17C-033 (6) Ll
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MAR 2 8 2001
INSPECTIONS
MA 01060-
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Cook Restoration&Construction
13 Grove Street+ Haydenville,MA.01039
FH Phone 413 268 3265
MAR 232001
March 20,2001
DEPT OF BUILDING INSPECTIONS
NOR1 MPTON
97 North Maple Street
Florence, MA.
Cook R&C will perform the following tasks from the April 29, 2000 "Phase 1" list
Job #1 Install 2 skylights in master bedroom (Velux TPS are $273.30 more than VS) $3,603.
Job #2 Expand MBR closet. $200. increase to replace door in front bedroom when appropriate
salvage door is located. $1,600.
Job #4 Provide and install 2nd floor window seat over front entry. Cedar lining price not yet
available-will be offered as optional extra during construction. $ 682•
Job #5 New windows in den.To be changed to 3 casement windows from 2 dbl. hung at a cost
increase of$636. Muntin pattern 2w/3h. $4293.
As per 4/29/2000 sheet, add 2 dumpsters and permit costs. ($325.savings if only one dumpster
used). $970.
New 2nd Floor. Bath-K-721 Memoirs (white) tub with $184. drain and $481. faucet, K-2268-8
Memoirs (white) pedestal sink with$375. faucet, K-3429 Memoirs (white) elongated toilet with
$23.60 lever and $42.70 seat, tile floor,(1"hexagonal porcelain [white]), 3"x6"white shower tile,
wood wainscoting 54"high all walls, eliminate built-ins to right of new sink location, add more
formal mouldings to built-ins nearer door, "swing"heater if feasible, add new fan -light-heater,
switching and wiring for 2 wall sconces at mirror, new plaster, insulate as necessary as wall
cavities allow Fiberglas with vapor barrier, labor to install mirror or med. cab., t.p. holder and
towel racks. $17,916.
EXCLUSIONS: No painting costs are included , but a competitive bid will be provided for each
of the work areas. Asbestos related costs are not anticipated or included. Wiring for new wall
sconces in den as well as the possibility of electric heat or new or improved functioning of caste/
hot water heat is anticipated but not included.
Payment schedule; Total cost is $29,064. before extras, of which$5,064. is due at signing as a
deposit for special order windows and plumbing fixtures. One third of remainder is due at start of
job, second third 2 weeks into project and final third at finish. Extras or paint to be paid on
separate appropriate schedule. /)
Benton Cook Date: John Go Date: C v
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DEPARTMENT OF BUILDITIG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licensee/permittee)
with a principal place of business/residence at:
P&'41 J-'W/3 4 (phone#)
`s ( ty/state/ap)
do hereby certify, under the pains and penalties of pet ury, that:
k ( ) I am an employer providing the following worker's compensation coverage for my
` employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) (am a sole prop en o, general contractor or homeowner(circle one) and have hired
the co elow who have the following workees compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
f.
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheer if neo=uy to include info tioa pettnining to all oowract r=)
KI 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 white homwwnets who employ persons to do mairdc a a e,co dru oo or repair wont an a dwelling of
not mote than throe tails in which the bonmeowner resides or on the vviads appurtenant thereto arc not generally ooandercd to be
employers under the vmc ees compenst4ca Ad(OL152,ss 1(5)),application lry a homeowner for a liceasc or permit may eviderloe the
legal tutu of an employer undert w Workeeit compematioa Act
I understand that a copy of this rtatcmeat may be forwarded to the Detnrta000t of Indruftial Acddm&t)foo of Iawraace for the
coverage vcrificelioa and that failwe to sac=coverage under section 25A of MGL 152 can lead to the imposition of criminal penalties
000sistiag of a fine of up to$1,500.00 anNor impttso=xcl of up to one year and civil pmattia in the form of a Stop Work Order and a
fine of 5100.00 a day agniust tae.
gPermit trae arse aoty
Number_.______—Lot#
Xlpabmicensee1permittee
SECTION -CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
TZ
Name of License Holder: �L
License Number
Address / Expir ion Date
L/
Signature Telephone l
' Not A
h pp licable [I
COMDanv Name Registr tion Number ,
M-e 17d ql ol
Address V Expi tion date
"—" PTelephone ,,2 C9-3,261
SECTIO, lU WORKERS''COMPENSATION INSURANCE AFFIDAVIT(M.G L.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.
igned Affidavit Attached Yes....... ❑ 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 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
5- F O P e al lic
New House ❑ Addition ❑ Replacemen endows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demoli ' n❑ New Signs [ ] Decks [ ] Siding[ Qther[ ]
Brigf Descripti n of Proposed yv or A d e IV fli. A q Q1 5 `<"v e.Mo )Ma
C toc,k+ I C ,�a f''w• ek P'D1c� ,
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Ren a�ting� unfinished basement Yes 04 No
Plans Attached Roll❑ • Sheet❑ J pus;,AS�N`g LU;V\rJ�t7tA� f L� �C�c�W its r c.o� V\Kkk��
A
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. D�m nsions
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 AGENT OR CONTRACTOR APPLIES FOR;BUILDING PERMIT
I , 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
l 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
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 0 0
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking) nn
#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:
D. A e ere any proposed changes to or additions of signs intended for the property ?YES_
No
IF YES, describe size, type and location:
� ,; r------ rthampton
1 Buil i epartment
I: MAR 2 3 2001 2 i n Street
Roo 100
D�opt BUItpING IN p m pt n, MA 01060
0 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
stCT:i# N 1-'SITE"FNFORMATION
1.1 Property Address: "his send tia!
c� v
7 � J P,
"Orfe
s.�
SEC ITVN Z'.011OPERTY.01NNI RSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'N 0" *"e 'r C-0. � V, /,!N 97 Ma s?
ame(Print) Current Mailing 3D
Telephone Lf�
Signature
2.2 Au ho ' A ent:
a� 3 S
Na (Pri Current Mailing Address: Q 039
T1 r y 3 A ,6 !>
Signat r Telephone
ECTI{?I "3.t frS I ATED-ONSTRU01ION 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 =G + 2 + 3 +4+ 5) Check Number Y
I This Secto "For Official Use Only
wilding Permit Number., �/ 7 `� date Issued:
signature;
Building CommissionerAnspector of Buildings Date
File#BP-2001-0750
APPLICANT/CONTACT PERSON COOK&PIASCIK CONSTRUCTION
ADDRESSIPHONE 13 GROVE ST (413)268-3265
PROPERTY LOCATION 97 NORTH MAPLE ST
MAP 17C PARCEL 033 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 / `_
T_vpeof Construction:_INSTALL SKYLIGHTS EXPAND CLOSET,REPLACEMENT WINDOWS&
BATHROOM RENOVATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 049209
3 sets of Plans/Plot Plan
T�/LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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 Co ssion Permit from CB Architecture Committee
� J
_3 O
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.
97 NORTH MAPLE ST BP-2001-0750
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-033 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
CateVory:Non structural interior renovations BUILDING PERMIT
Permit# BP-2001-0750
Project# JS-2001-1414
Est.Cost: $27000.00
Fee: $110.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: COOK & PIASCIK CONSTRUCTION 049209
Lot Size(so. ft.): 22869.00 Owner: GORRA JOHN M JR&
Zoning:URB Applicant: COOK & PIASCIK CONSTRUCTION
AT. 97 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
13 GROVE ST (413) 268-3265
HAYDENVILLEMA01039 ISSUED ON:3129101 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL SKYLIGHTS,EXPAND
CLOSET,REPLACEMENT WINDOWS & BATHROOM RENOVATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/29/010:00:00 1248 $110.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo