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29-228 (2) 32 u' is I ,j7 /Iij 51 52 54 55 ovf f e _ lZ C, / 44 t� v t Y,, This Agreement is signed and sealed on April 2002 . Siller Home Improvement Specialist, Inc. 301 Forest Glen West Springfield, Massachusetts 01089 (413) 733-2539 By: I Gerd Siller, President date Home Owner (s) i r r' + date date HOME IMPROVEMENT 301 FOREST GLEN CONTRACTOR LICENSE WEST SPRINGFIELD,MA 01089 No. 101557 MASS. GEN. CONTRACTOR SI'ECIALIST,I�G (413)733-2539 LICENSE No.054713 No. 05886 ca[pv REMODELING AGREEMENT Siller Home Improvement Specialist, Inc. , of West Springfield, Massachusetts, whose Registration Number is 101557 is entering into this Agreement with you, Joanne Gangi, 168 Acre:56ok Drive, Florence, Massachusetts, (413) 584-5649 (home) . ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS ARE REQUIRED TO BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301,BOSTON,MA 02018 (617)727-8598. SCOPE OF WORK: I will perform the work set forth in the Attached SCOPE OF WORK on your home or the property located at 168 Acrebook Drive, Florence, MA. If you would like to change any work to be performed or materials used, we will have to make such changes through a Change Work Order which may also change the total price and extend the date for completion. I reserve the right to make minor changes in any plans and to substitute materials of equal or better quality. Should I encounter any unknown conditions below the surface of the ground or concealed or unknown conditions in any existing structure? You will agree to make an equitable adjustment with me under a Change Work Order, which shall increase the total price and extend the date f ;r substantial completion of the work. PERMITS: To perform this work I, or subcontractors I hire, will obtain on your behalf the following permits: Building Permit Demolition Permit Electrical Permit Plumbing Permit Certificate of Occupancy Other IT IS MY OBLIGATION TO OBTAIN THESE PERMITS AS YOUR AGENT . IN THE EVENT THAT a c -- ' G : 10, 000 S F : o As 13t .971 S. F. �► ', O 57 r w 04 ; �o Ast0. 4 6 Ax /Y 696 S. F. t-�e w ► , q , f 1 .-j w rt: rs 9s is ts. is 3r w s 69 *,if 60.00 ' . Y ..> ..• ,••... t: tr�wr�r,r 'J /cc,00 �dc v 100. 00 loo s'Ir /0',00 'y' g a f oil At �' ' fit ' r% V tµ:'6 i� '�� �' �1 :'t.yfi7+ i ! ^.'. •.I f f y`y' y�•� ...-'.rw-��}'��4 y r d (, a T r•'�' '' '!.` r�Y 1�, #" 7 t+ °�. ��•F VJVT I.TOIL '� 'aV�� M y ! r5 � +r' f t f�'T' ffi'%' ;%t •,�•• 'f" r•.�.+ ri ' i 1y ` �. :(.'• YS ' yr i a, •�� .y, -iy,. ,, 'k .i��• .Y. 1 � .� .J"a i a.�� ter." a y�••{• �'"'; �r aC") 1 � • / 1 0 A Gxf� Jaf wart[jall ptoll A 6 �asaxchnsrtta' DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 y WORI<T,R'S COMPENSATION INSURANCE AFMAVIT (liceusee/permittee) — with a principal place of business/residence at: (phone#) (street/city/statdzlp) 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 worming on this job: ia'c� bJ C J '300 >6 19 (Insz=ae- Company) (Polio 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/PoLcy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach addtiec it sheet f ne«nary to inchlde informs:,. +I peztjllg to nll eocrtrnt ors) ( ) 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 aw-Atc that while homeo"'Dm who crnpl ay pczTom to do maintcnvac,oetxs:r�oa or repair work on a dwelling of not more than three unes Li which the homcozAvcr raidca or on the grounds appurtcz err i thttcto a c nx&,::z rly oorA ickrcd to be employers under the svo ,cecr�ioa Act(GL152,ss 1(5)),application by a homoow-na fora Laasc or permit may cvidcnoe the Itgal rtatLu of an employes under tho Woricels Compomation Act_ I undcritand that a copy of this natcmcrrt may be forwarded to the Dcpert,x of J.&L trid Aoci&.&Offioo of Im—for tbo coverage vaificstion and that failure to seatre covetago under section 25A of MGL 152 can lead to the imposition of criminal penalties comi ting of a f nc of up to S 1,500.00 and/or imprisoancL of up to one year and Civil penalties in the form of a Stop Work Order and a fum of S 100.00 a day t&&insl me F Foe icputnrz>i'I—only permit Number �._ ��--0/ p;I--Lot# Signature of Liccase&Perr itt= —Date 4 SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Q Name of License Holder : ���-� fa J c� ms s" License Number . u. Expiration Date L::ignature s Telephone S Not Applicable ❑ Company Name Registration Number :�:04 Fp 12r� Address 2 Expiration Date Telephone 7r3�2� SECTION 10-WORKERS',COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6)) 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...... ❑ m n ome � 14W. 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, provided 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 __ — SECTION 5=iDESCRIPTION01`PROPOSED WORK(check all pplicable) New House ❑ Addition X Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Q7v ZZXzo (�-s�-n Py. 4ol) A AX /6 Alteration of existing bedroom Yes ./ No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 6 IfANdWW6 $e ndrdK3addi idif f o EitistI n :h'ouisin`° com le a fht�4611 wiW : 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 No 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 SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR,BUILDING;;PERMIT I as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, ,CLL ai49;Fe-r-/Auth o ri zed 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. �1fI Print Name r ""_0z Signal Owner/Agent Date • 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 06 10V IV/obi i go/ o Frontage 7 Setbacks Front ► f 1�0 Side L: 4 a R: 2-c? L: L"0 R:- Rear � L5-0 o Building Height Bldg. Square Footage % 5 Open Space Footage % (Lot area minus bldg&paved parking) fE #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. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: s ' "City df Northampton _ ----_ $uil'd%ng Department P r Gu - 21'� Main Street MAY 1 "002 "aoom 100 a Northampton, MA 01060 a e a phone 4.1,3.587-1240 Fax 413-587-1272 P"N lSltelp* Ot er Spec1' APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be'completed by office 1.1 Property Address: C 2 142 0 G t<- Map lot � ht x � Z(-ne Overtay Distrtct ' Elm St. District CB District" SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ti -:S70 V4t rvE R►., �1 /6 8 cr�F �,ZOOk Name(Print) Current Mailing L `f Addres 4�1 Telephone Signature 2.2 Authorized Agent: Name rint) Current Mailing Address: Sign ure Telephone SECTION`S - ESTIMATED CONSTRUCTION COSTS` Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant_. 1. Building (a) Building Permit Fee 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) 3C�. C�©G� c�d Check Number This Section For Official Use Only Building Permit Number: 8�°Oz-66 8 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2002-0982 APPLICANT/CONTACT PERSON HOME IMPROVEMENT SPECIALISTS,INC ADDRESS/PHONE 301 FOREST GLEN (413)733-2539 PROPERTY LOCATION 168 ACREBROOK DR� MAP 29 PARCEL 228 001 ZONE URA I A) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 22 X 20 ATT GARAGE& 16 X 16 PORCH New Construction Non Structural interior renovations Addition to Existing - Accessory Structure Building Plans Included• Owner/Statement or License 005886 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOY6ATION PRESENTED: pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commiss. n Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. ' BP-2002-0982 GIs#: COMMONWEALTH OF MASSACHUSETTS Mg:Bl ck:29-228 CITY OF NORTHAMPTON ermit: Buildin Category:ADDITION BUILDING PERMIT Permit# BP-2002-0982 Project# JS-2002-1590 Est.Cost:$30000.00 Fee:$113.60 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME Rv PROVEMENT SPECIALISTS, INC 005886 Lot Size(sq.ft.): 10018.80 Owner: WELLMAN JOANNA S& Zoning:URA Applicant: HOME IMPROVEMENT SPECIALISTS, INC AT. 168 ACREBROOK DR Applicant Address: Phone: Insurance: 301 FOREST GLEN (413) 733-2539 Workers Compensation WEST SPRINGFIELDMA01089 ISSUED ON. TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 22 X 20 ATT GARAGE & 16 X 16 PORCH 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: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 5/22/02 0:00:00 8043 $113.60 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo