29-374 (2) (M Ka
T�''on
osal Vinyl Siding
Corbett Home Improvement
Windows
Northampton, MA 01060 Awnings
(413) 5$4-6571
Canopies
�C Shutters
PROPOSAL St remn mP TO PM DATE
S-1REET �t/L JOB NAM
MY—STATE and ZIP CODE JOB Ll]CAT ON / 'J
LTEIV Pt.ANS ill/ tO --197,2— JOB PROM
We hereby submit,4ve fications and estimates for:
3 ')
7 / 3
(NVC 9?r hereby to furnish ittaterial aril labor-caatq+kte in accordance will[the above specifications,fan•the sum of:
Dollars 06
Payments to be Jnade as follows: //) .11,10,vey ;oj 4 )A-,'A't
All material is guaranteed to be as specified. All work to be wulpleted in a wexk-tike manner avowding Atiduxized
to standard ptuctims. Any alteresrWas cr deviatiwt from above*fwW*WW ittwdving cum cion;will be Sifloure
executed only upon written emlers,and will become an extra du)rgc cwef and abewe the cstiHOW. All
agromicau ura Rent upcot strikes,ac dents of delays",ad cue auttnrl. ()'t ua to carry fie,tcraado Name: •dais proposal play be
and other ugc cssary nwxmz.am wtrkc>t^s are My cxwet'ed by W4rkma's Caotgwamatiun tnsaranc e. withdrawn by w if not accepted willsi n days.
{tt/iFrPl.
a g Crzt� of wort I1ttmpfoil ;
$ .� �aesacytssctts'
DEPARTMENT' OF BUILDNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01000 '
WORKER'S COMPENSATION INSURANCE AFI{'II?AVIT
1� T.
C646677 d 'F
(licx;nstc/pertnittee)
with a principal place of business/residence av
�Citvt (phone#)_ �0.5�'�
( t e/zip)
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 J&
(lam ance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (insurance Company/Policy Number) (Erpimaon Date)
(Name of Contractor) (I.nsurance Company/Policy Number) (Expiration Date)
(Na1r1e of Contractor) (Lnsurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (insurance Company/Pohcy Number) (E4iration Date)
(-.trash additional-bee if ntccnary to include infbr n oa pataining to all 000t xtors)
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 awzm thu v&Uo homcowocas who employ pcsso=to do n%&jaj nsz„ce,construction or mpa.ir work on s dvm1fm8 of
not more thou tbr"units in which the hom00%n r=dcs or on the grounds:ppurtenaat thatito are not gcrxrally coosidcrod to be
cmploycrs under the vimker'a compcwAilao.Act(GL152,ss 1(5)),application by a houwow=for a lir=a'cc permit may cvidcaoe the
lcg21 statue Of an employs undor the Workc+r'a C,oaspomttioa Art
I undmiand that a copy of this sxat—i may bo forwarded to tbo DW tmc d of IoAttstrid Av6dea&Offioo of Irssuraoce for tbe
coverage vaiflattion and that to sxune covetngo under soction 25A of MOL 152 an lead to tho imposition of tximinsl penalties
f
SECTION 8-CONSTRUC710N SERVICES
8.1 Licensed Construction Supervisor:'�_"1rv� --`` "� Noott Appfiicable ❑
Name of License Holder : EDWAA0 OiR� _�� do7M02
License Number
Address Expiration Date
S
Signature Telephone
n ��6113 Not Applicable ❑
t�1
le a77--
Company Name Registration Number
5-- /s- 041 Address S� Expiration Date
Telephone
SECTION 10 WQRKERS' MPENSATION INSURANCE AFFIDAVIT(M.O.L. t. 152, §25C{6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affid�
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)famili
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the_awner act
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(
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
w
t
VA' 4 +�N V li tt5
Mf3 5 ri >4 HS.S' '5i. A Ti A%�f
4�.�?�.,
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ j Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: d' & Alwwml
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
c t rzAfroNo BE CdMF'� TED wwf+l�
o� r� rN� >l~arvlYir
as Owner of the subject prope
hereby authorize to ac
my behalf, in all matters relative to work authorized by-this building permit application.
Signature of Owner Date
I �(.1tQsIT eoq$£ _)� Jf. 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. _ //,�—d✓
t
Section 4.
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:
r) Awn +k—^ �— -r-es—A nL.nn 'nr +- — -,4,4;+;--, n+ ++ J J f +L .L.,WE'C`
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587.1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
►s� ro,.
1.1 Property Address:
ELOR&k-
SECTION 2'- PROPERTY OWNERS HIP%AUTHORIZED,AGENT,
2.1 Own of�Reoor 171 f'dleewa e
Name(Pri t) Current Mailing Address:
Telephone c-Q��• �2
Signature �7Q
2.2 Authorized Agent:
ED WA 11 T' C
Name(Print) Current Mailing Address:
Signature Telephone
CTIQI�C 3^5 tM 171Ef]Co, S. Cl'i'QN CfiStS
Item Estimated Cost(Dollars)to be Official use Only
completed by ermit a licant
1. Building (a) Building Permit-f.-e-
2. Electrical (b) 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) I Check Number
This Section For Official Use Ont
Building Permit"Number Date Issued:
171 FLORENCE RD BP-2003-0453
GIS#: COM_lv-i _Y OF MASSACHUSETTS
Map:Block: 29-374 C;I'1f.'Y Of' NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2003-0453
Project# JS-2003.0768
Est.Cost: $4100.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sa. ft.): 13590.72 Owner: HOLLEY CYNTHIA LOUISE
Zoning.URA Applicant: Ed Corbett Jr
AT. 171 FLORENCE RD
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTON MAO 1060 ISSUED ON:1114102 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• 6 k
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA N OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Si nature: L/
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/4/02 0:00:00 1762 $25.00
212 Main Street,Phone(413)587-1240;Fax: (413)587-1272
Buildi.:g C,m,nss: _._. f'nthow- Patillo