24A-066 (8) 53 RIDGEWOOD TER BP-2018-1073
GIS s: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-066 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: ROOF BUILDING PERMIT
Permits BP-2018-1073
Projects JS-2018-001936
Est. Cost$6500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WILLIAM SAUNDERS 95459
Lot Size(sa. ft.): 8232.84 Owner: BURWELL REBECCA A
zoning: URB(100) Applicant: WILLIAM SAUNDERS
AT. 53 RIDGEWOOD TER
ApplicantAddress: Phone: Insurance:
53 LAUREL HILL RD (774) 272-1798 WC
SOUTH BRI DGEMA01550 ISSUED ON.-411912018 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspectorof Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: Houses 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:
FeeTvpe: Date Paid: Amount:
Building 4/19/20180:00:00 $50.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
2C5o r
Department use only
-\ City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION ew- Ir -!(f?
1.1 Property Address: This section to be completed by office
S'I f? I p6C_ WUU,) Map e-L`(A Lot 100 / _Unit
J Zone Overlay District
Elm St.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
fl _57 nioo�e(,iaop — ,(on7,u HAS
Nape ilPrint) Cl— I(��'- � � Current Mailing Address:
lZl4.lAQ l {�S/ / Telephone
gnmure
2.2 Authorized Agent:
w1116fM fA(14194? C S3G/��(el /fit /tO So�rl� � rDCe
Name(Print) Current Mailing Address',
/ � '794—� ,)—)?l i
Signature ?T Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Oficial Use Only
completed bpermit 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
6. Total=(1 +2+3+4+5) L SOO Check Number
This Section For Official Use Only
Building Permit Number'. Date
Issued:
Signatur
Building C issioner/Inspector of Buildings Date
PI, K&U @cfF�/t i air- �t i
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to b,filled in by
Building Dep utmmt
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Heigbt
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&pavM
parking)
#of Puking Spaces
Fill:
volume&duration
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 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 O NO `Q
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
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over t acre or is it part of a common plan
that will disturb over 1 acre? YES O NO:Q—
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addhion ❑ Replacement Windows Alteration(s) Roofing
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [[I] Decks [M Siding fO] Other[C]
Brief Description of Proposed,
Work: CI Ile p e?(t o6
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Sa. 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?
& Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodsloves Number of each_
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
Ii 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.
1, Septic Tank_ City Sewer Privateweil City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS 1' AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
e 6e C at lJ l 7 f Ls-. I as Owner of the subject
property
hereby authorize
to cl on my behalf, in a afters relative to work authorized by this building permit application.
Ct
Signature of Owner p e
I, ni I (11 //M S/3OhP UiS as Owner45c�
a ief.
by declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
Signed under the pains and penalties of perjury.
Lvi11r�M .J4/Nq(/
Print
Name
O/F— /
Signature of Owier/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervlsor: Not Ap
p
licab
l
e ❑Q
Name of License Holder: Wlf(1 P/vl . if}�N�r/1.� 7515
License Number
S3 G/t�f�( lfin RO suciHl�llfoGe 0
Address Eviration Date
nature Telephone
9.Registered Home Improvement Contractor. Not Applicable ❑
5 39 S5^
Company Name Registration Number
Address SAUNDERS & SONS ROOFING, INC. Expiration Dae
I_ R0.4D Telephone
i
SECTION 18-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...... ❑
City of Northampton
Massachusetts «jss
l DEBAR� OF BUILDING INSPECTIONS
212 Mnvn street pnl Building
Northamptanan, M NA 01060
Debris 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.
The debris from construction work being performed at:
S3 I? I;g'fetiw0 jL'/C
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Ad�dress)
Signaat e�of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth ofMassachuseas
Department of Industrial Accidents
EvilMI Congress Street,Suite 100
Boston,MA 02114-2017
o wwwmass.gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WI I'It I'III,PERM]"ITING AU I IIORITV.
Applicant Information Please Print Leoibly
Business/Organization Name: SAUNDERS & SONS ROOFING, INC.
^E( IIftL-RO
SOU I HBRIDGE, MA 01550
Address: 866 SFr ROOF
City/State/Zip: Phone#:
ovte pa an employer?Check the appropriate box: Business Type(required):
�m a employer with (7 employees(full and/ 5. ❑Retail
- ` 6. RestaurantTar/Eating Establishment
2.Li e proprietor or partnership and have no 7, []Office and/or Sales line].real estate, auto,etc.)
employees working for me in any capacity.
[No workers'comp,insurance required] R. ❑Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑ Emertainment
their right of exemption per c. 152,§1(4),and we have 10.[]Manufacturing
no employees. [No workers'comp. insurance required]" I L❑ Health Care
4.E] We arc a non-profit organization,staffed by volunteers,
with no employees. [No workers'comp. insurance req.] 12.❑ Other /100r(n/Z
'Any applicant hat checks box#I must also till out the section below showing their workerscompensation policy infortrelion.
'9fthe corpora¢otLeas have exempted
airmail s,but the corporation has other employees,a workers'compensation policy is required and such an
organization should check bas#l.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information.
Insurance Company Namc:
Insurer's Address:
City/State/Zip: _
Policy#or Self-ins. Lia# Expiration Date:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to second coverage as required under Section 25A of MGL c. 152 can [cad to the imposition of criminal penalties of a
fine up to S 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 5250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded 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 neA —Z2) 'IV
Phone#: �7
Phone '/��/'2 X19
Ojr,ciat use only. Do not write in this area,to be completed by clN or town official.
City or Town: Permit/License#
Issuing.Authority(circle one):
I.Board of Health 2. Building Department 3. City/Town Clerk 4. Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.m se.goe.dla
PROPOSAL
SAUNDERS& SONS ROOFING INC. BSB anoaosAL NO
I' FomdyTrrd&pwdlod Mi
SHEET O.
Accepting Discover,MasterCard.Visa 1 86901-ROOF
0,ou, Bill Saodderi Incensed& 1 50&765-0100 pgrE c o
Freo E,norecs (neared Cell: 1-774-2721798 � � 60 ✓G
PROPOSAL SUBMITTED TO:
Saunders& Sons Roofing INC. NAME rh
53 Laurel Hill Road LttG
Southbridge, MA 01550 ADDRESS
/ 61ffQ UQ
MA CSL 095459 _
MA REG 153955 ON 1-7.4
PHONE NO.
CT REG 0638641
I
We hereby propose to furnish the materials and perform the labor necessary for the completion of 'f/1 rW f sf'✓ H✓��G
e,XCPT - 'i Sej
/ �CrStrd6 t00 S - ,
� w0 e O p L ,- o %v ` B -
aS o /f o� Pe'. A =Cr✓ r C ' .� v
jT CC ie e1G OA f11 -,'%p lJ
It ,N w J 7,C
G N jt ea T6f6t,4 p,w �ee- i / .
O C 1 L fi7S 14A,,) iF 9,v i
9 c Oct ZC4v MN Yr o .2 C11 '
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DO NOT SIGNTHIS CONTRACT IFTHERE ARE ANY BLANK SPACES!!(
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications
submitted for above work, and completed in a substantial workmanlike manner for the sum of S 1X Tit 0 rvAN 4 Ft ✓e
14 VNo'i t':2 i IDollars($ 6, Yo)V )
with payments to be made as follows:, 0 SOO Ji ri
a, c«, HlpjF coMvaei e
C20 110UN GJMDLe i101/
�0 Respectfully submitted 131/f .:Ac AO c'i
Any alteration or devlatlon imm above specifications Inwivin, wire costs Per -�.9✓m0/.fid/ ,�-�J N.+
will be executed only upon written older,and will become an extra throw
over and all the estimate. All agreements contingent upon strikes,
accidents,or delays beyaad our control. Note - This proposal maybe iIii,thdrawn
by us if not accepted within days.
------------
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work
as specified. Payments will be made as outlined above.
Signature
Datel4i �Ci��' � ' d Signature -i
You may cancel this agreement if it has been signed at a place other than the contractors normal place of business,provided you notify the contractor
in writing at his/her main office or branch office 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.See the attached notice of cancellation form for an explanation of this right.
'� oaHa EonsumaVEME aurtrRACT R l
HOMEIMPROVEMEMT CONTRACTOR
g, TYPE:Ir�
l Bi6t6teWaD Ea61uB
olr2erzol9 ,
WILLWASAUNDE.
DBIA Samoers and$orm Roof§Ig
William SO Clem
53 Laurel HB RE.
J
Southbridge,MA 07550 Undo��,
,on
of ealM of,.n sl Dbuseus
Ory Bron n!arol Wm,.al Lme neure
Boartl of Bmlainq Regular ons antl Slantla+as
Construction Supervisor
CS-095459 Upnes: 01/0512020
WILLIAM D SAUNOEIMp
61 LAUREL HB:i ROAD .v
SOUTHBRIDGE M/A�0L/a66A
Commissioner �/"�