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PROPOSAL Page No. of Pages
Zak's Construction Services, Inc.
5 INDUSTRIAL PARKWAY - P.O. BOX 739 - EASTHAMPTON, MA 01027 -0739
PHONE: (413) 527 -4440 FAX: (413) 527 -4441 .
gruLeT gsl(S b lieE&ILS Jerez Es-raysuk4gE.s. •
'R SlfMITTED /1 w � �y/� /►� n
'(igiD� bio tf ,9 pi 1 " k PH ^ 7 c /7 DATE 7 -
3T ET ( JOB NAME V// /y (j ' ' -Qa
0 t age Rog 0 0 Plevciotfi hicioti Ar Le' / . ..
SIT Or �n "/ (' o / " -'/ /' �/ , NO 60
JOB LOCATI Me /V/.^ /0 .0 C? !
>RCHITECT / DATE OF PLANS v JOB PHONE
a
Ne hereby submit specifications and estimates for:
f. /751 G " (once P 4 PQ W/ l! gf(
fP 4(D'( N
,,.) Peld to k „ If
/D
2 a bo r lha i pr i q7 a 7 d ,t°r p7 A°10 s 60
,
Ail/Pd ofieP 1
cofi1 /2//'/n OK !we t4', ry
CASH UPON COMPLETION OF PROJECT
We Propose here to furnish material agd labor — complete in accordanc with aabb. specifications, for the sum of:
7 h ; s 15 q 1-1/le Q'1 / >hic ti r o /J Co //gym a dollars ($ ,
CONSTRUCTION SERVICES, INC. will not guarantee against pavement failure if sub- �'� ^ _ I
base /17//'-- base is prepared by others. All material is guaranteed to be as specified. Any alteration or Authorized 'fir
deviation from above specifications involving extra costs will be executed only upon written Signature
orders, and will become an extra charge over and above the estimate. All agreements i
contingent upon strikes, accidents or delays beyond our control. Customer agrees to pay all Note: this proposal may be 0 ,....----
costs of collection of the indebtedness due ZAK'S CONSTRUCTION SERVICES, INC. on withdrawn by us if not accepted within days.
customer's account, including reasonable attorney's fees. Our workers are fully covered by
Workman's Compensation Insurance. A 1.5% per month 18% annual rate service charge from \
date of invoice is added to unpaid balances over 30 days.
Accept of Proposal _The above prices, specifications :- el
and conditions are satisfactory and are hereby accepted. You are authorized to do Signatur
the work as specified. Payment will be made as outlined above.
r
Date of Acceptance: Signature
.0s KAMpi, 516:10 A
9 it ,a [ 1yJ e e �xi�J rd NLtdd1&mpfntt ='t
t4I utS i36ACl1nact15 N :
' ' - — DEPARTMENT OF BUILDING INSPECTIONS
ilk == li =
212 Main Street • Municipal Building
Northampton, Mass. 01060 r'"
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I,
(li censee/permi ttee)
with a principal place of business/residence at:
(phone #)
(street/city /state/zip)
do hereby certify, under the pains and penalties of perjury, that:
I am an employer providing the following worker's compensation coverage for my
employees working on this job: 1 0/47o(
..
he 7ry 1 !Dor'rV' (04 / " 9 kl"V °oA
„ (Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contl actor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
-'; (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
IC
r
(Name of' Contractor) (Insurance Company /Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
•
NOTE: please be aware that while homeowners who employ persons to do rnr.inreo e, construction or repair work on a dwelling of
not more than throe twits in whirr the homeowner resides or on the grounds appurtenant thereto arc not generally considered to be
employers under the wolitees oration Act (GL152,.s 1(5)), application by a homeowner for a license or permit may evidence the
legal status of an employee under the Wodceca Compensation Act.
I understand that a copy of this atatemmi may be forwarded to the Department of Industrial Areidea& Oboe of Insurance for the
coverage verification and that failure to secure coverage under section 25A of MOO, 152 can lead to the imposition of criminal penalties
consisting of a fine of up to 54500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a .
fine 0(5100.00 a day against toe.
.../ / _ For dgntt use only
iir 44- 7 i Permit f. _ Sat... a 1 ' of Licensee/Permittee I; e
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 1.0- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
C-o p o CG"l� irat / P Gh P� as Owner J s Own 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
o d , ( /?/7I/ /,'o) perf m x I M covic/rvnte.P
, as Owner /Authorized Agent
hereby 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.
ldda' m Ae/ /(//7d
Print Name
S of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Su er isor: )')) '' /‚‚/ Not / Applicable ❑
Name of License Holder : L� r " ► � T C 7 9 [/
License Num er
(97‘4 /f0:fecf Srptcitoi / //7
Address Expiration Date
' e'l./ c • 9'9"'/
Signature Telephone
SECTION 13 -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 ❑
Versionl.7 Commercial Building Permit May 15, 2000
SECTION, 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35;0'00 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
2 A Q I L
K 5 Co 7/f UG / ul Not Applicable ❑
Company Name:
dd ge l/ai '
Responsible In Charge of Construction
Address
m �r spy- f'gVT
Signature Telephone
Versionl.7 Commercial Building Permit May 15, 2000
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front 5' OO
Side L: l �O R: St 2 i L: R:
Rear (6-0 I f
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 DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
gj Accessory Building [ ] Repairs [ ]
f3eX . F VESaiP N•, coq; r k it r 5/9 (o r ig # o2 y
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A -4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ _ 2B I El
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1.2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential Jg R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION .6.BUILDING'HEIGHT AND AREA
(1FFI ' �®N
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION # fir � Y i� -
Floor Area per Floor (sf) 1 St �C
. f � �
y y , t
1st 2
nd
, a
2nd 3rd
4th , .,,y; -
3rd / /ii
4th / r /
Ortg r io
Total Area (sf) Total Proposed New Construction (sf) „ r '
Total Height (ft) 4 ' ,,
Total Height ft s / ' r ' -
r
File # BP- 2001 -0590
APPLICANT /CONTACT PERSON Zaks Construction
ADDRESS/PHONE 41 Avis Circle (413) 584 -2118
PROPERTY LOCATION 491 BRIDGE RD
MAP 17D PARCEL 012 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid e25I (.5 '-)
Typeof Construction: CONSTRUCT CHAIR LIFT SLAB FOR BLDG #24
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 054749
3 sets of Plans / Plot Plan
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w /ZONING BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w /ZONING BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Co i ion Permit from CB Architecture Committee
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
e4 t
491 BRIDGE RD BP- 2001 -0590
GIS COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D - 012 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: Non structural interior renovations BUILDING PERMIT
Permit # BP- 2001 -0590
Project # JS- 2001 -1058
Est. Cost: $3500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: Zaks Construction 054749
Lot Size(sq. ft.): 1169150.40 Owner: NORTHAMPTON MEADOWBROOK ASSOC
Zoning: URB Applicant: Zaks Construction
AT: 491 BRIDGE RD
Applicant Address: Phone: Insurance:
41 Avis Circle (413) 584 -2118 Workers
Compensation
FLORENCEMA01062 ISSUED ON:12/27/00 0:00:00
TO PERFORM THE FOLLOWING WORK: CONSTRUCT CHAIR LIFT SLAB FOR BLDG #24
A POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
e lk, Building 12/27/00 0:00:00 6338 $50.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo