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11A-051
Proposal t-age n4u. ur rayaa NEWMAN'S CONSTRUCTION 697 Bridge Rd. ' 4 Northampton, MA 01060 413-586-1093 PROPOSAL SUBMITTED TO PHONE DATE STREET _ JOB NAME F 1-:i E ;� CITY,STATE and ZIP CODE JOB LOCATION 4 c ) � 'ScSYn� ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: F1 0 J J1 Y1`l;- i7 < K r V1 yZ FI YZ G'SZ -t � _ `� 12 IV S 1Y-)S...L _ _5 L Cl el v,?lL V ............................................. . .................................. .............. ................... ............................ ................................... ...................... HIr VraPOSr hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: VIA n U ciC dollars($ Payment to be mad as follows: \ a 11 L r) All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized �7 involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents Note:This proposal a be 7 or delays beyond our control.Owner to carry tire,tornado and other necessary insurance. withdrawn by us if not accepted Rhin C r days. Our workers are fully covered by Workman's Compensation Insurance. Acceptance of proposal —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: ` t(` f I� —L t' Signature d -212 '%L A — CEMENT—D =,der780CNE, 108.3.4 to Uk Stye 0 �N�flcsz-cll=erz-S allo-WS ale h0m -5- rsc-a(s) a-a-EZ i- " 'I, - - "Let CofS -�7 'r T-": za� C" LS a p�,ce" In fZ?.z4v W LO, 0 on which helsh e res-id,es or to be, a One OT t,�O 7 -� s- ch an&0 r a= v—er' a: ed or.de-zche:� S Lr I.C. acc-tsscr t a us' persor.W.-C constr,2=more one home m a Fenoc shail not �e corsidere.d a holme 0-,Ymer."C�i who seek-,-C. T-hd �7.m-en:!BF tHe cnty d:* �-= be a7-are ue t h,e a.o O"WrIer exe=pLorL, to ac-, as tuelr Own rLzt'by doinz sc VO.-a- become ne-SPO=ible for compliamc,-• ilh s-.ate buEdIng- cedes and Froce-s-r,-qL;i-,res tEa!the buEd-m, ant be tc, fGund2tio&footjn:zs Cbefore badd:711). Mn otub.e holes r a ru Lr g-h buRdi-n-husnectfolz(before work is before court.r). divaj= --etilon- The rg-guL-ed)am- d-2 n r i=ec-tions before tae Fels is failure to deCZ-1 i,-tese Secure these.imsue--tions can result fn failure to obtain a c - cate of occu,uancy E :e h=e--Wmer ea czLer Lr ides o pe thperform-Wo :c plying r_—UC -d that they get their re I luired per=hs lz CCqju=L-"7crto tie buildi=- a- e cl-FrLe t 7 les to seczze±e pe,=Zs anc -fors as :=-e as the proper a e czz D'71—AY tHe prcjit such tT L T, e" 0 =ad-- tam L-e above- sigm-ature reques-dn=e:.-emption) .!z j='rectcz ne--esszly for tLe buildi enrmt Issued to r--le- Da:-t ------- ICCZ-zion - Office of In vestiv ations P� 600 Washington Street Bostony AJA 0 111 - Mvw..mass.;ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A c olicant Information Please Print Leaiblti N3n1e (Business/Organization/Individual): 1=f J VY-\Pr O rCj Y S+.(ZU C t(J A Aa_ 7 le City/State/Zip: f oa �• i Phone : S6 Are vo'u an emplover? Check the appropriate box: Type of project(required): !-,( T an:a employer witli 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time). have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in anv caracity. employees and have workers' 9. f7 Building addition [No workers' comp. insurance comp. insurance.- required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions I ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself: [No woi-lcers' comp. right of exemption per�IGL 12.�Reed repairs insurance required.] ` c. 152, §1(4), and we have no employees. [No workers' L3.❑ Other comp. insurance required.] Any applicant that checles bc;c r1 must also fill out the section below showing their worlcers'compe cation policy information. Ho meowners wLo submit this affidavit indicating they are doing all work and then hire oursidecontracton must submit a new affdavit indicating such. Coin[;actor,that checi<this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their worlters'comp.policy number. I am an employer tzat is providin,workers'compensation insurance for my employees. Below is thepolicy and,job site information. Ir_sura.ce Company Name: Ct u kL 7 v� Policy r or Self-ins. Lie. ?U 1 3 0� ,/�f r �,r Expiration Date: / n job Site A cress; City/State"Zip: 7S i �1A 0�CS Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 51,500.G0 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day aga i=t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DI-z for insurance coverage verification. I do hereby cer>z y u:rde, tl2e parrs- rd em4ae;�ef-pe=-jury- far-the information provided above is true and correct _&znature: Date: / 5 -!-- :zci�rl;L;e_.,11, _��,�r,r j,,•; his area to Ise com leted bv.city yr town o cial City or Towti: Per?I11tZiceIIS2 I ISSuiIl'�_zuthorlty (circle one): I� Dr lrtiycni ":;,"I J'+�'i CIL .i iL:Irical Di SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: _C�/ _ tin CS b3 , { w�U License Number `'1 C, !�lL© 1/0 Address Expirafi Date - 51,K /0 Signatur Telephone 9.Registered Home.,Impeoverirent C'onft6tor: a . ..�,.' Not Applicable ❑ IV L w Mt+i!V 5 ry ti 5 A� ,)c i�,c:at/ 1 9 76 7 Company Name Registration Number ,, y ✓t V- r Address % Expirati n Da .4-. )Z A Telephone e3/ SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(G 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...... ❑ I1. Ha> e E}w1Qe'r � >npti 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 4 � t SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors F-1 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [CJ Siding [0] Other[o] Brief Description of Proposed Work: W—' —L Q f-rL i R LL- ZQBSS -%-Z Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. IfiWw house and ar'addition.tc ezistinq-housing, complete the'fo[[6Mi q: a. Use of building: One Family X 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. Masscheck 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 AUTHORIZATIONI 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 Cwner Date L i J' as Owner/Authorized Agent hereby d6_c_iaf 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. Print Name Signature of ner/Aaent Date - w Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete 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 _. ...,.° oarkimt) #of Parking Spaces ~_.,____._, Fill: (volume&Location) -" A. Has a Spe iat Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES 0 IF YES, date issued:- IF YES: Was th permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 _ IF YES: enter Book _ Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW (D YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , 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: E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Pe'rinrt Building Department Curl}GrJt�Drtveway Pe€rrt�t 212 Main Street Seaver/SepficRvarlabi[ty Room 100 WaterAIVeIrA aiii6ifiity Northampton, MA 01060 TwSets @srlra' phone 413-587-1240 Fax 413-587-1272 Otheee%fjr APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMQLTH A(A O9 ILY gWELLING SECTION 1 -SITE INFORMATION f — -a 1.1 Property Address: This seo#ion to beiconap{gt6d y offic r © aQ' Lot Unit tz Zone Overlay District os Elni St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: aU Coca le Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-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) Check'Number This Section For Official'Use.Oni Date Building Permit Number. Issued: Signature: - ----- Building Commissioner/Inspector of Buildings Date d ' = I,tA BP-2008-0910 GIs #: COMMONWEALTH OF MASSACHUSETTS { CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0910 Project# JS-2008-001366 Est. Cost: $3600.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Cyrus Newman 142807 Lot Size(sq. ft.): 10018.80 Owner: BATES DEBRA J&PAUL S COOK Zoning:URA Applicant: Cyrus Newman AT: 9 VILLONE DR Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:411712008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL GARAGE RUBBER ROOF 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: FeeType' Date Paid: Amount: Building 4/17/2008 0:00:00 $25.005990 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo