24D-310 (6) Ali' � '( _U.S. METAL ROOFING
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till a
740 High Street-Suite 2-Holyoke,MA 01040
t�D�t nr� a 1-800-232-0399.1-413-536-5474-Fax 1-413-533-8166 nn,E nn,eSEe oeEnoNE�
f www.usmetalrooring.net /,� -/
suonlmep ro PHONE NUMRERs
STREET - JOn LOCATION
crrv.srarE nNO zIP cone
OInECTIONS ((
We will furnish and install new Englert Standing Seam mechanically locked system,24 gauge as listed below.
Work is guaranteed for_rLQ"_years and the manufacturer warranties the finish on the metal for 35 years.
coLOR:�I`-K
'990 n SPECIAL INSTRUCTIONS/COMMENTS
ROOFT c..�.^ On GI s(' �t ��'- b�' i.�- Yn
SOFFIT.
FASCIA: £' (t'1 l(ell. 0,
PLYWOOD.cYr �(,�l C<"
RIPIREMOVE.`__A �"�'S
OTHER:
HOUSE:
PORCH:_
ADDITION:
GARAGE:
J i
GUTTERS:
DOWNSPOUTS _ -
`.__.
REPAIR:
P,Y,C ,t)Prt
C-
Contractor will begin work on or about.6."= l✓''''.k:1"-_(date).Barring delay caused by circumstances beyond Contractor's control,the
work will be completed by l Cc.,I----(date).
All roofing panels are custom fabricated on-site with state-of-the-art rollforming equipment.
'As with any rollform steel panels,a certain amount of waviness or oil canning may become evident at certain times of the day when
sunlight hits them.This is standard in the industry and does not affect the integrity of the metal.This shall not be construed as a product
defect and shall not be cause for rejection.
Contractor does not perform or assume any responsibility for any painting,staining or wood or wall finishing on interior or exterior.
The contractor does further agree with the owner that(a)he will begin work within a reasonable time after the execution thereof,and will
prosecute it diligently and with due care,and in a good and workmanlike manner;(b)in doing the work,he will comply with all statutes,
rules,regulations and ordinances applicable thereto:
Contractor to procure all permits required by law.Contractor shall provide public liability insurances.
0 wanrnls that he is the owner of the progeny on which the work is to be performed or that he is oil wrwise aulhoi iz_ed on bohalf of the
owners to enter into this agreement.
llye Propose hereby to furnish material no labor-complete In accordance with above specific alio,;for the sum of:
1:_ A .; . ,' __ .__..__ dollars Iv
Payment to be made as lollows:
/ Narire M C 4rarla/mesiyruleu Regisaaex
'2`z I is/{Y/ 1 upon signing Contract;V U.S.METAL ROOFING DISTRIBUTORS,INC.
se—ndaest
jJ %($ pon start nl job:7�r/ 740 High Street,Suile 2,Holyoke,MA 01040
IY(_zi)7 i uPNw,c
7-600-2 2-0399
Y.f$�-?� 7--) upon 1/2 job completion: ne- a roa N
I
r " AN 1 40 TM 602546
mm
I shall be made forthwith upon copletimt 'Name lesoan J '
work under this contract
Notice No agreement kn Iwme tmprwonienl rA 1—fing work shall require a down payment Mrlhor lure
(etil a deposit)of more than one-third of the lelal c-Ifecl price or the total wilotmi of all
deposits m payments which Ilse canuactor must make,in aWance,to order and'or otherwise
Wrath deliwrry of special order materials and equipment,which—lo,ol igyreater. / "'-' --- -- To by ofr e
Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.
I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be
made as outlined above.
You,the Buyer,may cancel this transaction at any time prior to midnight o fthe third business day after the date of
this transaction.Cancellation must be done in writing.See accompanying cancellation.
90 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Srg adore ". - _ Date - _[�(�_-(' net e__.-__..__—_.
IMPORTANT INFORMATION ON BACK
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:
r�
The debris will be transported by: fir+ -1i i
The debris will be received by: P,�, l a_ - /'0 P �
Building permit number:
Name Permit Applicant�� S . -Jcr�ors �C�
Datec, off/ Si nature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
W
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Organization/Individual):
Address: IztJ ach — Lt i
City/State/Zip: / keJ . 010 0 Phone #: / S 'S
re you an employer?Ceck the ppropriate box: Type of project(required):
1. I am a employer wit 1 4. ❑ I am a general contractor and I
employees (full and/or partune).* 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 g, ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp.insurance.:
required.] 5. ❑ We are a corporation and its 10.F1 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1.❑ Plumbing repairs or additions
myself. o workers' com right of exemption per MGL
y [N p. 12.X Roof repairs
insurance required.] t 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ✓" G f i ' .ems
Policy#or Self-ins. Lic. 0
/ 6 Expiraf n Dater — U
Job Site Address: ACity/State/Zip: v Yj 0/0 -,0
Attach a copy of the workerscompensation policy declaration page(showing the policy number and a iration 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 h=ybj� nderthepqaw"anenalties of perju that the information provided above is true and correct.
Signa Date: c�G
Phone#: V
Official use only. Do not write in t is 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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: C Y N/ �_.s — )�J/
License Number
Address Expiration Date
Sig ature I Telephone
9.Registered Home Improvement Contractor: [[ Not Applicable ❑
l l r Tri G7 ✓J h i � �L70121U
Company Name ke
R gistra'tion' Number
rr r 014 U Adig UU U /
A dr ss Expiration Date
Telephon hi-5
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insura ce affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of N 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-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 D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[0] Other[CA
Brief Description of Proposed"
Works-k is d ✓av ,<^- /,IJO/ Of Ifide"'f e,full
JUJ-1 rn kv,p At i
Alteration of existin bedroom Yes No Adding new bi6droom Yes N (/
Attached Narrative Renovating unfinished basement Yel __� No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following: IV
�?
a. Use of building.- One Family Two Family Other d�
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 ,I !I S�(� as Owner of the subject
property Cl I
hereby authorize Cv �� t I %Y l�0✓� /'�C
to ct on my behalf, in all matters relative to work author' a by his building permit application.
i nature of Owner Date
I - D 1 r 7 ✓S." /r�1./� as Owner/ thorize
Agen reby declare that the st temen a d information on the fore oing application are true and accurate,to the best of my ledge
elief.
Signed under the pains and penalties of perjury.
G( 10 v S "rid ✓t' Qi
e
�c k21 1 5—,2U/ _
ure tOwner/ ent 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 Q DON'T KNOW ® YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DON'T KNOW 0 YES
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 ® Obtained ® , 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 ® NO 0
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
a---{--� ity of Northampton Status of Permit
uilding Department Curb CutlDriveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterfWell Availability
` No hampton, MA 01060 Two Sets of Structural Plans
pEPT.OF BUtli''�' �-* 3- 87-1240 Fax 413-587-1272 PlotlSite Plans
hpp,THAtv1F'rON,MA 0060 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
/ �✓G /�, �16xd— Map Lot Unit
M'4 010o Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: [ ,/
R14 6ariel-6-4
Name(Print) urrent Mailing Address:
0-d Tele hone
gnature
2.2 Authorized Agent: C /
me nt) Current ailing Addr�41
f c f(j
6jArure Telephone
SECTION 3-ESTIMA D CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building G U (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 of
6. Total=(1 +2+3+4+5) -% Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
84 BANCROFT RD BP-2016-1004
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-310 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate-or : ROOF BUILDING PERMIT
Permit# BP-2016-1004
Project# JS-2016-001697
Est. Cost: $8938.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: U S METAL ROOFING DISTRIBUTORS, INC 031003
Lot Size(sq. ft.): 8319.96 Owner: HEMPSTEAD MICHAEL
Zonim4: URA(100)/ Applicant: U S METAL ROOFING DISTRIBUTORS, INC
AT. 84 BANCROFT RD
Applicant Address: Phone: Insurance:
740 HIGH ST SUITE 2 (413) 536-5474 WC
HOLYOKEMA01040 ISSUED ON:2/10/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & INSTALL METAL ROOF 2ND FLR
FRONT OF HOUSE
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 2/10/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner