37-065 106 BLACK BIRCH TRAIL BP-2008-0761
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-065 CITY OF NORTHAMPTON
Lot: -006 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:_ ]BUILDING PERMIT
Permit# BP-2008-0761
Project# JS-2008-001178
Est. Cost: $830.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sy. ft.): Owner: ENTIN DAVID&DOROTHY RIEHM
Zonis ;: SR Applicant: ENTIN DAVID & DOROTHY RIEHM
.4 T. Ills, RI ACK
Applicant Address: Phone: Insurance:
106 BLACK BIRCH TRAIL (413) 341-3042 0
F LORE NCEMA01062 ISSUED ON:4/8i2008 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SHEETROCK & INSULATE
BASEMENT CEILING & BASEBOARD-NOT A BEDROOM, INSUL INSP REQ'D
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
i lnderground: Service: Meier:
Footings:
Rough: Rough: ]Huse# Foundation:
Driveway Final;
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: O fc A
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. 2
Certificate of Occupancy6--- 4r�_---4� Signature: ---.-
FeeType: Date Paid: Amount:
Building 4/8/2008 0:00:00 $50.001899
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo
BP-2008-0761
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -006 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0761
Project# JS-2008-001178
Est. Cost: $830.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): Owner: ENTIN DAVID&DOROTHY RIEHM
Zoning: SR Applicant: ENTIN DAVID & DOROTHY RIEHM
AT: 106 BLACK BIRCH TRAIL
Applicant Address: Phone: Insurance:
106 BLACK BIRCH TRAIL (413) 341-3042 ()
FLORENCEMA01062 ISSUED ON:4/8/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SHEETROCK & INSULATE
BASEMENT CEILING & BASEBOARD-NOT A BEDROOM, INSUL INSP REQ'D
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 4/8/2008 0:00:00 $50.001899
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0761
APPLICANT/CONTACT PERSON ENTIN DAVID&DOROTHY RIEHM
ADDRESS/PHONE 106 BLACK BIRCH TRAIL FLORENCE (413)341-3042()
PROPERTY LOCATION 106 BLACK BIRCH TRAIL
MAP 37 PARCEL 065 006 ZONE SR
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: INSTALL SHEETROCK&INSULATE BASEMENT CEILING&BASEBO17
New Construction
Non Structural interior renovations
Addition to Existing,
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan 1V et A 564I2-1'frt _ I NSW.. (N S PK"f(&) l V
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Demolition Delay
c:// 0 / alo
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.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
1+� I 212 Main Street Sewer/Septic Availability
` I Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
ws3 1 Q Oi e 41.3-587-1240 Fax 413-587-1272 Plot/Site Plans
'Re Other Specify
t C APPLICATION TO COt4STRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1. Property Address: �n �? 1
( 1 6 1 I'1,C IH 1 F Pr Map v '7 Lot �` 5 Unit l0
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
0 A V �i) ENT 1 l� lib l—�« �1 R C14- TR L
Name(Print) Current Mai ing 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 permit applicant
1. Building (a)Building Permit Fee
Sj0 3,7 •
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 /f9
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector ofB ildmgs — Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
HOC J'y Existing Proposed Required by Zoning
This column to be filled in by
• II Building Department
G 4'N 9 0 Lot Size
pJ Frontage ..
'V Setbacks Front ____ __.
Side L: R: L:`: , ..R: ._._..
Rear a
Building Height
Bldg. Square Footage %
Open Space Footage .._ __ ___.. % = _-
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) .. i
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES 0
IF YES, date issued:`
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q Date Issued: I
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
S ,
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) Roofing n
Or Doors E
Accessory Bldg. E Demolition ❑ New Signs [0] Decks [[J Siding[0] Other[0]
Brief Description of Proposed n [�
Work: APO CEZ -JMG- !tNO I A- 6 k'"A ))
Alteration of existing bedroom Yes / No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement ,/ Yes No 4 n,La(�(
Plans Attached Roll -Sheet
6a. If New house and or addition to 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? ;N
d. Proposed Square footage of new construction. l'2 �( ,S= Dimensions I
e. Number of stories? -
f. Method of heating? 6-A5 i? UCT' Fireplaces or Woodstoves V Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction llOcc( F c ;
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? f Yes No .
I. Septic Tank City Sewer I/ Private well City water Supply V
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
•
I )) \)'t E 1V f�l , as Owner of the subject
property
hereby authorize S 1 ► or) CAMP
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of of 0� Date
, 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 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
Company Name Registration Number
Address Expiration Date
Telephone
i —
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 0 No 0
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
Northampto rdinances, State and Local Zoning Laws
'and State of Massachusetts General Laws Annotated.
Homeow er Signature 6�i .
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 (Business/Organization/Individual): _
tA unless:
City/State/Zip: 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
employees (full and/or part-time).'
have hired the sub-contractors 6. ❑ New construction
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. ❑ 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.C I am a homeowner doing all work
officers have exercised their 11.0 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' 13.0 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 outsidecontractors 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-u-nder-the-pains-and-penalties:of-pexjuay-that the information provided above is true and correct.
Signature: Dater- -
Phone#:
___,...__OffciaLlrse..anl}r _Du rite_inlhis_azea to completed 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 #:
.? ,tom} \ r 173i ??LJ J► L =
i'_*n"`^ 1J LP?p 1..i=NT OF E . n\G Zv Sl Sr,'T?O ti S --=c '"
212 Main S Tett • Municipal E uilding "=
INSPcw ✓`
Northampton, MA QIG60 -
HOME OWNER NER EXEMPTION ACKNOWLEDGEMENT
1 The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to 1
act ZS his/her construction sup ~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
tvenirg, 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-btAld -Ze - ent for the City of Northampton wants any persons)who seek to
use the hone otivner 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 deparrient be called
to inspect work at various stages, which include foundation/footings (before bacidilI).
so-notube holes (before your). a rough building inspection (before work is
ca TIC€aled-). insulation insyectiun (if recruii-ed)and a f*hai bui1din,7inspection. The
building deparunent requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occunancv
until the-work--can--be insoecte ... .
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
>( 4-r ____ — understand the above.
(Home_owner/resident's signature requesting exemption)
I will call to schedule all required buiIdin,inspections necessary for the building permit
issued to me.
',-
Date _
Adcirs-Ss of work _. ..
location
Simon Camp
Ask Me How Handyman
78 Old Amherst Road
Sunderland, MA 01375
413 230 6626 • simon@askmehowhandyman.com
Work Proposal and Estimate of Costs
Customer: David Entin
Address: 106 Black Birch Trail,Florence MA 01062
Tele p hone: 413 341 3042
Job description: 1)Insulate and sheetrock basement ceiling.
2)Install lx4 baseboard in basement and on stair landing
Date: 14-Feb-08
Materials: Quantity Unit cost Total
Insulation:
6"faced insulation(77.5sqft) 4 $38.30 $153.20
Sub Total $153.20
Sheetrock ceiling:
112"x4'x8 I'h sheetrock 9 $7.86 $70.74
Screws, tape,joint compound etc $10.00
Sheetrock lift rental $33.00
Sub Total S113.74
Install baseboard:
1x4x12 select pine 3 $12.83 $38.49
1x4x10 select pine 1 $10.69 $10.69
1x4x8 select pine 2 $8.55 $17.10
Nails,glue etc $7.50
Sub Total $73.78
Total Materials $340.72
Labor:
Install ceiling insulation $70.00
Sheetrock basement ceiling $350.00
Install baseboard $70.00
Total Labor $490.00
Grand Total $830.72
Please retain a copy of this proposal for your records. Thank you.
`I
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