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30A-013 335 FLORENCE RD BP-2020-0270 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30A-013 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 P E RM I T Permit# BP-2020-0270 Prosect# JS-2020-000457 Est.Cost:$11995.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group JOHN WALZ 060612 Lot Size(sg.ft.): 15028.20 Owner. BIRISH JOSEPH Zoning: URA(100)/WSP(100)/ Applicant. JOHN WALZ AT. 335 FLORENCE RD Applicant Address: Phone: Insurance: 66 Bray Street (413) 592-2376 Workers Compensation CHICOPEEMA01020 ISSUED ON.8/30/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-NEW 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 Sienature: FeeType: Date Paid: Amount: Building 8/30/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �✓ 0S0I0HW'N01dWHH1a0N SN01122dSNI UNIMIMIM Td�a Department use my City of Northa pto Stat s of Lmit: BuildingDepa me t p 61H � ur�Cut/Driveway Permit 212 Main Street 6 Sew r/Se tic Availability Room 10 Wat r/We I Availability �. Northampton, M 01 _ Sets of Structural Plans phone 413-587-1240 F 4? - - bftte Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION &Q/X." ;) 6 1.1 Property Address: This section to be completed by office Map Lot Unit 335 Florence Rd. Zone Overlay District Elm St.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Joe Birish 335 Florence Rd. Florence, Ma 01062 Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 33 Gratten St Chicopee, Ma 01020 J�4, LJ �` �y 33 Gratten St Chicopee, Ma 01020 Name(Print) Current Mailing Address: 33 Gratten St Chicopee, Ma 01020 ! Telephone SECTION -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building N/A (a) Building Permit Fee 2. Electrical N/A (b) Estimated Total Cost of Construction from 6 3. Plumbing N/A Building Permit Fee . 4. Mechanical(HVAC) 'T 7o 5. Fire Protection I 16c N/A 6. Total=0 +2+3+4+5) 11995.00 1 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: `36-Zd19 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed I 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 s Bldg.Square Footage °/a ---� C, J Open Space Footage r . (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Hasa Special Permit/ ariance/Finding ever bee issued for/on he site? NO © D KNOW O YES O IF YES, date issued: IF YES: Was the permit r cor ed at the Registry-of Deeds? NO O ON KNOW © YES O IF YES: enter Bo k Page and/or D ument# B. Does the site contain a brook, b dy of wate or wetlands? NO DONT K OW © YES O IF YES, has a permit been or eed to be btained from the Co ervation Com ission? Needs to be obtained O tained O , Date Issue C. Do any signs exist on the prope y? YES O N Q IF YES, describe size, type and ocatio D. Are there any proposed changes t! or ad itions of signs intended for the pr erty? YES 0 NO O IF YES, describe size, type and 11 cati E. Will the construction activity disturb(cl arin ,grading,excavatio ,or filling)over 1 cre or is it part of a common plan that will disturb over 1 acre? YES NO O i IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑✓ Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [IJ Siding[O] Other[a Brief Description of Proposed New roofsee attached Work: Alteration of existing bedroom x Yes No Adding new bedroom X Yes xx No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete 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 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 . 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 1, as Owner of the subject property See attachet PROPOSAL hereby authorize t act on my behalf, in all matters relative to work authorized by this building permit application. 4�1­4 Signatur of Owner V Date I, c7�► n w LJ Ce Z 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑on Name of License Holder: c,r1(rL L,) LNJ cLZ 6666 License Number Address Expiration Date Signature / Telephone 9.ReqistOZd Home Improvement Contractor. Not Applicable ❑ r Vl. i l V N 1. Ll / yl C_ // .�L (- 7 5- _.> Company Nathe Registration Number Address 4 t rat Lam, Expiration Date Telephone—/O �'5;1>1'3-4 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....... 0/' No...... ❑ 11. - Home Owner Exemption 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 iJrj C1G�LIa Mill; Q Lr-1 i City of Northampton 212 Main Street, Northampton, MA 01060 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 debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: �/I e n = ,c O'` tr�C,& The debris will be transported by: The debris will be received by: (� s,� �a.st �� , ;�, L aaf w;,L d so; C-f Building permit number: Name of Permit Applicant : ,n (.1, n C- Date 9(griature of Permit Applicant The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anoiicant Information Please Print Legibly Name(Business/Organization/Individual): FINYL VINYL INC. 33 GRATTAN STREET Address: CHICOPEE, MA 01020-1327 City/State/Zip: Phone#: S 7 Q G Are you an employer?Cheek the appropriate box_ Type of project(required): 1.Q I am a employer with employees(full and/or part-time).* 7. []New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.[J I am a homeowner doing all work myself.[No workers'comp.insurance required.]+ 9. Demolition Q4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I coil l 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing mbing repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.: �J d p n 6.a We are a corporation and its otRcers have exercised their right of exemption per MGL c. 14. Other N 1°W e 0 6-P- 152, 152,§1(4),and we have no employees.[No workers'comp.insurance required.) *Arty 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. *Contractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. /� Insurance Company Name:NX V&J es S Pr�X CA C O O-r A Y1 Policy#or Self-ins.Lic.#: 7 pp kA 10 f Expiration Date: / Z/ a'�r7 Job Site Address:_ -2 f-^ /' Lo 6-6 f e-c.e 6 CL City/State/Zip: ( e� c-e- r ' rF p/ o 6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage verification. I do hereby certify un ert�pai s and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: flS 2,5k 3 7 (, Official use only. Do not write in this area,to be completed by ch),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#: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):E J'S Home Improvement Experts LLC Address: 103Putman St City/State/Zip:Hartford CT. 06106 Phone#: 1-413 507-8992 Are you an employer?Check the appropriate box: Type of project(required): 'M I am a employer with _employees(full and/or part-time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E] Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance: 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#I 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. :Contractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:N C C I Insurance co. Policy#or Self-ins.Lic.#:06-80411-18275449362 Expiration Date:09/28/2019 Job Site Address: -3Z .S— ��6n� �.► .P_ R !.� City/State/Zip: 6/01' e,n c AA q O/,,6� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 thepains and penalties of perjury that the information provided above is true and correct Signature: �zc J►`lruru2 /I. Date: Phone#: 1-413-507-8992 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#: Page No. of Pages CHOICEyi�ry y<i. � PROPOSAL 33 Grattan Street All home improvement contractors and subcontractors CHICOPEE, MA 01020 engaged in home improvement contracting, unless (413) 592-2376 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with Submitted the Birish the Commonwealth of Massachusetts. Inquiries about To: ._.___-�,.�-___- registration and status should be made to the Director, 335 Florence Rd. Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108 (617)973-8700 Owners who secure their own construction related Florence,MA 01062 permits or deal with unregistered contractors will be excluded from the Guaranty fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. - 112653 CT-REG. NO. 0051540 1-914-582-8423 18-15-19 LICENSE NO. -060612 JOB NAME/NO. JOB LOCATION We hereby submit specifications and estimates for work to be performed and materials to be used: 1. Strip roof down to deck. 2. Install Certainteed Lifetime Architectural Shingles. 3. Elephant Skin Underlayment. 4. Ice&water barrier. 5. Install a ridge vent. 6. Pipe vent boots. 7. Install new white drip edge&rake edge. 8. Remove all debris by truck or dumpster. 9. Install One"fherma Tru Fiberglass#5262 door with grids between the glass. (Use customer's existing lock,NO deadbolt.) WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein writing.Contractor will begin the work on or about 8 months from date of signing.Barring delay caused by circumstances beyond Contractor's control,the work will be completed within 1 year from date of signing. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of one year following completion and shall comply with the ,quiremenls of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including clean up,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship.The foregoing warranties shall survive a local or state inspection. We Propose hereby to furnish material and labor —complete in accordance with above specifications, for the sum of: Eleven thousand nine hundred and ninety-five dollars and 00/100. dollars(11995.00 ) Payment to be made as follows:A finance charge of 1112%per month(18%per annum)will be charged on unpaid balances. In additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency, the owner herein shall be responsible for reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here. 333958.00 John W.Walz Fin I Vin I Inc 0 ($ ) upon signing Contract; y y Name of Contractor/Designated Registrant 33 % 3$958.00 ) upon completion NTival of materials. 33 Grattan Street 0 ( /A Street Address �7 % �$ ) upon completion v� Chicopee,MA 01.020 34 4079.00 city/state 4 ) shall be made forewith upon (413)592-2376 65-1215510 completion of work under this contract. Phone Federal ID No. Notice: No agreement for home improvement contracting work shall require a John W.Walz _-or Ti thy J.Walz or Terry L.Messier Name of Sal rson• Na of Sale e n Name of Salesperson down payment(advance deposit)of more than one-third of the total contract price n or the total amount of all deposits or payments which the contractor must make,in ` advance,to order and/or otherwise obtain delivery of special order materials and Authorized Sign tur equipment,whichever amount is greater. Note:This proposal ay be withd wn by us it not accepted within days. Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. DO -1413N THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature Date Signature Date IMPORTANT INFORMATION ON BACK