35-054 (3) PROPOSAL
Joseph Lastowski
332 Kennedy Road
Leeds,MA 01053
(413)584-6505 Date: eY 2�Z- Q
PROPOSAL SUBMITTED TO WORK TO BE PERFORMED AT
Mike&Marilyn Brooks 957 Ryan Road
957 Ryan Road Florence,MA
Florence,MA 01062
(413)584-0599
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We hereby propose to furnish the materials and perform the labor necessary for the completion of:
Vinyl Siding of the house listed above.
Included: Removal of all old wood shingle siding
Wrap with Tyvek
Cover all with 3/8"Foam Insulation
Install Mastic T-Lok Barkwood Premium Siding
Wrap all windows,door and trim with Aluminum Coil Stock
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All material is guaranteed to be as specified,and the above work to be performed in accordance with the
drawings and specifications submitted for above work and completed in a substantial workmanlike manner
for the sum of Six Thousand Four Hundred Eighty----------------Dollars ($6,480.00)with payments to
be made as follows:
Three Thousand to Start. One Thousand Five Hundred when half done. Balance of One Thousand
Nine Hundred Eighty due on completion. /
Respectfully Submitted
Any alteration or deviation from above specifications
Involving extra costs will be executed only upon written
Order,and will become an extra charge over and above
The estimate. All agreements contingent upon strikes, NOTE-This proposal may be withdrawn by us
Accidents,or delays beyond our control. If not accepted within mays.
ACCEPTANCE OF PROPOSAL
The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized
to work as specified,Payments will be made as outlined above.
Date 3 Signature
Signature 74 qqrajj��
-s
OQ`'CHAMP�O
�dSSBChiiSCttS
DEPARTMENT OF BUILDING INSPECTIONS
f
INSPECTOR 212 Main Street • Municipal Building
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as l:is/her construction sups:,, or. 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/footing's (before backfill),
sonotube holes (before pour), a rough 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
UI-
G, 'iftr of 1�YZ-tl��tlt1}�fn�t
� 6 ��tiesearcflusrtls '
m
DEPARTMENT OF £UILDMG INSPL•'CT10NS
212 Drain Street ' Municipal Building
Northampton, Mass. 01060
'WORTCCR'S COMTENI SAT N 1NSURANC ' AFFMAV1-T
(llC t1S c/r- 11);`Uc ,)
v,,lth a principal place of busMcsslres:eenc n-,
(Strcetleit•;/s a jrj
CI0 hercby cCILuy} Lllaci" t11e hi:i lS ,':iid OCil ltle., O1 pel�Uf�r, thi!:
am an employer providing the 1,011ovvinc '.;Of};cl's cOlnT)C; s3uo1] GOVCI2`'C For my
- (I�ruan�. Conpam') (Pelic,NttmExr) ---- (`r.3.4.ir din Date)
I act a sole proprietor z'e a conk �r!or honleo,�aer (ci cle Oct) and 'tla,:e tureL
t.1i:'. contractors Lsted beiov ;i'1i0 i11 10i1G PP CrOrke�S GJ U°Il�3�On ;C!i '.CS:
'Name of(-wiL O-Lo r)
(Name of Contra c"-) -- 71lsur nce Com:Dam','Poh Numt] --r) :ion Dale)
— -- — --------—
(Namc of Coatmcior) In l l]cc Cow - —_-__ --_--.
� ' �G�;C': 1vil.rltlf_r) i:^u 1%ai,--)
- (Name of Contractor) -- (Insllranc- C0111erv,)t,Po1i---v Numr-r) (H--:ui-aiG- Date)
i
1, 1 iLTl ,Ole prOpFleCC]i <:r1Q Il ?vC i?O OIl3 '.','i;?�.iri ; for IIic.
N0,1T.:plc�sc to Ewalt t!r>:.,�
not mc-cc t7Ln throe uni,in t,- dt he f::i .;,tr rc: s a-ocr' :�.;;_3 u1:r s1 Lhee o e[r{ccr-xzll i
c^'•ployc3 u_z?cr t}r,wc1'.e_M x-_:!ira I-r.((it.1 S2,=-!{5)1,r a:ica t;+a hntn o„err`cr n Lcc c a p,rY.M::
legal etatuc of an emplo}'ar Uud tLc Wori;c-ft Co' ,>m_-..-tian;',j_'K
I undo:twd Ihi a cmy of ltiu ciatc—i r.ay l,�Io x v,inl to tl»IY_txi tzr:i of Iz�ts riJ Az6&—U'C:rcv of i:_1�-A for lx
covcss&c vcrifieatioc acrd tlr_t EAUTe to•- ±t cro�yr�ur3: c"iM 25A of MC3.1,152 c-m I=d to t}rc impDsition,;c ^_1 pall;:a
00-=istinz of a fur_of up to S 1-30U.Qoo n:t ' of up to nr.:}- r.r.j civil pcnattia in dc';ccrn of n stc,`:J i.0 tr-d s
fir>r Of$100.00 a CLAY t^.•.1Ir:!m;
For d U-I-fAl urc only
Permit
r.=_; i 11, turt :.iccn:cJPcrm;ac. a. ,.. i E
S'€CTiON 58 GONWUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
` o s&-Pe er(
Address Expiration Date
31DL K&0)610X AA Liras, vn� or s'
Signat re Telephone
e - tee >ova �Mm - �.VM R-; ntracto= y3 - Not Applicable ❑
Company Name Registration Number
Address Expiration Date
3a- K lv OL5 t3 605 1s1d . Telephone .32r1' 72�0 --24o 5
SECTION°10 WO�t1(ERS' COM,.PENSATION INSURANCE:.AFFIDAVIT N-pp: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...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)tram Kies
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
SECTOND S.:R PT�I.OTIOROPOSEdWORK checkll a lacab7e,
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing [03
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[V� Other [ ]
Brief Description of Proposed Work:4Lha2VF'FL t) CgE04k 51ti4 d-4.6�S VtK;Vj_ � t�trl� Cr-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative d Renovating unfinished basement Yes No
Plans Attached Roll D Sheet
Ca. f a O: d ORWRJtion to ex:istrif—h uo s"eng camp E a tfie followin
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. Mascheck 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
SEC��OT[ _ �Y�VNR;A,U�HORIZA,TION-TO BE COMPLETED WHEN
0f SSA CONTRACTOR APPLIES FOR BUILDING;HERMIT
as Owner of the subject property
hereby authorize to act or
my behalf, i a ma ers lati e to ork aut orized by this wilding permit application.
Signature of Owner Date
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
`- '� - Q.2
Signatur f Own 6r/Aent Date
Section 4.
ALL INFORMATION MIDST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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
s7-6 IV-I(/
Bldg. Square Footage Flo
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a S pecial Permit/Variance/Finding ever been issued for/on the site?
NO Y/ DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Y DON'T KNOW
YES 0
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:
City of Northampton
_ ing Department
2 Main Street
` --- i i Room 100
�No pton, MA 01060
�hvb n`e0413 7 1240 Fax 413-587.1272 P
i Aim ' A` '4d ,7 QILD34S , ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1'- SITE INFORMATION
E
This sect�o to om eted� y ffice
1.1 Property Address' `
7
M.
Zon � � Overlay #r ctt
EL CJZCEIVC� old 16106,L)
SECTION 2- PROPERTY 01NNERSH,IP./AUTHORIZED'AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
70c/67U!ff 1 <72)Q 5��C� �3a k6E, A C-Q Y ea
Aarn (P rint Current Mailing Address:
Telephone
SECTI0N.,3 - EST1'MATED CONSTRUCT170 COSTS
Item Estimated Cost (Dollars) to be Official Use`Only
com feted b ermit a licant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
_ Construction.from_5
3. Plumbing Building Permit Fee
4. "�echanical( HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number �c+�
This Section For Official Use Onl
Building Permit Number; Date Issued: >
Signature:
L Building Commissioner%inspector of Buildings Date
T
RA BP-2004-0206
GIS#: COMMONWEALTH OF MASSACHUSETTS
I
0,54
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0206
Project# JS-2004-0305
Est.Cost: $6480.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Joseph Lastowski 113349
Lot Size(sq.ft.): 19863.36 Owner: BROOKS MICHAEL D&MARILYN L
Zoning: SR Applicant: Joseph Lastowski
AT. 957 RYAN RD
Applicant Address: Phone: Insurance:
332 Kennedy Rd (413) 584-7404 ()
LEEDSMA01053 ISSUED ON:8125103 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING
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 Occupangy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 8/25/03 0:00:00 126 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
957 RYAN RD BP-2004-0206
G1S#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block: 35-054 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0206
Project# 3S-2004-0305
Est. Cost: $6480.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Joseph Lastowski 113349
Lot Size(sg.ft.): 19863.30' Owner: BR(")O ;�ITCIL E ,D nc vi��^.1'.YN T
Zoning: SR Applicant: Joseph Lastowski
AT. 957 RYAN RD
Applicant Address: Phone: Insurance:
332 Kennedy Rd (413) 584-7404 (�
LEEDSMA01053 ISSUED ON.•8125103 0.00.00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING
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: (q It l
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of OccuQancv S; nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 8/25/03 0:00:00 126 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo