29-112 Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527 -7124
Submitted To : Bernie Niedal Phone- 584 -4863
Address : 608 Ryan Rd. Date - 4/10/11
Florence, MA 01062
We hereby submit this estimate for - Porch
To start I will drill and mount anchors to the existing concrete floor.
I will install pressure treated 4" x 4" posts and frame a hip style roof.
The shingles will be 30 year architectural (color is customer's choice)
I will finish the ceiling with vinyl soffit.
The railings will be made with pressure treated lumber.
Price = $ 5850.00
The other option is to enclose the walls. P t A N
I will install 3 vinyl windows and 2 storm doors. Ko V
The exterior walls will have cedar siding.
Customer will do all painting.
rice = $ 635
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This proposal may be withdrawn 9
By us if not accepted within 30 days Authorized Signature 1
4 Acceptance of proposal Signature ';i
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 1 08.3.4 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 fami47
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, act as their own: construct on - supc;rvisor, 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 backfilD,
sonotube holes (before pour), a rough :build na- 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
Date
Address of work
location
f
4
. , • The Commonwealth of Massachusetts
Department of Accidents . ,
_ Z V I — - Office of Investigations •
:lttr _y • 600 Washington Street
Boston, MA 02111 •
�Y� www.massgov %dra
- Workers'. Compensation Insurance Affidavit Builders/ Contractors /Electrician.s/Plumbers
Applicant Information - Please Please Print Legibly
Name (Business/Organization/Individual): 51144:4--- 6 "�
Address: 'i ' 4} ?/vat- f
toy
City /State/Zip: fA1 1 Phone. #: _,c --- 1- --- 2 --- ?/
Are you an employer? Check the appropriate box:. Type of project (required): 1"
1ll 4. 0 I am a general contractor and I
• /' I am a employer with Z' .�
/ ' employees - (full and/oi parfft�.* - eve hired the- sub-contractors— 6_Q New co nstruct ion _
2. .0 I am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling •
• ship have no employees These sub=contractors- have 8. 0 Demolition
working for me in any ca pY employees and have workers'
t .
9. Building addition
[No workers'._ comp. insurance C9fl). insurance- _ •
required. 5. 0 We are a corporation and its 10.0 Elec repa or additions
3.0 I am a homeowner doing all work officers havefxercised 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.[1 Or i,4A/11-
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 mdir+++ng they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box mustattached an additional sheet showing, the name of the sub -contractors and state whether or not those entities have
employees. If the sub - contractors haveemployees, 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: 614I ' 8 0411 ' 4r1 J i -1
Policy # or Self-ins. Lic. #: r C 2 V l y Expiration Date:
,'
Job Site Address: VO W �C » i t - Ai9 / p City/StatrJZip:' ��evie2 j fri 4 , fa`/ eik2_
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
()flip to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investieations of the DIA for insu rance coverage verification
Ido hereby certify under the , ains.and penalties of perjury that the information provided above is true and correct
Sri. :lure: s. i , Dat
ory
ze, 7 2 /
/9 //
Phone # -- • •
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Perm t/License # •
Issuing Authority (circle one):
:'i. 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 Supenris / , �! Not Applicable; ❑
Name of License Holder : ) ►� / ) % l?„� 1 0 2 U"
License Number
Yl - 1 1 — /7 - 2 3- //
Address , � 2 Expiration Date
Signafure Telephone re 7- 7/
Not Applicable ❑
Cek1S"y . --- /1x
Company Name Registration Number
_5 1. / I
Address Expiration Date
-
Telephone f2-7 7 / 2/
SECTION 1Q 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 y No ❑
l � fl I
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
SECTION 5— DESCRIPTION OF PROPOSED WORK jcheck all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition El New Signs [D] Decks [E] Siding [D] Other [El
Brief Description of Proposed
Work: It C ie,) ) 41" 4 o G 7 / ✓e''l YX 2`
Alteration of existing bedroom Yes A No Adding new bedroom Yes X No ,
Attached Narrative Renovating unfinished basement Yes , No
Plans Attached Roll - Sheet
r;5 a ilZ:1; to ' 7 ,iA 01C il l°
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 74 - OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l , 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
L i/ /, - ti° '� " , as Ow% uthor'
Agent hereby d eclare hat the statements d information on the foregoing application are true and accurate, to the bes y nowledge
and belief.
Signed under the pains and •enalties of pe 'ury.
facie
Print Name AA r / `�
• a y Signature of Own= .g- Date
.wt
/ .
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inc - mplete Information
Existing Proposed Requir: • by Zotiri g y
This col , to be fill 4 j y •+
Building I epariment
' Lot Size 1 1 I
Frontage 1 ! 1
Setbacks Front \ EMI 1 ! I 1
Side I,, :( s° 1 L:13 0 I R:1
Rear 1 f P't 12
Building Height / . 1 "Ai '
Bldg: Square Footage / 7► 1 % ,
S2pen Space Footage °l°- — _
(Lot area minus bldg & paved v
pig)
# of Parking Spaces
I f
Fill: f
(volume & Location) a
A. Has a Sseclat Permit /Variance /Finding ever been issued for /on the site?
NO ! DONT KNOW 0 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 Page and /or Document # j
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES I
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 'yk
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO e
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
RECEIVED City of Northampton > & °Maf�����
13uiI ling Department • � k
Q 20tR 2' 2 Main Street
f
Z Room 100
Nc rthanpton, MA 01060
58 -1240 Fax 413- 587 -1272
IAA 01000
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
x This section to be compieted by office
60 /e C
*.�+ tS ._ t
SECTION 2 - P: ROPERTY OWNERSHIP!AUTHORIZED AGENT
2.1 Owner of Record: r ��
4-e-ff'Il1` /tJ /cde. / K: ;Os7
Name (Print) Current Mailing Addre
Telephone
Signature
•
2.2 Authorized Agent:
Name (Print) Y Current Mailing Address:
1
— biz
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTIO COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building / f 7 � , c%) (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 j
6
6. Total = (1 + 2 + 3 + 4 + 5) f I e Check Numbe rfq� v J�
This Section For_Official Use Only
Date
Building Permit Number- Issued:
Signature:
Building Commissioner/Inspector.of Buildings Date
F
efp KNQL)
File # BP- 2012 -0276 ��
H(( 0 P (1__ N V6 ¶
APPLICANT /CONTACT PERSON STEPHEN CAMP C d � t"1 ,p
ADDRESS /PHONE 46 EAST ST EASTHAMPTON (413) 527 -7124 60 It) a / - C 7PAC€
I A)i E ' a, '.S, f c� ( MA S
PROPERTY LOCATION 608 RYAN RD
MAP 29 PARCEL 112 001 ZONE URA(100) //WSP II ' � `"� �'� 0 3
THIS SECTION FOR OFFICIA USE ONLY: (1 9 41
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ) /J
Fee Paid (pf T
Typeof Construction: CONSTRUCT 8 X 20 ENCLOSED PORCH ON EXISTING SLAB
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
INFOAMATION 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
9 / i t
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.
L ,
608 RYAN RD BP- 2012 -0276
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 112 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ADDITION BUILDING PERMIT
Permit # BP- 2012 -0276
Project # JS- 2012- 000443
Est. Cost: $6350.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sq. ft.): 14984.64 Owner: NIEDAL BERNARD V
Zoning: URA(100) //WSP II Applicant: STEPHEN CAMP
AT: 608 RYAN RD
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527 -7124 0 WC
EASTHAMPTONMA01027 ISSUED ON:10/24/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT 8 X 20 ENCLOSED PORCH ON
EXISTING SLAB
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 10/24/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck— Building Commissioner
v 75