32A-221Material cost = $ 9200.00
Labor cost = $ 12,500.00
Total cost = $ 21,700.00
Contractor Supervisors License number 082531
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This proposal may be withdrawn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 30 days Authorized Si ture ?L"
Acceptance of proposal Signature
Stephen Camp Construction
46 East St.
Easthampton, Ma 01027
(413)527-7124
Submitted To : Roger Salloom
Phone- 210-7482 584-6324
Address: 83 Pomeroy Terrace
Northampton, Ma 01060
Date - 10-10-2014
We hereby submit this estimate for - Bathroom Renovations and other renevations as
found in Mark Gelotte's drawings. 5-28-2014
To start the project I will supply a dumpster and build a shoot to go
From the back roof into the dumpster.
I will completely demo were needed and work with the plumber and electrician
For there demo also.
I will remove the old tub and open area's needed for plumber & electrician.
Me and my workers will clean up on a daily bases.
I will do all framing for the floors, walls and ceilings as necessary.
The insulation will be done as requested and I will subcontract any spray foam needed.
R-19 minimum exterior walls.
The 5 new Marvin Integrity windows will be installed.
I will do all sheetrock ready for paint.
( roger will hire his own painter as talked about. )
(All linoleum and tile work will be done by others.)
The new doors will all be installed. ( pine 4 panel doors )
I will install vanity's and medicine cabinets picked out by the customer's.
All trim work will be done as the blueprint shows.
I will supply all building materials needed for my work.
I will supply the building permit and trash removal for complete job.
Jesse Camp will do all electric work
} y .
INSPECTOR
Louis Hasbrouck
Building Commissioner
City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
Chuck Miller
Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
Washington 600 W ton Street g
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: Gl �S 7�� V'f
City/State/Zip: 4-A k e)/0 2 7 Phone #: -5 2
Are you an employer? Check the appropriate box:
1. I am a employer with 2
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.T
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1(4), and we have no
employees. [No workers'
coma. insurance reQuired.l
Type of project (required):
6. ❑ New construction
7. Remodeling
8. ( Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other { C -/✓h--4
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
tHo meowners 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. /I _
Insurance Company Name: J`fC�Y►-t
Policy # or Self -ins. Lic. #: ('15-6
Expiration D
Job Site Address: (/G�m r'o �J _)� rr�1 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 an penalties of perjury that the information provided above is true and correct.
bate.
Phone # z ZY
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 #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:
Not Applicable £
/� ,,�
092— Y/-3 1.
Name of License Holder:
✓`�-Y��_
1T �"'/ "
License Number
Address /
Expiration Date
7 J vel
Signature % Telephone
-„ ;_r
9: Registered.Home Imbrovement Contractor
Not Applicable £
PP
/3 f2o y
Compant�yy{Nme
Registration Number
zi
I f
Address
Expiration Date
Telephone %/ 2/
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 being permit.
Signed Affidavit Attached Yes...(./.. £ No...... £ _ I
11 Home Owner_Exe"mp. ion
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
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing E]�
Or Doors t i
Accessory Blda. ❑ Demolition ❑ New Signs [❑] Decks (M Siding [❑] Other [❑]
Brief Description of Proposed
Work:_ �( �/►'I�,� 4jl;� f`fv„+1; �h ✓J� Mf / �� Ora,
Alteration of existing bedroom Yes _ No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa:'If Newhouse and or addtlonto ez]stnq':housin`q; comtlete tFe followlnq:
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
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
property
hereby uthorize Ap I m ( nun
to act on y behaqatters r�
elave to ork authorized by this building permap it
Owner
I, 5+616 111 .
Agent hereby declare that the statements and in
and belief.
Signed under the pains and penalties of perjury.
Print Name
of
Date
Yes No
as Owner of the subject
as Owner/Authorized
on on the foregoing application are true and accurate, to the best of'my"� knowledge
c>
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
i
Setbacks Front
Side
Rear
L:= R:!,____s
_------�
L:= R:=�--
t ---
Building Height
Bldg. Square Footage
L— —
s
Open Space Footage
(Lot area minus bldg & paved_
parking)
%
j
# of Parking Spaces
r----�
t-_-- —i
-
Fill:
(volume & Location)
s
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES Q
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q
IF YES: enter Book ; Page—�� and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtainedQ Obtained Q , Date Issued:------ —
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0
IF YES, describe size, type and location: i
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 Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
r�orv,,arrptor�,
.; 1 iCity of Northampton Sfatws ofPerm�Building Department Ct7ri; CuV. 0.ty ty, h +k IS 212 Main Street SeyverlseptRoom 100 WaterNe7Gvatla I #ynspections NOrthamptOn, MA 01060watP1 13-587-1240 Fax 413-587-1272 Plof/Slte Plans a
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Di
Efm st__Dlstrlct' CB Dlstnct
SECTION 2.- PROPERTY OWNERSHIP/AUTHORIZEDAGENT
2.1 Owner of Record:
/
Z C,-1-/ 0 1 s�/ >J( � � s fi-oliq ell j -1-e
Name Print) I Current Mailing Address:
Telephone '"
Signature
S f 2-
2.2
2.2 Authorized Agent:
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 ta/ oullulny r-willn rcc
2. Electrical (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) Z1 7 D ✓ Check Number
This Section For Official Use'Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspecter'of Buildings Date
File # BP -2015-0443
APPLICANT/CONTACT PERSON STEPHEN CAMP
ADDRESS/PHONE 46 EAST ST EASTHAMPTON (413) 527-7124 ()
PROPERTY LOCATION 83 POMEROY TER
MAP 32A PARCEL 221 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL 2ND FLR 2 BATHROOMS
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
INFORMATION PRESENTED:
roved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR
Major Project: Site Plan AND/OR
ZONING BOARD PERMIT REQUIRED UNDER:
Finding Special Permit
Special Permit With Site Plan
Special Permit With Site Plan
Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW
Septic Approval Board of Health
Water Availability Sewer Availability
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
D olition Delay
_e
4Zatureofl m
OfIT
f
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.
83 POMEROY TER BP -2015-0443
GIs #: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 32A - 221 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 -2015-0443
Project # JS -2015-000816
Est. Cost: $21700.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STEPHEN CAMP 082531
Lot Size(sa. ft.): 13198.68 Owner: SALLOOM W ROGER & DONNA C
Zoning: URC(100)/ Applicant: STEPHEN CAMP
AT. 83 POMEROY TER
Applicant Address: Phone: Insurance:
46 EAST ST (413) 527-7124 O WC
EASTHAMPTONMA01027 ISSUED ON. 11/4/2014 0:00:00
TO PERFORM THE FOLLOWING WORK. REMODEL 2ND FLR 2 BATHROOMS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service:
Rough: Rough:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:
Meter:
House #
Driveway Final:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
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 11/4/2014 0:00:00 $130.00
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck — Building Commissioner