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23B-046 (120) 62/25/E002 12:17 413-585-6226 YUUNG ROOFING INC/-. PAGE 02 FEB-22-2002 13:57 COGLE�' D t CK l NSON 413 582 2959 r P_02/03 i Ccntr.Lie.No, 1 01723 Proposal CAQ. 0 a- a 3 _ �- OUNG Tel. 413-584.1367 figfl. �. 413-586-9167 Fax 4I3-S85-0226 t Roofing j FEB 2 F ���'2 P.O. Boa 56 _.� Florence, MA 01062-0056 Ga. r,� ,yt� t ^iS tta Date, 2/8!02 Hospital a: 31 Locust Ott.Northamption,MA.01060 Job Location Boiler Roam Roof area thst has asbestos panels SPECIFICATION'S: 1. Install galvanized metal decking and anchor to the existing steel perlins. 2. Initall 26'gauW-Max-Rib"galvalume Kynar finish metal roofing. 3. Fabricate and install flashing for walls and roof edges. 4. Owner to choose standard color. Custom colors will be extra. 5. Owner will have the asbestos panels removed before roofing scans. IN3c�7C WE PROPOSE TO FURMSH MATERIAL AND L50R 1N ACCORDANCE WTTH THE ABOVE SPBCMCAMONS,FOR TM SUM OF. Twenty,roux Thouesad Fow Htn&ed&00/100 24,400.00 Pollan{3,_ - �• THE ABOVE PRICE IS GOOD FOR THIRTY(30)DAYS ,PAYN04 T TO BE MADE AS FOLLOWS: In full upon connpleaon. 110 M�l.eY1 r t•tx� Art r,erae�r selOtle��4� lenAee M l�r�t aw era�rYr16 pl yin rnrMeSt upa� MM&n aw wr•ft""O a•� w" «r AttthoriZeQ ttat+d Ptesidei►i rt reM w eM ww0 Odd.M eft w�OW am @Won M IM OMO-0-0— way am—6. �e �r ANOW" o�n r�+.l�ur+s �a Signatum Aec"tmat of Proposal- The above g ° priccc,apeaifications tad eeadidams are satisfactory 4" arc lgiut hereby toeapted. You en eathortud to do the work u 1peeifled: Peymsor aria be made u autlhWd above. Date of AccarAma al^o�'-0 � �a Version 1.7 Commercial Building Permit May 15,2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES -'FOR'BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address _ Expiration Date. -- --- Signature Telephone 92 Registered Professional Engineer(s): Name ii Area of Responsibility Address Registration Number Signature i Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Young Roofing Co., Inc. Not Applicable ❑ Company Name: Richard Young President Responsible In Charge of Construction P.O. Box 56 Florence, MA. 01062 Address If /� , 1b C"1Ci tG 584-1367 Signature T Telephone 04_(t�t plO 8� °g Cr laf wart 11aillpf oil z 6 �asat:rhnsrtts' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORETR'S COMPENSATTON INSURANCE + + AVTT I, (licenserJpermittec} with a principal place of business/residence at: (phonet#) (sti r�.t/city/stairJrip) do hereby certify, under the pains and penalties of perjury, that: (4am an employer providing the following worker's compensation coverage for lily employees woring on this job: (Ins-umnce Corapmy) (Policy Ivrumber) (Expiration Datc) ( 1 I am a sole proprietor, general contractor or homeowner (circle one) and have hire the contractors listed below who have the following worker's compensation policies'. (Name of Contractor) (Insurance Company/Policy Numbcr) (Expiration Date) ,f (Name of Contractor) (Insurance Company/Poiicy Number) (Expiration Date) (Name of Contractor) (Insmancrr Compary/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (attach additioml shect ifnoo=.vy to include informarioa pataining to aIl ooCjtractors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that vihile hooxxAvo a who employ persons w do maiatcnancq consirctioa or repay work on a dwelling of not ntoce than throo unit in which the hoes»owner resides or oa the p-otitxli appurtenant lhercto tiro not ctn=ny ooandercd to be employcr3 under the waakr's ration Act(GL152,m 1(5)�application by a homcoww for a liarru a pelmd may evidence the legal datua of an employer under the Workeet Compensation Act I understand that a copy of this rtalemcat may be forwended to the Deputaxai of Industrial Ao6d=&Offioo of Imivanoo for the covmge vcrificatioa and that failure to seam ooverngo under soctioa 25A of MGL 152 can lead to the imposition of criminal penalties ooasisiiag of a Sac of up to S 1,500.00 and/or imprisonnxut of up to one year and avil pcnaltia in the form of a Stop Work Ord-and a firm of 3100.00 a day agpinst tile_ For dq=W3- till uao only / Permit Number 17, ---L40t# s . Signature of Li ermit tce e Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-,STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION 11=OWNER AUTHORIZATION -,TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date _J as Owner/Authorized Agent hereby declare t t th tateme 'ts 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 11, o, a-:5 10.; Signature of Owner/Agent Date SECTION 12 CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Richard Young 011878 License Number P.O. Box 56 Florence, MA. 01062 8/14/03 Address i Expiration Date 66 �.I �C-Z 413-584-1 367 Signature Telephone SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. d. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavi- will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... El No...... ❑ Versionl.7 Commercial Building Permit May 15,2000 17. Water Supply(M.G.L. c.40, § 54) 17.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Q Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING 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: (vo}ume&Location) A. Has a Special Permit/Variance/Finding/ever been issued for/on the site? NO DON'T KNOW ✓ YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW Z YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are t re any proposed changes to or additions of signs intended for the property ?YES — No IF YES, describe size, type and location: Version 1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS:LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations Existing Wall Signs Existing Ground Signs [Additions ❑ Roofing M ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ lA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ( ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION F 1 - OFFICE GEtN P y Ns Floor Area per Floor(sf) St r y s 4 1st 2nd 3rd > 4tn y, 3rd 4tha s Total Area (sf) Total Proposed New Construction (sf) f a u. >; Total Height(ft) $' y i / 8 Total Height ft-------------------- �� I Versionl.7 Commercial Building Permit May 15,2000 �n City.of Northampton f e uilding Department 212 Main Street '4 Z Room 100 202 e No thampton, MA 01060 Two es fEc . 1 413- 87-1240 Fax 413-587-1272 P1 , ePia .a It herSpe�i ymp TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This section to be completed by office 1.1 Property Address: i1 Map. Lot Unit' F i ���r� I yA`Et LEI s "Zone Overlay District Elm St. District CB District SECTION 2 -'PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Young Roofing Co., Inc. P.O. Box 56 Florence, MA. 01062-0056 Name(Prial) Current Mailing Address: 413-584-1367 Signature Ll Telephone SECTION 3 -'ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building, Ck (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction.from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) r 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) I �. .).f1 Check Number v This'Settion For Official Use Onl Building Permit'Number: Date Issued: Signature: Building'Commissioner/Inspector of',Buildings Date f 39 LOCUST ST BP-2002-0728 GIS#: COMMONWEALTH OF MASSACHUSETTS � a :Block:23B-046 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2002-0728 Project# JS-2002-1198 Est.Cost: $18500.00 Fee: $92.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Young Roofing Co Inc 011878 Lot Size(sq.ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: Young Roofing Co Inc AT. 30 LOCUST ST Applicant Address: Phone: Insurance: P O Box 56 (413) 584-1367 Workers Compensation FLORENCEMA01062 ISSUED OIV:2125102 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL NEW METAL ROOF OVER BOILER ROOM AREA 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 2/25/02 0:00:00 12917 $92.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo