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32A-051 (2) ARCHAMBAULT BUILDERS Page No. of pages Excavating and Building Contractor 68 Amherst St., Granby, MA 01033 Proposal cell: 413-552-7410 home: 413-467-1655 LICENSE NO. r =,a k t\e \ GATE JOB PHONE NO. rt\iA ■5 � , ° JOB NAME/NO. a-. JOB LOCATION / ' We herebj submit specifi■.. -, s and estimates fOr: /41e1:?. /Z/©0 F.---! L tekl.+rte +4) t41,4,. kJ - r 1(2Y .6r4k i l 4 .5r c)XCI4 U. eOce P\ . - ' .. 4 f ...., ,7"--- '1/4 , --. b Re Lilo I \Nii, Vii. , ,sile_! 1c j'e Siopoatc lott4k L eAitks 1- iiiiiii‘o., ,, : 1 , , ...„.76:106.,_ • E 4' i ,,, ,,,, -- � � 1 4 5 t'" , , ' t 1e f: . 4 1 isj" ti ' Y.0 "t* Is 7 0°4 I P' '' t t All material is guaranteed to be as specified.All work to be completed in We propose hereby to furnish material and labor-complete a workmanlike manner according to standard practices. Any alteration or in accordance with above specifications,for the sum of: deviation from above specifications involving extra costs will be 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 and other necessary insurance.Our workers are fully covered by Workman's Compensation Insurance. dollars($ ). Payment to be made as follows: You, the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date Note:This proposal Signature may be withdrawn Sig of this transaction.Cancellation must be done in writing. Authorized by us if not accepted within days Acceptance of Proposal:The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date Signature Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1«I r E. Fr—r`F "7 , 600 Washington Street r... Boston, MA 02111 www.mass.g,ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 6e A -cIs/otJ] Address: 6 tSr��fct 71` 6j3- h y PL., 0/ b 3 3 City/State/Zip: - j, et. ,r e 3 Phone#: j 5 ) 7't d Are you an employer?Check he appropriate box: Type of project(required): 1.0 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. 0 New construction 2._❑ I am a sole proprietor_or_partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees . These sub-contractors have 8. E Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill 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: ' Policy#or Self-ins.Lic.#: V �• CAC)-5 60`-1 b I O I Y Expiration Date: at.©/4/ Job Site Address: ti ot 5-ice,t "1'" City/State/Zip: ( , , , i. Q 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 co py of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer under the p ins d penalties of perjury that the information provided above is true and correct. Signature: Date: g-/1 -/ 3 Phone#: -2yl 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#: Version1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR.:110 11)- Independent Structural Engineering Structural Peer Review Required • Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION TO.BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L?._ l.(�..e_....._. . '� _ Lf'.. as Owner of the subject property act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date , .�Iz . 1 _• as Owner/Authorized 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 a penalties of perurr .�� Print Name /_ ___..__ ...__._....._..._. Signature of Owner/Agent Date SECTION 12-CONSTRUCTION:SERVICES . 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:}1.. ( tx ' ,n ti �.M. mm._...4 1ti _ ,....,_._ l_SJ._72s^ ... ...g... License Number Addr-ss '\ Expiration Date Signature Telephone SECTION 13-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 44 No 0 Version1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF EISLOSED:SPACE) 9.1 Registered Architect: 1 Not Applicable ❑ Name(Registrant): I ___ - Registration Number Address c _. '---1_ Expiration Date Signature Telephone 9:2 Registered Professional Engineer(s): i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address . _ Rtgistration Number Signature Telephone Expiration Date _ i I 1 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date ____.w _ _ � __ f i i i i Name _ _ __ .«____ ._.. __.__.. . .._ _ _« Area of Responsibility Address Registration Number jjjje , Signature Telephone Expiration Date 9.3 General Contractor . .6?KA-5,-_k :..r 1 4..khv ! ._._.._ Not Applicable ❑ Company Name: Responsible In Charge of Construction _. Addre / ;I/ _ r - 1 3-. -.Z �o_ '.nna*re Telephone Version1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON.ZONING .. Existing Proposed Required by honing . This column tibe filled in by Building Department —_–...---------, . Lot Size Frontage i ,, Setbacks Front , , ,------: 1----1 ---- ,-- Side L: 1 R:'.1 I L:L 1 R:E.71 i ! Rear ;2_ I 2:— Building Height Bldg. Square Footage 2 1 ,22. ....22. Open Space Footage % ilf -- - (Lot area minus bldg&paved .......—.1 L...,.......I ,,... parking) #of Parking Spaces e---i :....._....1 r--1 1 1 f-----1 L._ Fill: I, , ; (volume&Location) '-------- A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 • 1 ,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 1 ; Page ' and/or Document#V , B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES 0 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 0 NO ) . 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 0 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 .40.441 • IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 a CUBIC FEET OF ENCLOSED SPACE .,, Interior Alterations ❑ Existing.Wall Signs ❑ Demolition❑ Repairs 0 Additions ❑ Accessory :u •ing❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Enter a brief qesAription here. R.a`ol�� C,a.ra .0__ Flat RooF Double C Of Proposed Work: Reirwov Ke. 1ta-e dl l- '6h An.6lr.5 c So..441.sic1t • Reper,ih- F f3 e- - SECTION 5-USE GROUP AND CONSTRUCTION TYPE I I Pp I USE GROUP(Check as applicable) ' CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A I ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B - r ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H-High Hazard ❑ -, 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 0 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B I ❑ U Utility ❑ Specify:}' __._._.,_..__...._... M Mixed Use ❑ Specify: _ , S Special Use ❑ Specify:I .,_...-. . _ ____ _____.___.... _�...............____.._, COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: ______ ___ __ __ Proposed,___ __ __ Proposed Use Group: , __ _. __ __ _i Existing Hazard Index 780 CMR 34): ____� _ _.... .. ___ Proposed Hazard Index 780 CMR 34):L ._._.____w_._ ____ „__, SECTION.6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) , 1st 1st 1 F.._ - _......._....____ 2 ._ - 7 2 nd nd _. *. --,.,,._., { 3rd i 4th _., 4 Total Area sf ( ) Total Proposed New Constructionist) Total Height(ft) Total Height ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone ,___ _` Outside Flood ZoneD Municipal ❑ On site disposal system Version1.7 Commercial Building.Permit May 15,2000 ; � Departmef�t use only ; n Ci of Northampton Cstuartb u eGo u PerrnE PerR m tt �, *A-W! lit r RECEIVED -rho%.. t 1 _ r 4.t �� t t x Bui sing Department 2'2 Main Street Sewer/SepttcAyatla�gllty Rx >s� AUG ' 2!i Room 100 WatE'r/ E.'�I�VaCtablllty} S � aLF: v � �k N•rth pton, MA 01060 Two Sets of Structil0E19tans:.! .x x phg 4,0 58 1240 Fax 413-587-1272 Plot/Srte Ptans /AO1060 atherSpecify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 SITE INFORMATION This section to:be completed by office 1.1 Property Address: o.v e1- Jr E- Map Lot Unit is Zone'.: Overlay District - -.w..•.-.-_--..__---M-..->----_.-_--._.,-,-< .,.r-----u-�-•--•---<>----.,....,.:..._...-. w EIm.St.`Distric CB District SECTION 2-;PROPERTY OWNERSHIP/AUTFIORIZ.ED AGENT 2.1 Owner of Record: j Name(Print) Current Mailing Address.✓ 56._. 6 'O G; Signature C46,111AArall Telephone 2.2 Authorized Agent: 6$ At.0 1 3 Name(Print) Current Mailing Address_ M _ > Signature 11�.�/i.—_ u .1. /, Telephone _. SECTION 3`-:ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost(Dollars)to be Official Use:Only completed by permit applicant 1. Building (ay' Permit Fee , DDD, cx� 2. Electrical .'.. (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) "°__ 5. Fire Protection Total=(1 +2+3+4+5) 5d 0 . Check Number dc9i.9 1,5":5" This.Section For'Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2014-0158 APPLICANT/CONTACT PERSON GERALD ARCHAMBAULT ADDRESS/PHONE 68 AMHERST ST GRANBY (413)552-7410 Q PROPERTY LOCATION 49 MARKET ST MAP 32A PARCEL 051 001 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 676/9 gg Fee Paid Typeof Construction: REPLACE GARAGE ROOF&REPAIR FRONT PORCH(POST&CARRYING BEAM) SAME FOOTPRINT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 010788 3 sets of Plans/Plot Plan THE FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN ATION PRESENTED: Approved 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 D do Delay, ill Sign. . e of Building ffi 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. 49 MARKET ST BP-2014-0158 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A-051 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-2014-0158 Project# JS-2014-000296 Est.Cost: $5000.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: GERALD ARCHAMBAULT 010788 Lot Size(sq. ft.): 5793.48 Owner: GOTTLIEB CAROLINE C Zoning:URC(100)/ Applicant: GERALD ARCHAMBAULT AT: 49 MARKET ST Applicant Address: Phone: Insurance: 68 AMHERST ST (413) 552-7410 0 Workers Compensation GRANBYMA01033 ISSUED ON:8/14/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE GARAGE ROOF & REPAIR FRONT PORCH (POST& CARRYING BEAM) SAME FOOTPRINT 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 8/14/2013 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner