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36-043 (1) P -3 homeowners' agent: Building Permit We Steve & Jessica Lacroix authorize Local Building and Remodeling to act as my agent to secure all necessary permits to carry out all work stated in this contract. 09 WARRANTY The GAF/ELK shingles include a 30 year "Systems Plus" Warranty. The 30 year warranty has 100% coverage for the first 20 years on all labor and materials, after 20 years it prorates still covering all labor and materials. NOTE: Extra care will be taken to protect shrubbery and plants but we cannot guarantee against damage due to the nature of the work performed. NOTE: Property is to be swept with commercial grade magnets to remove any excess debris. • Install new ridge vent along the entire ridge including dormer • InstalI 2 new pipe boot flashings • Grind out existing aluminum and install new lead flashing on the upper chimney • If a rain diverter is needed above any doors or windows it will be installed free of charge • Clean and haul away debris Note: The above price does not include the cost to re- plywood the roof. Re- plywood the entire roof: $3,170.00 Blown -in Cellulose Insulation: $1,300.00 • To be blow -in throughout the entire attic @ 12in. thick (Will bring to an R -value of 38) • This will be in addition to what is already in the attic (approx. 3in.) TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE The contractor agrees to perform the work, furnish the material and labor specified above for the SUM of: $9,920.00 (Nine Thousand Nine Hundred Twenty Dollars) Payments will be made according to the following SCHEDULE: $4,035.00 upon the start date ($1800.00 -roof+ $1585.00- plywood+ $650.00- insulation) $5,885.00 upon completion of the work The following schedule will be adhered to unless circumstances beyond the contractors control arise including weather or unexpected problems with other jobs. r , _ fi Work Scheduled to Begin: u V Expected Date of Completion: b V (Date Contractor will begin contracted work) (Date when work will be substantially completed) DO NOT SIGN THIS CONTRACT IF THER ARE ANY BLANK SPACES Ll L�� piU�/ Homeowner's signature Contractor's signature Date Date Required Permits The following building permits are required. It is the obligation of the contractor to secure such permits as the P Local Building and Remodeling Anthony Robitaille 413.626.5296 MA. License # 102453 Fax4132899611 MA. Reg. # 138144 HOME TIE O RMA M �T INFORMATION 15780 PCJ. i�� ,c- Fi92''7'1��,�- ��1Xr1LZ�C1 CONTRACTOR Name Company Name Steve & Jessica Lacroix Local Building & Remodeling Mailing Address Contractor /Owner Name 27 Winchester Street Anthony Robitaille City/Town State Zip Code Business Street Address Florence MA 01062 P.O. Box 892, 4212 Church St. Contact Number City/Town State Zip Code (413)586 -5514 Thorndike, MA 01079 Business Phone 1- 413 - 626 -5296 Contractor Registration #: 138144 - Expiration Date: 2 -25 -2010 WORK TO BE PERFORMED Roof Work: $5,450.00 • Remove existing shingles (approx. 18 squares) • Remove all plywood • Clean down any framing appearing to have mold on it with bleach and water mix • If more soffit vents are needed they will be cut in while the plywood is off of the roof • Install new 5/8 in. plywood on entire roof • Install 30 year GAF/ELK architectural shingles • Install GAF ice and water barrier around the eaves, valleys, and chimneys • Install synthetic underlayment paper • Install new drip edge • Install new step flashing 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 It- . 1 - ' • o .. - • es 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 -------- --pern its- in- conjunction..to_ 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 I, 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 me. Address of work location • The Commonwealth of Massachusetts Department of Industrial Accidents fi Office of Investigations ® ' p 600 Washington Street • • " Boston, MA 02111 ,;" . www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Lif3cR11 IkL /ML wJi t FN Over C tf ilfT(A; t. Please Print Legibly Name ( Business /Organization/Individual): Address: City /State/Zip: Phone. #: Are you an employer? Check the appropriate box: Type of project (required): 1 1. P I am a employer with 3 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2. ❑ I am a sole proprietor or partner- ship mid have no employees These sub - contractors have. 8. ❑ Demolon for me in any capacity. employees and have workers' t working Y ty. 9. Q Bulldin • addition [No workers' comp. insurance _ comp._ ;nsurance required ] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. C I am-a- hemeo-wner- deing- work o c_e� s ave xercise.. _• - — 13 1 Oth1 l_ P� er mg repairs or additions myself [No workers' comp. right of exemption per MGL 12.Q Roof repairs insurance required] t c. 152, 1 , and we have no 4 O employees. [No workers' 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. $Contractors 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: WALL _ _13 F ' t . • Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy nninber 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 yiolatar. ge advised that a copy of this statement may be forwarded to the Offi .: of Investigations of the DIA for insurance coverage verification. _ I do hereby certi under the pains and penoltiPs ofperjury that the information provided above_ astruemuLcorrea____ - . $! f' / Pate. 1 � 2 UQ Signa ,, , ' � . I- G • Phone #: L i 13 - (, 5 216 Official use only. DO write in thts area leted by city or town officiaL City or Town: Permit/License #_ - -- -_ - _ Issuing Authority (circle one): I: Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Ins. ector 5. Plumbing Ins. ector _ _ __ 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: (� T Not Applicable ❑ Name of License Holder:!" Ii I NvIV ' ( `( V-1 i4 lGk ic Z' 3 License Number ('c ft`t 'c72 '' ' r'I ta Mn 0:67g Address ji/c/2ci3 ratibn Date q1361 -6 52 i ✓, ` w r ✓� Signaturd Telephone 9. Registecctf;klome.Impro� cement ° C. nti ctor• , >,, ..<.. ; ,ate .,.. >, _... f Not Applicable ❑ be-E,4"--6 . • . 4 ii WI 1413f747t1t 13 5% Li if Company Name Registration Number • (fi:f D. f 4 1Lah G �fLSf Address c Expiration Date G ,5'1 ,''Ci Z j f -�Gj t rt �ui� CJI C Telephone L EI " (— _.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 ❑ it tt X I.. The_current_exemption for "honmeowners "was extended to include Owner 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, ui is intended to be, a one or two family dwelling, attached or detached structures accessory to snrh nse 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 building 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 o ampton a r. tnance , " a e • • .:. to . — , ®. eneralT;a =ws - Annotated. _ Homeowner Signature /\ ti SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House D Addition ❑ Replacement Windows Alteration(s) ❑ Roofing 14 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [p] Brief Description of Proposed Work: SrFzP t I'itituL RUci r P`1 We O RrPi w C A PL1 n wD Si - it�uL +� 3 c ' G4.F 4fK. Alteration of existing bedroom Yes I' No Adding new bedroom Yes V No Attached Narrative . Renovating unfinished basement Yes x No Plans Attached Roll - Sheet 6aiflieW, house ands radditionkoecistinf tiousincL amp a it ie f011ov liiq: a. Use of building : One Family Two Family Other it it b. Number of rooms in each family unit: Number of Bathrooms �..; v' + c. Is there a garage attached? I 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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR DUILDING PERMIT i, C t L G �'TI` - ,fi T as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by t building permit application. Signature of Owner Date I, , 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. S t Z CcOif/ Print Name Signature of Owner /Agent Date t .• 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 '_._._.__Y..._ m .... _ _ , Setbacks Front Side L:__ R.. L: R::,_____, _ __, Rear. ____: . Building Height Bldg. Square Footage l�_ % r Open Space Footage (Lot area minus bldg & paved L._ __ parking) # of Parking Spaces Fill: i 11 (volume & Location) ?.__ . .__._._. ; .___ ................__ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES 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 Book Page! i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 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 IF YES, describe size, type and location: ______ ._ D: ire tthiee a any proposed c anges to or a rtions o signs inten d-T t e property ? YES 0 NO 0 e 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 0 NO lea IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Stemut� Building Department 212 Main Street S��uue /S � a ; s Room 100 ob, Northampton, MA 01060 a 3��� phone 413- 587 -1240 Fax 413 - 587 -1272 �' �0 ` APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: �� I This section to be completed by office L 27 IAJ v gcsi P. 5r �'1- vitr �Ull" Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Add ss: 1 03 - 51t, 51`i - 1-1 ,' clef) Telephone Signature 2.2 Authorized Agent: Per] LIfii nn Name (Print) Current Mailing Address: / a • " 1 / 1 '1 /6 / �I / 3 - C ( - 5 2 �, 6 � Signatur6 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 q � 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 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of ° Buildings ' Date 27 WINCHESTER TERR BP- 2010 -0471 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36 - 043 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 -0471 Project # JS- 2010 - 000649 Est. Cost: $9920.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ANTHONY ROBITAILLE 102453 Lot Size(sq. ft.): 10018.80 Owner: LACROIX STEVEN E & JESSICA S zgrnnx_tIR 1100)//WSP II Applicant: ANTHONY ROBITAILLE AT: 27 WINCHES [ER TERR Applicant Address: Phone: Insurance: P 0 BOX 892 (413) 626 -5296 ThorndikeMA01079 ISSUED ON :10/29/2009 0 :00 :00 TO PERFORM THE FOLLOWING WORK :STRIP,PLY & 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: OK. 11 1 I3 107 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAI N OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu p anc /7 - ,_/ Signature: FeeType: Date Paid: Amount: Building 10/29/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo