24A-226 (3) 11. Payment
Customer agrees to pay Abeles Roofing for the work es follows:
Payment#1 � 21 G t-C.
Deposit upon signing this Contract in the amount of 1/3 the total project cost.
Payment#Z 4 y `�
Final payment upon completion of the work to the satisfaction of the Customer.
Abeles Roofing will take reasonable caution to leave the Premises in as close to its original condition prior to the work The
Customer agrees to allow Abeles Roofing reasonable access to the Premises in order to complete the work in a timely fashion.
Quotation is valid for 60 days from date of preparation_
Prepared by_ i' C
This is a quotation based on the project described in the above table.By signing this quotation and returning it to Abeles Roofing
with the first payment, the Customer agrees to the work described and commits to paying the full amount of the quotation
upon completion of the work described. In some instances, an unforeseen circumstance will result in an additional cost not set
forth in the quotation.An example of this would be water damage to the subsurface of a roof that was unknown prior to the
beginning of the Work and was not included in the cost estimate. in the event that this occurs the Customer will be notified
before any action is taken to determine the desired course of action as agreed upon by the Customer.
To accept this contract, please sign, below and return to Abetes Roofing.
Customer signature Date
e ej
Abeles Roofing signature Date
Thank u for your business!
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abeles
25 Groveland St Easthampton,rte►01027 413.282.8484 abetesroot@gmaat.com ROOFING
stima a/Contract for service work
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ROOFING Date z 3 0
serving the pioneer valley
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1. Description of work to be performed:
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Abeles Roofing will perform the following work on the Premises located at (� t
in a professional manner and in accordance with the terms of this contract, including the attached recommendations/work
order describing the work in detail which are incorporated herein by reference:
Type Description Unit Price Total
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25 Groveland St Easthampton,MA 01027 413.282.8484 abelesroo€ftmail.c
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 2`f Z p,�,ma���
The debris will be transported by: 6 l e r
The debris will be received by: UC1
Building permit number:
Name of Permit Applicant J0 f Q
Date Sign-ature of Permit Applicant
City of Northampton
k� Massachusetts
{V
V-
V
DEPARTMENT OF BUILDING INSPECTIONS �, �i
212 Main Street Municipal Building
Northampton, MA 01060 ssWy` 71��
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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 pour), 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 occupancy 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
F 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): aH A t e 1--S
Address: -2S C=::, v� 'a s
City/State/Zip: Phone #: Z 8 9 8 y
Are 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
2.eployees (full and/or part-time).* have hired the sub-contractors
I m a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working or me in an capacity. employees and have workers'
g y p tY• 9. F1 Building addition
[No workers' comp. insurance comp. insurance.T
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
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners 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: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided,above isl true and correct.
Signature
, "� Date: (4 /12b
Phone#: k/1,3 , 'Z 2 b lJ 8 cl
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: E"���H
A6�I�s to"t`i
License Number
zMd SJ. zk S-1 A oto<'7
Address Expiration Date
`_. `-- I 2 - y s 9
Signature Telephone
9.`Reaistered Home Improvement'Contractor Not Applicable £
Company Name Registration Number
Address Expiration Date
Telephone f3 Z$zy g
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 Attac ed Yes......:"E 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 ❑ eplacement Windows Alteration(s) E] Roofing
[,,]New r Doors E-1 Accessory Bldg. ❑ Demolition ❑ Signs [tom] Decks Siding [0] Other[0]
Brief Description of Proposed °
Work: e
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or adds
tion to�'exisfing h"ousing, complete the foilownct
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
,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
. , 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 Name _ 12 )
Date
Signature of Owner/Agent
^ ^
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tliis 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&payed L
#of Parking Spaces
(volume&Location)
A. Has a Special Pennit/Variance/RndinQ ever been issued for/on the site?
«~� �_��� YES ���~�
NO �� DONTKNO� Y
IF YES, date ioued:
IF YES: Was the permit recorded at the Registry ofDeeds?
NO �
DONTKNOY 0 YES
IF YES: enter Book Page and/or Oocument#
�� ��
B. Does the site contain a brook' body of water orwetlands? NO �^��� DONT KNOW �~� YES �~/
'
IF YES, has u permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �~\ Obtained �~\ Date
'
�~� �~/ '
C. Dn any signs exist on the prnperty �� ��� Y[� ��/ NO �_�
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 0
IF YES, describe size, type and location:
E Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre nris it part nfo common plan
that acre? YES K ) NO K l
' `~/ `�^
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
����
Department use onlX
'
City of Northampton status of Permrf
t 4 S
ing Department Gurla Cur�Drlyeway Perml#
Main StreeteNrer/SepticAvaifablhty
Room 100 �/VaterlVelEAvatlablhty
4 i
2p 7 015 N pton, MA 01060 Twa S+?fs of S#ructurai t?taps
T��e 413 1240 Fax 413-587-1272 Pioflslte Plans
Other 5peo�fy ;
qP nJ'r ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
te by o
1.1 Property Address: Th)s section to be compled ffice
Z�.2 Map Lot Unit
Zone Overla Distrrct
Y
Elm St:District CB.District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'E LtZA6—cr r2 u PV'E5$Pt T Nf'1_TA ^-.,_QT-vN
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Ic I 1 rW Pets Lri y2ovz�a�►D ST EhST44PO,rIt-6 N� w.
Name(Print) Current Mailing Address: v is
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com I to by ermit applicant
1. Building / O` (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
This-Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/In..spector'of Buildings Date
242 PROSPECT ST BP-2015-1029
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-226 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-2015-1029
Project# JS-2015-001963
Est. Cost: $6250.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ETHAN ABELES 105945
Lot Size(sg. ft.): 5706.36 Owner: SKOWRON JEFFREY J&S MAYHEW C/O ELIZABETH V V BEDELL
Zoning: URB(_100) Applicant: ETHAN ABELES
AT. 242 PROSPECT ST
Applicant Address: Phone: Insurance:
25 GROVELAND ST (413) 282-8484 (�
EASTHAMPTONMA01027 ISSUED ON:412912015 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 4/29/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner