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04/20/2005 18:31 41358799526355927779 KWASNEY-BURROWS PAGE 01
RH. &SONS CONSTRUCTION
RON HAS3MLL OWNER
1406 MAIN ROAD
GRANVILLE MA.01034
PHONE:413-357-9929
FAX:413-357-9991
MA RE STRATION NO, 13W7
MA LICENSE NO.082630
Barbara Burrows
1112 Burt's Pitt Road
Flarebce Ma.01062
413-587-9952
Estimate for a MIS deck aAd installation of a S' slider:
• lattaflotion of a MIS do&as per the drawing,
• AR eaterial will be pressure mated Number with 2u2 square post and
balssstrs,
* The decldeg will be 5 14x6 pressure bvetsd boards.
• All cement piers will be is accordance witls UK*t codes dug and installed 4' in
the ground.
+ lastantlatlon of a 5'suer.
Removal of a window and 2H the siding around where the door is gaistg to go.
• Cut a!sole in the wall sad property hime to receive a 5' slider we will be
putting a 2A bcader arrors the apam where the slider is to go to carry the
&aad of that part athe bsuse.
• The contractor will remove ail trash.
• The material will be provided by the contracter except for the door stated
below.
CUSTOMER IS RESPONSMLE FOR PURCHASING THE SLIDING GLASS
1100[.
Total price Ns the project is 549W.W
1. $1406.t10 slider
2. $39M 00 deck
• S200.00 deposit
• S1500A0 I we&before we start
• $100000 the day we start
• $1000.00 after the 4"r b 1astaDed
• $3i"0ao~the deck fo hweed
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of Wart4ampton
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CNM 108.3.4 to
act as his/her construction sups:•,ssor. 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 eegulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before baekfill),
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
1, 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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�-(lll.J-f p?, 1,.
.� (riff of �a�fltal)1}ifon
�:saicrEfntrlla' _
w DEPARTMENT OP DUILD0,1C INSPPCTIOI.'S
212 Main Strcct Municipal DuIldin�
I Northampton, Mass. 01060
I
w4RJUCERIS C0011PENSA'nON LEISURANCE AFFU)f1till-j-.
(I,ccusxJperm,ttcc)
%trlth a principal place. of businessfresidence at:
��� �,oh✓ _ hV�' �� �., O none;=)
(sa�.t/c�ty/sZaich p)
i
do hereby cerdf--, under thc.p?int and pen21ties of penury:, Lhal
I
I am an employer providing dlc follo%ving''workcr�s comocnszbop cove age Lor Iny
etuplovees worUng on Otis job:
Mszu-mac CoQr ) ✓(Pclic:l;u=ocr) (r:•pirrion Dat--)
i
( ) I am a sole proofictor, general coocractor or homeourner(c cie one) aad have hired
the cooiTaCgrs listed below wbo have the `ollo ' P- worker's comoen,aaon po5cies:
(l+^M Of Con actor) (In uranc;:Comoro)'ii'cuc; !qUMh---) (E.CpIFdL•Qn Datc)
i
i
(N me of Coatraor) Msuranec. CUmoanv/ OUC-Z' (-Expir-bon Dale)
(Name of Coan-acto,) (Insu-anc Compan)-/PoUq- MLm-kr) (Expirdoa Date)
I
(N2-Mc of Contractor) (Incuran Comr�sy/Poticy Numb`r) (E��ir<6oa Datr).
(aau�:ddia-ocal bca.if a�c�_-y w c�cuc�in(«w��on pc,.,;�w.11 00�•-�oa) ,
{ ) I rietor and have no one worldDg for me.
am-a sole prop
( } I am.a home owner perforrama all the work myself.
NOTE:plr--•^be cwN m tt—N;jjC 1 1 t t,.caxplay pc=caa 1A da r-,;- cz�.-zr oo c nc,air work oa r d. u-i-Z of
j aot mec-c 1h:a L"21'-$in«'Sch the bomoownrr reed=or oa the Qovnca+ zppurLc =tba cw�-r oot C=—.tty oo=.dercd to be
erlployc��n a the..o S d e ye-.,'m Act(GL'1 SZn 1(S)��; tG=6on by a bomnoama fv a lies_or pc:nn 1L•e
IrS11 n-n-of andr dao Work.e-Comp-..Lt:.Act.
t u04a�aad dIA a a-py a thi.—x—m„y b.f,,,,,i d w 11w Dcpartaaaoa of 1n6csJirl Ac doc:&OfL o ror 1b.
oov=x6c vcrTi ioo and ttt.t U- um to soaus tavcrasa und--soctioa 23A o(h(OL 132 can tcd to the i�oa of a-imin-sl pcmliio
eooaumg of a fine oCup to S I}00.00.ndlc,im o® oCup to aoc ycr and a%i1 pm.hia is tSc form of a Stop Work Ord=Lad a
fi=o(S 100. y[7yny me
- \ For
dcp.nu+=�•I
j ,/ / Pcrmit Numbcr
S tun of Lic=iscc/PcrrrdUcc Date _J :
SECTION 8-CONSTRUCTION SERVICES i
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Holder: �/1v+a t° �r4�. A w(f a
License Number
Address Exp'ation Da e
/r /y7
�tlp-
Signature Telephone
S Reasterecl�l1`ortr`eY�i�arove"r`YecitsC`a�tractaiiF ' ry '�- � � • - Not Applicable ❑
�»
Company Name„--� Registration-lVume ' ---
- CSC
Address Expiration Date
sf'ljd 4A,) / o,- fJ ZA 0 L,> >7 4Y t•A , Telephone e-11! F r 2 9
SECTION 10 WORKERS'COMPENSATIONINSURANCE;AFFIDAVIT j(M:G.Lli:.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...... ❑
�P
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-vear 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
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check'all applicable)
New House [] Addition ❑., Replacement Windows i Alteration(s) ❑ Roofing
Or Doors E-1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [ Siding[O] Other[O]
Brief Description of Proposed '� lf�-s
��1�
Work: h X I c 1: r J i.;l�
Alteration of existing bedroom Yes _No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes _ No
Plans Attached Roll -Sheet
' >..,--^.,. ..:+. '. �,.i "s"TMSi'Pi
sa_� IVev�hoase c a
Wild eft WdF! �si�c� ¢omp ei€
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 At1THORIZATION TO BE COMPLETED WHEN
OWNERS-AGENT-bPtbONTRACTOR APPLIES'FOR BUILDINGtPERMIT-
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
��� �+ u✓� /��� ' 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 N7
a
Signature of Owner/Agent Date
Y
Section 4. ZONING All Information 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
l �
Frontage —
i 1
Setbacks Front i
I �
Side R: �.. /.�~ � -✓k� ;io
L: R: d
Rear
Building Height
Bldg.Square Footage % I I J�
Open Space Footage %
F �
(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 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page' and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 4) DONT KNOW 0 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 0 NO
E '
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO
IF YES, describe size, type and location: s
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q , NO e
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Nortl7lampton o ��
L Building Department
212 Main Street i 1
Room 100
,North mpton MA 01060 Q 8truc �
ns .
phone 413-58 -1240 Fax 413-587-1272 'IatS n
�. tE12�Geetfy
APi LICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION'
1.1 Property Address.
ThissectiQn to<lb complete b� ffce
UrttL
OverCavD[strict
E1ttrS D 1ci CB Distctcf
SECTION 2-PROPERTYOWNERSHIPIAUTHORIZED AGE,NT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent: f n
f sl�f a rte !tom. /Y Au �—/' t<+J Z 1: r
Na� , Current Mailing Address:
Signature Telephone
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 d
This Section=For Official Use Only
,Date
Building Permit Number, Issued:
Signature:
i
Building,Commissioner/Inspector of Buildings- Date
File#BP-2005-1204
APPLICANT/CONTACT PERSON RONALD W HASKELL
ADDRESS/PHONE 1406 MAIN RD GRANVILLE (413)357-9929
PROPERTY LOCATION 1112 BURTS PIT RD
MAP 36 PARCEL 159 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT 10 X 15 DECK W/SLIDER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
B FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Pernlit 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 C mmission
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.
1112 BURTS PIT RD BP-2005-1204
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map.-Block:36- 159 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2005-1204
Project# JS-2005-1624
Est. Cost: $4900.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RONALD W HASKELL 082630
Lot Size(sg. ft.): 10497.96 Owner: BURROWS BARBARA
Zoning: SR Applicant: RONALD W HASKELL
AT. 1112 BURTS PIT RD
Applicant Address: Phone: Insurance:
1406 MAIN RD (413) 357-9929 WC
GRANVILLEMA01034 ISSUED ON.6120105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 10 X 15 DECK W/SLIDER
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 Sienature:
FeeType: Date Paid: Amount:
Building 6/20/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
1112 BURTS PIT RD BP-2005-1204
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36- 159 CITY OF NORTHAMPTON
Lot: -001
Pernut: Building
Category: BUILDING PERMIT
Permit# BP-2005-1204
Project# 35-2005-1624
Est. Cost: $4900.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RONALD W HASKELL 082630
Lot Size(sq. ft.): 10497.96 Owner: BURROWS BARBARA
Zoning: SR Applicant: RONALD W HASKELL
AT. 1112 BURTS PIT RD
Applicant Address: Phone: Insurance:
1406 MAIN RD (413) 357-9929 WC
GRANVILLEMA01034 ISSUED ON:6/20/05 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 10 X 15 DECK W/SLIDER
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: W4 r5
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: 67k (o as Oi-�i�yLy!
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS./ �
E'
Signature:of Occu anC
FeeType: Date Paid: Amount:
Building 6/20/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo