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31A-148 (2) 12 FORBES AVE BP-2017-1375 GIS it: COMMONWEALTH OF MASSACHUSETTS Map:Block:31A- 148 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT Permit# BP-2017-1375 Project# JS-2017-002295 Est.Cost: $13800.00 Fee: $0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NEWMAN'S CONSTRUCTION 64690 Lot Size(sq.ft.): 8015.04 Owner: Jim Levey Zoning: URB(I00U Applicant: NEWMAN'S CONSTRUCTION AT: 12 FORBES AVE Applicant Address: Phone: Insurance: 697 BRIDGE ROAD (413) 586-0273 WC NORTHAMPTON MA01060 ISSUED ON:5/31/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP EXISTING ROOFING/INSTALL NEW ASPHALTNENT, ICE & WATER 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 5/31/20170:00:00 4400 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner 4DepartnrtentoseEcnl �� City of Northampton - 'r �. Building Department Curb CiA/Dnveway Permit 212 Main Street Sewer/SephiAve/lablhty gn( y Room 100 WatergielhAva)abihty 1 WI Northampton, MA 01060TwaSetsofStmcturat Plans -phone 418-587-1240 Fax 413-587-1272 Plot/Site-Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION IOr '� 7--/'37S 1.1 Property Address: > cif section to be completed by office O� Foltz- tS /1 v L Map 3,4 Lot f Unit �-j Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: .3-1 Inn --1..V to calfs AL 'ampName(Print) Current Mailing Address: 5 tic— 3.;g3 Telephone Signature (Ch)G!/ / 2.2 Authorized Anent: / ��� l `A 697 /Jn.O ) ?rel % ,_p vjpj Name(Pr ru) Current Mailing Addre yi3-5n —/O �TQ Signature Telephone SECTION -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be 13 2-32;_,..„,"‘ a" Official Use Only completed by permit 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 / �j �y /J ry, /� 6. Total=(1 +2+3+4+5) / 3 dna Check Number paifQ rrf"V 6 This Section For Official Use Only Date Building Permit Number: Issued: Signature: /���/// X�ZSt 7 - Building Commissioner/Inspector of Buildings Date f 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 . ___._ �.L_.______ . _._.I L --- – - Frontage .. –= I____. --� – — Setbacks Front i -- - Side '— ; R::– LI' R:I,�I. -_ _ L _ Rear — – –. Building Height ...._ r– -I Bldg. Square Footage ,7-7. i % -._. Open Space Footage % — ...— . _ ea minus bldg&raved Ia ! I I parking? 1 #of Parking Spaces F '— Fill: - - (volume&Location) -- - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES O IF YES, date issued:7 i IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES 0 IF YES: enter Book Pagej i and/or Document#'' B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: 1 C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O 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 © NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Ti Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors C Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding IC] Other[CC Brief Description of Proposed Work: STK1p int'sr/7 Prhvin 2n57-Iva AAA, dS/AS71Ate". icri Alteration of existing bedroom Y No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes __No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: 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. 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 AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT .‘9sm !v/Ly , as Owner of the subject property / hereby authorize (n,•./ IV2( fikrk Rik/ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner / Date 11111111 I, ( ��c.-gym✓EV-V ,as Owner/Authorized Agent hereby deX are 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. C-9CLOSkit L.) Print Narhe /7 Signature of Owp Agent r,ate SECTION 8-CONSTRUCTION SERVICES 8.1 IIicensed Construction Supervisor - ,, Not Applicable ❑ C Name of License Holder' ()run AftW M/tN/ _ C5 '"- ice( 4'6 90 License Number r} 647 rt4nc? Z . t�a \. - : • `7/V�1 - Address ,> Expiration ate li 3 - 576 -49'1 S eat r Telephone 9.Rfe�oistered Home Improvement Contractor _ p Not Applicablele7❑ I t.F'A/en'4-tt'5 (L SQ C- C-tA r r AMOS CS Comp>anyy Name I ,r 1/� �-ty Registration Number 65`! U2..11 c) til. AL,. hL.-PLJ _._ ( Address (� ` Expirab n Da MA Oil)f. 0 Telephone •/j3-51a SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.OL 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....... 0 No 0 11 _ Home Owner Exemption 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 indiddual for hire who does not possess a license,provided that the owner acts as supervisor.CMIR 780. Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which helshe 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 homeownet. 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,duringand 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 tIe State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature _,�_ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: is t",":104- be s /tv£ ] The debris will be transported by:' /All 'kJs1� L L. Cr c The debris will be received by: 1/a(( < y Kt 7c(g '� Building permit number: C C l Name of Permit Applicant ,Lu-Jmd{,rJ s Date Si ature of Permit Applicant The Commonwealth of Massachusetts Department ofIndustrial Accidents 1' Office of Investigations —70 Congress Street, Suite 100 .i I Boston,M4 02114-2017 www.mrtss.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y((`` ( y/ Please/ Print Legibly Name (Business/Organizationfndividuai): jt}$'a+.lon ankjlZ t.. Jaye tj Address: 677 a.' f�-pt9� �.�.w City/State/Zip: - , ; e. `1 - .. • . Phone 4: t7t Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 9 I am a general contractor and 1 employees(full andlrr part-time).` have hired the sub-contractors 6. [ New construction 2.0..lam a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 9 Demolition working for me in any capacity. employees and have workers' 9 [' Building addition [No workers' comp.insurance comp. insurance I required.] 5. ❑ We are a corporation and its 10.17 Electrical repairs or additions ;.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.9 Roof repairs insurance required.]t c. I32, §1(4),and we have no employees. [No workers' 13.9 Other comp.insurance required.] "Any applicant that checks box it must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. !Contractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comppolicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: -_. City/State/Zip: 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: [ _/ Dztt S; 0402,47 Phone#: v�( 1//3 '516 '/d 73 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License#_, Issuing Authority(circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone it: Page No, el Pages Proposal NEWMAN'S CONSTRUCTION 697 Rd. Northmpt on,MA 01060 1231 413386.1093 PROPOSAL SUBMITTED TO PHONE DATE ut t I }E JJ E y .OY/ m S? a-3,�F V5 / 7 STREET /q Oe NAMEto "FcG2bcS 4JE _. ,a CITY.STATEpand ZIP CUM nn JOB LOCATION Pit en;/La Rn T ( <T—, 66c', 5erT'r L•. ARCHITECT DATE OF PLANS I JOB PHONE We hereby submit Specification and estimates for ,6J=.f> cA,s/!/' � /l:,�a r.. 1Cn4"/Z. Yl bh.v5 4/+s-vH iG., 5. .�.:r.,f&.if .4L-4-, H,Yit/ n ` l/!'?,�-2�/,t� eeil E ea Ru= 2�a/G* c5y\#^) Minn C ,,,,-�77 274 5fdtl. ...XXL2 f.U/•l/5'r- zk,.0_,f,,LC. .¢]" z'A:Di S` / (9 7/cl/f2y5r /INc 'n1� eGr•laaFyl //. A-r s/' oz-,2/4 /ts AnrliH/27i int.-yr / ! (�/(t} _4r/l Sful l/ 7c-/-,-,2c4 jt/L;/Ln Ti /rN�''r✓I i7/M4N/ ()N .t-f41'rCt/YNr/ y Sr.✓'.�. 6r S Li (c.✓\ 14z25 c),(7 r94-c...z-,1 nv 44, 5%er ?" //v"L-4- L.C.,,ISitr,.7 S .r`J,s �" b .,,,„ J..ti tC IL sett /tU..,,ncn, ��/ F- sfet./f _ p? 1 x..� t 15.�/t ) e7t ..4. ' 1 n' 4eL - �y�f,fi�[ea f .a:: hA-64,j // / t5 r n f t•JZF /Zr. /::2 /a Le L. „,5,N� c-zK/a.1,115il.. 40 ,ns-, c clic S /a// 7// vt, ' AT ya,o S / Cfip Gttfrrc... 2,A/✓ ..j�[-)J 5 ,4 f" 4J.S G r S /to.-+„ •N_r.',. . the propose her by to furnish materia and labor—complete in accordance with above specifications.for the sum of: J it/an 71 45471-7D Pr G,f/,..o pizs� /cv — doers($ 13 ;T/ro. —f. Payment to be made-s tel ows: [[ /� /J 1 / '1 s/cv✓L,' a,!' /. h /bc?/2i,/'1 ,••4,2" L , ,,.-, --->o://74/,c'I ._.. M ke iinvolving-malertair guaranteed N be as speciffed nn Hok W be c elea in a warknoANM1onzel /j AZ---_ manner avcAagl standard t .Anyangel de1iontroaboveeoninsSignaW2 p tl will beexecuted only uponwritten ordersand will become aextra charg and Move the estimate All agreementscontingent open strikes,accidents of of delays rs are Our mm d.Ownertocarry fire tornado aria other necessary- Note: If n al may be O Our workout are fully covered by WOMmans Compensation Insurance insurance withdrawn by u4 it n accepted way (1 Cl ddys/ /Acceptance of Proposal —The above prices. nPeeincations � eV/ and conditions are satisfactory and are hereby accepted. You are authorized Signaw': /� ���yy� to do the work as speceTled. Payment wiif be made as n timed at, O-�lJ � Date of Acceptance: Signature--- _ /