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29-553 (5) 17;A 10 C) C Ile � '0 '56 006f- New England Remodeling General Contractors Inc. www.neremodeling.net Proposal No.: 12001 Thomas M. Bacis Date: 01/24/08 67 Division Street Easthampton, MA 01027 MA Lic. #: 070061 (413)529-0801 MA Reg. #: 149948 TO: Kevin and Brenda Krumpholz 395 Ryan Road Northampton, Ma 01060 586-4910 Job Description Price Install 1 Bilco Stackwell egress area with cover, Including 1 vinyl double hung window and necessary trim. Bathroom. Install 1 power flush toilet, 1 pedestal sink, 1 vent light combo unit, and 1 gfi outlet. Flooring shall be a stock color of linoleum. Re-frame wall and install 1 door and trim. Bedroom Install 3 new 2x2 light fixtures, 1 smoke detector and relocate light switch into the new room. Install 1 closet and reuse existing bifold door. Install 1 wall and install 1 door into bedroom. Update hard wire smoke detectors and carbon monoxide detectors for entire house according to code. Painting and final landscaping shall be completed by the homeowner. TOTAL: $15,985.00 - A 1 1/2% monthly service charge shall be applied to any balance over 30 days. - Above prices good for 14 days. - Any additional work or changes will be priced at the rate of $55.00/hr. plus material. - Our contract may be withdrawn if not signed by both parties by the stated date. - Required deposit must be given upon signing to ensure price guarantee. Customer Signature: ever \CVL;Mp1UZ Date: Contractor Signature: 44". Date: �aSt' 6Mt VI-T Plate S 'L r/ D C ( a 4 c tel OF E=f:\�G 2 12 Latt" 0 "M UIECpall E Lilding ENTIDTION: ACKINOWLEDGE-A IJONE 01 X- 3- J- ;77NER EX 'IENT The ol-, Massachi:sletts allows the horne the r1ahl-L uzde,,780C, 08_3.4 to aS, So act, Coris*--uc-zor, SuD"-, -:scr. Th--- Sz,-K-, d•2�fnes -Home-ciwmer" L n(s) who O-V�ns a parc.A on wh ich he/s-e resides or intends to be, a one or two an,a ch ed or d,erac h ed. structa-,res acc,-s--,Gry to Such use and/or fa.= structures, A person-who Cons-trac"s zlore than one home in a two-year pel-'LOd stall not be considered a home owner." The build' d-e-Cal-tMent for the City of Ncrthamptcn wQnts an perscra(s)W-;-.o sees to use the home o-vner ex=ptlor, to act as t-Ile-, C-wn that by doing so you become responsible for compEance with state buildinz- codes and re:gu�---Idons. The izs-ce--Llor-. process-requices that the builld.mig departMent be called to =paper Work at ,-anous stazes, which include foundation/footings Cbefore backTiM. so-notube holes (before oour), a rough building inspection(before work is cmce�ed), i4silation in-s-nectian (if reauired) bu,Eding dlepa=ent relluires these inspections before the worn is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy T-7t.Le h eoF,yer hilres other trades to pert-o= work(ellec-mcz-L Plumbing&- gas th e ho=eOv,-"er VVEl be responsible tc, mare sue that the trades hired secure their proper- La c,-zjur-=cn to the build-m2 Pe=d� issued, and that they get their required inspections. Failure CI-Fthe individual trades to serge the permits and ms-p ectior-S as required can D s;-LAY the prover L-r:,T suci-L as tee proper permits and inspec-tions are made -r-ders-t and the above. (33ome owner/resident's signature requesting p tion) I will =-'I to schedule all required buildinc, 'msPecT,crs necessary for the buildmg pe,=.L * Issued to Me. D t-e Iccan(Dr. Department oj*Industrial Accidents Office oj�nvestigations _ 600 Washington Street ~~ Boston, MA 02111 <- www.Inass."VI(I it Workers* Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AnIDfleam, Irforniation C / /Please Print L.eaibly wine (Business;Organization/Individual): / � C P AaA_ films // b -� • Phone ;�. 5 Cit-y/State/Zip: (u -7/140 P ./� �`� jAre you an employer? Check the appropriate box: Type of project (7additions 1 I am a empluyer'with 4. ❑ I am a general contractor and I employees (full and/or part-time)." have hired the sub-contractors 6. ❑] New constr 2.❑ I am a sole proprietor or partner- These on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition worlcin for me ir.any ca uc it,✓. employees and have vvorkers' U ad p"'' 9. ❑ Building [No workers' comp. insurance comp. msurance.l 5. We are a corporation and its 10.❑ Electrical re required.] ❑ i' ❑ I ani a homeowner doing all worn officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per NI 12_❑ Roof repairs insurance required.] c. 152. s 1(4), and we have no employees. [No workers' 13.7 Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Ho tneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Cci t,: wrs that check this box gust 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. r, Insurance Company Name: A.5-CI&I a rCd &--M Orye.-j 0 S, Cu Policv;:T or Self-ins. Lic. fits C C Ud 6P'0 SG� �U©� Expiration Date: 5 eior. d d 3 of 5- to a&l 1A >rn 0, 01.4&0 . Job Site Address: City./StateiZip: a�7! P �� 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. 1521 can lead to the imposition of criminal penalties of a tine up to S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verfication. I do hereby terrify- nder tlze-gat-rrs-a-ntdpenatties-rr­ ju-iy-that-the information provided above is true and correct. Signature: ---- - Date:, _ Phone -,:t iciai i �e_ 'eted by_city-or town offi_ciirl --_--Imo==..----------- — -- -__ City or Town: Permit/License Issuinguthority (circle one): i. B+�ard o#Health 2. Buildin�4 Department �. C'itylTown Cie:% I. Electrical Inspector Plumbing Inspector I t .)ctact Per ,)n. ?hone #: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑/ Name of License Holder: __� A0V%d J (3U6� O-�<!)o& 1 License Number ur�hur� -? Address Expiration Date Signature Telephone 9.Registered Home ImprovementCoritractor: Nut Applicable ❑ &t—y :rrrgCAad [mt��1�,,y,� tjliItYul 1 NK Company Name Registration Number Address �r Expiration Date Telephone , 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-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,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 40VA SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing Or Doors C] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[IV Brief Des tio�of Proposed do v� , \0a e l s r �(JIl h Work: :Z—o5 4q eifPSi �� [ I� lt'/'+ 7 f �/1 1G L 7 Lf T� 7v1 Alteration of existing bedroom Yes X 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 //El'+d t G( � as Owne u A hereby declare that the statements and information on the foregoing application are true and accurate, to the best o khowfedge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date I I Section 4. ZONING ALI Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to betfled in by Building Department Lot Size Fronta-e Setbacks Front Side L:—R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bidg&paved Darkin2) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? L-1 11 NO 0 DON7 KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON7 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 DON7 KNOW C) YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over I acre or is it part of a common plan that will disturb over 1 acre? YESn NO -- ---- - %-� q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only Northampton Status of Permit: Buil i Department Curb Cut/Driveway Permit 21 ain Street Sewer/SepticAvailability Roo 100 WaterNVell Availability N ljl pto MA 01060 Two Sets of Structural Plans -1 Fax 413-587-1272 Plot/Site Plans Other Specify PYIL ION 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: 3 q S'— Map Lot Unit Zone Overlay District Elm St District CS District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ktyi►n Name(Print) Current Mailin Ad ress: a6- Telephone Signature 2.2 Authorized Agent: ovv^ �� Lr 5 lj 1 �i'y;f;u� �7 t4s71�rN►� , Name(Pnn Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ,? 1 (a);Building Permit Fee 2. Electrical )-016 (b)Estimated Total Cost of Construction from (6 3. Plumbing 0(,1 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection _ 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: -- -- --- Building Commissioner/Inspector ofBuiidmgs ate 410.0 ♦ 0.00-4.0 File#BP-2008-0703 APPLICANT/CONTACT PERSON THOMAS BACIS ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413)529-0801 PROPERTY LOCATION 395 RYAN RD MAP 29 PARCEL 553 001 ZONE URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE /_.ON1NG FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL BASEMENT EGRESS WINODW CLOSET& 1/2 BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 070061 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,ZIATION 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 Pernlit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay r Signature of Building fficial 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. 395 RYAN RD BP-2008-0703 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma3):Block: 29 - 553 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-2008-0703 Project# JS-2008-001086 Est. Cost: $15985.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: THOMAS BACIS 070061 Lot Size(sq. ft.): 20124.72 Owner: KRUMPHOLZ KEVIN J&BRENDA L Zon LURA/WSP applicant: THOMAS BACIS n— I: Wi:, r•:Y n r.. P r, Applicant Address: Phone: Insurance: 67 DIVISION ST (413) 529-0801 WC EASTHAMPTONMA01027 ISSUED ON.212212008 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL BASEMENT EGRESS WINODW, CLOSET & 1/2 BATH 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 „ � t � louglt:..CIlG; House# Foundation: �y (� Driveway Final: Final:, 013 ~✓ —, Final: .� Rough Frame: Gas: Fire Department Fireplace/Chimney: ,� :• Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY TH ITY OF NORTHAMPTON UPON VIOLATION OF Id ANY OF ITS RULES AND:REGU�LTION Certificate of Occu anc `1 Si nature: FeeType• Date Paid: Amount: Building 2/22/2008 0:00:00 $75.004054 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthoi.y Patillo