29-100 Turn Key Construction Estimate
410 Chapman Street
(jxw ifield, MA 01301 Date Estimate#
8/27/2003 104
Name/Address
Anne Bourbeau
23 Brierwood Drive
Florence,Ma.01062
Project
Item Description Total
Deck Deck built as per Ist quote 4,650.00
Decking to be Ipe 4/4 x 6
No handrails
2500 material deposit, 1250.00 after 1 st week,balance upon completion
All work done as per code. Total $4,650.00
Phone# Fax# E-mail Ma. Lic#075732
413 774 9946 413 774 9946 jimmarv@comcast.net HIC# 131830
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jy 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 l:is/her construction sups:•,isor. 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
f (l,zi�; z�f ,t� tlj�tllt}�tnll
P - 6 �s�,sexcflucctta' � -
t)Ef'ARTMENT OI' £UILDDJ G INSPECTIONS
212 Alain Street ' Municipal Building
Northampton, Mass. 01060
WOMCER'S COMTENSATTON INSURANCE AI~'F-Mz?,N7 A
(lIC`P.S^_JTf;II]IiiCr)
v"Ith a principal place of bush esslre;siceticc
/3--7741
(strc°ticif>i:>( ta.�p)
(10 hel-6by CCrtil}- un: I-tic and pcn 1t1C., of pc; Thai .
O I am an employer providing the coves ,e or my
emplovccs Nvo6diig on this job: V
(Ins mnG; Cor�pam') J c c:Num,be r) ---- (F�p;r ^n Date)
I a-c1 a sole proprietor, generiii G:)DtncCor tio-r"Cowcer (c'de one) and hZve 'Hired
contractors listed beiovv ,v o 11-i e, the oll vor ers cor xen on
(Name of(-0t1LMct0r) (TRH' _ 'iC l 0I ^::;i"1;l G!1Cr Tr1117�i) lT?:i:ritlCi: Datc)
(Name of Contractor) _ (7ltsur,_ne Co spa.�;'Po!ic,' Nuntrr; (I;xoratiG:Date)
("Name of coa tractor) (In; azlc� Com :+�;% olie: Nun t r) -s. ra:oD Late)
(Name of Cont actcr) — (Itis�lanc Cetilr_.},t olicy ivtlim� *) (F::rr.-:tior. Dare)-
(r.rLiGt
I iL[Tl <'. SOle t)rOprICIC)i <:i1Q t1I?'�'G i?O Oli'v '..'o?viii ' tot ni".
fill P_ homc OW?ic` i)crfc't Iii-g
NO'17i:plcau be atra;c ti:a:•.ii:;ic ffi<r�o��lr-s��:-o c::,a!:T;'i'=;.:�;,�;t�;-�_;_rsac�ar::>n:�:.:m cr:c;:air�c,;j;�_�«cl!ir:,c.
not imcc thn throo uui+s in tc-f idt the lx-y ;:tzr r=i,��cu-a; - _:,::z L'-t cr r1 LFCC o a c(rx C'ncrzlI."
c '.ployca unc > -n cc L.-
1 r ( , � ( ;
SECTa0N8. CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
/D GN �icJ 5i 60��2vg/EZD Z 12_0le,6
Address Expiration Date
li"il 3 77V
ure Telephone
i
.Re ewe °,.orne: m" r �uemenGon racto Not Applicable ❑
Company Name Registration Number
Address Expiration 5ate
yl� CIWA14AJ 57 &42 ZURe5W Telephone y13 77y9YY6
M 107
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...... ❑
h ;
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 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
SECTIONI DES. PT{O F .ROPbSED� GRRK(check all applicable)
q - xian Ga
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks Siding[ ] Other [ ]
Brief Description of Proposed Work: `�7K ZZ R&-Z;< /N
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet 0
awl, f e . o: d or �:dditton #o ezrs�ingh tao sung;:comp tfie follaw�n>?:
a. Use of building : One Family _ Two Family Other
b. Number of rooms in each family unit: 3 Number of Bathrooms
c. Is there a garage attached? ?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories? 0
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
}. 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
SECTIOS�7 +3�V IAUNORIATfON TO BE COMPLETED WHEN
OWIJEI� AAGEl1T0 CONTRACTORAPPLIES FOR BUfLDING 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
I, , 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
Signature of Owner/Agent Date
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
... _.. .,... ,._:.__......,_j Building Department
Lot Size 1,7 y�0 Sq pr:.. _. .
Frontage
f(� '76
Setbacks Front / 70t
r
Side L: R: 7, L: 512 R: 3l®
Rear g 2 (oG
Building Height
Bldg. Square Footage U� 7 % "Y12,
Open Space Footage _ l G
(Lot area minus bldg&paved -j } ! /050D
parking)
#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
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 r a Ap n '1�i (�E
Build V
21 in Street
Northa l AP01066 0 003
phone 413-587 124 Q �t
DEPT OF BUILDING I PE
NORTW1Mi'TON, oil
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
Rr
.This sectio to b com"Fetedbyo`ffice�
1.1 Pro erty Address: f Y
P12 Mapes �; Lot nit a
WIN
ElmrSt`=District ����°` �`���"�CB-D�s=,r►ct�"�� ""`
SECTION 2 -'PROPERTY OWNERSHIP/AU.THO,RIZED-A;C
2.1 Owner of Record:
�y'57
Name(Print) Current Mailing Address:
Telephone
Signature _
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
-///3 7 Z6 9�y�
St ature Telephone
SECTIOW —ESTIMATED CONSTRUCTI"ON.CO"STS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applcant
1. Building /� J!"�� (a) Building Permit Fee
2. Elec.rical ! (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: RP'Lc-loy -0246 Date I"ssued
Signature: — '�' --
D44 Building,Commissioner/inspector of Buildings
23 BRIERWOOD DR BP-2004-0266
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29- 100 CITY OF NORTHAMPTON
Lot: -001
Permit: BUiidinq
Category: Deck Addition BUILDING PERMIT
Permit# BP-2004-0266
Project# JS-2004-0388
Est. Cost: $4650.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES M MEEHLEDER 075732
Lot Size(sa. ft.): 13982.76 Owner: BOURBEAU ANNE M&
???''. Arplfrant: JAMES M M!EEHLEDER
AT. 23 BRIERWOOD DR
Applicant Address: Phone: Insurance:
410 CHAPMAN STREET (413) 774-9946
GREEN FIELDMA01301 ISSUED ON.919103 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 16 X 22 DECK
POST THIS CARD SO IT IS VISIBLE FROM TH
Inspector of Plumbing Inspector of Wiring D.P. X13.; City of Northampton
v
Underground: Service: Met w � BUILDING INSPECTION LABEL
Foo O
Rough: Rough: Hou ( A FI FI R V En
Driv `yy
Final: Final: Inspector
Date �� J
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: r;=. is pK / - . 3 :5 YGAle
THIS PERMIT MAY BE REVOKED BY THE CITE' OF NORTHAMPTON UPON VIOLATION
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 9/9/03 0:00:00 437 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo