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29-331 (3) / 5NV & Karen Carter =� .� ► 1 1.4 • CS LIC. # 070008 HIC# 124718 223 Main Leeds, MA 01053Street (413) 221 -7419 SCOPE OF WORK LUZ ENIEDA 276 ACREBROOK DRIVE FLORENCE, MA 01062 Project: Construct wheel chair ramp with a slope no greater than 1:12 which provides accessible entrance /egress to the front and right doors of the residence at 276 Acrebrook Drive. The Phases of the project are as follows 1. Planning / permitting: confirm design and materials with customer; submit required drawings and paperwork to building department for approval. 2. Lay out of ramp at site 3. Contact Dig Safe prior to any excavation or digging work 4. Work with masonry sub contractor to install pier foundations (4ft. depth) and concrete path of travel from the termination of the sloped portion of the ramp at grade to the existing driveway 5. Install filter fabric and 3 /4 crushed stone shall be installed below ramp to inhibit the growth of grass and weeds below the structure and facilitate good drainage 6. Ramp framing including three landings and three sloped portions shall be constructed of pressure treated lumber rated for ground contact where needed. The sloped portions of the ramp shall be +/- sixty feet. The two upper slopes, one from the existing front entrance and one from the existing west side entrance each of which will be around 20ft shall meet at an intermediary landing at the northwest corner of the building. The third and final sloped portion shall lead to above mentioned concrete path. 7. The decking shall be 5/4 "x6" GAF brand composite decking or equivalent. 8. The handrail system shall be of composite material such as Tamko brand or equivalent to provide as maintenance -free a finished product as possible. The decking and railings will require periodic cleaning but no re- coating products. Owner has made specific choices or the work has been performed, the Contractor shall inform the Owner of the Contractor's invoiced cost for the work and the allowance amount. The Contractor shall also add any charges for additional supervision required plus a 15% General Contractor's Fee to any amount by which the final choice exceeds the allowance amount. (L) CORRECTION OF DEFICIENCIES: The Contractor shall promptly correct any work of her own or her hired subcontractor's found to be defective or not complying with the terms of this contract. This obligation shall extend one year from the date of completion of the contract. Any manufacturer's warranties shall remain in effect according to the manufacturer's terms. (M) TERMINATION: If the Owner fails to make payment under the terms of this contract (through no fault of the Contractor), the Contractor may, upon ten days written notice to the owner, and if satisfactory payment has not been received by the Contractor, terminate the contract and take such legal steps as necessary to recover payment for work completed and any proven loss sustained on wages, materials, equipment and machinery, subcontractor's and other project related costs as well as reasonable attorney's fees. If the Contractor persistently fails or neglects to carry out the terms of this contract, the Owner shall notify the contractor in writing of the Owner's belief that the Contractor has failed to abide by this agreement. If appropriate remedial action is not begun by the Contractor within 10 days, the Owner may terminate the contract and may finish the job in an appropriate and reasonable manner. If the cost of completion exceeds the contract balance the difference, as well as reasonable attorney's fees, shall be paid to the Owner by the Contractor. Under Massachusetts General Law the Owner has the right to cancel this contract within 3 days of signing. (N) RESOLUTION DISPUTES: Claims or disputes relating to the agreement or any provision of it shall be resolved before a single arbiter approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and according to the Construction Industry Arbitration rules of the American Arbitration Association, unless both parties mutually agree in writing to other methods. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signed in duplicate this / 3 Yk . day of , 20 1 C7 (7------- - dile q . O : Luz Eni da Garcia Contractor: Karen Elisab ter 4 • (I) PROTECTION OF PROPERTY AND PERSONS: The Contractor is responsible for initiating, maintaining, and supervising all necessary or required safety procedures. She shall comply with all applicable rules, regulations ordinances, orders or laws of federal, state, county or local government. In any emergency affecting the safety of persons or property, the contractor shall act at her discretion to prevent threatened damage, injury or loss. Any additional compensation or extension of time claimed by the Contractor on account of emergency work shall be equitably determined through a change order after the fact. (J) INSURANCE: The Contractor shall purchase and maintain insurance to protect from claims for 1) damage to the Owner's property at the above address resulting from work during construction on the project: and 2) for damages insured by usual personal liability coverage which are sustained by any persons as a result of any negligence caused by the Contractor, his employees or subcontractors during work on this project. The insurance required by this section shall be written for no less than $1,000,000 aggregate, and the Contractor shall, upon request, produce Certificates of Insurance to the owner prior to the commencement of the project. The Owner shall be responsible for purchasing and maintaining their own liability insurance and builder's risk or homeowners insurance (or any reasonable combination of the two), and shall also maintain such insurance as will protect them against claims for personal injury and property damage which may arise from the Contractor's operations under this Agreement. This liability insurance shall be written for not less than $250,000 aggregate. The owners shall purchase and maintain property insurance upon the entire project at the site to the full insurable completed value thereof. This insurance shall include the interest of the owners. The Contractor, the lender, the subcontractors and the sub - subcontractors in the project, and shall insure against the perils of fire, extended coverage, vandalism and malicious mischief, and shall name the Contractor as an additional insured. Any insurance loss is to be adjusted with the Owner and the lender and trustee for the insured as their interest may appear, subject to the requirements of any mortgage clause. The Owner shall produce, upon request, a copy of all policies or certificates thereof to the contractor. (K) CHANGES IN THE CONTRACT: The Owner may order changes, additions, or modifications without invalidating the contract. All such changes which have a value greater than $150 must be written on the Contractor's usual form for this purpose, and must be signed by the Owner (or either of them) and the Contractor. The Contractor shall provide the Owner in writing the amount of additional costs or cost reductions resulting from changes ordered and shall do so within 10 working days for all changes with a value of more than $150. The cost of all changes shall also include the Contractor's supervision time and a General Contractor's fee of 15 %. If conditions are encountered in the course of the work in an existing structure which must be repaired or modified to conform to the current requirements of the building inspector or the various building codes, such work shall be considered an addition to the contract and handled by a change order unless said conditions have been explicitly identified and addressed otherwise in the contract documents. Certain sections of the specifications may be covered by the "allowances ": for details or materials not yet selected. This means that the contractor has budgeted the allowance amount for the work in question pending the Owner's final decision. Once the 3 • Contractor Registration, One Ashburton Place, and Room 1301. Boston, MA. 02108, telephone (617)727 -8598. (E) COST: The total amount to be paid by the Owner for performance (subject to additions and deductions by Change Order or for Allowances) shall be dollars Twenty three thousand nine hundred eighty -seven dollars ($23,987.00). (F) PAYMENT SCHEDULE: Progress payments will be made according to the following schedule: 1. 10% Down payment: Two thousand tlifee hundred and ninety -nine dollars ($2399.00) upon signing this agreement. 2. Payment Upon Commencement of work: Ten thousand eleven hundred and ninety -four dollars ($10,794.00) 3. Final Payment shall be the balance of the contract amount upon satisfactory completion of the project and submission of a final bill which will include any allowance amount adjustments (masonry/electrical not to exceed stated allowance amount). Not to exceed Ten thousand eleven hundred and ninety -four dollars ($10,794.00) Payments may be withheld because of the Contractor's persistent failure to: 1) correct defective work; 2) make proper payments to subcontractors, workers, or suppliers; or 3) to carry out work set forth in this agreement. Any payment or portion of a payment which is more than 10 days overdue shall accrue interest at the rate of 1.5% per month form the date on which the payment was originally due. Should concealed conditions be encountered below the ground in the performance of the work or should concealed or unknown conditions in the existing structure be at variance with the unknown physical conditions of an unusual nature, differing materially from those ordinarily encountered and generally recognized as inherent in work of the character provided for in this contract be encountered, the contract amount shall be equitably adjusted by a Change Order upon claim by either party made within 20 days after first observation of the condition(s). (G) CONTRACT DOCUMENTS: The contract documents consist of this agreement plus SCALE DRAWINGS OF WORK TO BE PERFORMED AND A WRITTEN SCOPE OF WORK. These additional documents are attached and initialed. Work not covered by the contract documents will not be required unless it is required by normal construction practice to produce the intended result. By executing this contract, the Contractor represents that she has visited the site and understands local conditions, including state or local regulations and conditions under which the work is to be performed. (H) SUBCONTRACTORS: Subcontractors shall be selected by the contractor. If the Owner has an objection to the use of any local trades person or subcontractor they shall tell the Contractor before signing this contract. 2 1. CONSTRUCTION AGREEMENT (A) PARTIES AND DESCRIPTION: this contract is an agreement between Karen E. Carter, Licensed Construction Supervisor 070008, Licensed Home Improvement Contractor 124718, of 223 Main Street Leeds, MA and Luz Enieda Garcia (the Owner) for the CONSTRUCTION OF A WHEELCHAIR RAMP, at the owners property located at 276 ACREBROOK DR FLORENCE, MA 01062 . (B) SCHEDULE: The work will begin on or about JUNE 10,2011 and the Contractor will use her best efforts to achieve substantial completion of on or about JUNE 30,2011. If the Contractor is delayed at any time in the progress of the work by change order, fire, labor disputes, acts of God or other causes beyond the Contractor's control, the completion of schedule for the work or affected parts of the work shall be extended by the same amount of time caused by the delay. (C) OWNER: The Owner, prior to work beginning, shall secure and pay for necessary approvals, easements, assessments and other charges required for construction, use or occupancy. If the Owner fails to do this the Contractor may void the contract. The Owner shall provide, at the Owner's expense, electricity, heat, water, bathrooms as reasonably required by the Contractor at the construction site. If provided by the contractor these will be billed to the owner. (D) CONTRACTOR: The Contractor accepts the relationship; of trust and confidence established between she and the Owner by this agreement. The Contractor will furnish her best skill and judgment and to co- operate with the architect (if any) in completing the work in a responsible and professional manner. The Contractor will provide efficient business administration and superintendence and use her best efforts to furnish an adequate supply of workers and materials, and to perform the work in an expeditious and economical manner consistent with the interests of the Owner. The Contractor shall supervise and direct the work and the work of all subcontractors. She shall use her best skill and attention and shall be responsible for all construction methods and materials and for coordinating all portions of the work. The Contractor shall provide for and/pay for all labor, materials, tools, construction equipment and machinery, transportation and other goods and services necessary for the proper execution and completion of the work. The Contractor shall pay all sales, use and other taxes related to the work unless otherwise agreed, and shall secure and pay for the building permits and/or other permit fees, inspections and licenses necessary for the completion of the work. The Contractor warrants to the owner that all materials used in the construction are new unless otherwise specified and that all work will be of good quality. The Contractor will reasonably provide shop drawings and samples and will produce data or other information as reasonably requested, subject to time and expense limitations. The Contractor shall keep the site reasonably free from waste or rubbish resulting from the work, shall remove all waste, rubbish, tools, construction materials and machinery promptly after the completion of the work, and shall leave the premises broom clean. The Contractor is registered with the Commonwealth of Massachusetts and any inquiries concerning this registration should be directed to: Director, Home Improvement 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 coristinctionr 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 emits 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 7 . - 4 , . . . : • The Commonwealth ofMassachusetts Department of Industrial ACcidents Office of Iniiestig,ationS - • 600 Washington Street i=1:1:1— a Boston, MA 02111 . . - . www.rnass.gov/dia , -Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information - Please Print Legibly ,--- . Name (BusineseOrganizationgndivianni): - c..A (<1W - . . .- • . • . Address: 2.- 2- 3 M ; I 0 T ' -- " 4 *43, • C i t y / S t a t e / Z i p : L J , ivi A- -nici95 Phone.#: I A I "5 — 2J--- 1 I . p Are you an employer? Check the appropriate box a general . • w ith contractor and I • : 371:1 1:3 e ; e : / 1. 0 I am a employer wi have hired the sub-contractors a (fall and/or part-time).* listed on thesattached sheet. 7. 0 P.,mnodelirsr 2_ ani a sole proprietor or partorr- These sub-contractors have •8• 0 Deino lition • . ship And have no employees • working for me in any capacity. eggIloyces,and :1ave workers' . -. ,.. ._ -.• • 9:1D [190 weectxts' corop. insaiance . rdqu .: . . : 5. El We are a corporation and its 10.nEleetrical repairs or additions • 3. p I am a homeowner doing ill work officers bait -4xeraised their . 11.n PluMbing repairs or additions . myself. [No workers' comp. - right Of exemption per MGL r-7 • . 12.0 Roof repans . - -1 t • insurance requirecLi . ' . c'. 152, §1(4), and we have no employees. [No workers' 13 -U Cithei r " comp - msurance reclnicall ' . • . • • • ' *Any applicant that checks box #I must also fin out the section below showing theirworkere compensation policy informatiOm . . t Homeowneri who submit this afradaVitisaficiating' ' they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . :contractors that rili. this box mustattached an additional sheet showing the nasne of the sub-contractors and nate whether or notthose-etnides have . • ainployees. If the sub-contractorshaie employeea, they mustprovide their workers comp policy amber. lam an employer that &providing workers' compensation insurrmce for my einplOyees. Below is the policy Undjob site 'information. • . Insurance Company Name: - • . • . . Policy # or Self-ins. Lic. #: - Expiration Date: - • ' • . - . . Job Site Address: : • • ' City/StafriZip:' • ' . . • - - .- Attach a copy of the workers' compensation policy declaration page (showing the policy flung:Her and expiration date). Failure to secure coverage as reiiiirdirdder Seetibil'25A 152 can Ted tO the iinPoi of eidrairia; Peoalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civt] penalties in the form pf a STOP wojuc_opDER and a fine of up to S250.00 a day against the Violator; Be advised 'that a copy Of this statement may be forwarded to ibe.OffiCeOf -.-----" _ tie h;;WAy:Ciiii; pains.and penalties ofperjury thairthe information provideadbavale_andiorir _ . Siu. -tire: ■ogil1111...___ _.........—: • - . - P a.te .„. i • , - = Phone ti: A 1 I '; - 2- ( 'r r'l / - -• ' : --; • - ' • . . • • • . . - Official use only. Do not write in this h7, to be completed by city Or toWn'afficia . . , City or Town: - Permit/License # ' Issuing Authority (circle one): :1. Board of Health 2. Building Department 3. CitylTown Clerk 4. ElectricalInspector 5. Plumbing Inspector 6. Other . • • . Contact Person: Phone #: • - • _ , SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Su •ervisor: Not Applicable ❑ � Name of License Holder : 113 . `. ! � 0 00 R. License Number Address Expiration to J- ,75 I l k oto Signature Telephone 3 - - 1 1- 1// 9. Recistered,Home:ImDroVement Oadfia`c`to + y ' ; i .;. r . ,t . > � liii ..... Not Applicable ❑ `J�✓ )24 W f' Company Name ✓Ni�� R egistration Number 1V � i Address Expiration ate Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 15Z § 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 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 (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [ID] Decks [CI Siding [O] Other [I' Brief Description of Proposed Work: WHL'f f 1-1 p. PkIA Alteration of existing bedroom Yes /No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes / No Plans Attached Roll - Sheet ( o0vls F2 [ 7 � " f � � /� � ; /y� K'.� p., y {{,"y -�,, `' /�" n Q ik is '.k. q '§ T1rA .�, ■■*■ 1 »�:' 6a "�{K��/IY ���iM�.���Iw71A`'\RLi.■ {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 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , 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. S ignature of Owner Date - A! , as Owner /Authorized Agent hereby declare that the statements and information • • - foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Kfrc • ``k) . A Print Name ■ 2. /I Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Inco , plet: Information- } `. 1 Existing Proposed Require = .Wing This col to by . filledin4Qy Building .a . ent i Lot Size _.__ ._ _® M1h rfp ° Frontage - Setbacks Front , Side L: ` R:€ .___ L:[ ' R:' .._., f t -� Rear t Building Height t i ( _' 1 Bldg. Square Footage - ! 1 % 1-I r i t i Open Space Footage (Lot area minus bldg & paved I 1_� ! parking) # of Parking Spaces I i °— -- Fill: (volume & Location) i r t k A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 I IF YES, date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Pagel 1 and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q ,Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property ? YES (J NO Q 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 O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. of Northampton ,,� < : ' R - V _ B lding Department a° R r •12 Main Street � � . �1�, Ali 1 1� .Fa 3� � Room 100 f � . �� . : mpton, MA 01060 = s -, : - r -1240 Fax 413 - 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: 2.1 AC -rebf8 1�t . Map Lot Unit (� /�, done " Overlay District Efrr1 St Disitrict CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: L � JE (Li Gek Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: V e%-) Z2 3 t �I A or o6 Name Print) Current Mailing Address: f/JJ " 22� 7 Signature Telephone // SECTION 3 - ESTIMATED CONSTRUCTION COS Item Estimated Cost (Dollars) toc be Official Use Only completed by permit applicant 1. Building ^ o a �N (a) Building Permit Fee 2. Electrical �( ( (b) Estimated C Constr Total from ost (6) of 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 4 ( ,!j l 6. Total = (1 + 2 + 3 + 4 + 5) 02 a ® ( ( � CA) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP -2011 -1041 APPLICANT /CONTACT PERSON KAREN CARTER ADDRESS/PHONE 223 Main Street Leeds (413) 221 -7419 () PROPERTY LOCATION 276 ACREBROOK DR MAP 29 PARCEL 331 001 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 / 2 �(,((! f Fee Paid (� 3J / T Typeof Construction: INSTALL WHEELCHAIR RAMP New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 070008 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO 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 ✓� /t3//i 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. 276 ACREBROOK DR BP-2011-1041 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 331 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2011 -1041 Project # JS- 2011- 001679 Est. Cost: $24000.00 Fee: $144.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KAREN CARTER 070008 Lot Size(sq. ft.): 10497.96 Owner: GARCIA LUZ E Zoning: URA(100) / /WSP Applicant: KAREN CARTER AT: 276 ACREBROOK DR Applicant Address: Phone: Insurance: 223 Main Street (413) 221 -7419 0 LeedsMA01053 ISSUED ON:6/16/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WHEELCHAIR RAMP 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 6/16/2011 0:00:00 $144.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 3040 I ff ' 11 H ,Fg DECK 0 x 9 ,_ 2 .r 1 g i LIVING AREA 1208 sq ft ........■....-----------------..,----......---------._---- ---------s-------------- - -- —. - ------- --------------L_\------::::-.=:. -,,, ---) P 1', 1-* .1- -.. H 2 9 '' • '.---,. ..', . v• l',. ', - 71 ap —.--... ' a?c Z. )1 2._(,44,-1.. ._ -- - _.. ---- .- - •. .. _,..._. / z . - • ..•__ _.... Z , 1 .".- -• .. - . _..- , . 9016 1 4I I i 1 ! , I C.. � `` 1• 2668 2668 M I I.I ! II !'I 2810 2810 f .� �\ N UP III I LIVING AREA 1192 sq ft ____,----- ---------------__:_______- _ ' ..",t10 -. •z--- ') ilL ; i 1 \ , . t . r l 0 2 / _..., Z 1 . z , 1± ), 1, )J ' )1. N'' \ • ', - --------.--- .-7- - - ', __ _ / , .....0 7 c? 6'_•(.. 1 ,--.- _- , 3040 'LO i I' ; i o n r l J I ; ,L], DECK 1 . - 0. : x 9,_2.. - - f2 1 2 i CD , , ,. ; m ©)'s 1 LIVING AREA 1208 sq ft 9016 f! I i I o 'i • I n 1. P.; �. 'am 2668 2668 :::■ I I [! 2810 2810 11' i 1 I { I fi II n o 1 L _j___„-' re,\, ,.i ,1 * UP ,, ,, G j ii II !, 1, ,, 1, 0 1, I T 0 v v i ii II, 1 I 1, 1, _ ,,. _ LIVING AREA 1192 sq ft File # MP- 2010 -0060 APPLICANT /CONTACT PERSON GARCIA LUZ E ADDRESS /PHONE 276 ACREBROOK DR (413) 582 -9097 Q PROPERTY LOCATION 276 ACREBROOK DR MAP 29 PARCEL 331 001 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 Typeof Construction: ZPA - 12 X 18 ADDITION - WILL REQUIRE GUTTERS & DRYWELLS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON C't U TER. $ 1Q ND INF(gMATION PRESENTED: (/Approved Additional permits required (see below) til Cv'� a lC) ` { O ( , t .?J tJE -) Co Nst l'. c -Ttc9) PLANNING BOARD PERMIT REQUIRED UNDER : § c�2 &}G15'+ l+ (' 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 /Mt ...._ 3 /2-6 lb SignaV Building Of icial 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 the Office of Planning & Development for more information. ACORD CERTIFICATE OF LIABILITY INSURANCE MIDD/YYYY) TM 05/17/2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chirgwin- Lengieza Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 262 Westfield Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Holyoke, MA 01040 1- 413 - 532 -3615 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Insurance Company William Drew IV INSURER a: Granite State Insurance Company DBA:Bill Drew Construction INSURER C: 64 Westbrook Rd INSURER D: South Hadley, MA 01075 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDD/YY) LIMITS A GENERAL LIABILITY I- 680- 2871N699- ACJ -10 03/06/2010 03/06/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO i ED X COMMERCIAL GENERAL LIABILITY PREMISES (Ea $ 300,000 CLAIMS MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 -i I POLICY JECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WC 006 -37 -2244 12/02/2009 TORY LIM 2009 12/02/2010 X WCSTATU- OTH- ITS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 100 , 000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS Certificate Holder listed as additional insured. CERTIFICATE HOLDER CANCELLATION Ratrelia Bryan SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Gauth Bryan DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 36 Stockman Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Springfield,MA 01101 REPRESENTATIV ' AUTOO'. ED - ATIVE / % a ► ACORD 25 (2001/08) V ( 0 t) ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department of Industrial Accidents ' l Office of Investigations f 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): 13. L .. ; t / CZ t •.,) Co 4, 5T R 'CTi O ..) C p Address: PI 6.1C-5 0 Qc, U lc_ 1 G ,')D City /State /Zip: 3 a •'i li R17 LZ 1' Phone #: '1 13 7 75 6 .y(0 Are you an employer? Check the appropriate box: Type of project (required): 1. Er I am a employer with Z_ 4. 0 I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition• working for me in capacity. employees and have workers' g any P tY 9. [t Building addition [No workers' comp. insurance comp. insurance.: 10. Q Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.0 I am a homeowner doing all work officers have exercised 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' 13.0 Other comp. insurance required.] *My 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 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: 2 3 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone #: 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction S / uoervisor: Not Applicable Name of License Holder : W g L L l ^I .J 1 E c ( C S ( / ' / 3 License Number Address Expiration Date �_ 33 35 _ 6 /o Signature e ep • - 9. Registered Home Improvement Contractor: Not Applicable ❑ GI �c�� Q.�s�lz�.c� K 2 Z3 Comoanv Name Registration Number C'1 s ; /3 /2 eatc T 2d4- Address Expiration Date 1 4 /0 75-- Telephone ` 3 - — 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 Dweliines 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 -vear 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, von 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 ® Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [0] Other [0] Brief Description of Proposed �� ,� -� Work: 'Hat t D .i e t A Di7/ To 1) W 0v,Z / TN Ozp?av- y/047 -J bedroom / e.`it° �e /A Alteration of existing � Yes No Adding new bedroom ✓ Yes No Attached Narrative Renovating unfinished basement Yes No 3 /1 TT34T+f Plans Attached Roll - Sheet ea. If New house and or addir existing housing. complete the following: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: 8 Number of Bathrooms 3 c. Is there a garage attached? Al 0 d. Proposed Square footage of new construction. Z 5 Z Dimensions e. Number of stories? 1 f. Method of heating? E. L E C T e i ( Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction LJv OD ¶27 M y' 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 . 1. Septic Tank City Sewer ✓ Private well City water Supply 1/ SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L `' Z r_'..--e , D a � A izc . 4 , as Owner of the subject property '� hereby authorize 1 A / ./J 4 Al .. ' %(-'c C 4J to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date air I, " " d "I // ? - 1 7 17 e 1 Vas Owner /Authorized Agent hereby declare that e state - nts an. 1 , , ation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. \A% `1rAtit __ l tC 2- (.4.) . 1/ Print Name / _ - i 7 "5' 'c / Signature of Owner/ ' or �- 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 +Oix fov i0 ( 0 c) Frontage Setbacks Front Side L: 7 R: l a L: 5J R: / C7 Rear 4f3 Building Height r 7 l 7 Bldg. Square Footage % % Z� Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ver been issued for /on the site? NO 0 DONT KNOW 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 er DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O ,Date Issued: C. Do any signs exist on the property? YES O NO 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, 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. Department use only City of Northampton Statu,�,o#P. : --� Building Departments uDri*lnraefrn 212 Main Street . , : , :. Ity yi Room 100 WsteiyirVeli Availability c Northampton, MA 01060 tvl s of `i t u r a i4ta phone 413- 587 -1240 Fax 413- 587 -1272 ri Plans { ther T e ^ f lO4S 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 '276 Merttt.coe Pat tie Map Lot Unit or 0 E 0 Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: L wz ir2A 6ACCCt4 Name (Print) Current Mailing Address: . / 3— Zi (7— ZY73 Telephone Signature 2.2 Authorized Agent: - / ‘A/.# /1 /i M -I t , 7 - . c,J 6 0 ©tC r?p l44 ' Name (Print)/ Current Mailing Address: �%/ e{/3 335.- 4‘ito Signature Telephone SECTION 3 - ES TED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building S 41, ©0 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of ti 0 0 0 Construction from (6) 3. Plumbing ©0 U Building Permit Fee 4. Mechanical (HVAC) fj 2,� 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 6 1 Z., O UU Check Number " ?-5 2,10 v This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 276` .s. F, ,. BP- 2011 -0099 GIS #: COMMONWEALTH OF MASSACHUSETTS Maa=o -:2Rt 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- 2011 -0099 Project # JS- 2010- 001222 Est. Cost: $42000.00 Fee: $252.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Bill Drew Construction Lot Size(sq. ft.): 10497.96 Owner: GARCIA LUZ E Zoning: URA(100) / /WSP Applicant: GARCIA LUZ E AT: 276 ACREBROOK DR Applicant Address: Phone: Insurance: 276 ACREBROOK DR (413) 582 -9097 0 FLORENCEMA01062 ISSUED ON:8/10/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:Addition and Renovation; whole house must have smoke and co detectors per current code 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 8/10/2010 0:00:00 $252.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner