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17D-040 (11) 8 HIGH ST BP-2016-1533 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I7D-040 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category:ROOF BUILDING PERMIT Permit# BP-2016-1533 Project# JS-2016-002605 Est. Cost:$19723.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GARY C REHBEIN Lot Size(sq.ft.): 16509.24 Owner: JARRETT ALEXANDER E&TAMMI I MCBATH& MATTHEW KOZUCH Zoning: URB(100)/ Applicant: GARY C REHBEIN AT: 8 HIGH ST Applicant Address: Phone: Insurance: 16 Jonathan Judd Circle SO UTHAM PTONMA01040 ISSUED ON:6/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK Strip roofing on house and install metal roofing 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 6/24/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner Department use only City of Northampton Status of Permit 1- Building Department Curb Cut/Driveway Permit l 212 Main Street Sewer/SepticAvailability !t,° Room 100 Water/Wett AvSlabMy DepT pu ,6.us Northampton, MA 01060 Two Sets of Structural Plans MOH N 13-587-1240 Fax 413-587-1272 Piot/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: .y/ This section to be completed by office gidyl / rt',e l Map Lot Unit, 1/ ( l'J }y}�'j , }t / Zone Overlay District 0re,VIC,' i.�.,, Try;y of 04-)—_ Elm St.Dtetrict CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT .1 Owner fftRe�cord: t II Irf Al%ei✓ 0 Ul' C ' H rttb Poreno Name(Print) (I C nt�np(tddress / / t � f/ Pn✓F . ,�28... oh 1^( tell Te phone kigneters 2.2 Authorized Agent: / I c / /' ti. 00 L.) r• I a� ri i7 ul/r% , Kree//r �'Ia�ia e/ /d4</✓yp Na .- (Print) "" Current M1 ing Address Telephone ECT • .. TIMA ! CONST- : ION C•ST• Item Estimated Cost(DWlars)to be Official Use Only completed by permit applicant ., 1. Building 000 (a)Building Permit Fee 2, Electrical ' (b)Esbmated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection B. Total=(1 +2+3+4+5) / 17a3 '.� Check Number /3 5 This Section For Official Use Only Building Permit Number r, �u ed- Date. ;lir err Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed, Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This cntumninbe filled m by Building Department Lot Size Frontage _ Setbacks Front Side 1.: R: L: R: Rear Building Height Bldg.Square Footage ,o Open Space Footage % (lot area minus bldg&paved parking) R of Parking Spaces Fill: {volume&Location) A. Has a Special Permit/Variance/Fi ding ever been issued for/on the site? NO O DONT KNOW YES O IF YES,date issued: IF YES: Was the permit recorded at tb R istry of Deeds? NO © DONT KNOW YES O IF YES: enter Book Page and/or Document k B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 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 ZRis 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(Gearing, gradin ex vation,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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) in Roofing Or Doors El _�_._.,.-_....-_.... Accessory Bldg. ❑ Demolition ❑ New Signs (0J Decks [q Siding [01 Other[fl Brief Dawnption of Proposed Work: TH.itr-f(,if al e. 61 enti/nrd foui0n irle 1(1 head a.,g hJil +lnJt4// te ,• nri3�on 2?CftinJ-4 Sean? z.F / (lou - ��1 /// i Iteration of existing edroomYes y No Adding new bedroom Yes No y Attached Narrative '\ Renovating unfinished basement es \( No Plans Attached Roll -Sheet 5a.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 1001t. of wetlands? Yes ____No. Is construction within 700 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT/(y/ OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. 44r,L toe tc) KO/5w .1 �_�_ as Owner of the subject iii 5 props y I 1'1 1 ,�, e If�.1 Q'X) +l Yt4 j fi i7r'ebu{ Iov jtn ." thereby authorize bee hj ion, r/ to ajj� on my behalf,in all matters relativeLto work authorize t s building applipermit/ / dc •gnature of Owner Date C Q y L(/� .J C7P n ( i;iftt �S Pe 4A(hr.; �' f/fl(` . �:�� ,as 4wrvffRuthorize) *.gen" ` ereby declare that the aten and information on the%regoing application are true and accurate,to the best of mW�owiedge a elief, Sign!, underil the pains aifibMgnalties of perjury. Print Name ..---- , t/Lift re , Owner Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su• •rviso/rr; n E-, Not �Appplicable ❑ Name of License Holder ( 1 ,- . ie h 1),l I J Cl,3 I en:) - 'Si �} nn; �1 , (� license Number ( vn jhr�—ray 1- er,• . n fii4 d[fl S-7 r/ Address ��/{ / / / ' (Nu) Expiration Date Petry ry ! L —' h/ -fit -5`7/- Signature Telephone 9,Reaist red Home lmpcotlUOdir�e ' d cc Not Applicable 0 l �- k�Lt-.I � ,"bti ors/kr..' • Na t. Registration Number `�° ( h 51E( � / •Hai.• ke /174 0./‘19c)) Ad ress r Expiration Date Telephone,ltd-J3b-5-$/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8)) 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 th building permit. Signed Affidavit Attached Yes di No...,.. ❑ 11. - Home Owner Exemption The current exemption for"homeowners'was extended to include Owner-occupied Dwellings of one(I) 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.CALK 780, Sixth Edition Section 108.15.1. 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 thrill acceptable to the Building Official that he/she shall be responsible for all such work performed ander the buildinn permit. As acting Construction Supervisor your presence on the job site will he required from time to time,during and upon completion of the work for which this penult is issued. Also he 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 Habig 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 r ^7&ie tJo/iron/owe/yea/4 a/c/( iaackezie/L. ,icaOffice of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 134740 Type: Private Corporation Expiration: 1/11/2018 Try 285782 U.S. METAL ROOFING DISTRIBUTION , IN GARY REHBEIN 740 HIGH ST. SUITE 2 HOLYOKE, MA 01040 Update Address and return card.Mark reason for change. scnI 0 20M-0011 T. Address IT Renewal ETEmployment 1 Lost Card • • ®. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-031003 { Constr tion ARYL REHBEIN Supervisor 24 CUNNINGHAM C REHBEIN SPRNGMSTREET SPRINGFIELD PAA//Oit07 • t-'j z t,.J4— Expiration: Commissioner 65/18/2015 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: t'() l"1 i ti 5/r�n,./Ji torr/^T;(a /r // The debris will be transported b : (?, .S. /7-1P,7i+,� )r17 nr -1i17.7.r1r!' , The debris will be received by:c/Irnf/n�r, (Jr 1G0Ir. I � u/t/e%n/ m4 Building permit number: / / /Name of Permit Applicant(, , ) • mini/ Ztl no Di iIr. b, ilor 1 U Date (F-/c,-/(� Signature of Permit Applicant Z\ The Commonwealth of Massachusetts Department of Industrial Accidents Ertsm Office of Investigations rilill= 1 w 1 Congress Street, Suite 100 ' Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �^ /-}^ / / //t Please Print Le�t'ibly Name (Ousiness/Organizationflndividual){:f�, . t } , t t �e,7f(1„l t f�(J(J it r3 Di 17Y - A/1C$/„ 7-c7t�:- Address: / itte el—Si; le, ? ( �.. CirylStatelZip:_rna _legPhone#: reyou an employer?C-eck thq :ppropriate box: Type of project(required): 1, I am a employer with !`!L 4, 0 1 am a general contractor and I 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g 0 Demolition working for me in any capacity. employees and have workers' 9Building addition [No workers' comp. insurance comp. insurance.: required.] 5. Q We are a corporation and its 10.0 Electrical repairs or additions 3.El 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 131✓i Roof repairs insurance required-]t c. 152,§1(4),and we have no /" employees. [No workers' 13.E Other comp.insurance required.] { "Any applicant hat checks box#1 must also fill out section below showing then workers'compensation policy informatton. f Homeowners who submit this affidavit indicating they we doing all work and then hire outside contractors must submit a new affidavit indicating such- :Contactors 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'comppolicy number. > I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and fob site information. Insurance Company Name:_..31?? r . Iii r(,r_riC.e., Caript Policy#or Self-ins. Lic. #: tLJC,a 62 I*-.5 I;,,,,, .,, Expi tion Date _ch -#: r�5/ Job Site Address:_„ a is r f^ t Iffy tI —...- City/State/Zip tar ene.o tLIJl7 0/0 �" Attach a copy of the worke compensation policy declaration page(showing die policy number and expiration date). Failure to secure coverage a- equired under Section 25A of MGt.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. M I doh e -• Air u der the pains = ,enables of perjury that the information provided above is true and correct S: at. - eM� �L - -.', W �r-E',�'— Date: 6 --A,/4 Phone q: /.. /.'Jh, / - .. Official use only. Do not write in this area,to be completed by city or town official. • City or Town: Permit/License# -- t 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#: 00 vi U.S. METAL ROOFING( 740 High Stmet•Suite 2.8ohokc.AIA 01040 ',5011332-0999•I-4J3-536-5474•Fax 2413.533-8146 I ,.cmbat .. -1 wow.usmetalrooing.net =_//q.� 7n 1424. .1 .r A s,/. A ,-,1 i _. ..._.—._.._ +fir mJ. 0/..2( r.—...._... _..- _ -._ __ _ wowrnMnbt d inset new Engithr I Slanthang Roam hanleayot , na a as hated Uefnw. WweWvanamw J L. mars%dthe mmmrua.rerraorsu mSbmmen layean ("ALOE t).C4rYthkfth '- SPECIAL INSTRUpTiONS/COMMENTS Iwo; y . e , Li (4 4- t 44 rthk4 t_. ?r x :1 .:3yr } r..q CT FASCu fi F n +l _i 3 ; .i ..- L. -_ wa,a Grr 4 rVZ-s I 7 Ip l La 1 s.a .ir ` 0 Tl .. f r1FkE _ - _ niPTI r ae— { : w nib -bt ._ Ia — . _ aaaryh„, -- G;anA E -. — nu.rrna_L__„_7( r doh DOWNSPOUTS .✓x/t✓rl 6- __.- -.... -._. _ ?3 ,thyr Lath; N. _ —.__ dl I PrA,/f Mr - 7,-< 4- to : .J rf / _;4nt, writ begin wkma:,..a - nf.±lc MIX batex Barp rray cartaed bycie iuett alibeyJM(bNr a ntmecontrol the work wit be completed ay 0r nth --n'AKKn mnpeNpmem. •tom ryw aiNyncrl Ism fib Xi 5 ti ra,a0 Idect toTarsie erten MryavpYa NaFaa�&kry . .a nv.✓mc.w cc ow asp P^wc Con traetor rieu net perra,ar.1 1..,,ra, , 0,4.thth , th, a athre aa,rrea Of..0,510 or 5,115 howthrlir al'motto Di la re cuter;with Cron alter the Y eel andm Nagenay end sett r svU �aM cow- ,bre bout Ot:;bVnWS/rwV mtlapryPy with all gTUtes, Mcx regulat+ry ate mryMnr'ccc aPPlraatrith thereto Contractor 10 procure en permits rearmed to taw.'entracte?shall mOarde public Uab➢liy BavunceaWWI le r . e�P rsM teal hen .leI opt di Mach the work o to Ire medof mnnm,a other Mou rowro net cm WOW°01 The 4Y fa Semay� .mm nuec raw -rn,New m .,wxh, hove ,%kiln as 2! 1 ` 1- pavmom to be made as rmawa: 1"rZ 4,/4/4 ,.n, 'OGSr. , _t 5 Asa nmwmarmie tROOFING Ora arrOPSINCC . ,,,‘„,,,40„. ]aa npn`suaac S:a 0..wpaxe-%malaria LV_x J��1,...t np^stat or Wx L e($.)us L. l lteane.., Bnp"ay th MAP A74-7 ba/ %7 ,.,a , enr; VOWV hIVOrNhervittalor hour vtX1fOrrWerst Ortarbw;cox shalt Iacono wwwwwww54 nunmend an Acceptance of Proposal r ere a I u of mt document am accepta p.amattn arid a sswled 1 UNnrs ate thal up(re srg,Nno this proposal becomes C home conchyou ate aiutvxWa4 to do the walk as specets,1'Mere.T war be made as oW4c0 above. You.lite Buyer,may cancel MIS transaction nt any time prior to mdrigtu 0 she CAM tura/Deft Jay after Me date or this transaction.Cancetlaton must be done in writing,See accompanying cancellation. DOOM SKIN THIS CONTRACT IF THERE ARE ANY BLANK SPACES �bm_ �S ffNorm,. nee._