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36-291 (5) A & J Home Improvements, Inc. _ 60 Washington Avenue*e• South Hadley, MA 01075 Certified Office / Fax: (413) 467-1500 • Cell: (413) 575-1290 ' 5 AJHome[mprovements @yahoo.com HIC Lic# 135399 • GAF-ELK ID # CE17267 • CT Lic# 600705 / CS, SL, RF, WS # 101017 Proposal Submitted To: Phone#'s: N� r Home: 3 y �S Cell: Street: 2c) 0�x cc-'ez4 zi &U-C( c% Ct 0- c(C( � City, State,Zip Code: 11/House ❑ Garage ❑ Other Proposal to furniYear-off d install the following: ❑ Re-Roof ❑ Gutter CAM. i�J Avn X66 66wtd_ cv Complete Roof Preparation U/'Home exterior to be protected by tarps and plywood hrubs, landscaping, trees to be protected U/R' oofers buggy shall be used where accessible with permission from owner 011(Entire existing roofing material to be removed to existing decking, including flashing, etc. U S.te to be cleaned everyday with roll magnet debris removed at project completion (included in price) teriorated existing decking replaced at 45.00 per sheet plywood (only if needed) hite�tBrown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only �ew flashing will be installed where necessary / install lead to chimney ©'I stall new pipe boot flashing e shall acquire all appropriate permits etc. for all roofing work Complete Roof System ❑ 3 ft. 0/11, e & Water Barrier installed at the eaves to protect from ice dams (and meet code in the north) 0'-6 ft. I e & Water Barrier installed at all valleys, around penetrations, and chimneys to protect critical areas - — g / yrithetic roof underlayment ❑ Install Ridge Vent �' r Shingles:. . C" k�,, e Series �J(L-*aam ❑ -}ttra tf Color r Ridge Cap Shingles OSAL: The-above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expens s and reasonable attorney's fees incurred by A & J Home Imnrnvements_ Inc. to recover _ this r_nntract_ 4� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 9J 7m2 1 (YIOO�� �t1� Address: LQ �t'Yi ion 19 vow City/State/Zip: d Ot�7S^ Phone#: Ll13 ytc7- !S 06 Are you an employer?Check the a ropriate box: Type of project(required): 1.9 I am a with employer �_— 4. ❑ I am a general contractor and I * have hired the sub-contractors 6• ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. []Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C 6a s — Policy#or Self-ins.Lic.#: ��- O y��QCei 1 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: g Date: Phone# N I� / Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: z ty o/ / Lase Number 4.)a.s Address Expiration Date ignature Tel hone 9.Reciistered Homd,lm rovement Coritracfor „ , Not Applicable ❑ Com an Name Registration Number C�? < e SA C ll y°/- 6 Address V / Expiration Date Telephone 113`x 7 -1o1%O 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 buildin permit. Signed Affidavit Attached Yes....... No...... ❑ I. -'Home owner Egempi©n 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(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing Or Doors I] Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [C] Siding[❑] Other[[3] Brief Desiiption f Proposed n11 Work: i1�c��a c_& lQue) Ac ry sit GnC /a7 c'f Alteration of existing bedroom Yes \/ No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If Newhouse and or additi6n to existing housing 'domplete'the following: 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 stones? 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. I. 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 's Or�ner 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 I, Arllf c .) /err'!,, 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 Signature of Owner/Agent Date e. 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 Department Lot Size _ ..._ _...__ .... _. ",. ... ...___ _..~,_', Frontage _.. Setbacks Front m Side L:"~~."........ R.;.... - L: ."_~ .._! R _.v 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 0 DONT KNOW 0 YES IF YES, date issued:.' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW C) 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 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. WE�7 Department use only �-�--I of Northampton S�atets of Per�lt k� � �� Building Department Curb DrivelaPen 0132015 2 Main Street uatta6ifty' Room 100 UUaterMieti Avatfabiltty t Electric,Plumbing&Gas Ins p ompton, MA 01060 Two Setsof Structural Plans Northampton - -1240 Fax 413-587-1272 �lotl�ite Plans "���R- •'4 � �z=: OterSpecify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit 7C � S n Gv ct� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Pn4. Curr t Mailing Add s ��/��(-/ 0,�/� Telephone Signature 2.2 Authorized Agent: (Pa h,,,nc. �� 4vc zcc), furll Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 7 ('� Item Estimated Cost(Dollars)to be Official Use Only com leted 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 =0 +2+3+4+5) Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 70 SOVEREIGN WAY BP-2015-0960 GIS#: COMMONWEALTH OF MASSACHUSETTS MW:Block: 36-291 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2015-0960 Project# JS-2015-001863 Est. Cost: $27500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: A & J HOME IMPROVEMENT INC 101017 Lot Size(sq. 1): 63946.08 Owner: TAYLOR DANA G&TERRYLYNN Zoniniz: Applicant: A & J HOME IMPROVEMENT INC AT: 70 SOVEREIGN WAY Applicant Address: Phone: Insurance: 60 WASHINGTON AVE (413) 467-1500 () WC SOUTH HADLEYMA01075 ISSUED ON:411412015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE ROOF OVER 1 LAYER 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 OccuVancy Sisnature: FeeType: Date Paid: Amount: Building 4/14/2015 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner