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete 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? 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 I, 6 I P G as Owner of the subject P roperty n hereby autho ize / � l ��s�� '� t�o.a n r Vr 'ehal , in all matters relative,to work a thorized his building permit application. Sig natu r—eof Owner Date r 4al as Owne uthorize reby declare hat the statemen s and info ati on a foregoing applicatio re true and accurate,to the best my k edge f. Signed under the pains and pen Ities of perjury. ee not am Signature of Ow r/Agent D to 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 % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Findi qg ever been issued for/on the site? NO ® DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Fistry of Deeds? NO 0 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 ® DONT KNOW _�) YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 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: E. Will the construction activity disturb(clearing,gradin a cavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only �_ ity of Northampton Status of Permit: E uilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability 6 �; Room 100 Water/Well Availability APR 15 �v � IC� rthampton, MA 01060 Two Sets of Structural Plans Plumbing& c 587-1240 Fax 413-587-1272 Plot(Site Plans rthampton,r�A o�06o Other Specify APPLICATION TO CONSTRUCT,ALTER, 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 ()'k �Jv," e Map Lot Unit 164 �✓� �� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 OOw—n'er of Record: / e e-4, Jr-1 e,e,- MA. Name(Print) /��S Current Mailing Addr ss: /f�Q�j P ct Q t� �l'� r ej T ephone ignature 2.2 Authorized Agent: t) : Cur ent Mailin Add s Signature Telephone SECTI N 3-ESTIMATED C NSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building J 00 (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=0 +2+3+4+5) Check Number 3 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 111 OAK ST BP-2015-0974 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-257 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-2015-0974 Project# JS-2015-001881 Est. Cost: $27385.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003 Lot Size(sa.ft.): 11499.84 Owner: STENSON JAN Zoninj4:URB(100)/ Applicant.• U S METAL ROOFING DISTRIBUTORS, INC AT. 111 OAK ST Applicant Address: Phone: Insurance: 740 HIGH ST SUITE 2 (413)536-5474 WC HOLYOKEMA01040 ISSUED ON:411612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP ROOF & REPLACE W/METAL 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 4/16/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner