29-282 EASTHAMPTON 19
SAVINGS BANK
Equef Oppd9ealy Lander
P.O. Box 351, Easthampton, MA 0`1027-0351 MEMBER FDIC
Connecting all offices 413-527-4111 MEMBER DIF
nour account information 1-877-ESE-24HR (372-2447)
www.bankesb.com
;r
RICHARD A RAMSDEN PAGE 12 of 14
DIANA D RAMSDEN DATE NOV 13,2007
375 BROOKSIDE CIRCLE ACCOUNT 820811785
FLORENCE MA 01062-3512
RN:HMD A.RAMSDEH rj ZTJ 7?-�'LS^R'r. t iE§ 4=
DWiA O-RAMiDEN b1AMA O.IIAAI6DBA dC5
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#4832 10122 $236.40 #4833 10122 $104.99
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#4834 10123 $24.81 #4835 10123 $48.16
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#4836 10123 $10.53 #4837 10/22 $900.00
INMARD A.RANISOM
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a aueau• pIClIARD A.RIIMSDEN
DIANA D.RAMSDER
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EASSTHAlil PION 19
SAVINGS BANK
Equal Oppomxiify lender
P.O. Box 351, Easthampton, MA 01027-0351 MEMBER FDIC
Connecting all offices 413-527-4111 MEMBER DIF
nour account information 1-877-ESB-24HR (372-2447)
www.bankesb.com
i
RICHARD A RAMSDEN PAGE 12 of 14
pt ? DIANA D RAMSDEN DATE NOV 13,2007
i 375 BROOKSIDE CIRCLE ACCOUNT 820811785
FLORENCE MA 01062-3512
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DIANA D.RAMSDON DIANA➢.RAMSDEN
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REMODELING
HOME REPAIRS
® - PAINTING
Free Estimates• Reasonable Prices
Two Good Guys to Know
3,r_ 6 f6`j 419Q9-;r1"2
rnL
R-ReFOSAL
PROPOSAL NO.
/ SHEET NO.
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME ADDRESS
ADDRESS
- F DATE OF PLANS
PHONE N0. ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of UT
203
All material is guaranteed to be as specified, and the above work to be performed:in accordance with the drawings, and specifi-
cations submitted for above work and completed in a substantial workmanlike manner for the sum of - - t
Dollars ($ `
with payments to be made as follows. ,
�F
Respectfuffy submitted
Any alteration or deviation from above specifications involving extra costs —
will be executed only upon written order, and will become an extra charge Per
over and above 'the estimate. All agreements contingent upon strikes, ac-
cidents,or delays beyond our control.
Note—This proposal may be withdrawn
by us if not accepted within—days.
ACCEPTANCE tJ FROPC)SAL
The above princes, specifications and conditions are sa-Isfacto l' and - r hereby a cepteu. 'i 3t are authorized .., do the work
as specified. Payments will be made as outlined above.
i
Signature u_
Date Signature
0 NC 3818-50 PROPOSAL
�0 Cr W
DEPARTMENT OF BUIIDL�G INSPECTIONS sc/
212 Main Street • Muuic:ipi wilding
INSPECTOR J
Northampton, MA 01060
HOME OWNER EXEMPTION ACIKINQWT EDGEME'NT
Fdwelling,e State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
as l:is/her construction sups: .•.sor. T he state defines "Homeowner" as, "Person(s)
o owns a parcel on which he/she resides or intends to be, a one or two family
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 back-fill).
sonotube holes (before pour) a rough building inspection (before work is
concealed) insulation inspection (if required) and_afnal_buildinainspection. 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
nntii the work ran he insnecttd.
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, ' i ,�1'e=_-,_,.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
The Commonwealth ofAlassachusetts
Department of Industrial Accidents
Office of In vestigations
600 ;IYashinb--ton Street
**--Boston, MA 02111
www.mass.govA a
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name(Business/Organizes ion/Individual):
Address:
City/State/Zip: Phone.4r:
Are you an employer? Check the appropriate box Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and I
employees (full and/or part-time).*
have hired the sub-contractors 6- ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet_ 7. ❑Remodeling
ship and have no em—,ploy ees These sub-contractors have g_ ❑Demolidon
worlang for me in an ca aci employees and have workers'
y P tY- 9. ❑Building addition
No worker' comp.insurance comp.insurance.:
re uired_ 5. 7 We are a corporation and its 10.7 Electrical repairs or additions
4 )
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.E]Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp.insurance required.]
----*'ky app can a c.ec ox twit a o n out a section ow s wmg etr workers cons xc-m-=on policy omration. -
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust submit a new affidavit indicating such.
*Contractors that check this box must attached an additional sheet showing the name of the sub,--ontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic. #: Expiration Date:
Job Site Address: _city/State/zip-
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 irmprisonment,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
Investiaations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
ignature: ,.
Phone#:
vTjcctai use oniv. Do not write in this area,to be completed by city or Town offlciaL
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 S-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9 Registered tfiome lmAroveinenContracfo r- � _ x Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE.AFFIDAVIT(M.G.L c..1'52,§-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...... ❑
ON
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 1083.5.1.
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
or .µ •
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[o] Other[0]
rief Description of Proposed
Work: %�'iv' is'itis+ /<�/G i� �.1 3 S '4 I
Alteration of axisttng bedrbom Yes Ar No Adding new-bedroom Yes Y No
Attached Narrative Renovating unfinished basement Yes L No I
Plans Attached Roll -Sheet
-
6a-ifiNev house and a addl#ibri#a-exls#1n4-nauslnc� alt plete �le`foCl'd in.g
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 o. s cons ru ion within 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--TG BE COMPLETED.;WHEN`
OWNERS'AGENT-OR CONTRACTOR APPLIES-FOR BUILDING-=PERMIT
I, 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
as Owner/Authorized
Agent hereby declare that a 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
Signature f Owner gent 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
Setbacks Front
Side
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
#of Parking Spaces
(volume&Location)
A. Has a Special Perm it/Yariunce/Fi nding ever been issued for/ondhe site?
- '--'----
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON7KNOW 0 YES
IF YES: enter Book Page� / and/or Document#� /
�� �� ��
B. Does the site contain a brook' body ofwa�rorwet|un�? NO �_� DON7 KNOW �~� YES �_/
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained �~� Obtained �~� Date /
\~� x�� ' �
C. Do any signs exist on the propert ��y? YES �~/ NO �~���
IF YES, describe size, type and location:
D. Are there any proposed changes toor additions nf signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E Will the construction activity disturb grading or filling)over 1 acre oris it part ofo common plan
thstmW|disturb over I acre? YES � ) NO � }
�� ��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_ Qepartmeni use only
.,L
City of Northampton StafusafFerrn _x
_ Building Department Curb ClDpuewaPe �- `
212 Main Street SwedSe c°Ayailanriv
Room 100 a6tC
Northampton MA 01060 v
phone 413-587-1240 Fax 413-587-1272 P1oSifaFlans
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
� SECTION 7 -SITE INFORMATION -_
This sectiorrta be campietea nyotttce
1.1 Property Address: -
�_ '� 1fICa dot _U
OvetlayDrsfrict
/ k; E St:.Distrscf 3CBD�str ...._. -.
SECTION Z-PROPERTY OWNERSHIP/AUTHORIZED AGENT -
2.1 Owner of Record:
/�i�.�5.1'i � i% i ��'��/ -� ✓`Si2 c,c LSi.G'c"` �o� /�<<, ?c.�c c r. 27
Name,(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be ,< w Official Use Only
completed by ermit applicant `11�> C
1. Building -(a Building:,Permit Fee
2. Electrical :(b}Estimated-Total Cost,of
Construction-from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section-For Official-Use Only
- -
Building-Permit Number. ate
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
imp BP-2008-0551
* cls#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pernlit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate,,ory: roofing BUILDING PERMIT
Permit# BP-2008-0551
Project# JS-2008-000676
Est. Cost: $450.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor _
Lot Size(sq.ft.): 18033.84 Owner: RAMSDEN RICHARD A&DIANA D
Zonin p,: UFA Applicant: RAMSDEN RICHARD A & DIANA D
AT. 375 BROOKSIDE CIR
Applicant Address: Phone: Insurance:
375 BROOKSIDE CIR (413) 585-5970 O
FLORENCEMA01062 ISSUED ON.1113012007 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 325 SQ FT
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 11/30/2007 0:00:00 $25.00MO
212 Main Street,Phone(413)587-1240,:Fax: (413)587-1272
Building Commissioner-Anthony Patillo