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35-016 F G c [IQ - -- ---( t r 1 yy Ls I �� f r ^� l .. _ 7 K3 Cy T W w, •REM - 6 S ,p R Estimate Rata:gain Date Estimate # � �� /�� 3/11/2013 1279 128 Ryan Road Florence, MA 01062 • Name / Address ' Lydia Hemphill 178 West Farms Road Florence , MA 01062 Terms Project On receipt Hemphill bathroom Description Roof vent kit for fan 1 Ea Storage cabinets for at the eves 4 LF Recycle fees l Ea Building permit fees 1 LS Project material, labor, subcontract Material, per job Labor. per job Subcontract. per job *Project Subtotal *Project Total Tota I $5,413.90 We propose to hereby to furnish material and labor - complete in accordance with the above specifications, for the sum total. Payments to be made as follows: half of fitll total upon acceptance, one quarter of full total upon the start of the project and the full balance due upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to • - •.id as specifies Phone # E -mail Signature 413 885 tomO)rainhome.net Page 3 /"/S\'>-- .REMO Estimate � Raintion Date Estimate # 3/11/2013 1279 128 Ryan Road Florence, MA 01062 Name / Address Lydia Hemphill 178 West Farms Road Florence , MA 01062 Terms Project On receipt Hemphill bathroom Description Flashing kit for skylight 1 Ea Ice and water shield before shingles are installed 20 SF Re use existing shingles 1 SQ Kraft -faced fiberglass insulation, 16 in. OC framing members 9 -1/2 in. (R -30C) Cathedral ceiling 48 SF Kraft -faced fiberglass insulation, 16 in. OC framing members 5 -1/2 in. (R -21) 20 SF Gypsum drywall, 1/2 in. moisture - resistant greenboard 200 SF Unfinished antique tongue and groove plank flooring White pine, 3 in. to 7 in. owner to finish 32 SF Board wainscot or paneling 42 inches high 126 SF Softwood moulding, wainscot cap and base 36 LF White wood 1 in. x 4 in. for trim around doors 34 LF Vertical discharge bath fan with light 1 Ea Total We propose to hereby to furnish material and labor - complete in accordance with the above specifications, for the sum total. Payments to be made as follows: half of full total upon acceptance, one quarter of full total upon the start of the project and the full balance due upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and • -- paid as specified. I / Phone # E-mail -, Signature — - 413 885 -9038 tom@rainhome.net rainhome.net Page 2 4 �� Estimate Rainhou �� Date Estimate # 3/11/2013 1279 128 Ryan Road Florence, MA 01062 • Name / Address Lydia Hemphill '178 West Farms Road Florence , MA 01062 Terms Project On receipt Hemphill bathroom Description This estimate is for the renovating of two closets that are back to back on the second floor to change into a half bath. Electrical and Plumbing are not included because home owner is dealing with them directly. Removal of flooring 3 SY Removal of plaster walls or ceilings 160 SF Removal of double -layer asphalt shingles 1 SQ Removal of wood boards on roof 16 SF Removal of rafters 32 SF Removal of stud walls 288 SF Rafters, 2" x 8 32 SF Window opening framing for skylight 1 Ea Velux Operable skylight VSMO6 -2005 (30 9/16 x 46 1/4) 1 Ea Total We propose to hereby to furnish material and labor - complete in accordance with the above specifications, for the sum total. Payments to be made as follows: half of full total upon acceptance, one quarter of full total upon the start of the project and the full balance due upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to : - aid as specified. Phone # E -mail Signature - - – l — 11111■. 413 885 -9038 torn@rainhome.net Page 1 City of Northampton , " 1p f bra Massachusetts y �' : : .''„ I t x vs yam X7 '! DEPARTMENT OF BUILDING INSPECTIONS � 212 Main Street • Municipal Building r v y �<, - \ ' ,.,, . ' �+ N orthampton, MA 01060 : t 5 ti INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that 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 permits 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 to me. Date ............. Address of work location • Y The Commonwealth of Massachusetts Department of Industrial Accidents ,� _ "t, r Office of Investigations ..— 600 Washington Street w Boston, MA 02111 - awl www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information , Please Print Legibly Name (Business /Organization/Individual): \L ' v Cci∎S : C.sL (% Address: \al Q.,.'-•tt,, Q-2-- City /State /Zip: cC.tZjv°e -� " ( Phone #: 'N `3 'WC T Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I 6. [1] New construction employees (full and/or part- time).* have hired the sub - contractors listed on the attached sheet. 7. VTRemodeling 1 )z, bc,\ki■ 2. El I am a sole proprietor or partner- ship and have no employees These sub- contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance. required.] 5. WWe are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ 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. 1 do hereby certify under the ains and penalties of perjury that the information provided above is true and correct. Signature: 9 Date: L \ — .5 Phone #: ' `1 \' l" `" -Co 31 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 #: 1 SECTION 8 - CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: ` Not Applicable ❑ Name of License Holder : � ,� �4� ��t- CS — 0S - 5Z-s. L License Number pdd re . Expiration Date Si nature Telephone 9 71keyisteied Home ImprovemeniContract �u. , 2 _ " , L 2 , , „ Not Applicable ❑ Com an Name Registration Number -S. (C. i✓ G ' 1) ' - "1 - 20Iq Address Expiration Date 0%1'7 O 1. ,-^ (C.A' _ Aelephone A\\ 41 3--f t : SECTION 10 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 15 § 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 b ermit. Signed Affidavit Attached Yes H No 1 .1, . Ho O 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 1083.5.1. 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 pert'nit. 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 • • J SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) • New House ❑ Addition ❑ Replacement Windows Alteration(s) Iv l Roofing n Or Doors 0 Accessory Bldg. n Demolition ❑ New Signs [1711 Decks Ip Siding [01 . Other [O] Brief Description of Proposed I Work: (�J� I Z b�4- (rCc1 C,J Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes ./ No Plans Attached Roll - Sheet sa_.If NewAfiouse arad or =a ddition to °existing Housing, ampl the: following: 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 QR CONTRACTOR APPLIES FOR ; BUILDING PERMIT 1 \ , ` \ , as Owner of the subject property --��,, hereby authorize �_,�\` \ __ -� V\ to ac4lyty behalf, in all ma ters relative to work autho • ed by this building permit plication. Signature of 0 e Date t o , 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. Print IN Signature of Owner/Agent Date • . • Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information r Existing Proposed Required by'Zonin gp Iry This column to be filled3d _ Building Department Lot Size L. , , _ Frontage . __ _ .._,. ,___..__ �_ Setbacks Front Side L:— R: _. L:_ R:_ _..._._._. Rear I Building Height Bldg. Square Footage % I _. Open Space Footage �o (Lot area minus bldg & paved parking) i # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T 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 I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO O 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 ec IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, ex vation, 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. • • �a: EIS t U Departmen use only ' t 6�� V City of Northampton Status o f P i rm t � '� 1 .�u� Building Department Cu C U Drtv a � � -; e 1 GYw 212 Main Street Sew / Septic Awal labi i j Room 100 Vl/ater/UUell Arallbity orthampton, M A 01060 u l� a °'� ° £ DEPT. OF B U IL PTON MA Oco 6 ° NS TWD Seta of Str UCtu�a PJans w NORTHAM t . " �� h ' k j- ' r - - a ; d s `hone 413- 587 -1240 Fax 413 - 587 -1272 P Pla 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 b comp leted by office t , L Ma Lot Unit , � \c c -- i ■ ' • (1\ Ob 2 Zone Ov Dis EIm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name nt) C urrent Mailing Address: /'•� Telephone Signature 2.2 Authorized Agent: Name (Print) Current Ma dress Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use . Only , , ,' completed by permit applicant 1. Building (a).Building' Permit Fee 2. Electrical � (b) Estimated Total Cost of U Construction from (6) 3. Plumbing Building Permit Fee • 4. Mechanical (HVAC) 1 fa , 116 , . - 5. Fire Protection Cam, 6. Total = (1 + 2 + 3 + 4 + 5) � �0‘3 `1 Check Number This Secti Fo Offic Use Only Date Building Permit Numbe Issued: - . _mop „,. ,..., 7,61, i ,„ Signature: Building Commissionerllnspector of Buildings Date 178 WEST FARMS RD BP- 2013 -0926 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 35 - 016 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-2013-0926 Project # JS- 2013- 001572 Est. Cost: $7614.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS MALONE 055236 Lot Size(sq. ft.): 44431.20 Owner: HEMPHILL LYDIA Zoning: Applicant: THOMAS MALONE AT: 178 WEST FARMS RD Applicant Address: Phone: Insurance: 128 RYAN RD (413) 885 -9038 FLORENCEMA01062 ISSUED ON:4/10/2013 0:00:00 TO PERFORM THE FOLLOWING WORK: CONVERT 2ND FLR 2 CLOSETS TO BATHROOM 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 4/10/2013 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner