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