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32A-027 Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527 -7124 Submitted To: Andrew Kubasek Phone- 584 -6223 Address : 30 Cherry Street Date 3 -25 -2012 Northampton, Mass 01060 We hereby submit this estimate for - Garage Roof To start the garage walls are concrete block and they are in need of repair. I will remove and re -lay as needed. I will install a pressure treated plate on the top of the block walls. We can either build a full trussed roof or a roof slanted to the rear. For the slanted roof I will install metal roofing and aluminum trim. Price = $ 4850.00 - - -- For the trussed roof I can build with plywood and shingles or metal roofing. I will finish off the gable ends and trim with aluminum. Price = $ 6360.00 e 8'x 8' garage door will be supplied and installed by Raynor Door) Price $ 1 500.00 (with elec. Opener )i .1z. Contractor Supervisors License number 082531 Home Improvement contractor Registration number 135204 I propose to supply materials and labor -in accordance with above specifications. This proposal may be withdrawn By us if not accepted within 30 Days Authorized Signature ,o _ _ .41 � 1 Acceptance of proposal Signature "' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of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 building department for the City of Northampton wants person(s) who seek to use the home owner exen ption,rto act as their own construbtzon supervisor to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requireslhax the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper emits 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 • 1, 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 • f 4 The Commonwealth of Massachusetts Department of Indusfrial Accidents.. ' _ ► = ffl Office of Investigations °=_ 600 Washington Street � ' � Boston, MA 02111 �� www.massgov /dr'a -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information gi Please Print LebIv Name ( Business /Organization/Individual): S) / - t-, . Address: /l „ $T S tir . City /State/Zip: Ze ` i / l/ 2,I j , P hone. #: 2 // f Are you an employer? Check the appropriate box:. . Type of project (required): • 1. ril I am a employer with 2.- 4.. 0 I am a general contractor and I 6. New construct.- on Io full and/or cti ees r arf- -time * have hired- the - sub - contractors — - - - 0 - Y ( or �' listed on the attached sheet. 7. 0 Remodeling 2.. [] I am a sole proprietor or partner- e li , shit, and have no employees These sub have .8. ❑ Demolition working for me in any capacity. employees and have workers' - ,-king Y P rtY # • 9. Building addition [No workers' comp. insurance comp. insurance. re • ed. 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 4 ) 3. ❑ I am a homeowner officers have exercised their, 11. Plumbing repairs or additions doing all work .f ❑ ?nS eP myself [No workers' comp. right of exemption per MGL 12.0Roof repairs - insurance required:] t - c. 152, §1(4), and we have no • employees. [No workers' 13.0 Other • 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 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 employees, they must provide their workers' comp. policy number. . . I am an employer that is providing workers' compensation insurance for my einplbyees Below Ls the policy and job srte information. Insurance Company Name: . eta f /9ei /D . Policy # or Self -ins. Lic. #: (. 3 5JggJ Expiration Date: G `7�/_.,T . Job Site Address: 50 a . a' - f"r'f . .. City /State/Zip:= /& /9 e"/ o 4- c' 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 of MGL c. 152• can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one -year imprisonment, as well as civil penalties in the form of g STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that 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 the pains and , enaltries of perjury that the information provided above is true and correct Siye:ture: - . 0 k -°<& - r i ilr- - ■P . Date: �/ 2 7 / 2. , Phone #: 5 7 - 7 . . Official use only. Do not write in this area, to be completed by city or town official • Cit or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. C.ity/Town Clerk 4. Electrical,Inspector 5. Plumbing Inspector 6.Other - Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : SP'.w / 022 5/? / License Number 6 ,s S ' 7 SS /7- Z3— l Address Expiration Date S"27- ?/2y Signa ure Telephone + .rentra . z s? � Not Applicable ❑ ,r f f2o Company Name Registration Number (t s � 3- /y Address Expiration Date -CY , Telephone 57) .,7/, — SECTION 10- WORKERS'. COMPENSATION INSURANCE AFFIDAVIT : (M 0.,L.. t . 452, § 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 41 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 posse ss 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing []" Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [O] Brief Description of Propose ( TX 1. 4 i " e .) / Work: f Vo+ h� < n ,Gw (j 1 r/�. C u+L "1" 25; 114 v.6 Alteration of existing bedroom Yes X No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes e' No Plans Attached Roll - Sheet r a '1:1,('-.411/4?, ':mss $` r® as � e ® a �' r Syr, r ��'t�,2�C: � =� � Q: a. Use of budding : 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. Wiil;: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 , 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. S i g nature of Owner Date X 1 - t1 , as Owne horize Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best o my knowledge and belief. Signed under the pains and penalties of perjury. S' Print Name V/e Signature of Owner gent Date , Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zo This column to be filled in by Building Department ' Lot Size I L-._ 1 1 Frontage 1 ( 1 Setbacks Front 1 1 1 1 Side L:' 1 R:1----1 L:I_..___J R: _J R:1----1 _._ Rear ri 1 1 1 I Building Height 1 1 I Bldg. Square Footage 1 1 1 1 % f _Open. Space Footage 1 % _ __ — - (Lot area minus bldg & paved t 1 I 1 � I 1 I parking) - # of Parking Spaces Fill: — (volume & Location) t A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW 0 YES 0 IF YES, date issued:{ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page 1 and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0 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 © NO 0 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 0 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. I. : City of Northampton 1 � r Building Department ' 3 i �� 212 Main Street" �� Room 100 ii ifrif 27 �' "� Northampton MA 01060 . — ot , phone 413 - 587 -1240 Fax 413 - 587- 1272�,;, ; . � � � . y o z .Y : 9 , n � A -L . y $, � � i f : APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Proverb/ Address: This sections to be completed by office S b ',� � ; Mel �.� '� � '-e aU�nt L i J i¢ it/ 7 �� " x '.` ' ' E O rend, P I t:t c t4 s 4Irt St �7tstrrct ,, _. CB »si ct i` SECTION 2 -PROPERTY OWNERSHIP /AUTHORIZED A G E NT 2.1 Owner of Record: Ail Dvi J ie tibi , f , e 4 J o ( a ,--y/ , Si ,L Name (Print )... Current Mailin ddress: , �°� �C�l,F'4'G Telephone G Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: (, 5 -' Signature Telephone " SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Perm Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) ...;... 3. Plumbing Building Permit Fee " s... ' . 5,.. aw 4. Mechanical (HVAC) 5. Fire Protection f 4 < / /O 1 6. Total = (1 + 2 + 3 + 4 + 5) Check Number v/ This Section For Officiai Use Only Date Building Permit Number: Issued: _ #1,, ? 0‘,. ..e . ' is0 / __, _/,. Signature , l Building Commissioner/Inspector.gf Buildings pate 30 CHERRY ST BP- 2012 -0940 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 027 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # B P- 2012 -0940 Project # JS- 2012 - 001639 Est. Cost: $4850.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STEPHEN CAMP 082531 Lot Size(sq. ft.): 7448.76 Owner: KUBASEK ANDREW E & MARGARET W Zoning: URC(100)/ Applicant: STEPHEN CAMP AT: 30 CHERRY ST Applicant Address: Phone: Insurance: 46 EAST ST (413) 527 -7124 O WC EASTHAM PTON MA01027 ISSUED ON:4/30/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:GARAGE REPAIR & NEW METAL 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 Signature: FeeType: Date Paid: Amount: Building 4/30/2012 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner