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36-099 �'/� �ominoo�uerr�Q(� oy°,�{aaaaaGuaetYa BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbeli'.CS, 031003 eirt �ft T / 944 0 1�IQ06 Tr. no: 26839 w Re st, GARY C REHBEIIN� t' 16 JONATHAN JUDD CIR / SOUTHAMPTON, MA`0'1073 Commissioner Board of Building egulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/19/1944 Number: CS 031003 Expires: 05/19/2006 Restricted TO: 00 GARY C REHBEIN 16 JONATHAN JUDD CIR SOUTHAMPTON, MA 01073 Tr. no: 26839 Keep top for receipt and change of address notification. DPS-CA1 O 50M-04/04-G101216 Nt1LL 6 NULL 11VJ. l.0 1-aX:413(31bbZJ May 11 2=) 11:15 h'.U1 ACORD„ CERTIFICATE OF LIABILITY INSURANCE CSR CO DATE(MMIDDlYYYY) vSMx-1 05/12/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Neill s Neill Insurance Agelacy HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 662 Riverdale Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West SpJcingfield Mh 01069 Phone:413-732-4137 Fax:413-731-6629 INSURERS AFFORDING COVERAGE NAIC# ..I. __. INSURER A: Western World Insurance Co. INSURER B: Conma -Ce Inaurance C 34754 II,B, ibuto s Inc t3 INSURER C: Granite State Insurance Co. Distributors Inc _ _ 740 High Street i INSURER D: Holyoke NA 01040 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED 9E,LOW HAVE BEEN ISSUED TO THE INSURED NAMFO 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 PERTAim,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE=CT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EF If LTR NERO. TYPE OF INSURANCE _ POLICY NUMBER -� —DAB T�MNJPPryY DATE M/ODIW LIMITS •QEmeAAL LIAWTV I EACH OCCURRENCE S 1,000,000 A ( X COMMERCIAL GENERAL LIABUTY NPPB64900 09/22/04 I 09/22/05 PREmiSES(Eaoawenca) 550,000 ( CLAIMS MADE n OCCUR I MED EXP IAny WO DOMOA) •S S,OOO PERSONAL 8 ADV INJURY 'S 1,000,000 i L GENERAL AGGREGAT E !s2,000,000 'GEWL AGGREGATE LIMIT APPLIES PER: /under Rindar---pending I I PRODUCTS-COMP/OP AGG;S 1,000,000 I A Po4CY jECT LOC '. i•AUTQMQMF-LAIIN ITY S L_ ANY AUTO I XQ7036 I 09/27/04 09/27/05 EM��,INGLELIMIT 'S ALL OWNED AUTOS i GODILY s250,000 X SCHEDULED AUTOS :(Par person) HN2EDAUT01 BODILY INJURY $500,000 I NON OWNED AUTOS I(Pet eCCideM) I__ I PROPERTY DAMAGE 8100,000 I (Per 34cideM) GARAGE LIA6IJTY I AUTO ONLY-EA ACCIDENT f • ANY AUTO I OTHER THAN EA ACC S AUTO ONLY: AGG S i EJICE96BIUYBRF11J1 LABILITY I EACH OCCURRENCE S jF-]OCCUR CLAIMS MADE I AGGREGATE S I ! S i I-• DEDUCTIBLE S I i• I RETENTION S I S WORKERS COMPENSATION AND ! X TORY LIMITS ER C '°MPL40 WC 831-16-80 12/02/04 j 12/02/05 E.L.EACH ACCIDENT 6100,000 ANY PRO PRIETDRlPAKTNER1MCUTIVE OFFICERIMEMBEREXCLUDED? EL DISEASE-EA EMPLOYEE 5100,000 res.describe under $I PECIALPROVISIONSbelaw j I E.L.DISEASE-POLICY LIMIT 3500,000 ' I DTMER ! I I I I• i ummmON OF oPERATiomaj LOCATIONS/VEHIcros 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION S _1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMMATION Insurance Purposes Only DATE THEREOF,THE ISSIANG INSURER WK.L ENDEAVOR TO MAIL 10 DAYS WRITTEN Indi.vi.daul Cartif icates Issued NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,8W FAl4YRE TO 00$0 SHALL on request IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE$. AUTHORIZED REPRE6EUTATME David W Neill ACORD 2S(2001108) ORD CORPORATION 1885 Board o an tan ar s One Ashburton Place - Room 1301 " Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 134740 Type: Private Corporation Expiration: 1/11/2006 U.S. METAL ROOFING DISTRIBUTION , IN GARY REHBEIN 740 HIGH ST. SUITE 2 HOLYOKE, MA 01040 Update Address and return card.Mark reason for chang Fl Address F� Renewal E] Employment F-1 Lost Card ✓fie �arn�ruyrc��reall� ��a�aczc/iu4ella , Board of Building Regulations and Staodards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 134740 Expiration: 1/11!2006 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Private Corporation U.S.METAL ROOFING DISTRIBUTION ,INC. GARY REHBEIN 740 HIGH ST.SUITE 2 HOLYOKE,MA 01040 Administrator Not valid without signature aS twr pr F E (rii-�) of Ncrufllarll}lfoll — 4 DEPARTMENT OP DUJLDn\iC INSPPCTIOt,'S 212 Main StrCCL • Municipal Building Northampton, Mnss. OIOGO WOFUCCRIS COMT�NSA_nON C?SURANCT_ AFFII)A\q-j' niccvsx�Cmvticc) \vith z principal place of((busioesslresidencc at G _��t L' ✓!l J "" �a / lrez t p✓�1 r - ()hone::') �sm�Uc�s flsuzcrDO do hereby certify, under Lhe.pa_itts --Lid pen2lties of perjury, hal (x) I am an employer providing the followinL workers comncns coverm- 'c for In) Ctuplovecs NvorUng on dtis job. (LayUj.:= (,POUC: Num.bcr) (T_:p;roor,Dztc) O I am a sole proon-ctor, general conaaaor or homeowner (c c:e one) and have hired the coocractors listed below wbo have the Iodow-i02 worker's comoensaoon policies: (Nsmc o-Co,.+-aao>) (hisurantz. Cornoan)-:P66c, (Name of Cootrcaor) -- (InsuzoC COMDa,-/?bt1C NUOC'f) (–L.\Pir,.uon Date) (Name o(Connaetd,) C'aLTwaocz Compa ytPoUicy N,urb;-t) (ExyoU`600 Dalc) (N2JDe of Coa(raeror (Iasutanc-- Company/Policy NumbJ) (Expir-.doa DaJZ) (.tladt:4!i'.ixsJ c:+ccs if orec,..ry to e,e�vek�nform.�oo perlaidint to+11 oocrae..o:a) � ( } I am a sole proprietor and have no one worlang for me.. ( ) I atn..2 home olwer performing all the xvork myself NOTE:plesc be eoyt t1,- 1i)e bemoowocn wbo anploy Pl-a to Lb orr_—_e oo r mpaa•.ork*3,d.,<1L^t or as nocc Lb-- Oz-tom,ie u+yeb 0..botaoawoa rc>ida or oa the fjvup6 tppttrt theao ez oo( oec,:d-od to tr ciiployc�uoe—the .ecsozc=V _.,;oa Act(GL1S2-=l S C )�wpp(i+csnoo by.6omrowyrf(u c lior_x a paten t>;y c.idcvcx tLr 1 r. rtsy<of m c>~,,loyx uod-d,o Workor,Compamatioa An. Iµnd.entaod tp.a w oopy of tAi.mlemc u—y b.for---d d to the pcq.nmm,of lobatn4 Ac d..&Mon ar 4w�ror t6 oovcn.sc w'iG cnioo wad a►a1 L-Jwc to.eaux Cove%r trader$4c600 1 S A of KtoL 151 as lad to tt o uapcaCioo or pcoaltio 000stticg of a G=or up to S QOQ 00 utdor 6nPrixpomccy of up to otx yc tnd o%iJ pmal'.io w cx roan or a Stop Work Orda.od. rim o(S 100.00,day t p,i"tnc roe d,y :=W y Pcrm;t Numb- - _— S LL ofL W ) ' S 'd dSE 10 b0 t,I daS SECTION 8•CONSTRUCTION SERVICES 8.1 61ceased Cons on Suipervisor: Not Applicable ❑ dame of License Hold— 0-, �C_ Al 6 r- K o3i 0(f%3 V License Number 0 AJ A 71-W k L-i L"2/9 Address f Expiration lbqte Signature Telephone p W— - L .' Not Applicable ❑ J ZA L- t'z S 13 q Company Name / Registration Number �-IZ7!0 1�--i a 5766,,� l S02L,- d - 1;1.,It/,(, (� Address Expilration Date Telephone SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1152,j 25C(6)) Workers Compensation Insurancq affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of thdbuilding permit. A Signed Affidavit Attached Yes........ No...... 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwelliggs 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 78D. 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 thcre 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 mrson 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 Officials that he/she shall be rcsvonsible for all such work performed under the buildlay pelmlit. As acting Construgfian 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 Employers 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 — Cl CISE : 10 bo t,I clas SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House [] Addition [] Replacement Windows Akeration(s) Rooflng Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks jM Siding j)D) Other[D) Brief Description of Proposed / f Work: Sik s Dt,SaQS* 'j E'—T ( vq 1�7fLjo �F.[im Alteration of existing bedroom Yes ` No ding new bedroom Yes 's�� No Attached Narrative -- Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet 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. 1. 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 f as Owner of the subject roperty hereby authorize to act on my behalf,irf all matters relative o� workauthorized by this building permit applic L,J Signature of Owner Date as Owner/Authorized Agent ere y de6fare that the statemen nd Information on the foregoing 6pplication a true end accurate,to the best of my knowledge and belief. f Signed under the pains and penalties of perjury. PrinM i signaturiof r/Agent Date E •d dSE � IO b0 b) daS ^ . . `- ` ' ' 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 Depamnent Lot Size Setbacks Front Rear ' Building Height Bldg.Square Footage Open Space Footage 0/0 (Lot area minus bidg&paved L A. Has a Special ever been issued for/on the site? NO 0 DDNTKNOW YES 0 r—' -------1 ' IF YES, date issued1___���_ IF YES: Was the permit recorded attoe Registry of Deeds? NO � ) D0N7nNOW YES � �— -----7^—. —'--- r � IF YES: enter Book � � Page,—\ --- � and/or Documontx B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 1� YES � . +F YES, has a permit been o,need mmuu obtained from the Conservation Commission? Needs wohe obtained �� Obtained »�� �muo�suw�� x_� v�v ' � � C. Do any signs exist on the property? YES x�� NO |F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO �0 IF YES, describe sizo' typeand looution: E Will the construction activity ^` excavation,m filling)over 1 acre cvisa part nfa common plan that will disturb over 1acre? YES �`�� NO ���r= IF YES,then a Northampton Storm Water Management Permit from the DPW is required. 2 'CI ' OisG ' TU 1'0 t,z 6aS ,S s W \o City o .Mprthampton ��Bui'_in epartment 2� 2 2 Ma Street Roo 100r ;Ngrdh5mpton, MA 01060 3187-1�Z4� Fax 413-567-1272 -74�PLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1,1 Proaerty Address: Thie sectlii4 be cdkojdted by office Map .,Lot Unit 0t4 }1e 4?wlayV strict 0/0( i- Eln St:District CWDistr[ct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ,J ti Ja1 '. � - 7f/ VIAL c � �1% Z-1(D Name��ml ��� Cur ent Maili� g�i Address: Telephone 2.2l//AF t i.t horized-Adent: ,l ! '.!(7- J(V 4 tl � y�J / r-1 ti1..4� .�t •-' Name rint) h Currint Mailing Addd-r) ( ! Signature � � Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b ermit applicant 1. Building r (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) ,- (j /7'"C., Check Number This Section For Official Use Only Date Building Permit Number. Issued: Signature Building Commissioner/Inspector of Buildings Date T 'd db6 TD t,0 t,T daS a s 981 BURTS PIT RD BP-2006-0231 GIs#: COMMONWEALTH OF MASSACHUSETTS MapBlock:36-099 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category BUILDING PERMIT Permit# BP-2006-0231 Project# JS-2006-0336 Est.Cost: $20750.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: U S METAL ROOFING DISTRIBUTORS, INC 134740 Lot Size(sq.ft.): 22956.12 Owner: POPIELARCZYK EDWARD J JR& Zoning URA Applicant: U S METAL ROOFING DISTRIBUTORS, INC AT. 981 BURTS PIT RD Applicant Address: Phone: Insurance: 740 HIGH ST SUITE 2 (413) 536-5474 WC HOLYOKEMA01040 ISSUED ON.813112005 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP SHINGLES & INSTALL METAL STANDING SEAM 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 Siinature: FeeType• Date Paid: Amount: Building 8/31/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo