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32A-183 (3)
March 2652007 Todd Boynton 83 Silver St. Greenfield, MA 01301 (413) 775-2775, (413) 772-8829 MA HIC# 126807, MA Cons&vcbion SWt lsor#CS 079221 Complete Asphalt, Slate, and Rubber Roofing Systems and Repairs, Siding, Chimney Pointing and Gutters Customer: Kendrick Property Management (Re-roof over with architectural shingles) 79 South Pleasant St. Amherst, Ma 01002 253-0285 Property @ Una 9-1 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, color to be chosen by contractor at a later date. © Re-seal and/or re-flash around all protrusions and walls. ti 5-year guaranty on labor, 30 year Manufacturer's Warranty on material. (. George Any questions,feel free to call Thanks, Todd Yqf Total Cost $ 13,325 (Labor and material) Deposit required of: $ 6,500 Homeowner: Balance upon Completion: S-69$25- Contractor: /) / Make checks payable to: Todd Boynton Top quality materials used — complete insurance coverage. References available. All trash removed by contractor. All permits secured by contractor. rte., •.J Board of Building Regulations and Standards License or registration valid for individui use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: z Registration: 126807 Board of Building Regulations and Standards Expiration: 7/22/2008 Tr# 125253 One Ashburton Place Rm 1301 Type: DBA Boston, Ma. 02108 TODD BOYNTON ROOFING & SIDING TODD BOYNTON 83 SILVER ST -7 r-- GREENFIELD, MA 01301 Administrator Not valid without signature 1 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): 101 Address: S,l✓ / S� City/State/Zip: 141+ 0130 Phone.#: W-3- Are you an employer?Check the appropriate box: Type of project(required): 1.F-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. ❑New construction 2.X 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. E]Building addition [No workers' comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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 12.8a Roof repairs insurance required.]t C. 152,§1(4),and we have no employees. [No workers' 131-1 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. 2Contractors 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 Investieations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: �? Date: V;-ZO;7— 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#: Version 1.7 Commercial Building Permit May 15,2000 SECTION,70 STRUCTURAL PEEFtREVIEW(Z80 CMR 19011 Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION-1+1=OWNER-AUTHORIZATION=W BE.COMPLETEM"W EN` OWNERS AGENT OR CONTRACTOR APPLIES-FOR BUILDiNG`PERMIT --- I, 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 r/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best and belief. Signed under the pains and penalties of pedua. �D ACY � Print Name - Signature of a gent Date ' SEC,ONAZ4 C TRUGTCON SERVICES 10.1 Licensed Construction Supervisor. Not Applicable ❑ t�, �, _ q i Name of License Holder-+ —(`� �t 0 ' 1 Q / �a License Number i Address Expiration Date Signature / Telephone `77 SECTIO 13 WORKERS'COMPENSATfON"IHSUR/XNCE pFFIDAVIT�M 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 0 No r Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND GQNS RUCTION SERVICES-FOR BUILDINGS-AND:ST#2UCTlTRES�UBJECT TO: CONSTRUCTION CONTROL PURSUANT TO 7130=CMR 11.6(CONTAINING MORE THAN 35X00�C.R OF"ENCLOSEDZP CE) 9.1 Registered Architect: Not Applicable ❑ i I egi - -- - ------ i ------------------ ---------- -Name(Registrant): - - - --- - Registration Number � 1 — Address Expiration Date - Signature Telephone 9.2 Registered Professional Engineer(s): G Name Area of Responsibility Address Registration Number L � 1 Signature Telephone Expiration Date' E i Name Area of Responsibility Address Registration Number i 1 Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date I Name Area of Responsibility S i I Address Registration Number ; Signature Telephone Expiration Date 9.3 General Contractor Not Applicable❑ Company Name: 1 i l Responsible In Charge of Construction r 1 I i ' Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage i { I Setbacks Front ; E 3 Side L: i R:= L: i R:= { Rear Bldg.Square Footage { { % Open Space Footage (-; % (Lot area minus bldg&paved 13micing) #of Parking Spaces Fill: ' volume&Location) 11 i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES i IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON-r KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: £ E D. Are there any proposed changes to or additions of signs intended for the property? YES � NO IF YES, describe size, type and location: j 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 0 ` NO q IF YES,then a Northampton Storm Water Management Permitfrom the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 t.. SECTION 4=COA1STt317C T10N SERYtCES��DR,PROJEC�'STLESS THAN 35,000 CiJBI,G EEET?QE3=i+1,CL05Ft�xSP°ACE' _ Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing( Change of use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: f �� e- � dJe,� o�►e a E SECTION 5-ISE GROUP AT(D CONS ON TYTRUCTIPE~ _... ._ USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ( ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ - 3A ❑ 1 Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential Ur R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use 0 Specify- S Special Use Specify. COMPL EfE TL IS SEC (ONfiF 1_XISTINGBUILDIt�IG t3Ni ERGO1t�G RENOa/#TfONS,.1#DOITIONS AI�7DiOR� RANGE IN USE Existing Use Group. i Proposed Use Group: Existing Hazard Index 780 CMR 34):! Proposed Hazard Index 780 CMR 34): I SECTION'68llICD11�G'}IEtGt AND AREA; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) t 1 at l 1 nd w . 3 r ! i 3`d th 4th i 4 i Total Area(s1 Total Proposed New Constructions Total Height(ft) � � ,} Total Height ft 4 s 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public E:] Private ❑ Zone Outside Flood Zone Municipal ❑ On site disposal system E] - Version 1.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room 100 ' Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SEG�10�_i_�513'EYNEORMATI4N'` _ _ .._ -"-Prop tame coteted i�y�ttice_ ",- ��.a,;W:;—z_,x...a:u c,.,.mm,.: .=s �Y:..,... 'si,a.4s .-n 91- 7it(t s�var• U nAi. / / i NOW, �X►eI[a��t5�[1C� � � � ltsiclx _ _. WN SECTIO14 2 PROPERTYOWNERSHIPiACJTHORIZEDAGENT . „ w 2.1 Owner of Record: 79 Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature `' N Telephone ,SECTIOM 3-ESTIM rC0NST T10N COSTS Item - Estimated Cost(Dollars)to be C�;ffiicialaise completed by ermit'applicant ° 1. Building (a Bwlding Permit Fee 2. Electrical , (b)Esfimated Total Cost of, + ,"\f CORStrl1C�IOrt.I"TOm 6 � 3. Plumbing j "Burld�ngPennit Fee 4. Mechanical(HVAC) 5. Fire Protection ` t 6. Total=(1+2+3+4+5) "Check.Number <Th!"ecfion7'For Official U, a OnI Bu�tdmg Permit Number$' Y~ - . °Date issued'' r Signature_ Building Commissionedlnspector of-Buildings Date < t ` "x B P-2007-1070 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-2007-1070 Project# JS-2007-001701 Est. Cost: $13325.00 Fee: $90.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TODD BOYNTON Lot Size(sq. ft.): Owner: KENDRICK PROPERTY Zoning: URC Applicant: TODD BOYNTON AT: 73 BRIDGE ST UNITS 9-17 Applicant Address: Phone: Insurance: 83 SILVER ST (413) 772-8829 GREENFIELDMA01301 ISSUED ON.5/3/20070:00:00 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 5/3/2007 0:00:00 $90.003451 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo