37-016 Proposal
SEXTON ROOFING AND :SIDING INC
www.sextonroofing.com
sow"Vow Con
Setting the Standard
P.O. Box 6327
p. 413.534.1234 Holyoke, MA 01041
f. 413.539.9906
MA HIC# 118239
sextonroofing@hotmail.com
SUBMITTED TO Rachel Rothman PHONE 210-0005 DATE 9-5-15_
STREET 748 Florence Rd. _ JOB NAME
CITY/STATE2IP Florence, Ma. JOB LOCATION
SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR:
1) Strip and remove existing shingles and dispose of in proper landfill.
2) Install new 1/2" CDX 4 ply on main roof and replace as needed on garage and breezeway. (Time and
material)
3) Install new metal edging to rakes and eaves of roof. (8')
4) Install ice and water shield on eaves of roof, (6) over vent pipes, at intersecting walls, in valleys and
around chimney.
5) Install synthetic roofing felt on remainder of roof.
6) Install new flanges over existing vent stacks.
7) Install starter shingles on eaves and rakes of roof.
8) Install IKO Architectural style roofing shingles as per manufacturers' specifications.
9) Install new cap over ridge vent.
10)Supply manufactures Lifetime warranty and SRC 25 yr, workmanship warranty.
ALL CONTRACTS INSURED WITH PROPERTY LIABILITY AND WORKMANS-COMPENSATION. ALL PERMITS APPLIED
FOR BY SRC.
We Propose hereby to furnish material and labor—complete in accordance with the above spftxjfic4P0Tts.,for the sum of:
Eight Thousand Eight Hundred ( $8,800.00 ) Payment to be made as follows:1/3 down ba
,K upon cfpple'on
All Material is guaranteed to be as specified. All work to be completed in a Aqftftm
workmanlike manner according to standard practices. Any alteration or Si ature
deviation from above specifications involving extra costs will be executed
only upon written orders,and will become an extra charge over and above
the estimate. All agreements contingent upon strikes,accidents or delays
beyond our control. Not responsible for water damage during Note: This proposal may be withdrawn by us if of accepted
construction. Owner to pay responsible legal fees for non-payment,and days
a licable interest.
Acceptance of Proposal The above prices,
specifications and conditions are satisfactory and are Signa re
hereby accepted. You are authorized to the work as
specified. Payment will be made as outlineo above.
Date of Acceptance. kA�'c , �'� , Signature
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work:
The debris will be transported by: /��1e1e- ,e�'is�s.��
The debris will be received by: /9
Building permit number:
Name of Permit Applicant DEG /1
Date Signature of Permit Applicant
The Cor�srr�onwecz,th ojflYlass achmse fts
eprwirnenl oflndAstffialAccidents
' Office of Investigations
600 Washington Sheet
Boston, MA 02111
SY www.mass.gov/dia
Workers' Compensatiou Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lelzibl�
1
Name (Business/Orgaciization/Individual): A J c( � ,(�a-j"Fue l� c T—no- 1
Address: U ❑_n°
City/Mate/Zip: 'n r�( �I;Z �Q l Q , �� ,�� (i I(�I Phone #:
Are you an employer? Check the appropriate box: 'Type of project(required):
1.5I am a employer with 4. ❑ I am a general contractor and I
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.$ E] Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required.]
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs
insurance required.] t employees. No workers'
comp. insurance required.] 13.0 Other
Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
r Homeovvners 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 then workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for pray employees. Below is the policy and job site
information.
Insurance Company Name: rl I _n> ; ❑ /�L Lbr)t o nu
/I _ 1 '1_, � C' � U ,
Policy# or Self-ins. Lic. #: ��I t , L� �0 V �. I - �1, Expiration Date: 1 f I l C
Job Site Address: City/State/Zip:
Attach a copy or the workers' compensation policy declaration page (sno n ing 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify undezllce_pains and penalties of perjury that the information provided above is trace and correct.
Sign ature: Date:
Phone#:
j
Official use only. Do not write in this area, to be completed by city or town official
I
City or Town: Permit[License#
Issuing Authority(circle one):
1.Board of Realth 2.Building Department 3. City/Town Clerk 4.Electrical lnspector 5.Plumbing Inspector
6. Other /
i
Contact Person: Phone.#:
The Commonwealth of Massachusetts
Depa-r rcent of Indv_strialAccidents
Office of Investigations,
1 Congress Street, Suite 100
Boston,))AE4 02114-2017
wl4w-TnaUs.{o-;)/dia
Workers'Compe- sation Pusuralacek davit: BuBders/Cam actors/FlectAcians)Pluxabexs
Applicant Laformatdon Please Print Le2JbIT
_ Name (Business/organizationllndividual):
Sexton Roofing Co.
Address: P .O . Box 6327
City/Sta_&Zip: Holyoke, Ma. 01041 Phone#:41-3-534-1234
Are you an employer? Check the appropriate bog: Type of project(required):
E El I azn a employer with 4. 0 I am a general contractor and I
employees(fall and/or part-time).T
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner-. listed ozithe attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, D Demolition
working for me in any capacity.. employees and have workers' 9. Bolding addition
[No workers' comp.insurance comp:insurance.$
required] 5. E] We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have e;ercisedthen I.❑Pl fibbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 ❑Roof repairs
insurance required.] t c. 152, §'_(4), and we have no
employees. [No workers' 13.n Ocher -
comp.insurance required]
=Any applicant th at cbecks b ox 4l must also fill out the section below showing their workers' comp ens ation policy inforation.
t Homeowner who sitbmitthis affidattinIcatingthey arc'doing all work andthenhire outside contractors must submit anew affidaAtindicating such
tContractors that checkthis box must attacfaed an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. Ifthe sub-contractors have employees,they must provide their Workers'comp.policy number:
I am an employer Ili at isyTovidingworkeTS' compensation insurance for my empZoyeUS._ Beiow is the policy aid job sife
information.
Insurance Comp any Name:
Policy#or Self-ins. Lic.#_ / Expiration Date:
Job Site Address: -7 City/State/Zip: d �'`� ``J
Attach a copy of the workers' compensation policy declaration page(showing the policy nnmbex and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 carrleadto 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 ofthe DIA for insurance coverage verification.
Ido hereby certify under t pains andpelzaZfies ofperjwy that the infonrzationprovided above is true and correct
Si ature: Date:
Phone#: 4135341234
OfficiaZ 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.BuildingDepaiiment 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact P erson: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
/2
Name of License Holder: e v
License Number
Add ss Expiration Date
Signature-- Telephone
red Home Improvement Contractor: Not Applicable ❑
cC, // a?
Com an 'Name Registration Number
Address Expiration Date
146 t yLQ P Telephone 573 /-12
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....... [ No...... ❑
Roine.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-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 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 1.53(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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all am3licablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors 71
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[Z] Siding[0] Other[Co
Brief Descriptio f Proposed / \
Work: e
Alteration of existing bedroom Yes 11�No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
e& if Now house and or addition to existinta housinsa, 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 co truction. 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 . of wetlands? Yes o. Is construction within 100 yr. floodplain Yes No
j. Depth of basemen 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
C3 `�— 1� AJ as Owner of the subject
property
hereby authorize O
to act on my behalf, in all matters relative to work authorized by thil building permit application.
0_2 b;:�- 4:: A
Signature 625T,Owner Date
6 as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing a0plication are true and accurate, to the best of my knowledge
and belief.
Signed under the p ins and penalties of perjury.
1�t"Yrzt"' -,
t
Print Name
Signature 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
Fi1L
volume&Location
A. Has a Special Permit/Variance/Findin ver been issued for/on the site?
NO Q DON'T KNOW YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW kv YES Q
IF YES: enter Book ` Page,; and/or Document#'
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW � YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO
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
er-
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 Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
[E I City of Northampton
t? Building Department
212 Main Street NOW
SEP 3 0 206 Room 100
orthampton, MA 01060 f� ' h "` �� � �414,10 4,4
>pr►c,Plumbing&aasd a -587-1240 Fax 413-587-1272
t
NOrthM1 eft MA tiloso ��' ` �a ,,� � :a, � ^-se•;� �; .� �'
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
-7y� Map Lot Unit
Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: n
"7r� �D►���'' 1�cxlPrtc
N e(P/ri nt) Current Mailing Address:
p o?�l� " OOO
Telephone
hone
Signature
2.2 Authorized A nt:
rU - Ea �,s � :i )4,
Name(Pri Current Mailing Address:
-Skjyra-ture 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 (b) 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 D
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
748 FLORENCE RD BP-2016-0439
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-016 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-2016-0439
Project# JS-2016-000724
Est. Cost: $8800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SEXTON ROOFING CO 99689
Lot Size(sq. ft.): 86684.40 Owner: ROTHMAN RACHAL
zonine: Applicant: SEXTON ROOFING CO
AT. 748 FLORENCE RD
Applicant Address: Phone: Insurance:
P O BOX 6327 (413) 534-1234 WC
HOLYOKEMA01041 ISSUED ON.9/30/2015 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 Deaartment 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:
FeeTyne: Date Paid: Amount:
Building 9/30/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner