The URL can be used to link to this page

32A-039 . • r Proposal vin sidi „,„ # Corbett Home Improvement ""'' ”' Root, -'= 4 Reed Street l�u �� Northampton, MA 01060 ``� I'r tA} ce t . 1 sl1i 1 (413) 584 -6571 ` „:" i Gutt,ir; II �/�/ HIC# 116069 CSL # # 67450 �y/'� s�,tnt�s PROPOSAL SUBMITTE TO OJ►/(L 2M i2 �� Vj3 DATE ' ' / I'. &,�-%/ STREET � 7 / JOB NAME CITY, STATE, and ZIP CODE /4) 402,1 / / / A 1 JOB LOCATION / DATE OF PLANS JOB PHON1: We hereby submit specifications and estimates for: 1 ST 77) p k j /.. AS BCS .Sr A"'d OfriltIce 0,z A y ihittd (,w rrr x 4.. r“..N..5- -z) typi 2 45' ti7 rs _/u5J/,*> :.1 +Jk a, Phi r�'_ 3 r LC t r4 0 / CitaU 'eciw .sv;,r :s),� W iiiivo diAl t -cit !7 1 M COUe. - T W flAQA,I,thu. t.= , L5:k C- S 00P/401423 C'�iiPt / b Y; y 1 ' s'et to /1i `l- I�+4s mI I rt. sC tms,C.r.I W W 1 ui4 tJ :t OLika, . n# d 1, ig c l D4y�,e S, B f� sikkrf �cK -5 �H- ti PRIG 15 (ALL -r ve) ar),ll,�l.1/ i4� o/e NA-c . Ce,l�� J �‘ ' G y _1 Al L. 'a . c1 `C rd JQU� hwrcI i Rt, j)∎1t'ir1, v /A/0),cis kmil- -a'f7 _ i 4 kl ibi Ag 510464 - 1 #3 i We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum Ste Dollars (S OK 1, 7S Payments to be made as follows: $ / 000 Deposit, $ 1 756 Due upon Day of Completion V / All material is guaranteed to be as specified. All work so be completed in a work -like manner Authorized according to standard practices. Any altercations or deviation from above specifications Signature involving extra costs will be executed only upon written orders, and will become an extra - charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: This proposal may be delays beyond our control. Owner to carry lire, tornado and other necessary insurance. Our withdrawn by its if not accepted within Jar's - workers are fully covered by Workmen's Compensation Insurance. Acceptance of Proposal - The above prices, specifications and conditions Signature i ' i 4, ' f Alik are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. t Signature Date of Acceptance: '' . , The Commonwealth of Massachusetts • .11111 .1•11011•1111. Department of Industrial Accidents ► ..= E Office of Investigations =.. • ' 600 Washington Street Boston, MA 02111 • ,�`,� + � www, mass.gov /dia • Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly � . Name ( Business / Organization /Individual) :` . (,OKeb J(� Address: y /ARP& City /State /Zip: MOR4ci ziA/ AM- 6)060 Phone #: (4 6s71 • Are you an employer? Check the appropriate box: ' Type of project (required):. 1. ❑ I am a em to er with 4. [ I am a general contractor and I P Y 6. New construction employees (full and/or part- time).* have hired the subcontractors. 2. I am a sole proprietor or partner- listed on the attached sheet. t 7 . n Remodeling ship and have no employees These sub - contractors have 8. El Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.❑ Other • *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information. 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. Lic. #: 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 c -an 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. I do hereby certify the pains an, penal(• of perjury that the information provided above is true and correct. .t� Signature: Date: /67 ` t • Phone #: ( g) ----C3 6 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): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 4d • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not n 1 Not Applicable / ❑ Name of License Holder : �/ 97 % rl U/CA ._ /J J jr 067 c) License Number . kleed <-E N `461.1 4 6 )o G, o Address I txpiraaon uate 41?) 6 1 7 4 Signature Telephone • 9r'Re. Istered Home Im rovement Contractor ° w " xt w a YzA ae > " "'` Applicable ., u: �.....� Not A ❑ Co2 e e .4,x0freineAcr -- Company Name / R Reaistratiolt.Number_ y ieeed,54 /V ddb /4 o) o 6 a 5-/.5 Address xp ri ation Date / ll JJ r Telephon(4 ��S7/ SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.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 1 No ❑ 11:`= Home" Owner`, Exemption The current exemption for "homeowners" was extended io include Owner- occupied Dwellings'ofone (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess,a lipense, 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 • • • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) Roofing I Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [1::] Siding [Iz] Other [O] 7 Brief Description of Prppose p , ` Work: C, l ; >l r, S «S \j41" Alteration of existing bedroom Yes 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 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 Owner Date I, �LA(r T (13P/o4 1 , as Owne horized ereby declare that the statements and information on the foregoing application are true and accurate, to the best of an. .elief. • Signed under the pains and penalties of perjury. /VW 54i241 Jr Print Name / 7 �1b _ Signature of Owner /Agent Date • Section 4. 'BONING 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 F Frontage J L_ _ __ -J I ___ I Setbacks Front (--1 r r ------ 1 Side L: R: 1 LIJ. I R:771 L Rear 1 1 Building Height I I I F .--- 1 Bldg. Square Footage - i F % r - 1 L_J Open Space Footage (Lot area minus bldg & paved r I I I I parking) # of Parking Spaces I I _ --, [1-1 Fill: L—_ ^�_ IL ______ (volume & Location) I L_._ .�_ A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page J and /or Document # B. Does the site contain a brook, body of water or wetlands? NO © DON'T KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission ? 11110 Needs to be obtained O Obtained 0 — , Date Issued: 1 C. Do any signs exist on the property? YES O NO 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 O IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, e avation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. s • Department use only RECEIVED City of Northampton Status of Permit :; ' ', ti ,t, Building Department Curb Cut/Driveway Permit'"' OCT 1 2011 212 Main Street Sewer /Septic Availability x Room 100 Water/Well Availability s t •orthampton, MA 01060 Two Setsbf Structural Plans 4',,• t • per. of eu�ou�a ws�cnoHS � woHnwrpron wa►o nn P 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site • Other Specify APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION . 1.1 Property Address: This section to be completed by office iker- 5 I Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ri Goa ty Name (Print) Current Mailing Address: Telephone Signature 2.2 �„�� _ 2.2 Authorized Agent: E AJi T OoR r T , -)f< Reed 6-& Ar40,1 pArct C)0(0 Name (Print) Current Mailing Address: C� i3j s 9J � s7/ Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be 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 6. Total = (1 + 2 + 3 + 4 + 5) � 7 5 Check Number p "3 5 This Section For Official Use Only T Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date . 65 CHERRY ST BP- 2012 -0380 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 039 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: vinyl siding BUILDING PERMIT Permit # BP- 2012 -0380 Project # JS- 2012- 000602 Est. Cost: $27750.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED CORBETT JR 067450 Lot Size(sq ft.): 4094.64 Owner: GORMLEY DARLA L Zoning: URC(100)/ Applicant: ED CORBETT JR AT: 65 CHERRY ST Applicant Address: Phone: Insurance: 4 Reed Street (413) 584 -6571 NORTHAMPTONMA01060 ISSUED ON:10/13/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING 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 10/13/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner