29-404 dee-
Troposal
Vinyl Siding
Corbett Home Improvement Rt�f,g
Northampton, MA 01060 Awnings
(413) 584-6571 canopies
/ Gutters
Shutters
tI e Q Q 2
-
pcopJsnt suBMTEDTO JT p( � �
STREET /{tf ,S/ /�I� / JOB NAM
CrrY,STATE,ant ZIP CODE JOB LOCATION
DATE OF PLANS TOOPHONE
We hereby submit specifications and estimates tier:
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CWQ PrOpOSC hereby to furnish material and labor-complete in accordance with the above specifications,for the sutn of:
Dollars(t 16 )
Payments to be made as fellows: )13 D nOt/7— ST 09 7-
All naterial is guaranteed to be ac specified. All work to he completed in a work-like manner according Authorized
to standard practices. Any altercations or deviation from above specifications involving extra costs will he Signature
executed only upc,n written urtters,and will beu,nle an extra charge over and above.the rtotintata. All
agreements contingent upon strikes,ac6dents or delays beyond our control. (Tuner to catty fire,tomadu Note: This proposal may be
and other necessary insurance. Our workers are fully covered by Wwkmen's Cbmpensatiot)Insurance. withdrawn by w?if not accepted witlna days.
,kcceptance of�ropO5Af-Tire above pries,specifications //
4'Ct1A1KP�O
a e Cats Of Nar#11a.litptort
9 6 �:�sttcifttsctta'
DEPARTMENT OP BVILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORTCER'S COMPENSATION INSURANCE AFFIDAVIT
T• C.0466M- die
with a principal place of business/residence av
IV6 91446 (Phone#)
Jr ( city/state/rip)
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 woziking 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 Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Daze)
(Name of Contractor) (Insuran-ce Comparry/Policy Number) (Expiration Date)
(attach additioml shoe(ifnooms.ry to irKh, informatioa perta.iaing to all oodtrnctors)
I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:plea=be aware that while homeowtxlz who a nploy perz<=to&¢xa intauus,construction or repair work on a dwelling of
not moan than thtro units in which the homeowner resider a on the Vnoi s apputtenaai tbwdo ace not Cvncrally oomiderrd to be
cmploYa3 undar the cootie 1 compcUS40a Act(GL1523a 1(5)),application by a homoowncr for a licsnx or permit may mid—the
legal otatua of an amployor under the wociroes Cocnpamai Act
I u,ndastand data copy of this ciatavcat may be forwarded to the DopuuwtA of Industrial Ao6&o&Of oe of Imuraoca for the
coverage YcrMcatian=44htt failure to somm coverago under soctioa 25A of MOL 152 can kad to tba impe»ition of akftb+l pe:naftits
SE0I6N:8,.:CONSTRUC170N $ERv10ES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of license Holder : &Du.Jr'fA-V L_00pP.5 MO
License Number
R�ecJ sf- 51..3y-oaf
Address Expiration Date
r 5
Signature Telephone
r 0113 Not Applicable 0 1 110i111 IN;.11 0:01111119ANNIMM
Company Name Registration Number
oy
Address Expiration Date
Telephone7/
5EC710N 1Q WORK RS' COMp:KNSATION 1NV" RANCEAFFIDAVIT(M:G,L.c: 152, §25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affil;
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 gwner 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
� 1 �
EC GN EDQW, OIL; li I'
i
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [,/] Decks [ ] Siding ICJ Other [ ]
Brief Description of Proposed Work:51JR1
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll ❑ - 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 .
1. Septic Tank City Sewer Private well City water Supply
B
RRN TO l COMPLETER WH�t
tZATIQ
OV4N SI� Cff x ACTOR AC'PI:1ES-FOR BtlllING PERMIT
as Owner of the subject prope
hereby authorize to ac
my behalf, in ail matters relative to work authorized by"this building permit application.
Signature of Owner Date
E_ D tQ 0 "r 100%q f j£J_11 J9 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.
Sign:�_u nder th ains and penalties of perjury.
~ f
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
Fronta e
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
puking)
#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'S Arn 4hnrn on+r nrnr.n 4 nhnn— 4-r. — .,. A;4-;„r... 1.... XL... .....-4—WCO
City of Northampton
- p __"_"". i Iding Department
i0 12 Main Street
i !
Room 100
N611 am ton, MA 01060
5�P ' �P& 41 17-1240 Fax 413.587.1272
hfORRL96N Q?0'CONSTR CT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
'All
� t e
e
u�� s
SECTION 2.- PROPERTY OWNERSHIP'%AUTHORlZEp'AGE'NT
2.1 Owner of Re rd:
Name(Pri t) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
LUflRn T 0048el7l SIN Al 1Q U s�-
Name(Print) Current Mailing Address:
Signature Telephone
" TIOI��S_1'�Ii)IA'FI3D"�dt�S"1'iI�UCTI"aN Cd��F�"""""
Item Estimated Cost(Dollars)to be Off icial Use Only
completed b permit applicant
1. Building (a)Buiidmg Permit Fie"`
2. Electrical (b) Estimated Total Cost of`
Construction from; 6
3, Plumbing Building Permit Fee
4. Mechanical (HVAC)
rBuilding,Perrnit.;ire Protection
Total =(1 + 2 + 3 + 4 + 5) OO Check Number ! 3
This Section,For Off icial Use"Ohl
Number: Date Issued:
46 SANDY HILL RD BP-2003-0326
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 29-404 _. CIT (` 'NORTHAMPTON
Lot: -001
Permit: B U l l d i nea
Category: BUILDING PERMIT
Permit# BP-2003.0326
Project# JS-2003-0544
Est. Cost: $6900.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq.ft.): 22869 00 Owner: PREMO DOUGLAS H&EILEEN K
Zoning:ulna Applicant: Ed Corbett Jr
AT. 46 SANDY PILL 5,D
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMA01060 ISSUED ON:9126102 0:00:00
TOPERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING
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:Q e I4 _ /7-0 a
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee Type: Receipt No: D-` •id: Check No: Amount:
Building 91=--- J:00:00 1733 $25.00
212 Main 3)587-12,," ,Fax: (413)587-1272
assioncr..:',,Aony Patillo
ins __