35-072 (7) 884 RYAN RD BP-2017-0276
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35 -072 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0276
Project# JS-2017-000470
Est. Cost: $6700.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: WALT KOWAL 100833
Lot Size(sq. ft.): 19994.04 Owner: KABAT HENRY F&JANE H
Zoning: Applicant: WALT KOWAL
AT: 884 RYAN RD
Applicant Address: Phone: Insurance:
13 REDDEN RD (413) 575-1105 n Workers Compensation
SPRINGFIELDMA01119 ISSUED ON:9/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REROOF GARAGE AND SHED
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:
FeeTvpe: Date Paid: Amount:
Building 9/1/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
• ,
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I AIG 2 9 2616 ibj Ci Nlorharnptrn �st rJs at ermt
.lLldll'() DBO Ilr(12YIi Ct.r UcdDnve+ass a rmR
212 Main Street [r ru, Ytr A.atahili' = - titEn
j��µr prpN,µ bC0 Roam 100 Water/Well Aralability.
Nlorthampton MA 010e0 Two SOO of Strt"rsal P ens
phone 413-587-1240 F221113-587-'1272 Flans -
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Prooerte Address - Thrs @)(`iron to 6€oampietetl 4y office
" .
Q(,j , ��� J/� Ma Py Lo Unt
t� ( Y r7T otia Overlay D strict `-I
EIrn'St,District OSDeem_,
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
21 ,Or�/w—nn'e-r of Record: �,(- PFS'
/e
gyr�,yn
VAA'e � OP 1 CG' / Yc o/7 ,,f
N carie(Print) Current Mailing itiege4
Signaturei.,,,,.5„,
Telephone ]�j" /r
22 Authorized Ag_nt:
Name
nn
59,wture > _���-����� - euera ru tca.'l��Sw./Orirn'"�/!Y/7 / rOP ®.///�
SEC TION 3-ESTIMATED CONSTRUCTION COSTS
}fern Estimated Cast(Dcliars)to be Ofir7a!No:Only
completed. by permit aoplicant _
1. Building itC6A
(a)Building Permit Fee 1 1
r 2 ElectrictO` (b''rtimstetl i otal Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC}
-. Fire Protec:e;
utd =(1 +2+3+4+5) - �.Check Number
dm 0
a
This Section Far Official Use Only
Building Permit Number Date
( auE.i}:
Slgnetui e: .r: r 7:2\51-1/4(
Bolding Cam„Isstoned nsP ctor or Buildings Cole
S
Section 4. ZONING All Information MLSt Be Campleted. Permit Can Be Domed Dae To Incomplete Information
Existing I Proposed 1 Required by Zoning 4
This column to be filled in by
Building Department
Lot Size -.
Frontage t
Setbacks Front l .—
Side 7,' R ___ r R ...
Rear --. -_._ ..
Building Height _ y _ .-
Bldg. Square Footage __
Open Space Footage _ /
(Lot areammus bldg&paced --
ng)
fi of Parking Spaces i_ . __ "
1
Fill ,
(volume&Location)
A. Has a Special Permit/Variance/Finding ever beer issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:[
IF YES: Was the permit recorded at the Registry of Deeds?
NC! 0 DONT 0 YES I
IF YES: enter Book Page, and/or Document#,
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and Location
D. Are there any proposed changes to or additions of signs intended for the property 1 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 DEW is required.
SECTION 3-DESCRIPTION OF PROPOSED WORK ichac:all applicable)
New House n Addition U Replacement Windows Alteration(s) I j 1 Reddng
Or Doors
Accessary Bldg. n Demolition U New Signs [Of Decks [ Siding(01 Other(Di
Alteration Phon of Proposed
Brief Desch (
Rare 4
of existing bedroom Yes No Ad‘g new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes Na
Plans Attached Poll -Sheet
ee if ittew houseand or addition to existence housiri , corn Sete the'fottawdnei:
a. Use of building:One Family Two Other
b- Number of rooms in each family unit: Number of Bathroomsc. Is there a garage attached?
d. Proposed Square footage of new construction_ Dimensions
e. Number of stories?.,,
f Method of heating? Fireplaces or Wocdstaves Number of each
g. Energy Consternation Compliance_ Massoheck Energy Comenance form attached?
h_ Type of construction_,,,,,,
i. is construction within 160 ft of wetlands? Yes No. Is construction within 100 yr- floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. I building conform to the Building and Zoning regulatans? 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
_,as Owner of the subject
properly
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
ftlia� S r). yi'; a {`Ai'il�i'rF"Aaf "R
LGA*/f I ` G!,AT / ,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.
Lim4/7 t G z / _ !
Print Name
8 ?9 / t
SignatureofAgent
Date ��
SECTIG'h 8.COPISSTRUCT/0bl SERVICES
8.1 Ligon=ed Comb uctiongoner/igen gNot Applicable
Name oYLtcsnsa Folder'—..yt-die/24 am'' o/q / Ace,/ {.a
License Number
40
17/ .141i
Address Edpiraticn Date
a S7 ii
Signature Telephone
91=eoistered Home improvement Contractor. Not Applicable
Company Name Regtstrat n Number
/lerY ,4'd .` , ,,)feSW/� /loil 4! 7^-29--/7
gdress �—>/� xuretion Date
0%2-4.441"4j4 ',.';....:- . I Telephone d /3//ot
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G,L.C.182,325C(6j)
Workers Compexsaton Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit wig result
in the denial of the issuance of the building permit
Signed Affidavit Attached Yet £ No P
11 :-Hoarse Owner Exemption
The currant exemption for"homeowners"was extended to include Owner-ocenuied Dwellings of one(I) 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 1093.5.1.
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 he,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 he 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 by regusca 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(Worker,' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts Genera/Laws Annotated,you may be liable for person())
you hire to perform work for you under this permit,
The undersigned"homegitmer"ceriics and assumesresponsibilityfor compliance with the State Building Code,City tri
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated_
Homeowner Signature
The ''aecros.t a,^ve&th of i'uiesszein, etO
„ Eepardaar,ea vrj a lawn real Accide4,18
Office of"rtyet a asoDoes
600 Washington Street
l
y ib !Sas>sr, VA 0111
cv'vJPN.ar•rsmmyv/i3,erf
Workers' Compemsadom amsar3t ee ihindasta Bod'dere/Cesus'reshot;siEleetrkc ns/Phsmbers
Anaemia finforrmnmfnor Plane Prrnat 1Le®u> b y
Name(illusiness/Organizationllndividual): /,w!) e
Address: 1y...._ s C G(
.5
one
Is: 2I sin " #:__ (77 57/x' _ ....
City/State/Zi
I.[Are you a employer Cheek tot appropriate box: Type of project(required):
an em 2an�eo-
with ( 4. b 1 am a general contractor and I
employees (Cull and/or part-time).* have hired the sub-conhaetors 6New construction
2. I am a sale proprietor or partner- listed on the attached sheet, 7. Remodeling
ship and have no employees These sub-contractors have g, 0 Demolition
worldn forme in an capacity, employees and have workers'
B S P 9. 0 Building, addition
[No workers' comp. insurance comp. dotmce.t
a
required.] 5. 0 We axe a corporation and its 10.7 Electrical repairs or additions
3.LI I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption perMGL h. Roof repairs
insurance required.] t o. 152, §1(4), and we have no
employees_[No workers' 13.7 Oher
cornp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information
i$o meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
^Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or rot those entities have
empioyevs. If the sub-contract is ban exap'oyees,they must provide their worker's.'comp.policy number.
I am an employer that is providing workers'compensation insuranceJor my employees. Below is the policy and job site
information. _ /
Insurance Company Name: //?J42YF e/'}' h..
Policy#or Self-ins.Lie. #: 621/61.61 're4p7G.2y/14 ExpirationDate: ��^^� ^'�e3 i7
lob Site Address: YY�( �VA'iL City/State/Zip: /6d/t pn 4 1--
Attach
Y.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 io$1,500,00 andior ane-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.
Ido hereby certify under the pains and penalties ofer' ry that the information provided above is true and correct.
eci
�- r� - .yam �y. ry l/4
SiCmature: J/-/ Q�G"(,� a:.•-na � .�.... Date: lJ�/J'7 �'
Phone if: -5.2.€/7 y3jl#j'�.....
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 It:
stir f
' le baz n s
rt
") fr c3I .'r
e Id. 4
212 Sun,t o H r Building .
va h r MB 0106 N''R, � 1 '
INSPECTOR
Lot,its Hasbrouck Chuck Miller
Bci'rding Commissioner assistant Commies/cher
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
j The State of Massachusetts allows the homeowner the right under T80CMR 108 3.4 to act as his/her 1
construction supervisor. The state defines "Homeowner" as, " Percents) who owns a parcel on which
he/she resides or intends 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 home owner."
The building department for the City of Northampton wants any person(s)who seek to use the home
owner exemption, to act as their own construction supervisor, to be aware that by doing so you
become responsible for compliance with state building codes and regulations_The inspection
process requires that the building department be called to inspect work at various stages, which include
foundation/footings (before backfill). sonotube holes (before pour), a couch buildlna inspection
Ibefore work is concealed), insulation inspection (if required) and a final building inspection.
The building department requires these inspections before the work is concealed, failure to secure
these inspections can result in failure to obtain a certificate of occupancy until the work can be
inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be
responsible to make sure that the trades hired secure their proper permits in conjunction to the building
permit issued, and that they get their required inspections. Failure of the individual trades to secure
the permits and inspections as required can DELAY the project until such time as the proper permits
and inspections are made
understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date
Address of work location
Cita of Northampton 212 Mein Street, Northampton, MA 01.050
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all cebris resulting from tie construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MDL c 111; S 150A
Address of the work: �� y "Vet," /< et
The debris will be transported by: //ty 4' (91/
The debris will be received by:
Building permit number:
Name of Permit Applicant Lyo/t AC'4-a
Date Signature of Permit Applicant
Kowai
General Contracting
13 Redden Road
Springfield, MA. 01119-2631
We are Fully Insured &Licensed
Email: WaltKowal@yahoo.com Cell: (413(-575-1105
Hic Licit 124626& CSL 100833
We hereby submits specifications for: Roof/Garage & Shed
Jane Cabot Date: 6/14/2016
884 Ryan Rd.
Florence, MA.
584-1565
Re:Above Address
We will strip the roof of the garage and the back of the garage plus shed.
All the waste will be put in the dumpster that will be supplied by Walt Kowal
We will apply Ice Guard 3 feet up.
We will apply synthetic felt paper on the rest of the roof.
We will install new drip edge.
We will apply a shingle to match the house(three tab or architect shingles).
We will remove the siding and install new flashing.
I will replace the missing soffit.
My damage plywood will be a cost of$45.00 per sheet for removal, application and disposal.
We propose hereby to furnish material and labor complete in accordance to
above specifications for the sum of f e/ .- ..fi r+ $ 6,700.00
I will apply for a permit.
This price includes labor,material,permit and dumpster fee .
All material is guaranteed to be as specified. All work to be completed in a work man like manner
according to standards practices.
Any alteration or deviation from the above specification involving extra costs will be done only upon
a written change order. The costs will become an extra charge over and above the estimate. This is
to include, but is not to limited to, hidden damages that are uncovered during the course of the job and
additional work required by local building inspectors.
All elements of this agreement are contingent upon delays beyond our control. The estimate does not
include material price increases, or additional labor and materials which may be required should
unforeseen problems arise after the work has started.
You,the buyer, may cancel this transaction at anytime prior to midnight of the third business
day after the date of this transaction. Cancellation must be done in writing.
Acceptance of Proposal: The above prices,specifications and conditions are satisfactory and
are hereby accepted. You are authorized to do the work as specified. Payment will be made
half down when material is delivered and the labor is started and final payment on completion
of job.
., :Pec,.... . _ -5e .cl;sit
(please do not hesitate to call me if you have any questions at the above number).
// /(Y! G< <G' please sign on the above line&return
l� it back so a permit can he pulled