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35-057 X A wttrtg ON Northampton, MA 01060 Awnings (413) 584-6571 Canopies / n r �y/ Gutters A 0, -'#— >/4��F'/ 1...'S L-�(/( �a Shutters PROPOSAL SuBMrrMD TO `�Cl �S.II PHo -D/ DATE \/ v/v P— J L— S7I m 5- I4r/ JOB NAME CrrY,SCATS,atxt ZIP CODE JOB LOCATION -- DATE OF PLANS JOB PHONE We hereby submit specifications and estimates fir: /4 Vj6 �tl c An docjs, ,et ce el s ,'.s �A 37 /y x � -X q5 3/ b / l 5 (We(Propose hereby to furnish nwterial and labor-complete in accordance with the above specifications,for the Sure of}Q� Payments to be trade as follows:IM M n NP� jj OGJ�i 2&,AN U. / 5 0)Q&Dollars 0A All material is guaranteed to he as xpecifietl. All work to be,completed in a work-like manner acamling Audi riml to standard pradices. Any altercations or deviation from above specifivatioae involving extra touts will be Signature executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our tx)ntnd. (honer to carry fire,tornado Note: This proposal way be and other necessary insurance. Our workers are fully towered by Workmen's Compensation Innurunce. withdrawn by us if not accepted witlein days. ,k CCeptance of 9propoSQl-nIe above prices,specifications /{ are conditions are satisfactory and are hereby accepted.You are authorized to Signature do the work as specified. Payment will be made as outlined above. Date of Acceptance: Signature: '�"' 4 DBPAR7UEN7' OF BUII.DITNG INSPECTIONS 212 Main Street ' Municipal Buil(ling ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT �, tr� T C�tD�PBt ►?" OF (licensec/llemlittee) with a principal place of business/residence at: �t/ (phone#) 8 •IP571 ( city/sta02iP) do hereby certify, under the pains and penalties of pe jiLry, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Nurnixr) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors fisted below who have the following worker's compensation policies: (Name of Contractor) (Insurance Courpany/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Nwnbu) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (atlach additioeal sbe4d if noDc=&ry to include wfxmsiion pertaiaiag to ell 000trac ors) I am a sole proprietor and have no one worlring for me. ( ) X am a home owner performing all the work myself. NOTE:p1cose be aware that whilo homcownesa wbo employ pc¢so=to do maintenaac,omsmictioo or repair work on L dwelling of not mosv than three units m which the homeowner resides or oa the grounds appurtcaaat thacto are not wally comWe ed to be employers under the Work&r oomp=sation Act(GL152„ss 1(5)j application by a homeowner for a Gce nse or permit way evidcnee the legal status of an employer under the Wodror's C.ompeoeation Act I uaderdaad dmt a oopy of ihir rtttemant any be farwardod to the Depexuocnt of lodu3trial Aoadeoly Offaoe of lwuraooe for the covaagc wnfieation and that far um to uattt oov¢raP vndet s&boa 75A of MOL 152 can lead to the mina of W=iasl penalties 00CMAM8 of a tine of up to S 1,500.00 and/or imprb oasneszi of Lip to one ytar and civa prnattia in the f(xm of a Stop Work Ord,pad a Brno 0f5100.00 a day aplast ax. For =� . permit • �'/�-���' Map' Signature of Lipermuit#cC 8.1 Licensed Construction Supervisor: Not Applicable U Name of License Holder:�A0 CO A15 ' 7 a 667 MO- License Number y Ke�r sf- Y-30-091 Address Expiration Date &�� -�-> - "-Y-- 5 Signature Telephone Not Applicable 0 i�1�.�" Company-Name Registration Number - 04 _ A dress Expiration Date Telephone/ N ERS' CAl4tl'irNSAT[ON (1 I+IR/FIVGE=AFFIDAVIT(NE G,L. C 152,§25, 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...... 0 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 Icense,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 resyonsible 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 JIM WO .a, i;":":' r^w ,i.k;?. a± ;-a t. New House U Addition 0 Replacernerit Windows Alteration(s)O Roofing Or Doors NT Accessory Bldg. 0 Demolition❑ New Signs [ J Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Wor0Q ad r C Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- 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 s z N y Pig 9 yVMEN as Owner of the subject proper hereby authorize to act my behalf, in all matters relative to work authorized by-this building permit application. W nature of Owner Date 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. + 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: D. Ar there any proposed changes to or additions of signs intended for the property?YES _ No IF YES, describe size, type and location: r r { 19 Q Vul uepai'tmen ain Street m 100 _ on, MA 01060 phone 413-5P7-1240 Fax 413.587-1272 nr :LUNG INSPECTIONS " M. ", LTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEcTIQN 1-s IrE INf.ORNfA►TIQN 1.1 Property Address: % SgCTION 2- PROPERTY:O..WNERS"I AUTirIQR[ZED A0, T 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone / 1 Signature 2.2 Authorized Agent: ED wiggiN Name(Pri t) Current Mailing Address: Signature Telephone AECT"3 Item Estimated Cost(Dollars)to be Use"Qlfi�i completed by ermit applicant A 1. Building (a) Buildifg Perm►#fee 2. Electrical (b) Estimated Total Cost of Cons,truction.from 5 3, Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) S47 Check Number his:$e t on, r df>flaf l Qse: - I Ciiild�ng Permit Nufter: Date issued;:: tnature. , l#uitdingbrnmissionerli��prectorc�f t x BP-2003.0254 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot:-001 Permit: B u i I d i n£ Category: BUILDING PERMIT Permit# BP-2003-0254 Project# JS-2003-0447 Est. Cost: $10950.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. ft.): 17380.44 Owner: TESSIER CECILE V& Zoning: SR Applicant: Ed Corbett Jr AT. 955 RYAN RD Applicant Address: Phone: Insurance: 4 Reed Street (413)584-6571 NORTHAMPTON MAO 1060 ISSUED ON:9112102 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & 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: 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: Date Paid: Check No: Amount: Building 9/12/02 0:00:00 1719 $25.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo 955 RYAN RD BP-2003-0254 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-057 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0254 Project# JS-2003-0447 Est.Cost: $10950.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. £t.): 17380.44 Owner: TESSIER CECILE V& Zoning: SR Applicant: Ed Corbett Jr AT. 955 RYAN RD Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON:9112102 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & 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: Q�( q—/7"©a THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc � si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 9/12/02 0:00:00 1719 $25.00 212 Main-Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo