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25C-137 WWW.RUGGLUMBER.COM Email: TCMGCI @AOL.COM Jay Czelusniak 584-5703 4130/2007 60 Elizabeth Street Same Northampton,Ma.01 060 Same 584-3585 MA HIC#100364 Exp 5/16/08 MA Const.Supervisor#053221 Exp 5/23/07 Estimate for the followin_a work to the 2 car garage. The estimate includes: Removing the existing 2 overhead garage doors, removing the dividing partition wall, install temporary supports, remove the existing header's and prepare the opening for a new double micro lam support header size 14"x 18', and all new framing. We will frame for a new 16' x 7'garage overhead door, ( customer to have this supplied and installed). We will install trim and wrap with white aluminum and siding to match the existing to finish. An Electrical allowance of$350.00 is included to install underground wiring and 1 outlet for the future garage door opener. We will 1/2"sheetrock to two side walls of the garage, taped 1 coat. We will remove the rear entrance door, supply and install 1- new steel 30"x 68" prehung door with new lockset and deadbolt. Includes sheetrocking the back garaae same specs as described above. All rubbish removal and clean up is included. Add for the Northampton building permit,we will get. Please sign where marked ,return with the contract&check,thanks Five Thousand Four Hundred Twenty and xx1100............. $5,420.00 30% Down for ordering&scheduling: $ 1,626.00 50% Upon Start: $2,710.00 20% Upon Completion: $1,084.00 45 Days DATE(MMIDDNYM ACORa CERTIFICATE OF LIABILITY INSURANCE 03/09/2007 PRODUCER.(413)527-5520 FAX (413)S27-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Nnelt & Perras Insuranee Ageney, Ine. ONLY AND CONFERS NO RIGWTS UPON TMR CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Rebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC# INSURED Thomas McCarthy Genera I Contractors,Inc. INSURER A: General Casual ty 24414 3 Broderick St INSURER 8: Easthampton, MA 01027 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,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 IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INOK LTR NS TYPE OF INSURANCE POLICY NUMBER DATE(MMlDD/YY) DATE MIDDIYY)(M LIMITS GENERAL LIABILITY H OCCURRENCE COMMERCIAL GENERAL LIABILITY PREMISES 7-o;'' QmL'noe) CLAIMS MADE ©OCCUR (Any one person , A POLICY JECT LOC COMBINED SINGLE LIMIT 5 (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) ANY AUTO OTHER THAN AUTO ONLY: ---XGG- mums OCCUR CLAIMS MADE DEDUCTIBLE RETENTION $ TORY LIMITS ER EMPLOYERS'LIABILITY eee s A ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? -f fee,ee If yea,describe under 5!SeASI!"P0t6&v'tamall, .3 5001 SPECIAL PROVISIONS below gATInMq EXPIRASiON DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY City of Easthampton OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Easthampton Building Inspector in R00RA �,, o �p 4n m e ti is wo g a �. x p, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street kv Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaiblv Name(Business/Organization/Individual): - Address:_; ' City/State/Zip:� //, �/jC�a` PhoneA 113,V1-151- V1 Are-you an employer?Chect the appropriate box: Type of project(required): 1 I am a employer,with 4. n I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction , 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, (]Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.= 9. E]Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing thcir worker;'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConttactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Poh�cy#of Self-ins.Lic.#: xpira. Date: fC1 ��/ � ��2�/�Fri/ Si /�U lstat�- lob Site Address: ����� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of criminal penalties of a - fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ;:/`°' �t l`' Date: 612 Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECT ION=9-CONtTRI CIION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address T Expiration Date Signature Tei phone M s ri "— 9 Not Applicable 13- _._w Co oanv Name _ �-, Registration Nu;mlbr zk Expiration D e Telephone � SECTION 10 WORKERS'COMPENSAT DN INSURANCE AFFIDAV=IT(M G:L.c..152,§25C(6)1 Workers Compensation Insurance affidavit ust be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the bui) ' permit. Signed Affidavit Attached Yes.......4 No...... ❑ 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 1083.5.1. 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 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 Frontage Setbacks Front Side L: W� R:. L:' ` R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: v ' z (volume&Location) ` A. Has a Special Perm it/Variance/Firldin ever been issued for/on the site? NO 0 DONT KNOW YES Q IF YES, date issued:; IF YES: Was the permit recorded at the.Regoiry of Deeds? NO 0 DONT KNOW YES 0 IF YES: enter Book `' Page' and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 NO �!r IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex ation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. JUN-6-2007 11:22 FROM:CZELUSNIAK FUNERAL H 1 413 596 2019 T0:5276893 p,2:3 �€ u.�:.PESCRIEM++fl!MMU9 WORN fcnQCA wti aeg icablot Now House Addition [ RWwem*nt_lMndows Alteration($) Roofing [7 or Door$ U Accessory Bldg. 0 Demolition 0 New Signs 101 Docks (CJ Siding fL J Oft?(= Brief Description of is /7z'�(/ r Proposed %� r � �j i�c'C �/(/%ZJ %L� e/g%moz j'/grr x4 'M//il'/�j% . Work: l a"'✓j C3 Alteration of existing bedroom Yec No Adding new bedroom Yes No Sal��� Attachod Narrows Renovating unfinished basement Yes No _ 7 S Plans Attached Roll -Sheet li-al16 .�l/I�S 8� .c+' a e it 'co the `},61w1 )C�Pzp a. Use of building:one Family Two FamUy________Other b, Number of rooms in each family unit. Number of Sethrooms c. is there a garage attached? d. Proposed Square footage of now construction. Dimensions o. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each 8. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. Is construction within 100 ft.of wetlands? Yes No. is construction within 100 yr. tioodplain Yes No j. Depth of boaament or cedar floor below finished grade k. Will building Wnfomt to the Building and Zoning regulations? Yes No. 1. Septic Tank City Sewer Prroayte wed_ City water Supply 3ECTJON Ts-OMER AUTHORIZATION-TO GO COMPLETM WHRN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ��' ILSA/41e ,as Owner of the subject property hereby authorize r u v ? '!e J to act on my bah in all rs five to work authorized thfs butMing ps application. S d Date t ! ' ` f ,as OwnerlA,uthgLUd Agent hereby declare that the statements and information on tote foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains>! pe/nettles of perrjurry. Print Name 1, r Sigrmturt of owned nt v Hate 2007-06-05 23:31 CZELUSNIAK,F 1 413 586 2019 Page 2 JUN-6-2007 11:23 FROM:CZELUSNIAk: FUNERAL H 1 413 586 EWI1 4 I U:Si✓tbu'J6 r. 1t1U J-titrAS 2Clti as 1411 Mb Ma r a of.., r, "i 4a-pit 1 tj_ ,h(„M,.s}�r• . t City of Northampton Building Department .. 212 Main Street steerlStlptic�ltrailagity �' 4 : z r , Room 100 tlVatetlWeN AVatlabilltl- Northampton, MA 01060 r"Duo Ssls of St�ucsual P = phone 413,587.9240 Fax 413-587-1272 ftl1ske an Other 9ixclry Ai�f+irlCAfiIOT I TO COW ALTER,REPAIR,RENOVATE OR DEMOUS14 A ONE OR TWO FAMILY DWELLING SECTION 1•SITE INFORMATION 1,t Praaorty Addresan. This eectiortttb 0 completed by ottTr v Lot ; UM 1111Y I NJI t't�' Wit /111 01466 OVertay DisMct' ; :Elm St.District ;'CS of bitt SEC77ON 2-PROPERTY OWNERSHIPIAUTHORIM AGENT 11 2vmpr of it•eord: am*(F'rantl current Malling Address: Talaphor4 2.2 Au thotlzed Aaant: Ac / -4 iRAPOM A4 Name(Print) , Current Mailing Address* .�y-t 7 5-22 2 2Y Signature �.M Tewphhono 2N s-EsrrMg TED,MNSMUCTIP N co,M Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 1 1�. 3 (a)Building Permit Fee ��t__ 2. Electrical �tr� CV (b)�limatti Total Cost of from 3. Plumbing Building Permit Fee 4, Mechanical(HVAC) 5.Fire Protection 6. Total=(1*2+3+4i*5) j �'ry . "J Ctmth Number Tht Section For QMdat Use Only Date Building Permit Number. issued: Signature: Building Commissioner/Inspector of gu'tdngs pale 2007-06-05 23:32 CZELUSNIAK,f 1 413 586 2019 Page 3 File#BP-2007-1201 APPLICANT/CONTACT PERSON Thomas C McCarthy ADDRESS/PHONE 3 BRODERICK ST EASTHAMPTON (413)527-5141 PROPERTY LOCATION 60 ELIZABETH ST MAP 25C PARCEL 137 001 ZONE URB 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:_CONVERT EXISTING 2 CAR DET GARAGE TO 1 CAR GARAGE 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 FqLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9AMATION 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 Co 'ssion 1' �12c-e 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-2007-1201 GIS#: � � COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: BUILDING PERMIT Permit# BP-2007-1201 Project# JS-2007-001916 Est. Cost: $5420.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Thomas C McCarthy 053221 Lot Size(sq. ft.): 4704.48 Owner: CZELUSNIAK JAY Zoning:URB Applicant. Thomas C McCarthy AT. 60 ELIZABETH ST Applicant Address: Phone: Insurance: 3 BRODERICK ST (413) 527-5141 Workers Compensation EASTHAMPTONMA01027 ISSUED ON.6/8/2007 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT EXISTING 2 CAR DET GARAGE TO 1 CAR GARAGE 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 6/8/2007 0:00:00 $50.002465 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo