23C-067 (3) U.S. METAL ROOFING
. -
740 High Street-Suite 2-Holyoke,MA 01040
1-800-232-0399-1-413-536-5474-Fax 1-413-533-8166 Dn EPROPOSED O6E DO NE ON
www.usmetalroofmg.net `(-d iS Z
SUBMITTED TC PHDNE NUMBERS
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STREET JCB LOLFTIpDN
�L°ITp'Y,STATE M'O ZIP CODE
DIRECTIDNS'
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We will furnish and install new Englert standing seam metal sly lock system,24 gauge as listed below.
Work is guaranteed for five years and the manufacturer warranties the finish on the metal for 35 years.
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COLOR: P4- �f"�`'�'�' HOUSE: 'f� SPECIAL INSTRUCTIONS COMMENTS
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ROOF: '._..!� l 'T�I;'fr PORCH:- f.l!t r/71 (CCU
SOFFIT: ADDITION: f.�^� �c�✓ 1rr.��c7_ce.`' _ �,x<' ,i-/,,,h.1„ �l.,,b: �,cl
FASCIA: GARAGE:
PLYWOOD:Uf-00:7f:'�fi�'i fS GUTTERS: �� �✓r/'�'>f 2.4 �v,�1V•..<?.=2+.1 �k_ �I?21 ttjQ_ .
RIP/REMOVE: DOWNSPOUTS: / T
- OTHER: REPAIR:
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Contractor will begin work o or about"4 �u 5 (date).Barring delay caused by circumstances beyond Contractor's control,the
work will be completed by C'Mo (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 thereof,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,:.:gWatbns and ordinances
Contractor to procure all permits thereto:-__
mits 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:
dollars
Payment to be made as follows:
11 4K�^fr I None of Cmlractor/Deagneled Regisl �
%($ �!r )upon signing Contract'f-(-,�--' U.S.METAL ROOFING DISTRIBUTORS,INC.
} �n.'� Sveel nadmss
- %(S ' )upon start of job; 740 High Street,Suite 2,Holyoke,MA 01040
_ PMne
`r °e
IS /�fir. )upon 1/2 job completion; q-600-2�3N2-0399
m.,
t tyn I 40 CT#602546
/✓ • - m salesmen,
'�(5 r )'shall be made forthwith upon completion i
work under this contract
Notice:No agreement for home improvement contracting work shall require a down payment Aomori eture
(ativancs Deposit)of more than one-third of the total contract price or the total amount of all y
Deposits or payments which the contractor must make,in advance,to order and/or otherwise
obtain delivery of Special order materials and equipment ibili; ver amount IS oRat¢r. \�- To be eppmvec by Office
Acceptance Of Proposal I 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 transaction.Cancellation must be done in writing.See accompanying cancellation.
//DO NOT SIGN THIS CO�F THERE ARE ANY BLANK SPACES
Signature ✓' Date Signature Date
IMPORTANT INFORMATION ON BACK Il,
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 debris will be disposed of in: C_ OMP P� '-'�J/��5�
QL o 2.' 1714. (If fhe debris will not be disposed as indicated,the holder
of th permitkhall notify the
Location of Facility building official in writing, as to the location where the
debris will be disposed.)
The debris will be transported by: ��G �' l Ir�.G'�7�r�rS� �(�
Name of Hauler .
�-�
Signature o permit applicant Date
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Mass. 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
l X
Name(Business/Organization/Individual): l ! V'U i r
Address: 5 tw e d 6
City/State/Zip: G ,- (9104-11-o Phone#: - `-
re ou an employer?C eck the appropriate box: Type of project(required):
I.K I am an employer with /�-` 4. L I am a general contractor and I 6.01 New construction
employees(full and/or part time).* have hired the sub-contractors 7. 0 Remodeling
2. ::.; I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. 7 Building addition
[No workers'comp.insurance comp.insurance.I
required] 5.❑ We are a corporation and its 10. 0 Electrical repairs or additions
3. 1- I am a homeowner doing all work officers have exercised their 11. 7 Plumbing repairs or additions
myself [No workers'comp. right of exemption perm MGL
insurance required]t c. 152,§ 1(4),and we have no 12 XRoof repairs
employees.[no workers' 13. 7 Other
comp.insurance required.]
*Any applicant that checks box#1 roust also fill out the section below showing their workers'compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contactors that check this box must attach 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: �/", I / f'' L(✓ (�
Policy#or Self-ins.Lic. 0 Expiration Date:
Job Site Address: City/State/Zip: 41�a LP _k14 Q/op Y
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 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
$250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby ffy under the nd penalties ofperjury that the information provided above is true and correct.
Si a Date: (�/
Print Name: Phone#.
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):
LBoard of Heath 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 ❑
i
Name of License Holder: i -,` 6 � / `---) .�
J License Number
! Expiration Date
Signature Telephone
9.Registered Home Im rovemen Contractor: Not Applicable ❑
J-S �Y) 1-3�L 1747-0
Co pane Name Ration Number
c
dr -761-761-3� Expiration Date
Telephone
SECTION 10-WORKERS'CO PENSATION 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 o e 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 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 ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs Decks [Q Siding[o] Other[C�
Brief Description of Proposed
Work: : Y3;s iQi SQ. eY;S 'yip Y:�;�vr��lot�i'_, tsr" ,Sf7d-1tysTu��f)tt� {c•� i Pc�,r,i'K d- IfU
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement es 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 /y
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 / j �✓ t f 7�l /to act on my behagin, ma erg relative to work authorized bT building permit application.
Signature of Owner Date i
i�' I as Owner t�zedge
Ag hereby declare that the statement and infor on on the foregoing application are true and accurate,to the best o
elief.
Signed Und er the pains and es of perjury.
Print arde
Signature of er/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:
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/ ' ding ever been issued for/on the site?
NO Q DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at th Registry of Deeds?
NO O DONT KNOW YES O
IF YES: enter Book Page and/or Do men"
#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO\o
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 O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
` V
212 Main Street Sewer/Septic Availability,
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
t P (CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.11 Property Address: This section to be completed by office
Map Lot Unit
Zone Overlay District
Flo�-�n�-, 6�0��d---
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
11?1/2 44 Ilf(5 I Lt!L 1'0 ZZ2, JL Or,,'I) p 61(
Name(Print) Current Maiiin ddress:
T ephone
Signature
2.2 Authorized A ent:
l ►1�' I if w, �J�;�o. Ls U elk r' Fri— _5e't /If__ 0Zk
N
(Pint) Current Mailing AIKIS. /
Sig—natur T lephone
SECTION 3-ESTIMATED C NSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building r G (a)Building Permit Fee
i0
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection L '-0 -
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
R .:Llinn(`nmmicc:nnnr/IncnnMnr of R..:W:nnc
82 BLISS ST BP-2015-1058
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23C-067 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-2015-1058
Project# JS-2015-002011
Est. Cost: $13400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003
Lot Size(sc. ft.): 35414.28 Owner: LAFOUNTAIN MARGARET E&DONALD
zoning. URA(100)/WSP(100) Applicant: U S METAL ROOFING DISTRIBUTORS, INC
AT. 82 BLISS ST
Applicant Address: Phone: Insurance:
740 HIGH ST, SUITE 2 (413) 536-5474 WC
HOLYOKEMA01040 ISSUED ON.51412015 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP ROOF & INSTALL 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 5/4/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner