32C-294 (5) Page No. of Pages
RICHARD LASONISARID, YR.
Generall Carpentry
119 Park St,
EASTHAMPTON, NAA 010,27
(413) 52�-7427
PROPOSAL SUBMITTED TO PHONE DATE
STREET JOB NAME
CITY,STATE and ZIP CODE JOB LOCATION
ARCHITECT DATE�OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
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WC PrOPOSC hereby to furnish material and labor complete in accordance with above specifications, for the sum of:
Z dollars($
Payment to be made as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices.Any alteration or deviation from above specifications Authorized T
involving extra costs will be executed only upon written orders, and will become an extra Signature
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. Note:This proposal may be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days.
Arreptaurr of proposal —The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature it
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: Signature ` ,
To Mr4de#COA
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(rity of Xartl aurpton z
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DEPARTMENT OF BUILDING INSPECTIONS
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INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060 ,
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as iris/her construction super:iosor. 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 rouizh 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
I, 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
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$ 6 �il3excllnsrtll' �>
^� !>EPAt2i'hSERrr OF £UILDD�G 1NSPECTIOTt'S
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WOrICER'S COMTENSATION INSURANCE? A FFED .v1.-r
-\vlth a principal place of businesslre:;idenc_
do llcrcb)' CCI—Lily III):I"�! the p%inS ;'.i10 pt it ILIe.; 01 pf:rJ11I�', ?}1f1i- -
Yr r C OF Iil}I am an enlp!O)'Cr pr Ovi6ing the lO11ov, t •votCr's C0111nC:1S3
employees worltnng on this job:
(LmT,U3IlC., Comp- ) (?c c;Number) (r—>T ir:oon Datc)
( j I am a sole propnetor, general 11001eowoer (circle one) and, "t;a.'e hired
the contractors llsted be10vv ;"l.0 iii 11]. Ori`:eIj S cotnlpeII� Oit O!I .�5:
(2,7nme of Contactor) (Insumncc Ccirr.::;?:'PoiieJ NulntYr) ;Lx):ration Date)
(Name of Covtmc"Or) - (llzsur_rce Co Ntrnb--r) (1;, iinn Date)
(Name of Contractor) (Ias:tr.uac:2. (_chi ilaovi?ol;cv Nl1.nI ,Ir)
(Name of Contractor) -- (Ian muc Come Y!Policr Numb T) (E: i-:tio- Date)
( 1 iml a :Ole l?!Ul?r]CL`Ji a-,,j havc no -)n. .. ;r�.iiiE for -m
.) I ,Iln t? home r lf.
0,IT":pICzaC bo at+-as c 11;> tti�iic tx rca it v�c.:rp! y,.. :::n(:>:7-, C--un C r,a.__rar_cn cr:c;aar cl!t c.
not uKCC 11LO Liu-cc waits ir, u a;
amployc3 urld--s th,workt-I'l r.(GL,L`2�s 1(51 ,r_,:,•;i.a:icn by a hntncoty for x Gccx cK P-T::!::: �rx
Icg31 ctatuc Of=eZOPIO)W uadrr tLo WO kc�'c �IxL
I uzsdc.^+ta d lilt a copy of thia ctatc::r•cuy bo to tl»IY[nzt-xrnt of Iz>�.utri:l Mal m'�LIf n of I:=%'_'r?=a for[lx
coverage vcrinclioc and ttut failtu-c to!^aLr:cote ur•.3c:sc,:�iM 25A al1.MGL 152 can Imd to[hc i•njnOsition of c� in_l pa al:cs
consisting of a ftrr_ofup to S 1,SWoo I:t.-'.'cr i^:prvr. ;1 of::p to cr. }-W ..-.j civil pcnittic3 in de fc',rrn cf a
f rm or's 1013.00 1 day 1:p6 a ttr.
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For dr.{:uux>extsl ure oily
Ycrrnit
Slwaturcofi.i a c^JI'crmiar.: r ''' F
S,ECTtON,8 CO�ISTRUC'f10N SERVICES
8.1 Licensed Construction SUQerviso r: ,. Not Applicableems d❑
Name of License Holder : C /J �� 053 3 7
License Number
Addres Expirarion Date
,Z
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Signature Telephone
Reg? s erP r om mpoveixient` on#racto Not Applicable ❑
/dlf01-0 `r .
Company,Nam e / Registra on mber
Z 0 /
Address Expiration Date
Telephone
SEGTIO�iO 1NORKERS' COMPENSATION INSllRANCE AFFIDAVIT(MG:L. c. 152, § 25,0,(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...... ❑
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 far 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
:
s
SEGTDI1ONfliROROSEDYVORK checkf! a pplica ble
,
i
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ .
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ Siding[ ] Other [ ]
Brief Description of Proposed Work: �>� €� �✓ /l�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative O Renovating unfinished basement Yes No
Plans Attached Roll 0• Sheet 0
M flU n o ' aItiOn #o e §,Vny e11
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? ` VA
-
e. Proposed Square footage of new construction. //`�7/ Dimensions ld-4/V A-
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction—�F
i. Is construction within 100 ft. of wetlands? Yes P"" No. Is construction within 100 yr. floodplain Yes_kLNo
j. Depth of basement or cellar floor below finished grade j
k. Will building conform to the Building and Zoning regulations? /' Yes No .
1. Septic Tank City Sewer Private well City water Supply
€ 150�
SEC�'�t ERAllTHORIZATION TO BE COMPLE7 ED WHEN
OYti(NffSgGN C�ONTRACTOR�APPLIES FflR f31fILD1NG PERN1fT
A.
I, as Owner of the subject property
hereby authorize to ac; or,
my behalf, in all matters relative to work authorized by this wilding permit application.
Signature of Owner Date
lii4 f�dM�f1r 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 Na
//A
Signature of Owner/AuKt Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This colunm to be filled in by
Building Department
Lot Size XX
Frontage
Setbacks Front (�
Side 3 L: R:_jC L: l3 (R: Ile
Rear�
Building Height
5T6�'
Bldg.Square Footage iTD %
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
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 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
YES
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 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:
i
tin
City Of Northampton
--��
, Department �
--
Building
{k.
212 Main Street
3 Room 100
Northampton, MA 01060
e 413-587-1240 Fax 413-587-1272
F- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE 1-NFORMATION
a
T#>t�s ae con e r o�plated'i Office
1.1 Property Add
`�Zone '� �� rla�r dlistisct��
SECTION 2-PROPERTY'OWNERSHIP AUTHORIZEDiAGENT
2.1 Owner of Record:
I . is/S�
Name(Print) Current Mailing Address:
Telephone ��� _ `Q P
Signature
2.2 Authorized Agent:
Name(Pi pp Current Mailing Address:
57;12. 7'`71;?
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION-009TS
Item Estimated Cost(Dollars)to be Wkial-Use Or ly
completed by ermit applicant
1. Building (a��8uilding•Perntit r=ee
2. Electrical =(bj Estimated,Total Cost of
'Constructi6n from)6.
3. Plumbing $uiiding Permit fee:
4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 + 2+ 3 +4+ 5) �Check Numbee. 3 9 q
This Seddon For Official Mii-Onl
Building Permit Number: Date issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2004-0648
APPLICANT/CONTACT PERSON Richard Labombard
ADDRESS/PHONE 119 Park St EASTHAMPTON (413)527-7427
PROPERTY LOCATION 24 VALLEY ST
MAP 32C PARCEL 294 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid 7 gt.06--
T_ypeof Construction:_CONSTRUCT 12 X 12 DECK&SLIDER DOOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 055340
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
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.
24 VALLEY ST BP-2004-0648
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-294 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0648
Project# IS-2004-0928
Est. Cost: $4200.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Richard Labombard 055340
Lot Size(sq.ft.): 6795.36 Owner: FISHER ADAM E&ELIZABETH R
Zoning.URC Applicant: Richard Labombard
AT. 24 VALLEY ST
Applicant Address: Phone: Insurance:
119 Park St (413) 527-7427
EASTHAMPTONMA01027 ISSUED ON:12110103 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 12 DECK & SLIDER DOOR
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: Receipt No: Date Paid: Check No: Amount:
Building 12/10/03 0:00:00 3377/3382 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo