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35-054 (4) I ;i ^ a fi. 'i�3n#a r IN " F � k i KD „ t73 :77 1 A7 3S nr' � ! JUL 7V oFPI of BRDINC INSPECTIONS NORTRAMPiON,MA 01060Ra 0) c + j lk �T3 f j PROPOSAL � fT sHEET No. JUL 1 6 2003 t' DATE PROPOSAL SUBMITTED TO: SpfC?iQNS W RK TO BE PERFORMED AT: 11 A&Rl III NAME QN„MA U1 DRESS 0 0 R NAB (?, ,/,41V ADDRESS DATE OF PLANS PHONE NO. ARCHITECT S” yr -- We hereby propose to furnish the materials and perform the labor necessary for the completion of f) - r0 i' t4„7 t 16 r-i 7-L e iJ R 7"`H4A,,r i_-'o04 `tr: r fx�. , .dt t_'e P. t:�V e,te C' 4l. P"'�'4r W;tfz tx» r rtJ�7fgL { '•, r✓,r.::-r'?'#'," tr l.4.?r „ati,.: +t'Vi r.: /C, -"}t f,` t.,'�7'a iii` f rt„= ,r? :.P._.f, * .� -" - A- 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 %r Pi t„7 !f4_)?' F i3 Al ir?r j :; r f _.a . p " _ - Dollars ($ with payments to be made as follows. ' %-5 r`D .: f'- ' ; 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 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 Note—This proposal may be withdrawn by us if not accepted within days. ACCIi'TANOI OF PROPOSAL' The above prices, specifications and conditions are satisfactory and are hereby/Pccepted. You are authorked to do the work' as specified. Payments will be made as outlined above. K Signature . 1 1 } � Date f ` �� Signature Zo CAdamsNC 3818-50 Proposal IN USA ,,..�,A.y,,�-�- . . . _ ,. , _ „. ��-- J.... �, iI I 7-i �y r a JUL ac`_°QF aiIL INS c ors No"TNAM N, 010 ZG KC( �b C� a i r i 1 Adams 3 PART Carbonless NC 3818-5u Crity of Xorf4ainVt(M � �lsssacl,usrtts si DEPARTMENT OF BUILDING INSPECTIONS ,r INSPECTOR 212 Main Street • Municipal Building ' Northampton,MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CM>Z 108.3.4 to act as has/her construction supcP,, sor. 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 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 R.S ttAN/'TO �0 C1,zftr of ariljcimptolt $ 6 ��ass>zcE)ucrlls' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSA'T'ION INSURANCE A F AVIT (lirtir_seJfr;miU ec th a principal place of business/res'dence do hcre'by CCrt1I} UJ1CIc1 till' pa!rlS i:ii7 pCil?1t1C:i �i 7l';rJllllt illi+_1 O I ::m an employer providing the follo':vinL .:c)rr er`s compensation coverave for my eluployees working on this job: (1.ILS'.1I-cn( Compam) l c;-ic N-LL tuber) -- (�"jiir::i]^Il Date) T acs a sole proprietor, generai c-:)ntrc`or or honleovvoci- (cLrcle one) and ha,,te hutr i t.liC COnt7aCtOrS 1.ISteC belOrl i'lJ0 il� tll f011`,;�,,y I -po jir; s- L. .t or ke, s cot: n z on ,ncik.;,_. ('NQIIIC Of CO l[T1CiGr) �n�L�nC C CI ^;:;i �GIIC{ NUS21)Yi) ?:Ii:rII CL Date) (Name of Contrctor) -- (71ts�rance Com z.tviPGiiei Nt tuber) ( NT .niioa Date) (2-,'ame of Contractor) (lI]SIr?S1C^ t_Oi :'_ .i/1?Ol]Cv IUI]IF i t;X.:;:: 0�• Datc) ('Name of Contractor) —- (Iasi ranee CGlnrrjr.y!Polier Nt>mbu) on Date) l 1 i1IT] it SOIC l)1 Oj?I'IC tJi c':11'1 have 110 OIJC '..'0?" ;-!iJ`y' for nll'.. ( ) I am 1 home oWne' 1)"'T-form, NO'rs:plc:ac t'c at+'arc L!s:xl iJc Ixc;co«zr_-s��rs c-play i>--_:::n >:-�_^,!:�ntc,ct:.::nc:m cr:-i�air,�•,::,�-_�"c!!i:::;c. not umet:thyn throo unili in ttt icdt he f:r..�;aZr-rni cK oa ca'ploy=ul-c ttr tvct+X,'s ca=x=_icn Ax', GL1S2--1!(5)1 - '' • io;by a ho:',cow'e—f for z Lcc c c<p-r.:i::: legal ctaws of an cmploye and r tL•o Workoc'.Coa-;-cry lion,.c4- I undczt.wd that s copy of thi■etatct>s_•ruy fo fa�wcied to t'»[Y%w tnr of Industj- q.o_iLmr�'CiLoo of L•::uraa-e for U. covmgc verificlioo and UL--t L•ijum to r-t~uc rnwr_o.,ut d:,cc.ien 25A of MGL,152 can Ir_d to the impmitia orcr�ir_1 paall:cs comistmg of a fire_of up to 51.100.00 an:'cK ir.pri_vr. •1 of up to cr. } -.j civil xruttia in do f c,nn of a firms of 5100.00 i day ig in_1 m:. . For rtcr wun,t1!u.o only i perrnit N -------------------l lti1'ir'n i.Ot L,nat r of I.ice Ir cJPcrnlia ? :i: c now- S�C7,ON8 � 0{ISICTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : TOM PH 4,l)-sn uSKL �g'�� License Number 331 f 67WtV, ny 626,, L45C , a0A Djc S3 Address Expiration Date S g atur Telephone MINES Not Applicable ❑ Company Name Registration Number '3.J a Address Expiration Date Telephone Set- D b0RS COMPENSATION INSIJRANCEAFFIDAVIT(MG:L: c 152, § 25 G(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...... ❑. i The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famiiies 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 acccptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine 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 v ROPOSEDMUM chec r a 1 ta'D 'I� able " New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [1.] Siding[ ] Other [ ] bl-OC 44 Brief Description of Proposed Work: 3011. 0 .4 azeOt"_ t�46;�V T' 7V �(Aliffl PAtW& PfAt Alteration of existing bedroom Yes L- No Adding new bedroom Yes L No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0. Sheet IV °"a o o� ,idti.n #o xh�s >inon ct . ._e a �oI;nw n� a. Use of building: One Family 4Z Two Family Other b. Number of rooms in each family unit: Number of Bathrooms % c. Is there a garage attached? (16_�s - d. Proposed Square footage of new construction. Dimensions e. Number of stories? t f. Method of heating? of 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 S MIN lZA!0 ON TO BE MPLETED 1NHEN0 IBC} OF(4APFLIEF ''IN i as Owner of the subject property hereby authorize to ac; or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date l 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 - 0 Si tore of 0 er/Agent Date �j Section 4. ALL INFORMATION MUST 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 D©� Frontage 1190 Setbacks Front 160 Side L: `f R: � � L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved 1O parking)nn #of Parking Spaces Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 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 _ DON'T 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 1/ 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 Building Department EC E Q v 12 Main Street UU Room 100 ampton, MA 01060 JUL 4 7.1240 Fax 413.587-1272 DEPT bNST UCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING S ECTI ON,3 -SITE lNFORMATIfJN H� tis�s fi.-: �� 1.1 Property Address: � 7 to yj IQ Elmt DistrictBTMis tc :: r SECTION 2 PRO:PER7gY OWNERSHIP AUTHORIZ ' AGENT 2.1 Owner of Record: 12WIG (C R&761e� _ 9S"J�y OIL i-fn2��yari` Name(Print) Current Mailing Address: -�1-8ya- 9 Telephone Signature 2.2 Authorized Agent: JD E'P '. '33.2 KflWes n y kO-b- eeo-5fg 9 ©/.G Name rint) Curren Mailing Address: f3 natur Telephon SE0TfON-3 ESTI3`MATED CONS TRUC:TIDN:C`OSTS' Item Estimated Cost(Dollars) to be Official Use Only. completed by ermit applicant 1. Building uEe (a) Building Permit Fee 3 2. Elec.rical (b) E,Stimated Total Cost-of _ Construction from .6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 15. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) Check Number This Section For Official Use Onl Buildin Permit-Number: ;Date I"ssued: g . signature: t Building Commissioner/Inspector.of Buildings b. te T File#BP-2004-0056 APPLICANT/CONTACT PERSON Joseph Lastowski ADDRESS/PHONE 332 Kennedy Rd (413)584-7404() PROPERTY LOCATION 957 RYAN RD MAP 35 PARCEL 054 001 ZONE SR THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 12 X 16 POOL DECK New Construction Non Structural interior renovations Addition to Existin¢ Accessory Structure Building Plans Included• Owner/Statement or License 059982 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INWRMATION 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 Buildin facial 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. BP-2004-0056 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0056 Project# 35-2004-0093 Est.Cost: $3250.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin Joseph Lastowski 059982 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.7118103 0:00.00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 16 FREESTANDING POOL DECK 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 7/18/03 0:00:00 216 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 3 r{w� ,� � � � ��` ax a,PF�,��st„K'�y�,��'}}`�..'1-sY w� ¢ ,,ra: �� ,?. �.��s � S r; � .� �, �. ik ir,•NY ? R _ ��,4 xs � �` sy �i k �y � �� ��� rs�`° P � � yA ,„ �S- �• 1 y �. 3w ,.' � ` �. , �� - :� ��_ �. � � � � �r��,� m,4 vt• � i> �. 5 �� � �� �, �x p � Y., �� � ,a d ,. � �£ �:. ��, �}k , � a ., �� k ., � � *� � ,� a.�� ,. �t� rs. � • � � �. �,� �.fir_ �' ����x ��� � zt� � �� � "1 � � ��" � � r �., � axe �� ��. � '.� �, � � t� � ��, � _ r �� � �, ����. � x ��`' ..;' � ..z k.;' �... �. ��� ��: � J ��_�. �- �`� `.y$� � `^_. $r" Sr��x fix. Y $ u Y ��t � il���#ri ;�����f�������F;if���,�Fs�' 2���``��.� ter` �� � �.` aE�; ,�y�+��ppSI � �� ���� ����i�i�Ind Mu u}�I�,', � � `� �ri r� ` ��,�� ��-�; �" Kr�i���l�l��l��l�i����. �� � ��p�� �il� lid @�,�j� � �+�����.'`,�fi, �'3: `�'�;,��Ar. , .,, 957 RYAN RD BP-2004-0056 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-054 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0056 Project# JS-2004-0093 Est.Cost:$3250.00 Fee:$50.00 PERMISSION IS HEREBY GRANTED TO Const.Class: Contractor: License: Use Group: Joseph Lastows1d 059982 Lot Size(§g.R.): 19863.36 Owner: BROOKS MICHAEL D&MARILYN L Zoning:SR - Ag cant. &h L StOWSKi AT: 957 RYAN RD Applicant Address: Phone: Insurance: 332 Kennedy Rd (413) 584-7404 O LEEDSMA01053 ISSUED QN.7118103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 12 X 16 FREESTANDING POOL DECK 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: -7' Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: OK !a -03 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS Certifica Of Occuaangy Si nature: FeeType Receipt No: Date Paid: Check No: Amount: Building 7/18/03 0:00:00 216 $50.00 212'Maixt Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo L