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17A-261 (2) 3propofsaY SEXTON ROOFING CO. Tamko Roofing Systems U.S. INTEC BRAI Gold Club #6822 (413) 534-1234 P.O. Box 6327 800-524-ROOF HIC #118239 Holyoke, MA 01041 PHONE -6-1546 DATE SUBMITTEDTO & 5 STREET 6 0 KI I "S JOB NAM?("`10Vt_' JL�l, .6 CITY STATE F-1 0,'i F_ JOB LOCATION ZIP CODE SEXTON ROOFING HEREBY SUBMITS SPECIFICATIONS AND ESTIMATES FOR: S TR i P 1"N Z� LE'11" V ,C"� i'A l 0-1- 14. PI R01 1"_ 1 Ai j f, -7, � OT K 2 4" 4.k9 t'q 6 4 A i) ij T; fJ �"'i 4) ZA'574LI 1""' _ /Vj C I j j,/,I _4 .'X 'j km/k I A 4 9 D I j SYPP01 JEA"',7 4 11C00FIIN(; 12) 411 CO*TRACT!, AR.r: FU ANA /�- U 13j _0'0i R(JOF V .;qe proyj�hereby to furniph material and-14bor-c,orrieletp-irl accordance with the above specifications, for the sum of: Z L V, , j ---- dollars $ PAYMENT TO BE MADE AS FOLLOWS Id d"I'', J"L f All Material is guaranteed to be as specified.All work to be completed in a workmanlike manner Authorized according to standard practices.Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and Signature above the estimate.All agreements contingent upon strikes,accidents or delays beyond our con- Note,This proposal may be trol.Not responsible for water damage during construction.Owner topay responsible legal fees for non-payment,and applicable interest. withdrawn by us if not accepted within days. 001 The above prices,specifications and conditions rop Signature fV of to taM 21rCtpt r r are satisfactory and are hereby accepted. You are authorized to do the re satisfactory Ctory p work as specified.Payment will be made as outlined above. work S specified. a of p Signature Date of Acceptance ptance. i - 0 e 8 �x IDriTZ# �I1t�1II1T ID �a54RChtrS[1ta' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFMAVIT CO r (li cellserJpermi ttee) with a principal place of busiuessJresidence at: v � ►Yor _ ct ox Si, ko d"qe MA , (phone#) ( city/Aafr/aP) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following worker's compensation coverage for my employees working on this job: A.— 'r.,,6, T,4-,,G, (IILSUI'3nce Company) (Policy Number) (Expiration Date) ( ) 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) f. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (InsZtraace Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml short if mcc to includc iafoctniIIon pertaining to all ooatmd f3) i ( ) 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 aw-. c that whirr hoaxowncra who cmplay paTo=w do ma iztn,.jc was ruction or repair work on a dwelling of not more than thtco units in which the homoowncr residc3 or oa the grounds appurtenant th tk t arc not grncra coaridcrcd to be cmployca under the vm6, 's cation Act(GL152,ss 1(5)),application by a homeoavcr for a liccn:x cc permit may cvidcnee the Itg21 rtatup of an employer under the Wockcet Compamaiion Act. I undasund dul a oopy of this rtatemcnt may be forwarded to tho Departm a of Dial Accidrn&Ofoe of 1""'n-for thn coverage va ificatioa and that failure to sxun oovecngn under soctioo 25A of MGL 152 can lad to tho"imposition of aimfiw penalties oomisting of a fine'of up to 51,500.00 and/or imprisoarncni of up to one year and civil pcaattia in the form of a stop Work Or+da and a firm of s 100.00 a day against tot For degut�u1O only Permit Number (o –A2-l I WP4 — --Lot# Signaature of Li a n ee/Pernu e 4 • , F G l X ECTO�1 ��NS7RUCTlON,SERVICE§,v 4 :, 3 s 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number Address Expiration Date Signature Telephone IN e m m r emen n Not Applicable z Co Company Name }� Registration Number Address{{ Expiration Date t4d I G h e 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 affida will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ r, The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)familie 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( 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 M"P." 10 O�F�PROPOSED WORK 'c eck a�a A'l cable IL New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work:_ 'SA V i D O �-Ii O a,A 1 vr--\J h a a Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet❑ I N;e s d or d"d t' n to ez§isti "�,o srn orff le. a BVIt,k: 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 1` 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 SEC '6*46/NER AUTHORIZATION TO BE�COMPI.ETED WREN QIf NERS i IVT., CQNTI�ACTOR'ApP1:lE$TF9 IOUII bING PEIt1 1T, 1. as Owner of the subject propert hereby authorize to act my behalf, in all matters relative to work authorized by this 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. Print Name � o — Signature of Owner/Agent 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/Find' g 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 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: f ,� _ ./� *'' �.._�...e, ..,.. .. ��a' e t; i a � y MD 0n jz of Northampton l'1 l5 ing Department 2 Main Street JUN t z Room 100 or h mpton, MA 01060 s f 3-5 7-1240 Fax 413-587.1272loS to DEPT OF BUILDING 0NS NORTWIMPTON,MA 01060 � ` APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section tobecompleted by office 1.1 Property Address: w -Unrt r ZoneOyerlay�Dstr�ct ".Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: P 4, k Al Name(Prin ) Current Mailing Address: Telephone ' Signature 2.2 Authorized Agent: < Y C%. rioo��•�°�. Cd � �0 yaw�'�6 Name(Print) Current Mailing Address: ev Signature Telephone SEC7104 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only 00 com feted by ermit applican t 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) Check Number This Section For Official Use Only Buildi,ng;Permit'Number: Date Issued: Signature: Building-,Commissioner/inspector of Buildings Date 1 Al BP-2001-1032 GIS#; COMMONWEALTH OF MASSACHUSETTS tAI;, CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofma BUILDING PERMIT Permit# BP-2001-1032 Project# JS-2001-1835 Est. Cost: $5860.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SEXTON ROOFING CO 118239 Lot Size(sa.ft.): 10759.32 Owner: DELISLE WAYNE L&DIANNE M Zoning:URB Applicant. SEXTON ROOFING CO AT. 83 OAK ST Applicant Address: Phone: Insurance: 573 NORTHAMPTON ST (413) 534-1234 HOLYOKEMA01040 ISSUED ON:6112101 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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 6/12/010:00:00 11696 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo