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37-065 106 BLACK BIRCH TRAIL BP-2008-0761 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 37-065 CITY OF NORTHAMPTON Lot: -006 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:_ ]BUILDING PERMIT Permit# BP-2008-0761 Project# JS-2008-001178 Est. Cost: $830.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sy. ft.): Owner: ENTIN DAVID&DOROTHY RIEHM Zonis ;: SR Applicant: ENTIN DAVID & DOROTHY RIEHM .4 T. Ills, RI ACK Applicant Address: Phone: Insurance: 106 BLACK BIRCH TRAIL (413) 341-3042 0 F LORE NCEMA01062 ISSUED ON:4/8i2008 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SHEETROCK & INSULATE BASEMENT CEILING & BASEBOARD-NOT A BEDROOM, INSUL INSP REQ'D POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector i lnderground: Service: Meier: Footings: Rough: Rough: ]Huse# Foundation: Driveway Final; Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: O fc A THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 2 Certificate of Occupancy6--- 4r�_---4� Signature: ---.- FeeType: Date Paid: Amount: Building 4/8/2008 0:00:00 $50.001899 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo BP-2008-0761 GIS #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -006 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0761 Project# JS-2008-001178 Est. Cost: $830.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): Owner: ENTIN DAVID&DOROTHY RIEHM Zoning: SR Applicant: ENTIN DAVID & DOROTHY RIEHM AT: 106 BLACK BIRCH TRAIL Applicant Address: Phone: Insurance: 106 BLACK BIRCH TRAIL (413) 341-3042 () FLORENCEMA01062 ISSUED ON:4/8/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL SHEETROCK & INSULATE BASEMENT CEILING & BASEBOARD-NOT A BEDROOM, INSUL INSP REQ'D 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: FeeType: Date Paid: Amount: Building 4/8/2008 0:00:00 $50.001899 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo File#BP-2008-0761 APPLICANT/CONTACT PERSON ENTIN DAVID&DOROTHY RIEHM ADDRESS/PHONE 106 BLACK BIRCH TRAIL FLORENCE (413)341-3042() PROPERTY LOCATION 106 BLACK BIRCH TRAIL MAP 37 PARCEL 065 006 ZONE SR 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: INSTALL SHEETROCK&INSULATE BASEMENT CEILING&BASEBO17 New Construction Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan 1V et A 564I2-1'frt _ I NSW.. (N S PK"f(&) l V THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: pproved 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 Demolition Delay c:// 0 / alo Signature of Building fficial 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 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 1+� I 212 Main Street Sewer/Septic Availability ` I Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans ws3 1 Q Oi e 41.3-587-1240 Fax 413-587-1272 Plot/Site Plans 'Re Other Specify t C APPLICATION TO COt4STRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1. Property Address: �n �? 1 ( 1 6 1 I'1,C IH 1 F Pr Map v '7 Lot �` 5 Unit l0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 0 A V �i) ENT 1 l� lib l—�« �1 R C14- TR L Name(Print) Current Mai ing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee Sj0 3,7 • 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) Check Number /f9 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector ofB ildmgs — Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information HOC J'y Existing Proposed Required by Zoning This column to be filled in by • II Building Department G 4'N 9 0 Lot Size pJ Frontage .. 'V Setbacks Front ____ __. Side L: R: L:`: , ..R: ._._.. Rear a Building Height Bldg. Square Footage % Open Space Footage .._ __ ___.. % = _- (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) .. i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES 0 IF YES, date issued:` IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q Date Issued: I C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. S , SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) Roofing n Or Doors E Accessory Bldg. E Demolition ❑ New Signs [0] Decks [[J Siding[0] Other[0] Brief Description of Proposed n [� Work: APO CEZ -JMG- !tNO I A- 6 k'"A )) Alteration of existing bedroom Yes / No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement ,/ Yes No 4 n,La(�( Plans Attached Roll -Sheet 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? ;N d. Proposed Square footage of new construction. l'2 �( ,S= Dimensions I e. Number of stories? - f. Method of heating? 6-A5 i? UCT' Fireplaces or Woodstoves V Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction llOcc( F c ; 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? f Yes No . I. Septic Tank City Sewer I/ Private well City water Supply V SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT • I )) \)'t E 1V f�l , as Owner of the subject property hereby authorize S 1 ► or) CAMP to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of of 0� Date , 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 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 Company Name Registration Number Address Expiration Date Telephone i — 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 0 No 0 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 Northampto rdinances, State and Local Zoning Laws 'and State of Massachusetts General Laws Annotated. Homeow er Signature 6�i . 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 Legibly Name (Business/Organization/Individual): _ tA unless: City/State/Zip: Phone #: 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 employees (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 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.C I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 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 outsidecontractors 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-u-nder-the-pains-and-penalties:of-pexjuay-that the information provided above is true and correct. Signature: Dater- - Phone#: ___,...__OffciaLlrse..anl}r _Du rite_inlhis_azea to completed 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 #: .? ,tom} \ r 173i ??LJ J► L = i'_*n"`^ 1J LP?p 1..i=NT OF E . n\G Zv Sl Sr,'T?O ti S --=c '" 212 Main S Tett • Municipal E uilding "= INSPcw ✓` Northampton, MA QIG60 - HOME OWNER NER EXEMPTION ACKNOWLEDGEMENT 1 The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to 1 act ZS his/her construction sup ~sor. 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 tvenirg, 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-btAld -Ze - ent for the City of Northampton wants any persons)who seek to use the hone otivner 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 deparrient be called to inspect work at various stages, which include foundation/footings (before bacidilI). so-notube holes (before your). a rough building inspection (before work is ca TIC€aled-). insulation insyectiun (if recruii-ed)and a f*hai bui1din,7inspection. The building deparunent requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occunancv until the-work--can--be insoecte ... . 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 >( 4-r ____ — understand the above. (Home_owner/resident's signature requesting exemption) I will call to schedule all required buiIdin,inspections necessary for the building permit issued to me. ',- Date _ Adcirs-Ss of work _. .. location Simon Camp Ask Me How Handyman 78 Old Amherst Road Sunderland, MA 01375 413 230 6626 • simon@askmehowhandyman.com Work Proposal and Estimate of Costs Customer: David Entin Address: 106 Black Birch Trail,Florence MA 01062 Tele p hone: 413 341 3042 Job description: 1)Insulate and sheetrock basement ceiling. 2)Install lx4 baseboard in basement and on stair landing Date: 14-Feb-08 Materials: Quantity Unit cost Total Insulation: 6"faced insulation(77.5sqft) 4 $38.30 $153.20 Sub Total $153.20 Sheetrock ceiling: 112"x4'x8 I'h sheetrock 9 $7.86 $70.74 Screws, tape,joint compound etc $10.00 Sheetrock lift rental $33.00 Sub Total S113.74 Install baseboard: 1x4x12 select pine 3 $12.83 $38.49 1x4x10 select pine 1 $10.69 $10.69 1x4x8 select pine 2 $8.55 $17.10 Nails,glue etc $7.50 Sub Total $73.78 Total Materials $340.72 Labor: Install ceiling insulation $70.00 Sheetrock basement ceiling $350.00 Install baseboard $70.00 Total Labor $490.00 Grand Total $830.72 Please retain a copy of this proposal for your records. Thank you. `I t5)0,-1 ko,oAtiw ( - Into tF (.-PcR , lAcH L F. 1,o 60c-E ) NA- 0iob