32A-046 3. Time
The work specified in Clause 1 will begin once down payment and Town permits
granted. Aprox end of Dec beginning of January Weather depended.
4. Licensing and Registration Requirements
Contractor will comply with all state and local licensing and registration requirements
for type of activity involved in the specified work.
Contractor's state license or registration is for the following type of work and carries
the following number:
Construction Supervisor License: CS 97208
5. Permits and Approvals
Contractor will pay for all state and local permits necessary for performing the
specified work.
6. Injury to Contractor
Contractor will carry his own insurance. If Contractor is injured in the course of
performing the specified work, Homeowner will be exempt from liability for those
injuries to the fullest extent allowed by law.
7. Additional Terms
Homeowner and the Contractor additionally agree that:
All agreements between the Homeowner and Contractor related to the specified work
are incorporated in this contract. Any modification to the contract must be in writing.
Homeowner's signature:
Date:
Contractor's signature:
Date:
Page 2
73 Market Street Agreement
Owner's name: Rebecca Schwartz
Address:
31 Teawaddle Hill Rd
Leverett, MA 01054
Phone:
Contractor's name: Eric Driver
Doing business as Sustainable Builders
Address:
556 Stage Rd.
Cummington, MA 01026
Phone: 413 - 695 -1947
Homeowner and Contractor agree that contractor will perform certain work on
Homeowner's property located at: the 73 Market Street in North Hampton Mass,
Work to Be Done:
1. Pour a new slab over the existing one 10x 4 inch deep approx.4 in deep
2. Plump, level and secure the existing posts to the new slab
3. Tear down the second floor, existing rotten roof over the stairs. Tear down the
gutters on the cherry street side of the house. All debris will be disposed of.
4. Reframe the roof with new rafters 4x4 post and 4x6 ledger to support the rafter.
post made of pressure treated materials , new sheathing and asphalt shingles to
complete the structure.
2. Payment
$2000 total
$1000 Down Payment and $1000 when job has been completed
Page 1
The Commonwealth of Massachusetts P Form
---% - Department of Industrial Accidents
Office of Investigations
il 1 Congress Street, Suite 100
* , ,I; Boston, MA 02114 -2017
.,-'° www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): r'�f Ca `> ' ‘k., C . i u S 4 , 06t. l o I f EL _ 11=7' >
Address: j �^ .2 ! G C
City /State /Zip: C ✓ <m-? /)i iri cip MA Phone #: 4//3 - L? 9 .--- 1 C7
Are you an employer? Check the apppriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
P J
gtnployees (full and /or part-time).* have hired the sub contractors 6. ❑ New construction
2. I am a sole proprietor or partner- listed on the attached sheet. 7. [remodeling
ship and have no employees These sub- contractors have 8. El Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions
3. CI officers have exercised their I am a homeowner doing all work 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs
insurance required.] t c. 152, § 1(4), and we have no 13. ❑ Other
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 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 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:
Policy # or Self -ins. Lic. #: Expiration Date:
Job Site Address: City /State /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 of MGL 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
Investigations of the DIA for insurance coverage verification.
I do hereby certi under the •ains a;e • enalties o •er'ur, that the information provided above is true and correct. -
Signature: � '-�- —�.i Date. ` 6 .--
Phone #: /j/ 3 6 5 / ? et 7
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 #:
,,
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisory. Not Applicable ❑
Nome of License Holder : 7 ,-- / `c._. C r l v r �"--- /6 6 q `7
License Number
.j 6 ,57/.,- . ci ( ,<�- ,/1 ���//gyp /�/
Addy (/ E xpr i�t on Date
12 A- -C-- q/.3 61 = /.41-
Si ure Telephone
8. r . �l l., !AL ii. . - i...n . _i7. .! : Not Applicable ❑
Company
,J - 6. 'h Q P1 (�/r t ` bpc 6G t Regi ti�on2 Abe
2C Telephone 7
r� Expiration Date
Address (e 7 3 - aff f p
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.O.L. 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....... ly 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 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 -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" certifi and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State ( ()
ocal Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
( i .
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition Replacement Windows Alteration(s) Roofing
Or Doors
Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Prop sed / �/ � / , / / ! /
Work: f r bvi I.4 "�kr_V,ri 1 p - TC< <CS &0 r c ljYi (/Fi' -C )1561177 jcfC 5Ictr;'•�7
Alteration of existing bedroom Yes i.------ No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
ea. if New house and or addition to existinn housina. complete the followina:
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, cp �. b.t- G- c& 5e.... 11 C ' 4 C + ` , as Owner of the subject
property
hereby authorize re �J
t' l G C Z Li e
to act on my beh= in all matters = , - to work authorized by this building permit ap licatio . Z1 77
Signature -, 0 - r A Date
I, gr ` ['.-- (" 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 sins and penalties of
Print Na
: —---
Sinat o f Owner /Agent c/ v Date :3/2-/// . 3
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SE ction 4. ZONING All Information Mia Be Completed. Ftrmit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled inby
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit / Variarlpe /Finding ever been issued for/ on the site?
NO ( ELEN Jlil' YES
IF YES, date issued:
IF YES VWas the permit recorded at the Registry of Deeds?
NO Kj.°1)4/ YES
IF YES enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DCNT KNOW 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 (NO)
IF YES describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES N
IF YES describe size, type and location:
E. Will the construction activity disturb (clearing, gr excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES l NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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..
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R E CEIVED Department use only
fill City of Northampton Stelae of Permit
Department CurbGut/DrlvawayPenr►it
2 7 212 Main Street Sewer/Sepik Ava�y 10
Room 100 Wat /watt Availability
Two Northampton, MA 01060 Two Sets of Structural Plans
x•11. - 4` one 413 587 - 1240 Fax 413 587 - 1272 Pkiti! 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
0 Ait cl,; (e t S f Map Lot Unit
r { L i c. v .,. vie, !O Li 5 S Zone Overlay District
EIm 3t. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
,R e a ,�-�•. ti wet i 4- z ?� 1 % �� wlic� /ry /I (l cur -,�`ft
Name (Print)/V7 � /' Current Mailing Address:
SUq- z-0 7— S iLZZ
r = Telephone
Signature
2.2 Authorized Aaentt :: //
Ev- t' I J r < ' t/ t ' �� _b .54 e _ --- CC. kii. r'( ( itry ) Os'°I
Name Print) Current Mailing Addres
@3 — 6 ,s-- (9 / 7
Si ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 2 e7Q 6 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection � f665" 6. Total =(1 +2 +3 +4 +5) 2 00 Check Number ✓ 97
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
1 of 4 3/19/2013 10:16 Plitt
File # BP- 2013 -0876
APPLICANT /CONTACT PERSON ERIC DRIVER
ADDRESS/PHONE 556 STAGE RD CUMMINGTON (413) 695 -1947
PROPERTY LOCATION 73 MARKET ST
MAP 32A PARCEL 046 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /�}
Fee Paid JU/ f 7 A56
Typeof Construction: REBUILD STAIR FOUNDATION & ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 97208
3 sets of Plans / Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
r- o i,y
Signa n e 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.
73 MARKET ST BP- 2013 -0876
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 046 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 # BP- 2013 -0876
Project # JS- 2013- 001498
Est. Cost: $2000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ERIC DRIVER 97208
Lot Size(sq. ft.): 4399.56 Owner: SYLVAN PETER G & REBECCA SCHWARTZ
Zoning: URC(100)/ Applicant: ERIC DRIVER
AT: 73 MARKET ST
Applicant Address: Phone: Insurance:
556 STAGE RD (413) 695 -1947 WC
CUMMINGTONMA01026 ISSUED ON:3/29/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REBUILD STAIR FOUNDATION & 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 3/29/2013 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner