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15B-008 BP- 2010 -0808 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-2010-0808 Project # JS- 2010- 001190 Est. Cost: $3000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN CORBETT 078297 Lot Size(sq. ft.): 13764.96 Owner: KAUTZ LISA V Zoning: URA(100)/ Applicant. JOHN CORBETT AT. 15 DIMOCK ST Applicant Address: Phone: Insurance: 56 Dimock St (413) 586 -8712 LEEDSMA01053 ISSUED ON :311612010 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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 3/16/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo V A 1 City of Northampton Building Department�� r 212 Main Street r = Room 100 Northampton MA 01060 x phone 413 - 5&74240 Fax 413-587-1272 x VW; � . ep� rF 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 Property Address Map Lot Unit Zane Overlay Distract °- ElrrySt District GB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Name (Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name (Pri t) Current Mailing Address: Sign ee Telephone SECTION !3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by ermit appl icant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Con. struction from 6' 3. Plumbing Building Permit. Fee 4. Mechanical (HVAC) 5. Fire Protection is 00 6. Total = (1 + 2 + 3 + 4 + 5) 1 0 , 00 Check.Number This Section F�WAfficial Use Onl Date Building Permit Number: Issued: _Signature: Building Commissioner /Inspector of Buildings — Date a 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 :----' L _.__.___ R :! Rear Building Height Bldg. Square Footage °' % -° Open Space Footage % (Lot area minus bldg & paved p arking) # of Parking Spaces - - - -•• • ~ ~ — ~° Fill: (volume & Location - -- A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued:._ b IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DO KNOW YES IF YES: enter Book Page: and /or Document #s ... _. B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 NO t' IF YES, describe size, type and location: ` 'y D: ire there any proposedc a�i rages to or adfions os gns intended foi tTie property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb (Gearing, 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. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [t]] Decks [p Siding [0] Other [p] Brief Description of Proposed -� Work: 5 � �" / � / �r >.� cam- GAr-,A . Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. if Newu house ar% nr acldE #lono.=ezistttarfiousina, ciiinr�te #e`' e- #o1Co�iiin: 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 o 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 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 I �r " s — as Owne uthorized gen hereby declare that the statements and information on the foregoing application are true and accurate, to the best o 7,,4 edge f. Signed under the pains and penalties of perjury. Print Name Si a of Owne gen Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder License Number Address ExpDir t ii nate ure Telephone 9. Registeredilirirne1moroverrient Ctrntractor- , w ,. Not Applicable ❑ l�o IU-�3 Company Name WINDOW WORLD Registration Number 56 Dimock Street Address L M 01053 Exgriratiorf Date 586 - 8712 Telephone _S ECTION 10- WORKERS COMPENSATION INSURANCE AFFIDAVIT (M _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...... ❑ Wm � �,. - -The-current-exemption for. `.`homeo_w_ners" 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 -vear 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 tint aF11At4i11 T f ►cgs: & General L -a --ws- Annotated. Homeowner Signature ne Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investi 600 Washington Street Boston, MA 02111 www.mass.gov/dia -Workers' Compensation Insurance davit: Builders / Contractors /Electricians/PIumbers Applicant Information Please Print LeQibIv Name (BusineseOrganimtion /Individual): WINDOW WORLD Dimock Street Address: Leeds, MA 01053 City /State /Zip: Phone. #: Are you an employer? Check the appropriate bog: Type of project (required): 1. Q I am a employer with 4.. Q I am a general contractor and I employees (full and/or part-time).* have hired the sub- contractors 6. Q New construction 2 XI am a sole proprietor or partner- listed on the attached sheet. 7- Q Remodeling ship and have no. tznp loyees These sub - contractors have .g. Q L working for me in any capacity- employees and have workers' 9. Q Building addition [No workers' comp. insuran comp..insurance. required:] 5. Q We are a corporation and its 10.Q Electrical repairs or additions 3.0 I am a -homeo-waer doing - -o Ce - e adAheir— 1 -1-Q-g -wing repairs or additions myself. [No workers' comp- right of exemption per MGL 12. Q Roof repairs insurance required] t c. 152, § 1(4), and we have no employees. [No workers' 13.Q Other comp. insurance required} `Any applicant that checks box #1 :riot also fill out the section belowshowurg their workers' compensation policy information- t Homeowners who submit this affidavit indicating they are doing aA work and then hire outside contractors must submit a new affidavit indicating such_ ( Contractors that check 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' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site I Insurance Company Name: Policy # or Self-ins. Lic. #: Expiration Date: _ Job Site Address: City /State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and ??�. a ahon 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 tip to $1,_500.00 and/or one=year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a ' fire of up to $250.00 a day against the violator. 1�e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby: _certify under the pains and penalties of perjury that die infornut on provided above istruezndcorrect___ _ Si tore• Date: Pho Official use only Do not wTrte in dtis area, to be completed y city or town officia City or Town: PermitUcense # Issuing Authority (circle one): I Board of Henith 2. Building Department 3. City/Town Clerk 4. Electrical I nspector 5. Plumbing -- -- 6. Other r ' Contact Person• Phone #• + 1 1 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton_ wants 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 regul T he inspection n rQEes���q�ire s that the building department be calle to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour) a rough building 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 p itsin- 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. Address of work location WINDOW WORLD HIC #160143 56 Dimock St. CSL #78297 Leeds, MA 01053 Telephone 586 -8712 CONTRACT Date ., ,A LcN /J, 20 This agreement, between r! �� r �, (Owner) of 1� �� .S'I�L= ,, Le �.� ' /Ul/� , and (Address) ' L/ ) -�, - f i G WINDOW WORLD OF LEEDS, MASSACHUSETTS. ' Phone s` SPECIFICATIONS Window World will o te 7 - - Z fL <,n - _- ?�7 Ve,>�' r3�•J� %L�e'. /ICU: ..�i� ✓���r "D on the premises located at I [ 1 rn z��! r ��- e �. �� a total cost of j e4y -) With this order owner pays down the sum of $ Owner agrees on completion of said work by the Contractor to pay the sum of $ T L �'�. dollars Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else. Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain material. This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be binding unless in writing signed by both parties. WINDOW GUARANTEE Window World's glass is guaranteed for 20 years from date above not to fog up between the panes of glass. All other parts will be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked glass after one year from date above or any damage resulting from neglect, abuse, 9r acts of God. Condensation build up on the glass is caused from high humidify levels and poor ventilation within the home therefore there is no guarantee that this condition will not occur. In witness whereof, I have hereunto signed my name this /,1 day of Al _- b 0 ©n ac or dfAuthorized Agent ne (Jointer