35-172 A.E REMODELING
ALDEN M. EMRICK
90 MOUNTAIN STREET
HAYDENVILLE, MA. 01039
413-268-7070
PROPOSAL
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
Gregory Lindahl 1373 Burts Pit Road
Florence MA 01062
WE HEREBY PROPOSE TO COMPLETE WORK AND FURNISH MATERIALS AS SPECIFIED BELOW:
• Remove existing ceiling in kitchen and install new ceiling, taped,primed and textured—$600.00
• Build new 2 X 4 dividing wall between kitchen and dining room, Sheet-rocked and prepared for
paint--$1000.00
• Remove existing kitchen door,stud in patch drywall,and repair vinyl siding--$350.00
• Mount homeowner supplied kitchen cabinets--$500.00
• Miscellaneous Plumbing—$200.00
• Remove all wallpaper and wainscoting from walls in kitchen and dining room and prepare walls for
paint--$600.00
• Paint all walls and ceilings in kitchen and dining room—$600.00
• Install new hardwood floor in entire kitchen and dining room area. (Material cost allowance is
$5.00/Sq.Ft.)--$2250.00
• Remove all existing window and door trim in kitchen and dining room area and install new,stained
and sealed trim.--$1300.00
• Electrical Portion: Install new electrical service in basement. Run new electrical lines for outlets,
stove and owner supplied lighting in kitchen and dining room areas.--$3200.00
FOR THE SUM OF-$10600.00
"wait cmu t be sdwduW or maieeiais adwW ua to signed ao p0aw is mmwd back. Paymm*4a be made a try wig+ft W
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Sign this cM xW=4 back
ACCEPTANCE OF PROPOSAL
DATE: �S SIGN TURE: 4�.
THANK YOU!
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Gifg of Wart4amptan Z
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DEPARTMENT OF BUILDrNG INSPECTIONS
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 his/her construction sup,J:.::-Or.. The stale defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or trvoamc —_---
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-buildi-n—g departmentfortheCityofNorthampton-w_ants-anyperson(s)-who-seek-ta -use the home owner exemption, to act as their oven 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 occupancv
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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li DEPARTMENT OF DUILDI>\'C INSPECTJONS
212 Main Strcct Municipal Btti{d;n�
j Northampton, Mass. 01060
WORIaaRIS CO1` 'ENSA77ON U SU Z-ANCF Al'I`U)AVIT
�Vlth a principal place- of business residence at: -
(phone:')
(SV-C- Cit}/n=lzi p)
Ido hereby certifj, under tllc.pz,nt aod penalties of perjury, h`ti
j ( ) I am an employer providing the followin-,1%vorker's colnDC'IS_7JoP, coverage for Illy
etnplovccs ivorong on ulis job:
i
(Lsur�c Conr ) (polio,Nt-i1D^_r) Dirtior, D2=)
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O I am a sole proprietor general contractor or homeowner (c cie one) aid have hired
the contractors listod below rrho have the tollo•vile workers campendon policies:
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(Nl am: Oi Con mci0r) (In5UI3ttC^ COIL 03,71)'/:'06Ci }��um=r ) �',�lsd C? 0,11c)
1
(Name of Coac cior) (Irsslan= Comoan-vP01in, NLLMl cr) - (Exp-Lm lon Date)
(Name olCoaaaao,-) (LnSwran= Comp2my/Poticy N=b:r) (^��piraoo Daic)
(Name of Contractor) (Lnsuran= Comrzay/Pobcy Numbcs) ��a-pirdtian Dais).
(saach�i�ocSJ rScC.ifac,ee:-r_�•to a�du�iaforra+�oa pe,•�w.i]eoc-tn-a) _ .
I .
am-a Sole pFOpnetor and have no one worl-ing for me.
( ) I am.a home owner perfornsiag all the work myself.
NOTE:plc==be no<•zrc Eb=while bnm�acra.t>o cmplay pc s.O=to do rgair+mrk on of
aoe most the tt.1o_-tsrs in%web the bomcwwner reach or oc the V ou--6 z,7artea_=the a_-c we C= _Ily cc-_d red to be
eirploycs 11 the =: - on Acs(GUI 51�1(5)),zppLj=L6 o by a bo nc act=fm c lic,-or pcmiz t✓y`46=:s el~
lc�.l e•-^„of ea-=:Ployer wader die Work e.Coaspom.atioo.Ac(_
[uad--z. d that a ooyy of tbia=uL c=—y be foco nrd..d to the Dcpo,—d of d Anidcss'OTIioa o(l+sa+r•noa for tho
covexse veirenlio0 sad the L-ilcm to so�irc bovereb-e tmdc==Sao 25 A of MGL 152 oa Icy to tht tzrzs2ion Of i�P��a
coazi�of a fsac of tzp to S I}00.00 and/or iaz;rtv,�csm,--s!orup to oac Y*,- n..d c.il pmatio io 6c fo=of a Stop Work Ord-
fl=
Of S 100.00 a 6y spinst ax
only
Pcrtnit Tftslnt>cs
P�
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Stgnatitrt of Lic=iscsJPcrmiu= — -
SECTION 8-CONSTRUCTION SERVICES f
8.1 Licensed Construction Supervisor: Not Applicable
Name of License Holder:A J c," t ,�,..-i.Lk� CG r6 o 1 r15
License Number
k3 �i% A7,y eA eb�(r:��-f' X'-' �O — o(.
Address Expiration Date
Signature Te p one
. :. ..
S to 6MI044 melm ro�vemen 4ontrac or. '` Not Applicable ❑
�4 , t, R -C .--7a -J C-I , W) 4 1 ,2,366
Company Name Registration tNum er ty ---- --
!? o -**1 QCA.-7 'T'v.r'&n, e .!�&A gaa 35a 3 —.9-5 —`
Address —T Exp+ration Date
Telephone'sb i�—7k O
SECTION 10-WORKERS"COMPENSATION-INSURANCE:AFFIDAVIT(MAL.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...... ❑
L�.b- �111T AA 'C1131
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 Beath)of the Massachusetts General Laws Annotated,you may be liable for uerson(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
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition ❑, Replacement Windows Alterations) Roofing
Or Doors F-1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[[I] Other[0]
Brief Descripti n f Propo e
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes ,/ No
Plans Attached Roll -Sheet
sa If New k'ouse andO cti '>an to x�sti c io�slnct:.corl� tet`e fiM en, a owincrr:
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 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
SECTION 7a-'OWNER AUTHORIZATION-.TORE COMPLETED WHEN
OWNERS AGENT OR`CONtRACTOR APPLIES FOR BUILDING PERMIT
I, Cr( t1 �j �� as Owner of the subject
property . A
hereby authorize -v`t t 1� E v,ny-�� C K
to act on m behalf,i all matters relative to work authorized by this building permit application.
Signature wner Date '
I, A 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.
c'<
Print Name
Signature of Owner/Agent Date
Section 4. ZONING Al I Informati6h 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
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
'
A. Has | Perm it/Vurance/F�di ever been issued for/on the site?
' �~� �~� �
NO �� D�7K�W �� YES ��
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 Documnnt#
'
��
B. Does the site contain a brook, body of water ormmd VV �~�ands? NO v�� DO0TKNO YES v=�
IF YES, has permit been or need to be obtained from the Conservation Commission?
~
Needs tobeobtoioed x�~� @btm[m�d v�� Date
x�� �~� ' �
C. Dn any signs exist on the property? YES 0 NO K�&
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? Y[3 0 NO
IF YES, describe size, type and location:
E Will the construction activity disturb(clearing,grading, .or filling)over 1 acre orisd part ofo common plan
that will disturb over 1acre? YES K � NO �g
`�' \
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
- .�s mDepartrxtenL:use.orily:�- .<:�4„,r;> .
City of Nortl;iampton Statix t `_
Building Department
212 Main Street s° ere ► ��
Room 100u f �� y
4 !
Northampton; MA 01060 0ia ”
phone 413-587-1240 Fax 413-587-1272Si � �
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be compidt6d byrofFce `
1.1 Property Address: °
r�� IV1�t 10�®b Zone overlay Dhs
trlct
�^Elfin S't:D�skr'ict GB-��.sfrict _
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
x2.1 Owner of Record:
Name(Prin Cu ent Mailin Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) tLlTrent Mailing Address:
—3-L
Signature `"Teslephone
SECTION 3-ESTIMATED CONSTRUCTION'COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
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 10 t
This Section For Official Use Only
:Date
Building`Permit Number.` Issued:
Signature:
i
Building Commissioner/Inspector of Buildings Date
File#BP-2006-0735
APPLICANT/CONTACT PERSON Alden Emrick
ADDRESS/PHONE 90 Mountain Street HAYDENVILLE (413)268-7070
PROPERTY LOCATION 1373 BURTS PIT RD
MAP 35 PARCEL 172 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out _
Fee Paid
Typeof Construction: REMODEL KITCHEN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 068078
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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
r�4� —
O1 Zb v�
ignature of Buil ing 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.
S "-
1373 BURTS PIT RD BP-2006-0735
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 172 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0735
Protect# JS-2006-1125
Est. Cost: $7400.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin: Alden Emrick 068078
Lot Size(sq. ft.): 21649.32 Owner: LINDAHI GREGORY
Zoning: SR Applicant. Alden Emrick
AT: 1373 BURTS PIT RD
Applicant Address: Phone: Insurance:
90 Mountain Street (413) 268-7070
HAYDENVILLEMA01039 ISSUED ON:112012006 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN
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 1/20/2006 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
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1373 BURTS Prr RD BP-2006-0735
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35- 172 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0735
Proiect# JS-2006-1125
Est.Cost: $7400.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: Alden Emrick 068078
Lot Size(sg.ft.): 21649.32 Owner: LINDAHI GREGORY
7.oning: SR Applicant: Alden Emrick
AT 1373 BURT wiz RD
Applicant Address: Phone: n` Insurance.
90 Mountain Street (413)268-7070
HAYDENVILLEMA01039 ISSUED ON:112012006 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL KITCHEN
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground. Service: Meter: Footin s•
g •
Rough; Rough: House# Foundation:
Driveway Final:
Final: PCcL4 Final: /
Rough Framer
Gas: Fire Dewrtment Fireplace/Chimney:
Rough: Q Insulation•
Final: Smoke: w Final: 01( 05it?(66 bout's
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL IONS.
Certificate of Occu ancy Si tia ure:
FeeTme: Date Paid: Amount:
Building 1/20/2006 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner Anthony Patillo
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