44-077 (3) U.S. METAL. ROOFING
_ _ 0
740 High Street- Suite 2 - Holyoke,MA 01040
1-800-232-0399. 1-413-536-5474 -Fax 1-413-533-8166 DATE PROPOSED TO BE C'.
www.usmtetalroofing.net CA
rih,-rinr: [� T r jam;
SUBMITTEDTO :.,' / PHONE NUMBERS
STREET ` �+ JOB LOCATION
CITY,STATE AND ZIP CODE
DIRECTIONS
We will furnish and install new Englert standing seam metal sleep lock system,24 gauge as listed below.
Work is guaranteed forinears and the manufacturer warranties the finish on the metal for 35 years.
COLOR: "!—T HOUSE: r> SPECIAL INSTRUCTIONS/COMMENTS
ROOF: & C^� PORCH:
SOFFIT: /s ADDITION:
FASCIA: - GARAGE �` c✓r/
PLYWOOD:
(,� "k, o"`hfelc ' GUTTERS: !C .l�°. cJ�ri/�. r �r.• ' r- `1 ! 1/'/
RIP/REMOVE: 1<4 LOW".SPO * 1 d f / ✓{/ �GC rtr'�- Ji �' �.-.
(THE
L
Contractor will begin work op or about (date).Barring delay caused by circumstances beyond Contractor's control,the
work will be completed by I UPfli� (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 he 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,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 inf accordance with above specifications for the sum of:
Payment to be made as follows: dollars($�v
) CS '
'p e ($ C 7 F 3 (/— 7-
Name of Contractor/Designated Registrant
upon
U.S.METAL ROOFING DISTRIBUTORS,INC.
,,, Street Address
sta
($_ (' )upon rt of job; 740 High Street,Suite 2,Holyoke,MA 01040
Phone
/t(J J 1-800-232-0399
($
upon 1/2 job completion; Registrettii n No.
j ?J NJOM 14740 CT#602546
%i$ I ) shall be made forthwith upon completion ame Salesman
work under this contract
Notice:No agreement for home improvement contracting work shall require a down payment Auth r d Signature
(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 is greater. To be approved by office
Acceptance of Proposal I have read both sides of this docum t 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_.
DON T 19N THIS CONTR T IF THERE A9E,4NY BLAN SPACE
Signature .�� T'G '�' Date �"' , g / '?"�'i. C.L.-, .L q
Si nature- _ Date
IMPORTANT INFORMATION ON BACK
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
Boston,MA 02114-2017
wM s www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual): l' l I Y %�/i ,' r C -
Address: ) /f � �= ,
! �A2 /), (,
City/State/Zip: v L t e ''''' (L Phone #: ' J �—S
re you an employer? Chick the appr priate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ 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 L❑ 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' 13.0 Other
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.
:Contractors 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: Y f ./ra t / _
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 re y d der the pains.and penalties ofperjury that the information provided above is true and correct.
Si h Date:
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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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 I I I §I50A.
The debris will be disposed of in: Olf 'l �°
- U (If the debris will not be disposed as indicated,the holder
of e pertnit shall 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: C_ Lu ld J �l
Name of Hauler ;
— of ermit applicant Date
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction S pervisor License(CSL)
License Number Expiration Dat
Name of SL older
List CSL Type(see below)
G
and Street kRRMC Description
// ,, Unrestric ted(Buildin s u to 35,000 cu.ft.)
ono Restricted 1&2 Famil Dwellin Ci /Town�State,ZIP Masonry Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address rrJ D Demolition
5.2 Registered Home Im r eme t Contractor(HIC)
!^ N� d.� E' HIC Registration Number Expiration 1Date
H C Compan' ame or HIC egistr nt Na
�r P i��1r. Yc�.rer �1� '� 7ei�Cc.L rrl
N . d Stree Email address
A4 /u� 1-<�-7�
ity/T , Sta e,ZIP Telephone
SECTION 6: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 ssuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
r . � . � .
I,as Owner of the subject property,hereby authorize G U r L2!�, f u,'
to act on my behalf, in all matters relative to work authorized by this building permit application.
V /5 v I
rint Owner's Name(Electronic Signature) bate
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best o -my owledge and understanding.
Print Owner's LAAorized Ag s a V(Electronl Signature) _Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.Iov%oca Information on the Construction Supervisor License can be found at www.mass.pov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
C onwealt of Massa usetts
r
it T r Board of Building Regulations and Standards FOR
y Massachusetts State Building Code, 780 CMR MUNICIPALITY
=�y
USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro ert Addrgss: 1.2 Assessors Map&Parcel Numbers
a
1.1a fs this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner' f Record:
/Jdl, Ir/o i e-1,e P,
Name(Print) City,State,ZIP
zt
No!andStreet Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction❑ Existing Building❑ i Owner-Occupied Repairs(s) ❑ Alteratio (s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other Specify: d L 1,
, <
Brief Description of Proposed Work 2: P 0 -, P,W.f Q r,% /
r " f} ✓ r /la/ f a 1 t
SECTION 4: ESTIMATED N CTION COSTS ,,i#t-rS y-di"ns „ic f j c-,),17-/44('.J
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression)
Total All F��N�heck
Check No. mou nt: Cash Amount:
6.Total Project Cost: $1 S3�' ./ 11 Paid in Full ❑Outstanding Balance Due:
17 AUTUMN DR BP-2015-1136
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-077 CITY OF NORTHAMPTON
Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-1136
Project# JS-2015-002139
Est.Cost: $17538.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003
Lot Size(sq. ft.): 10280.16 Owner: FILLION CHRISTOPHER
zonine: Applicant: U S METAL ROOFING DISTRIBUTORS, INC
AT. 17 AUTUMN DR
Applicant Address: Phone: Insurance:
740 HIGH ST, SUITE 2 (413) 536-5474 WC
HOLYOKEMA01040 ISSUED ON.511912015 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE HOUSE/GARAGE ROOF
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 Occupant Signature:
FeeType: Date Paid: Amount:
Building 5/19/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner