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29-109 (2) • • Page No. of Pages iF----, proposal ,----_, NEWMAN'S CONSTRUCTION 697 Bridge Rd. Northampton, MA 01060 1035 413-586-1093 J° Aln NrAit■tDVCk,/ ( o 7j V — cP657.5 PROPOSAL SUBMITTED TO PHONE DATE , „.....1 / e■Tareignenillilellaglia - ' ,,, 1 3 STREET JOB NAME ._ _ _ _ _ .._ _ _,M■ C51 iiiii CITY, STATE and ZIP CODE -JOB LOCATION --..-- -----, AtCy etit"\-. a yy-% kt, ,■:., NI .1; 01 oc, ,,-- 574/ R iv ARCHITECT DATE OF PLANS (--, JOB PHONE . . We hereby submit specifications and estimates for: c Q a_cy3 t , 'vV ctt vnQ %lc DA, Irz-. :: 5A It 1 1,, L I rvi 1 vs 1/4.., I'N byz. c p t A z (.,.., VA , (-).) C.) VA FtLe._ P....ff t-2 S A f rtt,'E S 1.--, � 115 It X 4 W Avi C 0- e. p.‘ 't sz, n- r t (i-Ai t t‘ SA t5 ,:)11. 1. y S c..m2k.s a 0.-ir -\ ) ll - 5tA - 1' iS - ( i t \ A" i) PT S CZ C A 12A t'v% SIN ' I\ 'k 5 („, .( ,-).( r • , 1 et 5t 4 ... k k '%' V \ 1 V ' .' k - \ : — 5'i .4L). \ i - 73(:) / ya i' ec\-11"t Ch __' ."\'‘%14_11.S c:` V\ t..- V Y2' R—c c:.: i: ti. t o t A. ■ ) ( ko,t_ Qui" Le_.=4 n 12-i 04. k ,-05kail vzc.,o vtifi+ ) c t p lz 0-- 1_ > 4 ---- e - Int Propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: dollars ($ 7 70 C , c (-- ). Payment to be made as /flows: L- 14 Du t' U ) 6 i' C , ii) a A l 4 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications Authorized S involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This pr :sal may be ....-9 , 5 0 . \ Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not . -pted within da s ..\\ , Arreptanre of Proposal —The above prices, specifications .40 Y‹ and conditions are satisfactory and are hereby accepted. You are authorized Signature , -..... to do the work as specified. Payment will be made as outlined above. / /7 -- Date of Acceptance: Signature 0./0.4? /...- % O y ((��'' j am + = * —a �� T t�1t Q:ifI7 of � �1 oZf > ntp Z r 3 ,, 4 , : , . zsacfiitscffs ' DEPARTMENT OF BUILDING INSPECTIONS =i ifs 212 Main Street • Municipal Building �\ INSPECTOR 5 Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as Lis /her construction sups;:. sor. 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 ins- ection if re • uired and a final buildina ins 9 ection. 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 i The Commonwealth of Massachusetts —�---- Department of Industrial Accidents 1- _ Office of Investigations ��"" ° 600 Washington Street lk c Boston, MA 02111 mi _� www.mass. /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): C (U 5 j Netk) ! 1 Address: j/ C4 P (7(1 City /State /Zip: Kibf(q..1&g , y LM -Gel &,3k Phone #: (t.( I �) 5i2,, - i 0 q 3 Are you an employer? Check the appropriate box: ox: Type of project (required): 1. a 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 listed on the attached sheet. 7. ❑Remodeling 2. [1] I am a sole proprietor or partner - ship and have no employees These sub - contractors have 8. ❑ Demolition for me in any capacity. employees and have workers' working 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 3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. (►�� Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] - - -- *Arty applicant that cheats box #T must also hll 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 is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G /d __1_.,r' . CO . NLLt1C ,^ Policy # or Self -ins. Lic. #: - O 1 W a Expiration Date: 5- 14 - Q t 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 fire 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 ins and penalties of perjury that the information provided above is true and correct 2 ASiQnature t Date: /`/ / a� Phone #: zTi? - l) • • r ' vlficiai 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): Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Other itact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES • 8.1 Licensed Construction Supervisor: A Not Applicable ❑ • Name of License Holder : Cy (O J J . y `i &O r C � D L09 0 License Number • _ t A - F5Y - CI i2d. N 4n—r -1 'K,10 ■ CAp 0 k i -0q Address 0 Expiration Date e - - /09 3 Signature Telephone _ . j_____________-- , Not Applicable ❑ 9. Register Home rniprdi ementContracior T. Net - z -ru - ark 1 2.P)0 - Companv a me Registration Number Coal s d( e0 /- 5- - (t® Address 0 Expiration Date Telephone(11/3) h - X0 9 3 SECTION 10- WORKERS' COMPENSATION INSURANCE. AFFIDAVIT (M.G.L. c.1 52, § 25C(6)) 7 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failui , provide this affidavit will result in the denial of the issuance of the building permit. <A Signed Affidavit Attached Yes /Lc No ❑ 11.. 14 e7 Q Wn r - - x e mp o 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. CIVIR 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 x '4 e , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House E Addition ❑ Replacement Windows Alteration(s) I I Roofing kl Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [❑ Siding [Cl] Other [0] Brief Desc of Proposed Work: 'e.-vs t? f'k;S-t; n r� rc r 4 t rna .r; cd) , i rte n 11 ni).41, Cup kat t + 6 ni I `- p v - _ .1 V Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6aa 1ENew-ho use a nd or addition.taexistiinc} hoiiith .coin etilb fiottoWhid: 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 Wi 100 yr. floutlplaii Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . 1. 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 1, , 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 1, CA/ (() S :T. 7J eco !y , as Owner /Authorized Agent he eby declare that the statements and inf mation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Cc. ,5 /Ve _1. t/ Prin ame Signature / wner/Agent Date • £ 0 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 — Setbacks Front Side L: _ R L:- - R Rear Building Height Bldg. Square Footage –' % Open Space Footage % (Lot area minus bldg & paved . parkine) . r- -- # of Parking Spaces • Fill: '_ I (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? -- a w. r � - IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW O YES 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 0 NO 0 IF YES, describe size, type and location: !. D. Are there any proposed changes to or additions of signs intended for the property ? YES ® 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. �- —^ Dep erse ortl City of Northamp Status c4 Peat- . Building Department Gur -fgg* Pe .,� �� " 212 Main Street ewe�FSep a f a b t r E Room 100 oaf r/ e(I Arrailabilify° E : " ' , f Northampton, MA 01060 T�r►o�etsofStrrccfora PFart ; 7 phone 413 - 587 - 1 2 40 Fax 413 - 587 1272 PtaFlSste PE s —`' '� -, « QtherSpecif I APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ON E OR TWO FAMILY DWELLING SECTION..1 -SITE INFORMATION 1 1.1 Property Address: �C This sectiorrto be completed byo ce 5 Pam, 2d Mai dot Ucxt �' or -e- �} t/� ' /-� /+� �`''+� ` Zane Ove rlay Drs tri 1" l/i 1� l ` , v \l�l l J V l Q , .. � St District . CB D�stFrcf SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED -AGENT 2.1 Owner of Record: � A to r, NQ L, j'�-L -t s: C -, ►2ct . F'I o Name (Print) Current Mailing Addres cta � �} x{ - 655z Telephone Signature 2.2 Authorized Agent: Name -Agent: : Current Mailing Address: oc ' 3) S--1.. i v9 3 Signature ., Telephone SECTION 3 STIMA C ONSTRUC T ION COSTS Item Estimate Cost (Dollars) to be Official Use Only co mpleted by permit applicant 1. Building J (a) Baitiiing Permit Fee 2. Electrical (b1 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 ���0 This Section For Official Use Only Date Building Permit Number Issued: Signature: Building Commissioner /Inspector of Buildings Date p 574 RYAN BP- 2009 -0529 GIS #: COMMONWEALTH OF MASSACHUSETTS 5 k Map :Btock: 29-109 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- 2009 -0529 Project # JS- 2009 - 000743 Est. Cost: $7400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CYRUS NEWMAN 142807 Lot Size(sq. ft.): 21 170.16 Owner: NAHLOVSKY JOANN Zoning: URA(100) / /WSP II Applicant: CYRUS NEWMAN AT: 574 RYAN RD Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586 -1093 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:11/18/2008 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 11/18/2008 0:00:00 $35.006190 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo