Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
24C-143
12/28/2010 16:56 4136252824 JOHN MICHONSKI PAGE 02/03 Property Address: /1 .4rN 4#.0D' , .7 i t fG d ew Contractor tJTW4' /' • Wfe//o '$x r d *•9 Name; uT�H.d'S ,fv.r�1� /P�BJf /,� B,cflf� Address: �.sr SF"` _ City, State: A v _ Phone: - Property Owner Name: _ GnAP/icTvie " " ".".e.s - — Address: City, State: , 4' fit.' 1, d . Z , ( . Sf'c (contractor) attest and affirm that the building I intend • to insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that 1 have provided the property owner with a copy of this affidavit. Contractor signature d � ff `te, p — Date 4. ,4, -,•20// // ' 0-57":" l0-•��j WAP Work Order Community Action of the Franklin, Hampshire Job Number: 10 -269 and North Quabbin Regions, Inc. Work Order Date: 12/13/2010 P.O. Box 1432 Ownership: Owner Greenfield MA 01302 John's Home Repair Auditor: BRAD COUNCILMAN 66 Conway Street Shelburne Falls MA 01370 Phone: 413-834-7725 Christopher Crowe ARRA WAP $1,234.00 11 Arlington St Bay State Gas $4,711.64 Northampton MA 01060 Total $5,945.64 413 -584 -1305 7 $ � �SDIa O f . • 'a - <q ,.f .'k.lE.aesn '� ,k- A 5 ,< � i' i'" e Attic stairs - fill with cellulose 1 $130.00 $130.00 t Perimeter Wrap R -5 reinforced foil 432 $1.82 $786.24 or vinyl faced ductwrap Sill two -part foam w /fiberglass batt 54 $2.00 $108.00 ., s ,..,;, a x+ fie. ry l +;"i a � W V;, -, Vin..: _ M .. fi : * .?Y a i °LCk. k . Automatic Sweep 2 $22.00 $44.00 R -5 Ductwrap or R -max on door 2 $44.00 $88.00 Attic door & basement perimeter door - rmax please Repair/Refit Door 1 $50.00 - $50.00 Front door; basement perimeter door. Weatherstrip s /Q -lon or equal 2 $43.00 $86.00 37 - egiv: i. '; Attic sealing with two -part foam 3 $75.00 $225.00 Open flooring to permit chimney chase sealing. Photo before closing. Basement sealing with two -part 2 S75.00 $150.00 foam Date: 12/13/2010 Page 1 Workers' Compensation and Employer's Liability Policy :, NorGUARD Insurance Company - A Stock Company IA INS URA tr /. Policy Number )0WC119640 I' v +... Renewal of NEW NCCI No.[25844] Policy Information Page [1] Named Insured and Mailing Address Agency John Michonski BOSTON INS BROKERAGE 64 Conway St 24 Federal Street Shelburne Falls, MA 01370 4th Floor Boston, MA 02110 Agency Code: MABOST10 Federal Employer's ID 26 4838401 Insured is Individual Additional Names of Insured (N2) John's Home Repair [2] Policy Period From May 28, 2010 to May 28, 2011, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $500,000 Bodily Injury by Disease - each employee $500,000 Bodily Injury by Disease - policy limit $500,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D. This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 8,751 Total Surcharges /Assessments $ 649 Total Estimated Cost $ 9,400 INTERNAL USE DK Page - 1 - Information Page MGA : )OWC119640 WC 000001A Date : 06/09/2010 MANOTE 16 South River Street • P.O. Box A -H • Wilkes- Barre, PA 18703 -0020 • www.guard.com Board of Buildin(5 Reoulation, and Stand art.k f-sonstruction SOpervisor License license: CS 94376 JOHN P MICHONSKI 66 CONWAY ST SHELBURNE FALLS, MA 01370 Expiration: 6/11/2012 .1111131kner 28400 Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 142709 Expiration: 5/1/2012 Tr# 293933 Type: Individual JOHN'S HOME REPAIR JOHN MICHONSKI 66 CONWAY STREET SHELBOURNE FALLS, MA 01370 Undersecretary • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 0 / /‘/ 5 i( / 0/3 7a License Number >e C G o v. /4 y sr SIM .41)4Ne 7=4 ,fit � � o�z Address I Expiratio Date y /3 - �3y - »1�� Signature Telephone 9. Registered Home Improvement Contractor: /atm/ /H c /yp vs/e/ Not Applicable ❑ ✓ 9 /,'it/ -s /5 A="11'14 / 7 7 Company Name Registration Number Address Expiration ate 5 /*AGve/tt f,5'14S //M %.j/ Telephones /j - r- 4 Y - »1-5 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 res t in the denial of the issuance of the building permit. Signed Affidavit Attached Yes Ar 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 on 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 -vear 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House I I Addition 1 1 Replacement Windows Alteration(s) n Roofing Or Doors E Accessory Bldg. C Demolition n New Signs [O] Decks [[] Siding [El] Other Brief Description of roposed // \\ Work: 67776 k"izi /A/SdL C,e::zza.`o J V / S7A , e =,/ri -' L) 4 v e q 1 f1l-s u%�/ /4 64i t-' Alteration of exstir�g bedroom Yes No Adding new bedroom Yes 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/ /n 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, C/1 4/s/ 'HE . as Owner of the subject property ,T eht �p /1 /icmgmvsK/ c;✓/J4 hereby authorize TON4' � S i �� ' _ .SEA' d / c- /= to act on my , in all ; atters or authorized by this building permit application. Signature • • r Date JO/M/ P /ipe- hiewsA! / o1 ha 1, k-7-171"1 s //v/ /Qe-//4/4 54 1 v. C-� 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. Al < /f / ,Q , - O/ ` / ' ice- /17/ Print -- e • i it4 / /2 /O Signature of Owner Agent Date s , 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 bv Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Hcight Bldg. Square Footage oA Open Space Footage (Lot area minus bldg &.paved parking) of Parking Spaces Fill: (vo'ume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW i YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T 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 ig DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO g IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO S. 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb`Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability ' Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office // Map Lot Unit /j/ 7 fnor,/ o€/ I27j�}. O/O 6 0 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: O /O <0 CH& /5 ro /fit <As/G fa adotr#Ater e/ Name (Pri• Current Mailing Address: _ 1 / /3 - 8'y - /3 03 „..►r 1 k Telephone Sig 2.2 Authorized Agent: � / I I © / J /3.�� d ce f i v S J/e' !e iQ60/1-/ SA(' r ' ct G6 Co r/i1`% S J' .S/,`Axo v,i[f A!/js Name (Pri ) n Current Mailing Address: ltA / 3 - g� 7 -Z ignature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only jompleted by permit applicant - 1. Building (a) Building Permit Fee 7.so. 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number --- This Section For Official Use Only 7777 Building Permit Number: Date Issued: Signature: 4111111. /'_.1� Building Commissioner /Inspector of Buildings Date 11 ARLINGTON ST BP- 2011 -0575 GIS #: COMMONWEALTH OF MASSACHUSETTS >M CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0575 Project # JS- 2011 - 000949 Est. Cost: $5950.00 Fee: $110.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: _ JOHN P MICHONSKI 94376 Lot Size(sq. ft.): 10410.84 Owner: CROWE CHRISTOPHER Zoning: URB(100)/ Applicant: JOHN P MICHONSKI AT: 11 ARLINGTON ST Applicant Address: Phone: Insurance: 66 CONWAY ST (413) 834 -7725 WC SHELBURNE FALLSMA01370ISSUED ON:12/27/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL ATTIC & WALL INSULATION & WEATHERIZATION & REPLACEMENT DOOR 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 12/27/2010 0:00:00 $110.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner