The URL can be used to link to this page

29-383 *�,.. +A �,y.""" Trop osa 2.00 (..�l,o® Siding Windows Corbett Home Improvement tij+�nsrc� Northampton, MA 01060 Awnings Canopies (413) 584-6571 cutters (� 6.7 Shutters PROPOSAL SUBMFMM To / PMNE,5 V2- 60/W DA78 Q C, YIRF>rT �00 JOB NAME /g CrrY,STAVE,mr ZIP CODE /GI JOB LOCATION -� A MA--DATE OF PLANS JOB PHONE f}n� We hereby submit specifications and estimates fw. LA d t All C . ` b c- S S I U 1;6-t eJY i-t ajwAdy r Tilal T- t O*e(Propose hereby to furnish material and labor-co nplete in wvordance wide die abovespecifications,for the suns of: Dollars Payments to be trade as follows:YA i1_ os All naterial is guaranteed to be as slw ifiaL AN wark to be c rupleted in a work-like tanner according Audionzed to standard practices. Any altercations or deviation froni above speeifcentions involving extra c(*ts Will be Signature executed only upon written orders,and will becxon a an extra charge over and above flue estinrete. All Note: This propc>ral nisy be agm reeents cxcntingent upon strikes,accidents or delays beyond our a,ntrol. Owner to entry fire,Mmado awl otter necessary insurance. Our workers are tally acveret by Worknw s Contrnsatioq Inoatrance. widArawn by u4 if not accepted widtia days. ,k CCeptance of CProposa[-The above prices,specific:atious are conditions are satisfactory and are hereby aecepte(I You are authorized to SignatUt ��_ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building y Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AF A IDAVTT L �rl T. Cojet3ET77 d iP (IicenseeJpermittee) �._._. with a principal place of business/residence at: &D .v 21M (phone#) 10.7 ( city/stafr/z�P) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (policy Number) (Expiration Dare) ( ) I am a sole proprietor,general contractor or homeowner (circle one) and have hued the contractors listed below who have the following worker's compensation policies-. (Name of Contractor) (Insurance Comparry/Po1icy Number) (Expiration Date) If. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Daze) (Name of Contractor) (insurance Company/Policy Number) (Expiration Date) (attach additional abed ifne=M.ry to include in�on patsiaing to ell oWtrad rs) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homeowners wbo employ pasom to do rnaiatau*� =svixd a or repair work oa t dwelling of not Croce than throe units in winch the boamumer residcs or on the groin appurtctawA tbendo are not guxrally comide ed to be cmpioyera undtr the wmker's compcus 4ca Act(GLI52,xs 1(5)),application by a homeowner for a 60co3o or permit may evidence the legal stzbu of an employer under the Woe's Compomatioo Act. I undesstaud that a copy of this tuts may be fmwaniad to the pttmmncot of Industrial Acd&n&Off oo of Imunnoe for the covcrago vrtiHcltioa and that failure to Secure coverage under sectioa 25A of MOL 152 can lead to tbd impositiota of criminal peaald'm 0094sixag of a Sne of up to S 1,500.00 and/or imiuisormzcat of up W one year and eitaT p=dti in the form of a Stop Work order atsd a fine of 5100.00 a day againA ma. m� For dial use mty permit Number Lo vp t . �,y Signature+,f Lic�cnseelP�rmitttc +�� 4 --aura^LA3: - a... .. 8.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder:_L LL�{Z� CO1l� f�' �(Z. da7MOO License Number kri!J St Address �.+ Expiration Date &�� .� Signature Telephone Not Applicable 0 Company Name Registration Number 1/ l� "D 5T" s'— /S'- Oy Address Expiration Date Telephone S CTI 3t? 1V0(21(1:R5�Ctl(FRE S1tT1©N; NS JRANCE 4FF1QAVIT(M.G:L. c. I52,§2 3 6 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...... ❑ 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.CM 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 � , s fi .', a�WiG New House O Addition O Replacement Windows Alteration(s)O Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding Other[ ] Brief Description of Proposed Work �fi Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet 0 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. Mascheck 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 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 IR as Owner of the subject proper hereby authorize to act my behalf, in all matters relative to work authorized by1his building permit application. Signature of Owner Date 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 and penalties of perjury. phoxo rl T ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF 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 parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW _ 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 NO IF YES, describe size, type and location: D. Ar there any proposed changes to or additions of signs intended for the property?YES_ No IF YES, describe size, type and location: � 4 � �?uepartment ain Street m 100 j; hi 9rtF on, MA 01060 phone 413-58 240 Fax 413.587-1272 PT APPLk�'It�t�'�`�7�` LTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFObRfi A± ON 1.1 Property Address: ` klod � ` ----------- g # Ei a '6i _!Lj; x , SECTION 2 -PR'OPERTY OWNERSMIPfAUT IOR ZEQ§AGJ~NT 2.1 Owner of Record: SAM Name(Print) Current Mailing Address: Telephone Signature `S 2- J9�! 2.2 Authorized Agent: kuwAiRIN -r. Al Name Zt) Current Mailing Address: S8y• (0 Signature Telephone SCTiON 3 E.r"TIMA IrF�. �STkLI��gN CO�kT�x f+ R Item Estimated Cost(Dollars)to be Offieial use.°Only completed by ermit applicant 2. Building (a) BUil dir gr Per i ee 2. Electrical (b) Estimated Totafcost of Construction,froir 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4+ 5) gjQ s Check Number phis Sectron,For Official Use,Or)l Building Pe:mit Number: Date!tssued gg Signature: .. i3uiidirg';Cammiss�anerJlnSpectar±�f,BU;��inB� . Data.,; ,. a• BP-2002.1099 G1S#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-1099 Project# JS-2002-1763 Est. Cost: $4500.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sa. ft.): 15812.28 Owner: BELKIN ALLEN L& Zoning.URA Applicant: Ed Corbett Jr AT: 27 BROOKWOOD DR Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MAO 1060 ISSUED ON:6110102 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL SIDING & REPLACEMENT DOORS 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 Occupancv Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/10/02 0:00:00 1607 1607 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo