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Karine Roesch
21 Sth Avenue Preliminary estimates Page 2
Craig Bradford new sink base and DW cabinet, 2
approx 3'0 range flanker cabs (1 drawer over 2 doors,
Cook- shelves), custom 3x6 butcher block table (work
height)
RESTORATION, $4,930
CONSTRUCTION
908 BERNARDSTON ROAD CR&C material costs (4'x4' skylight, floor protection,
GREENFIELD,MA. 01301 foam board, 4.5"clapboard, masking tapes and sheets,
413-475-3833 etc.) $4,000
CR&C 12.5% profit and overhead (100k rate) on subs
and material
$6,129
Total estimate (chosen tasks to be completed on a cost
plus, time and material basis)
$6 ,158
Benton Cook Karine Roesch
�C�' J �'�,C:(�.✓ F�Sf,"''' S G'"`f d'C��Ul � M C�^�,1/4'l0 �CC.(rVs-.
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Karine Roesch 1/10/16
21 51h Avenue
Proposed first round tasks, sub contractors and costs:
Cook Demo 3rd floor plaster and lath, allow Bishop Elec.
access (client's sub)—Hanrahan Insulation poly. foam
RESTORATIONS 3" to roof, 2.5" 3rd floor walls also 1" basement walls
CONSTRUCTION $4,934
908 BERNARDSTON ROAD Rich Fay new sheetrock 3rd floor, new sheetrock.
GREENFIELD,MA. 01301 ceilings over old 1St and 2nd floor and skim coat joint
413-475-3833 compound all walls after wallpaper removal plus spray
basement wall foam insul. with fire retard paint.
$14,350
Dion sand and 3 coats poly. all wood floors and stairs
$2,500
Dan's Plbg. install basement laundry (gas dryer),, rough
and finish remo. 2nd floor bath, rough and finish remo
kitchen (same sink location)(gas range) $9,31.5
Cyrus Newman new roof(arch shingles over exg. 3
tab) (optional remove gutters, cedar drip edge)
4 s;o-Cl� ,
Bruce Smith paint walls and ceilings 3 floors, no trim
$6,000
CR&C, Ben and Sam move 2nd floor bath wall, demo
and re-trim, prep basement, remove all wallpaper,
strip kitchen floor, move and refasten 3rd floor trim,
move ice room door to kitchen rear, clapboard ice
room door ext. wall, install new kitchen cabinets,
protect floors, protect all interior trim, run subs
$9,000
City of Northampton 212 Main Street, Northampton, MA 01060
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: �, /``�✓ ��
The debris will be transported by: �V
The debris will be received by:
Building permit number.-
Name of Permit Applicant
Date Signature of Permit Applicant
City of Northampton
i'� Massachusetts
J. „r ” n Y
I'' DEPART.�=IVT OF BUILDING INSPECTIONS - ,'
212 Main Street • Municipal Building
Northampton, MA 101060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION�ACKNOWLEDGENMNT
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 (b2fore 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
i
I �
The Commonwealth ofMassachusetts
Department of Industrial Accidents
- Q ce of Investigations
-. : 600 Washington Street
7r Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Informatiogn Please Print]Le ibiv
Name (Business/Organization/Individual):
Address: `L_ C�iv �� ,I/�A 1:
City/State/Zip < t' Phone#:
Are you an employer? Check the appropriate boa: Type of project(required):
4. I am a general contractor and I
1.❑ I am a employer with � 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. ❑Remodeling
ship and have no employees These sub-contractors have 8. 7 Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp. insurance comp. insurance.T
required.] 5. F� 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
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. #: 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 he pains a pen s ofper'ury at the information provided above is true and correct.
Si Date:
Signature:
Phone#• / T T-
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: Not Applicable £
Name of License Holder: -1`7��-mo
License Number
Expirati Date
Telephone
9 Reaisfered Home lmprbvement Contractor _ = Not Applicable £
Company Name Registration Number
Address Expiration Date
1C — Telephone r�Jo�Y
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...... £
11 Ho.ffie owner Ege �pt>io>a
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) ❑ Roofing
or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [M Siding[O] Other[M] VV
VV
Brief Description of Proposed �r it LL r
Work: // el tn l� rT 5IC1 vCC��2M (—
Alteration of existing bedroom Yes No Adding new bedroom Yes No 6
Attached Narrative Renovating unfinished basement Yes L,/No
Plans Attached Roll -Sheet
Ga tf New h.ause acl.d ora8alt10. to exstln '`Itousin` .cocci fetefhe fo:[lowln
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms o�
c. Is there a garage attached? Lf\-U
d. Proposed Square footage of new construction. 0 Dimensions
e. Number of stories?
f. Method of.heating? Fireplaces or Weedstoves_ Number of each
g. Energy Conservation Compliance. ul C cko ! Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes f No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade �7
k. Will building conform to the Building"and Zoning regulations? _L/Yes No.
I. Septic Tank City Sewer V Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION'-.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT
I. 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
as Owner/Authorized
Agent hereby declare that the statements an information on the foregoing application are true d accurate, to the best of my knowledge
and belief.
Signed underthe pains and penalties of perjury.
Print Nam
ature of Ow er/Age t Date
'
^
�
Section 4. ZONING All information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colurm to be filled in by
Building Department
Lot Size
Frontage
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&pay d
#of Parldng Spaces
(volume&Location)
A. Has a SpeEiat Pennit/Yariance/Finding ever been issued for/on the site?
x�K ~��
NO ��� DON7KHOV� �.� x~�
��5 �~�
IF YES, date issued:
IF YES: Was the permit recorded at the Registry ofDeeds? /
NO �� YY DONTKNO YES
\��
IF YES: enter Book Page! and/or Oocument#
�� ��
�� ��
B. Does the�1econtain abrook, body ofvvaterorwetlands? NO q2� DON7KNOYY �~� YES �
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained /~� Obtained �~� Date k~� �./ ' ' '
C. Do anysigns exist on the property? YES 0 NO [L(
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES K 1 NO Q
IF YES, describe size type an� location:
E Will the construction activity disturb grading . orfi0ng)over 1 acre oris it part ofo common plan
that will disturb over 1 oo�? YES [ � NO Kk�
' ^�' ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required. �
-
/
�
/
. �
| `
> �
. o
Department usa only
. f it ti mi
CEIV D City of Northampton St atus,ofh?erm�t J
Building Department Curb CutID7i�e�vaji Perms# t s '
L:.IN. IIjj�� I/h� 212 Main Street SewerlSeptPc Auaifa6�I�y `
( 3 Room 100 �LVaterl�f�i�Avarlability F
orthampton, MA 01060 Two,Sefis a€Str�cfrJrai Ptar}s
ursPEG�IgH�,e 4 3-587-1240 Fax 413-587-1272 Plof/Slte P[ans�� , G
WORTHANIKON,MA 01 'ri 4.. f 1 e K t L
Otfier Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This sect�onN be completed by�office
1._
_=Zone_:-�-_—_.,_--�-_--::_-_::=:OverJay�pisf t•tcfY;�_=-�� -�:=:'_-'_ - -.-:=
EIm:St Disft�ct ='- . __-•: GB Distiicl _ ..� .i�
. SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED:AGENT:.:.
2.1 Owner of Record:
Name(Print) Current Mailing Ad ress:
Telephone I
Signature
2.2 Authorized Agent: ,
Name(Prim Current Mailing Address: L 3Cd
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCT ON COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
com feted bv oermit aoQlicant _
{�,.- h ck l�a� (a) Building Permit Fee
1. Building f' � � 9
Ct w C1 �
b Estimated Total Cost of
2. Electrical r hr ��wt1C�, S C f C4_14e (:) Construction frorn'(6
3. Plumbing 3 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) j "� / Check Number
This Section For OfficiaWse'Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/In.spector'of Buildings: :. Date
File#BP-2016-0905 U
/0
APPLICANT/CONTACT PERSON BENTON D COOK
ADDRESS/PHONE 908 BERNARDSTON RD GREENFIELD01301 (413) E33-Q
PROPERTY LOCATION 21 FIFTH AVE
MAP 24C PARCEL 111 001 ZONE URB(100)/
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: RENOVATE 2ND FLR BATH SHEETROCK ATTIC,KITCHEN UPDATE&ROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 049209
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
proved 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
Demolition Delay
Signature of Building fficial 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.
21 FIFTH AVE BP-2016-0905
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 111 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-2016-0905
Project 4 JS-2016-001536
Est. Cost: $63317.00
Fee: $411.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BENTON D COOK 049209
Lot Size(sq. ft.): 5749.92 Owner: ROCSCH KARINE
Zoning: URB(100) Applicant: BENTON D COOK
AT. 21 FIFTH AVE
Applicant Address: Phone: Insurance:
908 BERNARDSTON RD (413)475-3833 O
GREENFIELDMA01301 ISSUED ON.111312016 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATH SHEETROCK ATTIC,
KITCHEN UPDATE & ROOF
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 1/13/2016 0:00:00 $411.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner