10B-063 25 WATER ST BP-2017-0082
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 10B-063 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-2017-0082
Project# JS-2017-000146
Est. Cost: $22755.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NORTH EAST SPECIALTY CORP 065521
Lot Size(sq. e.): 36241.92 Owner: WALKER BRUCE&LORRAINE
Zoning: URB(100)/RR(0)/ Applicant: NORTH EAST SPECIALTY CORP
AT: 25 WATER ST
Applicant Address: Phone: Insurance:
148 DOTY CIRCLE (413) 739-4333 WC
WEST SPRINGFIELDMA01089 ISSUED ON:7/22/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE ROOF W/METAL 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 7/22/20160:00:00 $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
—yr-env-EDBuilding Department Curb Cut/Driveway Permit7 2015 212 Main Street SewedSeptic Availability Room 100 WateriWell Availability
rthampton, MA 01060 Two Sets of Structural Plans
pGi /Broom 41 -587-1240 Fax 413-587-1272 Plot/Site Plans
eco. 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
?S LaAtC 5f7. Map Lot Unit
L6F43S r /'etA e,1053Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
132utc 9 w¢40 id, uuAw-a'4 2S wfRL Sr- /sees / AM 01053
Name(Print) Current Mailing Address:
Telephone Lk IS) --CNA-
55 32
Signature _l 77�c �r
2.2 Authorized Agent:
ctr -Vt I SAT_Ifii-r C "P l4 6 Doty c4cetE WtSr seap-iiirfan
Name(Print) Current Mailing Address: /vIft OI ()gi
7/Li--- 643) f39 - 4333
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
221-cSo
.r
2. Electrical r (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
01/4/,,
6. Total=(1 +2+3+q+5) '22 / '� Check Number 70---5-7 (��[((`��(
This Section For Official Use Only
Building Permit Number: Date
Issued:
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 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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DONT 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 0 NO O
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? YES O NO O
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) ❑ Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [q Siding[D] Other[p[
Brief Description of Proposed
Work: (LDMCUC ASAIHLT P/JDF ' IPEPLA E C-01TO (5ioac GArk)9 /+1(: SiSTE:`4
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 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 Ta-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, rY'V�t jl 'CRA,'A- CuAutt✓,_ ,as Owner of the subject
property II V II
hereby authorize ' c&coe
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I,
57Wal F_ A.4ti2e7r ,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.
iE: F, (4TH
Print Name /
lin/IL
Signature of wnertAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder 512.1k`t, iS4 Et C5' 065S P I
License Number
KO L)ArNAL E2- tjA.4 Vs—Lout-140o) MQ 0th 01 pc/20R
Addre Expiration Date
�� (`+3 t3) 1333
Sign Telephone
9.Registered Homo Improvement Contractor. Not Applicable ❑
Coat* sPELl u,.ry 'c /0e5313
Company Name Registration Number
!N g Dori c12CCE &7&3— Sinitsap e14, oivf oV/4/20/1
Address Expiration Date
Telephone4ll3) 7-Ys-9333
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,$25C(6))
Workers
Compensationthe issuance
Insurance affidavit mustm 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 I No 0
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.CMR 780, Sixth Edition Section 1083.5.1.
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 budding 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
The Commonwealth of Massachusetts
__ark=„= Department of Industrial Accidents
Iv s. . [/.
P ra,„1._ Office of Investigations
= t= I Congress Street, Suite 100
• i0= Boston,MA 02114-2017
�I. www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrganizatioNlndividual): i/e 'Qt9-..
Address: INP Doll Q¢cat
City/State/Zip:W E'2,)6- ASD /vl4 o13i5 Phone #: ( id i -339H 33'3
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
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.t
required.] 5. g We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I 1.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MOL 12 ❑ Roof repairs
insurance required.] r c. 152,§I(4),and we have no
employees. [No workers' l3.0 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: j Qjtlplor" 1-ussfert jtb , !QCs Cr+� t_11/41c.Policy#or Self-ins. Lie. #: S / clic N Expiration Date: c/(0 //1'
Job Site Address: Ps `a�TILI` ST. //a705 , ,'llll dlOi3City/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 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 u 4 e,ains andpitiesry,t at the information provided above is true and correct.
Signature: 7 Date: "[/4(/(L
Phone#: (413 ?3y —H333
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 Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
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: tuRTtt2- S•
The debris will be transported by: PiP061.4 c Lsrr
The debris will be received by: 0riteoPa"
Building permit number
Name of Permit Applicant PUScoC
`J/46 /jet 1,
Date Signature of Permit Applicant
NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR \
All home improvement contractors and subcontractors
MA License #103713 engaged in home improvement contracting, unless specifi-
148 Doty Circle • WEST SPRINGFIELD, MA 01089 cally exempt from registration by Provisions of Chapter 142A
1-888-NESCOR-1 1-888-637-2671 of the general laws, must be registered with the
413-739-4333 Commonwealth of Massachusetts. Inquiries about registra-
nescornow.com tion and status should be made to the Director of Consumer
Affairs and Business Regulation, Ten Park Plaza, Suite 5170
Submitted - Boston, MA 02116-Phone(617)973-8700
,
To: — --
JOB NAME
.. JOB LOCATION -
-- -
PHONE OATS .: •
"' - ESTIMATQR - , --
We hereby submit specifications and estimates for work to be performed and materials to be used'.
•
Do not do: - -- ` Cont t n related permits:
m r•
�_
WORK SCHEDULE
Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein.Contractor will begin the work on or about
(date).Barring delay caused by circumstances beyond Contractors control.the work will he completed by (date).The Owner hereby acknowledges
and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes.Acts of God,shortages of materi-
als.accidents,and all other delays beyond its control,shall not be considered as violations of this Agreement.
WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship or a period of following completion and shall comply
with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,Its subcontractors,employees or agents,is discovered
alter completion of any job,including cleanup,Me Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam-
ape or uch defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work.
We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of:
).
Payment to be made as follows:
%($ .ry'- " t')upon signing contract; NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR
Name of Contractor/Designated Registrant
%15 --' - )upon completion of I 148 DOTY CIRCLE
Street Address
i(S )upon completion of WEST SPRINGFIELD, MA 01089 413-739-4333
Ciy/State Phone
^r,($ .- C. )shall be made forthwith upon 103713 ___
completion of work under this contract. Registration No. _
Notice: No agreement for home improvement contracting work shall require a down Name of Salesman
payment(advance deposit)of more than one-third of the total contract price or the
total amount of all deposits or payments which the contractor must make in advance, Authorized Signature - - '(t
to order and/or otherwise obtain delivery of special order materials and equipment, y
whichever amount is greater /
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 may cancel this agreement if it has been signed by a party thereto at a place other
than an address of the Seller, which may be his main office or branch thereof, provided you notify the Seller in writing at his main
office branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following
the signing of this agreement. Please refer to the Notice of Cancellation.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Signature - '' - Date Signature Date