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22D-103 (2)
LI HEG.#0601: ANY WORE NOT STATED ON PREVIOUS PAGES IS EXCLUDED, The followi cg schedule will be adhered to unless circumstances beyond the contractor's control arise: /' Work scheduled to begin the week of _/----/ . Expected completion date_____/____/_ _Weather permitting. 651y .4-C/r,m7— The cash price for labor and material as described above is: 1st payment 2nd payment 3rd payment 4th payment Contract Total (upon signing) kin Ot —�j rr(, (,✓IOT r ` t0of va 1 Ventilation Wither work ybD Roofing total $ Fboa u $ � $ Siding $ $ r $ Windows $ $ r $ Special orders $ --a, $ -- $ $ $ Other $ $ $ $ $ Totals $mow $ 1600 , $ 70o. $ Terms: _Cash Finance 9&d Credit Card:#_ Exp.date____ / Code_ Payment schedule: Any balance not paid in full within thirty days, will be charge 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 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 s ed on reverse side and Aw part of this contract. In witness whereof Purchaser(s) has/have hereunto signed their names this day of ►, 2o-/ and acknowledge receipt of a true copy of this contract. UNLESS OTHERWISE SPECIFIED, IT IS UNDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTED ABOVE WILL BE HONORED ONLY UNTIL 3t' PA y S (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 NIGL 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. Representative: 11,41 Owner. a,1tt/j 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 A. Ili Accepted Q Representative Purchaser D fe Accepted Accepted by: by: Representative Purchaser Date 459 Main Street Tall Free (877)378-8739 Indian Orchard, MA 01151 Worcester (508)797-6600 E-mail: HR®SturdyHome.com Springfiicld (413)543-5906 STURDY www.SturdyHome.com New Haven (203)848-2118 Fax (413)543-3200 � WINDOWS 0 SIDI NG . ROOFING • ADDITIONS MA REG.#151711 CT REG.#0601525 Name � Home Phone Business Phone p u � � � I�f 1,,�-� 13 re,Y T2-0 Address �� C � q� � Cell Phone Other Town/City Representative Date F1 0 vo- 94/ 4�le e, I/we the owner(s)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: &r ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 4", 2 3=0 Family home. U2,0" ❑ 2. Provide certificate of insurance for workers compensation,general liability. (see attached certificates). Or' ❑ 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). ❑ 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). Qoo� ❑ 5. Keep job site in a clean and orderly manner. Rake work areas at end of job. Use magnetic sweep to pick up nails. Ate❑ 6. Provide OSHA approved staging to safely perform work. !/ o Uil-'❑ 7. Work consecutive days excluding inclement weather. (rain,snow, high winds, high heat,thunder showers, etc). Z'Q.y Lam. (A�❑ 8. Staff project with qualified mechanics experienced in residential asphalt roofing. Ur❑ 9. Strip existing 1_Y 2_ 3_layers of asphalt roofing(see roof plan, page 2). Number of squares _, A. one layer cedar removal. Number of squares O B. a one layer slate removal. Number of squares 2' ❑10.Inspect roof deck prior to re-roofing. Renail loose boards: A. Replace rotted or cracked boards at$ oo per linear foot. '31 11/ B. Install new plywood at$ -70, per sheet.fMp=ret-i�,.l-Lr6i No �t C. Number of sheets of plywood included into this estimate: Quantity 3 (see unit cost abq for additio I she s). e- ❑11. Furnish and install e�c�Th►�!eca( ZA� Ik -- - t shingles. Color fUX W- ❑12. Furnish and install 8"aluminum drip edge around roof perimeter.White � Mill_ 0 Brown o Q W13. Install cedar drip edge at eaves under aluminum drip edge. Linear ft-. [Ar ❑14. Furnish and install ice/water shield at eaves-03'--2 L`16' O other. Three feet in valleys and around all roof penetrations. Ur ❑15.Furnish and install underlayment to entire roof. 0 Roofer select Diamond Deck W ❑16.Furnish and install starter course shingles,eaves&rake. Wol ❑17.Furnish and install hip and ridge cap. A ❑18. Furnish and install new neoprene roof boots at soil pipes up to 4"in diameter. Quantity l Size q (boots at electrical mast to be reused). ❑ M'f9. Reuse stove pipe flashing kits. ❑20.Reuse existing step flashing at roof/wall intersections. ❑ W1.Furnish and install new aluminum copper step flashing at roof/wall intersections.Linear feet . If siding work is needed, a cost assessment will be made at that time. [�^ ❑22. Reuse existing wall flashing at roof/wall intersection. ❑ Er23. 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. �- ❑24. Furnish and install new 4"" aluminum D c.@Mmr step flashing at base of chimney under existing lead counter flashing. (� ❑25. Replace chimney lead counter flashing. 1 flue m 2 flues '�3 flues 0 other--!!!!-. ❑ &1126. Install new roof hood to vent bathroom(s)with insulated flexible tube.Remove roof deck to gain access into attic. Color:black only. 'p Zr ❑27. Gutter Helmets to be removed and reinstalled by others. 5TU- AI �``� I'� 5-t b u"• ❑ Mof8. Remove and dispose of gutters attached with spike and ferrule. ❑ W29. Remove and reinstall existing gutters strapped to roof. Install straps under shingle over shingles . ❑ W0.Remove and reinstall existing gutters with hidden hangers. Linear feet ` S k� at- ❑31 Quantity (Veldx r�ioc�eYs,stockoily). .❑ JIM.Remove and dispose of the following:Antennas Snow/Ice Wires Snow Guards/Ice belts Solar panels ,G�e33.Remove Satellite Dish up to 24'in diameter. Alignment and installation by others. Re.0 M Syva w C UA [r®❑34.Page Two= ROOF PLAN. r / ❑35. Page Three=VENTILATION. `at�� ❑ 616.Page Four=VENTILATION PLAN. ol"o-❑37. Addendum(A)=OTHER WORK. Q UJI& Addendum(B)=LOW SLOPE ROOFING. Ue'❑39.Acceptance Page Initials Initiels I Initials ow Moog STUR 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: T� Address: L1 � City / State / Zip: t ovw A, o 2- � (Owner), of the property located at: authorize Sturdy Home Improvement Inc. to act as 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: Date: Page 1 of 1 The Commonwealth of Massaehusetts Department of IndustriolAeeidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, ALA 021142017 s. avww mass.gov/dia Workers' Compensation Insurance Affidavit: Buiide>rs/Contr actors/Electrieians/Flu tubers Applicant Information c,,j_ J Please Print Legilb J I iy Nwile (Business/Organization/Individual): ar01 V y�wt ca _ Address: t{!,7eq kadli City/state/Zip: aU dqAJ 01/,"/ . Phone#: &13 5y 3 — 5 f b Are you an employer? Check the appropriate box: Type of project(required): 1.�—>Yl am a employer w em to with 4. [� I am a general contractor and I p 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 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, E]Demolition working or me in an capacity. employees and have workers' g Y p tY� 9. n Building addition [No workers' comp. insurance comp. insurance.- required.] S. F1 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 12.0 Roof repairs insurance required.] 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. 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 ritiz gait employer tliat is provirlirag workers'coinpeiiscatioii iiisiir(iiice for my employees. Below is the policy and job site information. r, Insurance Company Name: 741/�iG� �J 1e� ) / _ Policy#or Self-ins. Lie. #: 8 3,6g SV 5 l 5 Expiration Date: 7 i A Job Site Address: ZlG do,4 57 City/State/Zip: AlUe,,--�ae i A4 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 imprisomnent, 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 cerg ler the pains and pen=alties of peijmy that the inform ation provided=above is true land correct Signature. Date: 7 — `30 — Phone#: 5� '5,166 Official use only. Do not write in this area, to be completed by city or town offici=al. City or Town: Permit/License # Issuing Authority(circle one): 1.board of Health 2.building Department 3. Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Clow ( n a/a 2- eS_ O q 303 License Number 1-70 119 MoiNr s"` So-, , ell 44 oil Address �j� Expiration Date P �►13� ��3 �7 06 Signatur � Telephone 9.Re i tered Home Im veme ntractor: Not Applicable ❑ --�f" HbA% / 5 / 7 / Company Name Registration Number 5q M 4 t N 5T ., 1-,4t-au 6),A-eA 4 - X - l� Address /� Expiration Date MA r A y It 5 1 Telephone Sy 3 - �qOG 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 denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 2i 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, Sixtb 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 buildine 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 i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[O] Other[a Brief Description of Proposed j . ,Work: 5'tm0 ¢!a )np (-Vh slsk . lISVwl N: v C!10 rak- S- b1 utr��k�ww Alteration of existing bedroom Yes >, No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes ><—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 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 o 190- / J I UUI ? f1W .D-Oa WI iKUD� as Owner/Authorized Agent hereby declare that the statements 6nd 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. Print Name Signature o Owner/Agent Date ~, T 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? NO © DON'T KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DONT 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 © NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only of Northampton Status of Permit: ! ° B4lilding Department Curb Cut/Driveway Permit J L AUG _6 201 py12 Main Street Sewer/Septic Availability Room 100 WaterANell Availability Electric- F, ; ,,t car` ampton, MA 01060 Two Sets of Structural Plans r "' = tio11C 413-5 7-1240 Fax 413-587-1272 Plot/Site Plans 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 q6 (°1dr4 5t P rwce 11 A44 Map_� Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S(M f d ill C(w-Ur St P1dfe Ue Name(Print) Current Mq+lin Address: (ir1'5) -5 PLY— 415'7 'lT�t,N 2 n 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 per it 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) I b 0 Check Number 3 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 46 CLARK ST BP-2016-0155 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22D- 103 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-2016-0155 Project# JS-2016-000258 Est. Cost: $9400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sa. ft.): 43037.28 Owner: FOUDY JAMES&CHRISTINE M Zoning: URA(100)/WSP(100)/ Applicant: STURDY HOME IMPROVEMENT AT. 46 CLARK ST 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