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32A-183 (2) June 18, 2007 '-Fodd Boyiitori 83 Silver St. Greenfield, MA 01301 775-2775, (413) 772-8829 MA HIC#126807, MA Construction Supervisor#CS 079221 H Ind MHL"I " Customer: Kendrick Property Management (Rc-roof orc Lr with tirt*ifecittra"shingle..) 1185 North Pleasant St. Amherst, Ma 01002 253-0285 Property (), Unit 23-28, Coolidge Village Condos, 73 Bridge St., Northampton Work to be done: Complete main roof and porches: Re-roof over existing layer with Tamko Heritage 30-year designer architectural roofing shingles, Weathered Wood. Re-seal andJor re-flash around all protrusions and walls. 10-Ivill. :'tt111'a fill), lilt h1h1w, /lilt liffit 1111-er'N 11 arrallh 011 111WATidil. George— This should be done bl,the middle-end ofJuly. Antis questions,feel free to call. Todd Total Cost $ 9,615 (Labor and material) omeowner: Deposit required of. $ 4,500 H Balance upon Completion: $ 5,115 Contractor* (Sign and return one copy with required deposit) i141Aj, j-ht,( As It,,1'able to: Todd BoYntem Top quality materials used — complete insurance coverage. References available. All trash removed by contractor. All permits secured by contractor. OgTIiAMp�O � Grib of Xarthailrptan $ � �ssaxcf�usrtis t. � N B DEPARTMENT OF BUILDDN1G INSPECTIONS INSPECTOR 212 Main S Meet G v`1lIIiiCIP,U D iiiiiiiiL6 � Norduanpton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as i:is/her construction sups° :`Sor. 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 dtivelling, 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 d 600 Tflashington Street Boston,MA 02111 =v° www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Q Please Print Legibly Name(Business/Organization/Individual): � Address: 3 S7 e City/State/Zip: 41Wt 7e6 0f3GJ Phone#: 775 Are you an employer?Check the appropriate bog: 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 2.0�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 11.0 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. xContractors 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 1s 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 tine 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 andpenalties ofperjury that the information provided above is true and correct Signature: y- Date: /ffPhone# ( _ 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#: AV i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone istere .Home=1`M orovement Coriractor � Not Applicable ❑ kl Company Name / Regis ration N mb r Address Expiration ate Telephone Tim SECTION 10-WORKERS'COMPENSATION,INSURANCE""AFFIDAVIT(M:G.L.c.1"52,;§'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...... - � x 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 fob 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 f SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors u Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding[O] Other[E j Brief Description of Proposed e ,,./ /,± ' e 54.41 Work: 4W G� 1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa If Newhousean�oraddit�or�`ta-ex�s�n4""ttousrna:�comtite e=theollo±r�vrna: 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:AUTHORIZAT.ION-TO BE COMPLETED WHEN OWNERS AGENT.OR'GONTR ACT 0R'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 /�� G ,as Own uthonzed Agent ereby declare that the statements and information on the foregoing application are true and accurate,to the b;;;t of m kn and belief. Signed under the pains and penalties of perjury. Print—Name natur bwn ate ` . AO 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 Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) � A. Has a Special Perm it/Varia nce/F ever been issued for/on the site? NO \_��� DON7 KNOW YES x~�� � |F YES. date issued:! IF YES: Was the permit recorded at the Registry of Deeds? NO K j DON7 KNOW vux �� IF YES: enter Book Page; and/or Document#! � �� �� B. Does the site contain a brook, body of water orwetlands? NO DO07KN8VV �_� YES v�� IF YES, has permit been or need to bo obtained from the Conseh/odon Commission? Needs tobeobtained �~� Qb�a�ned �~� Date �~� �~� ' � 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 additi ons of signs intended for the property? YES 0 NO IF YES, describe size, type and location: ' E. Will the construction activity distoMb .grading nr filling)over 1 acre oris it part ofo common plan that will disturb over 1acre? YEG � ) NO �� R IF YES,then a Northampton Storm Water M anagerne nt,Permit from the DPW is required. ' Y �{//) C•-'/(f Department USe only City of Northampton StaWsofPtt Building DepartmentC �e 212 Main Street S w ,e atlabila �' �n Room 100 i 31 Ne ,ampton, MA 01060 i phone4' 13-5k7-'1240 Fax 413-587-1272 APPLICATION T "~ONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S9CTION,1-SITE INFORMATION 1.1 Property Address: Thas;secfion to be comp ted byofce t Map � : ry Zone Ouerlay DlistDCt CIKI o-5-Ri7 Eim St District CB District SECTION 2 PROPERTY OWNERSHIPIAUTHORIZED AGENT' 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Acie NaXent) Current Mailing Address: 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 tb)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 Date.. Building Permit Number. Issued: Signature: Building Commissioner/inspector of Buildings Date BP-2008-0044 GIs#. COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0044 Project# JS-2008-000066 Est. Cost: $9615.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: TODD BOYNTON 126807 Lot Size(sq.ft.): Owner: KENDRICK PROPERTY Zoning: Applicant: TODD BOYNTON AT. 73 BRIDGE ST - UNITS 23-28 Applicant Address: Phone: Insurance: 83 SILVER ST (413) 772-8829 GREEN FIELDMA01301 ISSUED ON.711712007 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER 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 7/17/2007 0:00:00 $50.003260 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo