32A-178 (2) PROPOSAL
George's Renovations LLC
30 Capital Dr. #C
West Springfield, Ma. 01089
413-594-2616
MA Registration#152176 NIA License 9065409
Proposal for: Notre City I-lousing
Northampton St
Springfield. Ma 01 109
Job Description: 82 Bridee St Northampton Bathrooms
Remove existing bathtub unit form room and install new 48 inch fiberglass SHOWER unit.
This will include a new valve,and newd rain.
Remove existing and install new 8 foot baseboard heat radiator
Install new light,new GFCI outlet,And new light-exhaust fan.
Install new sheet vinyl floor to replace existing.
Install new FRP sheathing over existing wails of bathroom area.
Install new moldings as needed to finish area where new panels go as needed to assure the flow of the room.
(existing pedestal sink and toilet will be removed and reset when bathroom is complete)
(Quote Assumes allowed access to Electricity and running water.)
tall other wood and structural replacement shall be done at a stock+S 40 per hour with consent of owner)
We propose to furnish material and labor complete in accordance to the above specifications for the sum of:
$4,680.00 Forty- Six Hundred and Eighty Dollars
Pavments are to be made as follows: -
Balance due 14 Days after completion of job.
All material is guaranteed to he us specilied. All work to be completed in a work—Mike manner according to standard peaeticm. Any alteration or dtv iation from ahoer
specifications involving extra costs will he e only onpon wrhte orders and will become an extra charge over and ahore the estimate. This agreement is contingent upnu
acridenty or dclu�x heyond onr contre4,, rner[ earn ttrssary-1 d,fire,theft,and other necessary insurances.Uuq workers;arc free covered by wnrkmans romp.and our
uayurancc. _
Authorized Signatur&:
Date:
Acceptance of Proposa . "1=hc above pd s,specitications,and conditions are satisfactory and are hereby accepted. You are
authorized to do the work a�sp'ecitied. Payment will be made as outlined above.
Acceptance Dat :'J
CSignature 9, __ Signature:______,_
'�-
r
The Commonwealth of Massachusetts
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 Leeibly
Name(Business/Organization/Individual): �:t2!"=''�t?e- ✓`, - ✓E? Gt�� t.— C
Address:, / t�1 I �r�j U P. / _r)1fIhT
City/State/Zip: 1;'i cg Y 0 L
Are you an employer?Check the appropriate box: Type of project(required):
1 XI am a employer with 5* 4. Q I am a general contractor and I
employees(full and/or pant-time)." have hired the iub-contractors El Now construction
2.❑ I am a'sole proprietor or partner- listed on the•attach6d sheet. 7. p Remodeling
ship and have no employees Thcso sub-contractors have g, ❑Dem lition
woe for me in an capacity, employees and have workers'
►g Y P tY 9. ❑Building addition
(No workers'comp.insurance comp.insurance.#
required.) 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
officers have exercised their 3-❑ I am a homeowner doing all Work 11.❑Plumbing repairs or additions
myself o workers'co right of exemption per MGL
Y [N mp• I2.[3 Roof repairs
insurance required.)t c. 152,§1(4),and we have no
employees.(No workers' 13.0 Other
comp.insurance requized.)
Any applicant that checks box#1 moat also 611 out the section bclowshowingtheit workers'compwsation policy infotmation.
t Hormowners who submit this affidavit indicating they are doing all work sod then hire outside connectors roust submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the taupe of the subcontractors and state whether or not those entities have
employees. If the sub-Cennawe have employees.they must provide theh-workm,comp.policy number.
lam an employer that l8 providing workers'compensatian insurance for my employees. Below is the policy and job site
information.
Insurance Company Name. t?1 t?, �f�;/to i'' t/"err n C 4'
Policy#or Self-ins. v Lie.#: 1✓ C 5-1-75-91 Expiration Date/:: ��y r /S-
Job Site Address: S�� /.�r-i City/State/Zipl 1'o'^/t": %�f� '''1 Mci-
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 S 1,500.00 and/or one-year imprisonmont,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of
Inv of the DIA for a coverage verification.
I do hereby certify err the ains•artdpenakies ofrJury that the information provided ab is qe and correct.
r Phone QjTkTal use on o not wr tte in &area,to a contplet y chy or town official.
or Town., Permit/I icease#
ng Autthority(circle one):
ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
her
Contact Person: Phone#:
<.' The Commonwealth of Massachusetts
-x Department of Industrial Accidents
,— Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. F-1 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. F�Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp.insurance.$
required.] 5. 7 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.❑Plumbing repairs or additions
myself.m se o workers'comp. right p
y � ht of exemption MGL P 12.7 Roof repairs
insurance required.]t c. 152, §1(4), and we have no I3 Other
employees. [No workers'
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.
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy 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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
Of 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#:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW.(780 CMR 110.11)
r
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION 11 -OWNER:AUTHORIZATION-TO'BE COMPLETED WHEN,l
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
_... . 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
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.perlu.rY_........, ._..._ .... _ . Tv. ..-
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION:SERVICES -
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder. �,r. Ltl..i '✓. �"a /- 6J !.
License Num r
Address Expiration Date
re PVI Telephone
SECTIO =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 0
Version 1.7 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(C'ONTAINING MORE THAN 35,000 C.F.OF EN!CLOSEDSPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
I
Name Area of Responsibility
P tY
Address Registration Number
i
Signature Telephone Expiration Date
i
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
p ty
i
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
F
Signature Telephone Expiration Date
3 General Contractor
Not Applicable ❑
Company Name:
G7�
Responsible In Charge of Construction
Address
i r Telephone
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by re This column to re filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L. R. ._._m_._. L. ..._._..a R'......_.".;
Rear
Building Height
Bldg. Square Footage ;__.:.. %
Open Space Footage _,_ , ° -°°-- °-
(Lot area minus bldg&paved - --
#of Parking Spaces
Fill:
(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 0 DONT KNOW_ 0 YES .._"
IF YES: enter Book Page, and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW C YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued
C. Do any signs exist on the property? YES 0 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,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.
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
v
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairsy Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description ;'Enter a brief description here.
Of Proposed Work: -
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ _ - --_ - - 3A ❑
Institutional ❑ I-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
t
M Mixed Use ❑ Specify.
S Special Use F-1 Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR.;CHANGE IN USE
Existing Use Group. _. -__...,.:.. . ._. ... Proposed Use Group. ._.._
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(so
1 St
1st
2nd _. ._. _ _...,:,,_ _.,._ .. _.: 2nd
3rd rd
4 h 4th
Total Area (sf) Total Proposed New Construction(sf)
Total Height(ft)
------- -- Total Height ft
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❑
Version 1.7 Commercial Building Permit May 15,2000
Departme.t`use,only
\, r ; City of Northampton States of Permit
I
Building Department Curb CutlDnveway Penmit,�
212 Main Street Sewer`18 eptrc Avarlabrfity
3 ! 26iiti Room 100 Water/Well Availability '
orthampton, MA 01060 Two yetis of Structural Flans
-` phone 4t 3-5
ectric. um .nr 87-1240 Fax 413-587-1272 PIatlSite Plans
F
North „°i
�,c, Other Specify=%%
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section.to be completed by office
V � Map Lot Unit
Zone Overlay District
- Elm St:District'' CB District
SECTION 2 PROPERTY OWNERSHIP/AUTH'ORIZED AGENT
2.1 Owner of Record
Name(Print) Current Mailing Address:
_._...__` 1.3_
Signature C-L&I ow 01- �� Telephone
2 2 Authorized Agent
Name Print Current �ailing Address
L w. w� i
Signature !� �' Telephone __ ...
SECTION 3--ES I TED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical c3 (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 975 Q
This_Section For'Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0915
APPLICANT/CONTACT PERSON GEORGE ABDOW
ADDRESS/PHONE 30 CAPITAL DR#C WEST SPRINGFIELD01089(413)246-5180
PROPERTY LOCATION 82 BRIDGE ST
MAP 32A PARCEL 178 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Tyneof Construction:_RENOVATE 2ND FLOOR BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 065409
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR TION PRESENTED:
AIKP-proved 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
o " lay
Sign a e o ui f6i ng 1 6ffifi al 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.
82 BRIDGE ST BP-2015-0915
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A- 178 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-2015-0915
Project# JS-2015-001771
Est.Cost: $4300.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: GEORGE ABDOW 065409
Lot Size(sq. ft.): 20908.80 Owner: VALLEY CDC
Zonings URC(,100) Applicant. GEORGE ABDOW
AT. 82 BRIDGE ST
Applicant Address: Phone: Insurance:
30 CAPITAL DR#C (413) 246-5180 WC
WEST SPRINGFIELDMA01089 ISSUED ON:313112015 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATE 2ND FLOOR 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 3/31/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner