25C-019 (2) CHARLES T LAVECK
HOME IMPROVE
413-527-5604
TOTAL ESTIMATE FOR 184-186 NORTH STREET $8,120.00
DEPOSIT UPON ACCEPTANCE OF CONTRACT $1,000.00
PARTIAL PAYMENT AT START OF JOB $3000.00
BALANCE DUE UPON COMPLETION $4,120.00
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THE ABOVE AND BELOW SPECIFICATIONS ARE ACCEPTED AND
UWE AGREE TO PAYMENT TERMS,ANY EXTRAS WILL BE IN
WRITING PRIOR TO STARTING, WORK MAY BE BEGIN AT ANY
TIME
DATE
ALL MATE AND LABOR PROVIDED,ANY EXTRAS WILL BE IN
WRITING PRIOR TO STARTING,WORKMANSHIP GUARANTEED,
CHARLES T LAVECK
ANY QUESTIONS PLEASE CALL , CHUCK 413-527-1142
THANK YOU
*CONTRACTOR MAY CANCEL CONTRACT AT ANY TIMEXW
DEPOSIT WILL BE REFUNDED
Charles T. Laveck
Home Improvements
25 Davis Street
Easthampton, MA 01027
O��x�pTO
Grify of Nortl ampton 11Z
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DEPARTMENT OF BUILDI],,'G INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sup<_, ,,is;or. 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
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
home owner."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner 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 department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
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
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
i
0
(!i'iflJ z�f `artlJampf Lilt
it l3SftCl11t6[ttS -
s m DEPAJRThfENT 01' EUIL DI G INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
W O RICER'S C O MT LN S A'Z'I O N 1N S U RAN C�-' A{ A Tl'T
v:'ith a principal place of business/residenc�c t:
�SLTCCL/CIt'i%'
CIO 11CICCy Ceruf}:7 uIK'E1" dle p !i1S ill 1)C it it]e: (�i pCfJllt�t, t,.Ili!i
O I ,rn an employer providing the foil o'.viIli- '.71,01't_cr1-5 compcnsauon covera c 'or my
employees working on this job:
CL=,L c: Company) c c;NtL tbcr) (rte pir.:tion Datc)
- n a sole proprietor, gents; conk or o: t?0n1e01.1+Z7er (CL-,Cie Oct) and hired
th contractors listed below -,-,to l:. the 'ollc-, jorkers co Lien on cleats,
('Name Of CORL-naor) �n_L 2,1C LGI ^ ';'i:lGl1C TviLllllLci) it?:! ':LCi, D?tc)
(Name of COn[Tac"Or) _ l7iL$J P.C^ COIIID ,i`'/PGl1Cf t iCrf) 0--Xolmiion D2_IC)
(Nlame of Contractor I -t -= D
) ( naJr3I1C� t_Oiil 3:i'ilt�OliC,r' Iv11SI11}'f) �:.X�,: "iI0❑ aIC)
- (Name of Cont aaGr) —— Jas-ufLlicv Comr--�ny,'P oUcy Ntlmlr_r) - (L::p! iU0'• Date)
(_ 1 i'L71 i1 101e pl Ul?I"1C vi <':ill'1 ela't'e i?O O II C '•'.'OI��;.!Iif� for n1c.
,m c? home
NOTE:plcaso L,a:vz c tl s .tier lc tx:rc n lr ::�r. pl :;r n;t: �_ cS cz>:: n va c
not 111C(c th_a throe L•11P3 in lc{::Gl]she 1:�::.>,•.�z,�rc::c'.-�or a; r::c_.rs Lhcc:c:._-c tict Cerrrilly C,:<� r:::::a N-
czlployc3 u_rx�cr the tw;k--i':c s ;a:ix,tom(GLI52.»:(5);.r. lt_-1lir;;h+a hn;aco«rs`cr a L"==tc}v-ra::::
Iegzl Razes of an azq:loyx under C:n wo,kcrs Co;.,;wr_-_ation.ct-
I uzndcrzt and ih,z a copy of tlia ststcts c;ay bo fowv do;l to tf'r-[Ytxi cni of Ind uiriJ A.ccj&�!f O icy of for llx
oovmtgc vrrificiioa and that f it ut to r•a c coy M un3: c-,iM 2 S A of?.1GL,
152 can lc.d to tlx impos teal r. t Pa:3
Com.i3ting of a fur-o p7to S! SCG.00 nn--Y i^;pr xr.� :_of.:p to ter.:}. :.-.j Civil peruttiu in d,resin of a Str.,`;JcrY.Chu and a
f t s of S a y tg•.ilra m:. .
rc,r 11—only 4
r`
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SEC,
10N8.=CONST RUC T[ON SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
e 'te°re° rne` Im"" emen. .Cori :act r
Not Applicable ❑
Company Name Registration Number
Address Ex iration Date
!S J _ Telephone_ -����-
SECT10N10 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...... ❑
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
A•
:SECTION IDES uR P aI.ON O hIRRORML,D WORK cffeck l a livable F
3
•.x:^:.a�vay.,a:."'hirKV :..y..?.4+-f�,m ,..vim .:";NP' ?f:iV??.i.e „a�_:,33:;TiX>+AC'.,'': ,a-w6K+R ',•:
New House ❑ Addition ❑ Replacement Windows Alteration(s) � Roofing ❑
Or Doors ❑ 1 7
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding Other [ )
Brief Description of Proposed Work: //,f!5044( tfi",yL
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll❑- Sheet❑
70r itcon #o ex.i-sting�hous ng; corraple e t ie follow=i°nom:
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. Mascheck 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
f. Septic Tank City Sewer Private well City water Supply
SECT lQ��=�31NNER�AUTHORIZATION' TO B'E COMPLETED WHEN '
OWPfEfS?;4 O CONTRACTOR APPLIES FOR BUILDING PERNItT
as Owner of the subject property
hereby authorize to act. on
my behalf, in all matters relative to work authorized by this wilding permit application.
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.
Sign ed under the pains and penalties of perjury.
t�''/✓ 5
Print Na J
Signature of Owner/Agent Date
Ilk
Section !
Se n 4.o
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES —
No
IF-YES, desbribe size, type and location:
t1 `� 1 of Northampton
U u ing Department
QMain Street
SEP _ J 2003 oom 100
No tha pton, MA 01060
cB%587- 240 Fax 413-587.1272 P t, n
pE�Q4 glfltOlN `MA 0106 -
ptr erg p �.
(CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: ' This sectlont
-�
tr o bLI letedby"office
Zone 0erl
g�
Elm StDistrict ,. :CBDis r ct
SECTION 2 -'PROPERTY OWN ERSHIPIAUTHORI.ZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature 3 6 C/ V-5-
2.22/Authorized Agent: r
Na P' ) Current Mai!ing Address:
Signature Telephone
SECTION.3 - ESTIMATED CONSTRUCTION CO"STS" L3
Item V�w Estimated Cost(Dollars)to be Dfficial Use Only
f Cv completed by ermit applicant
1. Building (a) Building Perm:it Fee
2 Eleccirical
(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
This Section For Official Use Only
Building Permit"Number: —ZOO14' `,0 Z4> Date Issued: a�
Signature:
Building Co mmissionerAnspector of Buildings Date'
86 NORTH ST
BP-2004-0261
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Hlock:25C-019 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0261
Project# IS-2004-0383
Est. Cost: $8100.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CHARLES LAVECK 121419
Lot Size(sq. ft.): 7100.28 Owner: NOW MARY
Zoning: URB Applicant: CHARLES LAVECK
AT. 186 NORTH ST
Applicant Address: Phone: Insurance:
25 DAVIS ST (4131 5)7-5604
EASTHAMPTONMA01027 ISSUED ON.919103 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL VINYL 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 Si nature:
Feel e: Receipt No: Date Paid: Check No: Amount:
Building 9/9/03 0:00:00 3665 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo