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25-012 Carpentry a Remodeling BY Kenneth h Picard 68 Hayes Ave. West Springfield, MA. 01089 Phone 413 433 1943 Email khpic @comcast.net CS -SL #99193 March 13 2010 MA Reg #147235 CT Hic #0606233 Sandra L Yell 214 Riverbank Road Northampton MA. Phone 584 -0504 JOB SUMMARY (1) Contractor to strip existing roof to decking, re- nail decking. Ice & water barrier low slop roof on right side of house.& apply 30 LB paper on rest of roof. (2) Install new white aluminum rake & drip edge, replace vent pipe flashing Step flash chimney and counter flash chimney with 12" lead flashing. Total ridge vent with lomanco high point shingle over ridge vent. (3) Re -roof house with a Elk 30 year fiberglass laminated architectural asphalt roof shingle. (4) Contractor will remove all debris from the premises caused by his work. Our workmanship is guaranteed for five years (5)Any wood thats needs to be replaced will be billed out as cost plus labor. Labor & Material $3,199.00 Deposit $100.00 Start of job $1,500.00 Balance due upon complexion $1,599.00 Acceptance of ag eement " M � Contractor Owner Signature---b-d€--- - -- 'Ve • A ® CERTIFICATE OF LIABILITY INSURANCE DATE(rj /lO�l) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rejean J. Remillard Ins Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 23 Southwick St HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Feeding Hills, MA 01030 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: National Grange Mutual Kenneth Picard dba INSURER B' Carpentry by Kenneth Picard INSURER C: 68 Hayes Avenue _ INSURER D: West Springfield, MA 01089 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POUCY EFFECTIVE POLICY EXPIRATION LIMITS IJR IlLSRD TYPE OF INSURANCE DATE IMMIDD/YYYY1 DATEIMM /DD/YYW 1 GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X X COMMERCIAL GENERAL LIABILITY MPS27949 8/5/09 8/5 DAMAGE REMSES occurrences $ 500,000 CLAIMS MADE I X I OCCUR MED EXP (Anyone person) $ 10,000 PERSONAL & ADVINJURY 1$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 —_ POLICY PRO LOC .IF CT AUTOMOBILE LIABI UTY CC/WINED SINGLE LIMIT $ 1,000,000 A ANY AUTO M1B27949 1/28/10 1/28/11 (Ea accident) ,000 - ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY AGG $ • EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y/ N TORY I MTh F R ANY PR OPRIETOR/PARTNER/EXECUTNE E.L. EACH ACCIDENT $ OFFICERMIEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT I $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFT HE ABOVE DESCRIBED POLICIES BECANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUNG INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of Northampton NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn: Building Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Northampton, MA 01060 _ REPRESENTATIVES. AUTHORIZED RE PRESENTATIVE I / �1 ---' /� may:.) ACORD 25 (2009/01) ! © 1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines `Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two -year period shall not be considered a home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper jermits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to Date Address of work location _ .. . . . . .\ The Commonwealth of Massachusetts , —. Department of Indus Acidents - $ok -........=..--. A 5.. Office of Investigations F.= .$ 600 Washington Street t =...:. e. T..-,:w=.-..., Boston, PIA 02111 . www.mass gov/duz , - -.5 ...- -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly ' Name pusineseorganizationandividuaD: .,, . : - - . Address: , . . City/State/Zip: .. Phone.#: - .. Are you an employer? Check the appropriate box: ' Type of pioject (required): /' • 1. 0 I am a employer with 4. 0 I am a general contractor and I 6. 0 New construction have hired the sub-contractors employees (full and/or part-time).* listed on the sheet: 7. 0 Remodeling 2. P:i I am a sole proprietor or partner- These sub-contractors have .111 "... andhave no =ployees S. 0 Demolition • working for me m any capacity. eamloyees and have workers - - 0 atiition [No workers' co mp. insurance p 5. 0 We are a corpora 10. 0 - Electrical repairs or additions rocluirc 3 tion and its , ` -• - . I am a homeowner d6ing all work officers haVe4xeraisecl their . 1 • 11.0 Pluinbiug repairs or additions • myself [No workers' comp. Hen Of exemption per MGL 12. 0 Roof repairs insurance required.] t • c. 152, §1(4), and we have no . employees. [No workers' 13.0 Other • • ComP losurance regifired-1. 'Any applicant that checks box #1 must also fill out the section Mow showing their compensation policy information*. t Homeownert who submit dtii affidivitintficatimi they are doing all work and then hire outside vontraCtors =1st submit anew affidavit indicating such. . :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whediterlxnotthose entities have • employees. If the sUb-contraCtorsbaie employees, they must provide their workers' comp. policy number. l an employer that is providing workers' compensation insurance for my einplOyees. Below is the policy and job site information. . • . Insurance Company Name: . . • . - . Policy # or Self-Ms. 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 tinder Sedtion'25A 152 can lead to the iMPotitibri Of dining penalties of a fine up to 51,500.00 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 may be forwarded to the•Ofrtce UtiFeliiiiitions the forliiitiCe' COVeiraie•■ieiihCalfOn. . . • ' . -- 7 . 7 - '''' --- 777.777 - -7 -- ..., - 77 I kir herb_y__Certt under tie is ' and mottles ofpOraythaf the infeinnatiOnprovidistabOv - _iud_Cisrr.p Signature . , , e_____.e : . i . .... nate ... :. 5 . ., 0/ . 60 . : , --,_ , , . , - , . - - • . . Phone ii: - - 7 - Offset& use only. Do not write in this' area, to bi CO by city iii townOfficiaL • . . City or Town: • PermitiLicense #' _.„ Issuing Authority (circle one): :1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical ,Irispector 5. Plumbing Inspector 6. Other . • . . Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed r Constructions ervisor: Not Applicable ❑ Name of License Holder : kett �— T 1 +4 P co t c. 1 License Number ( _ 74a -S 1790-Q W. 9 4'?cp Q 1 (TN Addres r A Expiration Date g p._cz.a.A.A zi(j Ll3 /.74. Sign - ure Telephone 3 /y/ gets AV--- 1 iiiite fi tidrtto>l i lri>iaforai mertf �i `t a* °_ n 'te r x Not Applicable ❑ hn0 AC, 4 R Companv Name Registration Number / 4174 C Address / W ' / J Expiration Date /� (1-ate i e. W ' A6(1 Telephone q3 C l 4 13 / /d 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 ❑ ri l Qlmtl u Wn x Ezelm e The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) 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 farm 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 buildine 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E Siding [0] Other [0] *Descpo / fl CCU(? (✓l i Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 1 ct��ia��inl�l�te�fr Iull'nq: a. Use of building : One Family V' 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 stones? 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 la - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date , as Owner /Authorized 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. Print Name Signature of Owner /Agent Date 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 ; l Lot Size 1 __,1 i Frontage 1 Setbacks Front ? y Side L:: i R: L:f i 12:1 1 Rear Building Height t I € ; t Bldg. Square Footage 1-1 I 1% F-1 1 1 1 i Open Space Footage — L1 t i g % [ (Lot area minus bldg & paved - i = a parking) # of Parking Spaces i _: Fill: ��. i . (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Books 1 Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ,Date Issued C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: 1 D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q IF YES, describe size, type and location: 1 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - " ; i t Via.- 1 ,.,, 1 , , 1 . t' , City of Northampton t: �: Building Department l r� 212 Main Street ,� =. = . y -a . 1 oom 100 4 ;r -41 :F7r' }'a `I k NOrtharnpton, MA 01060 .1. ,',7,'„::::-,;1 ` 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 I 1.1 Property Address: e This section to be completed by office 301 V: �,et& bo: ,AV Map " Lot Unit zone Overlay District EHri -S Dlstrtc CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner f Record: s L QC k ALL J,Lk (Q'i bo RA. Name (Print) Curre Mailin ss: Telephone Signature 2.2 uthorized Agent: ] I f h 11 4 fl a J rY 3 s Na e Print) /t r . Current Mailing Address: t - i : LC -e - ftd Signature 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 6. Total= (1 +2 +3 +4 +5) , Check Number 32 , This Section For Official Use Only Date Building! Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date ¢: ,. BP-2010-1005 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -1005 Project # JS- 2010 - 001477 Est. Cost: $3199.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENNETH H PICARD 991190 Lot Size(sq. ft.): 44866.80 Owner: YELL SANDRA L Zoning: SC(100)/ Applicant: KENNETH H PICARD AT: 214 RIVERBANK RD Applicant Address: Phone: Insurance: 68 HAYES AVE (413) 433 -1943 WEST SPRINGFIELDMA01089 ISSUED ON:5/11 /2010 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 5/11/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo