Loading...
24B-024 31 BARREFTST BP-2019-1377 GIs#: COMMONWEALTH OF MASSACHUSETTS Mao�Block:24B-024 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-2019-1377 Pro eel# JS-2019-002216 Est. Cost SI 190W00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Clams Contractor: License: Use Group ROBERTS ROOFS CO INC 100333 Lot Size(sa. 8.1: 20342.52 Owner: SULLIVAN ROBERT E&JUDY C Zoning: URB(IOO),'HB(0)/ Applicant: SULLIVAN ROBERT E & JUDY C AT: 31 BARRETT ST Applicant Address: Phone: Insurance: 31 BARRETT ST Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON.5/31/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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 5/31/20190:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (4 13)587-1272 Louis Hasbrouck—Building Commissioner g-M F Department use only City of Northampton stain of Permit Building Department Curb Cut/Ddveway Permit 212 Main Street Sewer/Septic Availability !), Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 41 - 7-1272 Plot/Site Plans RE Other Specify_^ „ APPLICATION TO CONS RU ,ALTER,REPAIR,RENCIVAT4 OR DEMOLISH A ONE OR TWO FAMILY DWELLING y 3 1 2019 6,0— �— / 377 SECTION 1 -SITE INFORMATIO This section to be completed by office 1.1 PTOneM Address DEPT OF BUILDING INSPC-0TONa ' 6 � NORTHAMPTON.MA01060 31 Barrett Street . Lot 0-3- { unh Zone Overlay District Elm St District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 OWrrer of Record: Robert 8 JudYSullivan 31 Barrett Street, Northampton, MA 01060 Name(Pnnl) // Current Mailing Address: 413585-0361 Telephone Sign re 2.2 A Agent Roberts Roofs Co., Inc. PO Box 1312 Bondsville, MA 01009 Name(Penn Cunern Mailing Md.. 413-283-4395 um Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by pernnit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction fmm 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) G 5. Fire Protection 6. Total= 1 +2+ 3+4+5) $11,900.00 Check Number sj This Section For Official Use Only Date Building Permit Number. Issued: signature: -5-3) -20)9 Building Commissioner/Inspector of Buildings nate info a robertsroofsinccom 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 be filled in by Building Deparonent Lot Size Frontage Setbacks Front ' Side L: R: L: ! R: Rear Building Height Bldg.Square Footage Open Space Footage (I,ot area minus bldg&paved parking) #of Parking Spaces Fill: vowmc.Imation 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 © YES O 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 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 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 DESCRIPTION OF PROPOSED K all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors O Accessory Bldg. ❑ Deolition ❑ New mSigns 101 Decks IO Siding[OI Other[CI] Brief Description of Proposed Work:Remove existing roofing Install architectural shingles on sleep slopes and EPDM on shed dormer. Alteration of existing bedroom_Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement _Yes x No Plans Attached Roll -Sheet ea. 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? I. Method of heating? Fireplaces or Woodstows 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 OCR CONTRACTOR APPLIES FOR BUILDING PERMIT I, \k)"mi >\1` -,I CIN , as Owner of the subject property Roberts Roofs Co., Inc. /Brian Blanchette hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. ' S114 SignatunAof OweA Date Roberts Roofs Co., Inc. / Brian Blanchette as OwnedAuthonzed 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. Brian Blanchette Print Name Signa re edAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Thomas R Roberts CSSL- 100333 License Number PO Box 1312 Bondsville, MA 01009 7/3/20 Add Expiration Date Signature Telephone 413-283-4395 9.R"Istersd Home Improvement Contractor: Not Applicable ❑ Roberts Roofs Co., Inc. 128264 Company Name Registration Number 400 Franklin Street Belchertown, MA 01007 (3/16/21 Addressn Expiration Date ✓✓S�1l�D �• Telephone 283-4395 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted vnth this application. Failure to provide this affidavit vdll result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....._ IN No-.— ❑ Caf.,mortweaitn of Massachusetts ® diol Bion in Regulation and Stan Board of Building RegulalipnS and Standards Cor.Sf;ac4�oID SupeP�iaGr Srepiatiy C5SLA00333 Expires 07103i2020 TVbMAS R ROBERTS,JR , POGO%1312 BONDSVILLE MA 010" ' Commissioner slawinuol xaucf "SLLRFteRPo npp S✓krWsorB N� Failure t0 ppy4p State gMWh1y Cos.vrreht a"" Fair in'. D&I(61 ]2 9�aaabas this k.sa 'his ficei l Z, rIVJ!/)zCRCOE'OC/ O ✓7/(J2✓iICCJJ.1tJe�� Office of Consumer Again:and Business Regulation jl 1000 Washington street-Suite 710 j Boston,Massachusetts 02118 Home ImWowrent Contractor Registration Tm Como-Rmn ROBERTS Ii 5CO.MC, RulhbElbn'. 11e]aC M BOX 1312 E�pnWun: OY1613p1'1 e DSVUE.w DIM I K.r.. vuu.n Nan XbYwna Rxum csa. � a.rvwa.,,.R.uMrv...nwXw�.Mn MJME MMWEYEIn CONIe.1CTpR R�XWebn Wtlb YgFtluY uwuYE IYR:Cnlatlin EavRtlb EMiRlbn Yb.XbuMrvbnb. aWYOY OIIIm MLWunw XlnF�atlaWYna RPoWY,m 1• � XYINIE3� WENwNnymXuan-BulY 11X ROBEnT9FttYXCO.MC. aNut IM ENIE ��•(((��� I..R,RORFRU. �Ocl�x`OiowH wXlmr O�aReWY Nut nlq wlltpul alanalun City of Northampton g9..•":..rr� •s! " Massachusetts c Z " � DEPAItTNNNm OF SOILOLNG MSPBCSIONS 2 fa 212 Nein St Bat • Mu,i.ipal Building Noitpampton, [A 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any preexisting owner-occupied building containing at least one but act more than Pour dwelling units.._or to structures which am adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity mast be registered. Type of Work: Ra rstf 6c r"i'A Est. Cost: it I( no •00 Addressof Work: 3t -.,rw- Ct Date of Permit Application: (j�IC1 I hereby certify that: Registration is not required for the following resson(s): _Work excluded by law(explain): —Job under$1,000.00 Owner obtaining own permit(explain): Building not owneroccupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 5130/1 q Roberts Roofs Co., Inc. 128264 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton .?' Massachusetts A G L D9EPANTHENS of WTLDLNo MGMCTIMS p 212 Nein St .t •Municipal sniliinq I 1V6 C� NOrth 0 ton, M1 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, 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: 31 Barrett Street (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: USA Hauling & Recycling (Company Name and Address) ( S�3O�19 iKggal re of P pplicant or wner 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 Commonweakh of Massachusetts Department of Industrial Accidents Office of Investigations wi 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/OrganiaetionIndividual): Roberts Roofs Co., Inc Address: PO Box 1312 City/State/Zip: Bondsville, MA 01009 Phone#: 283-4395 Are you an employer?Check the appropriate box: Type of project(required): 1.f] 1 am a employer with 3 4. ❑ 1 am a general contractor and 1 6. ❑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.1 Z ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'wrap.insurance 5. ❑ Weare a corporation and its required.] officers have exercised their 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12E Roof repairs insurance required.]t employees.[No workers' 13 ❑Other comp. insurance required.] "My applicant Nat checks box ql mart also fill out the sermon below sim ongtheir workers'compensation polityfo inrmaion. t Nam who submit this affidavit indicating they are doing all work and Brea hire outside contractors most submit a new affidavit indicating such. Contractors that chink this box must attached as additional sheet showing the name ofthe sub-contmctors and their workers'comp.polity informatim. Into an employer that is providing workers'compensation insurance for my employees. Below is the policy and job she information. Insurance company Name: Farm Family Casualty Insurance Company Policy k or Self-ins.Lic.#: 2008W6216 Expiration Date:4/17/20 Job Site Address: 31 Barrett Street City/State/Zip: Northampton, MA 01060 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 under the pains andpenahies ofperjury that the information provided above is nue and correct. Si Date: stW19 Phone 0: '4395 --- Offtciat use only. Do not write in this area,to be completed by city or town offrciat City or Town: PermittLicense# 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#: s►coad CERTIFICATE OF LIABILITY INSURANCEo4n72o1s°0 /17/2 19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON WE CERTIFICATE HOLDER THIS CERTIFICA E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, MEND OR ALTER ME COVERAGE AFFORDED BY ME POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: M flue aHl1aNa holder Is an ADDITIONAL INSURED,the pogey(lw)nm.r M anrbnatl. N SUBROGATION IS WAIVED,infect W OR,Names and eond of the policy, In policies may miquos an eMereenn,Mn. A sts amerd on this cortllkaM roes wo,center rights W Has cerUSats holder In lieu of such s Pn KIC'Ma 1 Seen Rooney Seen PatrFk Rooney,Sr.doe RacesMosaa. 4136876817In—; 877-7716087 Rooney insurance Servkea sNamRxw*y@famqamNy.com 2341 B~Rd. AFFdeseIaCWBMOE MACe WHINge m MA 01095 MIyNERA. Farm FamYy Casualty lm nance Company 13003 IMAM® n NNER.: Roberts Roofs Company, Inc. �e; PO Box 1312 wrrxao: Bondsville, MA 01009 NWIERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE P IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAk1ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWOHSTANDING ANY REQUIREMENT,TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POUCHES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCW SIGNS AND CONDITIONS OF SUCH P(LICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYI£aFMemMME PwlLYM1rBE1l ER W LYIe CeMa31wALOBWL uNMTY 000000 wAINSWGE ❑GCgM R£M f 10 NEO FXP f 5,000 A Business Owners PoliQy 2007XO329 04/17/19 04/1720 s 1000000 asrrLAaaREwreuesrApwBs pER GETHEaWAaarucaE s 2,000,000 watt❑Jcn E:1- vRaoucls-COMpepAGG s 2,000 000 OT ER f NIfOYaLEYNYN N SNwEIM! f NIYAUTO a Y. p—) f .e1O D SCXEWIEO apwLY INIMY1Pa,aagsM) f MR08 W GS HM.. Rrl'MWGE f S ,IIIOResIA lige IIn EACHO RMN CCLCE f Ex®eWB fLl:.E AGGREGTFMR f p EM OH f W_al®1lCWBINIICN aT EGn .err��Tmvs YIN eE EecH Acacem f 100,000 A omcswMsrMSR vnu.. ❑xrA 2008V 6216 04/17/19 04/17/20 HIueyNraa EI OBFw•.E-u EMROYE i 100000 aEBCNI°RIWI��WA EL.OI8EA9E-FgY'Y U. s '100 000 omasrxM aFopw.TlaerLorwTlaervEBwn IACORe tol.Aeew,r wi,�ri.ee.amA m.r W Nixdxmweq�o M neeael CERTIFICATE HOLDER CANCELLATION SME E ARYOFTHEABOVE THEREOF NERTICE VVBE GJlCELIID BEFORE THE EIwIRATIOH ME THEREOF, N . WBL BE DELIVERED M ACCORDANCE WRXTHE POl1GY PROVBION9. /Nnlwl®P@IEBBIfATVE Seen Pabick Rooney,Sr. 01988-3014 ACORD CORPORATION. All rights reserved. ACORD 25(301401) The ACORD name and logo am registered marks of ACORD