18C-177 693 BRIDGE RD BP-2017-0856
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: ISC- 177 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-2017-0856
Project# JS-2017-001439
Est.Cost: $21602.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
ConstClass: Contractor: License:
Use Group: YANKEE HOME IMPROVEMENT INC 89442
Lot Size(sq. In: 15812.28 Owner COUCH KATHY C&CANDICE SALYERS
Zoning: URB(I00)/ Applicant: YANKEE HOME IMPROVEMENT INC
AT: 693 BRIDGE RD
Applicant Address: Phone: Insurance:
36 JUSTIN DR (413) 341-5259 0 WC
CH ICOPEEMA01022 ISSUED ON:1/13/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE EXISTING ROOF & REPLACE WITH
NEW ROOF , NEW SHINGLES, NEW UNDERLAYMENT
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 1/13/2017 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Al "QIX tt
City of Northampton r . sa '�
^V Building Department fA'
/ 212 Main Street
�} Room 100 _°'x=
T Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1•SITE INFORMATION P-I 3669
ThOo11 Property Address: f:Nrikn to be byomee
G3 5( vOge 'het .
NCO( k-b crri on , V\P of obc zoos aeedertxeala
Eim St DtWk%.. C6 DIea�I
SECTION 2•PROPERTY OWNERSHIP)AUTNORIZED AGENT
2.1 Owner of Record: n a t i l u ( tV 1.\oft,
�t X\ti ' .t
Name(Print) 1\ /� /` `' Cu r�tMoiliilddress:0r,.to
x- o I Cookral ic-v. Telephone "t ()
Signature
2.2 Authorized Anent: OIO2'a-
Mon Co Or-Mt 3(, (jusrri Dr . C,kyft ee,,MR
Name(Print) Current Mailing Address:
ILO (4 3 31n 57 e x� t2
Signature Telephone
SECTION$-ESTIMATED CONSTRUCTION COST$
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building G r7 I /l9 C 0`7 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction Igen(8)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection t
6. Total=(1 +2+3+4+5) `7..-� , (rat, Check Number 74'5 f
This Section For Official Use Only
Date
Building Permit Number AirIssued:
Signature. - -HT„re< ��� / 7 V117
Bulldog Commissioner Inspector of Buildings pate
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 I __. _
Frontage i _ __J :L_ I
Setbacks Front r-1 —
Side Uri_r __I R: -1 L:� I R:1 _ : : F-1
Rear L i !
Building Height f- 1 r 1
Bldg. Square Footage — r-' % : t - .
Open Space Footage % _____
(Lot area minus bldg&paved , L j i_' . i._)
parking)
#of Parking Spacesr
L_J r i u
Fac
(volume&�ation) —
_ --- 1
A. Has a Special Permit/Variance/Findin ever been issued for/on the site?
NO O DONT KNOW YES 0
IF YES, date issued:I
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES
IF YES: enter Book 1 I Page i and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO `1!' DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location: 1 1
E. Will the construction activity disturb(clearing,grading alion,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRPTION Of PROPOSED WORK(chock all walkable)
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition C New Signs [0] Decks [p Siding[0] Other[O]
Brief Description of Proposed �, `� C �` ^ ) Q
Work: V`Q, ex\= Irk r pta 4 Mt)A tn�les...,,n.{,P,U,t
Alteration of existing bedroom Yes No Adding new bedroom Yes No u1 UAJLyi(11eft
Attached Narrative Renovating unfinished basement Yes No JJJ
Plans Attached Roll -Sheet
, .i� .a '•' 4'.:�' a L "y. $ ;`_ i �t _r_ .r.';. t -mi a �: I'xv.�Si``:
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
properly
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Srgnature off/Owner Date
IIMMIIII
I. I /reby
a Lt, U/I!1 ,as OwnerfAuthorized
Agen h reby eclare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Si ned under the pains and penalties of perjury.
n m Ori
Pint NaNe71/triltOA Or q / / 7
Signature of Owner/Agent Date
SECTION S-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:sI ^/� r� Not Applicable
1, 1❑`J
Name of License Bolder: Cie YQYCk 3' Vol c 1 CS W \t1`I `
License Number
c?io jiAStin -N. ONctve NIA on-27 3 ' \ 7,0Ig
Address Expiration Date
/IAA( l 913 3(1) Sas4
Signature Telephone
._ „ .. v [. "...; Not Applicable ❑
4inV�P� Hc° cnn pi- € mens t(00584
Company Name Registration Number
3h41 T \\e ONczype,e, m€+ ,xy& 8 ' 7 7.02
Address Expiration Date
Telephoneg13'3..1 �1
SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§23C(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 Nor No 0
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 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 fano
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: 1. S, .' ' J . S *t Ili Pin 1 PiR
The debris will be transported by: �'Vic' 11tn Y rVI c f�
The debris will be received by: �Iv cplC�"' ` \ elOnot-
Building permit number:
Name of Permit Applicant
( . Q • 17 iat C
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
= Department of Industrie:Accidents
Office of Investigations
➢ --::
% _Alla 1 Congress Street, Suite 100
_1Boston, MA 02114-2017
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
Address:
City/State/Zip: Phone#: T _
Are you an employer?Check the appropriate box:
Type of project(required):
L 4. I 0 I am a employer with_ am a general contractor and I
6, 0 New construction
employees (full and/or part-time),* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance? 9. D Building addition
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12,0 Roof repairs
insurance required.] t c, 152, §1(4),and we have no
employees. [No workers' 13.0 Others
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 subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'romp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: 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 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 fonvarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
• City or Town: PennitfLieense#
issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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Roofing and Gutters Agreement
Thousands of Satisfied Clients!
yk►iKEE 36 Justin Drive MA 10Og94 1224 Milt Street,BIg 82n43
Jf"r11�11G�r q�foopea,MA 01022 CT Uc 0673924 in,CT 08029
HOME IMPROVEMENT 413 3414259 RI tic 133382 877 88-YANKEE
11.1111.1 Al home improvement Contractors and subcoMractora must be re9Mared and any in4Wnes.'.
about.contractor or subcontractor relating to a registration ahouldbe directed to:
OMce of CouameAffrn.W Labial Ra0iYdoaTa Park Plea,Salta 5170
www.YankI�eeHome.com Boats,MA 02116 Para:(617)971#791
Date 1-.2- I ) Homeowner Information
Name ►SaSk1 eAUCa•-. Email La.1 utt.Ts/...r.LA-
.
street b9& &dr Town natALn.rpla. state 0%Ota
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7he-Conlactragrees to db MIs tri'wig on*fix Os Homeowner:
(ROOFING Type c141c \ Color Fienr stint Style freA...\01...1
Removal of Existing Roofing ttfikes ONo Ice and Water Berner CpetEuf 0 Partial
Removal of Garage Roofing Sas [lo Ridge Vents rifles ONo
Dummies thee ONo Replace Pywood O ✓
yes b o sheets Ind.
Mail House Roof (Dies ONo Rolled 0.ow Slope OYesalo w l
Garage Roof te�i'ee ONo N
Location 1l,
Front Porch Roof Lives ,Fleshings r�`tkee OPto
Rear Porch Roof OYes�lo AS
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Drip Edge W �yy�res ONo Co
!GUTTERS Color LS:,L. Downspouts Color L :t2 ,��ym1
Layout Attached 1 Gutter((P��rdfe�ciion °Yea 1.10eD
CfrilSdeniel Sin 0 Commercial Bin Type tau�rq'
Downspout (7'tesidential 0 Commercial
Locationbiwra aViiar t96...�.ss o f4,1re0 cicc.uv
Garage 0Yes04 Color li+\:.�
Pace DYes oils
Special tnoUuctionsPi.�t A 4. .,
sIui4 \
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I—S—I 7 (drrl.eardl cants nary
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by the dnm.mrkMura.but mNordbsh* Ar al Cad+saw
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WARRANTY
The G. L.wnrr tidal.wok karewda andrldI M 6..wndden.NW mwWen wkaaalytor.eabd ay .na, it empl .aaWrnadeOraae
Ma nnraarmwa tlr IawnwrL a en MMC any ddid In wrwwae Or mnwW.Or daraea r.we by the rar.rm.b wawaata _.arcOY.r rear,a rbwar
arm,l iciav OR w finriad..r.oa,to C.a.S.Wet nbsume e,bw,Mt ronnd/.i.pr,ra.a ndar,nrnrb b ,rand ornanr,r
temp amid dated hnarW an wrnary.The bpke warw.W.per wMJO tiny awe Jean Wrbm.d ii memos Welts prwd.pon wank
VW.agrees to ,a perform the work,furnish the material and labor specified above for the total sum of: t27
_ova 11,con )wartoro rirr5(1m mdownd Name or a.rraaOrbev y 7.1 ek '! -• _ .
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(GUTTER& Color LLL Downspouts Color LLtst. s.at
Layout AlNctled( ' ea ONa
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Type OauAES
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vV� ,,.,,t Is ,... : YetUte,Drr
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,S,.Jite color 1.;
YANKEE
HOME IMPROVEMENT
3/4
36 Justin Drive,Chicopee,MA 01022
Tel:413-341-5259 Fax 413-341-5269
MA 160584 CT 0673924 RI 33382
August 22, 2016
To who it may concern,
I,Gerard Ronan,the CSL License holder,authorized Monica Orta to sign
the building permit application on my behalf.
Please don't hesitate to contact me if you have any questions.
Sincerely yours,
Gerard Ronan
Owner of Yankee Home Improvement,Inc.
Office of Consumer Affairs and Bdsiness Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 160584
?vpe. Rovate Corporation
Expiration'. 8/7/2018 Tr// 290702
YANKEE HOME IMPROVEMENT INC
GERARD RONAN
36 JUSTIN DR.
CHICOPEE, MA 01022
pdate Address and return card.frlark reason for change.
Address Renewal Employment Lost Card
Office of C umer \Ra irr&Rumness Regulation License valid for ndividual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 160584 Type: Office of Consumer Affair and Business Regulation
Expiration: 8/72018 Private Corporation 10 Park Plaza-Suite 5170
Boston_MA 02116
YANKEE HOME IMPROVEMENT INC
GERARD RONAN
36 JUSTIN CR. _
CHiCOPEE.MA 01022 t nder,ccremrs of valid without signature
CS-089442atit
GERARD.1 RONAN
38 JUSTIN DRIVE
CHICOPEE MA 01022 fAri.ma✓Ski
03/1911018
DEBRIS DISPOSAL AFFIDAVIT
In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit
# was issued with the condition that all debris resulting
from this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by M.G.L c. III, s. I50A.
The debris will be disposed of in:
_ t pbLc Sco,,1RGc -.-
Name of Waste Facility
1O Rye 3 Sri c'tQ_
Address of Waste Fa lity
i
illi Debristiti As a condition of issuing a permit far the arta,
renovation.
rehabilitation or other;4temion of a beNvg Or suture. Mair c.40I s.54 requires
a the debris resulting therefrom theft be disposed of in a phipmly Boded solid wase
disposal Scility as defined by M G.L.c. Ills. 150 A.Signature of the pat appllw¢
dee aidmanber of she building pen*to be issued shell be indicated aiprovided
by the Building CJryanment and attad to the office copy of tha 4rfm lag permit
ermined by the Builamg Depaonema If the debris will not be disposed of as indicated.
the holder of the perim shall not:be buildmz official.in writing es to the laza
where the debris well be disposed.
78DCMR—6"Edition
Air
of Permit Applicant
Date
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4▪ `ORO CERTIFICATE OF LIABILITY INSURANCEoats pacurrnal
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THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORTIXDON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT APRRMAnVELY OR NEGATIVELY AMEND, STENO OR ALTER THE COVERAGE AFFORDED BY THE POUOEM
BELOW. TMS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE,A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOIt6Ea
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER
IMPORTANT. If no cornices holder Is a.ADDITIONAL INSURED,the
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MA 01022 MA
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Workers' Compensation Insurance Affidavit:
Aiatlisaaadarmaliss Please PAS LetWr
Name . l: Yankee Home Improvement
Adm: 36 Justin Drive
C'tis _. . .: Chicopee, MA01022 -_.-_ phone#: 413-341-5259
Me fat as empbyer✓t Geek the appropriate Mn 7we.trejae(rgaketl)r.
t.{]Ilnamployer wish . 4. ❑ lam apoaat.asamt�aid' a. ❑Nary as
—'fall=Pot rialto)! have kited mesot-eaauanas
2.0 ran a solepteprit+a orparmao. titmdm�eatmcMddlcd 7. ❑Resodetng
ship mad have soemployees lhrse.aeb-cootrartra have 3. p Dmo&im
nits fee meinanycapacity. employees yaandhavewarn' 9. 0ming a on
'No ' . atop.amnaam.
r«>mted.1 5. p We aro a corporation ant 6s lAQStatical Maas aratakes
3.0Iamaipaaaowna al/aaek officers have exercised ter ll.pi' impala arMditios
nayoelE(No vrpa ..'eaa>Q. rabtofemaytatpaMGL 12.0 Roofneays
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_
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t sintoneta redo>✓®t this*MIMI vffidic they a s de*as wo t dap tdr oabasraathawaW aaYo•net ant kat;not
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easieyta. le!—` - ra"--An eml9ae'day ata eta***sputa'es policy ameta.
Iaw an employer that srps lip wa*es'°aapmaa Gs demwsatrwemployees. Mew Is dmpolicy aadfbsite
.
paay Phillips Insurance Company
lastroacefocoNone
per,#or�s.Lie st 61-1UB-66016144.16-MA Expiration Date 0525/2017
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