25A-041 C p o n
�A 128 Ryan Road Estimate
Raintutuu
Florence, MA
01062 Date Estimate #
PRO
11/11/2009 935
Dave and Diane Pascucci
26 Marshall street
Northampton, MA 01060
Terms Project
On receipt Pascucci upstairs bath
Description subtotal
1
Project material, labor, subcontract
Material, per job
Labor, per job
Subcontract, per job
*Project Subtotal
*Project Total
Total $9,598.41
We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as
follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to
be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications
involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary i 1 _ rance. Acceptance of
Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory an;i ar• hereby accepted upon
signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as sp " ed. This esti ate is good for 30 days.
1r
Phone # E -mail
Signature
413 885 - 9038 tom @rainhome.net
Page 3
• r
�� - i -E�A, 128 Ryan Road Esti m ate
Raiinhiwo
Florence, MA
01062 Date Estimate #
11/11/2009 935
Dave and Diane Pascucci
26 Marshall street
Northampton, MA 01060
Terms Project
On receipt Pascucci upstairs bath
Description subtotal
36 SF
Tile backer board Floors
36 SF
Tub surround with shelves, trim and valves (allowance $200.00)
1 Ea
Linen cabinet shelves
20 Ea
Disconnect and reconnect heater
1 Ea
Medicine cabinets Swing door, 16 in. x 22 in., recessed (allowance $80.00)
1 Ea
Softwood moulding, casing 9/16 in. x 3 -1/2 in.
50 LF
Interior surfaces
228 SF
Recycle fees
1 Ea
Building permit fees
1 LS
Plumbing to install new tub and shower unit, existing toilet and existing sink
3
Electrical to code
Total
We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as
follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to
be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications
involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of
Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory and are hereby accepted upon
signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. T stimate is good for 30 days.
Phone # E -mail II
.
Signature
413 885 - 9038 tom @rainhome.net
Page 2
e \>- - - - t — ` \ y 128 Ryan Road Estimate
Florence, MA
01062 Date Estimate #
1 1/11/2009 935
Dave and Diane Pascucci
26 Marshall street
Northampton, MA 01060
Terms Project
On receipt Pascucci upstairs bath
Description subtotal
Removal of linoleum
4 SY
Removal of gypsum wallboard on walls and ceiling
228 SF
Removal of plywood on floor
36 SF
Removal of Softwood moulding (all patterns)
50 LF
Remove existing plumbing fixtures
4 Ea
Unfaced fiberglass insulation, on walls
228 SF
Kraft -faced fiberglass insulation, on ceiling
36 SF
Gypsum wallboard nailed or screwed 1/2 in. green board on ceilings and walls
228 SF
Plywood subfloor 3/4 in.
36 SF
Ceramic floor tile, 8 in. x 8 in. Minimum quality (allowance $1.60)
36 SF
Installation of tile in thin set mortar, floors 8 in. x 8 in. to 12 in. x 12 in. glazed field tile
Total
We propose to hereby furnish material & labor complete in accordance with the above specifications, for the sum total. Payments to be made as
follows: 1/3 of full total upon acceptance, 1/3 of full total upon the start of project and the balance upon completion. All material is guaranteed to
be as specified. All work to be completed in a manner according to standard practices. Any alterations or deviations from above specifications
involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements
contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado, and other necessary insurance. Acceptance of
Proposal will commence with the home owners signature. Prices, specifications and conditions are satisfactory a are hereby accepted upon
signature. Rainbow Home Improvement is authorized to do the work as specified and to be paid as specified. This stimate is good for 30 days.
Phone # E -mail •
Signature
413 885 - 9038 tom @rainhome.net
Page 1
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, 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
------- per-mits- in- conjunction,_to_ the. building ..p -ermit_issued,_and_. 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
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
_,,-- Department of Industrial Accidents
g =-- t..:3 Office of Investigations
4 _ 600 Washington Street
; Boston, MA 02111 .
WI .• y www.mass crov/dia
Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print LegibIv
Name (Business/Organization/Individual):
Address:
City /State /Zip: Phone. #:
Are you an employer? Check the appropriate box: Type of project (required) ,
1.0 I am a employer with 4.. 0 I am a general contractor and I
6. ❑ New construction
employees (full and/or part- time).* have hired the sub- contractors
listed on the attached sheet 7. ❑
2. ❑ I am a sole proprietor or partner- h Remodeling
These sub - contractors have
ship and have. no envioyees 8. p DentD on
working for me in any capacity. employees and have workers' 9. ❑ Winkling addition
[No workers' con:p. insurance Comp. insurance. .
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3. -I -am a- hemeewacr doing-all-work- o ce_rshve xezcisecl heir_- _14 .Q -Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.E1 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 belowshowing 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_
CContractors 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
formation. . _ . ._
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 fnft
of up to $250.00 a day against the violator: Ige 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 in and pena ties ofperjury that the information provided above_istrue.and_correcz _ _
Signature: • Date: 2 — -10
Phone #: l— \ (
-Official are only. Do not write in thLfi rea, to be completed lycity or town officiaL
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector _
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
—
Name of License Holder : t Y`civvN --y 0\41 CA/C.= % 'j 2 3 G
License Number
Address Expiration Date
S nature Telephone
9:. Registered:Home Improvement Contractor , Not Applicable ❑
Company Name Registration Number
Address ` Expiration Date
t Y
\ 41 1 \Uo [ 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 ❑
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 Supervisur your presence on the job site will be required from time to time, during and nrnn
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
o ampton • r. mances, . - . • • . • : " - .. • tts- General - . Annotated.
Homeowner Signature
,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House [l Addition [D Replacement Windows Alteration(s) LJ Roofing ❑
Or Doors C[ ,
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding [0] Other [0]
Brief Description of Proposed r 1 _
'
Work: �fZ1;m W-AS �r \�k t S4�C.02.ccn, r ■ ∎N . ,.w+ -�`S tZ a.+.c� '` t,,ne. P�urn '" T " �6 - Fez,
Alteration of existing bedroom Yes No Adding new bedroom Yes ✓ No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
ii If f &AAA house,andtsr_additiort t exlstinci touilna, oinAletethe- fotf`amAriq:
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 PERMIT
4 1/ 1, cal ` i d -66 c,ticc / , as Owner of the subject
property
hereb
n ure o thoriz cam. 1: (1%,,,, .r ;1 t� 'Z%-C-
to my b a f, in all matters relative to work authorized by this building pe it application.
Si of Owner Date
Y 1 !.J Q„J 1 d L,-i/"G c / , 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.
Sig d under the pai s and enaltie of perjury.
v - C WG7,i
Pri t me
/ / 2 ///z/ — - - - .._
Si natur o f wner /Agent Date
1.
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,,
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 YES
IF YES, date issued:',
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW er YES
IF YES: enter Book Page; and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW 0 YES 0
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 er
IF YES, describe size, type and location:
Il" b r a } 1 i ? r ? a n y prnpnsa_'".- ang?s to nr a . attnnc n signs intPn Prfi r f ia'prnperfy 7 YFS 0 NO e
IF YES, describe size, type and location:
E. W+II the construction activity disturb (clearing, grading, ex ation, 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.
•
City of Northampton
Building Department
212 Main Street S S r •' x�
.\ Room 100
\ Northampton, MA 01060
phone 413 - 587 -1240 Fax 413 -587 -1272 ' t
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Z41 =-v c- S Map Lot Unit
,- V ,"2�'� 4\4^ done Overlay District
�
Zhu St. CB District
SECTION 2° PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Recor- :
Name (P Current Mailing Address:
Telephone
1 11 Signature ,.~ 2.2 thorized Agent:
Name (Pe t) 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
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fcc
4, Mechanical (HVAC)
5. Fire Protection
6. Total= (1 +2 +3 +4 +5) `(� 27I Check Number / rtliz-
This Section For Official se Only
Date
Building Permit Number Issued:
Signature:
Building Commissioner /Inspector of BuildingsF, Date
File # BP -2010 -0699
APPLICANT /CONTACT PERSON THOMAS MALONE
ADDRESS /PHONE 128 RYAN RD FLORENCE (413) 885 -9038
PROPERTY LOCATION 26 MARSHALL ST
MAP 25A PARCEL 041 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ter r f tc5
Fee Paid It
c5"---
Construction: REMODEL BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 055236
3 sets of Plans / Plot Plan
THE F Oj LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I F ATION 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
I '
a L
Signature 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.
26MARSIiALLST t BP - 2010 - 0699
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map ck: 25A - 041t 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 -0699
Project # JS- 2010- 001028
Est. Cost: $9500.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THOMAS MALONE 055236
Lot Size(sq. ft.): 10193.04 Owner: PASCUCCI DAVID E & DIANNE MACK
Zoning: URB(100)/ Applicant: THOMAS MALONE
AT: 26 MARSHALL ST
Applicant Address: Phone: Insurance:
128 RYAN RD (413) 885 -9038 WC
FLORENCEMA01062 ISSUED ON:2/4/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: REMODEL BATHROOM
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 2/4/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo