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RUGG LUMBER COMPANY PAGE NO 2
66 NEWTON STREET
PO BOX 507
GREENFIELD MA 01382
PHONE; (413) 773-3661
ORDER PICKED EXPERIENCE QUALITY SERVICE EVERYDAI] DRIVER
BY WWW.RUGGLUMBER.COM
MER NO. JOB NO. PURCHASE ORDER NO. REFERENCE TERMS CLERK DATE TIME
19416
cgs JO'
s ON THE LEVEL S
SHAWN FOREST & HELICA USSACH H E . DATE; 8f29/83
L DOCB 141912
L
D, 8 CHAPMAN AVENUE P ***********
EASTHAIPTON MA 01827 0 * ESTIMATE
PR: 82 JOHN 0 ****** * ****
TAX 881 MASS SALES TAX EST. 141912
QUANTITY
SHIPPED ORDERED UM SKU DESCRIPTION UNITS PRICE/PER EXTENSION
18 A 4612RC 4X6X12' RED CEDAR STY. 18
27 A 4608RC 4X6X8' RED CEDAR STK 12.73 /Ep 229.14
4 A 412RCS 4X12 RC D & BTR SEL 27 8.88 /EA 239.76
96 A 236RCB X2X36"RED CEDAR BALUSTERS CLEAR 4 58.48 /EA 281.68
4 A 4618RC /4X6X18' RED CEDAR STK 96 1.79 /EA 171.84
8 A 2410RCS X4X18 RC D & BTR SEL 4 11.13 /EA 44.52
8 21.13 /EA 169.04
TAIRS:
3 A '1228PT iXl2X2@ 82 .48CCA PT SYP 3 29.31 /EA 87.93
i 9 A 4614RC /4X6X141 RED CEDAR STK 9 14.83 /EA 133.47
4 A 4618RC /4X6X10' RED CEDAR STK 4 11.13 /EA 44.52
8 A 41ORCS X018 RC D & BTR SEL 8 21.13 /EA 169.84
% A 236RCB X2X36"RED CEDAR BALUSTERS CLEAR 96 1.79 /EA 171.84
4 A 408RCS 008 RC D & BTR SEL 4 34.96 /EA 139.84
HARDWARE ALLOWACE :
1 EA SST.SCREWS,BOLTS,NUTS,WASHERS 1 88.08 /EA 208.08
TAXABLE 21,37.78
X NON-TAXABLE 0.00
** ESTIMATE ** ESTIMATE ** ESTIMATE ** ESTIMATE
RECEIVED BY SUBTOTAL 30.78
TAX AMOUNT 31.89
TOTAL AMOUNT 2 169.67
RUGG LUMBER COMPANY PAGE NO 1
66 NEWTON STREET
PO BOX 507
GREENFIELD MA 01302
PHONE: (413) 773-3661
❑ORDER PICKED EXPERIENCE QUALITY SERVICE EVERYDAU DRIVER
BY WWW.RUGGLUMBER.COM
CUSTOMER NO. JOB NO. PURCHASE ORDER NO: REFERENCE TERMS CLERK DATE TIME A/p 99416 CAS JO JAR-1
o ON THE LEVEL H EX). DATE: 8/29/03 DOC# 141912
SHAWN FOREST & HELICA USSACH I *** ****** *
D 8 CW MAN AVENUE P
T EASTHAMPTON MA 01027 T ESTIMATE
O O S PR: 82 JOHN 0 *************
X 001 MASS SALES TAX EST. 141912
QUANTITY
SHIPPED ORDERED UM SKU DESCRIPTION UNITS PRICEPER EXTENSION
QTINGS:
5 A ET104 10" SONATUBE 4' LENGTH 5 6.05 /EA 30.25
28 A GM88 8 LB CONCRETE MIX 20 4.22 /EA 84.40
5 A 128AB 9NCHOR BOLT 1/2 118" W/NUT&WASH 5 .43 /EA 2.15
1 5 A ABE66 fOST BASE 6X6 STANDOFF 5 18.73 !EA 53.65
5 A 8612PT EX6X12 #2 .4000A PT SYP 5 27.43 /EA 137.15
EAMS:
2 A c1216PT EX12XI6 #2 .40CCA PT SYP 2 21.06 /EA 42.12
I, 1 A h288PT iXl2X8 #1 .4000A PT SYP 1 11.68 /EA 11.68
I OISTS:
16 A 101OPT cXl@Xlg #2 .4000A PT SYP 16 11.64 /EA 186.24
2 A 1020PT CXIOX20 #2 .4000A PT SYP 2 20.58 /EA 41.00
32 A US210 OIST HANGER 2X18 32 .85 /EA 27.28
28 A 3 fAFTER TIE (REPL W/H2.5A) 20 .33 /EA 6.60
18 A 266E LAG SCREW EA. GALV. 1/2X 6 18 1.02 /EA 10.28
18 A 2GW fLAT WSHR EA GALV. 112" 18 .26 /EA 2.60
r
CONTI D
X
RECEIVED BY
IUINL RODUNT 2769.67
228 SOUTH ST MP-2004-0017
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
IGIS#: 17741
Map: I38B
B1°ck: 244 J' ZONING PERMIT
Lot: 001
Permit: ZONING PERT APPLI APPLICATION PERMIT
'Category: ,Zoning Permit
(Permit# IMP-2004-0017 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2004-0207
jEst.Cost: 1$0.00 Contractor: License:
Fee: $15.00 Homeowner as Contractor
#of Fixtures: Owner: LANCOUR RONALD A SR
Applicant: HEIN HILDE
AT. 228 SOUTH ST
ISSUED ON: 14-Aug-2003 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
ZPA-ADD 2ND EGRESS TO 2ND FLR APARTMENT
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO F
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Zoning Permit Application REC-2004-000400 06-Aug-03 2175 $15.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272
GeoTMS®2003 Des Lauriers Municipal Solutions,Inc.
�'Ct1AMP�.
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Gift' of Wort4a rp tan z
$ � �assacl�usrtfs -
c
s, DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNIR 108.3.4 to
act as has/her construction sups:-, 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
� C%ii�f of �ILt�-�lJ�i1�t}�tnit
� 6 ji�sseacfln6rtie '
• I
^� DEPARTMEN'T Of' EUILBD? G INSPECTIONS
212 Main Street ' Municipal Building
No:thampton, mass. 01060 ,
WORICER'S COMPENSATION INSURANCE AA It AVIT
\vlth a principal place of business/r_sid�nc
(Jpholle'=i
CIO 11CI-Cby CCI—ZI '• UnC'ci- tllc' }J<'_!i1S :'.tiCl pCi]iai1C:; Cl'i pC:f�llf�', ?hi!i
1 am an Crilp(oyer providing t11C 1011o'.':inz '%"ol-}_Cr'S compC11SaUon GOVC`.rt C for In)'
emplovees woridlig on t=his job:
(InsuanG Cornpruy) Glic;?�ti,ilxr) (Explmtion Date)
l j I ant a sole proprietor, nen-rLl G-xitT c77or U' 1?OIIiCo`•��e kCUC1e Oct) ?IIG haN,-e, 111If t]
the contTactoTs listeC b=rio\•= tii1:0 iii thl� `:O 1G v.: •joikPrS noll'iCits'
(R`Imic of"wiL.ICtor (Ills' �I]C CCIP.^`.iitiPG!]Cj 1USIl�i) T?'; . ..iC'Datc)
(Name of Contr ctGr) Ilns�r rice Com�_a�/Po!icI' Ntmrrr) (F?:pi tin 1 Date)
(Name of Contractor) (III�I r Zc� Cou an.;i'o1ic: Numtxr) =.x .ir. iica Dal,-)
- (Name of — (Insjanc: Ce_n r y!'o`licy h`um;wr) (E?:ri-::io,, Dare)
^tt.�di:.d�itimal z::c._t ii::!,-�-•,-::n i^-:'...:._:. � __..:..:;,_
1 7um it sole 1)1 U1)r1CtC)i ci11 "In C 110 1 U?%J t01 IIle.
I 'Im a home i:�'r'?] '' lit ?i,'1111I1 ?11 i!. .., iiiy c
No'IT:picas be aware ths,•.h'ilc or::;Nair <<,;;c c _ •cl!i^
not mete then Uu-oo umits in t%j:idl cr oc;'` �::w:xo••_r cr 1 LbCrce c c n t uarrra]ly
eaIploycs urre�et tlr uroci:^r s cc -_ .n!r ((i •152 c!(51 .a,: ._:!ic::by a he:ncotN•ncs`or e i cc c ct p:r::i:::
legal status of an enplo)w udder tLn Work; js co Ir>m_-.ation!.cL
1 un,:Lcxtaud thi,a y of this to I fYSic.rtzunt of Indiu;rieJ gnad�:s'Cific•o of i:_.0 ra for U
covrn gc vcrilicatioa �d th t f to r- ::rovr�urn::cCtion?5A of MGL,152 c_tn lad to tfx impozitiaa cf r i._1 pasl::�
comisiina n Cur_-Cup to S CMG n:t�'c?r i^-pr•,vr�ti:�_of 11p to cr.:}- r.--I civil pcml6cs in t-:f(--n of'Sic-.,
f,rr.ofS1 Wa ytp.i .1tr
/ For cicr>v'tr=rlraJ u.o cnly
�/ Pcrrnit NIIIIIInr _ --___----------
1
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• Siena urc
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S�CTOf Gi�NSRUCTION;SERVICES
8.1 Licensed Construction Supervisor: _ N,,��o~~,`t Applicable ❑
Name of License Holder : .� � � 640 ZcA
License Number,
�� ! �i 7
Address Expir tion Da e
71 4 -27, ZZ
Signa a Telephone
'e.n Q 0n3r Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECUONOYIIORKERS''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 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
I - '
A. R
I ,
I
„ t
5EGTdOIlN OROPOSED�WORK cleckatl a
ble I�ca x0
x ,�
i
New House O Addition ❑ Replacement Windows [Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks
,p Siding[ Other [ )
Brief Description of Proposed Work:_0 6h �en�,r r � w '`? eC� h' Pre.!i 2nd
2es
Alteration of existing bedroom Yes �No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes "'--No ��Tl
Plans Attached Roll D- Sheet I�
Via_ a t� a �ti.on t e fisting " "t s=ing .co ta�Je- e Yeff,-01J iw 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 y
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 Nc
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
EC WE MHORIZATION TO BE COMPLETED MRACTO�RAPPL1E5 FOR BU31LD NG'PERM17
�r
I
as Owner of the subject property
hereby authorize to ac; or
my behalf, in all matters relative to work authorized by this building permit application,
Signature of Owner 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.
Print Name 1
Signature of Owner/Agent Date
ot.
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 g y 00 )o C,�-
Frontage
& t`
Setbacks Front a
a
Side L: tO R: 1 L: R:
Rear `� l z — 3 3 (9 °12 — 3 3
5� s le da.4.sx/�
Building Height
Bldg. Square Footage t 3 a s %
Open Space Footage %
(Lot area minus bldg&paved
parking)_
#of Parking Spaces 3
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
IF--YES, describe size, type and location:
City of Northampton
Building Department
I (5 (n 212 Main Street
Room 100
I I rtham ton, MA 01060
L"A"3
1 p
phon 1 587-1240 Fax 413-587.1272
u
A STRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1'- SITE INFORMATfON
1.1 Property Address:
r
EIm�St district . '•�'-� . .�::.'.,r CS�Dts�c....�
SECTION 2- PROPERTY'OWNERSHIP/AUTHQRIZED-AGENT
2.1 Owner of R c rd:
Name(Prjnt) Current Mailin$,Address:
��A-•�✓ Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECT 0W,1- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only,
completed by ermit applicant
1. Building q� (a) Building Permit Fee
2. Electrical .4 l (b) Estimated Total Cost of
Construction,from 6
3. Plumbing Building Permit Fete
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Onl
Building Permit Number. Date Issued:
Signature:
ate
Building Commissioner/inspector of Buildings, D
File#BP-2004-0239
APPLICANT/CONTACT PERSON SHAWN FOREST
ADDRESS/PHONE 8 CHAPMAN AVE (413)527-7258
PROPERTY LOCATION 228 SOUTH ST
MAP 38B PARCEL 244 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 2ND EGRESS TO 2ND FLR APARTMENT
New Construction
Non Structural interior renovations
Addition to Existing --
Accessory Structure
Building Plans Included•
Owner/Statement or License 080296
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Signature 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.
,
""T BP-2004-0239
G1S#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: BuildL'%
Category: Deck Addition BUILDING PERMIT
Permit# BP-2004-0239
Project# JS-2004-0207
Est. Cost: $6650.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SHAWN FOREST 080296
Lot Size(sq. ft.): 8407.08 Owner: HILDE HEIN
Zoninz: URB Applicant: SHAWN FOREST
AT: 228 SOUTH ST
Applicant Address: Phone: Insurance:
8 CHAPMAN AVE (413) 527-7258
EASTHAMPTONMA01027 ISSUED ON.913103 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2ND EGRESS TO 2ND FLR
APARTMENT
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 9/2/03 0:00:00 526 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo