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DATE: May 29, 2015
e- - -;- EST# GC52915
MARION GELLER& KAMAS CHOI
MA CS LIC. 70008 HIC# 124718 22 Lincoln
223 Main Street Northampton, MA 01060
Leeds, MA 01053
Phone 413-221-7419
email: arbetkar @crocker.com
-� CARPE TRY REPA[R
SCOPE OF WORK
Side Porch Entrance: New stairs matching existing pressure treated materials. Handrail
materials to be determined. (also add"threshold" board @ shed)
Front Porch Entrance: New Stairs, *Sister(fasten)a new new framing member to
existing framing or replace diagonal framing member under rotted flooring, replace
triangular section of flooring with tongue and groove fir to match existing.
Interior Wall repairs: above refrigerator and at stairs to 2nd floor.
Total Job Cost for Above Work: $1,600.00
PAYMENT SCHEDULE
Due Upon Accepatance of this proposal $800.00
Due Upon Completion of Work $800.00
CONSTRUCTION AGREEMENT(Sign to accept proposal)
This is an agrep.Ment between Karen Carter, Licensed Construction Supervisor
(Contractor) (Date: ?� - l,",sole proprietor ofiKaren Carter Carpentry
and Marion Geller _ (Date: 5 t 3d I 1_5 )and/or
Kamas Choi (Date:5,;�. IS ) (Homeowner(s)of property at 22
Lincoln Street, orthampt n, 60 for the scope of work as outlined above. Contractor agrees to
provide materials, keep work-site neat and clean for duration o fand upon completion of work, provide dust
protection for interior work and complete work in a timely and worker like fashion.The time frame of the
work is expected to take approximately 3 work days to complete with the understanding that interruptions
due to bad weather could prolong the duration of the work.
UNFORSEEN CONDITIONS
*ff there is more rot damage to the support structure than visible on initial site visit, Contractor shall stop
work, notify Homeowner(s) of the condition, and discuss the scope and added cost to complete the repair
effectively. Homeowner(s) shall approve scope and cost changes prior to Contractor continuing work.
CONSUMER RESOLUTION DISPUTES and COMPLAINTS
The Contractor is registered with the Commonwealth of Massachusetts and any inquiries concerning this
registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton
Place, and Room 1301. Boston, MA. 02108, telephone(617)727-8598.Claims or disputes relating to this
agreement or any provision of it shall be resolved before a single arbiter approved by the Secretary of the
Executive Office of Consumer Affairs and Business Regulations and according to the Construction Industry
Arbitration rules of the American Arbitration Association, unless both parties mutually agree in writing to
other methods.
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 27 L i
The debris will be transported by: j P� � cl%-Tep"
The debris will be received by: �- � 7, UDC L :57
Building permit number:
Name of Permit Applicant C �
Date Signature of Permit Applicant
City of Northampton
r
j Massachusetts
--x
DEPARTMENT OP BUILDING INSPECTIONS
1 212 Main Street • Municipal Building
`���•" Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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
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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant-Information Please Print Le ibl
Name (Business/Organization/Individual):
Address: 2 2 )A A 1 ,
City/State/Zip: A– C)I 0� Phone#: /_0 r 2 2 ( — �(
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
e ees (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' g ❑ Building addition
comp. insurance.T
[No workers' comp. insurance
5. F-1 We are:a corporation and its 10.❑ Electrical repairs or additions
required.]
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 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 their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors 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. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job 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 c. 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 ofperjury that the information provided above is true and correct.
Sign ature: Date:
Phone#: 2 2 t
Official use only. Do not write in this rea, 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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su rvisor: Not Applicable £
Name of License Holder: � ?r/ dog
License Number
Address Expira on DA
1-ql� ' 2-11 -?01
Signature Telephone
9.k61flater6d Home.improvement'Con'tractor ,. ._.._ ., Not Applicable £
Company Name Registration Number
�� � � . 6 �
Address Expira on Date
Telephone Nay�-2 f. Cj(
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c..162,§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...... £
11 -=Home Owner"Exemption;
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.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors D
Accessory Bldg. ❑ Demolition New Signs [[J] Decks [p Siding[0] Other[o]
Brief De ripption,oqf Projapsed �A ,,r 1
Work: OU K C1'�(i u(J UP-,kc 90-rm PI ��-VjAL f� NIla6fJ
Alteration of existing bedroom Yes -""No Adding new bedroom Yes ----No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Ba,:If.New house and:or'adtlition to existing h66' In- `complete the fo)"64:
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-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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
1 � as Owner/Authorized
Age 6t hereby declare that t e statements and in n on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signeq under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
. .
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
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved L--j
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Varianoe/FindinQ ever been issued for/on the site?
��
�-\ x�� x��
NO ��' DONTKNOYY YES «��
IF YES, dateissuedj
IF YES: Was the permit recorded at the Registry ofDeeds?
NO �� DO
NT" / ^no,, 0 YES
IF YES: enter Bnuk Pag and/or Document#
B. Does the site contain a brook, body of water orwetlands? NO 0 DON7 KNOW 3 YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained x~� Dbtained �-` Date |ysued.
'
�_� «�� '
C. Dn any signs exist on the pvoperty ��� 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 0 NO 0
IF YES, describe size' type and location:
E. Will the construction activity disturb(clearing,gradingexcavation,orfi0ng)over 1 acre nrbit part nfo common plan
,
that will disturb over 1acre? YES NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
' -.
D tv C5 F- s � '-'(- 1 s-
.. I r
4 u�,p k `}3i' ,�r'�Pepattr,�eht use only at P�to .,, sr M'
(lam City of Northamptontatus,of Permit jM:a �� k ,. r..-1 �i{6�iEtif�s,En sr2`r r'�'
01
uBuilding Department a
L
212 Main Street
Room 100
orthampton, MA 01060 TwaSetsrdt5#rciulal Plan 1,V n 11' ,n: i'Al ieA 3-587-1240 Fax 413-587-1272 PloWte Plans'S ��7
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
' � This section to be completed by office.'-
1.1 Pro a Address:
Map Lot Unit
Zone 1 . Overlay D►sYr�ct
1.
Elm St_.Distnct CB:Distract :.
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
71
2.1 Owner of Record:
a r hccky C-ie I l-er-
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 A thorized Agent:
Name(Print) urrent ailing Address:
Signature Telephone c1=�
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Feb
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) C� Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspec tor'of Buildings Date
File#BP-2015-1256
APPLICANT/CONTACT PERSON KAREN CARTER
ADDRESS/PHONE 223 MAIN ST LEEDS01053 (413)221-7419
PROPERTY LOCATION 22 LINCOLN AVE
MAP 25C PARCEL 088 001 ZONE URB(100)/
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: REPLACE FRONT PORCH ROT&POUR FOOTING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 70008
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
oved 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 Commission Permit DPW Storm Water Management
Demo ' ion Delay
S� ure of Buildin 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.
22 LINCOLN AVE BP-2015-1256
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-088 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:renovation BUILDING PERMIT
Permit# BP-2015-1256
Project# JS-2015-002315
Est.Cost: $4000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: KAREN CARTER 70008
Lot Size(sa.ft.): 6621.12 Owner: GELLER MARIAN J&GINA-KAMAS B CHOI
Zoning.URB000)/ Applicant: KAREN CARTER
AT. 22 LINCOLN AVE
Applicant Address: Phone: Insurance:
223 MAIN ST (413) 221-7419
LEEDSMA01053 ISSUED ON.612312015 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE FRONT PORCH ROT & POUR
FOOTING
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 Shinature:
FeeType• Date Paid: Amount:
Building 6/23/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner