23D-012 _ � Balieb �tirfdiif 4t'( s $d a.i'�dif License or registration valid for individul use only
g g
"1! ..2; HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
j'` B oard of Building Regulations and Standards
+:r ' ii Registration: 152935
,i / 1 One Ashburton Place Rm 1301
.., s Expiration: 10/14/2010 Tr# 275093
Boston, Ma. 0210$
Type: DBA
BRAIN BURROWS GEN CONTRACTING& HOME IMP
BRIAN BURROWS
95 SOUTHAMPTON RD. Q ---. '' _-
WESTHAMPTON, MA 01027 Administrator Not valid without signature
:7-2e ( r lit nlirt:cvral r/ llr;.:uei; ri.:alf1
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
e i v Number: CS 092972
Birthdate: 10/09/1973
l Expires: 10/09/2009 Tr. no: 92972
Restricted: 00
:3RIAN BURROWS
95 SOUTHAMPTON ROAD .
WESTHAMPTON. MA 01027 1 ' - -;. a ,
Commissioner
VDAC Liberty
ISSUING OFFICE 181 roA 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 -018 XX X WESTON 102 REPRESENTATIVE 3000 1 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
[tem 2. Policy Period: From 11 -21 -2008 to 11 -21 -2009
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 listed
here:
MA
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our
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
tem 4. Premium - The premium for this policy will be determined by our Manuals of Rules Classifications Rates and Rating Plans.
Ul information required below is subject to verification and change by audit. _
Premium Basis Rates LINE 110
Per $100 Estimated
Code Estimated of RE- Annual
Classifications No. Total Annual Premiums muneration Premiums
;EE EXTENSION OF INFORMATION PAGE
ninimum Premium $ 500 (MA ) Total Estimated Annual Premium $ 500
nterim adjustment of premium shall be made: ANNUAL
'his policy, including all endorsements issued therewith, is hereby countersigned by
Authorized Representative Date 11 -03 -08
oc. Code Term. Oper. Audit Basis Periodic Payment Rating Basis Pol. E.G. Home State Dividend
11 -03 -08 NR MA NEW
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Proposal
Brian Burrows General Contracting & Home Improvement
looking to renovate?
95 Southampton rd.
Westhampton MA 01027
50 413 - 527 -8920
submited to:? Freeman
address:8 Nonotuck st..
Florence Ma 01062
phone: 586 -8958
date: 5 -30 -09
We hereby submit specifications and estimates for: Removal and disposal of upper and lower
porches from roof down.Once removed,we shall re -frame to existing size with pressure treated
wood and exterior rated fasteners.New porches are to be fully enclosed installing windows home
owner provides.We shall install yellow pine plank flooring.All exterior wood shall be wrapped in
metal or sided to match existing house.Inside priced out two ways,base package or gold
package.The base package would consist of finishing all interior walls and ceiling with sheetrock
and pine trim for windows and doors.Sheetrock would have three coats of compound and be
finish sanded ready for primer. Base price= $6,580.00.The gold package would consist of tounge
and groove pine ceiling with pine trim.All pine sanded and ready for primer or poly.Gold
package price 7,265.00 ob site is to be kept neat with trash removed daily.All work comes with
a one year contractonVirranty.
We propose hereby to furnish material and labor -co ance with above
specifications,for the sum of: $6,580.00(base price)( 6,ic 7
Payment to be made as follows: $1,580.00 down and $5,000.00 upon completion(unless
package changed.) S
Proposal life: 30 days
Authorized signature:
Accepting signature:
Zft.14Z
Gri -ZOO Cordially,
Brian Burrows
General Contracting
And
Home Improvement
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, whictinclude foundatiou/fuatings (before baek
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 wor came instecfed,_... w... n.. .
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 me.
Date
Address of work
location
The Commonwealth of Massachusetts
..a Department of Industrial Accidents
Office of Investigations
600 Washin Street
Boston, MA 02111
www. mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /EIectricians/PIumbers
Applicant Information Please Print Legibly •
Name (Business / Organization /Individual): �� aA.ftzk. � 6 eel erh., , 1 fi
Address: QS Soo'va-N 2a
City /State /Zip: uje.,544„ pi oit fl Phone #: Cd.- P
Are you an employer? Check the appropriate box: Type of project (required):
1. 511. I am a employer with c2.. 4. 0 I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ( Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner - doing -all -work- — __ officers have exercised their _ _ 11,(l 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. Other }?tirclve S
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.
=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
employee's. 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 the
information.
Insurance Company Name: Li hu` i 1 --
Policy # or Self -ins. Lic. #: Jt: j 5 — LIG S-- Cif), Expiration Date: I i —a-1' v 9
Job Site Address: g Nom: -ue IC City /State /Zip: Fic,rer ce ri 010Ca
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 - on - e- 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 pains and penalties of perjury that the information provided above is true and correct.
Signature: '" Date: - i 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):
I. Boar- d-- o.4Iealth 2— Buildizng- Departmetit 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
.
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : { Ia� k rC'e, CfR aq 1 a
License Number
D -
GS S a.t'iw.t- t� ar - � �r'o'6Y, tl � li'X, � rt-
Address Expiration Date
413—C22- £ 2b
Signature Telephone
9_ Renistereo,.Haine:lti Rrauerrient,Contriain 1� jam4 .. ' Not Applicable ❑
\earl 1 i!n - • �' ♦ `,, �✓1e ' V� r 4'.JeYh2ii4 I S99•1,J `
Company Name - Registration Number
95 So , le - 14 —ic
Address T Expiration Date
Iw ,. M / 6107 Telephone ti i 335Q
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 ❑
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- yearperiod 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-o€-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 (check all applicable)
New House Addition El Replacement Windows Alteration(s) n Roofing El
Or Doors 0
Accessory Bldg. n Demolition ❑ New Signs [r_ Decks [It Sidiiiy [Q] Other [u]
Qa^c>^e5
Brief Description of Proposed
Work: [' -- _ - i.aa 5 o cCc
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes . No
Plans Attached Roll - Sheet
64-21f NelOtt/Use ciead°ditictiai ie kith hoes i fai»rileteith .f �FOt i ria:
a. Use of building : One Family Two Family k Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? IJO
d. Proposed Square footage of new construction. ) 4D Dimensions 6)09, - °2
e. Number of stories?
f. Method of heating? Nof1(. Fireplaces or Woodstoves Ah.,) Number of each
g. Energy Conservation Compliance. — Masscheck Energy Compliance form attached?
h. Type of construction Sk`-iLk tt�^'e
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 'C'
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I Sr E , 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 B 3urrr -' , 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.
• An 1. 0‘--)5
Print Name
– 2-1 3-
Signature of Owner /Agent 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
Rear ... , _.
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved I
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 0 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 's, Page' and /or Document #!
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 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
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 0 NO G
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
• 1, ..,,,,,, ; ' Oft .; %.--`•." ',rt. .,,,,,$),.'.' ' .„ , 4 V
k,.`ee '.10:4 ' " ' Qt '''' 4. ' T .'.00.. ,...- ; ",; . -04)',
City of Northampton
Building Department
212 Main Street
., ,,,P 4 ',. - -_-_:
' - „--="'., - stilt*: ' - til mit, , I
Room 100
,„,.,,,,,,,„,,„,,,,,„•, „,„, , ,,,,,,,...„4.,„,.,•„,,,,,,,,,,,,,,, '4 -',-, • - `.. :
Northampton, MA 01060 - -- -fm,—
phone 413-587-1240 Fax 413-587-1272 , ' • , 4 a. --, r . , - ' ,..,.(1W
- s- 4 = ' - 0 , veC''' , ' ,7 ir , ''' ' - / tp.,',4 'If ---.:5' ,,,,,•, -', , ,
..,
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLJCA Or& dlOWO FAMILY DWELLING
, t
SECTION 1 -SIT E INFORMATION
1.1 Property Address: L
■ This section to be:Cmgglefasiby office
—
U MO RD+VC*- 4 - Map Lot Unit ,
'
------- k ---- v E -r
Zone. --- vp.. t9 ts, Oct ,
N et - Fklfr.A M A- 4106 a- ' ) '-'—"----------- k
_
( I- torerx - ,Etrn St. District ',- 4 1
\ I CB District
, r '
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 3 2.009 .,
i \
2.1 Owner of Record:
St , FL044.1.{.t 6.4----2-
Name (Print) Current Mailing Address: L -------- - '
Se6—&qS
‘-r:E- CrvT4ca.c4— Telephone
Signature
2.2 Authorized Agent:
U r Ian R (Ara)t--->.5 c iS 5:%,441exr-t?ftr) fed UiJeSi-i,c,vqfoi-k fv14 OlQ")
Name (Print) Current Mailing Address:
(------------ ' .- g ------- Lii 3- 521- Gqc20
signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars)-to be - Official Use Only
completed by permit applicant
1. Building .-7 (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 (;/2
6. Total = (1 + 2 + 3 + 4 + 5) .1 4V Check Number
This For Official Only
Date 9 .
Building Permit Number: /CP 2 -0–• to —00 (40
Issued: 4F/7 2 00?
Signature: __...---- ....2, d , .......,i LP' ■
Building Commissioner/Inspector of Buildings Date
„.,
8 NONOTUCK ST BP- 2010 -0040
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D - 012 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 & RENOVATION BUILDING PERMIT
Permit # BP- 2010 -0040
Project # JS- 2009 - 001375
Est. Cost: $7625.00
Fee: $60.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BRIAN BURROWS 092972
Lot Size(sq. ft.): 12588.84 Owner: FREEMAN OTIS STANTON
Zoning: URB(100E Applicant: R !AN ° ?! :!PRc)\i't =
AT: 8 NONOTUCK ST
Applicant Address: Phone: Insurance:
95 SOUTHAMPTON RD (413) 527 -8920
WESTHAMPTONMA ISSUED ON:7/14/2009 0 :00 :00
TO PERFORM THE FOLLOWING WORK :TEAR DOWN AND REPLACE 2 STORY DECK
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: ek 719, c7 '?
K y -a ?
Gas: Fire Department Fireplace /Chimney:
Rough: Oil Insulation:
Final: Smoke: Final: /I
e.yr g „0,
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate ofOccu'am « i! nature: "' �` 't✓:�"
FeeType: Date Paid: Amount:
Building 7/14/2009 0:00:00 $60.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Buildin 'Commissioner - Anthony Patillo