35-031 (4) New England Remodeling
General Contractors
Proposal No.: 716
Thomas M. Bacis Terms: 1/3 Down
114 Line Street 1/3 Mid- way
Easthampton, MA 01027 Remainder upon completion
(413)529-0801
MA Lic. #: 070061
MA Reg. #: 126116
TO: Roger Kazakiewich Date: 03/12/03
782 Ryan Road
Florence, Ma 01060
(413)586-4584
Job Description Price
Remove and dispose of existing window. Install new Pella new construction window,
new trim and replace necessary siding.
All painting to be done by the homeowner.
Window allowance. $1,225.86
Labor, trim, siding, Miscellaneous material. $1,315.43
Disposal. $100.00
Acquire building permit. $75.00
ze
TOTAL: $2716.29
i
- A 1 1/2% monthly service charge shall be applied to any balance over 30 days.
- Above prices good for 30 days. .
- Any additional work or changes will be priced at the rate of $47.00/hr. plus material.
Signature: Date: Y Ji d 3
i
�THAM p�,
Crz#fir of Paz#4antv#art
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I'1ASSAC]?liSttt6
`STS i DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR 212 Main Street 9 Municipal Building
,y s`ey
NorthamPtlnl, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as !Js/her construction sulj - "sor. T he 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 �Ict a �,xi,sttuction 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 rou=h 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
��-
61111 of \"L11,111alliptoll
a 5 5 a c il[T 5 r t 5
v
01, DMIDING INSPEC71ONS
212 Mali i Street ' Municipal Bull(II11f,
N101-thamptoll, MRS.S. 01060
VF'ORI{1 R'S CO-iNIPENSATION INSURANCE AFFIDAVIT
v"Ith a principal plact, Of bmsinessh(n�d ClIc" I
(31
do here)}'
aill z1:1 (2,11plOY("i pr OVicllaQ thy: V-):
C111plovecs working on t-�,Ils Jjulh,
(Insusail Core any) 3
I)c c7 Number)
O I Lti;l a solc 1)O11100WOU
the contractom hstcL b;I,iov,, v, ) f-( i1r v ()F�,Cr�s c.01-
(Nanic of Cont-mcto-)
(Name of �11�',"T! cy
(Name of coliti-,3cto-L)
(N,:unc of Da c
11111 a "Mic,
I a l.on�c
not thaw uniti i:-,\,i. (-.1 IL n Z;,,j[ILzr_-,,j <
ur".,:T th,��16�1'1 C,-�:r,, c ",-a 1(S)), i--, a hom�,w�r fcl❑L—:1-
IC611 etaruc of an uncle
ca
CO(IlistLngofa lire Ofly to to
firic of S t N.,Xj I(lay I ga irnt
SECTION 8-:CONSTRUCTION SERVICES
8.1 Licensed Construction SuD rvisor: Not Applicable ❑
Name of License Holder
License Number
e- _ c�,r
Address Expiration Date
5,)
Signature Telephone
. •e.°.F j,e �q ^stC'�A. _ a t x7N si
9 .Regrstered�Homelmprouement Contractor. �xa � , „� _ ��, , ;, .t Not Applicable ❑
d e f
Company Name Registration Number
/LsP r,>✓ zlo 1;,Je tl-o _ k 2 7 y
Address / Expiration Date
Telephone ��
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 result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... 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 fr: which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 :1f,iability 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 3- DESCRIRTION OF PROPOSED WORK(checkiall applicable)
New House ❑ Addition El m
Replacepr)t Windows Alteration(s) ❑ Roofing ❑
Or Doors X/
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work:- Q-C 10 t c ' ,d `" U P1 r' - -
Alteration of existing bedroom__Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6a. 1VNeuy House antl or addition to"existing Kddsin�,°`comp eterahe'followtnir_
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
SECTION 7a-OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR''CONTRACTOR APPLIES FOR BUILDING PERMIT'
Fmya L as Owner of t��e subject property
eby authorize to `;` or— -- -
behalf, in all matters relative to wor'�k ar)Ihnrizec by th : r>uilding permit application.
Signature of Owner Date
as Own</1\,ut1horize,(- [it
hereby declare that the statements and information on the foregoing application are true and accurate, ,es f my
knowled ge and belief.
Signed and r the pains and penalties of perjury.
Print Name
Date
Signature of caner/Agent
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book _ . Page and/or Document ##
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 —Y-1
IF-YES, describe size, type and location: ---
cif;Northampton Status of
Building Department CurbC�utlD.,zr :.' r
212, Main Street SewerfSWptte
�• Y
A�'� �.vU ,Roora� 100 WaterlWe11,FAV t t „-
Northampton, MA 01060 Two Sets of Str 'c urat ans � 4
phone`4 3X37 1240 Fax 413-587-12.72 Plot%Site Plans
OtheraSpec�fy
_ �sa
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 _
P alt ,/� G4 Zone Overlay,Distrtct
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT —�
I
2.1 Owner of Record:
Name (Print) Cr.uenl Mailing Address:
�i� iat�ue
2.2 Authorized Agent:
Nariie(Print) C�,rrew Mailing Address:SECTION 3 ESTIMATED CONSTRUCTION COSTS I
Estimated Cost (Dollar Official Use Only
completed byperrnit t--
(a) >uilding Permit Fee
rl tirnated Total Cost of
Instruction from (6)
PI imbir g Building Permit Fee
f��echanic�I (HVAC; � I
�- i ire Protection
G i otal = (1 1 2 + 3 + 4 + 5) '1 06 _ - —Check Dumber
This Section For Official Use Only
Building Permit Number: Date Issued:_ —..
Signature:
Building Commissioner/Inspector of Buildings Date -
BP-2003-0925
GIS#: COMMONWEALTH OF MASSACHUSETTS
{ w . CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0925
Project# JS-2003-1483
Est. Cost: $2700.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const, Class: Contractor: License:
Use Group: THOMAS BACIS 126116
Lot Size(sg^fQ: 19994.04 Owner: KAZAKIEWICH ROGER A&
Zoning: SR Applicant: THOMAS BACIS
AT. 782 RYAN RD
Applicant Address: Phone: Insurance:
114 LINE ST (413) 529-0801
EASTHAMPTONMA01027 ISSUED ON:4129103 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE PICTURE WINDOW
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 4/29/03 0:00:00 2082 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo