42-044 A i .,
1- '586-5413 218-9277
1-15-2011
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Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527 -7124
Submitted To : Gail OBrien Phone- 586 -5413 218 -9277
Address : 661 Westhampton Rd. Date - 11 -15 -2011
Florence, Mass 01062
We hereby submit this estimate for - Kitchen Remodel
To start I will remove all cabinets and counter tops.
The floor will be stripped and the new floor will be installed.
The rough electric work will be done at this time.
I will remove all the old tiles and repair the sheetrock as needed.
The new cabinets will be installed ready for the counter top template to be made.
The tile will be installed and grouted.
All wood trim will be installed as needed.
All final electric and plumbing will be done to finish the job
( customer will supply all materials )
Price for my labor = $ 3250.00
Price for electric = $ 2185.00
Price for plumbing ( estimated = $800.00)
Total Price = $ 6235.00
Contractor Supervisors License number 082531
Home Improvement contractor Registration number 135204
I propose to supply materials and labor -in accorda ice with above specifications.
This proposal may be withdrawn /1
By us if not accepted within 30 days Authorized Signature ..eie'....t.i.. ,
i
Acceptance of proposal Signatur ) bLV)g.i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
" = /4 Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business /Organization/Individual): `ilIF . d
Address: / ,-C1
City /State /Zip: C�,//, A.4 D/a Z7 Phone #: r2 ? 2 ' / 2- '
Are you an employer? Check the appropriate box: Type of project (required):
I . a I am a emplo er with 4. Q I am a general contractor and I
employees eh. d/or d/or part- time).
* have hired the sub - contractors 6. ❑New construction
2. 0 I ama sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub- contractors have 8. 0 Demolition
for me in any capacity. employees and have workers'
working Y P ty 9. Q Building addition
[No workers' comp. insurance comp. insurance.$,
required.] _ 5. ❑ We are a corporation and its • 10.0 Electrical repairs or additions
i
h
d i
h
ffi
ocers have exercised their 11.
3. ❑ I am a homeowner doing all work ❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §I(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 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.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: AN.-- . /4 C- �j/
5/4) Policy # or Self -ins. Lic. #: 62 5/7 / Expiration Date: / / 2-
Job Site Address: . ,., . f �. /...s ii City/State /Zip: 7 144. .i. Z e /O G
i
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 co py of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby certify under the ins and penalties of perjury that the information provided above is true and correct
Signature: (� Date:
/ — — / 2- Phone #: 522- 2r/ 7
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 #:
Version 1.7 Commercial Building Permit May 15, 2000
4
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
•
7 4•/
, as Owner of the subject property
hereby authorize t
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
i nj_ l ordPir - - - - - - --
1, ' d•dr0
, as Own: • uthorized
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 -nalties s
Print Name
Signatur: • 0 r/A.en Date
SECTION 12 - CONSTRUCTION. SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
,
Name of License Holder : —
,12 r,/
,
License Number
I 4 .6•
/ # __)/A,(A- _,/(-
Address ExpiLation Date
7- 7I /
Signatur
c 2,9
Telephone
- 2 -
SECTION 13 -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 cP No
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF EILOSED SPACE)
9.1 Registered Architect:
`" Not Applicable ❑
Name (Registrant): l
_ _.......____..- . .«._.— ---_____ Registration Number
Address _ .._m...__... ....,..
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
I
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
i
Address Registration Number n
Signature Telephone Expiration Date
Name Area of Responsibility
1
i
Address Registration Number
I M _
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number _� _
Signature Telephone Expiration Date
9.3 General Contr
_, _ .._ t'" ' ry, `�_ Z ['�/4 T �� _ _ . __ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address _
Signature • Telephone
•
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON:ZONING ,
Existing Proposed Required by Zoning ,
This column to l a filled in by
Building Department
Lot Size _. t .! L_. _____
Frontage __ .___ ... ___ . ._._ _.
Setbacks Front - --
l
Side L , R:. L: L R::-_,-,j _.
Rear ? t ) I.
Building Height j__
Bldg. Square Footage % t
Open Space Footage % _
(Lot area minus bldg & paved , 1 . s..,„
parking)
# of Parking Spaces 7-1 `; : L, _--;
Fill: _.. i
(volume & Location) — .. --
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q 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 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
Version1.7 Commercial Building Permit May 15, 2000
J
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE '-"
Interior Alterations Q Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description ':Enter a brief description here. /� 414), ,tr /i
Of Proposed Work = re i , i � /74 /e/ ovv$ (UVh'�' fe
SECTION 5 USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A ❑ A -2 ❑ A -3 ❑ 1 A I ❑ ❑
A-4 ❑ A - 5 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ' r ❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑
U Utility ❑ Specify:
._.- _. .
M Mixed Use Specify: .._,... w w
S Special Use ❑ Specify: I i
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
_. _ w�....
Existing Use Group: _..., _ .. ` Proposed Use Group: _...�' � �� ._.��
m
Existing Hazard Index 780 CMR 34): ..,_, Proposed Hazard Index 780 CMR 34): ____ ._...._...,_. _._,
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
_.. 1st 1
1 st
......_ _..._..Y. nd `
_
_ 2
2nd i
3'11 .___ — - 3` d
4th .._..._..___ _ _ # Ott, ' ..._.. . _...
Total Area (sf) . Total Proposed New Construction (sft_
Total Height (ft)
Total Height ft .a. -, ._ ,__ - . . _:. wa,. ,
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood _ Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone '__._ Outside Flood Zone❑ Municipal ❑ On site disposal system❑
..4.
r, E V =Q Version1.7 Commercial Building Permit May 15, 2000
N 2012 City of Northampton
� . 3 Building Department eft
_____.____..\
212 Main Street C
EEpT OF SHi DING INSP RTHAMPTON MA a Room 100 _ l . z 3�
NORTHAMPTON Northampton, MA 01060 ' t . it(.... �g. �'
phone 413 - 587 -1240 Fax 413 -587- 272 l l r 5 , ` ' e� �,
Qa � 4C1 � ,� " t A � '
APPLICATION TO CONSTRUCT, REPAIR, RENOVAT CHAN E TH . SE OR • CUPANCY OF, OR DEMOLISH ANY BUILDING
OTC THAN ONE R TW A FAMILY • ELLING
SECTION 1 - SITE INFORMATION /
This section to be completed by office
1.1 Property Address:
6 6 / Glies ,',' Map Lot
i Unit
/ Zone Overlay District
l D ✓y° ist G . z it/ r w6 2-
__._ . -_ -, .-- - --.... __-_ . &Ill St. " i District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
1 / ELI A /r _ -- ..._._
Name (Print) Current Mailing Address:
5 - - G/1 . ,1
Signature Telephone
2.2 Authorized Anent:
' ` ! - 4 7
Name (Print) Air i Current Mailinc Address: _ ._..
�.1f/'
Signature - Telephone
SECTION 3 - ESTIMATED CONSTR 4 ION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building Z 10 i (a) Building Permit Fee �-
2. Electrical 2-1 C/ s ---- (b) Estimated Total Cost ) f
d , ' Construction from (6) _ _ _____ __. _........_._... __
3. Plumbing OD i Building Permit Fee
4. Mechanical (HVAC) ° ,-
5. Fire Protection �� _._.. ,
6. Total = (1 + 2 + 3 + 4 + 5) Check Number /771 ,e, --
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
r
File # BP- 2012 -0656
APPLICANT /CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413) 527 -7124 Q
PROPERTY LOCATION 661 WESTHAMPTON RD
MAP 42 PARCEL 044 001 ZONE SR(100) //WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out TWA?' Fee Paid / W� )0it-
Tvpeof Construction:_REPLACE KITCHEN CAB,FLRS & COUNTERS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 082531
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION PRESENTED:
t 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
Demolition Delay
1 17'iZ.-
Signature of Building 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.
661 WESTHAMPTON RD BP- 2012 -0656
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 42 - 044 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- 2012 -0656
Project # JS- 2012 - 001126
Est. Cost: $6235.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sq. ft.): 25047.00 Owner: O'BRIEN MICHAEL J & GAIL L
Zoning: SR(100) //WSP II Applicant: STEPHEN CAMP
AT: 661 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527 - 7124 0 WC
EASTHAMPTONMA01027 ISSUED ON:1/18/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE KITCHEN CAB,FLRS & COUNTERS
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 1/18/2012 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner