23D-167 B '-2023-0025
130 MAPLEWOOD TERR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-167-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-0025 PERMISSION IS HEREBY GRAN ED TO:
Project# ROOF 2022 Contractor: License:
Est. Cost: 23135 ERIE CONSTRUCTION 106394
Const.Class: Exp.Date: 05/11/2024
Use Group: Owner: RAND WIGHT AMANDA &ALON J
Lot Size (sq.ft.)
Zoning: URB Applicant: ERIE CONSTRUCTION
Applicant Address Phone: Insurance:
121 F WEST DUDLEYTOWN RD 860-358-9240 WC6-Z5 1-293 745
BLOOMFIELD, CT 06002
ISSUED ON: 01/09/2023
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VI LATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: A
I'
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
RECEIVED RFC ' --
JAN - q 2023 JAN - g 20
S , The Commonwealth of Massachus tts
__: -- B Dard of Building Regulations and Sta ida -- FOR
D_P WING INSPECTIONS GUItffNGlPho r,,;r MUNICIPALITY4rmN,MAo1o6o Massachusetts State Building Code, 780 CM1t/ lr., MA USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: 2 3! �� Date Applied:
c-vI 0x ZZ3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION i
1'1 30Property p dress 1. Assessors Map& Parcel Numile>fs
1„ good TerraC� !i(,R'
l.la Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yesD
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Akin Rand N0r4atit o /`/ ' 0 i062
Name(Print) City,State,ZIP 7
/3D Mueie-u I-r aC_P.-- 'L3-scl-1S2c) 4*e,1101.se.DgM&;I•cep,
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify:
Briefri Description of P opo ed Wor 22: /gc_ei flick. p C� C.
£ - e. %Aria-o hi ='4v-v /as 4,.. -r �-•-oi a..e.r_e m n.`s 4-, Cow/
/ 24./...,ll.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $.3 13s. 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List: —
5. Mechanical (Fire $ —
Suppression) Total All Fees $
Check No.0LO Check Amougi_ Cash Amount:
6. Total Project Cost: $ 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
o i�39y (ii 12t(
C.hrie,� 1_ . SM( License Number Expiration Date
Name of CSL older
23135 Oak
�/��_ �� `v( I.L( Rd List CSL Type(see below)
No.and Street �,� l Type Description
/4®I/n�w+ (.f?J s�� U Unrestricted(Buildings up to 35,000 Cu.It.)
CJ l R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
Telephone Email address D Demolition /
5.2 gistered Home Im rov ent Contractor(HIC) /g!
r►e, Cons- ICI VI HIC5 Registration Number Expiration to
HIC Coma Na r HI ate trant Na e
No.and Street Email address 1
RIve,,1•F<..ld GT 06eo2 q•6o3sYct'2-Yo
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6))
I
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 No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN '
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information I
contained in this ap 'ration is true a ccurate to the best of my knowledge and understanding./
Print Owner' r Authorize gent' Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count _
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
. . .
Massachusetts 4,?'' , �i
14
r
y DEPARTMENT OF BUILDING INSPECTIONS D
' 212 Main Street • Municipal Building yJ�ik iv
Via`
orcr.e
�"'•� Northampton, MA 01060 ..1“ ti y�'.'0
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: /0 3cDAnhafril e //riccx / 774,
The debris will be transported by:
Name of Hauler: fln ` ,:er-
Signature of Applicant: Date: /e fL 4
The Commonwealth of Massachusetts
► °— I Department of Industrial Accidents
—6'el_ 1 Congress Street,Suite 100
•' l'Fisi 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 Legibly
Name (Business/Organization/Individual): Erie Constuction
Address: 121 F WEST DUDLEYTOWN RD
City/State/Zip:BLOOMFIELD CT 06002 Phone#:8603589240
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. Q New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. ['Demolition
10 Q Building addition
4.0 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 11.0 Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.� p
Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
6.0 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#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 indicatin 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 Dave
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 the policy and job site
information.
Insurance Company Name:LOCKTON
Policy#or Self-ins.Lic.#:WC6-Z51-293745-022 Expiration Date:04/25/2023
Job Site Address:130 MAPLEWOOD TERRACE City/State/Zip:NORTHAMPTON MA
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$1, 00.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$ 50.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for in urance
coverage verification.
I do hereby certify under . f perjury that the information provided above is true and correct.
Signature: ` Date:/2/ /. -Z—
Phone#:86035 240
Official use only. Do not write in this area, to he 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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their empoyees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. Howev r the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of th
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions ishall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situatio and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees oth than the
members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit hould
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Ton n Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo om
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applic t.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an app icant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicatin current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided t the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled o each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial nture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
DocuSign Envelope ID:7AB1B6DC-OBE2-40C9-8FB9-BEAEOECF169B
•
Specification Sheet
Buyer Name: Amanda Wight Co-Buyer Name: Alan Rand
Address: 130 Maplewood Terrace, Northampton, MA, Date of Contract: 12/12/2022
01062
Phone Number: 4135849520 Reference Number: R043-005805
Buyer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services listed below,
in accordance with the prices and terms described on this Specification Sheet and the Custom Re odeling
Agreement, of which this Specification Sheet is a part. Additional terms and conditions are list below.
Shingle Profile: Fiberglass Shingle
Color: Emerald Green
Product(s)
Fiberglass Roofing
Remove 1 to 2 Asphalt Layers
Erie to remove existing roofing and properly dispose.
Erie to furnish and install fiberglass dimensional shingle.
Erie to furnish and install Radiant Barrier Synthetic Underlayment.
Erie to furnish and install all accessories that may include drip edge, pipe boots,
and flashing.
Erie to vent roof properly.
Erie to furnish and install ice and water shield where applicable.
Erie not performing work on any of the unheated space or garage.
Price includes all labor, material, warranty, and 100%job cleanup.
It is agreed and understood by and between the parties that this Specification Sheet, along with the
Custom Remodeling Agreement, constitutes the entire understanding between the parties, and there
no verbal understandings, changing, or modifying any of the terms. This Specification Sheat may not
be changed or its terms modified or varied in any way unless such changes are in writing and signed
by both Buyer(s) and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read the antirety of
this Specification Sheet.
Erie Home Representative Erie Home Representative
Name: Christopher Malloy Name: Daniel Casper
DocuSign Envelope ID:7AB1 B6DC-OBE2-40C9-8FB9-BEAEOECF169B
Signature: Signature:
r—DocuSlgned by: r—DocuSlgned by:
taFte 59Ai7L2 f'z°F2022 A6b 5 4
/� / ua�e: ���1�jZ022
Buyer Information Co-Buyer Information
Name: Amanda Wight Name: Alan Rand
Signature: Signature:
DocuSlgned by: DocuSI ned by:
`1 98 A4
CQOBFF21D089410..
Date: 12/12/2022 Date: 12/12/2022
Product-Specific Terms
Window Sales
Window Condensation: Contractor is not responsible for condensation that may form on or within a window or
between windows resulting from pre-existing conditions in Buyer's property and internal or external
temperatures. Reducing the humidity in a home will often remedy any condensation problems.
Roofing Sales
For Flat Roofs: Due to conditions beyond Contractor's control, the structure below the roof system may allow
the roof to pond water. If Buyer(s) does not opt for tapered insulation, Contractor can reduce the ponding by
adding insulation and roofing material in the ponding areas at additional cost to Buyer(s).
Precautions Taken by Buyer(s): Skylight openings can allow debris to enter the structure during construction.
Drop cloths should be placed under skylight openings prior to commencement of roofing activity. Skylights may
require removal to install new flashing. In the process of removal, drywall at the top of the shaft may crack or
break, especially if it is glued to the skylight. Because this is a pre-existing condition, any drywall repair to the
skylight shaft is the sole responsibility of Buyer(s). Normal roofing operation causes vibration to the structure.
Contractor is not responsible for nail pops or hairline cracks in the drywall due to vibration. Buyer(s) should
cover items in attic or top floor of the structure, as debris may fall. Buyer(s) should remove all fragile items prior
to Contractor's commencement of work. Buyer(s) must remove solar panels, wires, and large antennas prior to
Contractor's commencement of work. Contractor is not responsible for electrical work or painting.
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
Registraticr= 159905
ERIE CONSTRUCTION MID-WEST. INC. Expiraticr: 06i18/2023
C/B/A ERIE METAL ROOFING
3516 GRANITE CIRCLE
TOLEDO. OH 43617
Update Address and Return Card.
Office of Consumer Affairs &Eusiress Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE: Corporator before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
159905 06/16/2023 'O0C Washington Street • Suite 71C
ERIE CONSTRUCTION MID-WEST. INC. Boston. MA 02118
D BA ERIE META_ ROOFING
PATRIC<TROI•M1PETER
3516 GRANITE CIRCLE r+k�, !<<%t
TOLECO. 0-1 43517 Not valid without signature
Underseceetarr
Commonwealth of Massachusetts
[ i�iltilc 8 Vein isrzal .`at!St
Boer o w rng edu�atwns and Standards
•
\l'll l to '1
COnstructla Suporvlsa*r,1 S 2 Family
CSFA-106394 {. ijpires:05/11/2024
CHADLEY L M rs< <p
8935 OAK V LEY RD
HOLLAND ONE • i
4tAt Vdi1J�•
Commissioner -1421 f,. &nt4r.�,
ERIEhome remodeling delivered.
April 26, 2022
RE: Permits
To whom it may concern:
Letter of Authorization
Janae Fitzpatrick,office administrator of Erie Construction Mid-West, is authorized to represent myself
and/or our company in signing permits. If you have any questions, please contact Nicki,our risk
management coordinator at 567-408-2145.Thank you.
Sincerely,
♦
Randy Hamilton
President
Erie Construction Mid-West
3516 Granite Circle Toledo,OH 43617