29-256 (3) t
Corbett Home Improvement
Northampton, MA 01060
(413) 584-6571
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a guar areal to he as sl,ecdied. All work to he ana[Ileled In a work-like manner acconlwg Autllouzed �—J —
,-11 hr:i,,_s. Any ullercations or deviation from above sl,ecificalwns involving exiru iosls wil;he Si�llalure
ul'v un nl wrinen,r Ian,and will become an extra charge over uud ahove the eslunale, All -
—ill gent Upon strikes,accidents or delays heyond ,ur control. Oweer hi curry file,nirna,iu Note: this lxofxwsal may he
._....ury,usurunre Our workers are rally covered by W<,rkwen's t',nlgn nsuuon In,urauce wrthdrawn by LIS It not accepted within
' c ccptwncc of(PropoSAl-The above prices.specificatimis
anuuinl.,are satrcfactor) and are herehy accepted. You are authorized R, Slguuwre i. ���? 4 -6
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11, . ork as specified, Payment will he❑lade as outlined above.
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DEPAR i ME1J Y OP PUPPING G INSPECT IONS
212 Main Street ' Municipal I3u,ld,nl,
No, thnmptnil, P1aE;!;. 010611
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Icg,l ctahu of an—plo•;K ucnd,t}o W'vin a l:x malxm Ac[.
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—o ,Lv,mg of a fine of up to S l.500.00 nnrthx r:: rtxxvtr:::of up to-Y.yr_nr eat C,11 V,:LO'ua LO dY f(xm of n St,,,)Work
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of-License Holder
License Number
dress Expiration Date
S gnature Telephone
9. Regisf'e'r`ed`Nome'trti2oyemerit'Co"ntra'cto`r.-". '�,.q �s„actt,«e;� ,;,':. p; Not Applicable ❑
—�— =ki &c)&' -
Company Name Registration Number
s1' Jt; ,y.0 - s- 6 .
;' dress / / Expiration Date
Telephone,5 ell— - 5 71
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
,v it result in the denial of the issuance of the building permit.
signed Affidavit Attached Yes....... ❑ No...... ❑
It-", Home,-Owner..Extemption"
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 nets
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 buildinL, 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 1512 (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)
Vc)u hire to perform work for you under this permit.
I11e 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 __ `
ECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicablg)
ew House ❑ Addition ❑ Replacement endows Alteration(s) ❑ Roofing ❑
Or Doors
ccessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ J Other [ ]
rief Description of Proposed Work: �_.,1vS'}�► �� �OC.Li �� ,�vGl� E hV •�j C)7
Iteration of existing bedroom Yes No Adding new bedroom Yes No
ttached Narrative Renovating unfinished basement Yes No
lans Attached Roll C' Sheet 0
com leteth foll'owin :
a, If New hous'eand"or�adtlitioii�fo�'ezi'stingfi"ousin�; p I
Use of building : One Family Two Family_______Other
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Number of rooms in each family unit: _ Number of Bathrooms--_-_
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Is there a garage attached?
I Proposed Square footage of new construction. Dimensions l
Number of stories?
Method of heating? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance. Mascheck Energy Compliance form attached?
T ype of construction
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Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain __Yes No
Depth of basement or cellar floor below finished grade
<. Will building conform to the Building and Zoning regulations? —Yes -No .
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
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as Owner of the subject property i
rlereby authorize _ __ _ to act on
my behalf, in all matters relative to work authorized by this building permit application.
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Signature of Owner Date _
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as Owner/Authorized Agent j
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed nder the pains and penalties of perjury.
�t> l 0 d'T
Print Name
CP -lI_�
Date
Signature of Owner/Agent —
s .
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:--_ —
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: _
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
NJI to nn le
ity thampton
Q ildi partment
12 a i Street k '
om 00 r 4
ton, MA 01062
D� F,BOOM Fax 413.587-1272
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 Prooperty Address:
r
Map Lot-'" unit ` I
Zone` Overlay District
Elm"St District' CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
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`lame (Print) C rrent Mailing Address:
Telephone -
ignature ----_ -
2.2 Authorized Agent:
----
Janr: (Print) Current Mailing Address:
C 6,_S 7/
S gnature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
com leted by ermit applicant
1. Building (a) Building Permit Fee
?. Electrical (b) Estimated Total Cost of
Construction from 6 _
3 Plumbing Building Permit Fee 1
1. %lechanical (HVAC)
Fire Protection
Check Number
Total = (1 + ?_ + 3 + 4 + 5)
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This Section For Official Use Only
Building Permit Number: _ Date Issued:_ --
Signature:
Building Commissioner/Inspector of Buildings Date __
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101 OVERLOOK DR BP-2001-1054
dis s� COMMONWEALTH OF MASSACHUSETTS
M : rock:29-256 CITY OF NORTHAMPTOIN
Lot:-001
Permit: BUildirtc
Category:window+ =I wed BUILDING PE; IT
Permit# BE-29Q1-1054
Project# JS-2001_1$$$
Est Co.$2900
Le 2500 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Gonb avatar: License:
> _ Ed Corbett Jr 116069
Lot Nizetsa. 1J: 16202.44 t,'hl�n�r: Ai.D�tic�DALE
zoning u1t n dga 9d Ca heta Jc
A?': 101 OVERLOOK 12R
AndlicantAAr?r'+css: .Fha e: Ins e:
4 Reed Street (413)584-6571
NORTHAMPTONMA01060 ISSUED lff_.-6 31019:(1F1,04
TOPUPO M ME FOLLOWMG WORK INSTALL BOW WINDOW IN EXIDSTING
,OPENING`
POST: � S C ; : �IT I '►VIA LE F . ET
Ins of Plum tg p for ot`Wiring m 11':W. Inspector of Buildings
Underground: . Service: Meter:
Footings:
Rough: Rough: House# Foundation;
Final.. Final:
Rough Frame:
Gas Fire UeuarEntent . FireplacelChmuey:
Rough: ih insulation:
Final: + Final: 1pir t•?l,of. i
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF,
ANY OF ITS RULES AND REGULATIONS.'
Certificate f Occupwu signature.
Fee IVIM. Nd: Date Paid: ek No: "o ' t:
Building, 6/13/010:00:00 1273 $25.00
212 Main street,Phone(413)581 124{1jax:(413)587-1272
Building Commissioner-Anthony PatiHo