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23A-232 p roposa l Page No. , of Pages CORBETT HOME IMPROVEMENT .. .1188 • WINDOWS •SIDING • ROOFING 4 REED ST . NORTHAMPTON, MASS 01060 ' A C #>f //G b G Y (413) 584 -6571 0,5C..#0.0() PoononvI. SUBM TTED Tr, 0i� , DAT 4j/2 ADDRESS � – 1 /' �.4 ;, , 'a PHONE DATE OF PLANS JOR NAME AND LOCATION ARCHITECT — — .LOB PHONE We herenv submit specifications and estimates- subject to a) terms and onditions as set forth on both sides, as Wows: l (C1---- A A4c4_, . .,:q 24 T X , tl VII 4L1 51/A/, 6 r � . .......... 3 / .'. 11 -,cue ,. e i ✓ ,l�rcto� rl' <>L iC� `1 r ; ,Q siAi ; J K ' (-'4C e: r ,, FIA, 7 r ,, �7.A1.Z / /t3�+� / / /l✓�C S g, R erpi\ e/ , r ' / iii466( Elm I VI? , al),U (.2 ) U(.41 S O'' A \ C IC. 4- Th( V&f'-', Le Please make checks payable to:EDWARD CORBETT (Read Reverse Side) Mr j'j rP pO v hereby to furnish material and labor -- complete in accordance with above specifications. i r the sum of. ---- --- -_- dollars ($ ; - ) 30c c O e o n r + )Axv lai/ K &Ay IS70/ NOTE: This proposal may be w thdrawn by us if Authorized not accepted within days. Signa . . A rrepte6: The above prices specifications and '- -- p• conditions are satisfactory and are hereby accepted. You S natur � are authorized to do the work as specified. Payment will be made as oath d abmve. Date ^ (�J J 1 i/ — __U 2 _ Signature n p (r)Li 0 L)/ - - )a i.• " ' • City of Northampton ._ - R 3 'i Massachusetts DEPARTMENT OF BUILDING INSPECTIONS Y 212 Main Street • Mnniaipal Building Northampton, MS 01060 �t .►" INSPECTOR Louis Hasbrouck Chuck Miler Building Commissioner Assistant Commssiaraer HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her constriction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which twetshe: resides _or_intendsio_ 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 i fur- .the- .t»iding- permit issued- to -me. Date Address of work location The Commonwealth of Massachusetts --- x Department of Industrial Accidents 3r, Office of Investigations 600 Washington Street } a., R Boston, MA 02111 www. mas &gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business/ organization /Individual): 00Retir R ok ttwet Address: 1-/ gf-ed City /State / Zip: /UO R LM 144 frW 0 ) t 1(O 0 Phone #: ..�8 ' ^ 6 5 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. ❑ New construction 2.p ti I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition g for me in working __. employees and have workers1- - -- - - -- - -- - - - - -- - - -- _ - - -- any - $ 9. ❑ Building addition [No workers' comp. insurance required.] 5- ❑ We are a corporation and its 10. ❑ 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 per It! L 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no empkiyees. [No workers' 13.❑ Other comp- instamice required.] *Any applicant that checks box #1 must also lin oat the sectirin bek w showing ter waders' policy information. t Homeowners who submit this affidavit they me doing' all wait and then lice outside er atractars must submit a new affidavit indicating such tContractors that check this box most attaehed an adthional sheet showing the name of the sub - factors and state whether or not those entities have employees. If the sub-contactors have employees. they mast provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employee& Below is the policy 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 25prof-MGL--e. 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. T do hereby certify nder the pains and r' ., o perjury that the information provided above is true and correct Si ature Phone #: ( 5?7 — Official-use only. Do not write- in- this to be completed by city ortown 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 #: 4 • _ - „ill.: '• SECTION 5- DESCRIPTION OF PROPOSED WORK foheCkill - - . • - _ . • - . . - - New House 17:1 Addition Replacement Windows Alteration(s) Roofing 52 Or Doors Accessory Bldg. 0 Demolition E.1 New Signs [Dl Decks ED Siding [Dl Other [DI Brief Des_ccipfion of propopecl -- T ee _ HjA l etz _ , f - Work: ETHif —2 1-/PICAS t A, 4 5 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 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 X 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 - tathtbk7i - ;viii4EFtACrrHtita tkticitt jro BE COMP ED WHEN lowNERsAGEN - rocccoNmeroptiEsFoRttitgapkotPERMIT , 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 ..MJAAD ; rs. atictee , as Owne ut"Tto 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 perjury. radARD 6R06 Print Name 6/9-/2 Signature of Own- rlAgent Date • SECTION 8 CONSTRP_OioN4Ei ra y` 8.1 Licensed Construction Supervisor. Not Applic a ble ❑ Name of License Holder : Fbt , T . (n O az �� 67 7 / -7'/50 ���� � � License Number Address Expiration Date gnature Telephone Not Applicable ❑ Ao e. 3m a nn :r) /146 OCR 9 Company Name Registration Number �1 R-e -ec s4 f )vi 4a 45-.42012i Address 1 Expiration Date Telephone 5-6)41— 6 S' „ 9 ENS/kT1O[INSfIi;AiVD4Nl 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...... ❑ 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 submirtcrthe 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 • A a ' Section 4. ZONING All information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing . Proposed Required by'Loning This column to be filled in by Building Department Lot Size 3 1 i 1 1 ! Frontage ► II Setbacks Front i 3 1 1 Side L:" -1 R:1 i L:I R:1 1 3 1 1 1 Building Height 3 3 I I I I Bldg. Square Footage 3 3 I ;% __ 1 1 j i -- - Open Space Footage _ % _:. _ = (Lot area minus bldg & paved i 1 I f 1 1 I 1 t i Ping) # of Parking Spaces = 1 1 3 Fill: 1 j (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 0 IF YES: enter Book l l Pagel and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW YES Q IF YES, has a permit_been or need to be_obtained from the Conservation Commission? Needs to be obtained ® Obtained , Date Issued: C. Do any signs exist on the property? YES (j NO O 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 O IF YES, describe size, type and location: 1 1 1 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. - 4 r nQ@ c k4 4= o !,1,,,',..,• y ,^.. .at City of Northampton ---- . Building Department u t 4 �h' � . - "; 212 Main Street e . 6 r Room 100 c'e, ' c !t s 2 4,=f 1 Northampton, MA 01060 ; �_, r-� .. rrvri, =, o s �ti „ phone 413 -587 -1240 Fax 413 -587 -1272 . r; , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING k z_, S 1 SITE INFORivwnOM ti e* L Tfiiis seetro `tP Ieted.`byy t 1.1 Prot�erty Address: a r ti. ; ` .. f /1��N�iI�I� S , ,�_ .41 ��- w II- SS ', ' [te � �` .�' a pistil" � � �� �� - i -: ,, ' ,..`s. "-,,:- _ ' 1 'i { s Y xx7: -=- ` .5;"& (- "� . �3- SECTLQ0 . PROPERTY QWNERSHIPPAUTHORtZED - AGENT 2.1 Owner of Record: ,d//q /3 j c vo di) C1 t' Name (Print) C urrent Mailing Address: Telephone 4 ) / 4 33 6. / Signature f (Q 2.2 Authorized Anent: Ept,Att=o r, C©Pte Jh 2/ Reed s.e rvoR -Aaine r✓ Name (Print Current Mailing Address: &ow Set ' to s Signature .. Telephone I SECTION 3- =- ESTI ED- CO " Item Estimated Cost (Dollars) to be Official Use Only , completed by permit applicant _ - -_. - 1. Building ( a) BuildrngPermd Fee = = 2. Electrical (b) Estimated) Total Cost of ._ Construction from {6} . . — . _ -_ _ 3. Plumbing Building Permit Fee- M 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 7 5O "� Check Number , /- - This Section For Official "Use Only_, -? " _ - Da#a Building Permit Nu mb e r. is Signatur - _„�- -- . Commissionedlnspector of Buiidinc, -s _ - :: - .. 139 NONOTUCK ST BP- 2012 -1136 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A - 232 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- 2012 -1136 Project # JS- 2012- 001948 Est. Cost: $7250.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED CORBETT JR 067450 Lot Size(sq. ft.): 11499.84 Owner: STREHORN KREGG C & MOLLY RYAN STREHORN Zoning: URB(100)/ Applicant: ED CORBETT JR AT: 139 NONOTUCK ST Applicant Address: Phone: Insurance: 4 Reed Street (413) 584 -6571 NORTHAMPTONMA01060 ISSUED ON:6/19/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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: 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 6/19/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner