25C-060 (4) proposat Page No. of Pages
_ EUGENE BATTISTONI CONTRACTING
r r 11� _ ""`�. f 534 Market Hill Road
AMHERST, MASSACHUSETTS 01002
(413) 549-2693
PROPOSAL SUBMITTED TO PHONE DATE
Steve Md Harriet Rodgers - 586-7605 April 10,2002
STREET i t JOB NAME
11 Lincoln Avenue Same
CITY,STATE AND ZIP CODE JOB LOCATION
Northampton,MA 01060 Same
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
Removal of existing shingles from entire main roof,front porches and rear upper entry roof. Installation of/z"CDX fir plywood to
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existing roof boards. Installation of snow and ice shield on bottom 3' of roof edge and in valley areas. Installation of thirty pound
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felt on remainder of roof" Installation of aluminum drip edge and rake edge. Installation of thirty year architectural shingles to all
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roof areas listed above. Cut in lead flashing to chimney. Clean up of job related debris.
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Price: $13,740.00
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NOTE: If forty year architectural shingles are installed,price will be an additional$780.00
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We Piropose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
dollars($
Payment to be made as follows:
One third deposit,remainder due upon completion
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized
manner according to standard practices. Any alteration or deviation from above specifications Signature } Zk
involving extra costs will be executed only upon written orders,and will become an extra
charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: Thi4roposal may be
delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Our Withdrawn by us if not accepted within 15 days.
workers are fully covered by Workman's Compensation Insurance.
04eeeptAnce Of PCOpOS611 — The above prices,
specifications and conditions are satisfactory and are hereby accepted. Signature
You are authorized to do the work as specified. Payment will be made as
outlined above.
Signature
�ItnMPT
04 O
b 4 Gxt� of wort 11a 1iptolt
$ B
Isis XChnsrlis'
m DEPARTMENT OF BUII.DrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WHO-RKER'S COMPENSATION INSURANCE ATTITDAVIT
(licenser.Jpezmittee}
with a principal place of business/residence at:
(phone#) S'Y/
( city/stalr/ap)
do hereby certify, under the pains and penalties of pemiry, that:
(e�I am an employer providing the following wor-leer's compensation coverage for my
employees worlcing on this job:
(Insurance Company) (Policy Number) (Expiration Daze)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance ConlpmyiPolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Hxpiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(anach additicail sheet ifncccni to inc}udc information pertaining to all ocar ctors)
( ) I am a sole proprietor and have no one wor�dng for me.
( ) I am a home owner performing all the work myself.
NOTE:pluae be aware that while homcownm who employ persons to cio aa nlcazncc,c zvnuxice cr repair wuk cn a dwelling of
not more than thme units in which the boasoowncr rt=des or oa the g viw,6 appurtenanS thucto arc oo(Ccncrally coasidcfcd to be
cmploycr3 under the work s o=gcns4c-a Act(GL152,'s1 1(5)),application by a homoowvcr for a licrase or permit may cvidcnoc the
legal statue of an omployar under tho Workces Compomsiion Art
I uadcnund d"t a oopy of this statcmcut miy ba forwardod to tho Dgmztm al of Industrial Aocid=&Oftioo of Inwrsnco for thn
coverage verification and that failure to aoauc covctago under soctioa 25A of WIL 152 can lead to the imposition of criminal penalties
ooasistin of a fine of up to 51,500.00 and/or imprison of up to one year and civil pcnallics in the form of a Stop Work Order and a
fim of s t . a day against tz-
For dcpsr�—only
Permit Number
maps Lot#
i of L censee/Permittee e
SECTION 8'-:CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
/ License Numb r
Addr s Expi rat ion bAe
Si ure Telephone
"q �` . . Not Applicable ❑
e)
Company Name Registrati n Nu ber
fs 71
Address Expiration Datle
Telephone
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....... le, No...... ❑
:n ne O MUM-1111
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 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
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION'OF-PROPOSED WORK jche'ck all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: �-
Alteration of existing bedroom Yes L— No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
�a�1'fiNew�h�o`�useand`or acl dtion`°to�ezist�ng�.h�ousing�cortplete' th�xfollowiriir:
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. Mascheck 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 7a,-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNEFMIGENT 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
e— f •,r e "V— ,4- as Owne horized A en
hereby decla that the stat ments and information on the foregoing application Jre true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penaltie/ ;�A
G�
Print Name _
Signature of Owner/Age Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
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:
volume&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 YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO L' 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 there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location: _
pi `,�f Northampton
ng Department
Main Street
APR ? '2002 - oom 100
,.
Nojtha pton, MA 01060 a
i 0 ne.413 587 1240 Fax 413-587-1272 ,►' fit '
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This sectipn to be compl"eted by office
1.1 Property Address: *E
Awq
r /` ®! Map Iota z �'� U�rt,Y
! h9 / • ✓ u ` _ tea., � q"
Zone 0verlayD�str�ct :
Elm St. District CB District .
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
" �e 9��1 'e—
Name(Print) Current Mailing Address:
. 4�- 4d5
Telephone
Signature
2.2 Authorized Agent:
Nam nt Current lVfz ilin ddress:
Sig u e Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building (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) 4 Check Number
This Section For Official Use Only
Building Permit Number: Date issued:
Signature:
Building Commissioner/Inspector of Buildings Date
NiT'1'114
BP-2002-0910
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0910
Project# JS-2002.1484
Est.Cost: $13740.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Eugene Battistoni 003175
Lot Size(sq.ft.): 9496.08 Owner: ROGERS STEPHEN M&HARRIET
Zoning:URB Applicant. Eugene Battistoni
AT. 11 LINCOLN AVE
Applicant Address: Phone: Insurance:
534 Market Hill Rd (413) 549-2693 Workers
Compensation
AMHERSTMA01002 ISSUED ON:4122102 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:
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 4/22/02 0:00:00 15319 a�
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo