036-258 CERTIFICATE OF INSURANCE REQUEST
TO: Finck & Perras Insurance Agency, Inc. PHONE: (413) 527 -3000
ATTN: Rebecca J. Kubosiak, CSR FAX: (413) 527 -5970
DATE: 4i /
COMPANY: Robert H. Dunn Jr. Construction Services, Inc./
PHONE NUMBER: (413)527 -2953
FAX NUMBER:
****************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Certificate Holder (Recipient): C,Fe r5p 7 _ :,', EGTV,r^'
Attention: J
Address: - 7 _ f 'Z- (NI
Address: 100 r'r 4 - 1 R rn p 1'Y►
l
City, State, Zip: c.{ . 9 7 _ 1 Z7 Z- P(-,‹
❑ Certificate is: URGENT V SAME DAY NEXT DAY
❑ Please Fax Certificate to (Enter Fax #):
❑ Please Name the Holder as Additional Insured
❑ Please Name the Following as Additional Insured:
51 Please Reference the Following Job:
❑ Additional Description (If Any ):
Please no • that the original certilc∎ e sent to the certificate holder even when faxed. Also a copy will be sent to
you and t e insurance corn, any.
X A di-AA • /Printed Name: b 6 i4 . n ✓L
a e of Person Requestin. : rtificate
Proposal
Customer /Owner: Cathy and Joe Savarese
Robert j.J, Address: 111 Maple Ridge Rd.
we
low
Dunn, Cj Cit State, Zip: Northampton, MA 01060
Phone: 586 -4475
Construction Services, Inc.
43 Burt Rd. Westhampton, MA 01027 Proposal Date: 04/30/10
(413) 250 -7430 Project name: Deck
We propose to furnish all material and perform all labor necessary to complete the following:
Remove current decking, deck trim, and rail system. Add supplemental 2x8PT bracing where required.
Add approx. 9 4x4PT rail posts and secure with ledger lock fasteners. Install new "Portico" decking in a picture
frame style with no exposed ends. All decking will be installed using a hidden stainless steel fasteners
made by "Tiger Claw ". Add one additional stair stringer to existing stairs. Expand stairs to 4' and enclose
risers. Add a stair rail to meet current building code. Add "Trademark" fiberglass post covers, with bottom
skirts and flat caps. Add "Trademark" rail system with fiberglass rails and balusters to meet current building
code. Trim deck and stair risers with white "Asek" maintenance free material.
Price includes all permits, inspections and associated fees due the city of Northampton. Price also includes
work site clean up and proper disposal of all construction related debris at the Northampton Sanitary
Landfill.
We propose to complete this project in accordance with above specifications for the
sum of: Thirteen thousand five hundred forty three dollars $ 13,543.00 °'' -= `
Payments to be made as follows: 1. $5,000.00 Deposit
2. $5,000.00 When decking completed, before rail system
3. $3,543.00 When complete
Acceptance: If the price, specifications, and conditions are satisfactory, please sign and return one copy
to: Robert H. Dunn, Jr Construction Services, Inc. 43 Burt Road Westhampton MA 01027
The customer copy of this proposal will be signed by the contractor before work commences. Any work or
materials not specified above will result in additional ar e& is proposal is valid for 30 days unless
otherwise specified.
Customer /Owner signature: Date:
Contractor's signature: c +.i...9 /- Date: ' 5
%T };on �'uuas .ouLccein.�. �)�a {,aif. C.n, }' -,. enarsudlan c5es „c.,i �OS sous r:.o�ul
A
Massachusetts - Department of Public safct\
Board of Building Regulations and 'standards
i Construction Supervisor License
License: CS 85846
Restricted to: 00
ROBERT H DUNN JR '.°% .-
-V. \ ' '
43 BURT RD �;
WESTHAMPTON, MA 01027
g-- - ---- �"„ Expiration: 3/5/2011
( iunmi.aiamcr Tr»: 13540
, ✓itie em manaseaa of - GLaavac% €ae1ts
\ Office of Consumer Affairs & Business Re ulation License or registration valid for individul use only
�� st g before the expiration date. If found return to:
- � HOME IMPROVEMENT CONTRACTOR
_ Office of Consumer Affairs and Business Regulation
Tr. 1 1- Registration: 133318 10 Park Plaza - Suite 5170
Expiration: 6/6/2011 Tr# 700220 Boston, MA 02116
Type: Individual
ROBERT H. DUNN, JR.
ROBERT DUNN JR.
43 BURT RD. 4�i--- --
WESTHAMPTON, MA 01027 Undersecretary Not valid with ut signature
•
The Commonwealth of Massachusetts
.�.. Department of Industrial Accidents
Office of investigations
IMEND S _ 600 Washington Street
s Boston, MA 02111
=•.;• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual) 1pE'ie_T �:�✓� J� rys T" Crvt - r(fiCe S �S (
Address: `f 3 ta' c),2T 0
City /State /Zip: LQ,S ✓n '✓) 7)1 II Phone #: 4 (3 a-SO 7'4-3 O
Are you an employer? Check the appropriate box: Type of project (required):
1. a employer with ,3 4. ❑ 1 am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. [j] 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 capacity. employees and have workers'
g any p tY 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 11.12 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t e. , §1( 4), and have no 13.❑ Other .
employees. [No workers' kers' _ — —
comp. insurance required.]
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
I 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: C 14D '1"
# or Self -ins. Lic. #: (A- 202.0 °- CO2.3 ^ 00 Expiration Date: 1 18 Z 0
Job Site Address: it � t,v t. q City /State /Zip: 1 A - ty. Q Ttrrx in A
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 $250,0Q a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investi ions of th IA for insurance cov . 1 ; verification.
1 do ereby certify der the pains and p. alt' of perjury that the information provided above is true and correct.
Sign ure: Date: - X
Phone #:
Official use only. Do not wri % in th'. 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 Supervisor: Not Applicable ❑
Name of License Holder : ">O 1 • � Lr✓► �� C ASP/
License Number
43 B ozT e 0 °�- t} m � ,-, r� 02S`ir, //
q ig Gt" - ` ExP tionpate 1 S �- ly - 7 Telephone
9. Registered Home Improv nt Contractor: Not Applicable ❑
be �h,-� �1 �" /3331'
Company Name Registration Number
•
-3 k�i} (2 T i�D kk) F.3TH R I , •e17/v` 004 ao�/
re Exp
/ "� -`r Telephone q/3 .- Z 3)
SEC ON 1 0- WORKERS' C ENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
rkers 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 buildin rmit.
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.
Defmition 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 [0] Decks [gr ******--- Siding [0] Other [0]
Brief Description of Proposed
Work: 'i E.rtA(G 3 '�_K(r� n' #rri F7l IS : 17Eci_
Alteration of existing bedroom °Yes No Adding new bedroom Yes 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: 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.
Signature of Owner Date
I. I • �� , 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.
• • - • under the pains and enalties of perjury.
Vi
• ure Owner/Agent Date / ,
Su
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 WaterNVell Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 - 1240 Fax 413 - 587 - 1272 Plot/Site Plans
Other Specify
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
r
AP a 0 Map Lot Unit
f Zone Overlay District
lV i• ?` en /3 117
Eim St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
sr-5-,C x �n & op r S� /1 7 e_ t�
Name (Print Current Mailing Add
41/3 ! 2r - 5 4- V 7-C"--
Telephone
Signature
2.2 Authorized Agent: `�
-t')� �� - -r A �ti r-� 'r-s ' Kr �C �J u- � p1 in
Current Mailing Address:
gint)
ei� Vi ,fri L Sa -� y c� re27
Telephone
N 3 - ESTI TED C ' NSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building /0 (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
6. Total = (1 + 2 + 3 + 4 + 5) /3 Dc/_3 Check Number /j7 7 ,SS —
This Section For Official Use Only
Building Permit Number: I sssuu
ed:
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2010 -1004
APPLICANT /CONTACT PERSON ROBERT H DUNN
ADDRESS/PHONE 43 BURT RD WESTHAMPTON (413) 527 -2953
PROPERTY LOCATION 111 MAPLE RIDGE RD
MAP 36 PARCEL 258 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out �(�
Fee Paid /1 ►�C/��
Typeof Construction: REPLACE DECKING ON DECK
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 085846
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOyMATION PRESENTED:
L./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 1110
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.
111 MAPLE RIDGE RD BP-2010-1004
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 258 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 -1004
Project # JS -2010- 001475
Est. Cost: $13043.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
L.TseGroup ROBERT H DUNN 085846
Lot Size(sq. ft.): 91040.40 Owner: SAVARESE JOSEPH C & CATHY ANN
Zoning: SR(100)/ Applicant: ROBERT H DUNN
AT: 111 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
43 BURT RD (413) 527 -2953 WC
W ESTHAMPTONMAO1027 ISSUED ON:5/17/2010 0:00 :00
TO PERFORM THE FOLLOWING WORK: REPLACE DECKING ON 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:
Gas: Fire Department Fireplace /Chimney:
•
Rough: Oil: Insulation:
Final: Smoke: Final: Ck 7 -- 1 Y — 16 c .._
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
0 ii44/4914,do
Certificate of Occupancy-40/7-4'43 Signature:
FeeType: Date Paid: Amount:
Building 5/17/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo