11A-048 (2) 3 VILLONE DR BP-2022-0145
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 1 lA-048 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:replacement windows/siding BUILDING PERMIT
Permit# BP-2022-0145
Project# JS-2022-000255
Est.Cost: $37300.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(so.ft.): 11630.52 Owner: CHAMBERS COLIN&KERRY M
Zoning: URA(100)/ Applicant: STEPHEN CAMP
AT: 3 VILLONE DR
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527-7124 () WC
EASTHAMPTONMA01027 ISSUED ON:8/9/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS, DOORS,
SIDING
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/ ` ' .,2 . 9-0,
FeeType: Date Paid: Amount:
Building 8/9/2021 0:00:00 $100.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
9P'
r IV r —--- Department use only
,,Ts�-r�r City of Nor� E
ham atus Permit:
Building Depart ent rb C t/Driveway Permit
212 Mal Street AUG - g 2021 wer/ eptic Availability
rt%,. fr
Roor i 10 ater ell Availability
Northampto , M wo S is of Structural Plans
_phone 413-587-124 F P 44 "272PECTio ovae Plans
N.MA 01060
.Q ier pecify
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¢y office
/ ��+ Map ti /4 Lot OqQ Unit
3 t/i
Zone Overlay District
-e-- ,f P2 'cirfri5',' 40 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ieer-KName(Print) / Current Mailing Address:
53/- 271/
Telephone
Signature
2.2 Authorized Agent:
S4'riplv_44 C'4'^'r, £ 3/ fi''1- 1A-5Aleh.,1 ✓L.i'.-
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 *1? 3d0 /9 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
di 00
4. Mechanical(HVAC) g
5. Fire Protection
6. Total =(1 +2+3 +4+5) isf ` 3 a a, ciu. Check Number of
This Section For Official Use Only
Building Permit Number: Eta- -7'1'/ /'S Date
Issued.
Signature:
Building Commissioner/InspectorCem
o of Buildings Date
- try 6 @ /9 l Ai. oil
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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
Side L: -- R: t
$ l W
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 0 DON'T KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES ® NO 0
IF YES, describe size, type and location: I
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, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding[ J] Other[O]
Brief Description of Proposed —7
Work: < D� ��zGus�wrf�1/�..e�,�,,i� yf Cr�c" Ddc'.e_y New itI iyl S!n 1,1
Alteration of existing bedroom Yes X No Adding new bedroom Yes K No U.FoQ
Attached Narrative Renovating unfinished basement Yes ,' No
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?
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, , 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
et) , as Owndr/Authorize
Agent hereby decla e that the statementf 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.
C '1es
Print Name
41
37 e/
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder " 4411 ,v 2 0)
/� License Number
C 4 cer L �}�y 4!-�w/ h�'� 01027 11 ZJ Z
Address Expiration Date
q/9 [2 7- /27.
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
CA--vip' •z/Tr�/Gfz /) $7
Company Name Registration N mber
1 o- //3 z2
Address ,�� v� Expiration6-fro
Date
G Telephone ) ^ / g7 '/ 19//!7
viyryy
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 No ❑
City of Northampton
' , + *' A Massachusetts
N
$t DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building
Northampton, MA 01060 Wr-'ti�
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:
//9 °-L,C r /c-44,
(Please print house number and street name)
Is to be disposed of at:
(Please/print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
4-bys Cat4-)-/-4-t & /-41,/k,
( pany Name and Address
272-
Z /
Signature of Pe Applicant or Ow er 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.
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
• 1 Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information / Please Print Legibly
Name (Business/Organization/Individual): S` /'L /
Address: V/ Ik-ft 51"/GGr
City/State/Zip: i,. 4 4r.1) MA AeLQPhone#: 9/3 5'27-- 7/sf
Are you an employer?Check the appropriate box: Type of project(required):
I.Kam a employer with employees(full and/orpart-time).* 7. ❑New construction
2. am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]f
9. ❑Demolition
10 ❑Building addition
4.❑I 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.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.0 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.[ thee IA n yl 5'pi
1ti{
152,§1(4),and we have no employees.[No workers'comp.insurance required.] '1 r J
*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 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: ke„ P✓Ltti✓'/G<.,/ Z f, Co.
Policy#or Self-ins.Lic.#: (./7 Z///.SJaf 2 2 Expiration Date: j2 Z
Job Site Address: 11'//lo i!,C fi►"&G+. /G4-Qf " ( City/State/Zip: /t iJ )14•L Ot p 3..
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and enalties of perjury that the information provided aboveve is true and correct.
Signature: Date: ?/d/ Z-/
Phone#: '//? X2 9— ?/2-
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
,r
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To ; Kerry& Colin Chambers Phone- 531-2361
Address : 3 Villone Drive Date—3-13-2021
Leeds, Ma 01053
We hereby submit this estimate for—Siding Job
To start the job We will install backer board on the whole house.
I will trim all fascia boards,window and door trim with aluminum.
All siding will be installed(color is customer's choice) n l E S k
All overhangs will be covered in vinyl soffit.
Price for materials=$ 9850.00
Price for labor= $ 12,400.00 Total =$ 22,250.00
Building permit and trash removal is included in my price.
2(;r V. New Garage door installed by Raynor Door=$ 2050.00
-2,6, % Exterior doors=$ 650.00 each installed
d
5-7 I ' Sliding Glass Door=$ 1650.00
•7,, 7- Replacement windows= $ 350.00 each installed j IAA,410.A„,,,
Cc
Z Z ` Contractor Supervisors License number 082531
311 i ,
4, .
Home Improvement Contractor Registration number 135204
I propose to supply materials and labor-in accordance with above specifications.
This proposal may be withdrawn
By us if not accepted within 305lays
Authorized Signature
Acceptance of proposal Signature( L��� / Juju., 0 cx;v0,6.(2,6_