29-383 (3) Troposaf
vinyl siding
Corbett Horne Improvement ow's
Roof-Ing
Northampton, MA 01060 fools
Awnings
(413) 584-6571 Callopies
GutLers
Shut(crs �
I'I PkuPo.SAl..tit BMrt-IEn T(). PIIONaZ—OO DATE
g ov X� pX NAME
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('It '.STATF mud ZIP CODE Flo JOB LOCATION
DATE:uF PLANI
JOB PHONE
We hereby submit specifications anal estimates for:
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(WC (J)VOPOSe llerehy to furnish material and lahur-complete iu accordance with the:awve specifications,for the..ant of
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Pa}'tuents to he made as follows /y{
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Ali mal,rlai is guarnueed lu be as spec'itied. All work Iu he completed in a work-like ucnwer uccurding Autlwrizell
n,st:ud:ml practices. Any altercations or deviation(ruin above specificatiuu.s involving extra costs will he Sig[I h
cxerWed ,uly upon written orders,and will become an extra charge over and above The estincne. All
Note: 'ILis xo wsul may he
�ugrcentenrs cuntingenT upon strikes,accidents or delays heyuud our anttnol. Owner to carry tire,tornado
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and o cr IIPCe55arY insurance. Our workers are fulIV covered by Workmen's Compensation Insurance withdrawn by us if not accepted witlu n days.
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Acceptance of Troposd-The ahove prices,.specificati(at.s
are couditiou.s are satisfactory and are herehy accepted.You are authorized to Siguatur(`/'C�
to the work as specified. Payment will he ut: le as uIII ied above.
(l Date of Acceptance: L Signature
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czw DEPARTMENT OP BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSAITON MSURANCE A.FMI AVIT
T. C'MB67_ - d IP
(Ii tx;useelpertmi tt ee)
with a principal place of business/residence at:
!� N MW (phone#)� 4 lO,S7/
( city/stafrJxip)
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 Dale)
( ) 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 Comparly/Policy Numbcr) (Expiration Date)
,,
(Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Date)
(Name of Contractor) (Insuranct Compauy/Poticy Number) (Expiration Daze)
(Name of Contractor) (Insurance Compazzy/Policy Number) (Expiration Date)
(attach additional sheet ifncassary to inchu4e infotmuioa pertaining to all ooa4uaors)
I am a sole proprietor and have no one working for me.
{ ) I am a home owner performing all the work myself.
NOTE:ptea&e be aware the wbilo bomcowncra who cmploY perzcm to do tnaiaicaanc�wasuvctioa ar repair work on s dwelling of
not snore thaa tbtt a uatu in tcfiich the bomootvncr mid=or oa the ground,appurtenant thccato arc not generally no=tched to be
"MPloYCrs UDd r thn wocktes ration Act(GL 152,=1(5))�'applica6m try n homcowntr for a U0==or panic may cv�the
lrgai ctatur of an omployer under dsA Work.«'&comperuution Ac<
I uad=u=d that a oopy of chit wtcmcat may be fotwnnimd to the Dt9wuaant of Industrial Aocid4a&Office of Iaauanoo for tho
coverage verification and that fad=to&ewm covetago under socuoa 25A of MOL 151 can lmd to tba iw�-of criminal peaakiea
j /��-0.3
SECTION l3 CONSTRUCTION SERVICES
8.1 Licensed ConstructionnySupervisor: (1 mss .► _` Not Applicable ❑
Name of License Holder : wA1�� J, d����i___�l� 7 CO—
License Number
(4 Re�ecJ s�- �l-3d-off _
Address Expiration Date
Signature Telephone
111111"OWN 1,31 .Will
Not Applicable ❑
a&TY 14 o mokow-ro& rr /1(a ob 9'
Company Name I Registration Number
14 &E-L) ST" 5" /S- Dy
Address Expiration Date
Telephone ra!C6�
S �TIQN lt) WQRK�RSItOMPENSATION INSh1RANOE AFFIDAVIT(MAIL. c. 152, §2506))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidi
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 e–o 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
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SE TION S E50' iYT aP O EDW
R"' Jkk3,afiJw llc 1
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors X
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work-- t )rt/ (f S ,W 1—old bJ�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D - Sheet D
�fiI' ry 1 " ""c1tl11t� E s #- 1�Ig�coL7 tlf1 IM:
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
�tfZAATION TO BE OO�M D WHEN
C IC1`��ti �F��tES-FC1FiBtlI�M[ +a PERMIT
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, 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.
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:
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City-ofi'Northampton
l=µ$ui ding Department
:212 Main Street
20( .,Room 100
orthampton, MA 01060
„phone 413-587-1240 Fax 413-587-1272
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APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
07 L00KweOjg D-k
S4
SECTION 2 - PROPERTY OWNERSHIP/AUT140iD'AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
-- - Telephone 6,9.2-00.-c
Signature
2.2 Authorized Agent:
Name(Print) Current Maaiiling Address:
4 Y- (a�7�
Signature Telephone
S CTJ 3 1±�TiMATTED Ct)) TF�GTI ,N CONS;
Item Estimated Cost(Dollars)to be Official Use�Qnly
completed by ermit ap licant
1. Building (a) Building''Perr lf'- .6
2. Electrical (b) Estimated Total Cos#of
Construction.fr*; t5 ;
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) / lCheck Number
This_Section For Official Uso"i2inl'
Building Permit Number: Date lssued,
27 BROOKWOODR BP-2003-0607
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-383 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0607
Project# JS-2003-1004
Est. Cost: $3170.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq. ft.)15812.28 Owner: BELKIN ALLEN L&
Zoniniz:URA Applicant: Ed Corbett Jr
AT: 27 BROOKWOOD DR
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTON MAO 1060 ISSUED ON:116103 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation: -
Final: Smoke: Final:()k j-$ -Q 3 —VAW
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND EGULATIONS.
---
Certificate of Occupancy: si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 1/6/03 0:00:00 1805 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo