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24C-009 17 ADARE PL BP- 2012 -0066 GIs #: COMMONWEALTH OF MASSACHUSETTS Map 24C - 009 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2012 -0066 Project # JS- 2012 - 000097 Est. Cost: $15000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HARVEY MESSECK Lot Size(sq. ft.): 11848.32 Owner: STOUT NANCY J TRUSTEE Zoning: URB(100)/ Applicant: HARVEY MESSECK AT. 17 ADARE PL Applicant Address: Phone: Insurance: 271 Prospect Street (413) 584 -4460 NORTHAMPTONMA01060 ISSUED ON :711912011 0:00:00 TO PERFORM THE FOLLOWING WORK.- Egress Window 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 7/19/20110:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner ity of Northampton Building Department ' 212 Main Street Room 100 or OOFBUILDINGINSPE� orthampton, MA 01060 P MA01 e 3- 587 -1240 Fax 413 - 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION! 1.1 Property Address This sectton to be completed by office W SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record r Name (Print) Current Mailing Address: tX �° _`_ "` Telephone Signature 2.2 Authorized Anent: Name (Print) Currenf Mailing Address: Signature Telephone SECTION 3 - ESTIMATEMCONSTRUCTI ON COSTS Item Estimated Cost (Dollars) to be Official Use Only ` completed by ermit applicant 1. Building (a, 0tliiding Pemtit Fee 2. Electrical () Estlmateii Total Cost of Construction from 6 3. Plumbing ; s' 13uHdlif Permit (=ee 4. Mechanical (HVAC) 5 5. Fire Protection 6. Total= (1 +2+3+4+5) Cht'ck Number Thls Sectlon For Offlclal Use Only Date Building' Permit Number: Issued; Signature: .. Butlding Commissioner /InspeCtof flf Buildings Date t 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 I Setbacks Front Side L: E.._._..._.= R: L:� R: _ Rear Building Height Bldg. Square Footage % nu Footage (Lot a rea ea minu bldg &paved ' — p arkin g) # of Parkin Spaces I r- Fill: volume & Location A. Has a Special Permit /Variance /Finding ever been issu d f /on the site? NO ( DONT KNOW 0 Y IF YES, date issued: IF YES: Was the permit recorded at the Registry of ds? NO 0 DO�-N7 KNOW 0 YES IF YES: enter Book I Page and /or Document # ! B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES f IF YES, has a permit been or need to be obtained from the Conse ation Commission? Needs to be obtained Obtained Q to Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: _ D. Are there any proposed changes t 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 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. M SECTION 5- DESCRIPTION OP PROPOSED WORK (check all aaalicable) .w New House ❑ Addition ❑ Replacement,Mdows Alteration(s) ❑ T Roofing ❑ Or Doors Cm Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [[3] Other [f�] Wo e r f k Description of Proposed Alteration of existing bedroom ✓ Yes No C Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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 j g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes V No. Is construction within 100 yr. floodplain Yes No i j. Depth of basement or cellar floor below finished grade k. W-M.building conform to the Building and Zoning regulations? ✓ Yes NO. I. Septic Tank City Sewer `� Private well City water Supply °f SECTION 7a.- OWNER AUTHOR�TJOIV 7d BE GOMPt+ETElL7' VYHEI4C' . OWNERS AGENT OR CON7rRAGTOR f►PPILIES. FOR. B II.DING PERMI f as Owner of the subject A/ RAI property p r hereby authorize h to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Omer Date / N iq �G `� 5 _ -r v r - 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. - /JAAf c Print Name ' Signature of Owner /Agent Date SECTION 8 - CONSTRt1GTl ©N SERVICES ' 8.1 Licensed Construction Supervisor _ Not Applicabl2 ❑ r Name of License Holder - 7 .& ✓{1 Y P C `j `>� C License Number Address Expiration Date Signature Tel phone Not Applicable ❑ Co mpany Name Registration Numbe 27/ l� Address Expiration Date Telephone SECTION !0 VItOR : PRS' COMPJENSATION INSURANCE A FFII3AYlT.(II11.G l- c 1:52,:.§ 2 5C(C}1 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 Dwelling 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 a sup ervisor. 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. ALgerson 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 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 In dustrial Accidents ' Office of Investigations 600 Washington Street Boston, MA 02111 www. massgov/dr'a -Workers' Compensation. Insurance Affidavit: Builders / Contractors /Electricians/Plumb.ers Applicant Information Please Print LegibIv Name ( Business organizationanaividual): Address: f Z ,o q S PZ e City /State/Zip: /Vn-74/ f'� , e CS D Phone. #: 7 �° [ you.an employer ?.Check the appropriate boa:.... 'Type of project (required):. 4.. [] I am a general contractor and .1 Q N co I am a employer with 6. Io ees fnIl and/or - art time . en3p * - - -- - have hired -the snb -,co. Y- - ( - p - listed on the attached sheet 7. Remodeling I ani a sole proprietor orspartner- -._ - These sub- contractors - have. - - -- - - .g Demolition — slid and have no employees- - employees and have workers' working' for me in any capacity. $ . 9: [❑ Building addition [No work ers' Comp. insurance COmp. mc�ma� . . 5. We are a o oration and its 10 EElectrical repairs or additions c required:] ❑ rP� 11. _ _ officers have exercised their ❑ Plumbing repairs or additions I am a homeowner doing all work r , myself [No workers' comp. right exemption per MGL 12. [1 Roof repairs c. 152, §1(4),'and we have no . insur required.] t . ' � ' 13.[j Other employees. [No workers'.. qomp. insura_nce _regtured.}. `Any applicant that checks box #1 must also fill out the section belawshowing tbemr workers'compensation Policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must.attached an additional shed showing the name of the sub-contractors and state whotheror not those entities have employees. if the sub- conuactoms have employees, try must provide tie's workers' comp. policy number. ' tam an employer that is providing workers' compensation insurance for my employees Below is the polity and job site information. Insurance Company Name Policy # or Self-ins. Lic. #: Expiration Date: Job Site Address: City /Sta&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 ofMGL 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 Investieations of the DIA for insurance coverage verification — - Ida hereby certcfy un a pains f p rjury at the information provided above is true and correct - -�i ture:- Date: Phone # 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 #: HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) 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 builduig department for the City of Northampton wants persons) who;seek to use 1. the'liom owner exempt on,-to °act astheir con&lracCrgn-sapervisor tobe'aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection. process requires thatthe.building department be called to inspect work at various stages, which_include foundation /footings (before backrdl), sonotube holes (before-your), a rough building:- inspection (before work is concealed), insulation inspection (if required) and a final buildine inspection. The building _ depart re quires; thes in before the work is concealed, failure. to secure these ins uections`can result in failure to obtain a certificate of occupancy until the work can hi insi ected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) -the homeowner will.le responsible'to make sure "thatthe trades hired secure their proper �ermits 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 I, 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 tome. Date Address of work location Name/Address Charles Jeffrey 17 Adare Place Northampton, MA 01060 Date Estimate No. Project 06/28/11 1198 Item Description __ _._ Quantity Cost Total boiler Viessmann Vito 200 74,000 btu condensing boiler. 3,883.00 3,883.00 vent pipe vent pipe for boiler 375.00 375.001 Materials materials_eesed to complete job 1,675.00 1,675.00 Labor installing boiler, removing pipes, radiators, 3,500.00 3,500.00 installing radiators. ermit -Gas Resid _. 75.00 75.00 ermit- Plumbing 1 120.00 120.00 water heater Rinnai LS75 on demand gas fired wtr htr, includes 2,200.00 2,200.00 labor, materials and vent. radiators 8 radisson radiators 7 i 2,221.70 2,221.70 thermostats thermostats for hydronic alternative rads 334.62 334.62 H valves H valves for radiators 483.60 483.60 /8 pex for Hvalv 3/8 pex fittings for H valves 136.50 136.50 Gas piping new Rinnai water heater and new 3 Viessmann boiler, removing cast iron radiators and steel pipe, installing Rinnai and Viessmann ! units, running supply and return lines, plumbing in i units, calling for inspection, installing new Hydronic Alternative Radiators, calibtating Viessmann boiler for correct effiency. i Skee's Plumbing & Mechanical, 348 -3009 & / J Total $15,004.42 C7 gj" Print Quote Page 1 of 2 w ' A � . �rtz �vmq,— More doing.. Home Depot Store # 2662 179 DAGGET DRIVE WEST SPRINGFIELD, MA 01089 4137319700 CUSTOMER: DATE: 07/14/2011 MESSECK,HARVEY 271 PROSPECT ST NORTHAMPTON, MA 010602126 4135844460 SALES ASSOCIATE EARL Thank ou for sho p m The Home De ot! We value our business! ,..'1r , ➢ y�. PRODUCT CODE UNIT WAS UNIT UNIT NOW TOTAL ITEM FRAME SIZE LOCATION DESCRIPTION PRICE SAVINGS PRICE QTY PRICE 0001 Andersen Windows $286.71 and Patio Doors Item price valid through 07/24/2011 RO Size = 2' 8" W x 3' S 3/8" H CX135, Unit, White /Clear Pine, L $261.61 $26.16 $235.45 Handing, Straight Arm Hardware, Unit Size = 2'7 1/2" W X 3'4 High Performance Low - E4 Glass 13/16" H 1321105 r 400 Series, PSC Single Units CX35, Insect Screen, Stone $20.21 $202 $18.19 c Unit Code /Item Size: CX135 1398403 ❑ Operation /Handing: L Clear Opening Size: 25 Inch r Part Number: 1321105 r, Frame Option: Nailing Flange ri Exterior Color: White Hardware Pack, PSG, Andersen $4.89 $0.49 $4.40 Interior Color. Clear Pine Classic Series - Stone 1361537 Glass Type: High Performance Low - E4 Glass u Insect Screens: Stone Hardware: Andersen Classic Series - Stone QUOTE #: Quote Summary « . � lz,,A http: / /vendorapps. homedepot .com /usp /PrintQuotejspx 7/14/2011