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DATE: July 1, 2015
Estimate# REVFR7115
FOR: Francie Riddle
MA CS UC. 70008 HIC# 124718 17 W. Center St
223 Main Street Florence, MA 01062
Leeds, MA 01053
Phone 413-221-7419
email: arbetkar @crocker.com
DEMO PORCH FLOORING/FRAMING & REBUILD
SCOPE OF WORK
1 Develop scope of work costs for project and drawings for building permit
2 Install 2x6 strong backs for temporary support of existin p porch roof
3 Remove existing rotted porch floor framing and t&g fir flooring; removal of all
4 Dig for and pour 1310" diameter footings @ 4 ft. depth where existing posts are
5 Build new floor framing with pressure treated 2x8 and 2x10 material
6 Trim Framing perimeter with exterior grade 1x8 stock.
7 Re-build lattice structure with newexterior trim stock (re-use as much of vinyl
Install new tonge and groove 1x4 fir fl000ring primed on all 6 surfaces of each
8 board.
9 Build new set of stairs @ same location. Re-use existing handrails.
10 Re-affix existing posts To newly framed and re-floored porch
Total cost for above work $16,000.00
CONSTRUCTION AGREEMENT Sin to acce t ro osal
This is an agree t betty en Karen Carter, Licensed Co s�etion Supervisor
(Contractor) (Date: 7 @� ), sole proprietor of Karen Carter Carpentry and
Francie Riddle � eowner(s)of property at 17 West Center
Street, Florence, MA 01062 fort a scope of work as outlined above. Contractor agrees to provide materials, keep
work-site neat and clean for duration of and upon completion of work, provide dust protection for interior work and
complete work in a timely and worker like fashion.The time frame of the work is expected to take approximately 4
work weeks to complete with the understanding that interruptions due to bad weather could prolong the duration
of the work.
UNFORSEEN CONDITIONS
*If there is more rot damage to the support structure than visible on initial site visit, Contractor shall
stop work, notify Homeowner(s) of the condition, and discuss the scope and added cost to complete
the repair effectively. Homeowner(s) shall approve scope and cost changes prior to Contractor continuing
work.
CONSUMER RESOLUTION DISPUTES and COMPLAINTS
The Contractor is registered with the Commonwealth of Massachusetts and any inquiries concerning
this registration should be directed to: Director, Home Improvement Contractor Registration, One
Ashburton Place, and Room 1301. Boston, MA. 02108, telephone (617)727-8598.Claims or disputes
relating to this agreement or any provision of it shall be resolved before a single arbiter approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulations and according to
the Construction Industry Arbitration rules of the American Arbitration Association, unless both
parties mutually agree in writing to other methods.
I t
City of Northampton 212 Main Street, Northampton, MA 01 060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: _ -� -,e�
The debris will be transported by: V'-� 7tV
The debris will be received by: U----
Building permit number:
Name of Permit Applicant K>rc�� CAP-I� O Z
Date Signature of Permit Applicant
City of Northampton
Massachusetts
V.
y DEPARTMENT OF BUILDING INSPECTIONS
w� 212 Main Street • Municipal Building
Northampton, MA 01060 ssy ...y'ti�4
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
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
F 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: 7i?i') ,L4& F 57
City/State/Zip: S 0� Phone #:
Are you an employer? Check the appropriate box: Type of project(required):
. I am a general contractor and I
1.El 4
I am a employer with � 6. E]New construction
ployees (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. E] Demolition
'
working for me in any capacity. employees and have workers g ❑ 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.❑ Roof repairs fj,6,1,A 4
insurance required.] t c. 152, §1(4),and we have no � AN I(6—
employees. [No workers' 13.[�Other
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo 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:
Policy#or Self-ins.Lic. M 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.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Si ature: Date. y
Phone M Z�
Official use only. Do not write i his 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: Not Applicable £
Name of License Holder:
� License Number
7, Ai K i -STIA C S - U Wo?
Address Expiration Date
4ie-��p(i /-1 A f ��/ 0 1 -�-
Si gnat Telephone
13 2
9.Re s red Home Im"ro ent Contractor: C�� :;: Not Applicable £
Tun_
Company Name Registration Number
Address /,y��, / Expiration Date
10 3
Q Telephon/-11 L 2,('
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 ding permit.
Signed Affidavit Attached Yes....... £ No...... £
11. Home Owner'Exemption,
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.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolit' n ❑ New ns [ Decks [❑ Siding[0] Other[0]
MY
04 ym 4 41
Brief Description of Proposed
Work:_�'P1rZ.E P17 M_0 `th Ld �'/ 1 i�'(;-f Fi.QQP./,1 fr N'I✓WT�titA �/tT710E
vac
Alteration of existing bedroom Yes t/� Adding new bedroom Yes /' No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet -L
sa. if New house and oradditionto existing housing, 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
1 as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
1 to y"'— �y r��' 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 �t'
Tliis column to be h1led in by
Building Department
—~
Lot Size
Setbacks Front
Rear F-7-1
Building Height
Bldg.Square Footage 010
Open Space Footage %
(Lot area minus bIdg&paved
#of Parking Spaces
A. Hasa Special Permit/Vahance/Rriding ever been issuedfor/on the site?
»—� �~�
NO �~v-� DONTKNO� \� �~� 'ES «��
|F YES, date issued:[ /
IF YES: Was the permit recorded at the Registry ofDeeds?
NO ��
K ) DONTKNOYY 'ES
`~� __--
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water orwetlands? NO 0 DONT KNOW 0 YES »~�
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ��/«~� x�/Obtained �~� Date Issued:
'
C. Dn any signs exist un 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 0 NO
|F YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre orieit part ofo common plan
' that will disturb over 1 ace? YES NO K �
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
:r-
--�
L I'� of Northampton Status ofPermtt
`7 ding Department CtrrBCt�ft�DrireeWarPerrrtt#
JUL " � �QiS j 12 Main Street ,Sey�er/Septle Auaifablllty k"}�, Y , f
Room 100 :11Vetet/UVeitAvail'ablhty . ' }
r
�eCtric,Plum a
bing g G ort ampton, MA 01060 l'wa$ets'ofstructr;ral Plans `�r " ' � r.
Northam to as in
n, 87-1240 Fax 413-587-1272 P[of/Slte Plans " ' k r "
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
This section to be completed by office
1.1 Property Address:
P Urnt
(1 \/V. C;ENTr-P- 7� AAa Lot
> — ..
FLD 1Q E N c t M A. �i0 4,L- Overlay Distinct `
Zone r
I
Elm St District I = CB District -
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT.
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building +�1 QOD (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)
Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0004
APPLICANT/CONTACT PERSON KAREN CARTER
ADDRESS/PHONE 223 MAIN ST LEEDS01053 (413)221-7419
PROPERTY LOCATION 17 WEST CENTER ST
MAP 23A PARCEL 310 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid - 0
Building Permit Filled out
Fee Paid
Typeof Construction: REPAIR PORCH(FRAMING FLOOR LATTICE/TRIM&NEW FOOTINGS(SAME
FOOTPRINT)
New Construction
Non Structural interior renovations
Addition to Existing _
Accessory Structure
Building Plans Included:
Owner/Statement or License 70008
3 sets of Plans/Plot Plan
THE FOLLOWING 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
D litio y
Sig di O ic ie 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.
17 WEST CENTER ST BP-2016-0004
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-310 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-2016-0004
Project# JS-2016-000005
Est. Cost: $16000.00
Fee: $96.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KAREN CARTER 70008
Lot Size(sq.ft.): 6403.32 Owner: RIDDLE FRANCES M
Zoniniz:URB(100)/ Applicant. KAREN CARTER
AT: 17 WEST CENTER ST
Applicant Address: Phone: Insurance:
223 MAIN ST (413) 221-7419
LEEDSMA01053 ISSUED ON.71212015 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR PORCH
(FRAMING,FLOOR,LATTICE/TRIM & NEW FOOTINGS (SAME FOOTPRINT)
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 7/2/2015 0:00:00 $96.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
17 WEST CENTER ST BP-2016-0004
GIs#: COMMONWEALTH OF MASSACHUSETTS
MW:Block:23A-310 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-2016-0004
Project# JS-2016-000005
Est. Cost: $16000.00
Fee: $96.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KAREN CARTER 70008
Lot Size(sq. ft.): 6403.32 Owner: RIDDLE FRANCES M
Zoning:URB(100)/ Applicant: KAREN CARTER
AT. 17 WEST CENTER ST
Applicant Address: Phone: Insurance:
223 MAIN ST (413) 221-7419
LEEDSMA01053 ISSUED ON.71212015 0:00:00
TO PERFORM THE FOLLOWING WORK.REPAIR PORCH
(FRAM ING,FLOOR,LATTICE/TRIM & NEW FOOTINGS (SAME FOOTPRINT)
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 SiSnature:
FeeType• Date Paid: Amount:
Building 7/2/2015 0:00:00 $96.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner