25A-101 (3) Dmitriy's Construction Invoice
P.O. Box 1051
W. Springfield MA,01090 Number: 1041
(413)222-6879 Date: September 30, 2004
Bill To: Ship To:
Ray&Phyllis Capers Ray&Phyllis Capers
344 Bridge st. 344 Bridge st.
Northampten, MA Northampten, MA
Description Amount
6.Take permit,insurance and clean all trash to the dump.
2.Remove old siding from a house and install new siding,3/8 insulation to do all 20,250.00
trim work and suffit.
replace reg. D/H windows (22), and (12) wndows w/roud top 13,250.00
Total $33,500.00
Amount Paid: 12,000.00
Amount Due: 21,500.00
0 - 30 days 31 - 60 days 61 - 90 days > 90 days Total
$21,500.00 $0.00 $0.00 $0.00 $21,500.00
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DEPARTMENT OF BUILDING INSPECTIONS /
INSPECTOR 212 Main Street • Municipal Building 'e
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sups. :0sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be,a one or two fami --
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
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P E g1csa�ccfirttrll a' _
DEPARTMENT OP DUILDr-,,C INSPECTION'S
212 Main Strcct Municipal Building
Northampton, Mass. 010GO
\--Y0MCEIt`S CONMENSA"1;'>;ON GgSURANCF AF1;7)„'�Arj-j-'
�--�iccnsx/ Acc
j (I perm )
\VILh a principal place of businessfresidence at: ------ -
(phonc,!)
(sa�vci ty/5121c/zi P)
do hereby certify, under he.pa_int and penalties of pefiury., hat
1 ”
I - -
( ) I am an employer providing die following!workcr s comocnsEtiop cove age for Inv
empiovees worUng on this job:
(Las-u n=Conrz-m,) (Folic:Numixr) -- (r:piruor, Dzze)
I
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( ) I am a sole proonctor, general coou-actor or homeowner (ci cie oee) and have hired
the couu-aciors listed below wbo have the `ollowing worker's cam:)en_taiion policies:
1 ( +afI)C o; Co„^cior) (ln uranc.�: Cornpan)-P, o6ci u-m _`::)IidL•Q I�ItC)
I
(Name of Coocaaor) (Iaisruzne:, Comoan)•rPo!ic \um6cr) FDD ._lion Date)
(Name of Connaad;) (Iaamnc Compan)-RoUq- Nwnbzr) (Expimioa Daic)
i
(Name of Contractor) (Lase=(-- Comrzay/Policy Numb`.r) (Etpirtioo Date).
(naxh oCa1 r'iccr,ifncccri�to rsx!vc<iafortni'ioa pc-tbiain6 w.11
( I am a sole prop
netor and have no one wor�dng for me.
( ) I am,a home owner performing all Lbe work myself,
NOTE:ple.se be a w-am tfi,•Mj-jo 6emeoKaers.vbo c=play prior=to 6o csr oo c rgair—0ric as e d%--IL-Z of
on(Mcce Lb=thr-tmitr is u'akh the bomoo+wc resido or ca the pvuadr t9purtcc=tbcao c."c oo(C=�. _Uy oo=.d- d to be
eitployc-z I' a the Duids O=P--+.oa Act(GL452-=1(5)�apptiesDon by a bomcoava far a lira=or pc-n I=y cvidmcc the
1--FA etaast oC es==Player under dao W,+,ce,Coazpoaaalioo Aet
i
[und,astaad tha a Dopy oC thi,mt.cros�m„y be for�.d•ded to rho pcparrmcoa of In�triJ ncedmcs'Offoe of ls�vr.noe for th.
eovar sc vcif eslioa and this Utz-=to s==)cvcracc uadcr soaioa 23A of),(GL 132 m ied w Lb-impositioa of aimiaA pca 16
000tix.iug of 1 fine orup to 51}00.00 arzfcc iMPriyoamey oCup to oac yar Lod n%i1 pcoxtoa in t x form of a Stop Wor--Ord-- and a
j fl=o(S 100.00 1(Ly tpinst me
For dcp.it u.e on17 -
Pcrtnif NUM cr
P. _ Lot rt
S i&natlur of Lic=Lscrfpc rmiucc Date
I
SECTION 8-CONSTRUCTION SERVICES "
81 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
r 3/ 3/e2
Address
—7 Expiration bate
Signature k Telephone
NotApplicable ❑
9�2eaixed� ome' 1-mprovemen€contra cz "° j
`
Corn nv Name Registration um er --
Address Expiration Date
016% 7 V(2 Telephone
SECTION 10-WORKERS'COMPENSATION 1NSU RANCE.AFFIDAVtT(M:G E.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......
It
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 Alterations) ❑ Roofing
El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks [Q Siding p': Other[dj
Brief Description of Proposed r
Work: I N Gi cl /�'-i�Lt dcnC^6'_'
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
'z.vl
ea.51 PTeW:,house.�a fno'. a -&'tl'li',-Y Mx+Ae+ s§'d!mpi`s e+C^#w e
#fa`e#o[TovlrEnu:
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.-:TOBE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR-APPLIES FOR BUILDING-PERMIT
I
I, /� �.1}yT�,��>/ X -c cif ,as Owner of the subject
property
hereby authorize L lir, ,��r-/ r, 1 fnf�ra✓ri
to act on my behalf,in all matters rel ve to work authorized by this building permit application.
Signature of Qhner Date
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. r
Print Name
Signature of Owner/Agent Date
or
Section 4. ZONING All Informatibtl 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 i I
Frontage `
Setbacks Front
Side L:k R:I L:� RJ E
Rear
Building Height
I
Bldg.Square Footage F " %
Open Space Footage % 4
(Lot area minus bldg&paved i
parking)
#of Parking Spaces 1
Fill:
volume,&Location) E
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW Q YES 0
IF YES, date issued:' I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW
1."k YES 0
IF YES: enter Book Page; and/or Document#"
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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 I
IF YES, describe size, type and location: j
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location:
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 0 r NO I
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Nortoampton �
Building Department ,.
RMain Street s
oom 100
rnpton,, MA 01060 s ra
410. 1240 Fax 413-587-1272
APPS FG E
N N TRUC r,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: Thrs section to be completed byoce
/ u €
,� p Lot Unit
Zonew Uverlay'Drsricf
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SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name I Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) 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 Z t 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=0 +2+3+4+5) Check Number
This Section For Official`Use Only
,Date
Building Permit Number. Issued:
Signature:
i
Building Commissioner/Inspector cf Buildings Date
rf
...344 BRIDGE ST
BP-2005-0460
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A- 101 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0460
Project# IS-2005-0609
Est.Cost: $33500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DMITRIY'S CONSTRUCTION 130937
Lot Size(sq. ft.): 29185.20 Owner: CAPERS RAYMOND L JR&PHYLLIS
Zoning:URB Applicant: DMITRIY'S CONSTRUCTION
AT. 344 BRIDGE ST
Applicant Address: Phone: Insurance:
P O BOX 1051 (413) 222-6879
WEST SPRINGFIELDMA01090 ISSUED ON:10119104 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS & SIDING
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 Occupangy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 10/19/04 0:00:00 1244 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo