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23B-019 (2) 30 HATFIELD ST BP-2020-1153 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-019 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-2020-1153 Proiect# JS-2020-001945 Est.Cost: $6375.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JEREMY SAWYER 106836 Lot Size(sq.ft.): 15638.04 Owner. KELLY PETER Zoning: SI(100)/ Applicant. JEREMY SAWYER AT. 30 HATFIELD ST Applicant Address: Phone: Insurance: 121 WEST STATE STREET (413) 478-1536 WC GRANBYMA01033 ISSUED ON:5/22/2020 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF ON HOUSE 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 Sipuature: FeeType: Date Paid: Amount: Building 5/22/2020 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: Building Department Purb Cut/Driveway Permit 212 Main Street, mer/Septic Availability Room 100 ,tier �� \/Vafer/Well Availability Northampton, MA 01'66 ,' ,� , ��2, Twd§ets of Structural Plans phone 413-587-1240 Fax 413-58 '1272O Ze!r ite Plans % Specify n APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENO*it,, R DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office /c/P� S Map Lot V Unit Q {- �►,� 7Zp n rnfi- D/D 6a Zone Overlay District V Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: //�� / y� �e �c� Yc L O r0�t/T/e ti SD3 nI /-G /w!S geV ,��erlry� i Name(Print) Current Mailing Address: 32o v16 Telephone Signature 2.2 Authorized Agent: —�PrPM S� e / �.� S �ti �e- n Name(Print) Current Mailing Address: /7/7d�_i5-3 6 Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ` -7 (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 014 6. Total=(1 +2+3+4+5) 3 7 S_ Check Number This Section For Official Use Only BuildingPermit Number: Date Issued: Signature: S- ' 2026 Building Commissioner/Inspector of Buildings Date 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 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 ParkingS aces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW 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 ® YES 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? YESO NO 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 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) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[o] Other[❑ij Brief Description of Proposed r / Work: e 140 0.1 2 XC"7 S G,71 T � S n y�✓ � �i„�/i Y�0 1� S c� s�c � , Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes X 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 X_ 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, Le C Ke as Owner of the subject property / hereby authorize ,--r to act on my behalf, in all matters relativeAo work authorize0y this building permit application. Signature of Owner Date /h e as Owner/Authorized Agent hereby declare tKat the stateme s 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. Print Name Sign at Owner/Agent D e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: =fre.-in,. 9 6 8,3 6 License Number 4 e- o 3 457/- / /te r, ;Ad;dress Expirat on Date e Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 00q /r h -1-c e--in rs / 7�/sa Company Name / Registration Number /�/ S �� Tc `Sf- Ccn-pip � t O/03.3 C91,2S� / AAdd6ress Exon Dat Telephone7��S-3� SECTION 10-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 �G DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building J� CDS Northampton, MA 01060 fS1, -y.)\1J 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 pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: d2D 0+1 'nEst. Cost: 6 3 7,5-- Address of Work: 30 - 5 la� Ala 46,; 4-1,0,7Ir Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied 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: s/ice/ v ser-,.n ti 5- 7 y s�8— Dat/e Contractor Ndme 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 �6. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS - i� x 212 Main Street •Municipal Building Northampton, MA 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: -e la/ ,sf (Please print house number and street name) Is to be disposed of at: (Please print name and I tion of facility) Or will be disposed of in a dumpster onsite rented or leased from: A/,o rjhf { 1) , fa6jd 2-1 GU /Qn I f J:rrinfIi-ell '-V 1�7 "0 (Company Name a d Address) Signa of PerrrrifApplicant 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. Department of Industrial Accidents ` Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le i0bly Name(Business/Organization/Individual): �Tere,-7c, SC`✓y�� ,/� �/ ,�r� iJ Address: /Q? I ` fes e SJ City/State/Zip: Cb d p 33 Phone#: / Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with S 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'- 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.N Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ 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. tContractors 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: –7—)7 �; � � �c�rC Policy#or Self-ins. Lic.#: 6 S 60 U G 9 F /,l t% /,;)F/5 Expiration Date: Job Site Address: 30 City/State/Zip: Alo(4 Aar+D �v r• �F� D /06 Z 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 p and penalties of perjury that the information provided above is true and correct Si nature: -- Date: ' 6 O Phone G—2 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#: ALL EXTERIORS ROOFING—FLAT ROOFING—SIDING—WINDOWS WEARE LICENSED REPAIRS-SNOW PLOWING FULLYINSURED Phone# (413) 478-1536 FACTORYTRAINED Fax # (413) 255-0125 OSHA CERTIFIED Jeremy Sawyer,President/Owner MA Registration#174528 HONEST&RELIABLE 121 West State St.,Granby,MA 01033 CT Registration#0636067 Allexteriorsl@gmail.com MA C.S.L.#106836 Proposal Submitted To: Date 4/.,].s/mac Phone#'s C: G L L lH: ' o Street Email: City,State,Zip Code Special Requirements:/O / ►I, , r7 /� /�tt: v� !JX V"�� rc c+ �S /i r a�� ❑ Recover Strip Complete Roof System Rrwe shall acquire all appropriate permits for all work Home exterior and landscaping to be protected Do Not Do ,;C f C;c r C x! Strip existing roofing to the decking and dispose of it in a proper landfill nk Deteriorated existing decking will be replaced at$75 per sheet of plywood after a full inspection. Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights(6'min.on all eaves) © Instail]37.G..IWu kynthetic)underlayment over remaining decking area od Install metal drip edge at eaves and rake 5") hit rown/copper) Da Install manufacturers starter shingle on all eaves Install new pipe boot stands opper) Install new vent ridge ven Ro Rigid) Shingles: (6 nails per shingle) is/7 F Shingles 4 HD Lifetime ❑ Ultra HD Lifetime Colorr' L Jd Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years(see our warranty coverage) Estimated Start Date i, t� Estimated Completion Date / Chimney Options: R1 Lead Counter Flashing ❑4"Box Vents(Black/Silver) ❑ 12"Box Vents(Black/Silver) We propose hereby to furnish materials and labor-complete In accordance with above specifications for the sum of:Total Due($ ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are Down Payment($ satisfactory and are hereby accepted.You are authorized to do work as specified. Payment will be 113 down at start of job,and balance due upon completion. Balance Due Day of Completio S Do not sign unless all sections are fille t r I Date: Owner.(Print) (Sign) CL Date: Estimator:(Print) t� Vic,r.�,r (Sig Estima s are honored for sixty(60)days from above date ATTENTION HOMEOWNERS:Please cover all personal belongs in the attic,garage or,storage due to the possibility of roofing debris or dust coming in through cracks of the wood.All Exteriors will not be responsible for debris or dust in the attic or storage areas.