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18C-106 /t .,h 6/g,- T /10SC,4n1,4- ►7A S b e oL . eD ✓>-, T roposa! Vinyl Siding Wind 4 - ,i.7. - . _ • Corbett Home Improvement Roofings Doors Northampton, MA 01060 Awnings ``'{ I. 1,/ IL 1' (413) 584 -6571 Canopies gi Cdf 1J1.(f 9 c,5/ 3(n ' Gutters Shutters PROPOSAL S1 TWITTED To L / 404 P` ~ 1 1 - %IctCD DATE mAil eit l6 o 8 STREET 84+ Hca W JOB NAM CRY, STATE, and ZIP CODE ( c �S . JOB LOCATION �� A V l�l� VVV DATE OF PLANS JOBPHONE" We hereby submit specifications and estimates for: I &MOW 446 ,4 f /lot ee ....f ,1f -,, iN VA et S anf /�aei< ely,, All AS e,Xiii..n.e- 3 8 l A iv � Y� r.4 r ae6- . erar= / ,/ n eICX. if t v Anew vA - { aS,i, G R4 UY. .r�v AAK,S ,- t/6 i )pdar/ IT/5)141j, GA- / 36 yx ,cX"./,� g (RlCt C(A s � e -rs t ih° c� s a 40-1-1-c5 w ( nvs b ars ac�l,6tt , �. . t~ r 4008 M 61 o .s i J../-in ,e.41 a,. r O, 1 k - /he /9 ofd ( We 9vopose hereby to furnish material and labor - complete in accordance with the above specifications, for the sum of: 1- Dollars (S ) Payments to be made as follows: ep - a O@ d , /�� _� „ / ii , _, / �JCI ) / 3F� �1) r 41�/ / Q{�/ All nuterial is guaranteed to be as specified. All work to he completed in a work -like manner according Auth ,`....' ----"" to standanI practices. Any altercations or deviation from above specifications involving extra coats will he Signature executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado Note: This proposal may be and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Acceptance of Troposa[ -The above prices, specifications 1 are conditions are satisfactory and are hereby accepted. You are authorized to Signature / do the work as specified. Payment will he made as outlined above. Date of Acceptance: Signature J • The Commonwealth of Massachusetts �,- _ Department of Industrial Accidents =� Office of Investigations iO . +C =::111 600 Washington Street ; Boston, MA 02111 .a' www.mass.gov /dia NO Workers' Compensation Insurance Affidavit: Builders /C ontractors /Electricians/Plumbers Applicant Information Please Print Legibly . Name ( Business /Organization/Individual): CoRj s (A 9 RP1/4/01 r WtUeeU Jr Address: R s I City /State /Zip: NOat1A v/ M4 6)0(00 Phone #: L 9/ 3 )( 5 Y — 6 5- 7/ Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. (— 1 am a general contractor Wild I 6. n New construction employees (full and/or part- time).* have hired the sub - contractors 2. (NI I am a sole proprietor or partner- listed on the attached she::. 7• ❑Remodeling ship and have no employees These sub- contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. P I am a homeowner doing all work right of exemption per MCI. 11.11 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers comp. insurance required.] 13.0 Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1 Contractors that check this box must attached an additional sheet showing the name of the sub- eontractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance jOr ml employees. Below is the policy and job site information. Insurance Company Name: - -_ - -- - _ __— Policy # or Self -ins. L.ic. 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 251\ 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' penal( of perjury that the information provided above is true and correct. Si_nature: _ � � � — — Date: Phone #: 4i/ )—��y 6 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 Ap plicable // Name of License Holder : / ¢ �r 067 7 , License Number / 0 '-eed g-f- N i l m6- ©l0 6 0 Address / Expiration Date _Z (4 1 1 , 1/4_3) -- e9 S Signature - Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ C ©R Be Tr e i� 1110069 Company Name Registration Number y reed friA ol06o � /3 8 Address Expiration Date AM....- p �� /)s89' 7/ Tele hon 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 building permit. Signed Affidavit Attached Yes S No ❑ 11. - Home Owner Exemption 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 I Addition n Replacement Windows Alteration(s) n Roofing f e, Or Doors 0 Accessory Bldg. ❑ Demolition I New Signs [0] Decks [Q Siding [0] Other [0] Brief De cri do of ropQsed Work: � /ee'S /�✓ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: 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 . 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 I, , 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 l d zI1'f,edl`QIQhIo.JT J {� , as Ownei horized ereby declare that the statements and information on the foregoing application are true and accurate, to the best of - ' • edge an. •elief. Signed under the pains and penalties of perjury. — aitie, Jr Print Name Signature of Owner /Agent / Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning p 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 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES Q IF YES: enter Book Page and /or Document # NO B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW YES O 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 Q NO t IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, e avation, 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 "' Permit from the DPW is required. ? V7 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit APR 2, 2 2008 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability ' Nortfampton, MA 01060 TWo Seta of Structural Plans l Wow 413 Fax 413 - 587 - 1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office S9 leASo/ Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 5--e^1 R WOO d∎c Dx41 8`/ X0sA 0 t2 eP 11 5 "14 o /o3 Name (Print) Current Mailing Address: Telephon X89 Q/ 2/ Signature 7 Q b 2.2 Authorized Agent: D4Jf , t T 00 T Jr2 ' Rffd S& / j 40/.1 o(o0 Name (Print) Current Mailing Address: ( i3J sc 9- �s7J Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 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) 7375-- Check Number 144 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2008 -0933 APPLICANT /CONTACT PERSON Ed Corbett Jr ADDRESS /PHONE 4 Reed Street NORTHAMPTON (413) 584 -6571 PROPERTY LOCATION 59 GLEASON RD MAP 18C PARCEL 106 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT FA uildinl Permit Filled out e Paid 2 .O 1 > - - Typeof Construction: Strip and Shingle Roof New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 3 sets of Plans / Plot Plan THE F O LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: p 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 Demolition Delay l 0(0,3/air Signa ee of 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. 59 GLEASON RD BP- 2008 -0933 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C - 106 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-2008-0933 Project # JS- 2008 - 001396 Est. Cost: $7375.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr Lot Sizejsq. ft.): 7143.84 Owner: WOODWORTH DOUGLAS STEWART Zoning._URB Applicant; Ed C orbett Jr AT: 59 GLEASON RD Applicant Address: Phone: Insurance: 4 Reed Street (413) 584 -6571 NORTHAMPTONMAO1060 ISSUED ON:4/23/2008 0:00:00 TO PERFORM THE FOLLOWING WORK:Strip and Shingle Roof 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: O`( - 7- a8 THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL / Certificate of Occupancy 4,- Si !nature: FeeType: Date Paid: Amount: Building 4/23/2008 0:00:00 $25.003776 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo