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32A-058 BP- 2011 -0655 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: renovation BUILDING PERMIT Permit # BP- 2011 -0655 Project # JS- 2011- 001066 Est. Cost: $12650.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DAVID MILL 80477 Lot Size(sq. ft.): Owner: RIPPEL JENNIFER L & LOUIS M FRANCO Zoning: Applicant. DAVID MILL AT: 50 UNION ST 24 Applicant Address: Phone: Insurance: 18 WALES RD (413) 267 -4677 WC MONSONMA01057 ISSUED ON :1/31/2011 0:00:00 TO PERFORM THE FOLLOWING WORK.- REMODEL 2 BATHROOMS 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: FeeType: Date Paid: Amount: Building 1/31/20110:00:00 $75.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner File # BP- 2011 -0655 ' APPLICANT /CONTACT PERSON DAVID MILL ADDRESS/PHONE 18 WALES RD MONSON (413) 267 -4677 PROPERTY LOCATION 50 UNION ST 24 MAP 32A PARCEL 058 000 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL 2 BATHROOMS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 80477 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO�IMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay r� Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. City of Northampton Building Department` 212 Main Street Room 100 Northampton, MA 01060 phone, 13 -587 -1240 Fax 413 - 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION This section to be completed by office 1.1 Property Address j D t.�-n 10 v� S+ Map Lot Unit one = Overlay Aistnct ko EIrr1 St °t)tstrict " CB District " SECTION '2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record h LDUI� Co So cAwid� C.un ;f d� l�o�I- N -.adbti Name nt) Current M iling Address: Y/3 - -512 - 011 1 19 Telephone Signatu 2.2 Authorized Agent 1 /C_. 1� 1. �` S V7G4tGZ/ � pi-- �Cl LC/C✓L� / /� /�•• /��R Ql(J�� Name (Print) Current Mailing Address: n Signatur6 Telephone SECTION 3 - ESTIMATED CONSTRUCTION!COST& Item Estimated Cost (Dollars) to be Official Use Oniy completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of S Od • Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+3 + 4 + 5) / oZ 6' Check Number This Section For Official Use Onl Date Building Permit Number: Issued: Signature: Building Commissionerflnspector of Buildings', Date 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 7-7 - -- Side L: R L: L-- ' , R: I Rear E� Building Height -- _ I L Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved g p arkin g) # of Parking Spaces Fill: volume & Location _ _ . A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO (D DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q 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 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 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 C) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION'S- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [K Brief Descrip on of Proposed Work: e,� c ,1 �ln rrsews Alteration of existing bedroom Yes _Q� No Adding new bedroom Yes 0 ( No Attached Narrative Renovating unfinished basement Yes Of No Plans Attached Roll - Sheet 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 I, I�A A ( (Y' -�J as Owner of the subject property Q % / hereby authorize u e' M:1� S �ec�c�/ �► to act on behalf, i II attersr lative to work authorized by this building permit application. Signature of r ) Date S 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. � � • rtQ �(v`9 41 Print Name Signature of= wner /Agent Date � a SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction 1 Not Applicable ❑ ./ Name of License Holder : , I JGe t9 iCX , I SO / 7 ,7 �, n License Number U6 &A eS KGB m ©�5ok �� CIO 7 9 / / /x/ Address Expiration Date ,7 Sig Telephone •� ,,= x r .: Not Applicable livable ❑ ml iQ1s exethl + Yre�mtjra ►em �i a a : a n � .. . _ ��k _. PP 1 et,.rc_ tM ; l l fo•a E G G c— /-S 6 3.S 6 Company Name Registration Number tj , ( aAf7 _?/,2 y /--) Address Expiration at Telephone `1/JJ67- Y6 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MAL. 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....... ❑ No...... ❑ m el n� M - 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 buildine 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 hive 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 d Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 8 - CONSTRUCTION SERVICES 81 Licensed Construction nS Superviso r /► / Not Applicable ❑ Name of License Holder License Number Way e,5 M,+ d/VS2 L/ 0/// Address Expiration at /%/ Sign re L- Telephone Not Applicable ❑ fQ -� 6 Company Name Registration Number Address Expiration Date $I GS /�� iLUi.tiSe ti Telephone Y13 - c161 - Y6 7 SECTIOfV'{0- IA/QRK RS't t�ilAEEMSATIUN INSUiZANC� i4FfIDAVIT 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...... ❑ 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 cons idered 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 perm 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street UT Boston, MA 02111 wipmntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Orpnization/Individual): PAM' ey Address: wo�e_17� City /Sta,6/Zip : __JM v�50 ,� �,/�- Phone. #: y/3 ' I Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. [] 1 am a general contractor and 1 employees (full and/or part- time). « have hired the sub- contractors 6. Now construction 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' [No woricoirs' comp. insurance �' insurnce t 9. []Building addition required,] 5. [] We are a corporation. and its 10.0 Electrical repairs or additions 3. El officers have exercised Brcir I am a homeowner doing all work 11.❑ Plumbing repairs or additions myself '[No workers' comp. right ofexemption per MGL 12.❑ Roof repairs insurance requirod.] t c.152, § 1(4), and we have no employees. [No workers' 1311 Other comp. insurance required.] 'Any appliant that chocks box 11 musralw an out the soctioa brow showing d,* gotta' comp n=doa policy inf0=tioa. t Honmww; who submit ibis s &vd indiatin6 they ere doing A wore ad dwo lire omW& eoahactots must vAcnk a new affidavit indicating such. 3 C— U%dors dW Cb** dds box must sumcW an aMdoatl abort showing the utuuo of the aboon&sma and state whcdw or not those entities have =nptoy s- If tk Vib- cookadorc have "k *vcs,ihcy mist p wA& ib* wor1=v comp. poky amc W. I am an employer that Is providing workers' compensation Insurance for my employees Below is [he policy and Job site Information. Insurance Company Name: SS oGa e.rs S Q Policy # or Self -ins. Lk-#. W GL .Svc 65 d do 1;-� Ex pitation Date Job Site Addtrss: u v► l.K St- CRYIState/zip: - - `T Attach a copy of the worikets' compensation policy declaration page the policy number and expiration date). Failure, b $CCUre Coverage as requirod to da Section 25A of MGL c. 152 can kad to die imposition of criminal penaltics of a fine tip to S 1 atrdlor one.-Year fnVdsouni* as vell as civil pews in die form of a SPOP WORK ORDER and a fine . o1'up to $250.00 sa dayagalust ft violator. - Be Ovised drat a copyof iris stlietda ay be forwarded to the Office of L" of$eafor everifrcattion. I iio heray C&O kaff pwks wd'parada of p4my that the Wenvsdw provided above is Irate aid oofnd Phorlo ti: y/ 7 - i 08kW&rSFVKV. Do not wrke 14 thk erM to be comlp y . ortown qp? W Cxty or Towns PermitiLicease # Issuing Aathoi lly (dale one): J. Board of Health Z. Building Department 3. pty/Town perk 4. EWWcd inspector 5. Plumbing Inspector 6. Other Contact Pe6on : Phone A!: t DAYE/1/ /Ll Proposal General Contractor, LLC 18 Wales Road NOTE: This Proposal remains valid for 60 days from Monson, MA 01057 the date shown below. Phone 413- 283 -1616 Fax 413- 267 -9222 Cell 413 -519 -2010 DATE: 1/6/11 david.mill @comcast.net TO: FOR: Jennifer Ripple 50 Union Street Bathrooms Unit #24 -1St, 2 nd & 3rd Floor - Northampton, MA DESCRIPTION AMOUNT l floor Bathroom *Install new toilet, sink and faucet, relocating sink plumbing to center of sink *Install baseboard and clear trim. *Paint trim -2 coats *Install toiletries — Paper dispenser, hand towel ring, ect. 2 nd floor Bathroom Remove tub, shower, sink, vanity, and toilet. * Install new 4 -piece tub /shower unit. *install shower valve with trim *install ceramic tile floor * repair drywall as needed * install new vanity, sink, faucet, medicine cabinet *install new toilet *install new fan /light *paint walls and trim *install toiletries — Paper dispenser, hand towel ring, ect. 3rd floor Bathroom *Provide selective demolition to expose plumbing and electrical for rework and inspection. *Install Ground Fault protection for whirlpool *Install drywall and remainder of tile as necessary *provide drywall repairs at demolition areas * Install baseboard and door trim * Install new faucets with trim and drains * Paint walls, ceiling, and trim * install toiletries. *) Note 1 - The following quote includes all permits, inspections, clean up and removal of all debris. The removal and replacement of wall tiles is not anticipated or included. Should removal and replacement become necessary, it would be done at an additional cost. i ( *) Note 2: You can expect to pay approximately $ 3,600.00 in addition to the price shown for the following items (to be selected): Toilets, sinks, faucets, vanity's, tub /shower, shower valve and trim, medicine cabinet and mirrors, ceramic tile, fan /light and toiletries. ( *) Note 3 : The city may require architectural plans for permitting. Should that be the case, this professional fee would be at owner's expense TOTAL COST $ 12,650.00 ( *) CONTINUED ON PAGE 2 Bathrooms -1St, 2 nd & 3rd Floor- Continued from page 1 Unless otherwise stated, we propose to furnish all labor, materials and egz , iI.G uuiipmmeent to complete the above work to said specifications. AUTHORIZED SIGNATURE — 6 2ramCL _�• 0% {' 1 DATE_( above Payment Terms: 1.5 interest will be charged to all accounts over 30 days. All merchandise remains the property of this company until paid in full. In the event of any default in payment, I agree to pay all collection costs to include attorney's fees should this become necessary. Dave Mill General Contractor LLC may, at the option without process of law, retake possession of any or all materials. I agree to the terms of payment (NET 30), the Scope of Work proposed, and you are authorized to do the work set forth above. CUSTOMER SIGNATURE DATE If necessary, Please Provide your Purchase Order No. t sev tare i�_f 1�+ Qj �I 11 l I I I �'� �I f Y hhe^II .a� s c y�, C r w Ud m s = U S J O i4 ! %(j c p y a �t w w z .L � _ Q � kyM,' j 0 0 y � T, 7 6 I S Vii' u LL y ~°J � O � a ZCD _N V w M O UJ o M y �C oc �� d O c J ZZ W N m z w O a x (w9 O Q O S2' W 0: 2 Pz1 r \ I ui zz :a4 y v i l�u O Q to O Z Q oo 1 rt5r �l� � �