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24D-161 Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527-7124 Submitted To : Betty & Nick Duprey Phone 527 -5401 Address : 164 Northampton, Street Date - 9 -27 -2011 Easthampton, Mass 01027 C. e l l 6 0 44-1 q / / 7 1 V We hereby submit this estimate for - King Street Garage The job is to remove existing glass units and Re -use them. The section with the door in it will be moved to the left. I will frame in the opening to except the unit. (I am not responsible if the glass breaks while untie construction.) In place of the middle opening there will be a garage door supplied and installed by Raynor Door. 1 will do all work necessary for the rough openings. Any stucco or concrete work will be done by other's. Customer will supply all materials. 1 will supply the building permit. Price for permit and my labor = $ 1800.00 Contractor Supervisors License number 082531 Home Improvement contractor Registration number 135204 I propose to supply materials and labor -in accordance with above specifications. This proposal may be withdrawn AI By us if not accepted within 30 days Authorized 'l : ._ e _ tf 7 ,;� Acceptance of proposal ' igna . - AMII) � v EMI \ 11 111 \ Up' ik raOrifili4 ird+s 1 /A./ __,,,l hi-y/ / / ,nom �' �a -�' /,�,,,, ( o / © ll, ivi S 1 t,, a --,.91, 1,1-4 22-5 5/ 7Y"74.1 1� , 4I F § xA k i i 1 � N � � h t. 1 , u ;I,U,'I' {ilz 11I ,�, I�I[ VIII Il 1 a r t0T b �j { hi l i l'l i �! t � . '1'1 ,1'1 i l,1 Atl I' i � s. f111hd�11,�1111 I 1 I 1 1 I ,T 1 I II I11 §. 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I l 1 11 i , 1,,( • -,� >'t. „ * • g.', llll h�it 1' {( a ` i 1 117111;II�IIiiii1 1 II ui Il(1 ∎F1 I w.f (1 { e , 1 I 1 ∎{ C 1 iI - ° �Iir " 4 r— f 1 1 fy U r l{ 1 (i 1 � > <, � I� h �� i , ' 11 I l � 1 1 a usa( .. �' tx 1 i1 1{ I A • 1 �a iN ± . , . .� ( 1 I� 1 � 1 • � 1i1 ■ y s 1 III: .1d1101 X11 ( �, 4+:4 6 4 'i . re $` ` w :u. , ` it II11I��11 -� 1 , 44 f ., x F #.' i 11 �� "k � Mar , `s (x r s s .A....,-,, i a : - ,r ? 3 ,� ' � + _ I '',' • S k 3' �' d ' f ; a '3» -4^ ' ,w n" V Iii ti t #, a , t a � N .�i kr z u dim �� z l ,3 � � • . At ::ij. o f Y {t 3 A A NIt A M II , A liNi vw. * A ILIA i*y� 3 , - A4P A IIP Abl k A A 6 �'�, ,A" .AA O +'�er, i�""�I� y y �� 4 o A A �Mt,,,""'�t. ,,� ' The Commonwealth of Massachusetts Department of Industrial Accidents _ - Office of Investigations — ° = 9 600 Washington Street `r- s •ice 4 „ ='�=� Boston, M4 02111 > -, ;.y www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Maine ( Business /Organization/Individual): ... ' 94 (�1 4/1/ Address: "f - O is.-31 5. City /State /Zip: f / ,�; ©/02? Phone #: T2 7 - 2/ 2Y Are you an employer? Check box: Type of project (required): 1. Er I am a employer with CZ- 4. 0 1 am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction listed on the attached sheet. 7..1! Remodeling 2.0 i am a sole proprietor or partner- ship and have no employees These sub - contractors have g. ® Demolition working for me in any capacity. employees and have workers' g Y P h 9. ❑ Building addition [No workers' comp. insurance comp. insurance .t required.] 5. 0 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' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1 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: &d,./ 0 kV Z4$, /426- e Policy # or Self -ins. Lic. #: 9 -0 `• 2 /6/1-9 Expiration Date: Vide Job Site Address: ( ` I y kcm -i- City/State /Zip :4'DY9 J nom. D/O G n 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 p 'ns and penalties ofperjury that the information provided above is true and correct. Signature: Date: /'e / / r' 2- Phone #: «'y 3 7- 2/2/ C .1 /) Y/3 5 - ,, 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 #: ' Versionl.7 Commercial Building Permit May 15, 2000 • SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes © No do SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 / ° /G '� ' / Par as Owner of the subject property hereby authorize ,c4fAC Zn' 641"-le to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date eAlf , 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. - A4wW _ Print Name j am;' - — // Sign. re o • 'Agent 1 Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: � Not Applicable ❑ Name of License Holder : �� " ' e^' 0223'V / License Number ;744- 9.4–. C- ' -9. –. 7� 7 /.. A4 O/022 //- 25- // Address Expiration Date ,- 7i zy Sign lute Telephone SECTION 13 - 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 1? ; No Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor CG.nM 5 Ccw►S i Not Applicable ❑ Company Name: Responsible In Charge of Construction 1/4 E-04, z Address 5 7 - 7/24 Signature Telephone ' Versionl.7 Commercial Building Permit May 15, 2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: _ _ R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 1 ,4 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO fik DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 0 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ' Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition '41 Repairs ❑ Additions ❑ Accessory Building 0 Exterior Alteration pa Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Enter a brief description here. At lc G.-fe- C x i! f6 -55 2°" € (" Of Proposed Work: �t7uJl Oe'of 1�Gt 1�� °� �GC� p � �1<rc D SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 0 A -3 ❑ 1A ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business 111 2A ❑ E Educational ❑ 2B ( ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H Hi•h Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 st 1 2"d 2nd 3rd 3`� 4 th 4 Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public El Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑ Version1.7 Commercial Building Permit May 15, 2000 ■ Department use only RECEIVED .Cit of Northampton Status of Permit: Bulkling Department Curb Cut/Driveway Permit 'OCT 1 2 MI 212 Main Street Sewer /Septic Availability Room 100 WaterJWell Availability rth impton, MA 01060 Two Sets of Structural Plans iiemwrra 1 31 3 W-1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office , y Sfi Map Lot Unit 4 et, vCG Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: A/1 CJ Qv ere._ y 16 4/0/ y St 14,E Name (Print) Current Mailing Address: 522-sra/ Signature Telephone 2.2 Authorized Agent: Name (Print) Current Mailing Address: OIL/ 5? 7 - 7/ zr '('3.5 V `" 5' Signature Telephone C e / SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building ( / / GO (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) ,oa0. as Check Number . 3 2O ,jr This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2012 -0369 APPLICANT /CONTACT PERSON STEPHEN CAMP ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413) 527 -7124 0 PROPERTY LOCATION 144 KING ST MAP 24D PARCEL 161 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 'f 5 Fee Paid �� ` " Typeof Construction: RELOCATE GLASS DOOR & FRAME NEW FOR 2ND GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 082531 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved _ t/ Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND /OR Special Permit With Site Plan 3S — � rA131. Major Project: Site Plan AND /OR Special Permit With Site Plan (A- S 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 l 10 131! Signature uilding 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.