24C-006 Contract
Brackett Contracting
(508)371 -0318 DATE: NOVEMBER 24, 2012
17 Hancock St.
Worcester, Ma 01610
TO 283 Prospect St
North Hampton, Ma 01060
QTY ITEM # DESCRIPTION MATERIALS LABOR TOTAL
Remove Existing 3 Floor Deck Structure to attic
apartment.
Reframe and dig /pour new footings. Deck to be
Framed, decked, and railings with 1 Vs" balusters to
be constructed using pressure treated lumber.
Landings to be framed on stairways as needed.
Decks to be constructed with 2x8 joists, 4x6 posts,
all necessary hangers and hardware, galvanized
hardware, lags, bolts and nails. $11,000
Cost includes building permit, dumpster to remove
trash /debris and labor /material costs.
Payment Terms
One -Half of total price down payment up front to
begin work.
Remaining balance (half) upon completion.
Homeowne Signature
(vi
Robert Brackett
TOTAL DISCOUNT I I
SUBTOTAL
SALES TAX
TOTAL $11,000
_v4
�,, Of /e � onsumer Affairs & B i�anvinoowreat o� Bess ✓�aaaae�euaeka
«: Office of SI Regulation
. K_ �= , HOME IMPROVEMENT CONTRACTOR
" Re
i— : Registration:
162513 Type:
_ r{_ /` Expiration: 3/9/2013 Individual
ROBERT BRACKETT
ROBERT BZACKETT -
17 HANCOCK ST. g
WORCESTER, MA 01610 Undersecretary
Massachusetts - Department of Public Safet■
Board of dud Standards
•
Construction Builing Supervisor Reglations Licens e
License: CS 74727
ROBERT M BRACKETT
i g-, 14 -
17 HANCOCK ST
', WORCESTER, MA 01610
�i--e-..- -- -- Expiration: 1/30/2013 '
('onunissioncr Tr#: 10349
Northampton, MA Property Detail Page 2 of 2
Interior/Exterior: Same
Condition /Desirability/Utility: GD
Vacant/Dwell /Oby Status: Dwelling
Additional Features:
Brick Trim: 0 X 0
Stone Trim: 0 X 0
Remodeling Data:
Year Remodeled: 0
Kitchen Remodeled (Y/N):
Bath Remodeled (Y/N):
Land Data Outbuilding Info
Square Foot Type
Type F Qt Value Utilities
Prime no
Site 7,500 155,000 information
Residual 18,785 6,570 Type Qty Year Size 1 Size2 Grd Cond
RS1 1 1991 1 60 C A
Acreage Type
Type Acres' Value Street /Road
no
no information
information
Sales Info Permit Info
Date Type Price Validity Date Permit # Price Purpose
no information' no information
http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =24C- 006 -001 &pag... 11/26/2012
Northampton, MA Property Detail Page 1 of 2
City of Northampton, MA: Residential Property Record
New Search Property Type Classification Code Reference Card 1 of 1
Parcel - Location - Zoning - Assessment
Map -Block -Lot: 24C- 006 -001 Zoning: Assessment:
Location: 283 PROSPECT ST Neigborhood: 9 Land:
#Living Units: 1 Deed Book: 9000 Building:
Class: R - 352 Deed Page: 185 Total:
Dwelling Information ________ Building Sketch
Style: Conventional
Year Built: 1900p r pus
' Story Height: 2 ' '
Attic: Part Finis 38 6
f� i OF
Basement: Fu i 8
Total Rooms: 8 !
Bedrooms: 4 32 FA /2Ms /B 32
Full Baths: 26 D 26
Half Baths: o
Exterior Walls: Bric
Unfinished Area: t 8 38
Ground Floor Area: 1216 34
EFP
Total Living Area: 2736 10 10
Finished Basement Living 0 X 0 C
Area:
Basement Recreation Area: 0 X 0 I jl PL4A5
Woodburning Fireplace
1 / 2 Addition Information:
Stacks /Openings:
Metal Fireplace 0 / 0 Lower 1st Story 2nd Story
Stacks /Openings: One Story
Heat/Central A/C: Basic Basement One Story Masonary Masonary
Heating System: Stream Enclosed Frame
Fuel Type: Oil Porch
Quality Grade: B- Open Frame Porch
Physical Condition: Average Wood Deck
http: / /www.northamptonassessor.us/ noho /propertydetail.php ?map_no =24C- 006 -001 &pag... 11/26/2012
Version1.7 Commercial Building Permit May 15, 2000
,
SECTION 10- STRUCTURAL PEER REVIEVV (780 CNIR 110.11)
Independent Structural Engineering Structural Peer Review Required • Yes 0 No fel)
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
-'---,. lS --- ----- ---- --- ---- asOwnerofthesubjectprope
• -- P) , q i ^r P - t- n VfrLx)
hereby authorize —,„, , ,. –",,---
--,
act on n -Ieh , in all r9 7 .9tters relat.$54 to work authorized by this building permit app ation.
y
Signature Owner Date
1 _ f ___ 2 30,:t4ce ilf
----
' , 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 • - p.'ns and 7,Lnalties • .zriuni, _ __________ .,,,,. .................. . _ .,
/ _ , /-------
– X - . ,
Print Name
1 ii • ' / , AVM
Signature of Owner/Agent lifiliVAIr.1 R it _ 40
SECTION 12 - CONSTRUCTIO ' SERVICES
10.1 Licensed Construction Supervisor: _,S0A2ey4 Zreteziett Not Applicable 0
Name of License Holder
'--- ...
1 CC„ „tt _, ,
y 7-
License Number
( 7 Hill CC 1 J-r eNber c ,piti_ o/ /c) , p i
....._ _., _... _
Address Expirab Date
�'r hr W .” 1— e)
Signature Telephone
SECTION 13 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 0 No 0
s -, The Commonwealth of Massachusetts
- Department of Industrial Accidents
Office of Investigations ,
, � -; ^ a, 600 Washington Street .x
' Boston, MA 02111
�._-^ www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information 1 Please Print Legibly
Name ( Business /Organization/Individual): a 4-trt 2! 4,-7.
Address: / 2/ h /1C 0 (- S f
City /State /Zip: `A4i piA 0/!.70 Phone #: ,SD eY- — 7 / — O 3Ie7
Are you an employer? Check the appropriate box: Type of project (required):
1.2r I am a employer with 4. ❑ I am a g eneral contractor and I
6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2.,0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
g Y P tY 9. ❑ Building addition
[No workers' comp. insurance ' comp. insurance.:
required.] 5. ❑ We are a corporation and its 10. Electrical repairs or additions
❑ officers have exercised 11.
3. I am a homeowner doing all work h id their ❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. ❑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. �.y�
Insurance Company Name: , C `' `��S (it 1'r // 5 -'75--).-33 0 0
'/ C ' Expiration Date: i / v
Policy # or Self �� j /-
- -ins. Lic. #: (/� �N p
Job Site Address: 4 11 3 Pi'7.ee J Si City /State /Zip: / 4r i7 nJ77 O I 6 d ()
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 cert; i u; der the pains and peg , lties of perjury that the information provided above • true and correct.
� Date: 1 D 1,2
Si. nature: It,. ' ,,, .l
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 #:
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to re filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side
L:___ R -= L
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 C I) DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page ' and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 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 1 NO
IF YES, describe size, type and location: YC� w'
D. Are there any proposed changes to or additions of signs intended for the property ? YES (3 NO 0
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 0 w
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15, 2000
f
SECTION 9- PROFESSIONAL DESIGNAND CONSTRUCTION SERVICES- FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116;; (CONTAINING MORE THAN 35,000 C.F. OF EILOSED SPACE)
9.1 Registered Architect:
.__ _ Not Applicable ❑
Name (Registrant):
.. Registration Number
Address
.,..'_.._.......____..__ Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
„_. .... __ _ n
Name Area of Responsibility
— . __
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address'. .___...._.....w_...__..._ ___.._.. . .._._,_...._......_..____..�.._ _ _., Registration Number
1
Signature Telephone Expiration Date
9.3 General Contractor
/31t. -.... W.., // r�...____ .._ _ _ . w_..._.. Not Applicable ❑
Company Name
Responsible In Charge of Construction
Address
L.../filLbef r.
Signature Telephone
•
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
.�
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Buildi OS
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other
Brief Description Enter a brief description here. fart e;ece C+/Y t,', f f / G7
Of Proposed Work Ar 4 hw/ / v(/ � , (rt , _/ / I c / c
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE jC 15T r(` FO cTT 0 12.E NT
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A-4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ® 2B - ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 1 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B I tEl
U Utility ❑ Specify:
___ _ . ______
M Mixed Use ❑ Specify:'
_
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS; ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: ______ ____ _,.__.._ _ Proposed Use Group: ;
~
Existing Hazard Index 780 CMR 34): ___ _ Proposed Hazard Index 780 CMR 34): i" _ __,,,_ ..__.
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
st s
___
1
2 n d 4
rd
4th 4
th
Total Area (sf) Total Proposed New Construction (sf)____
Total Height (ft)
Total Height ft _
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone _ _ _ Outside Flood Zone❑ Municipal ❑ On site disposal system El]
Version1.7 Commercial Building Permit May 15, 2000
i t a D t uSe,or(I ( i t .
r� 4 r t of Northampton ® t � _ �� 4r
EC V _D Ity p All �*nliv es � � .��
: uilding Department a Cu Dnueway Per i -ti. a
212 Main Street SewerCSep c�r�aiJa rllty `` , h t
NOV 26 `
� Y x� , g
Roo 100 Ulfater ,QU'Ft�eit�1��€arta�l)�it��°w� `� � � � � � �� �� �
No hampton, MA 01060 fT Set'sctfi,q ctira >?Itns° �', .`e'
DEPT OF BUILDING IN. ,
• ::. ca.. .87-1240 Fax 413- 587 -1272 Piot/Srte P� s
NORTHAMPTON A01060 ' g '
i ZS peCI y
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1.1 Property Address:
>, - f3: c Map Lot Unit
NO Y+
/7 f4 1b) P I/y'J� lit I' Zone
Overlay District
,/ Elm St "District CB District°
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
■
1 e/ 11/11/_..1 ._
, j /
Signature . % , Telephone 03 j c ;25 C ?.
2.2 Authorized • gent:
��
Name (Print) � 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 ��__._.... _._. _ .�,..___ Bu Perm Fee
4. Mechanical (HVAC) . __________________ __.....
5. Fire Protection -- — — (c) 8 4Wtf
6. Total = (1 + 2 +3 +4 + 5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2013 -0586
APPLICANT /CONTACT PERSON ROBERT BRACKETT
ADDRESS /PHONE 17 HANCOCK ST WARE (508) 371 -0318
PROPERTY LOCATION 283 PROSPECT ST
MAP 24C PARCEL 006 001 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 �O C'
Fee Paid a - e�, �
Typeof Construction: REBUILD DECK CI TA 1 f�- F' C. a- c--e.� P-t "� \ (.O sal ( f � (t(i "
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 74727
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
/1 f l?
ignature 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.
283 PROSPECT ST BP- 2013 -0586
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 006 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 -0586
Project # JS- 2013- 000947
Est. Cost: $1 1000.00
Fee: $66.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ROBERT BRACKETT 74727
Lot Size(sq. ft): 26266.68 Owner: BOULAIS CHERYL J TRUSTEE
Zoning: URB(100)/ Applicant: ROBERT BRACKETT
AT: 283 PROSPECT ST
Applicant Address: Phone: Insurance:
17 HANCOCK ST (508) 371 - 0318 WC
WAREMA01610 ISSUED ON:11/28/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REBUILD DECK/EGRESS STAIRS PER
CURRENT COMMERCIAL 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 11/28/2012 0:00:00 $66.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner