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17A-188 (7) 21 KIMBALL ST BP-2016-1072 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map.Block: 17A- 188 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: BUR4ing DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) CateiZory:renovation BUILDING PERMIT Permit 4 BP-2016-1072 Proiect# JS-2016-001826 Est. Cost: $14264.00 Fee: $�92.0 Q PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HARLOW BUILDERS 052460 Lot Size(sq- ft.): 14810.40 Owner: BELL ROSS J Zoiiiim: URB(100) Applicant: HARLOW BUILDERS AT.• 21 KIMBALL ST Applicant Address: Phone: Insurance: 336 COLES MEADOW RD (413) 586-0465 Workers Compensation NORTHAMPTONMA01060 ISSUED ON.318120160:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE BATHROOM & CLOSET 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: FeeTvpe: Date Paid: Amount: BUilding, 3/8/2016 0:00:00 $92.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1072 APPLICANT/CONTACT PERSON HARLOW BUILDERS ADDRESS/PHONE 336 COLES MEADOW RD NORTHAMPTON01060(413)586-0465 PROPERTY LOCATION 21 KIMBALL ST MAP 17A PARCEL 188 001 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: RENOVATE BATHROOM&CLOSET New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 052460 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Commission Permit DPW Storm Water Management of ' n lay Signature o Build' g Officia 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. Department use only ity of Northampton Status of Permit 2. e uilding Department Curt►_cut 6rl 212 Main StreetSewer/septic Room 100 WaterlWellAvailabil Northampton, MA 01060 Two Sets of Structural Plans NP= -=T phone 413-587-1240 Fax 413-587-1272 Plct/Site bans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: (� This section to be completed by office kC l rn tJ CN, I I Map Lot Unit 1C) Zone Overlay District i Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of • rd: �SjPi I at k;rpl-g-xi), 1)1() Name(Print ' CMailing Address: urrent 1141'7) _7�;k'7 _ '3/ Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature 10 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building --7 D �? (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=(1 +2+3+4+5) 1 y (�'j y,C) Check Number This Section Far Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 7 ' ' 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 3 Frontage Setbacks Front Side R: L: R: f 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/Fi ndi 4ever been issued for/on the site? NO Q DONT KNOW y YES IF YES, date issued: IF YES: Was the permit recorded at khe Registry of`Feeds? NO Q DONT KNWW 0 YES IF YES: enter Book Page` and/or Document# B. Does the site contain/bk y of water or wetlands?', NO ® DONT KNOW Q YES IF YES, has a permed to be obtained from thip Conservation Commission? Needs to be obtaiObtained © , Date Issued: C. Do any signs exist ony? YES © N01`\IF YES, describe sizlocation: D. Are there any proposo or additions of signs intended for�he property? YES ® NO IF YES, describe sj e, type and location: E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1�cre or is it part of a common plan that will disturb over 1 acre? YES ® NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable New House ❑ Addition Replacement windows Alteration(s) Roofing r__J Or Doors 13 1 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[0] Other[M Brief Description of Proposed Work: 'e- k.)A (I\ "A_ Alteration of existing bedroom v"- Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existina housin , �omplete the following: a. Use of building:One Family Two Family_Other b. Number of rooms in each family unit: x0 Number of Bathrooms c. Is there a garage attached?—'I R,5 d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fire aces or Woodstoves Y 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 Buildingand oning regulations? —Yes No. I. Septic Tank_ City Sewer 7 Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED W"EN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PEWIT 0s5 Se 1 as Owner of the subject property hereby authorize to act on my behalf,in all ma rs relative to work authorized by this building permit application. � �..� �-7 fir . Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foreg6ing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name L7 Signatwe-of—Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Superviso : Not Applicable 0 Name of License Holder: \:�ClcA(J 5- 1-f License Number Address Expiration Date Sigh-aTure Telephono/ 9.Registered Home improvement Contractor. Not Applicable 0 5-- Com anyName Registration Numper \\N Address f Expiration Date Telephone SECTION 10-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. Signed Affidavit Attached Yes..... I No...... 0 11. _ .Rome 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston,MA 02114-2017 s www matssgovldia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: \U!.3 k:�Y4 G- Are you an employer? Check the appropriate box: Type of project(required): 1 Q 1 am a employer with 4. ❑ I am a general contractor and 1 6 ❑New construction employees (full and/or part-time).* have hired the sub-contractors __- 2.❑ I am a sole proprietor or partner- listed on the attached sheet. /• U Remodeling ship and have no employees These sub-contractors have g"] Demolition working for me in any capacity. employees and have workers' 9. F1 Building addition [No workers' camp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 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.[] 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. t Homeowners 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 nam 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 isproviding workers'compensation insarance for my employees. Below is thepolicy and job site information. Insurance Company Name: j���a�-tct�'�� / Policy#or Self-insC—C- S`' � DaterQ� Expiration SG 0�1 )(Z V� kk� �� Ci ��fi ev,\�"' � �1�6Q Job Site Address: ty/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 thepains and penalties of rju that the information provided above is true and correct. Si nature: ..../� � Date: (_7 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#: 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: f( v--'`�'1 S� � k h The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant -�� -7 lJ,0 Date Signature of Permit Applicant PROPOSAL Harlow Builders 336 Coles Meadow Rd. Northampton,Ma 01060 (413) 586-0465 Submitted to: H-(413) 727-3113 Ross & Erica Bell G- (413)210-6505 21 Kimball St. Florence, Ma, 01062 Page 1 of 3 March 2,2016 The scope of this project is to renovate the existing hall bathroom area. We hereby submit specifications and estimates for the work to be performed. All materials and labor to complete. All permits obtained by Harlow Builders. All debris caused by construction removed by Harlow Builders. See attached drawings for details on framing and placement of fixtures. Drawings by Harlow Builders Dated 11/12/15 Demolition: Remove all trim,shelving,wall and ceiling finishes down to framing.Remove finish flooring down to sub floor. Remove partial subflooring in the bathroom area.Remove partial framing to create a new doorway opening. Remove a 5068 bi-fold door in bedroom 2: Framinp_• Frame for two closet and two doorways as per plans,for a complete job. Electrical: (Allowance of $800) Includes: Permit for electrical work.Disconnect and relocate wiring for new construction. Bathroom: (1)Panasonic 110 Fan/light combination unit with(2)switches (1) GFI outlet (1) S1 for vanity light location Material and labor to complete.(Owner to supply decorative fixtures.) Heating: Replace existing floor register with a new floor register(Color to be determined) Plumbing: Includes: Disconnecting and removal of existing plumbing fixtures in the bathroom area. Re-plumbing as needed to install a new tub/shower,toilet,vanity sink and faucet. Fixtures and faucets listed below. (1)Aker SBA-3260 LH white soaking tub with Swanstone SSIT-60-3-010 bath panel system(white) (1)Hangro universal rough in valve (1) Hangro trim with volume control diverter. (1) Hangro shower arm and raindance 150 spray head. (1)Hangro focus tub spout. (1)Gerber#41-613 bath drain (1)Delta Lahara faucet valve trim (Chrome) (1) Gerfix AV-21-818 white Avalanche 17"Elongated Toilet. (1)# 1190 white elongated plastic seat Insulation: R-15 fiberglass batts installed to the exterior 2x4 walls. We will spray foam insulation around exterior windows. Sheetrock: l/2"Moister resistant gypsum board applied to the wall and ceiling areas. Fastened with 11/4"screws,taped,coated(3)applications and sanded to a paint ready surface. Bedroom closet area to be patched and finished as needed to complete. Interior Painting,staining& Urethane: New walls and ceilings,to be painted with (1)coat primer and(2)coats of finish paint.(Color by Owner) Interior doors to have with 3 coats of satin urethane applied. Bathroom Vanity Cabinet: (Allowance of$535) 30"x 21"Bertch Cabinetry,one door two drawers(birch,alder,hickory or oak wood) Vanity Top: (Allowance of$516) Cultured Marble solid surface vanity top/bowl 21 %"x 31".Granite pattern. Interior Doors: Hollow Core birch Doors,Hung on 4 9/16"clear pine Flat Jambs with chrome Hinges. (1)2068 bathroom closet door and (1)2668 bedroom 2: closet door. Interior Door Hardware: Schlage chrome knobs(1)Privacy Knobs,(1)Passage Knobs(1)Door Stop and (1)Hinge Stop. Interior trim: All door,window and base trim to match existing. Window and door casings to be 2%' ranch.Window sill to be 1x4 clear pine.Baseboards to be 31/2"ranch. We will install(4) 16"deep AC plywood shelves to the bathroom closet area.We will install a closet pole and shelf to bedroom 2: closet area. Underlayment: Install 1/2"ULC underlayment to the bathroom subfloor. Flooring Tile: (Material Allowance of$130) Install ceramic tile to the bathroom floor area. Bathroom Venting: Attach the existing fan/lite ductwork to the new Panasonic fan/lite unit. We propose to furnish the material and labor necessary for the completion of the above stated work for the sum of: Fourteen Thousand Two Hundred& Sixty Four Dollars. $14,264.00 Payment as follows: $4,000 upon completion Start of Demolition. $5,264 upon completion of the rough inspections. $5,000 upon completion of the project.(Certificate of occupancy) All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra cost will be executed only upon written orders in the form of a change order, and will became an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire tornado and other necessary insurance. Our workers are covered with workman's compensation insurance. Certificate of liability insurance will be sent to the above address upon signing. Respectfully Submitted by - �f Harlow Builders. ACCEPTANCE OF PROPOSAL I accept the above stated prices,specifications and conditions. You are hereby authorized to do the work as specified. Payment will be made as outlined. Date Signature Signature Option: (1)Aker 4 piece tub/shower unit#KDTS3260LHWHI (1)Hangro universal rough in valve (1) Hangro trim with volume control diverter. (1)Hangro shower arm and raindance 150 spray head. (1) Hangro focus tub spout. (1) Gerber#41-610 bath drain (1) Delta Lahara faucet valve trim(Chrome) (1) Gerfix AV-21-818 white Avalanche 17"Elongated Toilet. (1)# 1190 white elongated plastic seat Deduct$1,504 from Proposal Sw��\o��, e C oQ�S . �,�, ���� � S��o�� v� wcc�\ S 3 6 ��a m OOG �S III N N WT O //►Jy� 0 W j 1Rv1 o = 3 S9Al9us ul-jpng 01 5068 bi-folds 0 CD o00 c N 30" N 00 N 0 4 3 9902 Pole & shelf S;9Al9gS ° Ui 2668