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17C-194 (5) Harry L. Barstow Estimate DBA Handy Man Hank 136 Middle ST. DATE— ESTIMATE# Hadley, MA 01035 2/21/2004 57 Scott Norris 20 Wilder PL. Phone& Email Florence, MA. 01060 413-584-5346 - HandyManHank136 @aol.com DESCRIPTION QTY RATE TOTAL Remove old windows, scrape and primer case, 6 192.00 1,152.00 insulate weight pockets, install new windows and g trim and paint. Disposal Fee old sashes. 35.00 35.00 Material, insulation, caulk,paint, 6 27.00 162.00 Material Marvin windows with screens from 5 576.00 1 2,880.00 Cowls. Material, Marvin window with screen, from Cowls. 1 541.00 541.00 pant' Window prices may be different when actual sizes are ordered. I i i I 1 Terms: $3000.00 down and the rest due upon completion of work. TOTAL -- --$4,770.00 I authoize this work. ACORD `CERTIFICATE 017 .INSURANCE, 11/13/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Brooks-Neylon Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 80 West State Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Granby,MA 01033 INSURERS AFFORDING COVERAGE COMPANY A Atlantic Charter Insurance Company VDAC INSURED COMPANY Handyman Hank COMPANY 136 Middle Street C Hadley,MA 01035 COMPANY D 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. IN IR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS L Ck DATE(MMIDONY) DATE(MMIDDNY) (In Thousands) GENERAL LIABILITY BODII-Y INJURY OCC % COMPREHENSIVE FORM BODILY INJURY AGG $ PREMISES/OPERATIONS PROPERTY DAMAGE OCC $ UNDERGROUND PROPERTY DAMAGE AGG $ EXPLOSION&COLLAPSE HAZARD BI&PD COMBINED OCC $ PRODUCTSICOMPLETED OPER BI&PD COMBINED AGG $ CONTRACTUAL PERSONAL INJURY AGG $ INDEPENDENT CONTRACTORS BROAD FORM PROPERTY DAMAGE PERSONAL INJURY AUTOMOBILE LIABILITY BODILY INJURY ANY AUTO (Per person) $ ALL OWNED AUTOS(Private Pass) BODILY INJURY ALL OWNED AUTOS (Per accident) $ (Other than Private Passenger) HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS BODILY INJURY& GARAGE LIABILITY PROPERTY DAMAGE COMBINED $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X I STATUTORY LIMITS A EMPLOYERS'LIABILITY WCV00349201 7/25/03 7/25/04 EACH ACCIDENT $ 100,000- DISEASE-POLICY LIMIT $ 500,000 DISEASE-EACH $ 100,000 OTHER DLA;CRIPTION OF OPERATIONS ILOCATIONSIVEHICLESISPECIAL ITEMS C ,RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City Of Northampton EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL City Hatt 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT Main Street BUT FAILURE TO DO SHA IMPOSE NO OBLIGATION OR LIABILITY Northhampton,MA 01060 OF ANY KIND UPON TH ER,IT GENTS OR qfPRESENT 1VES. AUTHORIZED REPRESENTATI ArORD 25-N 3/93 ©ACORD CORPORATION 1993 AGENT COPY marry L Ba,rsto�' I)Ba Sank Mandy M 136 Middle S'T• Hadley,MA. 01035 W - 413-584-5346 C - 413-537-0135 C — 413-427-4432 - Roger —° Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 119936 Expiration: 9/21/2005 Type: DBA HANDY MAN HANK HARRY BARSTOW 136 Middle Street � ,o HADLEY,MA 01035 �✓ Administrator �anirrcoruvPal a�'� czc�uraetta BOARD OF BUILDING REGULATIONS . License: CONSTRUCTION SUPERVISOR Number: CS 086648 Birthdate: 05/06/1978 Expires: 05/0612007 Tr.no: 86648 Restricted: 00 ROGER W BARSTOW 136 MIDDLE ST HADLEY, MA 01035 Administrator Kitchens Carpentry Hank Barstow Baths Remodeling Decks THE HANDY MAN HANK Co. 413-584-5346 HandymanHank136@aol.com Property Yard Care Management Snow Removal MA.tic#119936 and Maintenance r �ASSAChIiSltt6 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 780CMR 108.3.4 to act as iris/her construction supc:-.,i,:or. 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 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 (lifyl of Narfljallipfnit 4 6 ��issacllttsctls ' - DEPARTMENT OF BUILDDJ G INSPECTIONS 212 Main Street * Municipal Building Northampton, hfnss. 01060 WORTCER'S COMTENSATION INSURANCE AIT'II AVIT v"Ith a principal place, of btlsir,esslresidoIlC^ .. , r Cl0 11CfE Uy CCI-LlI}-, U11:1 1 ?l1C palTl-s 'In'l Oi 7C'.f�1111', '.Ila!- ( I am 111 employe providing the iollov,,Mt ' :OI'r:C S compcns noll COi'Cr2`1,C i0r nl�' employees woi-Erig on t leis job A-r(.r4,vTlc- cf,(,,J e y- Lg C y Q 03 Lt g)�-n (h2-s-dranc- Company) l C C Nimnbc-r) Date) j I any a sole proul-Ictor, -len-T nonleO";v-De: (C"Cie one) and t:a':e aired this, contractors Listed beio ;i'i;0 c- th (T+alIIC Of COnIS1Ci0r) IRS nCC l CI ^2:i'j:PGI1C{ Tvt liIl�i) T?:.: 'li:C- Datc) (Name of Contracto:) 71IS� lace Co-�_r wPo!ic+' Ntslber; (3 fir,lion Date) (Nainc of Contractor) (Insr nc� Co ;_ ;iPolic. Nusr..rr r) �;. ;:cio.n Dat',) - (Name of Contractor) -- (Ins�rallc< Cotnr_.y!Potier Num>y�r) (I::r:i-:tio Dare) (cIL�Gt rc:'d+;t nc:al zist::;:!.^<-•.-::� t..,:-- - - � . ( l •Ull a sole prOprl Ui 2:1'1 ilt:'; no OI: i;?lliit' f0i :i1 "1111 a home No'Ii::plcasc tc ntvxrc t1uI sl:ilc tx:-c? r a 1 .3 m cr:-p.it not uxce t1t-o throo uni+s i u{ �+t he 1: ��;ttiz✓ r >u a;'`�:�:_.._i z ur cr r1 Lhc�o e c n{tvrall:i c; :::;_:c :o wc;i:ct's cc :_im -r (GL152 1(511 r+:;iir^ir;.,by a hntam. rs:`or a Lccx c�p-r,:i:::r.: :i rrc lcgsl ctatuc of r-n cz:ployx undo ti:-Wocicfc oz wr.tion?.ci I undc_-=taad thi i cmy of ttii ctatc:s'my bo fawn tldJ to tl»fY-Sxi t un of I d is ricl Mil :� Off-,w of ,c =a for t1x oov=&-VC-M=1ioo and tlt_t f1d'urc to c cot-r uc c,:�,icn 25A of 1.(GL.152 rut lc i to ttx imPOsilicr c r, ir_1 pcc�li s cvmistutg of a ftrr_of up to S 1-SWOO a:�1'x ir.:;trsr.=ti; of::p to cr.:)-:r .-.1 civil xrultia in f(-,-n c•f n Sic-,)';: i_Ch a:1 s fr of 51OO.W a day trr_in:t m:. _ - _ _ ------ i -- F,ciq;a:urv-""oil y ' Ycrrnit Numtx:r ___ i T ire n. /�j tr i -- ? 4L SCT10N 8 CONSRUCTION SERVICES 8.1 Licensed Construction Supervisor:j Not Applicable 0 Name of License Holder : 2OA�y d%,9-SJn L" C S OR(p(p y g' Ham L. Rars;tt3W License Number ... .A. Hanriy Nian Hark tl td# '°,+ �r- �7 C _ © 7 Address "1 ( � 584-3,A6 Expiration Date Signature Telephone �Re�e°re` i ame rnp ovement nntrar tnr Not Applicable O I.19 9 3 G Company Name Harry L.Barstow Registration Number D.B.A.Handy Mar,Hank 1:16 Middlar Rf. Hadley,NAIA Address 01)35 (A1 3 4 581f-5A6 Expiration Date Telephone SECTION 30 WORKERS' COMPENSATION-INSU,RANCE:AFFIDAVIT(M.G:L.•c. 152, § 25C(6)) +9lNwh`Y 9 .'i"cu 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...... O 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 buildine 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 R i i a � x .. SECT,lON5�ES,R FT�IONOF�F?�ROPOSED¢ IORK checktla I�ca�le 3 °mmxa New House ❑ Addition ❑ Replacemen endows Alteration(s) ❑ Roofing ❑ Or Doors I1 Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other [ ] Brief Description of Proposed Work: L lv�M ViA# IZeo L tmemf W JHJcw,5 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative B' Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 6 , ' .:Mw=0—a ndodition to" existingousrng compeefohlow.rng; 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? h. Type of construction L Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes Nc 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 SECT�t�TC 1+1NE8AUT#fORIZATION TO BECOIVIPLETED WHEN OWNEftSp ENTCONTRACTOR APPLIES FOR BUILDING PERIVII I, Cxo` Norr�S as Owner of the subject property hereby authorize/'. to ac or my behalf, in all atters ative oric authorized by this wilding permit application. Sao Li Signature of 9+r Date I, To as 9wme/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. �'A'N,y L l i�CTO w _ Print Nam Signature of Owner/Agen Date R t � 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 DONT 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 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 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: r t City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 - APPLICATION TO CONSTRUCT,ALTER,REPA}R��REAbVifi R DEMO ?' SH A ONE OR TWO FAMILY DWELLING 2 SECTION 1-SITE INFORMATION - i us on t4 be completed by ofFce 1.1 Property Address: 1 1 SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ff ff t� S T drr Is © wt le!_tr 1' Name(Print) i Current Mailing Address: i' Telephone Signature 15 2.2 Authorized Agent: Harry L Barstow, L N n D.BA. rr Ha Man Hank w � Name(Print) Current Mailing Address: Hadley MA 01035 - -" <9- -<-S�Z -S 3 Y6 C - .5-3 7 - 03 Ls- 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 (ti) 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 This Section-for Official Use-Ohl Building Permit Number: Date issued: Signature: Building Commissioner/Inspector of Buildings Date 20 WILDER PL BP-2004-0911 GIS#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 17C- 194 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateaory: BUILDING PERMIT Permit# BP-2004-0911 Project# JS-2004-1361 Est. Cost: $4770.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grout: HANDY MAN HANK 119936 Lot Size(sg.ft.): 5967.72 Owner: NORRIS SCOTT A Zoning:URB Applicant: HANDY MAN HANK AT: 20 WILDER PL Applicant Address: Phone: Insurance: 136 MIDDLE ST (413)584-5346 HADLEYMA01035 ISSUED ON.3129104 0.00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS 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:0 h 4/_a_O y —141 7 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. of Certificate of Occu anc si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 3/29/04 0:00:00 3524 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo