18C-093 (7) 28 GLEASON RD BP-2016-1137
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-093 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-2016-1137
Project# JS-2016-001948
Est. Cost: $19000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sq. 1): 21126.60 Owner: LESLEY DANIEL&NAOMI
Zoning: URB(100)/ Applicant: STURDY HOME IMPROVEMENT
AT. 28 GLEASON RD
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON:3/28/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 40 SQ 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 3/28/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
x pepartment use only
City of Northampton status of Permit:
2 5 ROIs Building Department Curb Cut/Driveway Permit
NR 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
DEPT Q air:.r .G,INS':C IONS Northampton, MA 01060 Two Sets of Structural Plans
NOF.rnnsFIoN,naAc;cso hone 413-587-1240 Fax 413-587-1272 Plot/SitePlafls
tither Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: n
This section to be completed by office
2g 1. � �S C� V � Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
C W0 r,\r eS1� 2,9 C�1 od
Name(Print) Curreat A i`ing A
Telephone '
Signature
2.2 Authorized Agent:
�a.0�d`
Name Current Mailing Address:
-73
Signature Telephone
SECTION 3-ESTIMATED CON TRUCTION 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 064 0e; n
6. Total=(1 +2+3+4+5) G Check Number
This Section For Official Use Only
Building Permit Number: DateIssued:
Signature:
Building Commissioner/Inspector of Buildings Date
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 [Q Siding[O] Other[p]
Brief Description of Propqsed
Work: i& th 40 pe- (R ISy1 Ctrtc,k �nS�i!(
Ulr-0 yvvq S YN �Alteration of existing bedroo Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
fa. 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 i )
hereby authorize
to act on my behalf, in all matters r Iative to work"duthorized by this building permit ap ' ation.
Signature of Owner Date
1, � rd 1 1'�L�V C 1 V�C � as Owner/Authorized
Agent hereby declare
hat 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.
Print
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicablle110
2L 2
Name of License Holder: , �Q C ' C5' CM
License Number
oySq
Add s Expiration Date
4
°732
ature Telephone
9.Re istered Home Improvement Contractor: Not Applicable ❑
6 �� 15 t 711
Company Name Registration Number
Address Expira ion Date
'—� 1SV+11 t i 6 A CX kS Telephone LI� 1 'fGY
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 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
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: L�1
The debris will be received by:
Building permit number:
Name of Permit Applicant
Date /Signature of Oermit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of.Investigations
600 Washington Street
IF Boston,Mass. 02111
www massgovldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): AiA Y� i
Address:-04),q I�k iA j V 'S d kk k-�S .
City/State/Zip:\066 aD� 0[('Fl�._._m ., (V 4� o (.S I Phone#: (A
Ar ou an employer?Check the appropriate box: Type of project(required):
I. Q I am an employer with_ 9 4. 0 I am a general contractor and I 6. 0 New construction
employees(full and/or part time).* have hired the sub-contractors 7. ❑Remodeling
2. D I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' g. ❑Building addition
[No workers'camp.insurance comp.insurance.$
required] 5.0 We are a corporation and its 10. 0 Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work officers have exercised their 11. 0 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. 0 Roof repairs
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.
tliomeowners 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. 7T- c !�, !< ns,
Y�
1(
Insurance Company Name: \t{l-�Y 9
Policy#or Self-ins.Lie.#: !e)3 J 'L t 1^Expiration Date:
Job Site Address: � G-1-W50 0� City/State/Zip: 1 i)dh 4(q 1
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 natacre. Date:
Prin arne: Phone#: jV)�_5e 43 )
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):
LBoard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact person: Phone#:
HOME IMP* RO'V,EM' EN'T
WORCESTER SPRINGFIELD HARTFORD
459 MAIN STREET-P.O.BOX 51033-SPRINGFIELD,WOW
MA.REG#151711 GT.REG#601525
1-877-3-STURDY 808-797-6800 413-*5y4-3.6906 FAX 413-543-3200
-PERMITOWNER
HORIZATION
Narne: �bl� d�'�' �SA
Address: o`� �a PP,
City/State/Zip:19fAN""4f).' 010 C�
(Owner), of the property located at:
authorize Sturdy Horne 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.
r
Signature of Owner-4,'� Date: (hiin f
Page I of 1
Toll Free (877)378-8739 459 Main Street
Worcester (508)797-6600 Indian Orchard,MA01151
E-mail.HR omSpringfield (413)543-5906 www.SturdyHome.comNawHaven(203)848-2118
Fax (413)543-320.0 . .
WINDOWS • SiDiNG • ROOFING . ADDrrIONB MA REG.#151711 CT REG.00601525
Nnm Harte Phone Buslne�Phone
ax oo i 1
o� e
Addrl y
keit hon, i-1Other
TawnlCI'll R tative Date
�` t t
I/we the owner(s)of the premises bescribed hereinafter,referred to as Owner,offer to contract with Sturdy Home.Improvement, .nc.hereinafter
referred to as Contractor,to furnish,deliver and arrange for installation of all materials to Improve the premises as described below.
v03 N0 ROOFING SCOPE OF WORK:
} ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1,1<, 2 3 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).
LJ 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).
by ❑ 5. Keep job site in a clean and orderly manner.Rake work areas at and of job.Use magnetic sweep to pick up nails.
3 Q 6, Provide OSHA approved staging to safely perform work.
[d O 7. Work consecutive days excluding inclement weather:(rain,snow,high winds,high heat,thunder showers,etc).
FA ❑ 8. Staff project with ualified mechanics experienced in residential asphalt roofing.
! ❑ 9. Strip existing 1_ 2_ 3_layers of asphalt roofing(see roof plan,page 2). Number of squares _.
A. one layer cedar removal. Number of squares
B, one layer slate removal. Number of squares
t ❑10.Inspect roof deck prior to re-roofing.Renall loose Boards
A.Replace rotted or cracked 12pards.at$ 1:9. per linear foot.
B. Install new plywood at$. -per sheet.
C.Number of sheets of piyw od indu into this estimate,Quantity^ (see unit cost above for addition s eQts�'�i
Q 11. Fumish and install sNngles. Color , 1 -.1 r
�" []12.Furnish and install W-aluminum drip edge around roofpedinetet White Milt Brown
❑ Of 13.Install cedar drip edge at eaves under aluminum drip ed Linearft
CX ❑14.Furnish and Install iceMater shield at eaves 3' 6'_other. Three feet in valleys and around all roof penetrations.
❑15.Furnish and install underiaymerit to entire roof._Roofer select-*<CDi eck
Z ❑16.Furnish and install starter course shingles,eaves&rake.
Q 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 eiect&W
mast to be reused).
❑19.Reuse stove pipe flashing kits.
R 20.Reuse existing step flashing at roof/wall intersections.
15„� ❑21.Furnish and install new__aluminum copper step flashing at rooftwall intersections.Linear feetIf siding
work is needed,a cost assessment wjil be made at that time.
Q la22.Reuse existing wall flashing at roof/wall Intersection.
❑
5M,Fumish and Install new aluminum wall flashing at roof/wall intersections.Linear feet .If siding work Is needed,a cost
assessment will be.made�f _that time.
)W ❑24.Furnish and install new 2� aluminum copper step flashing at base of chimney under existing lead counter flashing.
Ll 25.Replace chimney lead counter flashing. 1 flue"2 flues 3 flues other-- I
❑26.Installo _I new roof hood to vent bathroom(s)with insulated flexible tube.Remove roof deck to gain access into attic.Color,black i
ly.
Q 0 27.Gutter Helmets to be removed and reinstalled by others. E
❑ to 28.Remove and dispose of gutters attached with spike and ferrule. I
Q iff 29.Remove and reinstall existing gutters strapped to roof.install straps under shingle ____over shingles
Q 3 30.Remove and reinstall existing gutters with hidden hangers. Linear fee
0 ❑31.Reuse skylight flashing kits Replace skylight flashing Il Quantity (Velux models,stock only).
C1 N 32.Remove and dispose of the following:Anterill SnowAce Wires Snow GuardsAce beltsSolar panels,_ I
C� 33.Remove Satellite Dish up to 24`in diameter. Alignment and installation by others.
jff ❑34.Page Two=ROOF PLAN.
Z Q 35,Page Three=VENTILATION.
GI IS 36.Page Four=VENTILATION PLAN.
❑ i$37.Addendum(A)=OTHER WORK.
0 &'38.Addendum(B)=LOW SLOPE ROOFING.
19 ❑39.Acceptance Page Initlats��Irritlal �� lniflals -
STURDY HOME IMPROVEMENT,INC. ACCEPTANCE PAGE MA REG.11151711
ANY WORK NOT STATED ON PREVIOUS PAGES IS EXCLUDED OT REG.#0601525
The lallar,-,iag schedtle,will be adhered to unless circumstances beyond the contractor's control arise:
I"VOA SC"duted to begirt the week Expected completion date-_--1_-1—Weathar permitting.
The cash price for labor and material as described above Is:
1st payment 2nd payment 3rd payment
Contract Total (upon signing) 4th payment
Roof
Ventilation
Other work
Roofing total $
Siding
Windows
Special orders $
Other
Totals
Terms: —Cash Finance
---Credit Card: Exp-date___1 ...Cop_
Payrrent schedute-
Any balance no/paid is tuff WfWh thirty days,will be charged 1.8%interest per month.
10 order 10 Meet the COAWetm schadUls,the lolrowvV materiaLlewipment most be
SEEDIAURDEM before the contracted work begins.
(Law requires 11h4t 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 equIPm.ant 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. Alt
I understandings and agreements must be set forth in writing in this
contract. Additional provisions are stated on rqverse side and are part of this contract. In witness I whereof Purchaser(s)has/have hereunto signed their names
this—. 1.1rio day M—MIA 20Lj-(,,_ and acknowledge receipt of a true copy of this contract.
UNLESS OTHERWISE SPECIFIED,IT IS
UNDER D 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 cartella-
tion form for an explanation of this right. Signature affixed below also acts as receipt that Purchaser(s)received separate cancellation forms,
ilii The following Isarequirement by Massachusetts General Law,Home Improvement Contractor Law MGL c 142A:
The contractor d the homeowner hereby mutually agree in advance that in the event that the tact,the contractor
maysubmitsuch d ute to a p*lata arixtration service which has been approved by the office of ConsumerAflarts and Business Regulation and the conwmar
stratistratibe required to it
ubmil to s h arbitration as provided in hfGL c 1424.
Representative:_ Owner,
Owner Daniel Y Leslej(Mar 11,201 15)
NOTICE.-The so
tures the patties above appty only to the agreement of the parties to alternate dispute resOlulibn Inillated by the contractor. The owner
may initiate ah _i --of
tive dispute resolution even where this section is not signed separately by the parties"
Po not sign this contract.If there are any blank spaces
Submitted Am
by: by. Mar 17,2016
Representative anie es e 0artDate
a or
Accepted Accepted
by"—
Representative
Purchaser Date