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17A-043 188 BRIDGE RD BP- 2010 -0756 GIS #: C OMMONWEALTH OF MASSACHUSETTS Ma p:Bloc k: 17A - 043 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP-2010-0756 Project # JS- 2010- 001125 Est. Cost: $7240.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor License: Use Group: BRIAN BURROWS 092972 Lot Size(sq. ft.): 9016.92 Owner. FENTON JOHN R JR & PATRICIA J Zoning: URA(100) / /RI Applicant BRIAN BURROWS AT. 18$ BRIDGF Pn Applicant Address: Phone: Insurance: 95 SOUTHAMPTON RD (413) 977 -1389 () WESTHAMPTONMA ISSUED ON :31312010 0.00.00 TO PERFORM THE FOLLOWING WORK .- REMODEL BATHROOM & NEW KITCHEN COUNTERS 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: )1 - /0 4� Final: !� . 1 c, P � Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: �T 1 Final: Smoke: Final: O f THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. ' y 1 3o J(o Certificate of Occu anc . Signature: FeeType: Date aid: Am mount: Building 3/3/2010 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Conunissioner - Anthony Patillo File # BP -2010 -0756 APPLICANT /CONTACT PERSON BRIAN BURROWS ADDRESS/PHONE 95 SOUTHAMPTON RD WESTHAMPTON (413) 977 -1389 Q PROPERTY LOCATION 188 BRIDGE RD MAP 17A PARCEL 043 001 ZONE URA(100)//RI 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: REMODEL BATHROOM & NEW KITCHEN COUNTERS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 092972 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 -_, A Z I CJ Signature of Building Cffficial 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. City of Northampton Building Department 212 Main Streets Room 100 Northampton, MA 01060 phone 413 - 587 -1240 Fax 413- 587 -1272 c"r APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION N 1.1 Property Address a ^, This section to be completed by office Lot Unit Overlay District 0"t: :District CB District SECTION 2 - PROPERTY OWNERSHIP /.AUTHORIZEDAGENT 2.1 Owner of Record: '►c�_-- F er► -- . — ----- - - - - - - -lg�_ o BP X - t'_ -._ -_ Flocev�ce �+ (D1 Name (Print) Current Mailing dress: JL��: nnk'�c�- tit ; -- 5 Q< -76 8 1 -1 Telephone Signature 2.2 Authorized Agent: 13r► ° ter, l��rro.,sS 9 �vkl•«,��►� �.pe5'�r��4�i, �"' c z7 Name (Print) Current Mailing Address: t4i3-- 97�- l3g`j Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only com leted by ermit applicant 1. Building s, f; (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 6CXj Construction from 6 3. Plumbing j, Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 + 3 + 4 + 5) '� �Q Check Number - 5 This Section For Offrcial Use Oril -. Building Permit Number. Date issued: Signature: Building Commissioner /Inspector:of Buildings - 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 - _� _.. Frontage Setbacks Front Side L: R: L:_ R ... _ w Rear Building Height Bldg. Square Footage I F , % ? Open Space Footage % a ± (Lot area minus bldg & paved p arkin g) # of Parking Spaces - ° _••_.•. Fill: � volume & Location) Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNO 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW 0 YE S 0 IF YES: enter Book Page and /or Document # ._.. B. Does the site contain a brook, body of water or wetlands? NO 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 eZN C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location ... .. . .... .... _ -t -° "-�`��`° -_,D. _`Are any proposed cran ges to a i ons o igns lnfen ed for tFie property ? YES NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, Mavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) Roofing ❑ Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [O] Other [pJ Brief Description of Proposed Work: _�`'� ILi cu ^ G,- less R,-14a yer,tAel Alteration of existing bedroom Yes - 7 4 No Adding new bedroom Yes X_ No Attached Narrative . Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa, i1..Neu� iiose£aiiid ©a#cliotci ez #ictFwi�sia,,.cninpiee tii fcifovrr r►n: 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 iPERMIT I, 7 4C_k as Owner of the subject property hereby authorize Rrio,r\ to act on my behalf, in all matters relative to work authorized by this building permit application. 5- (!. + R�'C+- Signature of Owner Date I, f7r't'a✓� ��..t' �..)� 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 0wne nt Date SECTION 8 - CONSTRUCTION SERVICES , 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder Rr irxar� �ut^tY, '� U Ac, 7 License Number �5 So�%+- wt�la,• t-Jcs ,•, ,� w1$4 ol07 Address Expiration Date Signature r Telephone S "/ ReAisteiil hlomlritnny�erttO +Dritri+�ar M ,:� ,,, Not Applicable ❑ (3t-i� f�v.cro...�5 �e•uCZ,,1 Car.Eta�: }i-ra �- l�r+c �►n�c�ve, -1 �5'2.,�.3� Company Name Registration Number ci ea , nn l7io2� I Address Expiration date Telephone SE CTION 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...... ❑ �! _ 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 lure who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3. Definition of Homeowner Person (s) who own a parcel c f 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, attac ied 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, cn 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 (Work 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 resp for compliance with the State Building Code, City of o - ampton r mances, a e Ztstring°L� - tts-General•Laws- Annotated. Homeowner Signature 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 p Please Print Legibly Name ( Business/ Organization /Individual): Br,4r� R,rm_S5 GcneMi Address: 9S wes+Q.,.r,p1nn KI -A 0toZ� City /State/Zip: Phone. #: Lf t 3- 521- 89 Zv Are you an employer? Check the appropriate box: Type of project (required): 1.0- -I am a employer with X 4.. I am a general contractor and I employees (full and/or part-time). have hired the sub- contractors 6. ❑ New construction 2. El I am a sole proprietor or partner- listed on the attached sheet. 7. aRemode� ship and have, no employees These sub - contractors have .8. ❑ Demolition working for me in any capacity. employees and have workers' 9. Q Building addition [No workers' comp. insurance conp.. insurance.; _ required.] ] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 am -a -homeowner loin g -all- wOr�t - - officers ha exercised xlle?i 1•1 lPht nbing repairs or additions - -- - _ -- myself_ [No workers' comp. right of exemption per MGL Roof repairs insuran required.] t c. 152, §1(4), and we have n Other employees. [No workers' comp, insuran required.}. *Any applicant that checks box #.I must also fill out the section below showing their workers' compensation policy in1brMation. t Homeowners who submit this affidavit.indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sheet sbowing the name of the sub - contractors and state whether or not those entities have employees. If t s contract have employees, they mustprovide their workers' comp..policy number. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site formation. Insurance Company Name: -- Policy # or Self =ins. Lic. #. W(- i - 315 - 3 6ci 4 b 5' rJ Expiration Date: Job Site Add gQ Bt "awe City /stafe/Zip: ptut►,ce Me3 0 106 � Attach a copy of the workers' compensation policy declarafion page (showing the policy number and expiration date). Failure to secure coverage as required under Seotion'25A of IvIGL c. 152 can Lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or on=-Year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fie of up to $250.00 a day against the violator. ge advised that a copy- of this statement may be forwarded to the Office of Investisations of the DIA for insurance coveraee verification. I do hereby certify under the pains and penalties of perjury that the information provided above L"rus and_correcG_ — _ ._ Signature Date —t la Phone #• H t 3 - S Z7 - Z6 L l use only Do not write in r Town: PermitUcense # Authority (circle one): d of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5 Plumbing Ins ector r 2_ t 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 sate 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 aci;essory 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 proces require:; that the building department be call 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 requi 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 ------ - - - - -- puts i-n -conj unction.- to _the-building- permi :.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 ';ime 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. Address of work location Proposal Brian Burrows General Contracting $ Home Improvement looking to renovate? 95 southampton rd. Westhampton MA 01027 413 - 527 -8920 submited to: Jack and Patty Fenton address:188 Bridge Rd. Florence Ma 01062 phone: 586 -7684 date: 1 -27 -10 We hereby submit specifications and estimates for: The complete renovation of upstairs bath.We are to remove and dispose of all tile,flooring,tub,sink,toilet, cabinets, sheetrock and lights ect ... A new ceiling fan with light shall be installed and properly vented outside.A new 2 piece tub is to be installed. Costumer is to purchase tub,toilet sink,and towel racks ect ... Price includes the installation of each.All new fixtures are to be installed to new codes.Costumer is to purchase lights for mirror but installation included in price.All outlets and switches will be brought up to code.A PVC wainscoating shall be installed 4 feet high around all remaining wall areas.The top portion shall be bathroom rated sheetrock.Any area that requires insulation shall be insulated.All sheetrock walls are to be taped, sanded, primed and painted.All trim shall be new.Trim shall be painted or stained.A new molding shall be installed where PVC meets sheetrock.A new lenolium floor shall be installed.All work comes with a one year contractor warranty. We propose hereby to furnish material and labor - complete in accordance with above specifications,for the sum of: $7,240.00 Payment to be made as follows: $2,700 down and $4,540 upon completion Proposal life: 30 days Authorized signature: _ Accepting signature: r- ti 7 `i� , Brian Burrows General Contracting And Home Improvement iVDAC Liberty ISSUING OFFICE 181 Mutual,. Workers Compensation and INFORMATION PAGE Employers Liability Policy ACCOUNT NO. SUB ACCT NO. Liberty Mutual Insurance Group/ Boston 1- 369465 0000 LIBERTY MUTUAL INSURANCE CO 15628 POLICY NO. TD /CD SALES OFFICE CODE SALES CODE N/R 1ST WC1 -31S- 369465 -019 XX X WESTON 102 REPRESENTATIVE 3000 2 YEAR ASSIGNED 2008 Item 1. Name of BRIAN BURROWS DBA BRIAN BURROWS GENERAL Insured CONTRACTING & HOME IMPROVEMENTS FEIN 01- 2521595 Address 95 SOUTHHAMPTON RD RISK ID 541372 WESTHAMPTON, MA 01027 Status 01 - INDIVIDUAL Other workplaces not shown above: SEE ITEM 4 Mo. Day Year Mo. Day Year Item 2. Policy Period: From 11 -21 -2009 to 11 -21 -2010 12:01 AM standard time at the address of the insured as stated herein. Item 3. Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states lister here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of ou: liability under Part Two are: Bodily Injury by Accident 100,000 each accident Bodily Injury by Disease 500,000 policy limit Bodily Injury by Disease 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE END WC 20 03 06A D. This policy includes these endorsements and schedules: SEE EXTENSION OF INFORMATION PAGE Item 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans. All information required below is subject to verification and chan e by audit. Premium Basis Rates LINE 110 Per $100 Estimated Code Estimated of RE- Annual Classifications No. Total Annual Premiums muneration Premiums SEE EXTENSION OF INFORMATION PAGE Minimum Premium $ 500 ( MA ) Total Estimated Annual Premium $ 500 Interim adjustment of premium shall be made: ANNUAL This policy, including all endorsements issued therewith, is hereby countersigned by Authorized Representative Date 11 -20 -09 Loc. Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. H.G. Home State Dividend RENEWAL OF: 11 -20 -09 1 1 NR I I MA WC1 -31S- 369465 -018 GPO 4030 RI Copyright 1987 National Council on Compensation Insurance WC 00 00 01 A License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 152935 Board of Building Regulations and Standards Expiration: 10/14/2010 Tr# 275093 One Ashburton Place Rm 1301 Type: DBA Boston, Ma. 02108 BRAIN BURROWS GEN CONTRACTING& HOME IMP BRIAN BURROWS 95 SOUTHAMPTON RD. WESTHAMPTON, MA 01027 Administrator Not valid without signature ��fe Cr'an1ln�JZUpllf�il a j�rrturcfusef.�2 ^._ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 092972 B i rth d ate: 10/09/1973 Expires: 10/09/2009 Tr. no: 92972 Restricted: 00 BRIAN BURROWS 95 SOUTHAMPTON ROAD WESTHAMPTON. MA 01027 Commissioner