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36-118 (2) MAR-26-2003 08:13 r.ei/nl P&MUCER (413)527+-5'S20 FAX Z4-13)S27-5970 TM CERTIFICATE IS 108M AS A MATTER OF MFORMATKX Finck d Perras Insurance Agency. Inc. ONLY ANO COWVM NO MM UPON THE CERTIFICATE 6 Campus lane T M t"OU1PMA71 DOES @�Y AMIYI00,ENDOR Easthampton. MA 01027 Richard Perras HERO APPORMO COVERAGE NAIC 0 IeWED Thomas McCarthy ra Contractors,Inc. INWRERA. Blue Ridge Insurance Company 24503 3 Broderick St esURERe Co"Orce Insurance conywy 34754 Easthampton, MIA 01027 INSURERC: MaSS"St Insurance ny 1 34100 ONSURER O: I GURLR E: AMMMES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOME FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUMREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF StJCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& sVPE OFMISURAN66 POLICY NUMBER UWTS GENERAL UNNIM AWM3S3741 02/10/2003 02/10/2004 EACH OCCURRENCE I 1 QQ0 X COMMERCIAL QENEM LW WW =Q.&W=:vW f S0• CuuAS MADE QCGVR MAD EICP(Any ene Ps�eon) i 5 A PERSONAL A ADV MJURY $ 1000 ZERALAGGREGATE 1 LOW . GENT AQW150ATE LIMIPAPPLECIPER: PRODUCTS-COMPW AGG i 2.OW. ' POLICY ,E LGC AUTO OWILE UAMUTY VN7470 01/02/2002 07/02/2009 COMOWD ANY AUTO me *SII(aYE LIMTf i ALL OWNED AUTO@ HOOILYIVJURV = Bl X 9CHEDULEDAUTOS (P-POIW) X HIRMAUTOS SODM,Y INJURY X -OWNED AUTOS (I'« Mf 3� PROPERTY H -(P- DAMAGE - - loo GAR4=UAIN."T AVTO ONLY-6AACCIOENT $ ANY AUTO OTHM THAN EA ACC i 4 AUTO ONLY' AOO EXCESSMAIDRELLA UAaUTY EACH OCCURRENCE _ OCCUR CLAIMS MADE astErt DEMJCT13LE i RETENTION s WMUM Ago +va+oolosaz 6-2/10/2003 oxlio/zoo4 ST; EMPILVIFEWL1111IRVIT ER C ANY PROaRIE70R/PARTgEq/p(�CUTNE E.L.EACH ACCIDENT ! OFFICER/MEMBER EJ4CLUOE59 EL 018EA8S•GA EMg.O 1 M�rp AL P01O un1O E.L.DMEASE•POLICY LOAD m NO BPECNL PR041610NS below OTHER DIeCAPT10N OF OPERA710"I LOCATtOW I VEINCLEa I EAG.Ua1**ADDED BY END0011EEENr I V%=&PNOMMONS SIIDINDAM OP TM ATCIIL'DMCRI M POLICIES NE CAMMU O OM 71R EMPAVION*AT%7`1111"AN.Tft M VMNG WVJWR VS-LENIN AV=TO MAIL Northampton Building Departmant 10 DA77iM11 rrw11N1ftCETOTRECr&RIIFWATEH0LO RWAEDTOTHmLEPT, Building Inspector WT FM AM TO WL mUp}NOTICE IN"mN 111D OOLM AT10N OR IJAINI 1r1I 232 Main Street OF ADn#M U!•OFI TM NWML R'!AGWM OR REFIVINWATRIEII. Northampton. MA 01060 RT>n1E ' ACaW 25(SOB AN) GACORD CCRPORAT"i6M TOTAL P.01 r. r' rt, � fit tl i S T t � � r ,.r THOMAS C. McCARTHY kr ' •. '� �.4F. t ` ' GENERAL CONTRACTORS, INC. ° s ' = 3 Broderick Street ' ' Easthampton, MA 01027 (413) 527-5141 Fax (413) 527-6893 99 PROpQSr L�a ;. WaCkie PHONE 2017 7A, 1/2003 STRIYIT JOB N E 2 Brookside Circle Agame CITY STATE and ZIP CODE JOB L ATION =n`ce,Ma.01062 Same ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: Estimate for the following work for remodeling the lrst floor main bathroom. The estimate Includes.gutting_all existing fixtures,including.the tub/shower,the sink and top,_. the toilet,the medicine cabinet,and we will save the lav faucet to re-use. .__ ...We.will_frame—for the. tubf.shower,install blocking.for.2 grab bars,patch flooring where " needed. We.will gut all ceramic tiles and.sheetrock behind_them,48".above.the_floor,_and than.insulate____ the exterior wall. We will.than-install_now-112"moisture resistant shestrock,taped.3_coats,sanded and.sponged We will supply and install the following plumbing: 1-Sterling tubishower fiberglass unit in Bone)-5'Acclaim 1-Delta 1748 Tublshower valve-1 curtain rod4/36"&1118"grab bar for shower area. 1-E1jer patriot toilet in bone----4 Shower head T diver ter-#4923 M chrome,Alson model. 1-Eljer Murray china lav 20"x 17"in bone with a Delta 2522faucet in chrome. Electrical,we will hang-the new light supplied by the customer,install a ii new ground fault outlet and supply and install 1 Nutone fan/Iight,110 cfm,ducted to the exterior. ........... We will install 1�pre form top-Wilson art#4141-60 Neutral Glace. We will install 114"Juan plywood and prepare the floor for linoleum and install a linoleum with an allowance of$24.00 per square yard,Congotium,Ultima,Belge,Brazilion Siate#UL464.___ We will also install 8"x 10"ceramic tiles with a 2"x 8"bull nose.48"up from the floor,grout ........................................ .. . color,customer's choice: . . .......................................... All rubbish removal and daily clean-up is included.Add for the Northampton Building Permit. _ Mass.Construction Supervisor's License#053221,ex.05/23/03 Mass.Home Improvement Contractor's Registration #100364 ex.6/16/041 .1 11 See some of our aroiects on the internet At Ruealumber com&www.easthamptonweb.com/mccarthy E-mail address TCMGCI @ AOL.com die PropoSe hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: Ten Thousand Nine Hundred and 1x/100-------------- S9 dollars($ $10,900.00 )- Pa ment to be made as follows: 1�%To hold date,order and schedule: $1,090.00 45%Upon Start: $4,905.00 45%Upon Completion:$4,805.00 All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices.Any alteration or deviation from above specifications Signature C involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents Note:This proposal may be 45 or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. withdrawn by us if not accepted within days. Our workers are fully covered by Workman's Compensation Insurance. �rreptattre of Proposal —The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature ® To Reorder. �.�tiAMp�o •0 a g (rx� of 'Wart4aillvfan V B �lasaachttsctts' DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building 'a Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (� pelmittee} T with a principal place of business/residence at: /L C ✓^ (phone#) S-P 5 �7 (stneei/city/statr/ap) do hereby certify, under the pains and penalties of perjury, that I am an employer providing the following worker's compensation coverage for my employees working on this job: ' rlil�,tC� �mil. (G G�✓��L�'C�/Q�'�� ✓ �J (Insusnnce Company) (Policy Number) cation ais) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired ' the contractors listed below who have the following worker s compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) t (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (atlach additloml shoot ifnooemry to include infottnsiioa pertaining to all ooa2mdors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that whilo homcownem who employ person:to do man,tc aaoe. suction or repair work on a dwelling of not more than throe units in which the homeowner raid=oc oa the grounds appurtenant thereto are not ecarally oo=daed to be employers under the wmicct oompc=u4m Act(GL152,ss 1(5)�application by a homeow=for a license oc permit may evideaoe tho legal slaw of an employer under the Wocitoes Compamation AcL I undeauad that a copy ofthia etatemeat may be fbrw uxW to the Departmcot ofI.&L risl Aoade&Office of Inst+rsoce for the coverage vaificatioo and that failure to satire coverage under section 25A of MAIL 152 can lead to tho imposittoa of-mimal peo=ples comisting of a&ere of up to S 1,500.00 wdfor imptiso�of up to one year and civil pmaltics in the form of a Stop Work Order and a firm of S 100.00 a day against ma For&Vatnnaw uao only Permit Number Map#-----Lot# �� Stgnahtre of LicenserJPertnit#ee scto�asu - 1 srlrar>=s Licensed Construction Supervisor: /°l /, /' Not/Applicable �ry❑�J Name of License Holder: 71 A6Y l i ��7L'Lt-+�' 14 y / License Number Address Expirati n Date Signat Telephone Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SEC7IQ.N 11 , W{}l71<ER$'CpMPENSATIQN INSUl1ANCE AFFIDAVIT.{M.GL ic.452,§250 t;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...... ❑ ;1 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 ;F' PO W' K c all a licable New House ❑ Addition ❑ Replacement Windows Alterations) (] Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work: iemct7 d�q C :v.V L- Alteration of existing bedroom Yes X No Adding new bedroom Yes _ No Attached Narrative N-*' Renovating unfinished basement —Yes No Plans Attached Roll ❑ - Sheet B 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? 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 -TO:BE COMPLETED WHEN OWNERS'AG1`N OI2 CONTRACTOR APPLWS FOR BUILDING PERMIT as Owner of the subject property hereby authorize �1 'y S , �� ��`�'�" �✓ to act on � C my Aalf, in PII matters relative to wor authorized by this building permit application. ' f,,, - U 5 Signature of Owner Date efg�r�X4 Y 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 Z" T V-44 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 Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved 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: f D. Are there any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: a City of'-'Northampton Building Department ✓ 212 Main Street 2 u4laRoom 100 mpton, MA 01060 phone 41.3--587-1240 Fax 413-587.1272 APPLICA-TIOf-t'TB,CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-,SITE,v"RMATI, N, 1.1 Property Address: . This Se ytio %fle s Ue (ley' ► y Or c k ,.. SECT[QN PRbPERTY OYIiNERSHIPlALI7HOR12ED`'AGENT, 2.1 Owner of Record: G iae Name(P ' t) Current ailing Address: Telephone Signature p 2.2 Authorized Agent: Name P ' t) ' Current Mailing Address: ' r S-2 > Signature Telephone S„IW MON COSTS Item Estimated Cost(Dollars)to be OffOAI else Only completed b permit a licant 1. Building p (a`) Building Permit Fey 2. Electrical ©e2 (b. E tjmated,Total Oast of tr�uction'Jrorn_ 3. Plumbing auill ing„Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) C o r ©0 Check Number ;Ch'is S°ec#iidn`For,Official Use.0n1 %ilding.Permit Number: pate Issued: Signature: 'Building C mmlss vrierfln$pect r of F3ttil tiiigs Date File#BP-2003-0792 APPLICANT/CONTACT PERSON Thomas C McCarthy ADDRESS/PHONE 3 BRODERICK ST (413)527-5141 PROPERTY LOCATION 232 BROOKSIDE CIR MAP 36 PARCEL 118 001 ZONE URA 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 BATHROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 053221 3 sets of Plans/Plot Plan THE FO LOWING 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 C94Aission Signature of Building 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. BP-2003-0792 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: BuiiainQ Category: BUILDING PERMIT Permit# BP-2003-0792 Project# JS-2003-1301 Est.Cost: $10900.00 Fee:$55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Thomas C McCarthy 053221 Lot Size(sg. ft.): 19079.28 Owner: MACKIE RODNEY W&PHYLLIS M Zoning:URA Applicant. Thomas C McCarthy AT. 232 BROOKSIDE CIR Applicant Address: Phone: Insurance. 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTON MAO 1027 ISSUED ON:411103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM 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 Occugancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 4/1/03 0:00:00 1330 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 232 BROOKSIDE CIR BP-2003-0792 GIS#: COMMONWEALTH OF MASSACHUSETTS MV:Block:36- 118 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0792 Project# 35-2003-1301 Est.Cost: $10900.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Thomas C McCarthy 053221 Lot Size(sq. ft.): 19079.28 Owner: MACKIE RODNEY W&PHYLLIS M Zoning:URa Ap_licant: Thomas C MCCarthY AT: 232 BROOKSIDE CIR Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON.411103 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM 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: Roug Rough: House# Foundation: _ Driveway Final: Final: Final-' -/ ( � Rough Frame Gas: Fire Department Fireplace/Chimney: Rough: Oil: Final: Smoke: Final:QK Ll. 7-0 :3 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy "C si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 4/1/03 0:00:00 1330 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo