25C-139 WWW.RUGGLUMBER.COM Email: TCMGCI @AOL.COM
Czelusniak Funeral Home W:584.3585-H:584:4358 6/10/2008
173 North Street Abbie
Northampton,Ma.01060 Same
MA HIC#100364 Exp 5/16/10 MA Const.Supervisor#053221 Exp 5/23109
Estimate for the following renovations to the second floor bathroom at the above listed address.
This estimate includes gutting the existing vanity top, vanity, toilet, all Formica"202"system on the walls
behind the vanity, toilet and the rt.side to the tub/shower. We will gut the existing tile flooring,&all underlayment.
We will remove the radiator and save for reinstallation after the floor is completed.
We will relocate the heating pipes under the floor, install sub-flooring plywood, 3/4"and underlayment, preparing
for the new tereza floor.
We will install plumbing for new Pedestal sink, faucet, and prepare for the new toilet. Plumbing and heating
allowance for material and labor is$2,100.00
Electrically, we will install 2 customer supplied vanity lights, and install a new switch and ground fault electrical
outlet.
We will prepare walls where the Formica"202" system was, supply and install pine shiplap horizontally,
trim as necessary.
We will remove all old silicone in the tub/shower and re-silicone with 50 year white silicone.
We will install ceramic tile,approx. 80 square feet that the customer will supply, for the entire floor area, including,
the closet. (My supplier is checking on the rest of the tile needed.) I'll let you know,we need total of 8 boxes.
All priming, &painting is included of the entire bathroom. Ceiling white and wall color the customer's choice,
with a$450.00 allowance. We will install the pedestal sink, faucet, new toilet and re-install the radiator
All rubbish removal and cleanup is included. Add for Northampton Building Permit, we will get.
Regular price: $11,900.00 Courtesy Discounted Price: $10,800.00
Ten Thousand Eight hundred and xx/100-------------------------- $10,800.00
20% Down for custom order: $2,160.00 50%Upon Start: $5,400.00
30% Upon Completion: $3,240.00
45 Days
�lae -�omvnu�ruaea�i o�',/�cxaw.r,�u�aeAa
Board of Building Regulations and Standards
lugHOME IMPROVEMENT CONTRACTOR
Registration: 100364
Expiration: 6/16/2010 Tr# 267558
Type: Private Corporation
THOMAS C.McCARTHY GENERAL CONTRACT
Thomas McCarthy
3 BRODERICK ST
Easthampton,MA 01027 Administrator
Board of Building Regulations and Standards
Construction Supervisor License
,. License: CS 53221
Sirtndate: 5/23/1958
Expiration: 5123/2009 Tr# 1
Restriction: 00
THOMAS C MCCARTHY
3 BRODERICK ST
EASTHAMPTON,MA 01027 Commissioner
I Itttt'1(—CNJCIG 11•.1� t-1!Y4f4 SS• 1 L,.t'tt\I'i.,; t l Y`r
)DUCER {413)52 -5520 fAX (413)527-5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INt•uKMAi(ION
inck .& Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE=
Campus Lane HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW.
as'thampton, MA 01027
ebecca Kubosiak INSURERS AFFORDING COVERAGE NAIC#
wm Thomas McCarty Uh-erai Cantiactors,Xnc. WSURERA: General Casualty 24414
3 Broderick St INSURERS:
Easthampton, MA 01027 INSURERC:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDIN
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
SK r M O:INSURANCE POLICY HUMBER PbLiCY E AE EXPIRATION LIMITS
GENERAL LIABILITY CC10395169 02/10/2008 02/10/2009 FAcnoccuRaNce S 1 00010
)( COMMERCIAL GENERAL LIABILITY DAMA E 0 RENTED S 100,OO
CLAIMS MADE OCCUR MEOW(Any.vne perso) S 5,00
A ! PeWMAL&ADV INJURY $ 1,000,0001
GENERAL AGGREGATE $
2,000,000
GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO 3 2,000,000
POLICY j LOC
AUTOMOBILE LIABILITY GOMeINED SINGLE
LIMIT
ANY AUTO {Fa auaaernj 5
ALL OWNED AUTOS i BODILY INJURY
SCHIEDULED AUTOS (Per onion) S
HIRED AUTOS BODILY INJURY
NON•OWNED AUTOS (per acaeent) 3
PROPERTY DAMAGE S
(Peracddeml
GARAGE LIABILITY AUTO ONLY.EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC S
AUTO ONLY- AGO 3
WCF33/UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE 3
.S
DEDUCTIBLE 3
RETENTION S S
WORKERS COMPENSATION AND CWC0395169 02/10/2008 42/10/2009 WlCSraru• a?N-
EMPLOYERS•LIABILm E L EACH ACCIDENT $ OO
A ANY PROPRtETOR/AAR7NERlEJ(EGUTNE
OFFICERAIEMBEFt EXCLUDED t E.L.DISEASE-EA EMPLOYEE $ 100
H yes,dC?�lIDB t�dd
gpELtRt pROyl+IONS peipw E.L DISEASE•POLICY LIMIT $ Soo,00
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS t VEHICLES I EXCLUSIONS AVOW BY ENDORSEMENT I SPECIAL PROVISIONS
E E
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE MUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO JIM CERTIFICATE HOLDER NAMED TO THE LEFT,
Thomas C. McCarthy BUT FAILURE TO MAIL SUCH NOTICE$HALL IMPOSE NOOPLIGATION OR LIAVIRM
3 Broderick 5t OF ANY IIND UPON THE INSURER.,rs AGCNTS OR RBPRESENTATPIft
Easthampton, MA 01027 AUT4ORl7%OREPReSENTAT(VE V
lRebecca Kubosiak BECKY
ACORD 25(200IMS) FAX: (413)527-6$93 CACORD CORPORATION 1988
2008-03-1622:39 4135275970 1413 527 5970
Page 11
The Commonwealth of Massachusetts
Department of Industrial Accidents
w
Office ofinvadgadons
600 Washington Street
Boston,MA 02111
www massgov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
AviDlicant Information Please Print bl
Nameonandividual).Address:
j
City/State/Zip: Phone.#:_ Z13,V! 5/y
Arepn an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. 0 I am a general contractor and I
employees(full and/or part-time).*
have hired the sub-contractors 6• New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These,sub-contactors have 8. 0 Demolition
woriting for me in any capacity. employees and have workers' 9. Building addition
[No workers'comp.insurance comp.insurance.t ❑ _
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself[No workers'comp- right tdf exemption per MGL
fionance�i�•]t c. 152,§1(4),and we have no 12.0 Roof repatrs
employees.[No workers' 13.0 Othu
comp.insurance required]
;Any'Any sppSeant that checks box#1 must also fill out the Section below showing their workers'compeasatiou policy iotomation.
who submit this affidavit indicating they are doing all work and then hire outside contractor mud Adnnit a new affldayit inditing vtCb:
kM taetats dint slash Bus box Slat attached an additional Slxet showing da name of the sub-contractota and state wbodie r or W those entities have
emtloyces lfthe sub-muaetm have employees,they mat provide their workers'comp.potiry number.
lam an employer that it providing workers'compensation insurance for my employees Bdow is the policy and job site
information.
Insurance Company Name:
(�/�/L lq `7/,O Expiration Date: /
- Policy#os Self-ins.Lie.#:
Job Site Address: I ✓ AM, 5/- City/Stateaip:
Attach a copy of the workers'compensation policy declaration page(showing tie 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 S 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
In_ vestisations of the DIA for insurance coverage verification.
I do hereby certify under the pains annd penalties of perjury that the information provided above is true and correct
f� r° .Z �'`. L�"�`f�` Date. ,
-gi�ature' ,�
Phone#:
Off 1-cial use only. Do not wr in this area,to be completed by city or town of, iciat
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#'
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction SuR2rvisor Not Applicable ❑
r
Name of Llcense Holder: f
i�
License Number
!
!
Address Expiration Date
Signature- ` Telephone
9.Rea"fed Home Improvement Contractor. Not Applicable ❑
Company Name Registration Number
Addres(s� Expiration Datef
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwelling 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 1083.5.1.
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 buildine 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
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: 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 0 DONT KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Re 'stry of Deeds?
NO 0 DONT KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES O NO
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
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,gradin a vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
//
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ( Roofing ❑
Or Doors ID ►-
Accessory Bldg. ❑ Demolition ❑ New Signs [E3] Decks [M Siding[[Oj Other[[I
Brief Description of Proposed / /IGi�ill�7ve�1s �} CCU/ �( /Z�c o'/
Work: 5 S 3 IAI h9, e
Alteration of existing b qdroorn Yes No Adding new bedroom Yes No n
Attached Narrative Renovating unfinished basement Yes No ��
Plans Attached Roil -Sheet
ea.if New house and or addition to existing housing,complete the followinsa:
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.
1. Septic Tank City Sewer Private well City water Supply
SECTION Ta-OWNER AUTHOR17ATION-TO BE COMPLETED WHEN
O S AGENT OR CTOR APPLIES FOR BUILDING PERMIT
` as Owner of the subject
pr
hereby authorize
to my�ehaif,in a m tters relative to work authorized b this building permit application.
Si re f Owner Date
as Owner/Authorized
Agent hereby declare that the statements and informs' n 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 Na 7 51 r'
l-C'''
Signature of Owner/Agent Dat
Department Use only
City of Northampton Status of Permit
wilding Department Curb Cut/Driveway Permit
Main Street Sewer/SepticAvailability
l loom 100 Water/Well Availability
orthajpton, MA 01060 Two Sets of Structural Plans
i} Q,han9 -58�°P'240 Fax 413-587-1272 Plot/Site Plans .
v, Other Specify
APPi.ICATI(G5N, O C1 UCT,AL R,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
11 Property Address: This section to be completed by office
Map Lot Unit
M, 0 Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record: .Iraq an�fG r l�tS�s�e4G
�1W
me(Pri ) Current Mailing Address: G' F '
Signature Telephone /y !� 2 —
2.2 Authorized Agent: `!
Na N Current Mailing Address: orm vv
Signature --r b Telephone sa 1 S
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ��f�Q 66 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Oe e7 6i Construction from 6
3. Plumbing /, 12 4),�), Building Permit Fee
4. Mechanical(HVAC) 1;e F 7'ew
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2008-1159
APPLICANT/CONTACT PERSON Thomas C McCarthy
ADDRESS/PHONE 3 BRODERICK ST EASTHAMPTON (413)527-5141
PROPERTY LOCATION 173 NORTH ST
MAP 25C PARCEL 139 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Pen-nit Filled out :200 4 id 42
Fee Paid
T_ypeof Construction:_RENOVATE 2ND FLR BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 053221
3 sets of Plans/Plot Plan
THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
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
Z
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.
lift� BP-2008-1159
G COMMONWEALTH OF MASSACHUSETTS
*0 1'W111C I .q
0 -I` CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-1159
Project# JS-2008-001708
Est. Cost: $10800.00
Fee: $54.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Thomas C McCarthy 053221
Lot Size(sq. ft.): 30709.80 Owner: ROBERT F CZELUSNIAK&ABBIE
Zoning.URB Applicant: Thomas C McCarthy
AT. 173 NORTH ST
Applicant Address: Phone: Insurance:
3 BRODERICK ST (413) 527-5141 Workers
Compensation
EASTHAMPTONMA01027 ISSUED ON.612412008 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLR BATHROOM
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 6/24/2008 0:00:00 $54.002916
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
- --- --
4
f:
BP-2008-1159
73 NORTH ST COMMONWEALTH OF MASSACHUSETTS
a1_S#: CITY OF NORTHAMPTON
Map.._Block: 25C- 139
PERSOrrscoNTRACTIN THE GUARANTY FUND (MGL� 142A)
Low Buildi� DO NOT HAVE ACCESS TO PERM
Permit BUILDING P
Cat��ory_
Permit# BP-2008-1159
Proect# JS-2008-001_ 7lQ 8
Est. Cost: $10800.00 pERAIISSION IS HEREBY GRANTED TO:
Fee: $54.00 License:
Contractor: 053221
cons— t— Thomas C McCarthy__—
Usepl—
r .§t Size(sg ft) 30709.80 Owner: ROBERT F CZELUSNIAI'8 ABBI
A icant: Thomas C McCarthy
Zoning ERR 3 �,r�v>_:
%=�• Insurance:
Ph!one_ Workers
Apnl�icant AAddress: 413 527-5141
3_ERICK ST
Co_mpensttion
EASTHANIPTONMA01027 ISSUED WORK:RENOVATE 2ND FLR BATHROOM
TO PERFORM THE FOLLOWING
pOST TEAS CAR2 SO IT IS VISIBLF. FROM THE STREET Building Inspector
Inspector of Plumbing Inspector of Wiring D.P.W
Meter:
Service: Footings:
Underground: Foundation:
Rough: Q/ l House#
Rough: v /pg� Driveway Final ,
-.3�—O��pnal: Rough Frame: dK
Final:
ins aEvc'tcN –
Gas:
Fireplace/Chimney:
gh Fire Department
ltl•
Final
Final:
Smoke:
REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA�0N OF
THIS PERMIT MAY BE v
ES AND REGULATIONS.
ANY OF ITS RUL
Si nature: ---
Certificate of Occu anc Date Paid: Amount:
Fee'T�pe_
Building
6/24/2008 0:00:00 $5.4.002916
212 Main Street,Phone(413)587-1240,Fax: (413)587-12,72
Building Commissioner-Anthony Patillo