29-415 L 1\VVLLI�
Northampton, MA 01060 Doors
gs
(413) 584-6571 Canopies
Gutters
Shutters
PitoP<.IsAL sVW4fhw To fR#ON °199
.IIIIEET /3 / JOB NAME
CTTY,STATE,awl ZIP CODE JOB LOCATION -
DATE OF PLANS iOB pHONE�-
We hereby submit specifications and estimates for:
6MP 0j
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910,K. -VX1 K d A-IUNvVVPA
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CWe 9prOPOSe hereby to furnish material and labor-complete in accordance with the above specifications,for the suln of:
Dol rs( )
Payments to be made ac follows: /y r mss'.` l e
All material is guaranteed to be as specified. All work to he completed in a work-like manner acc,nting Authorized
to standani practices. Any altercations or deviation fruit above specifications involving extra costa will he Signature
executed only upon written orders,and will bminte an extra charge over ulna above the estimate. All
agreements contingent upon strikes,accidents or delays beyond our control. (honer to carry fire,tornado Note: This propsxcal may be
and other necessary insurance. Our workers are fully cuvere+l by Wurkinen's Compensation Insurance, withdrawn by w;if not accepted within days.
IkCCeptanee Of TrOpOSAI-The above prices,specifications
are conditions are satisfactory d are hereby accepted.You ate.authorized to signature
do the work as specified. P n twill he made as outlined above.
Date of Acceptance: Signature
¢.�l1AMPTQ
$ � �aa::achasctta'
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFYM A.VI'T
T, cm,667 - 0 i2
(li censeeJpernli tiee)
with a principal place of business/residence at:
WEED N (phone#) 87-�0. /
( city/statr./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 job:
(lanirauce 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/Poucy Number) (Expiration Date)
.,
(Name of Contractor) (Insurance Comparry/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Daze)
(Name of Contractor) ansurazice Company/Policy Number) (Expiration Date)
(attadr additicaal tboet if noxssry to include infrxtnsiioa pertaining to all cowractors)
I am a sole proprietor and have no one working for me.
( } I am a home owner performing all the work myself.
NOTE:plesre be aware that wbilo homcowocrs who employ peaons to do maintcaznca,comuucdoa or repair work on a dweUing of
not more than throe unite in which the homoowncr rt4dca cc on the grounds apps d uw t theccto arc nod gaxrally oomakred to be
employ=undo the worke,o vcasatioa Act(GL152 m 1(5)),application by a homeowner far a Gctnse cc pama may-id—the
legrl status of an employer under the Workees Oompooution AcL
I undersund that a copy of this t atcmcot may be forwarded to the Dep wu0cet of Io du3hisa Aoc idea&Offioo of IaA00cc for the
coverage verificalioa failure to awwre oovange under soctioa 25A of MOL 152 can lead to tba irapos Oa of aiminA Waaiti'm
SECTIQN$ ;C NS TRUCTION SERVICES'
8.1 Licensed Constructignn.SS�upervisor: /��i ss.�.- ` Not Applicable ❑
Name of License Holder : AMUA1ZO COA&G J I Aft f.�7Y 4:F02
License Number
14 Reed sf- 4-30-0y
Address Expiration Date
• S
Signature `telephone
F IN Not Applicable ❑
Company Name Registration Number
q �E�"D ST" 5- /5'- 01/
Address Expiration Date
Telephone 47/
S6CTIt N 1Q ,w OK S''o VIPENSATION aN$VRANCE.AFFIDAVIT(M.G.L. c. 152,;,§25.(6))
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 owner 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 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 �
x
New House ❑ Addition ❑ Replacernerlt Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding NA Other [ J
Brief Description of Proposed Work., 01riq 9 Lhm l
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet o
MI; e= -d a HOME E's Tn Vin. cb ► =t r
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
ECT N t7 ORI�ATION; �0 BE4COMPLTED VVHN
N � 0> { R�Cf��R/�TUit`A 'LtES-FOR BC11'I�g1NG`PBRMI7:
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
l LOAR0 T r�0{2�£ J�, 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 ury. _
+� r
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) Avg +k^— �-- —n-e 4 +r. — n,4,4.+;--.. ..+ .......... ...+.....Jw,J F.... +L... ...........-+..�VCC`
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413587.1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REP E�) T a R 0 S E OR TWO FAMILY DWELLING
1; 1 .}
SECTION 1 -SITE INFORMATION
1.1 Property Address: DEPY Ut I
H(Dt;`
3 y Sr�NdN
'A
a g
SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZE,0-AGENT
21 Owner of Record:
Name(Print) Current Mailing Add�ess:
Telephone --5�/"�y�(c�
Signature
2.2 Authorised Agent:
%wag T Cog Serr- JO, y Afro s-I`
Name(Print) Current Mailing Address:
AO ai??t A.
5-89 4T7
Signature Telephone
U&T�0 3 E5,IMATT D Ob T���`tIQN C05�"T
Item Estimated Cost(Dollars)to be ,,official Use Only
completed by ermit applicant
1. Building (a) Building'Permiffi~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) --' Check Number 1733 This Section For Offieial Use .Al
Building Permit Number. Date kssued: .
.34 SANDY HILL RD BP 2( 2-7
GIs#: COMMONWEALTH OF MASSACHUS-
MU:Block:29-415 CITY OF NORTHAMPTON
Lot: -001
Permit: Buildiniz
Category: BUILDING PERMIT
Permit# BP-2003-0327
+tProiect# JS-2003-0545
Est. Cost: $8000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq. ft.): 16639 92 Owner: FROST RONALD H&TERESA A
Zoning:URA Applicant: Ed Corbett Jr
AT: 134 SANDY HILL_ RD
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTON MAO 1060 ISSUED ON:9126102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL SIDING & 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: 0 K j a a g 09--44*w�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc y si nature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 9/26/02 0:00:00 1733 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo