22-022 •C�
OR
sTU UY
11 HOME IMPROVEMENT
WORCESTER SPRINGFIELD HARTFORD
459 MAIN STREET-P.O.BOX 51033-SPRINGFIELD,MA 01151
MA.REG#151711 CT.REG#601525
1-877-3-STURDY 508-797-6600 413-543-5906 FAX 413-543-3200
OWNER PERMIT AUTHORIZATION
Name: (C-- a rd ) le. rh v e�
Address:
City / State / zip: (:I_X c&; iou o
(Owner), of the property located at:
y authorize Sturdy Home Improvement
Inc. to act s my agent for the construction project taking place at the above
address. I also authorize Sturdy Home Improvement Inc. to obtain a building
permit. I understand and accept responsibility to comply with all regulations and
required inspections.
Signature of Owner: Dater f 5�
Page 1 of 1
STURDY HOME IMPROVEMENT, INC. ACCEPTANCE PALE MA REG. #151711
CT REG.#0601525
ANY WORK NOT STATED ON PREVIOUS PAGES IS EXCLUDED
The following schedule will be adhered to unless circumstances beyond the contractor's control arise:
r Work scheduled to begin the week of----I / . Expected completion date-----/ /----Weather permitting.
The cash price for labor and material as described above is:
1 st payment 2nd payment 3rd payment 4th payment
Contract Total 4/4
g *-I Prnt%� W- WTC 4- Clu
Roof $ b-
Ventilation $
r4-4'd
w
Other work $
$ J � `~
Roofing total $ $ $ 4'("00, $
Siding $ $ !� � $ .� $ - $
Windows $ $ $_ _` $ $ ---°
Special orders
Other $
Totals $ $ "" $
Terms: _____Cash Finance
Credit Card:#_ � � - � � ��J P�
�� �
— _ _ _ _ _ _ Exp.date'___ / Code-
Payment schedule:
Any balance not paid in full within thirty days, will be charged 1.8%interest per month.
In order to meet the completion schedule, the following material/equipment must be SPECIAL ORDERED before the contracted work begins,
(Law requires that any deposit or down-payment required by the contractor before work begins,may not exceed the greater of(a.)one-third of the
total contract price or(b.)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the
completion schedule)
to be paid for
$ to be paid for r::)
Any additional work orders are to be paid for once accepted and approved by purchaser.
Verbal understandings and agreements with representatives shall not be binding. All understandings and agreements must be set forth in writing in this
contract. Additional provisions are stated gn reverse side and are part of this contract. in witness whereof Purchaser(s)has/have hereunto signed their names
this Z/ day of 20_,e=and acknowledge receipt of a true copy of this contract.
UNLESS OT��OOH�TEEiRW�ISSEE SPECIFIED, IT IS NDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTED
ABOVE WILL BE HONORED ONLY UNTIL (Date).
You the Purchaser(s)may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See notice of cancella-
tion form for an explanation of this right. Signature affixed below also acts as receipt that Purchaser(s)received separate cancellation forms.
The following is a requirement by Massachusetts General Law,Home improvement Contractor Law MGL c 142A:
'The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor
may submit such dispute to a private arbitration service which has been approved by the office of Consumer Affairs and Business Regulation and the consumer
shall be required to submit to such arbitration as provided in MGL c 142A. �y )
Representative: Owner:_ _ !ti` 42 1.4
Owner: _
NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner
may initiate alternative dispute resolution even where this section is not signed separately by the parties"
Do not sign this contract:if there are any blank spaces
Submitted Accepted 1(� J
by:---- by:�� ��'t5�/;ten .�._��,��v``-,� �,�Z�' _
Representative Purchaser Date
Accepted Accepted
by: _ by:—
RAnrFAGRntativP Purchaser Date
459 Main Street
Toll Free (877)378-8739 Indian Orchard, MA 01151
Worcester (508)797-6600 E-mail: HR@SturdyHome.com
Springfi,eld (413)543-5906 www.SturdyHome.com
New Haven (203)848-2118 , ,
Fax (413)543-3200 WINDOWS SIDING ROOFING • ADDITIONS MA REG.#151711 CT REG.#0601525
Home Phoe G � �� Business Phone
W
Address q Cell Phone Other
kJ
Repr senative Date
Town/City -7
z&*A-e w c- AV-c / 4 a�
I/we the owners)of the premises described hereinafter, referred to as Owner, offer to contract with Sturdy Home Improvement, Inc. hereinafter
referred to as Contractor,to furnish, deliver and arrange for installation of all materials to improve the premises as described below.
Yes No ROOFING SCOPE OF WORK:
�❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1�2 3 a Family home.
❑ 2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates).
�❑ 3. Provide job site dumpster,set on planks,to remove job related debris only. Please Note:dumpster for contractor's use only.
(see dumpster clause).
s❑�'❑ 4. Prior to stripping roof,tarp sides of house beneath work area,from roof edge to bottom of wall.
(see additional protection clause on back).
(��❑ 5. Keep job site in a clean and orderly manner. Rake work areas at end of job. Use magnetic sweep to pick up nails.
❑ 6. Provide OSHA approved staging to safely perform work.
7. Work consecutive days excluding inclement weather. (rain,snow, high winds, high heat, thunder showers,etc).
❑ 8. Staff project with qualified mechanics experienced in residential asphalt roofing.
��- ❑ 9. Strip existing 1 k1-2_ 3_layers of asphalt roofing (see roof plan, page 2). Number of squares 3�• l�'
A. 0 one layer cedar.removal. Number of squares O
B. D one layer slate removal. Number of squares-.
�❑ 10. Inspect roof deck prior to re-roofing. Renail loose boards:
A. Replace rotted or cracked boards at$ '),GD per linear foot.
B. Install new plywood at$ ZO • per sheet.
C. Number of sheets of plywood included into thi estimate: Quantity (see unit cost above for additi nal she
ice❑ 11. Furnish and install ��,�forcfi( 'd�-, L -shingles. Color__T
[A- ❑12. Furnish and install 8"aluminum drip edge around roof perimeter.White m Mil! a Brown .
❑ [ Install cedar drip edge at eaves under aluminum drip edge. Linear ft-.
(�- ❑14. Furnish and install ice/water shield at eaves-1;L3'--!L-6'_!5!-other. Three feet in valleys and around all roof penetrations.
(�" ❑ 15.Furnish and install underlayment to entire roof. d Roofer select 4"Diamond Deck
( ❑ 16.Furnish and install starter course shingles,eaves&rake.
❑ 17.Furnish and install hip and ridge cap.
[ ❑18. Furnish and install new neoprene roof boots at soil pipes up to 4"in diameter. Quantity Size (boots at electrical
mast to be reused).
❑ 4,1195. Reuse stove pipe flashing kits.
❑ Elr20. Reuse existing step flashing at roof/wall intersections.
[ ° ❑21. Furnish and install new aluminum copper step flashing at roof/wall intersections. Linear feet . If sidinf
work is needed,a cost assessment will be made at that time.
❑ [ 2. Reuse existing wall flashing at roof/wall intersection.
❑23. Furnish and install new aluminum wall flashing at roof/wall intersections. Linear feet . If siding work is needed, a cost
assessment will be made at that time.
'� aluminum 4� step flashing at base of chimney under existing lead counter flashirn
�❑24. Furnish and install new P g ,�Y g
( ❑25. Replace chimney lead counter flashing. 1 flue_ flues �3 flues other_2C/414
❑ ( 6. Install new roof hood to vent bathroom(s)with insulated flexible tube. Remove roof deck to gain access into attic. Color: blac
only.
❑ C Gutter Helmets to be removed and reinstalled by others.
❑ E . Remove and dispose of gutters attached with spike and ferrule.
❑
0'29. Remove and reinstall existing gutters strapped to roof. Install straps under shingle over shingles
❑ afg�,.'3�.Remove and reinstall existing gutters with hidden hangers. Linear feet .
5
❑ L Reuse skylight flashing kits Replace skylight flashing kits Quantity (Velux models,stock only).
❑ Remove and dispose of the following:Antenna Snow/Ice Wires Snow Guards/Ice belts Solar panels
❑ 33.Remove Satellite Dish up to 24'in diameter. Alignment and installation by others.
( ❑34.Page Two= ROOF PLAN.
❑35. Page Three=VENTILATION. 5 1'�Al�
❑ 6.Page Four=VENTILATION PLAN. J
0---[]37.Addendum(A)=OTHER WORK.
❑ gkl$. Addendum (B) =LOW SLOPE ROOFING.
r-As-r'��o errantanra Pane
Initia Initials Initials
The CorN2monweiffItZ of Mossachuseffs
department of IndustrialAceidengs
Office of Investigations
' C`o��gTess Street, , uite 100
Boston, MA 0, 114-2017
ww w(iss.govldia
Workers' Compensation Insurance Affidavit: Bu riders/Contr ac tors/I le ctririans/Plu>rnnbers
Applicant I>rxformation Please Print Legibly
Na.1r1e (Business/Organization/Individual): �Ln rwal,-A _
Address: �S q R 10 ST
City/State/Zip. TAlw 0A0 0 05! Phone 4:
Aire you an employer? Claeck the appropriate 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. ❑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 8. FI Demolition.
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp, insurance.'=
required.] S. F] We are a corporation and its 10.F1 Electrical repairs or additions
3.1:11 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.] 1 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.
rerai an eriiployer that is providing workers'compensation insurance for my employees. below is the policy rand job site
ir2forniation.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date: 7— d
Job Site Address: d-�17 City/State/Zip: g) k�O
Attach a copy of the workers, compensation policy declamation 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 cer . under ie ns land penalties ofpeijmy that the information provided above is true and correct
Signature:-
Date: 7 — 3( ��S
Phone#: St!3 5V66
Official use only. Igo not write in this are(i, to be completed by city or town official.
City or Town: Permit/License #
Iasuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town, Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone 4:
FSEG'TION 8-CONSTRUCTION SERVICES
Licensed Construction Supervisor: \ Not Applicable ❑
es
Nam olLicense Holder: V/' �D 01 AZ CS — Q g 36 63
License Number
)Z 0 The NIU,JT 5 T 5��,., �,��1 , � � 10 Ll �-
Address �— Expiration Date
Signat / Tel hone
r
9.Re a isfered Home Improvement tractor: Not Applicable ❑
4-urk-, Ho X0 T."-n'JdtPi � ' r, t 77
I
Compary Ifame Registration Number
1454 M ti ST 1 U����l d� M/� o �1 S I 6 _)6 _ a
Address ''ll Expiration Date
2
Telephon
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 derial of the issuance of the 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-vear 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
t
SEC?ION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0]
Brief Description of Proposed �,/
Work__5triq t�dSCi d6]p A ttbf � jbt-, . i�c�1�� Htw 6s0 (� 1'u1� S^7)�G'" (�K��( ,.��`
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing complete the following:
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
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
I, &VI V 01 Az /57U1 o g°VN ✓gyp zoilo " 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.
0000 b A?,
Prinnw/If / 7_ /3-
Signs ure of Owner/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/Finding ever been issued for/on the site?
toT
NO 0 DON'T KNOW YES C)
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 Date Issued:
C. Do any signs exist on the property? YES 0 NO ED
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
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 NO dAN
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
t, City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
L r-
< 212 Main Street Sewer/Septic Availability
i' AUG fD ROOM 100 Water/Well Availability
N rthampton, MA 01060 Two Sets of Structural Plans
�- p t�af* l'3 587-1240 Fax 413-587-1272 Plot/Site Plans
E1ec'r .6D
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
(47 J�yalj p /, F/J�e� J ,, �) Map Lot Unit
IC a'1 / �^�T Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�ic arU� 1 e Kuudl x'17 2uat~ nd1��►. MA
Name(Print) Current Mailing A dre s:
5��
SPQ ft-M c0ty) Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (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) tj wU Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
247 RYAN RD BP-2016-0154
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22-022 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pen-nit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2016-0154
Project# JS-2016-000257
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sq. ft.): 19079.28 Owner: DIEMAND RICHARD A&ANITA
Zoning: Applicant: STURDY HOME IMPROVEMENT
AT: 247 RYAN RD
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON:81612015 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 8/6/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner