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02-021 (3) Page No. Of Pages � fro�Q SM I NEWMAN'S CONSTRUCTION 697 Bridge Road NORTHAMPTON, MA 01060 (413) 586-0273 PROPtQ2 13MITTED T PHONE DATE ta:� r-, 5,T-6 -.195-Z 3116 4.1, STREET' JOB NAME A71 1-11 a-42e�z< 1, s-g- 0/ /�2x CITY,STATE 7n COD JOB LOCATION Awl A ITEC DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for .. ........................... 7,1-5, 41-*A�t/�9-r........... . ....... Vv PZ' "'O L-7 5 .... ....... Alc2.s 1A........... "o 4-s............ f -7L Z4 .................. ........ ..........0- -ha-v"I... . ..... ........... .&L /?rajJ0Sjt hereby to furnish material and labor complete c e e in ordance with above specifications,for the sum of: 74 dollars($ 6 4 V --5 Payment to ade as fol v U a-u4 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 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 Not P; rice t 16i may be lays beyond our control.Owner to carry fire,tornado and other necessary insura Pte Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us-This d within 1<4 days. or de Arrep!diti 0 tattre of Proposal—The above prices,specifications !nd conditions are satisfactory and are hereby accepted. You are authorized Signatu to do the work as specified. Payment will be im de as outlined above. E) t f Date of Acceptance: ;Z� zaro Signature 04�tSAblA�O r + $ � �iiftsssac}�aseifs DEP,AaTMENT OF BUILDrN INSPECTIONS /= INSPECTOR '212 Main Street • Municipll Building Northampton, MA 01060 . HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups:.?`sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be,a one or two famiVy - 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 home owner." The buil ing department for the City of Northampton wants-airy person(s)-who-seek-to - use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour) a rough buildinz inspection(before work is concealed) insulation inspection(if required) and a final building-inspection.'The building department requires these inspections before the work is concealed,failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued-to me Daze Address of work location r 4itw•t��, r.. fiO j Oy R E (rii 3 Torfllail picil B � E ��coawrllutctla' c. o DEPAL.RiMEIJ7- OF BUILDING INSPPc'TFOI.'S _ j 212 Tfain Street ' Municipal Building j Northampton, Tfass. 01060 wOR.10ER'S COKPI;NSAZTON GgSURA-NCE AFF'U)t'� rr (li ccnsxlperm�ttcc) with a principal place of businessfresidence at: — -- (phone=) (st/ci r/s[atcrap) do hereby certify, under the.paui s and penalties ofpetlury, h:l 1 ( I am an employer providing the following!Workcr's comocnsado, cove age nor my etnplovees Nvorlang on tills job: 7_i-6 . Co. 5- 1-4-r) (Insurance Comrzm,) (Polio: (T:•pir`dor.D2L.) ( ) I am z sole proprietor, general contractor or hotneoW-0 (cztie one aid have hired t_he col=clprs listed below wl;o have the following workers comoen_tzuon pa!icies: i I 1r+11Ile O. COntmcwr) (Irisurancc Cornpanyili Gut D.11c) (Nzmc of Contraor) (Insurzne ComoaalyPOUM, Numcer) (%xpimtion Date) I . (Name of Coamim r) (I�sur-aacz Com • pan}•lPoUc}• Numb,-J) (Expirae!3 Dale) I - (l�!atne of Cotltraetar) (Intllran Comcatry/Poticy Numb r) kE.%pirtioa Date). (aa�L1•' _dasiocil dcc.if nceexa�•to incud;iaforty�on petaii:.a�to aU oo=-_=.o:s) .. - --- -- O I am a sole pFoprietor and have no one working for me- ( ) I am.a home owner perforr=g all the work, myself. NOTE:pl=..be aorue �A jc hemco 4acrs w'bo csaplaY pezoax to dJ c• ,-• cst+oo c repair work oo.d,.et1_;,of ant —,h--Lb.--its is t t clx the bomoow oc r=dam or ea the Q-t t zppurtea-.�tbeeto Z:-,oo(V=)=ly a=:d-ai w be eitplcycs un?--r the kui r Aa(G1;152F 1(5)�=ptinboa by.bomeoQae fc:6 _or p==s t ray c ideooc tl`e lc-sat elan LS or.a e2loyar under do Wor oe,Coc=p__,ao Act ' I undcaxyod t'.a a copy of thi:c=—cc a—y be foc m d.sd to tS.C V,=a W of In�wiJ Ac ,ia Off oa of t,s s+�for th. covefx vcitecioa.ad that(_lilac to striae Lover tmdc soGioa 23 A of Mot,152 Qo lead to the is =idoa of peatltie oocz r;� of a floc of up to S l}00.00 andror of up to ooe y-._.-e.od c vii peasY,ia m be form of a Stop Work Ordc and. rt>=of S 100.00 t d_y cP�=a>- For dGs.rtc.�1 u.c only Pcrmit Nu bcr bI gyp::— Lot za�ze of Lic nsaJpct�ttitt- e I A SECTION 8-CONSTRUCTION SERVICES t 8.1 Licensed Construction Su ervisor: Not Applicable ❑ Name of License Holder: Ucens Number Add ss Expir4tion bate Si ure Telephone 9R stetedkfortre lrrraveiies ,Ga <tracfa -"3 ' Not Applicable ❑ Company Name Registration Num er - -— Address Expiration Date Telephone, SECTION 10 WORKERS'COMPENSATION INSURA14CE.AFFiciAvkT'k.C,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...... ❑ 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 i a SECTION 5-DESCRIPTION OF PROPOSED WORK(check al[applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.[��`�v��ro�ise=oft �� dl�caxlstl�c�i�us�na� �orl�p�e� ��te�o[faur��t,�a: i GG of building•One Family Twn 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 Ta-OWNER AUTHORIZATION-.TO BE-COMPLETED WHEN OWNERS AGENT OR-CONTRACTORAPPLIES` FOR BUILDINGPERMIT- 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 as Owner/Authorized Agent a eby 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. Pdrif Name S' of Owner/Agent Date a Section 4. ZONING All Informatibfi 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 L R•� f� 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 0 DON'T KNOW Q YES 0 IF YES, date issue&: ' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES Q IF YES: enter Book Page;. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 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 0 NO l IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0 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 Q . NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. :,• f, ;��}� ` �®epa��ittse�a�il`�'� �" Cit NortfPampton '� P x ,.ZTui ng partment ` 2� Mai Street �otoom 00 eF1 aJiifit © on, MA 01060 esntc� �eans K IN phonh ., 7-1240 Fax 413-587-1272 PtatS �Pfan APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1,-SITE INFORMATION w Thrs sectronta be completed F?yrnffice 1.1 Property Address. to-41 Nprdti� �Ct•'mS P� Lot Untt �C�►'�- y'� M C( Zone Overlay Drstrrct olouo &Elti St Distncf CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: � � Telephone Signature 2.2 Authorized Agent: C d ru-, -T. N >i)rga r'l , 0-4 ►^SY )cl(y (m. &I `v(o 016(06 N rint) Current Mailing AddresV Si tut `telephone TION 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. t"6-7 co x3 This Section Foy Official Use Only .Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date 671 NORTH FA RD BP-2006-1030 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma -,Block:02- 1 CITY OF NORTHAMPTON Lot: -001 Permit Building Category BUILDING PERMIT Permit# BP-2006-1030 Project# JS-2006-1531 Est. Cost: $5745.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Cyrus Newman 142807 Lot Size(sq. ft.): 273121.20 Owner: GOGGINS DENISE M Zoning_: RR Applicant: Cyrus Newman AT.• 671 NORTH FARMS RD Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:41412006 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER 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 4/4/2006 0:00:00 $25.005167 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo