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38C-050 . • . , . . , , . • . • . , . . , . , , , . • , • . . , • . , . • . . , . • . . . , . . , • • . . , • ' • , , , ' ' , PROPOSAL Harlow Builders 336 Coles Meadow Rd. Northampton, Ma. 01060 (413) 586 -0465 Submitted to: October 29, 2012 Donald Horton 586 -7995 55 South Park Terrace 320 -8552 Northampton, MA 01060 The scope of this project is to replace the decking and railings to the existing deck. We hereby submit specifications and estimates for the work to be performed. All materials and labor to complete. All permits obtained by Harlow Builders. All debris caused by construction removed by Harlow Builders. Demolition: Remove the existing hand rails, railings and balusters from the existing 4x4 pressure treated posts. Remove the existing 5/416 pressure treated decking from the floor joist. Decking: Install New, 5/4x6, GAF, Burnt Walnut, square edge, decking material, fastened to the existing pressure treated floor joist, using 2 %" brown split top screws. Railing: Install new 2x2, 2x4 and 2x6 pressure treated material, along with Brosco #wm -231 handrail to match existing. Material fastened with galvanized screws. Stairs: Replace existing stair treads and railings also. We propose to furnish the material and labor necessary for the completion of the above stated work for the sum of: Six Thousand Forty Nine Dollars $6,049.00 Payment as follows: $3,000 due upon start of demolition. $3,049 due upon completion of proposal. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra cost will be executed only upon written orders in the form of a change order 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. A certificate of workman's comp. insurance, liability insurance, license and registration will be presented upon signing. Respectfully Submitted by e j of Harlow Builders. ACCEPTANCE OF PROPOSAL I accept the above stated prices, specifications and conditions. You are hereby authorized to do the work as specified. Payment will be made as outlined. Date - J 1 - sc). (a Signature City of Northampton � , � ` Massachusetts DEPARTMENT OF BUILDING INSPECTIONS Pt 212 Main Street • Municipal Building Northampton, MA 01060 Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and /or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 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 �" Office of Investigations rase --- 600 Washin Street a - Boston, MA 02111 ,, www.massgov /dia se. Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers Applicant Information . Please Print Legibly Name (Business /Organization/Individual): \ \ 9C Address: -- C - C (<3 Cam\'_ -S� \w C City /State /Zip: �v t\ ' . F� Phone #: C 4 7 T Are you an employer? Check the appropriate box: Type of project (required): 1. E Yi am a employer with a 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction listed on the attached sheet. 7. [1] Remodeling 2.1 I am a sole proprietor or partner - 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.] ] u 5. n We are a corporation and its 10.n Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.1 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other • comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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: Qi\Sq k e'M04 44-2- S Policy # or Self -ins. Lic. #: -.c---:S ' 3 `- `.' \ '' .' \ Expiration Date: ) ` 1 Job Site Address: S V: �kk V■C- City/State /Zip: `\D- 'N\ 1\1\ % \c40v 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 p ns ' d penal ., ofp jury t at the information provided above is tr e and correct. Si. lature: _...#1 .� /�� ' ,� /i' 411e. Date: % c)? R JP. 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 Supervisor: • Not Applicable ❑ Name of License Holder : S C, / O ��O \� "�� `2 License Number C — 44 ■1.11 V_‘ -7 k ( Address \xpiration Date ■ Signature Telephone 9::Regist Home Improvement Contractor _,„ „_, _ , ., T S „L ,_ Not Applicable ❑ % V.� Ci: \\ , Company Name Registratio Nu ber �S ���� --� \ . \ ► t a Registratio 1 1.2 Address Expiration Date Telephone CV.— O4 (of 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 l No ❑ 11: some Owner Exe 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) n Roofing IT Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [D} Decks [© Siding [D] Other [O] Brief Description of Proposed ( Work: ► h � Z � . t�1 Q�r. \Y\ �h �\` y / g Alteration of existing be room Yes v No Adding new bedroom � es No 9 9 Attached Narrative Yr Renovating unfinished basement Yes No Plans Attached Roll - Sheet s If, New h se an d OJ dditionn to- ezistin`q h ing cor�iplete tFie; fntlowing a. Use of building : One Family Y 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. '/-� J IMlasscheck 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 - OWNERAUTHORIZATION - 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 �,� � LJ , 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. aX �w Print Name - Signature of Owner /Agent Date 4 Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by . 1pnina m , , This column toititifilled) by Building Department Lot Size _ 1 -- -- — -- - a , . Frontage . „ Setbacks Front . . , . Side L:. '•, . R: L: R: , .' . Rear L \ 1 i : , . - .,, , . Building Height ‘, \ Bldg. Square Footage ..,, -: % ; . , Open Space Footage \ % , i 7-- (Lot area minus bldg & paved parking) # of Parking Spaces .,. ., .- . . A Fill: (volume & Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 ./. ''., , YES 0 IF YES, date issued:; , IF YES: Was the permit recorded at tlx`e Registry of DeeFls? NO 0 DONT KNOW 0 \ YES I , 0 IF YES: enter Book : i Page I and/or Document # B. Does the site contain a broo , body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit be n or need to be obtained from the COTIservation Commission? Needs to be obtaine. 0 Obtained 0 \ \;,, Date Issued: C. Do any signs exist cn the property? YES 0 NO 0 IF YES, descri• - size, type and location: D. Are there any .roposed changes to or additions of signs intended for the p operty ? YES (3 NO 0 IF YES, d-scribe size, type and location: I . E. Will the c nstruction activity disturb (clearing, grading, excavation, or filling) over 1 acre • is it part of a common plan j that will.disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. y • r- De�artmea�# use only - ` RECEIVED_. 1, y o Northampton S t� t u of Pemait A „ � B ildl Department Curb Cut/Drly y P rr ftrt g '� , NOV � ' 12 ain Street SewerJSepticfiyaila IJ It`y � � �� �, Rom 100 11VaterlWetivail a DEPT of t3un Jr INtF o am ton, MA 01060 TwoSe s- ofStruural lans� NoRTHAr 4 -587 -1'240 Fax 413- 587 -1272 P1ot/S e Can � � z � Ofher 5 ecr p fy'",, ,. 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 S ©v. �C 0.c'\ <�� �C �' M' Lo Um `:Zone -.. r; Overlay Dist 3 EIm St. District ! CB District "! SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED A 2.1 Owner of Record: 4 (�0.\ fl �ot.r �{� Sow Qc c��� �c��(� Name (Print) Current Mailing Address: Telephone Signature . 2.2 Authorized Agent: (� S CE \L� \\‘'.-c"-\4.-"' 5 ( �R, \45 V`'■RC� v .`-'' 4 j Name (Print) Current Mailing Address: Sig ature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official .Use Only , completed by permit applicant 1. Building (a)`BurldingPerr 2. Electrical (b)_ Es ti m ated Total Cost of ' Constru fro (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) , 7 , , - - yk 5 5. Fire Protection " 6 6 . Total = (1 + 2 + 3 + 4 + 5) Co,�� Check Number Thi Section F Us e Only Date Building Permit Number: Issued: . ' ' t Signature: ` . , Building Commissioner /Inspector of Buil Date 55 SOUTH PARK TER BP- 2013 -0612 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38C - 050 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2013 -0612 Project # JS- 2013- 000991 Est. Cost: $6000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HARLOW BUILDERS 052460 Lot Size(sq. ft.): 14418.36 Owner: HORTON DONALD Zoning: URB(100)/ Applicant: HARLOW BUILDERS AT: 55 SOUTH PARK TER Applicant Address: Phone: Insurance: 336 COLES MEADOW RD (413) 586 -0465 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:12/3/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REPLACE DECKING & RAILINGS 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 12/3/2012 0:00:00 $50.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner