17A-091 (6) 20 GRANDVIEW ST BP-2020-0926
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-091 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: ADD BATH BUILDING PERMIT
Permit# BP-2020-0926
Proiect# JS-2020-001577
Est.Cost: $15500.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO.-
Const.
O.Const.Class: Contractor: License:
Use Group: JASON FORGUE 092886
Lot Size(sq.ft.): 11630.52 Owner: FORTON DAVID
Zoning_Ri(100)/URA(100)/WSP(0)/ Applicant: JASON FORGUE
AT. 20 GRANDVIEW ST
Applicant Address: Phone: Insurance:
23 BROMLEY RD (413)205-6504 SOLE PROPRIETOR
HuntingdonMA01060 ISSUED ON:2/18/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 3/4 BATH IN BASEMENT, REPLACE
KITCH COUNTER
POST THIS CARD SO IT 1S 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:
FeeType: Date Paid: Amount:
13 u i d i n
2/18/2020 0:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
rQ
_ _ _ Department use only
City of NorthamptonSt tus of Permit:
r Building Department FEB 1 4 Curb CWDriveway Permit
212 Main Street -00- Sglwer/Sjeptic Availability
Room 100 W terl ell Availability
T. Northampton, MA 8 sun-D!�ir,insPFc Tiara Seth of Structural Plans
�.
phone 413-587-1240 Fax 41 ' ` °1' rna of
WSite'Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: aA �n/��/��1 S�, / This section to be completed by office
11AI Y/t { Map l 7/f Lot aol—1 Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of ecord:
FY40A /I k y"M I r1ol�nc�+�D�a
Name(Print) /��n n/y Current Mailing Address: , 3_n'3`(99 j
y. WUL IVIS Telephone l� S �/�U
Signature
2.2 Authorized A ent:
V 3 OSe
Name(Prin Current Mailing AddresV
X113- 'foS -I
Sig re V Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed bV permit applicant
1. Building q1300
(a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
a(�'j
vvvv Construction from 6
3. Plumbing 000 Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total = (1 +2+ 3+4+ 5) j Check Number -Z 6f
p /� This Section For Official Use Only
Building Permit Number: Ae—Q0 %, Date
Issued:
Signature: 0 AG _
Building Commissioner/Inspector of Buildings Date
�ToW @ yahoo.(�
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
'41�.—*-Vn�-",,';,-Ils (-N, Co
IZ
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 [0] Decks [0 Siding[0] Other[C7]
Brief Description of Proposed3/
Work: WV0D
' � rm"
Alteration of existing bedroom Yes_X_No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Ye _No
Plans Attached Roll -Sheet LA** ,V6
6a. If New house and or addition to existing housing, complete the following:
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
I, NA1
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matts relative toto wcl�i c aut
o authorized by this building p rmit application.
,Of (see � ow
Signature of Owner Date
I, 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 penaltiesof p rjury.
-Tdsl PAW /sO/k 0 QA_ p4mm
Print Name
Signat f OwnerlAgen Date
'Ace
:rsa .,.Y.. R,pixr'''Rip.' ,
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applica(b�llee(❑
Name of License Holder: Jmml� O�M U�0
License
Num
B . Dig �17a' i
Addre Expirati n Date
qW-
�-
V
i nature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Com an Name Registration Number
S bl M 3I as
Address Expirdition bate
&Mug 11 elephone 03'A-4%
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....... 9 No...... ❑
VIC
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City of Northampton
Massachusetts ���5`5
S'�,l;
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DEPARTMENT Or BUILDING INSPECTIONS a
212 Main Street • Municipal Building yeti �D
\ ... Northampton, MA 01060 -P
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes. Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered
Type of Work �,s6al� � , WWI � 1 � Est.Cost:—
Address of Work: dil
Date of Permit Application: Vlql
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
—Owner obtaining own permit(explain):
Building not owner-occupied
—Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
a rf uegotr W 19101q
Date ontr a HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
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City of Northampton
` Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
Northampton, MA 01060 ,
Debris 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.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
%qAM,
Please print n me 6 nd I ation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
Sd I\� ma 2 IN . RA*/ a�
(Company Name and Address)
Siture of P r pplicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
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\ The Commonwealth of Massachusetts
Department of Industrial Accidents
0 1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Leizibly
Name (Business/Organization/Individual): k - w
Address: N-) Pau �1
City/State/Zip: &AA4, MA0 Phone #: �L�' J_U 6V
Are you an employer?Check the appropriate box: Type of project(required):
I.F]I am a employer with employees(full and/or part-time).*
7. New construction
2.R I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. Demolition
3.a 1 am a homeowner doing all work myself. [No workers'comp.insurance required.]'
10[� Building addition
4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees.
12.E]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.*
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
"Any applicant that checks box#I 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 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 MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify der the d e alties of perjury that the information provided abovelissl1true and correct.
V?
Si nature: //fi�tt �.p� Date: J_U
Phone#: 3- tI,l1J - J
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 S. Plumbing Inspector
6.Other
Contact Person: Phone#:
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Proposal
�r. Solid BASE Enterprises LLC
23 Bromley Rd.Chester,MA MA 01011
(413)205-6504
047
MA CSL#092886 J
HIC Reg.#171014
Proposal Submitted To Work To Be Performed At
Name David Forton Street 20 Grandview St.
Street 20 Grandview St. City Florence
City Florence State MA
State MA 01062 Date TBD
Telephone 313-8775
We hereby propose to furnish all the materials and perform all the labor necessary for the completion of
Construction of a 8'x7'bathroom in basement including shower unit,toilet and single bay vanity and sink. Price
includes opening up and replacing basement floor to allow for connection to main sewer line. Allowance for all
fixtures is$1,400. Price includes waterproof flooring over Dri-Core subfloor with allowance of$450. $11,000
Replacement of countertop in kitchen with granite(Allowance$40/square foot)and new sink and faucet to be supplied
by homeowner. Gas stove top to be installed in counter along with spacers installed to allow for the installation of
a dishwasher where current stove is located. Color to match as best as possible with existing and new toe kick
installed. Allowance for stove top and dishwasher-$1,000. $4,500
No additional work to existing home is expected beyond what is expected to complete items listed above. All overage
costs require 50%due upon acceptance and 50%upon completion. Verification of setbacks to be completed upon
acceptance of proposal and application for building permit.
Solid BASE responsible for removal of all debris resulting from construction.
All material is guaranteed to be as specified,and the above work to be performed in accordance with the
drawings and specifications submitted for above work and completed in a substantial workmanlike manner
for the sum(in US dollars)of: $15,500.00
with payments to be made as follows: 10% One thousand five hundred fifty dollars due upon acceptance of
proposal. 300/6 Four thousand six hundred fifty dollars due two weeks prior to commencement of work. 30% Four
thousand six hundred fifty dollars)due upon rough traming/insulation signoff by inspector. 209'0(Three thousand one
dollars)due upon installation of all electrical and plumbing fixtures. Remaining balance(One thousand five hundred fifty
dollars)due upon completion.
Any alteration or deviation from above specifications involving extra costs will be executed only upon written
orders,and will become an extra charge over and above the estimate.All agreements contingent upon
accidents or delays beyond our control. Owner to carry all necessary insurance upon completion of above work.
Respectfully submitted Jason For ue,President
Date 12/27119
Note--This proposal may be withdrawn by us if not accepted within 21 days.
ACCEPTANCE OF PROPOSAL
The above prices,specifications,and conditions are satisfactory and are hereby accepted. You are
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allU194led to do the work as specified. Payment will be made as outlined above.
Accept. �/� CI'J Signature
Date Signature
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constructiop,-Sup r °: ir.1 &2 Family
CSFA-092886 Expires: 06127/2021
JASON R FORGUE
23 BROMLEY ROAD
HUNTINGTON MA 01060
Commissioner
office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:LLC
Realstration &N*AILQD
171014 01/31/2022
SOLID BASE ENTERPRISES LLC,
JASON FARGUE /
23 BROMLEY RD. `
HUNTINGTON,MA 01050 UndetsecretwY
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