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31B-237 (8) N. P. HOME HTROVEMENT INC. 575 Granby Road*South Hadley,MA 01075 CSSL#100481 Office:413-532-7603 fax:413-532-6435 g�� MAReg#143099 Email: NPIU@Verizon.net CT Reg#.0673197 NFIB Member Name: Lid tti c- l Date: Street Address: T City St Zipo/06 C/11 t���tti<< ,�.r1 At waJ M�1 �' Telephone: Cell: email: PROPOSAL FOR. USE GARAGE OTHER *Specifics* RE-ROOF TEAR-OFF GUTTER Layers: 1 2 3 4 Plywood:Yes No — ° CPbt�E e COMPLETE ROOF PROTECTION SYSTEMS. C6 All proper permits shall be obtained �S it Oip S&" Certificates of insurance provided upon request All N e vj g Proper measurements will be taken to protect home Nt and property r ANPHI will remove old roof system to wood decking Eli 1 c I'd Provide home owner with full exterior inspection AgAny unsafe-or decayed deck boards or plywood will be ,replaced at$3.25 per sq.foot(with customer approval) 1aNPHI will leave the homeowner with a safe and clean environment at the end of each work day Ad NPHI will perform a final clean up with a ro11 magnet to remove any nails left behind R AB project waste shall be removed by dumpster(dgmp4er far contractor use only) ROOF SYSTEM Install ice and water shield%-i-A 6' according to MA code requirements linstal ice w er shield around penetrations,chimneys,and in all valleys 5" 1(8 j hit or brown drip edge will be installed on aves Instaljjjjprecut starter strip shingle on rakes and eaves. S the jlalorl5lbunderiayment installed Install ridge vent - Snowcountry or Roll vent O Install soffit vents Iii Step flashing will be installed in all necessary areas 10 Install Lead counter flashing on chimney SFIIN ES ifetime _,Ultra Lifetime _GAF Ridge Cap Shingle Color WARRANTY:NP Home Improvement Incorporated will provide the above stated homeowner with a 7 year workmanship warranty. This estimate is valid for 15 days. D Extended warranty$275.per year____yr(max 20 ai We Propose hereby to fumish materials Ojabor r Fomplete in cordance with above E specifications for the sum of: 11 (-Z45? �� 00 Total Sale:$�/T�{p� Down Pa ent$ �' Bali nce Upon Completion$•7�d y Acceptance: The above price,specifications d�conditiona ctory and are hereby accepted. Payment will be 1/3 down upon sig ing,and bale etion. Unpaid balances shall accrue with interest at 18%1M ann urchaser(s)will pay for all costs,expenses and reasonable attorney's fees incurred by N:P-Ho m vement Inc.To recover any sums du under this contract. Signature Date G1 Estimator Signature Z41, Date: Phone: '5SO `f aF ATTENTION:Please cover all personal belongings in attic,garage or storage areas due to the possibility of roofing debris or dust coming through cracks of wood decking.N.P.Home Improvement Inc.Will NOT be responsible for debris or dust in the attic or storage areas. 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: � I GO/k, C '131- - The debris will be transported by: d"','k'k P The debris will be received by: OEGI � 12 Building permit number: Name of Permit ApplicantLi �I �"/h�YJ� S Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): W .P. "orAFT= myP_mE 4 Inc. Address: 515 Can City/State/Zip:,_C) NA n1Cff5 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am an employer with 5 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7. ❑ Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.$ 9. ❑ Building addition required] 5.11 We are a corporation and its 10. ❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required] t c. 152,§ 1(4),and we have no 12. ❑ Roof repairs employees. [no workers' 13. [1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box must attach 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. J� Insurance Company Name:__ A• S - �P 1 mN r Tntur nx ti.0 Policy#or Self-ins.Lic.#: lag -4%51 P l ate- 14 Expiration Date: 11 - 2 0-RO15 Job Site Address: 6D 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: ( S Print Name: NICkdAS PC4ER5 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 Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: 1 �' R±ms /60V License Number Address Ex ration bate 1 2 (vim ignature Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Co Nu ber 6'75 C�� ►�br,>7 ( S 11�U M 4(D�� /I'� Addre Expiration bate Telephone41353a7f�1 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...... ❑ 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 10835.1. 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 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs gD] Decks [❑ Siding CI) Other[[:I Brief Description of Proposed Work: 51Rih hank OF hake ip Clle(k o T16 I EPbm qwyc e" (e( S(�{C►�Y� �CCD l��aU Alteration of existing bedroom Yes)—No Adding new bedroom Yes _�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 'y 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, ,?F+ff R L)h C4 n as Owner of the subject property ll hereby authorize !v`a omt TM fUf bJ)f)-n(?A J� 71✓)L to act on my behalf, in all matters relative to work authorized by this building permit application. S aid Signature of Owner Date I, ) � • hm F, M EYV)F' ( - __ 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. C, 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 Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW � YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O 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? YE£ O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: L D Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability 5 orthampton, MA 01060 Two Sets of Structural Plans pho a 3-587-1240 Fax 413-587-1272 Plot/Site Plans u-nONS Other Specify O30 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 Aq q LG� 't� sf {� j,, Map Lot Unit IV of �h arnpi 1 , MA ©1®WD Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Wh A kn 11 q Gat h l Burnt, NI I C�,C�o Name(Print) CurrIt Mailing Address: 1 I� 1 Telephone Signat 2.2 Authorized Agent: N.P. �'1� C �d .S N leu MA ap)� ;' Name(Print) Current Mailing Address: q13 5-1a -703 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 (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) i�] Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 49 GOTHIC ST BP-2016-0641 G1S#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B-237 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-2016-0641 Proiect# JS-2016-001069 Est. Cost: $11769.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: N P HOME IMPROVEMENTS INC 100481 Lot Size(sq. ft.): 7753.68 Owner: WHALEN PETER J Zoning: CB(100)/ Applicant: N P HOME IMPROVEMENTS INC AT. 49 GOTHIC ST Applicant Address: Phone: Insurance: 575 GRANBY RD (413) 532-7603 WC SOUTH HADLEYMA01075 ISSUED ON:111612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP TO DECKING & INSTALL EPDM RUBBER ROOF SYSTEM 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 11/6/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner