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Massacnusetts -Department of ouoi c Safety Board of Building Regulations and Standards Construction Super.isor CS-053221..,cense CS-053221 1 . , .... , THOMAS CMCCA 3 BRODERICK ST ,At EASTHAINP1014MA . ° ; - • 0512312015 -.`,.$1--rolssor•er i -At ..•-,..., . • .- -Irk! Mks et Csatimernin°Affsituaggflikeifigi6e• • : 'jit P HOME IMPROVEMENT CONTRACTOR • . • - ReElMndon: ,400364 TYPE 1 -:'-'' 1 I 7* Expiration: ENELO014 Private Comore • S C.14 AMP 44iikl-- CONTRACT , I Thomas McCarthy t' r 3 BRODERICK ST - „ -- •f____ solietk. ,.._., Easthampton,MA 01627 —i Undersecretary . . k i ' Jim Natale 586-0358 9/12/2013 382 Acrebrook Drive Same Florence,Ma.01062 374 Acrebrook Estimate for the following work for repairing the rotted sheathing,floorjoist', ribbon joist', sill plate,wall studs and sub flooring. We will jack up the house in approx. a 6'area. We will remove approx.3'of siding,3'x 6'backer board& 3'x 6'of 1/2"sheathing Remove 5'of the ribbon joist,5-6'of the sill,cut back sheetrock to the studs,remove 3'damaged studs. Remove approx. 16"x 72"of 112"sub flooring Install new pressure treated sill plate 2"x 6", and ribbon joist'2"x 8" Install 3-12'x 2"x 8"spruce floor joist,sister to damaged ones Install 1/2"sub flooring, 112"sheathing, backer board and re install the siding Install new 2"x 4"studs,3-3's, insulate 3 bays,and sheetrock,tape and baseboard. Other's to remove and re install the drop ceiling, remove oak flooring,electrical,prime&paint and trim bushes.. All rubbish removal&clean up included. The Northampton Building Permit is included. MASS.HOME IMPROVEMENT Contractor's Registration#100364 ex-06/16/14 Mass.Construction Supervisor's License#053221,ex.05/23/15 E-mail address—TCMGCI(a?AOL.com Three Thousand Two Hundred Seventy Five and xx/100 ---------- $3,275.00 20%Down for order: $655.00 50% Upon Start: $1,637.50 30% Upon Completion: $982.5 45 • _41". Print Form °�. The Commonwealth of Massachusetts _mss..._. Department of Industrial Accidents Office of Investigations ..�� 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.ntass.gov/dia • Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /,�� Please Print Legibly Name(Business/Organization/Individual): lb-01A t A j " !�( c t��✓ f r�/ dew ti„e,Z/(70,4 Ap4c f tc Address: ._. ,g//'62 'f"r'p, City/State/Zip: t2 . i(1l 4i "X')//-*. Phone#: �1 j Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with r 4. 0 I am a general contractor and I �-�{ employees(full and/or part-time).* have hired the sub-contractors 6• t�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. []Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [No workers' comp. insurance comp.insurance.I required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 1 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.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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: T1e4 'e le d' Policy#or Self-ins.Lic.#: (. if,i,� 3S7 e) /9 Expiration Date: .2/14//7 c Job Site Address: . ; / e :lf1 _r to- ✓"K' J� A City/State/Z:p: /�Cr�-r"e,i( � !r 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 r Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and enalties o f perru9,that the information provided above is true and correct. Signature: Dates, Phone#; Vi .S'-) > Official use only. Do not write in this area,to be completed by city or town offtciae 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 0.5'1,ppliicable ❑ 6 " Name of License Holder: �(�l 4/)J C �' e L#4 iL �(�1 i/ V 02 License Number 3 & b, iiitAtietu S - #.? 3 15"-* Address Expiration Date E 5 r i-r 4 A4 01-64 ?l,4 0/CC 'S Signature WIANelif Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 7t-e,-4 C e'- - &j.e )' y e 4,4'-el , /069 Company Name Registration Number it iege,e J e t( 57-- -/co -A/ Address // Expiration Date $ j/f%2 Ctrl/,�44i1 AM< f t PTelephone V/3 -5-2> .5iV7 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 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 y 4 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [o] Decks [p Siding[p] Other ,e , � . Brief Description f Pro o d / l� l Work: ,2Pp4r�_p h , s'1!( 11 © 1( tlt1 51I2'JL )'dkft/ r sr Alteration of existing bedroom Yes )(. No Adding new bedroom Yes k No,`/ Attached Narrative V Renovating unfinished basement Yes 7� No Plans Attached Roll -Sheet X 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 I, /79 04 to r e- ,as Owner of the subject property // Cr fr he -by authorize G��"'L'�, Cy �,-` C ("2/! `'7 to . •n my behalf,i i a ma r I=��e to work authorized by this building permit application. Sign of-owner Date I, 7/0414 < CI MC cal ,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. Print Name 9 - i2 -i � Signature of Owner/Agent 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg.Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained ® , 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 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. s NI— m,..'- Department use only ' �I ity of Northampton Status of Permit: ' X0`3 :uilding Department Curb Cut/Driveway Permit SEP 212 Main Street Sewer/Septic Availability -- tions Room 100 Water/Well Availability pramb ng 8',GSA onobo ► •- ampton, MA 01060 Two Sets of Structural Plans Electric.IorthamPton p one 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 1.1.5Property Address: This section to be completed by office ,.S e7 (.l A C: e 4 itoo 4: Ow iv L-. Map Lot Unit j`-I c,'eM C i 1/44/1• Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: !IM es 4)/I fit- e-- (ic_ /)Foe) 4 ,,,,/,/ ti,47e a g�1 Name)rint) Current Mailing Add s.3 �,y 6 _ 0 3 (� E'C 7:7, rte/ – 1723�� Telephone (( 3 o Cr Sig atu , 2.2 ■ orized Ascent: 40.014 5 6 "CCU' Oilgy 3 di't7dievit.i s e Lei S It.'.7/0's 4 wf,g_. Name(Print) Current Mailing Address: ,_ ( /21/x`.._. '/73 3".7 ) 11,7/ Sign ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building l 7 re t Q (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ? /L, O 5. Fire Protection �}U(r9D� � i� 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: --- Issued: Signature: 41111111,' � L Building Commissioner/Inspector of Buildings Date 374 ACREBROOK DR BP-2014-0333 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-308 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-2014-0333 Project# JS-2014-000570 Est. Cost: $3275.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THOMAS C MCCARTHY 053221 Lot Size(sq.ft.): 16117.20 Owner: NATALE JAMES F JR&CLAUDIA J Zoning: Applicant: THOMAS C MCCARTHY AT: 374 ACREBROOK DR Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMAO1027 ISSUED ON:9/17/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ROTTED SILL PLATE,RIBBON JOIST, SHEATHING & FLOOR JOISTS 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 9/17/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Louis Hasbrouck—Building Commissioner