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37-022 (2) Board of Building Regulations and Standards • ==c HOReg ME IMPRistrationOVs EMENT 134958 CONTRACTOR i � Expiration: 2/15/2006 Type: Individual WILLIAM E.SORENSEN WILLIAM SORENSEN �_` PO BOX 15 l G-� " W. CHESTERFIELD,MA 01084 Administrator ..•, ---- �/�uascu,�ucaelta �-iie.oan'vow/iuuea BOARD OF-BUILDINREG S i CONSTRUCTION SUPERVISOR License: _ - 967059 • Number: `.i --- Birthdate: 08/25/1954 ,,h, :. Expires:08/2512005 Tr.no: 22929 Restricted: 00 WILLIAM E SORENSEN PO BOX 15 ,01Q84 Acting mis oner W CHESTERFIELD D, • CARBONLESS PROPOSAL �S ® FORM 3850 TRIPLICATE PROPOSAL �? Imp c) ,0-1 k Z. re ��, -i' 5-r-, „ ate 1)1) /es €r eec-i ��° , C) 16, 9 Sheet No Proposal Submitted To: Work To Be Performed At: Name Street P Mk . r Street \1 . • b - 0 06a- City x rf A.. [ State ' City ' �SYCe-. State .(V/ /(6 Phone 4e,”'3 `r�S - Ct` .� �..f'\1°1> � Date of Plans 1 Architect _.. "We hereby propose to furnish the materials and perform the labor necessary for the completion of e l._f Z./ )C/.. r y4 �(;S f 4 LJ r ti v Wit. eG .. „._..r � 4_i_�/4:3 1, / j!._.. Cc r3'l e �(�r i' �{ LL l __. t� .._._. . +'1 ,� iV,�L✓_- �Ge.1C' .._..fit � 0 , -i-o �'.x t s`ed ,N 5 fJ ,i ` -R l`'"//t/<S I1 G (54.5e.7-c- 0,0, ex^ _5..7 -_�.►^.1. _. r 9C),11 , 77'7/nv o rt- S t rS i'1^eAd - c�c. ('S, 5 , ?C SS- P a I L L e r e «e GY u A r ' r'v 'r Vern' r; ) 7 ,P%l am /v4 V R\-, G a��i L /`"%�U ..� Z b: l s� 1a e, _ Ctc(t- I S 3-'0L/ &.ce o q e C0 C +�© d c-te // he Or Cti06u°-1- _AU J ` Si O All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and spec fications submitted for above work and completed in a substantial workmanlike manner for the sum of ` Olvt- (e u -14o0 L'J 4 r-c-r r2Gi e Dollars f$ 7.3 OCc) ]. with payments to be made as follows: 1,000.00 C ep sd - is/174,k121&,-,7=OF Lfi©Do, o q1 �-c&'7 cD/ Luc1 c , a _ )c yr,—* 0 s*'OD0 co a#hattih y_3 ;.�*, ayryrertit F.J'©o ,vim a'Ae,v /-7,,,,s4 4 Any alteration or deviation from above specifications involving extra �^ costs, will be executed only upon written orders,and will become an Respectfully submitted 101‘,64//14)v1 I loy-e ./S-eU-- extra charge over and above the estimate.All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry - �9 7 fire,tornado and other necessary insurance upon above work. Work- Perv-eUseit% Ho _ Me -Ti'n l� 'er4. ►( ± men's Compensation and Public Liability Insurance on above work to be taken out by Note-This proposal may be withdrawn by us if not accepted within days. ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. / Signature ` ..... ro.;_,,.` -�'' / _ ~ � ° ^ . °.�� ` • ` ^ � � � • ' ^ � .. ` � . � / . • . ` -�'| ------- - -- - . ` ' / ' t ry { __ | | • . `_ w� - ' ' / , - | | | / • — O0 i v« ~7- | ~ | ` +---. � • `-!• || }i \ o -1, ^ L- N . ` - _' - -_ _ _ || I | | �-- - ' | } - | | 1 � . . ~______- ^ ' _ - \ , � . ~ . - � -- ` � „..s ,+* ., = ^ ,..,, ,„-,, - � - -- '^� '� ' . . . 00t AMP2O •4 °;~$ (r,z# r of Narflpnuptart • Pz =*-" _ /,5.V="41:-"g"_SY i J sacIFusetts ' DEPARTMENT OF BUILDIT;G INSPECTIONS ', - /, INSPECTOR 212 Main Street • Municipal Building a,,� 5,4`; Northampton,MA 01060 . e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supc-.' sor. 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 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 to me. Date Address of work location • . , ..c1V,H • •, 0.9- 04. (flit tr t I. 7 _ ttfei = =7, T L)EPARTMENri Oi DUI LDI-7,ZG INSPECTIONS 212 Main Street Municipal Building Northampton, Mass. 01060 WORKE,R'S CONITENSA'I'ION MSUIZANCE A,F1e1J)E4,-.V1.T i. 1144.... 5"-ef7-/ with a principal place of business/residence a:: q do hereby certify, under the pains and penaltie:: of perjiir■„:, that. ( ) I am an employer providing the follovvtini.: compensation ct,oveita:ie for my employees working on this job: (Insurance Company) Number) (Expiration Date) ) I am a sole proprietor, zentral coon-actor or homeowner (circle one) and have hired the contractors listed below v,rho have the foilov.,-,-)p.; worker,js compensat:lon (Name of Contractor) (Insurancc Company,Totic-f Nuiribc,r) (3:: :-,-;t107, Date) (Name of Contractor) (las-urance CompanwPoNcy Number) (Expiration Date) -------- _ — (Name of Contractor) (insurance (:o ri-,riany/?o1 Number) :,Exa:ratiori Date) (Name of Contractor) (Insurance Co=iy,Toticy Number) (EXT:,1-,1:1071 Date) (acLach : • AC), I 1.11.1 a tiole proprietor and have no one vorhinr for me. ( ) I am a home owner --)(':, 1, 1-fC:Thinq all the nvrr : self NOTE:plc:14c b awarz that wIrJe Le) 'Pau" not unr-t then thrtx,wilt,in wilth the T j-a3 (Xi Oi gni zot.,..u-tzr_tstt thccto rjc trot lvz cznploycs urv:lcr the v.trkeer. (GL,152.1-..m1(5).1, nci:by a botricowner for a Lc-zu-.4 I tgal cta.tus of nil ccroployer under t.t,a Wozicc,t1 1 urxierstand that x copy of a:,rtatcr...-...1 may bo fona.mrda.ci to tho 1),Iiart..-ncaat of lndalstrial Oinc'o of for lb' coverage vL.--ifiaiou and that Eilu..rt to rmcirc cov-orr_go -:;cc-tio.c.25A of MOL,152 can c=4 to the impositicc of cz-Untritl Pct:-511=c3 cooaisting of a fux:of up to S1,500.00 an- 'c irt:pri.---xin-k-nt of up to cr.-.yzz.:cvi civil 7nrultics in=1.4 c.f and 1-u- of S100.00 I day LE.7..inti Fcx- onfy P Cr Mit Nan :r _1,-ot S!gna turt of ,iccItr,cc/Pc.rn) • SECTON`8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : f/!// /I/ 4 il- c r S6 (506.5- License Number � X 1 tu. fiea ) 01:.ft, 6R.' C), Address ('i Expiration Date /d< ;!�' I7e7 3 0 1 N -ignature Telephone "orn&rn'•r4uenner! o`ntraeto - _- = � 0°,' ` K* Not Applicable ❑ �} 1-442 ,� a �,L, rc,` /3 2 9'c Company Name Registration Number 1 Address Expiration Date Telephone 61674,- OiS C[ SECTlO iO '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 result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes V8°"" 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 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-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 • • SECT^I0N S R ferd'ONLORPROPOSEDMORKii check a1I a• i lic alt e New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: w� s � Alteration of existing bedroom Yes 7 No Adding new bedroom Yes No Attached Narrative 0 / Renovating unfinished basement _ Yes No Plans Attached Roll 0- Sheet 0 . a .fNe OUS'e at d o'�°'"J add"ition to ezistin`Yhorsing om° let e ileMt .owl.ng: 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. Mascheck 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 S,E01,64WtI ER AU ID IZATION TO.BE COMPLETED WHEN • OWNESA , CONTRACTOR APPLIES FOR BUILDING PERMIT • I, )4-t9 ifNa , as Owner of the subject property hereby authorize t � -5� r\ to act on my behalf, i all m. te;s rlativet work authorized by this building permit application. _ Signature of 0 ner Date I, , 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. Cl) I Ci t'a'i E e seAti Print N am e j fi G `am -,;2i.—(" 71- Signature of Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by 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/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT 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_ No IF YES, describe size, type and location: i City of Northampton ; . � fic 3 V i th ' .. 1'. Building Department =- °' 212 Main Street . ; � , ,,,.: , ; Room 100 �t��,_ s Northampton, MA 01060 � � ` `�w phone 413-587-1240 Fax 413-587-1272 ��'�" '' ._ � T r - ~� t APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION- tt This section be completed"by office 1.1 Property Address: fia r -., � -,s E -q 4"*� � i s� aY©istnct, * ( O ( �Uf-. f . � cne K ''Q j az c k-i '''b` J k"* Y �.a 't Y f SECTION 2-PROPERTY`OVYNERSHIP/AUTHORIZED AGENT " 7 , 2.1 Owner of Record: -2- 6, ''')--i L.Lf Wit /6144'' iv i ,)(- Name(Print) Current Mailing Address: ilibibt Telephone Signature G� ( ,l 2.2 Authorized Agent: ei (63e-Ek5 Name(Print) C rr'ent v Ma/ili5 ng A/d�dres��s: s r f 14P /1//? arc (-C.'—' H�� . 9'6, .67 5"."7 c.�/ Ci't- >34G 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 �, 1 G 6 Construction from(6) 3. Plumbing b�� Building Permit Fee r 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3 +4+ 5) %`3,O. d ' °`' -Check Number This Section For Official Us' se Only Building Permit Number: Date Issued: Signature: 2Z 2�/ Building Commissioner/Inspector of Buildings Date . t 600 FLORENCE RD- 17 MT LAUREL PATH BP-2005-0090 GIS#: COMMONWEALTH OF MASSACHUSETTS ock:37-022 CITY OF NORTHAMPTON r:-017 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS t'ermit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2005-0090 Project# JS-2005-0109 Est. Cost:$13000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM SORENSEN 067059 Lot Size(sq.ft.): Owner: STEINER ABBEY&JOHN NORRIS Zoning:SR Applicant: WILLIAM SORENSEN AT: 600 FLORENCE RD - 17 MT LAUREL PATH Applicant Address: Phone: Insurance: P 0 BOX 25 (413) 296-0129 WEST CHESTERFIELDMA01084 ISSUED ON:7/22/04 0:00:00 TO PERFORM THE FOLLOWING WORK:FINISHED BASEMENT 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: Receipt No: Date Paid: Check No: Amount: Building 7/22/04 0:00:00 142 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo