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24D-112 273 STATE ST BP-2020-1154 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24D- 1]2 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-2020-1154 Proiect# JS-2020-001946 Est.Cost: $8700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JEREMY SAWYER 106836 Lot Size(sq.ft.): 6359.76 Owner: YUN SUN AE Zoning: URB(,100Applicant: JEREMY SAWYER AT: 273 STATE 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 FRONT MAIN ROOF ONLY 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 5/22/2020 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 NortFampt�' Status of Permit: Building Departrr `. Curb Cut/Driveway Permit f 212 Mai , Stroet /y�' ' Sewer/Septic Availability [ Rooln 100 �, ;• Water/Nell Availability �. Northampton, MA Ol lJti(0,D a Two Sets of Structural Plans phone 413-58k^`� 413-587-1 ePlot/Site Plans - Other Specify APPLICATION TO CONSTRUCT,ALTER, REk �'�R DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION v 1.1 Property Address: This section to be completed by office (� 7 3 S T c- S Map Z2 �� Lot_ // Z. Unit N 0 r+ a Q 1060 Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S V rx 19 f- WC C 7 3 .Sl-ti f t S7L Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: y7 Si a 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 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= 0 +2+3+4+5) Q Q Check Number 6-c/ Date Section For Official Use Only BuildingPermit Number: . I �/ Date Issued: Signature: 5-ZZ-20m 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 Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW Q 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? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YESO 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 0 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 [0] Other[0] Brief Description of Proposed r Work: /� P n 14 10D oT n Ece /-7,z //o J J-egoo 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 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT e VJil as Owner of the subject property T hereby authorize ) :e oc�l r-1 c„ L t to act on my behalf, in all matters relativ o work authorized/6y this building permit application. // Z /av Signature of Owner Date I, � �e�-+� �, SGr �,�h (/� as Owner/Authorized Agent hereby declare that a statements a d 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 Sig a u gent Ddie SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: --V-Q `n� 3 6 License Number c s 4 /'yl D o3 S�� 6 /d C) Address Expir�Date Sig a Telephone 9.Renistered Home Improvement Contractor: Not Applicable ❑ // x�cr-�d �s / 7 V S- Company Name Registration Number /a / Iii/ �' s - t s� �r4 � s�, � � o10J- ,,;� /as/a I Address / Expirat own Date' Telephone 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....... k No...... ❑ City of Northampton t� • v `- Y:� Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building D� Northampton, MA 01060 Js'Njy ,�OP 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: /�o 6 * t n Est. Cost: ?0 0 Address of Work: 7 3 -S�c, -� L S �— 4 r� h � �-/J Ae 1-�2 �9 62 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: Datce Contractor Marne 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 S/C •"`� Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 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: (Please print house number and street name) Is to be disposed of at: �., �S�- S� 'C 1-17 l9 011OX (Please print name anc6focation of facility) Or will be disposed of in a dumpster onsite rented or leased from: Ndr4n S 6 , n .S o / --5�✓ n S Tit/ 11-717 0//0,V (Company Name andAddress)dress) Sig re of Permit Applicant or Ownerbate 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. Sk\ l/LG L'Um//LV/{we"51/L Vf LYl IfJJ(Il:/�IiJGI{J e� Department of Industrial Accidents Office of Investigations 600 Washington Street . r Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): _,,) t'f- P,-v,t. SC�✓ �� �7 ✓� /� jr _��if Address: / 1 L 11 e S f City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.[3 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 working for me in any capacity. employees and have workers' $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required-] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.a 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: �C� Policy#or Self-ins.Lic.#: 6 S 60 U G o9 F 1 t 1.;?lr/S Expiration Date: V1/6/) Job Site Address: o� J 3 S4<4 C S F City/State/Zip: NO rV(c,ti 11 f o gif 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. Signature: Date: U Phone G'" &_ /,_.9 9 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#: t�„ •\ 1 ase L Urrifflu"Mcustrs UJ Irl tsJauCR UJCtts etc Department of Industrial Accidents = Office of Investigations f 'i 600 Washington Street i; Boston, MA 02111 www mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Flectricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): -__) ere,,-,L4 S Ga�✓ �� G' �� �1tr_ .0 Address: IQ 1 141 .S j f e S. City/State/Zi b rL v e;3 Phone#: � Are you an employer?Check the appropriate box: Type of project(required): 1.M 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance. $ required-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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' 13.0 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. 2Contractors 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'contpen.cation insurancefor my employees. Below is the policy and job site in formation. Insurance Company Name: / er.1 -6r)1—cl Policy#or Self-ins.Lic.#: 6S byy e -9 F /1 o-),Fj 5 Expiration Date:�r-/�/6 X) Job Site Address: L fl City/State/Zip: Alo c-�A a r—,Q �v r7 A c) 662 F 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 Signature: - Date: U Phone L/.7 ls' /.5_S 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 WEARS LICENSED REPAIRS-SNOW PLOWING FULLYINSURED Phone# (413) 478-1536 FACTORYTRAINED Fax#(413) 255-0125 OSHA CERTIFIED Jeremy SaWyerf 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 4- Proposal Submitted To:/ Date 3j/i ,;f p Phone#'s C: 4)/// t' J I?� / H: �- /SCJ� W: Street Email: ,:� -54- City,State,Zip Code Special Requirements: ©n 6 'J ❑ Recover Strip 005-0.q Complete Roof System11� o(,r� S -/a7 /ma We shall acquire all appropriate permits for all work v/'—, tC7c Home exterior and landscaping to be protected Do Not Do Z27a 4L.! rev E S tc f Strip existing roofing to the decking and dispose of it in a proper landfill ❑ Deteriorated existing decking will be replaced at$75 per sheet of plywood after a full inspection. Install Ice&Water Barrier at all eaves,valleys,chimneys,pipes and skylights(6'min.on all eaves) ® Install 51b.felt NSynthetic)underlayment over remaining decking area W Install metal drip edge at eaves and rakes 5") white rown/copper) 91 Install manufacturers starter shingle on all eaves ® Install new pipe boo copper) 0 Install new vent ridge ven of Rigid) Shingles: (6 nails per shingle) &/�� Shingles ErFHD Lifetime El Ultra HD Lifetime Color�dk 4 ; Ridge cap shingles Warranty Options: We guarantee our workmanship for 10 full years(see our warranty coverage) Estimated Start Date 6��a Estimated Completion Date�� Chimney Options: ,k Lead Counter Flashing ❑4"Box Vents(Black/Silver) ❑ 12"Box Vents(Black/Silver) 1 r We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due($ 2G)cI I ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are I Down Payment( 7 O satisfactory and are hereby accepted.You are authorized to do work as spec fied. y�ll� Payment will be 1/3 down at start of Job•and balance due upon completion. Balance Due Day of Completion($ V Do not sign unless all sections are filled out Date: - f '�� Owner.(Print)!7 L[_Lt� L(Ilj (Sign) Date: 3 / Estimator:(Print) —J ej—'1,1"7* Sc a_ •z c (Sign Estimates are honored for sixty(60)days from above dat 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.