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City of Northampton
Massachusetts _ '*
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DEPARTMENT OF BUILDING INSPECTIONS `
212 Main Street • Municipal Building -
c Northampton, MA 01060 ss
Roland LaCasse
87 Spruce Hill Avenue
Florence, MA 01062
August 25, 2011
22 -011
Dear Roland,
I have approved your building permit application for an addition to your existing attached
garage. The plans you have submitted do not show enough detail for me to determine whether the
proposed construction will meet the requirements of the Massachusetts State Building Code. The
foundation proposed by Cotton Tree Service would meet code requirements but the framing and finish
plans are less complete. I encourage you to submit plans showing the structure in greater detail and
also addressing fire protection and fire separation between the house and garage. If, when we inspect
the addition, we determine that it does not meet code requirements as built, you will have to make any
corrections that are necessary for compliance.
If you have questions, feel free to contact me at the building department. My telephone number is
(413) 587 -1240.
Sincerely,
Louis Hasbrouck
Building Commissioner
City of Northampton
lhasbrouck@city.northampton.ma.us
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David Cotton, President
Cotton Tree Service, Inc.
248 Hatfield Street Northampton, MA oio6o
Complete Care of Shade Trees
4
Please call me if you have any questions regarding this proposal.
Sincerely,
David J. Cotton, President
Cotton Tree Service, Inc.
o
David Cotton, President
Cotton Tree Service, Inc.
248 Hatfield Street Northampton, MA 01060
Complete Care of Shade Trees
4
August 3, 2011
Roland LaCasse
87 Spruce Hill Avenue
Florence, MA 01062
Dear Roland:
Below please find Cotton Tree Service, Inc.'s scope of work with associated pricing as
discussed during our site visit.
The scope of the work includes the following:
1. Excavation of one 3o" diameter oak stump with roots located to the right of the
existing garage is $250.00. The stump will be removed from site.
2. Excavation for the foundation and backfilling with compaction as well as grading
the inside foundation for the floor is $1,950.00.
3. Installation of 20" wide x 10" thick concrete footings and 8" thick x 4' high
concrete walls pinned to the existing foundation with cutouts for one pass door
and one overhead garage door. The price is $4,287.00.
4. Installation of one 16' long x 4' wide concrete apron 6" thick with steel wire mat
in front of the garage door. The price is $385.00.
The total price for the work listed above is $6,622.00.
Please see the notes below:
1. Footings and walls are to be 2,50o lb strength concrete. The floor and apron are
to be 3,50o lb strength concrete.
2. There are no provisions included to import materials. Backfill material is to be
material previously excavated on site.
3. Work access is to be along the existing asphalt driveway.
4. No provisions are included in this proposal for reconstruction of disrupted
surfaces
5. All permits and inspections required for this work are the responsibility of the
owner.
Work will begin immediately upon a notice to proceed.
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Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub - contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self- insured companies should enter their
self - insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617- 727 -4900 ext 406 or 1- 877 - MASSAFE
Revised 4 -24 -07
Fax # 617 - 727 -7749
www.mass.gov /dia
The Commonwealth of Massachusetts
•
...�. Department of Industrial Accidents torporm
saarofral
= =3 ' M Office of Investigations
tzir4a= 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): R, 0 L ( 14 C> L P C P S
Address: R 1 S P R t.L c L H f L1 Ali
City /State /Zip: FL o U C l't R , Phone #: 59? y - '7 q 5_3
Are you an employer? Check the appropriate: Type of project (required):
1. ❑ I am a employer with 4. 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. ❑ Remodeling
ship and have no employees These sub - contractors have 8. D Demolition
working employees and have workers'
g for me in any capacity. P i tY $ 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
q ] ocers have exercised their 11. Plumbing re
3. � I am a homeowner doing all work ffi h id hi
❑ g airs or additions P
myself. [No workers' comp. right of exemption per MGL
12.E Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13. ❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors 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 certi un er the p ins d pe , hies of perjury that the information provided above is true and correct
-lei-
rt.... /Signature: / C pV�,"'�(Gt,/Y Date:
Phone #: $ 8 I '7 95 3
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 #:
•
City of Northampton
p Massachusetts
} ;*' DEPARTMENT OF BUILDING INSPECTIONS s :'
212 Main Street • Municipal Buildingb
Y X" Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 any 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 DELAY the project until such time as the proper permits
and inspections are made
C " understand the above.
(Home owner /reside signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit issued to me.
Date l q-1
Address of work location Q 'T 5 P K til C t H ! LL
.,... L o r b J C Lw
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9. Reeistered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
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 ❑ No ❑
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
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature �„e•� --�
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition El Replacement Windows Alteration(s) El Roofing D
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding [0] Other [p]
Brief Descrigtigqn of Proposed '` am.
Work: Q ba.ii - in (''�araj y / e , �`� !° 1
Alteration of existing bedroom _ Yes No Adding new bedroom Yes V No
Attached Narrative Renovating unfinished basement Yes /No
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: NIA Number of Bathrooms N/A
c. Is there a garage attached?
'
d. Proposed Square footage of new construction. .381f .381f Dimensions 1(p x
a't
e. Number of stories? A � / N
f. Method of heating? _ /A Fireplaces or Woodstoves N d' Number of each A0
g. Energy Conservation Compliance. (VP' Masscheck Energy Compliance form attached? lVi1
h. Type of construction Wood _
i. Is construction within 100 ft. of wetlands? Yes /No. Is construction within 100 yr. floodplain Yes L/No
j. Depth of basement or cellar floor below finished grade 1 / ..
k. Will building conform to the Building and Zoning regulations? V Yes No
I. Septic Tank City Sewer % / Private well City water Supply 6/ /
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , 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
•
I, i O I_ A ki D LAC' S S 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.
ROLOiJb LPCP ct
rint Name
Signature of Owner /Agent Date
w
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 S3) ( 4(DV Aq
Frontage q .'ea 6
Setbacks Front RLt q
Side L: `oZ R: (37 L: t� Ra if
Rear 142
Building Height I ?
Bldg. Square Footage 11n62 % 6$q
Open Space Footage a
(Lot area minus bldg & paved 33)
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW J YES
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 #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained i Obtained , Date Issued:
C. Do any signs exist on the property? YES i NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES (3 NO er
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, ex vation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES te
i NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
L AIN/110,.. • 1.076.11.....4040....
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Wate ' 7 7 '
Northampton, MA 01060 Two ets =� -
phone 413- 587 -1240 Fax 413- 587 -1272 Plot/ ite • ans
0th= Sp: cifylitr
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEM aI A ONE OR TWO FAMI: WELLING
�HNG I sacaT7p 6p
NORTHAMPTON MA 010
SECTION 1 - SITE INFORMATION
1.1 Property Address: A This section to be completed by office
87 Spruce, I-h ii A Veil t Map Lot Unit
FlorenCQ AA Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Roland Lcd ssz _ A7 n� a ruci. Hill 4�n v! F/ orz -z.c (//4
Na Print) Current Mail g 4li 5f' _� 53
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
I5
J
2. Electrical , 00 00 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing A !/ Building Permit Fee
4. Mechanical (HVAC) IV
5. Fire Protection —
6. Total = (1 + 2 + 3 + 4 + 5) 1 f 0 0 0 0 ' Check Number ,," I' , / i •
This Section For Official Use Only
Date
Building Permit Number:, Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2012 -0182 '
APPLICANT /CONTACT PERSON LACASSE ROLAND & DIANE M
ADDRESS /PHONE 87 SPRUCE HILL AVE FLORENCE (413) 584 -7953 0
PROPERTY LOCATION 87 SPRUCE HILL AVE
MAP 22 PARCEL 011 001 ZONE URA(100) //WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /
Fee Paid olp5 457C-YD
Typeof Construction: CONSTRUCT 16 X 24 GARAGE ADDITION —' e � 8
New Construction AP P ao:1 13 W i'T+t Co rJ Cs i 1 i o K) S
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
t 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��i b'r6 it
Signa e 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.
•
87 SPRUCE HILL AVE BP- 2012 -0182
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:1 lock: 22 - 011 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 -0182
Project # JS- 2012 - 000281
Est. Cost: $15900.00
Fee: $76.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 39944.52 Owner: LACASSE ROLAND & DIANE M
Zoning: URA(100) //WSP Applicant: LACASSE ROLAND & DIANE M
AT: 87 SPRUCE HILL AVE
Applicant Address: Phone: Insurance:
87 SPRUCE HILL AVE (413) 584 -7953 ()
FLORENCEMA01062 ISSUED ON: 8/25/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT 16 X 24 GARAGE ADDITION
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 8/25/2011 0:00:00 $76.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner