29-047 J CORBETT
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HOME EXTERIORS HIC #160143
413 -665 - 2286.413- 586 -8712 CSL #78297
38 Graves Street, South Deerfield. MA 01373
WINDOWS • SIDING • GUTTERS • ROOFING
"Locally Owned and Trusted Since 1966•
Serving the Entire Pioneer Valley
CONTRACT
Date vLy t l 20 1,
This agreement, between j t 4 r Ra ; e .
of 9% q fir' (owner)
y ak" a o A . o f (A eon t „ct_ , and
JCORBETT HOME EXTERIORS'. SOUTH DEERFIELD, MASSACHUSETTS
Phone S t 14
SPECIFICATIONS
V L a r f I �. ^ Q. : .
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S 1.11.4 r 1 U+ LL t � { tut Al e LA . 5.
t. Li„Lp P+tlkrr �/
on the premises located at S 9 7 re y IC,, f2 a t oL a total cost of / 6,5,1-. 0 #
With this order owner pays down the sum of $ 3'00. u tJ
Owner agrees on completion of said work by the Contractor to pay the sum of $ 1 1 17 oa dollars
($ ).
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be
binding unless in writing signed by both parties.
WINDOW GUARANTEE
Manufacturer's glass is guaranteed for life from date above not to fog up between the panes of glass. All other parts will be
supplied free of charge for life. Service will be free of charge for I year from date above. Guarantee does not cover broken or cracked
glass after one year from date above or any damage resulting from neglect, abuse, or acts of God. Condensation build up on the glass is
caused from high humidity levels and poor ventilation within the home
. therefore there i rguarantee that this condition will not occur.
In witness whereof, I hav hereun signed my name this / I
-T4
day of v 20 1)
J'
by r/t 1 .�I:,�� L” �L
( ontr ctor o uThorized Agent) 1 111, mlir rr ner
(Joint Owner)
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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 person(s) who seek to use
the home owner exemption, act as their own'constraetign 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 occuoancv
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 tome.
Date
Address of work
location
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The Commonwealth of Massachusetts
Department of Industrial Aecidents
Office of Investigatio' n.f . .
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600 Washington Street
i 7_,•:ifir___=-- 4 ..." ,
Boston, MA 02111
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- Workers' Coif. pen.sation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
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Applicant Info it . lion • Please Print Legiblv
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Name (Businesi/Or: ......, :ort/Indiviiiii21): _ C;,, ,r- ,k ,Tc /4 e --__- y le_ gr . , c r - S ,
. • Address: s 1 , Ic_ 1 t 2- -e..._ .c...4... q z.,t4 A- , -
City/State/Zip: ...-A 04 0- Phone.#: 5 er 7 / -,— -
Are you an employer .Check the appropriatehox: ' Type of project (required): /
1. 0 I am a employer - lb. 4.. 0 I am a general contractor and I • 6
0 have hired the sub-contractors ' 1 --- 1 New ecmisi4lleticm
employees (full - . d/or part-time).
2I am a sole propri for or partner-
listed on the attached sheet. 7. 0 R,emodeling
ship and have o
a .
These sub-contractors have -8. 0 Der • .
n -....loyees
• egrAgo_yees-anclhave workers lat
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working for me -.. any capacity. 9 - 0 - Iihnig risIdideM
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[No workers' co ..,.. basuiance
„._, r&luire d ". •
5. 0 We are a corporation and its 10.0 Electrical. repairs or additions
• 3. LI I am a homeo • . . doing ill work officers have tir.excised their 11.0 Plunibing repairs or additions
myself [No wo i• ' comp. right of exemption per MGL r-/ ...
1/ u Roof repairs
insurance requir • t - . . 152, §1(4), and we have no •
employees: [No work 13 0 Other
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' ' . • comp. insurance reqUired.j.
*My applicant that checks box - :must also fill out the section below showing theirworIcess compensation policy inkmation.
t Homeowneri who submit this .i. . . 't incfiCating they are doing all work and then hire outside contaCtors must submit anew affidavit indimting such.
Icontractors that check this box ..,... attached an additional sheet showing the name of the subcontractors and state wietherornotthose =tides have
anp]oyees. If the sub-con ,. haVe employees, they must provide then wOriceis' comp poky number.
Jam an employer that is 17' oviding workers' compensation insurance for my einplOyees. Below is t h e po ricYand job site
information. •
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Insurance Company Name: - •
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Policy # of Self-ins. Lic. #• Expiration Date: - • .
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Job Site Address: : :. City/State/Zip:' - • . . : - -
- Attach a copy of the work s'• compensation policy declaration page•(showing the policy number and expiration date).
Failure to secure Coverage, - required inkier Seetroh25A ofMGL - C: 152 ca lead the iiiiPo illicinlif es of a
fine up to 51,500.00 and/or • • -year imprisons as well as civil penalties m the form of a STOP woluc-a.RDER and a free
of up ta $250.00 a day ag ' the violator. Be advised that a copy of this statement may be fOrWardedintheOfffce .
Utkestteaticiiiftlie DIA f Eli Coveiaze ve . • _ . . __. _ , , ..., .-;.-, ....:_;_-__ -,.,_._-._,_: ____ _ „,_ , .. _.,
_ rdii lieiibyTierith
under t I, gin s --- Hand penalties olperjmy Mai theinfornurtionprOvidedabove_andiorioct '
ari
Shmature: Date: VP - Z . -2-6 1 ( - . •
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Phone li: . _ , . -
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. - Official use only. Do not write in thrs* area, t O .be . completed by city Or townOfficial
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I City or Town: Permit/License # '
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Issuing Authority (circle one):
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.1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical,Inspector 5. Plumbing Inspector
6. Other F. •
Contact Person: Phone #:
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : CAA /1 1� , C / - S �-t 1 e r A-9'7
License Number
s 4 A hvic ttf te
Address Expiration Date
£f
S' ature Telephone
8:;# eegisster id,Ho e I mt rov itmeri� , tiviiiiiatitaggaimiggeomIiirmai Not Applicable ❑
f CCJ v Sv1 if o LPL c L5:-- -/ � 16(21-41.-
Company Name // Registration Number
"KZ t l 1L4 G (<-- s7" !� ,r c` /N,4- VP' G// '
Address Expiration Date
Telephone 's zr 7/ 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 building permit.
Signed Affidavit Attached Yes ❑ No ❑
1 mte O er_•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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [E] Siding [0] Other [0]
Brief Description of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
p4., if tci ezi tkncr`h'ai 5rnq':comptete th _fOtlow It p:
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
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SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
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
_( G (A__ c" S r f � , as r /Authorize
hereby declare that the statements and information on the foregoing application are true and accurate, to the best wledge
n elief.
Signed under the pains and penalties of perjury.
fri
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Print Name
Signature s �%'' er /Agen Date
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a
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplet Information ,
Existing Proposed Required by oni
This column t fil in b ' '
Building Dep `c
w
Lot Size € n , ,
f 1 l
Frontage 1 t a i. „, i
Setbacks Front i I ( 1 [.
Side L: i R: [ L:' l R:! , 1 t f
Rear F =1 Ell
Building Height = = 1' J
Bldg. Square Footage [ — i % ”` t
f
Open Space Footage
(Lot area minus bldg & paved [,_. �111�� d w J s ,
parking)
# of Parking Spaces --- ~
Fill: i q ..� e.�.,�.ma_..�.�..�_,�..�., ..� �.a.. � �� �.� �. -�«.,. �
(volume & Location) . I ` z t,
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
,
IF YES, date issued:1 I
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book 1 Pagel I
I and /or Document # _ _._
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q ,Date Issued: ;
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: 1
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
IF YES, describe size, type and location: s
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.
VI .
�� v City of Northampton ¢.f i `r f. . 1,-!°:m4,,,,,--:,, ; ,1 Z - ,. ., ,
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Building Department ''?:14:1 � <- � � � ��
�� Room 100 %\ 212 Main Street ° : a - " T . :.,
Ok �'f
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hampton, MA 01060 = , • - - .off
� "° � : ='. - e 413 - 587 -1240 Fax 413 - 587 -1272 • 4 4 `. >�
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
Map Lot Unit
9.57 r '7 ,ev Cc Zone
Overlay District
Etni St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
/e_et //4 / S -. 6 ff #4m- - r-1 7
Name (Print) Current Mailing Address:
• i. fn m- 4. ,- (.
'� - � ! Telephone
Signat/'
2.2 Authorized Agent: '''',.,--.5.--1(
,S c- 1 A _, � 0 S4 4 i 4 c C. I. 5 l i' e-e-- S g4 it;
Name (Print) Current Mailing Address:
/ /
Si.y..: - 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 �aa
1 +2 +3 +4 +5 - /430 � jVS
6. Total=
( ) �� �S Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Date
Building • Commissioner /Inspector of Buildings
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298 RYAN RD BP- 2012 -0115
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 047 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit # BP- 2012 -0115
Project # JS- 2012- 000173
Est. Cost: $1665.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN CORBETT 078297
Lot Size(sq. ft.): 12501 .72 Owner: FARRIE THEODORE J & SANDRA J
Zoning: URA(100) / /WSP Applicant: JOHN CORBETT
AT: 298 RYAN RD
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586 -8712
LEEDSMAO1053 ISSUED ON:8/1/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 8/1/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner