08-007 e l CORBETT
HOME EXTERIORS HIC #160143
413 - 663.2186 -566 -8 CSL, #78297
- 38 Graves Strcct, South 413 Dc - r M 112 A 01373
WINDOWS • SIDING • GUTTERS • ROOFING
"Locally Owned and Trusted Since 1966"
Serving the Entire Pioneer Valley
CONTRACT
Date O Ci 0 4(2 /I 20 (/
This agreement, between AL Co i o N e R
`� �/ (Owner)
of 506 /1l0 1Cin fttcl kortTNacm , /MA , and
(Address)
JCORBETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS
Phone W.3- 6s - / /Ji
SPECIFICATIONS
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� j � � A L f t cL ;nc Lvrlkiii -r t1uit.1C,... ,Peltivtilj
on the premises located at /06 /(f wens JC, . drii cxr a total cost of /a1 ITT. (yp
With this order owner pays down the sum of pp 0 . t0 0 ') �it,, Pi ,
Owner agrees on completion of said work by the Contractor to pay the sum of $ 7 4 ? 9. ea 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
Manufacturer's glass is guaranteed for life 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 ycar from date above or any damage resulting from neglect, abuse, or acts of God. Condensation build up on the glass is
caused from high humidity levels and poor ventilation within the home therefore there is no guarantee that this condition will not occur.
In witness whereof, I - ve here t • signed my name this / I 114 day of 0� ij f en. 20 // _
�l mil. by on ac or o • ut orize Agent) — (owner)
(Joint Owner)
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 farnily
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
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 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
iermits 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.
Date
Address of work
location
, . .
. , .
The Commonwealth of Massachusetts
Department of Industrial _Accidents .
Office of Investigations .
600 Washington Street
"-LIM— a Boston, MA 02111
..
4'
www.mass.gov/dia . .
.....
- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information - Please Print Leiiblv
Name (Business/Orgamiialion/Indivirbin1): -7 il.f C p ‘ FT'
, , ,, i • ,
Address: ,2": (5ft,tv ,Pri, t ., r - j -
City/State/Zip: ,c 6fir nc; 1 1,t, MA- Oi ".?_ Phone.#: JP/ , ..S - 36: , Y 'T.. 0,,
•
Are you an employer? Check the appropriate box:
• 1. D • I am a employer with 4. 0 I am a general contractor and I Type of project (required): /
6. 0 New construction
.....loyees (full and/or part-time).* have hired the sub-contractors
listed on the attached sheet: 7. 0 Remodeling • 2. ilt I am a sole proprietor or partner-
These sub-contractors have
ship and have no employees -8. 0 Dernalidon
• employees and have workers'
working for me in any capacity. 9. 0 Building additOn
No workers comp. insurance
10.0 Electrical repairs or additions
requir' ed.] . • 5. El We are a corporation and its
3. 0 I am a homeowner doing all work officers haveCercised their . 11.0 Plim2bing repairs or additions
t
myself [No workers' comp. right Of exemption per MGL 12.0 Roof repairs . •
insurance required) t • c. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
• . coi :p. insurance required.1 • •
*Any applicant That checks box #1 must aLso fill out the section below showing theirworkers' compensaXion policy information. ,,.. • •
t Homeowners who submit this affidaVit incficatini they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an adcltional sheet showing the name of the sub-connactors and state whether ar not those entities have
employees. If the sub-contractors have employees, they must provide their woricers' comp policy nmnber.
lam am an employer that is providing workers' compensation insurance for my einployees. Below is the policy a.ndjob site
information. . • .
Insurance Company Name: - • ' • .
Policy # or Self-ins. Lic. #: Expirai ion Date: - -
Job Site Address: • • City/State/Zip:*
Attach a copy of the workers' compensation policy declaration page•(showing the policy nuinber and expiration date).
_._ ....
Failure to secure coverage, as required Mid& Sectibil'25A ofMGL c 152 can lead to the imposition of ciiininal Penalties of a
fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fme
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_
Effeiftiitions &the Dm foriniiirance eov6rai; . 1 ------ - ,,--, — T, , , „ =
I dit lzereltycertibl the, 4 : tuu l pentdties ofperjzay that the information providedaboveittnte_and_correct
Signature:
.. ,
. Da: ./ , -2 ' ) •
- -
Phone 90: >//.? - S t r 91 0.,__ - - • •
• Official use otzly. Do not write in this area, to be completed by cizy or townofficial
• City or Town:
-
Issuing Authority (circle one): . Permit/License #
- .
•
.1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #: . ' .
,..
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : i" / C r% r' C�_ • T 7 f
License Number
36 6` A v- s ) A r . . ti % j f't !. / r ;. 4 .44-h, 6 t), 6' d, vi
Address / 74 / Expiration Date
Signat - Telephone
t
I .,..� f :�. Not Applicable ❑
I 72
9�tl�etaisteret> �El oii�fMprG '�emelti�;�f►i1�1<51�'"�`� �� Mq, A . a.
Company Name Registration Number
4. , .4 ,i r . e7 S 7T I / ,'4 "J. ,- W : ri,ni.:
Address Expiration Date
Telephone / 74;i
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 ❑ No
ni*Jiiitteo *RI brlExemption
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 1083.5.1.
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 aoalicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E] Siding [l( Other [D]
Brief Description of Propose
Work: / !`f S i. , V No p L otG e / i( ) t 5` f dill
Alteration of existing bedroom Yes V No Adding new bedroom _ Yes V No
Attached Narrative Renovating unfinished basement Yes V -No
Plans Attached Roll - Sheet
sa [f ti f iiiiii al c l ai i of x stiisit i s `I ; t t thiittli r na:
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
1 J Pi j , r ,J 2 i2 , , as Owner/. uthorized
Agent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of m • •w edge
an elief.
Signed under the pains and penalties of perjury.
Print Name
`, d it Tri'l)
Signatur•• n= /Age Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To IncompletO
Existing Proposed Required by oning
This column t fillld in by %'',fit
Building Dep ent& i
Lot Size 1 --- 1 '.- 4
Frontage , =
Setbacks Front I I 1 mm
Side L:' R: L:= 1 R:` ' ,
Rear � --
Building Height i I E x
.
Bldg. Square Footage I -^I % 1 1 � I
FT "
9
Open Space Footage % _ m ____ .
(Lot area minus bldg & paved s i
parking)
# of Parking Spaces ET
Fill: i y ._ .„ _..�...
(volume & Location) 1 i
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:1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book' ¥ Page and /or Document #'
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained
0 , Date Issued
C. Do any signs exist on the property? YES Q NO I
IF YES, describe size, type and location: I
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 0 NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Lam/ t City of Northampton fg9 _ Y
Building Department - r �
p Z0\ 212 Main Street ¢ $
1A
Room 100 ..E®
= 0 • rthampton, MA 01060 g
00$"'!::,. • one 413- 587 -1240 Fax 413- 587 -1272
'"
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
a Y, r l '01
Map Lot Unit
Zone = Overlay District
Elm St District ' CB District
SECTION 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
AL Co fiet nc _ b . V sr ■r∎eei
Name (Print) Current Mailing Address:
//j - (Pa. - /Ci_c
Telephone
Signature
2.2 Authorized Agent: /
.J / Ce:' -b FT) f� r2 ��C1S �f1J1.CC! l. r 'P[OL_
Name (Print Current Mailing Address:
Signat Telephone
SEC N 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) /t4,1 q � j, G'ife Check Number '
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
906 NORTH KING ST BP- 2012 -0537
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 08 - 007 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 -0537
Project # JS- 2012 - 000895
Est. Cost: $12989.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN CORBETT 078297
Lot Size(sq. ft.): 15594.48 Owner: CORDNER AL
Zoning: HB(100) //RI Applicant: JOHN CORBETT
AT: 906 NORTH KING ST
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586 -8712
LEEDSMA01053 ISSUED ON:12/1/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE 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 12/1/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner