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29-384
(Proposaf ------------- Corhett Home Improvement Northampton, MA 01060 (41 3) 584-6571 7L�, C JI) ,m',s-i A T-E,a id 711 DATE I)F PLA N iA c.,,v --- ------- We tor P '-s N 4 L WC )-opose 1wi,l" t') i 01"T 'I, will Ilia the—11,d,t Pav iiwnt�t,,he made a, ly)CAJF'i '.",JLrJ ' �el f AP is vuunalred N'he as p,( fi,d All u,,rk lo I adtrlo,d in i w,)rk-Jik,in;amrr ur,rdmg Aijili,,riz,-,l t—t�md mlpri,,tires. Ariv re,iti,i,twn,uiv(dving extra o,sts will hr Signatury cX,,(11,1 mIN,upd,n written oriltra,and will ht-couit, m extra(h.irgv d ver mtl fiv rsfiumih, All Nolc� 111is ,n,x>vul turd hr ','!""'e", 11"t ai-,-ptod"Ithi I) Our w(,rktvs ort,Lull, crt-d bv Workmen'x(',III ip,n,il ri Instiran— withdrawn 1,\ kly it Acceptance of Troposd are,d,ndopms are saris ac.fory and ar,,herel)v accef)Wd, You arc autli(�ri/cd F, Signature J;' do the wofk;L, cIxcifiefl Pa'vnient will hr motile;L,dmtljtwd [)air of Acceptance. Signaturl-- w � DEPARTMENT' OP BUILDrNG INSPECTIONS 212 Main Street • Municipal Building ' Northampton, Mass. 01060 " WORKER'S COMPENSATION INSURANCE AFFIDAVIT a T. l"OM 6E7T d ie with a principal place of business/residence at: 1 � J d (phone#) 8 -/0.7/ ( city/sta0zip) 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 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) (Expiration Date) (Name of Contractor) (insurance Compauy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional sheet ifnaocsssry to irl} infocmaflon pertaining to all ooatra ra) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plcaae be aware that wbilo homcowucca who employ pctsam to do m,,i�suction or repair work on a dwelling of not moon than tbrao mots is which the homoow r wide oc on the Vvunds appurtenant ibecdo arc not&--14 maTi k-ed to be empioycn under tho wockees compecu4on Act(GL152,ss 1(5))�application by a homeowner for a liccnx or permit may evidence 1110 leg4 clan"of ast etuployec under the Workoes Compomatioa Act._ I undcstaad tb.at a oopy of thu s3atetnecd may be forwarded to the Dtpw mm2 of LALL3hial Accidents•CJffioc of Inca for the cover*g verification and that fa um to secure coverap larder section 25A of MOL 152 can lead to tba imposition of criminal Pcaataa of tt fine of up to S 1,500,00 rmdror im{asso of tip to one year and dVil petntlia is the form of a Stop Worfc Oreler and a fim of Slo(1.00 a day tpinst me For dial use o°ty permit Number • 7 Map*t Lot# �,w SiPatmt of LicensedlPermittee Mte 8 1 Licensed Constructio-n Supervisor: Not Applicable U ED Name of License Holder: _ � . 1-d11Q� a� C%7 MOP License Number (4 kipecJ *30-0q Address Expiration Date Signature Telephone r 122 Mumma Not Applicable ❑ ComRany Name Registration Number Ll A-p S?-" S-r /$*- oy Address Expiration Date Telephone -A -46 S 1 � NIfOEtKERS' Iklllrf�1814�1O1 f �IRANGEFFIDAYIT(IlkGr::t.c.152,§,26 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,y vided 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 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 r 4 � ;.y New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing `' Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed Work:_57-1fJP t: - Aiteration 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 i 1, 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. Phl.)APA T C�h�e6e�-- clt2 r 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 Arkin #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 T No IF YES, describe size, type and location: Fit, � - buiming Uepartment r-- � �� U c� 212 Main Street Room 100 ,.I'';j , ry I hampton, MA 01060 " �Y{0 ne 587-1240 Fax 413587-1272 r N i�1,u Q 00�CON TRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1--SITL INfdRiVt/Al IQN 1.1 Property Address: MOO&� bg � 4 SECTION 2-PR4PERTY OWNER iirP°TAUT IOR!FED nNT 2.1 Owner of C) 6�Mell alt Name(Print) Current Mailing Address: Signature Telephone `7 2.2 Authorized Agent: Ben- 4*. Name(Pri t) Current Mailing Address: spy- Signature Telephone Item Estimated Cost(Dollars)to be Official�Usetly completed by ermit applicant 1. Building (a) Buil fit" Perrnrt Fr~g 2. Electrical (b) Estimated Total Cost of Construction.frorn� 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) Check Number fi or.Offtcial Use Onl Buildi�n Permit;4 tir0ber: Date lssuedr: Signature: .. , I uIldi g;Gorrrmi WOW Ins 28 BROOKWOOD DR BP-2002-1181 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-384 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-1181 Project# JS-2002-1892 Est.Cost: $3925.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sg.ft.): 15986.52 Owner: SPENCER STEVEN G&MICHELE V Zoning:URA Applicant: Ed Corbett Jr AT. 28 BROOKWOOD DR Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON:6127102 0.00:00 TO PERFORM THE FOLLOWING WORK:STR I P & S H I N G LE 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: ©/< 7, THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION F ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 6/27/02 0:00:00 1639 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413) 587-1272 Building Commissioner-Anthony Patillo