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10B-051 tax BP- 2010 -0974 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 `'ERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit # BP- 2010 -0974 Project # JS- 2010- 001437 Est. Cost: $9700.00 Fee: $58.20 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS MALONE 055236 Lot Size(sg. ft.): 124494.48 Owner: JOHNSON TRAVIS & JENNIFER Zoning: RR(98)/URB(2) / /WP Applicant. THOMAS MALONE AT. 64 RESERVOIR RD Applicant Address: Phone: Insurance: 128 RYAN RD (413) 885 -9038 WC FLORENCEMA01062 ISSUED ON :51712010 0:00:00 TO PERFORM THE FOLLOWING WORK: FINISH BASEMENT 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 5/7/2010 0:00:00 $58.20 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo File # BP- 2010 -0974 APPLICANT /CONTACT PERSON THOMAS MALONE ADDRESS/PHONE 128 RYAN RD FLORENCE (413) 885 -9038 PROPERTY LOCATION 64 RESERVOIR RD MAP lOB PARCEL 051 001 ZONE RR(98)/URB(2) //WP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T_ypeof Construction: FINISH BASEMENT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 055236 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON ATION 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 Permit DPW Storm Water Management Demolition Delay S i l0 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. i City of Northampton .. Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413- 5 _nt�1240 Fax 413- 587 -1272 APPLICATION TO CONSTRUCT, ALTER,!REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION "1 -SITE INFORMATION ow A This section to be completed by office 1.1 Property Address (� �I �S i V ,VT �� Map Lot Unit �,.+2�,.��j t`11. � � Zotia Overtax District " EIm St Distrfct CB District SECTION -2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Current Mailing Address: .7 7 — 3 a —uS3� Z CL r Telephone Signature 2.2 Authorized Agent: 2 L ei rn4 �n a 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 (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 t) Check Number This Section For Official Use Onl Date Building Permit Number. Issued: Signature: Building Commissionertinspector of Buildings Date • . r F 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 Frontage Setbacks Front h I 3 j Side L: __ _.! R: L--� L: 1 R: l Rear f Building Height Bldg. Square Footage -� % Open Space Footage r (Lot area minus bldg & paved par # of Parking Spaces — --� Fill: q i volume & Location)--- ---- -- _ } [ A. Has a Special Permit/Variance/Finding ever been issued for /on the site? NO ® DONT KN OW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book L�_ Page I and /or Document #'i B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 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 Q NO 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 NO M IF YES, then a Northampton Storm Water Management Permit from the DPW is required. a , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[_] Siding [0] Other [V Brief Descri Lion of Propose Work: V-. Y\ V Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 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 WHIN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT: I - T tZ 0�>�r� as Owner of the subject property `_ 1 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, _ N� V"W - J � N �Z.✓� , 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 in. Not Applicable Applicable ❑ 1 Name of License Holder l� '��CJM� , " �� c �j� Z J t License Number f GR U 6 z- � - lt- x 1Z Addre�ss -y� Expiration Date Signature Telephone �� .. .. Not Applicable ❑ �11s1e >r�31�c�tn�lavednt.Ctm(xactnr ,,�a��� _� Company Name t Registration Number �'-) Ltn � A-, C� �� fit. l� ' \ ij LA `� Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT.W.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...... ❑ � � z The current exemption for "homeowners" was extended to include Owner - occupied Dwellines 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 buildine 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 s T The Commonwealth of Massachusetts ` \<' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Le�ibIy Name ( Business /orgaru=owTndividual) Address: City /Stat&Zip: Phone. #: Are you an employer?. Check the appropriate'box: -Type of .. 0 j proect (required):. /' 1.0 I am a employer with 4 I am a general contractor and I 6. New ect r ui employees (full and/or part time).# have hired the suer- contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet 7. ( Remodeling ship and have no eWla loyees These sub - contractors have. .8. 0 Dem bliaon working for in any capacity e=plgyees_anid hape workers'. - 9 Bw1 ' _= a�difion [NO workers' eo=P, insurance -. comp. menranrr f . -. _ � . required ] 5. 0 officers bavehercised their We are a corporation and its 10 ❑ Electrical repairs or additoons 3. ❑ I am a homeowner doing all work . 11.0 Plumbing repairs or additions myself [No workers' comp right of exemption per MGL 12.D.Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers'- 13.0 Other comp. insuranc =q6i ed.J 'Any applicant-that checks box #I rriust.aiso fill out the section belowshowing the¢ workers'- comgrmsatien policy uiformation. t Homeowners who submit this affidavit, indicating they axe doing all work and then. hire outside contmaors must submit anew affidavit indicating such. =Contractors that check this box xmat.attached an additional sheet showing the name of the sub contractors mid state whether or not those entities have employees. .if the sub- cmbwtors have employees, they must provide their workers' comp..poScy number. I am an employer that isproviding workers' compensation insurance for my employees Below is thepo&7 and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Sits Address: City/Staf ziv: Attach a copy of the workers' compensation policy declaration page - (showing the policy number and expiration date). Failure to secure coverage: asregni ed briefer Section 25A ofMGLc. 157 sari lead -to the iui pod tiori of of a fine tip to SI,500.00 and/or one year as well as civil penalties in the form of a STOP WORK ORDER and fine of up to S250.00 a day against the violator. Be advised 1hd a copy of this statement may be forwarded to the Office of Iavestisatrons of the'bIA for ir'tstsrance` coverage vcrificztion. - _ . _ _ . ,. ,_ .. , ., . _: I do hereb �,cerft under the a xs-and exalties o .- - -- -- - " -- fy P P. - fperfury thatthe cnformat�on:provrderl abav Sitmature: bate Phone# - Official use only. To not write in this area, to be comp . d by city or town offu:ial .City or Town: Permlt/Llcense # Issuing Authority (circle one): J. Board of Health 2. Building Department 3. City/Town Clerk .4. Electrical,Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #• 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 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 D1ELAY 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 Date Address of work location t �` N —c \9 128 Ryan Road Estimate r Florence, MA 01062 Date Estimate # 4/2/2010 987 U C. . Jennifer and Travis Johnson 64 Resivior Road Northampton, Ma 01060 Terms Project On receipt Johnson basement Description subtotal Move hot water tank over near other room 1 Ea Furring down on ceiling 17.3 SY Stud walls 2 in. x 4 in. 264 SF Kraft -faced fiberglass insulation, 16 in. OC framing members 3 -1/2 in. (R -15) 264 SF Gypsum wallboard nailed or screwed 1/2 in. on ceiling and walls 684 SF Gypsum wallboard nailed or screwed Add for taping and finishing ceiling joints 684 SF Painting ceiling, walls and trim 684 Softwood moulding, base (all patterns) 1/2 in. x 3 -1/2 in. 62 LF Softwood moulding, casing 7/16 in. x 2 -1/2 in. 74 LF Door framing, 2" x 4" To 3' wide (4 in. x 4 in. header) 1 Ea 2 -panel prehung interior doors 36 in. x 80 in. Total We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted u on signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is d for 3 ays. Phone # E -mail Signature 413 885 -9038 peter@rainhome.net Page 1 128 Ryan Road Estimate Florence, MA 01062 Date Estimate # 4/2/2010 987 Jennifer and Travis Johnson 64 Resivior Road Northampton, Ma 01060 Terms Project On receipt Johnson basement Description subtotal 1 Ea Closet shelves 2 Ea Closet pole 4 LF Carpet nylon, 50 (plus) ounce, with 1/2 in. (6 lb. density) pad 1 SY sprinkler covers for sprinkler heads 1 Ea ,p A l LF sawing, subcontract To 8 in. depth, Cone. #4 V W dow wells Model 4862 -66, 66 x 62 in. three tier _6�ln W dow wells 4866C polycarbonate window well cover Fits Model 4862 -6 1 Wi E Ow opening framing, 2" x 4" Over T to T wide (4 in. x 6 in. header EgNs window double hung Integrity by Marvin Ductwork for forced air furnaces one supply and one return 2 Ea Recycle fees Mixed loads, per load (7 CY) Total We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone # E -mail Signature 413 885 -9038 peter@rainhome.net Page 2 � \� 128 Ryan Road Estimate Florence, MA 01062 Date Estimate # 4/2/2010 987 Jennifer and Travis Johnson 64 Resivior Road Northampton, Ma 01060 Terms Project On receipt Johnson basement Description subtotal 1 Ea Building permit fees i LS General hand excavation Heavy soil or loose rock 8 CY Project material, labor, subcontract Material, per job Labor, per job Subcontract, per job *Project Subtotal *Project Total Total $14,x$90 We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as , follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone # E -mail Signature 413 885 -9038 peter @rainhome.net Page 3 Estimate m ate 128 Ryan Road 4 Florence, MA 01062 Date Estimate # 4/6/2010 992 Jennifer and Travis Johnson 64 Reservoir Road Leeds, MA Terms Project On receipt Johnson Basement R... Description subtotal Move hot water tank over near other room 1 Ea Furring down on ceiling 17.3 SY ` Stud walls 2 in. x 4 in. 264 SF Kraft -faced fiberglass insulation, 16 in. OC framing members 3 -1/2 in. (R -15) 264 SF Gypsum wallboard nailed or screwed 1/2 in. on ceiling and walls 684 SF Gypsum wallboard nailed or screwed Add for taping and finishing ceiling joints 684 SF Painting ceiling, walls and trim 684 Softwood moulding, base (all patterns) 1/2 in. x 3 -1/2 in. 62 LF Softwood moulding, casing 7/16 in. x 2 -1/2 in. 74 LF Door framing, 2" x 4" To 3' wide (4 in. x 4 in. header) 1 Ea 2 -panel prehung interior doors 36 in. x 80 in. Total We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone # E -mail Signature 413 885 -9038 peter @rainhome.net Page 1 128 Ryan Road Estimate • ' Florence, MA _ 01062 Date Estimate # A 4/6/2010 992 Jennifer and Travis Johnson 64 Reservoir Road Leeds, MA Terms Project On receipt Johnson Basement R... Description subtotal I Ea Closet shelves 2 Ea Closet pole 4 LF Carpet nylon, 50 (plus) ounce, with 1/2 in. (6 lb. density) pad I SY sprinkler covers for sprinkler heads 1 Ea Ductwork for forced air furnaces one supply and one return 2 Ea Recycle fees Mixed loads, per load (7 CY) 1 Ea Building permit fees I LS Project material, labor, subcontract Material, per job Labor, per job Subcontract, per job *Project Subtotal Total We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone # E -mail Signature 413 885 -9038 peter @rainhome.net Page 2 vii M O O \�� 128 Ryan Road Estimate • Florence, MA _ 01062 Date Estimate # 4/6/2010 992 Jennifer and Travis Johnson 64 Reservoir Road Leeds, MA Terms Project On receipt Johnson Basement R... Description subtotal *Project Total Total $9,714.53 We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This estimate is good for 30 days. Phone # E -mail Signature 413 885 -9038 peter@rainhome.net Page 3 .+off ct frf cc( V 4 A kJ > ITY w C::D OS� c 3 F � � Cvx Q •co za�� s mfJ� CJ c Cc) v,..,✓ti.�� y ° t c A c a t'+x; WN k w F 1 T W �u x ^.:N maim I NMI �" ��> ������. �� "�`- ���- sb�.�"✓.���'�'��'�;,�' .tee G k 3 � ryy t