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29-349 (6) DECK PROPOSAL To: Dianne Lake 56 Austin Cir Florence, MA SPECIFICATIONS 413-584-2475 Foundation: `C Cement pier s 7 Sonotubes. Conc rete p system; 6' apart; 10" wide; 4' deep; with metal base and J bolt � Framing: g Floor: 2"x6" KDS lumber; double in the outside, single inside- with metal joists 6" L's in the corners; 6" U's in the inside Railings: Made with 2" x 4" KDS Lumber, 45" high Floor: Finish with 1"x6" KDS Lumber All Lumber to be pressure treatment wood. JR Construction Company 4413eebe Rd Monson, MA 01057 413-455-9944 / 896-6627 NOT TO SCALE To: Dianne Lake 56 Austin Cir Florence, MA DECK PROPOSAL 413-584-2475 JR Construction Company 44 Beebe Rd Monson, MA 01057 413-455-9944 896-6627 aft T- EXHISITNG HOUSE 16ft 8ft 12ft To: Dianne Lake 56 Austin Cir Florence, MA NOT TO SCALE 413-584-2475 DECK PROPOSAL JR Construction Company Existing House 44 Beebe Rd Monson, MA 01057 413-455-9944 /896-6627 1" x 6" Wood Spindles � � Decking Boards Metal L-8 4 apart I Finish Floor Corners `Metal U-8» Inside j 21"W1 @ 16„ Doubled in the outside Single in the inside XGround Level 4"x4" @ 6' apart Metal Base 4' Deep Wood railings With 8" long J Bolt 8" wide 35" high To: Dianne Lake NOT TO SCALE 56 Austin Cir Florence, MA 413-584-2475 DECK PROPOSAL JR Construction Company 44 Beebe Rd Monson, MA 01057 413-455-9944 896-6627 i To: Dianne Lake NOT TO SCALE 56 Austin Cir Florence, MA 413-584-2475 DECK PROPOSAL 8' JR Construction Company 44 Beebe Rd Monson, MA 01057 413-455-9944 /896-6627 5,e^w,,� �F 12' I 1 OF led 401- OFIF I E OF X131 Gr nd Level `/ y P Doubled in the outside Single in the inside 16' To: Dianne Lake NOT TO SCALE 56 Austin Cir Florence, MA 413-584-2475 JR Construction Company 44 Beebe Rd Monson, MA 01057 413-455-9944 896-6627 EXHISITNG HOUSE To: Dianne Lake 56 Austin Cir Florence, MA NOT TO SCALE 413-584-2475 JR Construction Company 44 Beebe Rd Monson, MA 01057 413-455-9944 896-6627 ti FWHISITINIG HOUSE < ��.%.�IS4 -Oolv Northampton, MA Property Detail Page 1 of 2 City of Northampton, MA: Residential Property Record Card [New Search Property Type Classification Code Reference Card 1 of 1 Parcel - Location - Zoning - Assessment Map-Block-Lot: 29 -349-001 Zoning: Assessment: Location: 56 AUSTIN CIR Neigborhood: 1 Land: #Living Units: I Deed Book: 10724 Building: Class: R-101 Deed Page: 141 Total: 1 Dwelling Information Building Sketch Style: Ranch Year Built: 1970 12 Story Height: 1 Wood Deck 2 Attic: None y 92 Basement: Full 24 $ Total Rooms: 5 4a Bedrooms: 3 12 Full Baths: 1 Half Baths: 0 4 24 1FrlB 24 960 Exterior Walls: Alum/Vinyl Unfinished Area: 0 Ground Floor Area: 960 40 Total Living Area: 960 aFP Finished Basement Living $ 6s s A 0 X 0 Area: Basement Recreation Area: 0 X 0 Woodburning Fireplace 0 / 0 Addition Information: Stacks/Openings: Lower 1 st Story 2nd Story 3rd Story Metal Fireplace 0/0 Basement one Story Frame—] Stacks/Openings: Wood Deck— I Heat/Central A/C: Basic IE=Fopen Frame Porch==l Heating System: Electric Fuel Type: Electric Quality Grade: C Physical Condition: Average Interior/Exterior: Same Condition/Desirability/Utility: AV Vacant/Dwell/Oby Status: Dwelling http://www.northamptonassessor.us/noho/propertydetail.php?map_nO=29 -349-001&pagec... 7/24/2014 for a period of one year following the final acceptance of the work or final payment for work under the contract. Massachusetts Contractor Licenses • Copies must be made available upon request i-icense information is not reauired for sub-contractors Home Improvement Contractor's Registration # 151682 Expiration Date 0612112094 Construction Supervisor License# 097254 Expiration Date 0412912016 Elevator Mechanics License# Expiration Date (Required for projects w/elevator or wheelchair lift installations) Lead License A license is required by the Commonwealth unless. (please check which one appiies ❑ Home Built in 1978 or after Less than 6 Sq. Feet will be disturbed Name of License holder Jailyn Gonzalez • Deleading Contractor License # Expiration Date • Lead-Safe Renovation Contractor License # LR001639 Expiration Date09/18/2018 • Lead-Safe Renovator Supervisor License# Expiration Date Certificate of Insurance Insurance Carrier State Auto Name of Insured Jailyn Gonzalez DBA JR Construction Com Policy# CB00572582 I, the undersigned, hereby certify the above license and insurance information is valid under the penalties of perjury this 2Y day of June, 2014. Signature of Contractor Jailyn Gonzalez/JR construction Com,oany Name of Contractor/Company r Accepted by- Signature of Romeowner Signature of Homeowner Date r/72/7l11A. TOTAL PROJECT COSTS (Subcontractor, Materials, Labor) Work Item Total Cost Egress $0. Exterior Modifications $6,000. Bathroom Modifications $3,786.00 Carpentry sauo Kitchen/Laundry $0. Permanent Adaptive Design $825. Permits $175.ou Disposal/Dumpster $300. Total Project Cost $11,086. TOTAL COST COVERED BY HMLP: $11,086.00 ADDITIONAL ITEMS Please provide the hourly labor rate for any additional work that may be requiredireauestec.. General Contractor General Laborer Rate $25.00 Other Plumber Rate $65.00 Other Electrician Rate $60.00 Timeline Estimated Start Date: August 26, 2014 Estimated Completion Date: September 13, 2014 Payment Schedule Milestones should reflect identifiable measures of progress, for example: completion of rough plumbing and framing: (Borrower Contribution, if over$30,000) $ $0.00 Up front material Costs: $2,975.00 Description: Permit& Exterior Modification Materials Milestone 1: $2,399.0 Description:Bathroom Materials & Subcontractors Back deck and stairs done; old shower removed and new one in-place Milestone 2: $1,125 Description: Permanent Adaptive & Disposal of trash Kitchen floor installed and site job cleaned up, labor for kitchen floor Milestone 3 $3,478.00 Description:Part of labor -`inai Payment (10%): $1,109."" Description: After final inspection: Rest of labor Certification Statement The quality of workmanship and finish shall be, consistent with a high quality of workmanship and finish in accordance with industry standards for like projects. The Contractor warrants a) that materials furnished pursuant to the proposal and will be of first class quality and new unless otherwise stipulated, b) that the work will conform to the requirements of all authorities having jurisdiction and, c) that the work will be free from defects and encumbrances. All work performed under the contract shall be warranted by the contractor to be free from defects in labor and materials ti/72/7!1'1 n_ 4_' Quantity: Cost: ❑ Windows: Quantity: Cost: ❑ Doors: Quantity: Cost: ❑ Framing: Quantity: Cost: ❑ Foundation/footings/slab- Quantity: Cost: ❑ Electrical: Quantity: Cost: ❑ Plumbing: Quantity: Cost: ❑ Gas: Quantity: Cost: ❑ Ductwork: Quantity: Cost: ❑ Mechanicals: Quantity: Cost: ❑ Finish Carpentry: Quantity: Cost: ❑ Flooring: Quantity: Cost: ❑ Other (describe): Quantity: Cost: ❑ Other (describe): Quantity: Cost: ❑ Other (describe): Quantity: Cost: Material Cost (total) Is this an allowance? ❑ Yes ❑ No SUBTOTAL PERMANENT ADAPTIVE DESIGN COST Subtotal Material Cost: $400.00 Subtotal Labor Cost: $425.00 Subtotal Plumbing Cost: $0.00 Plumbing work performed by subcontractor? ❑ Yes ❑ No Subtotal Electrical Cost: $0.00 Electrical work performed by subcontractor?❑ Yes ❑ No ti/72/9AI A. 4- Central Air Conditioning Please describe the full extent of work being performed (i.e. new ductwork, electrical upgrade_ , etc.): _ N/A Location (s): Materials: Manufacturer: Model No.: Cost: Subtotal Electrical Cost: Performed by subcontractor? ❑ Yes 0 No Other Adaptive or Safety Design Modifications to Interior Living Space Please describe the full extent of work being performed: To level kitchen floor, we propose to install new VCT ❑ Window locks Quantity: Cost: ❑ Specialized door locks Quantity: Cost.. ❑ Alarm system Quantity: Cost: ❑ Security Lighting Quantity: Cost.. � Other (describe):Kitchen subfloor and finish vinyl floor. Manufacturer: ArmstrongModel No. 51830039 Square Footage: 970sg Cost: $400.00 0 Other (describe): Cost: Material Cost (total) Is this an allowance? ❑ Yes ❑ No Addition to Dwelling (new bathroom, laundry & kitchen please use those dedicated sections.) Please describe the full extent of work being performed: N/A ❑ Masonry work Quantity: Cost: ❑ Carrying beam/tally column Quantity: Cost- 0 Insulation Quantity: Cost: ❑ Roofing: Quantity: Cost- Siding: ti/72/701 A. 9)_1 Other Kitchen Safety Features ❑ Cabinet locks: N/A Cost: 0 Other (describe): Cost: ❑ Other (describe): Cost: ❑ Other (describe): Cost: Material Cost (total) Is this an allowance? 0 Yes 0 No Accessible Appliances Appliance Type: N/A Manufacturer: Model No. Material Cost (total) Is this an allowance? ❑ Yes 0 No Appliance Type: Manufacturer: Model No. Material Cost (total) Is this an allowance? ❑ Yes 0 No Laundry Modification or New Construction Location: NIA If reconfiguring space, please describe: Plumbing Hook-up/Venting: 0 Yes ❑ No Material Cost (total) SUBTOTAL KITCHEN/LAUNDRY COST Subtotal Material Cost: $0.00 Subtotal Labor Cost: $0.00 Subtotal Carpentry Cost: $0.00 Subtotal Plumbing Cost: $0.00 Plumbing work performed by subcontractor? ❑Yes 0 No Subtotal Electrical Cost: $0.00 Electrical work performed by subcontractor? 0 Yes ❑ No PERMANENT ADAPTIVE DESIGN Interior Door Modification Location(s): N/A Quantity: Please describe, include dimensions: Door Material: Width: Hardware Type Material Cost (total): Is this an allowance? 0 Yes ❑ No ti172 /)A1A. Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Floor Joists, please describe: Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Sub-flooring, please describe: Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Insulation Quantity: Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Sheetrock or Plaster Quantity: Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Prep & Paint, please describe: Material Cost: Is this an allowance: ❑ Yes ❑ No ❑ Other (describe): Quantity: Cost: ❑ Other (describe): Quantity: Cost: SUBTOTAL CARPENTRY COST Subtotal Material Cost: $0.00 Subtotal Labor Cost: $0.00 performed by subcontractor? ❑ Yes ❑ No KITCHEN/LAUNDRY Cabinets N/A Number of wall cabinets: Height of wall cabinets: Cost: Number of base cabinets: Cost: Manufacturer: Model #: Hardware: Counter Top material: Cost: Counter top height above finish floor: Total Material Cost: Is this an allowance: ❑ Yes ❑ No Kitchen Sink Manufacturer: Model #: Sink Height: Sink Depth: Material Type: Material Cost (total) Is this an allowance? ❑ Yes ❑ No Kitchen Faucet Type: ❑ Lever-operated ❑ Push-type ❑Touch-type ❑ Other- Anti-scalding device ❑ Yes ❑ No Manufacturer: Model No. Material Cost (total) Is this an allowance? ❑ Yes ❑ No ti P)Q V)01 A. L--)N I- Grab Bars (Please indicate where and how many grab bars will be installed) Shower Quantity: 2 Horizontal 1 Vertical 1 Height 26in Height 24in Diameter or width Material Type: Smooth Stainless Steel Material Cost: $86.00 Is this an allowance. ❑ Yes � No Toilet Quantity: _ Horizontal Vertical Height Length Diameter or width Material Type: Material Cost: Is this an allowance: ❑ Yes ❑ No Other: Location Quantity: _ Horizontal Vertical Height Length Diameter or width Material Type: Material Cost: Is this an allowance: ❑ Yes ❑ No Flooring Material Type: Vinyl Manufacturer: Armstrong Model No. 51830031 Square Footage: 48sg Material Cost (total) $41.Q0 Is this an allowance? ❑ Yes J No Other Bathroom Modifications Please describe: N/A Materials: Material cost: Is this an allowance? ❑ Yes ❑ No SUBTOTAL BATHROOM(S) Subtotal Material Cost: $1,199.00 Subtotal Labor Cost: $1,387.00 Subtotal Carpentry Cost: $0 Subtotal Plumbing Cost: $650.00 performed by subcontractor? 4 Yes ❑ No Subtotal Electrical Cost: $550.00 performed by subcontractor? VYes ❑ No Any Carpentry Work Required Location: N/A ❑ Demolition, please describe: ❑Framing/Blocking, please describe: - /____1 Is Electrical/Lighting required? Yes ❑ No Please describe Install new GFCI Subtotal Electrical Cost: $550.00 Is this an allowance: ❑ Yes 4 No Sink Manufacturer: N/A Model No. Dimensions (height, depth, knee clearance, clear floor space): Faucet Type: ❑ Lever-operated ❑ Push-type ❑Touch-type ❑ Other (describe): Anti-scalding device ❑ Yes ❑ No Other Materials: Material Cost (total) Is this an allowance? ❑ Yes ❑ No Bathroom Door Modification Description of work, include dimensions: N/A Materials: Material Cost: Is this an allowance? ❑ Yes ❑ No Hardware Type: Tub/Shower Surround Material(s) Manufacturer: Sterling Plumbinq Model No. 62040100 Material Type: solid vickrel material Dimensions: 35"x 60"x 76" Material Cost (total) $720.00 Is this an allowance? ❑ Yes 4 No Shower Drain Manufacturer: ECONOSINKS Model No. G15-BRN Drain Type: Without overflow in brush stainless steel Material Cost (total) $110.00 Is this an allowance? ❑ Yes No Tub/Shower Fixture Handheld Shower Manufacturer: MOEN Model No. 2550015KN Material Cost (total) $70.00 Is this an allowance? ❑ Yes No Shower Head Manufacturer: MOEN Model No. 3868BN Material Cost (total) $172.00 Is this an allowance? ❑ Yes No Toilet Manufacturer: NIA Model No. Dimensions (height, clear floor space): Material Cost: Is this an allowance? ❑ Yes ❑ No i,)Q 19111 A z Location: Materials: Material Cost: Is this an allowance? ❑ Yes ❑ No Hardware Type: Fence Please describe & include location, approximate linear footage and height: NIA Materials: Material Cost: Is this an allowance? ❑ Yes ❑ No Driveway Modifications Please describe and include depth of gravel sub-base, depth of asphalt base, depth of asphalt finish coat and approximate area to be modified. NIA Location: Materials: Material Cost: Is this an allowance? ❑ Yes ❑ No i Other Exterior Modifications Please describe: Demolish the stairs in one door and build a deck X x 8'to connect both doors and build new stairs with railings Location: Rear Materials: 2"W', 2"W', 2"x4"KDS Lumber. 9"x6"deck flooring assorted screws/nails/hangers, concrete cement for base: etc. Material cost(s): $2.800.00 Is this an allowance? ❑ Yes 4 No SUBTOTAL EXTERIOR MODIFICATIONS Subtotal Electrical Cost: $0.00 performed by subcontractor? ❑ Yes ❑ No Subtotal Material Cost: $2,800.00 Subtotal Labor Cost: $3,200.00 Bathroom Modifications Please describe full extent of modification(s) : Remove existing bath tub and install new walk-in tub with surround walls To level the floor we propose to install new VCT tiles. Bathroom floor dimensions 6'x 8'. Location: First floor Is Plumbing work Required? 4 Yes ❑ No Please describe Install new shower head and drain Subtotal Plumbing Cost: $650.00 Is this an allowance: ❑ Yes 4 No Detailed Scope of Work and Cost (Note: All costs should include work performed by subcontractors.) Please complete all sections that are applicable. Egress Ramp Location: NIA Description: Rise per 1 Foot, Length and Width : Material type: Material Cost: Is this an allowance: ❑ Yes ❑ No Ramp Hand Rail Height: Diameter or width: Material type: Material Cost: Is this an allowance: ❑ Yes ❑ No All ramps require building department inspection. Wheelchair Lift (interior or exterior) Location: NIA Manufacturer: Model No. Is electrical work required? ❑ Yes ❑ No Please describe Material Cost: Electrical cost: Stairlift (interior or exterior) Location: NIA Manufacturer: Model No. Is electrical work required? ❑ Yes ❑ No Please describe Material Cost: Electrical cost: Elevator Location: N/A Manufacturer: Model No. Is electrical work required? ❑ Yes ❑ No Please describe Material Cost: Electrical cost: SUBTOTAL EGRESS Subtotal Electrical Cost: $0.00 Electrical work performed by subcontractor? ❑ Yes ❑ No Subtotal Material Cost: $0.00 Subtotal Labor Cost: $0.00 Exterior Modifications Exterior Doorway Description of work, include dimensions: NIA ti/72/7111 A -0-11 Home Modification Loan Program Bid Form and Scope of Work Date: June 23, 2014 Property Owner Name: Dianne Lake Property Location (street address, municipality, zip code): 56 Austin Cir Florence, MA Home Phone: 413-584-2475 Cell Phone: Email Address: Name of General Contractor: Jailyn Gonzalez Business Location (street address, municipality, zip code): 44 Beebe Rd Monson, MA 01057 Business Phone: 413-455-9944 Cell Phone: 413-896=6627 Fax#: Email Address: iailynrosario 19 82(a-)-yahoo.com Narrative description of work scope (attach additional sheet, if necessary): Outside- To facilitate the entrance in and out the house through the back we propose to remove the existinq stairs in one of the doors and connect both doors with a deck 3'x 8' and build new stairs with railings Inside: KITCHEN In order to level the floor in the kitchen we propose to install new VCT tiles BATHROOM We propose to remove the bath tub and install a new walk-in tub with surround walls. If the project includes any electrical work, list the home's current electrical circuit load capacity (ie 200 AMPS) 110 AMPS Please describe how the electrical will be effected by the work scope: Install a GFC1 in the bathroom Required Permits (please check all that apply) �l Electrical ❑ Plumbing ❑ Gas 4 Building (if the town/city requires plans, please include) ti/72/91) A 0 maw ate Insumnee CiORlpalle5 INSURED COPY BOP 2696908 01 BUSINESSOWNERS POLICY COMMON DECLARATIONS t0i"NSURW AND M AM AooRM A Wff NAME AW AMOM FW Nomad k=Md is S WAKlTo 8W R G NEVLION M AGENCY RIC JAR.YN QDKZAt.EZ PO 8W(1220 DBA JR t,ONStRUC110N co CRA1tBY,t/A 011612 44 BEGBE 81'9 EET YONSON,MA 01067 POUGY PEFOM AGM TELEPHONE NUMBEFL A L NO_ Fiorw: 19J013 Too 1q"/2014 667-133 00x77040 COAL PWAADM gt. A STATE AUTO RMNIED SNCE Por ws Ywba1 canoe of Cowwe 2006 ALWABLEPr7LM POUCYSTMUM AFTER440tM CLAW SERYCE Yes I PAnw d-Sid 800.7W1a63 or The coverage and these declarations are effective 12:01 AM Standard Time on 10/03/2073 at the above mailing address. BUSFAM E NlirYTYPE BLUW ACXX UW MAWlBM eLum oESno w. Died Bill hmo ed 4-Pay BUSWAMDESCFWFFM ( - idr+ltl0al Upm yaW peyrnert:of premium when due,these renewal dedaralions carom m your policy for the period indicaled. In re"n for the paymerrt of the WaTiium and subject to aY the terms of this policy.we agree with you to provide the insurancae.as sued in this policy. P1 GARY i811 COVERAGE PARTS AND POLICIES This policy consists of the following coverage parts or policies for which a premium is indicated.This premium may be Subject to adjustment. COVERAGE PARTS' PRENKIMS 8usneswmiers special Property CW rages $27.00 Oommercid General Liability Coverage PW $722.00 ®usiuessowners ixra Coverage - $24.00 Caftimercial nland Mane-See AI Declarations SM 50 00 $78.00 Terrorism(included in total below) $8.00 POLICY TOTAL AT INCEPTION $851.00 If terminated at your request,this policy is subject to a minimum retained premium of $350.00 i hem declarations together with the Common Policy Conditions and coverage form(s)and any w4a sement(s)identified on these declarations and atthched to your policy complete the above numbered aobcv. grrea By lDde) (Authmkad R dW) -{ City of Northampton Massachusetts 1 Gy�Y DEPARTMENT OF BUILDING INSPECTIONS \N , £ 212 Main Street • Municipal Building 5Jb~p Northampton, MA 01060 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 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busines s/Organizati on/Indivi dual): 7S P. OU n\VN(Q1kA1) 00)tl Address: 4�4 (' CA City/State/Zip: ��Q,-, A 011W) Phone 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. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. E� Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp.insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no b ,l Ae cK employees. [No workers' 13.© Other Ali comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fHo meowners 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:Qakvia� 1�Vk�Ci� r)_VDnY� Cv'\Qg0 — Policy#or Self-ins. Lic. #:G(',�tl"j�l Z 2- Expiration Date: 1 01 03ll`/ Job Site Address: 50 AUS�+ (,r R J I-P Y) 1� r M k1 City/State/Zip: FL,&rit e, W`W 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 rtify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: �j 4J 1 Cac�2Ca i r'Z.� Date: �S 2 u' Phone# wr S 9 Q Y� 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: O Lj Not Applicable £ Name of License Holder: lallsA o ,2 ' ( e ✓ C S q�) 3514 l� License Number I�'1 Cne �.�(?((i �"r�Cil'1.� �1 OP c ���J� L'�C7CIr Address Expir t noa ii Date ►��- ' I13 ([5S- 94H Signa a Telephone 9.Registered'-Home Improvement Contractor , - Not Applicable £ 5R C'crzsl-►�.tL i I-vn C��nc�,n�� _ l�iC Company Name Registration Number Y-k Aoehe Ra P C110 51 Q I41 b Q1(a Address Expiration Date Telephone((*t ) 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.x... £ No...... £ 11 :^.Home Owner Exempt>lon, 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Q Roofing Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks � Siding[0] Other[i3] Brief Description of Proposed a Work: BtAi►d '5Y-b' 6-t*JL � �NJ-,%' rermy!� Cyid r'—'01 IC P bc'l kkub Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a:.lf.Newhouse'and oraddifion to exisfIng..houstng;complete 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 OR CONTRACTOR APPLIES FOR,BUILDING PERMIT I, N Clvw\4-;,- L n l as Owner of the subject property ` hereby authorize �R COr1S� C�'u`�vr�oO>nJ to act on my behalf, in all matters relative to work auth rized by this building permit application. Signature of Owner Date I, 'I)1 01111 e U(A 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 Signature of Owner/Agent Date ^ Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Setbacks Front Rear Building Height Bldg. Square Footage 010 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces A. Has a Special Permit/Variance/Finding ever been issued for/on the site? .10N, x�� �—� NO ��� DON7KNOY� x�� YES �~/ |F YES, date ioued:! | IF YES: Was the permit recorded at the Registry ofDeeds? NO DUN | Kwuv /c� IF YES: enter Book 1 P and/or Document# �� B. Does the � ��site a brook' body NO �~� DON7 KNOW �~� YES IF YES, has a permit been or need tobe obtained from the Conservation Commission? Needs tobenbtained �~\ Obta|ned �~� Date � ��/ x_/ ' C. Do any signs exist on the pmperty �� NO YES K ] l J 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 0 IF YES, describe size, type and location: l E Will the construction activity disturb(clearing. gradingexcavation, or filling)over 1 acre orisit part ofo common plan ' that will disturb over 1acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW ia required. ^ — r � Departmeht use only 4 , c n C l City of Northampton Status of Permtt s f' l 7 4 Building Department GUr6 cut�Dn�eway Permit f, 212 Main Street SewerlSeptieAuairabtlrty f JUN 2 0 2014 Room 100 WaterlVttellAvallabihty Northampton, MA 01060 TwoSetsofs#ructural Plar}s --- t' , r,!, lans ho 413-587 PElect is P r r t c G _ "s pcons a Qther Specify + APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION This section o be completed by office _ 1.1 Property Address: f 1V�� '� CI Map Lot Unit �+(Q 11CL M Zone Overlay Dtstncf Ei.m St District CB District SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ��Ch nL L o,, Q Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: _5a'kAn GQrg de? 44 6P111vy Qd �JvySljn, M►9 U/3S7 Name(Print) Current Mailing Address: C2i n`- q(t -QSS-9Q(4 q Signat Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building i a+ (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 6. Total=(1 +2+3+4+5) (,0 bu-� Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector'of Buildings Date File#BP-2015-0022 APPLICANT/CONTACT PERSON JAILYN GONZALEZ r ADDRESS/PHONE 44 BEEBE RD MONSON (413)522-9944 PROPERTY LOCATION 56 AUSTIN CIR MAP 29 PARCEL 349 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 42:2 �n Fee Paid Typeof Construction: CONSTRUCT 120 SO FT DECK New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: - Owner/Statement or License 97254 3 sets of Plans/Plot Plan THE FOL OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 moli ion Delay natu4ouil mg icial 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. 56 AUSTIN CIR BP-2015-0022 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-349 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-2015-0022 Project# JS-2015-000030 Est. Cost: $11036.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JAILYN GONZALEZ 97254 Lot Size(sq.ft.): 14157.00 Owner: LAKE DIANNE S&DENNIS C Zoning-: Applicant: JAILYN GONZALEZ AT. 56 AUSTIN CIR Applicant Address: Phone: Insurance: 44 BEEBE RD (413) 455-9944 O MONSONMA01057 ISSUED ON.81112014 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 120 SQ FT DECK 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: FeeTyDe• Date Paid: Amount: Building 8/1/2014 0:00:00 $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner