24B-019 Pt rage NO. or rages
I (', L I \ 7 EWIV AN'S CONSTRUCTION
697 Bridge Rd.
'Northampton, MA 01060 101
3 2009 ,,,.� 413- 586 -1093
PROPOSAL SUBMITTED TO _.._J 1 PHONE DATE
STREET l_ - --- ___.`. JOBN E '45'
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CITY, STATE and ZIP CODE A JOB LOCATION
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ARCHITECT DATE OF PLANS JOE( PHONE
We hereby submit specifications and estimates for:
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Mr Proposr herehy to furnish material and labor — complete in accordance with above specifications, for the sum of:
L' } L C
dollars ($ j ).
Payment to be made as follows: /
t-1, i ' (-? c.2 } \oL x`24- c.,.. k )
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All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifications Authorized 7 �_
involving extra costs will be executed only upon written orders, and will become an extra Signat '
charge over and above the estimate. All agreements contingent upon strikes, accidents --
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Note: This propose m), b e
Our workers are fully covered by Workman's Compensation Insurance. withdrawn withdrawn by us if not accept d Within _days •
—The a bove specifications ,
Acceptance of Proposal prices, p
and conditions are satisfactory and are hereby accepted. You are authorized Signature ' 1 1-041.
to do the work as specified. Payment will be made as outlined above.
r •—
Date of Acceptance: / / r 0 _ Signatu j
Ncrtacilltcr., Mc. G? ei)
7-l-1 m xT^ ow- -ER E + CZ; i OW T V.DGE IT T
I I Ire St.'-' G ._ M`.Szri :T'SerrS n r io —s the homeowner the ri hL under 78OCMR 1083.4 to I
f act as ii =pi=er corc Sur"'._' .sor. ine Sz.:re defines romeowne: as, Person(s)
I who owns a c a cep on which he/she resides or intends to be a oJ2e or two faiz1Ziy
cede : structures res rt to such use and/or fa. f^
G.:�:ed Cr detached :.ZCL' ..., cCC °s so
i person w`e constructs more than one home in a two-year period sitP not be considered a j
home o .vner." 1
^n(s) who seek to
?'EZ 6L: E'er- . . ., e?� f:-.).r the City of L'i,`�'P r?DIOII Tr any p ..z:
G] act -t sup >�ncnr , to be C w r
use the the LLa o -rvTowner r^ exemption, �pL�t71� L(i .�L their own �.�:i:..t�'.t �:t� -:vim .ac�� w J....va;Y._.
t _t by don_ so You become responsible for compliance with state building codes
and re T.th t ons_ The ins ecpion process recyires that the building cep . i ent be wed
to inspect work at Mar s sees, which include foundat:on/fooi (before bads/11A
sr.--no tube boles (before pour). 2 reu�4 buiidin? insuec oir (before work is
cc ce edk - s- - -i r._ ectirn. reouirr. .) .I- a frii7 bell =11'3 eriien_ The
b , ;can; d ;gent recuires these inspe ores before the work is concealed; failure to -
secure t • ins ;eons can result in failure to obtain a certificate e of occunancv
If the homeowner hires other trades to perform work (erect plumbing & Ves) the
ho o w :er will be responsible to make sure th the trades s hired secure their proper•
perrurls in cor. ju"�on to the building permit issued, and that they get their required
inspections_ Failure of the individual trades to secure the permits and inspections as
rce2: ed can DELAY the pro ect until such t,. _e as the proper permits and inspections s are
made
- - - — - - -- undearst n d the above.
(EC M.°. Own Lr signature requesting exemption)
I w - :11 call to schedule all r pct red buildz 1nspecdon necessary for the buildinit pert
issued to Ire_
Dane _
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t- C_. s - .
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- Boston, 11 --I 02111
_= 31 30v. mass.gov/dia
• "Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers
Applicant Information Please Print Legibly
J
dividual): C
Name ( a_isiness;Or`anization /Iny r =, • .J A1t.te )rff'A 2 J i\ / .e(f_)fl(1 '- ( "-)rc yi- _
Address: Ui -i -',,► ., -
city/state/zip: iN.1 c> (- }-), -c . i-,L 5rl IL t c,11 Phone #: Z -' 1>) . r(- - --
I Are you an employer? Check the appropriate box: Type of project (required):
I 1. Zi I am a etnoioyer with :- 4 . ❑ I am a general contractor and I
I employees (fz ar_dior part-time).*
have hired the sub - contractors 6. Q New consn
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers'
9. ❑1 Building addition
[No workers' comp. insurance comp. insurance.-
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doinn all work officers have exercised their 11.11: Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.� Roof repairs
insurance required.] c. 152, §1(4), and we have no 13.( Other
employees. [No workers'
comp. insurance required.] .,
'Any applicant that checks box :4I must also fill out the section below showing their workers' compensation policy information.
Ho meowuera who submit this affidavit indicating they are doing all work and then hire outsidecontractors mist submit a new atldavit indicating such.
Contractor, that check this box must attache: 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 polity and job site
information.
Insurance Company Name: l 'CCU- C ! + '6 ' (-) -
Policy _ or Self-ins. Lic.. C. \ P F r`, c` q -- e
_Expiration Date: J ` 1 ;
Job Site a ddress: 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 ofMGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,f00.00 and/or ore-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day ay -'rst the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verif cation.
I do hereby ceiiyy urrder -tlrea rd eerdtte5'- jui that-the information provided above is true and correct
i anature: / Date -: _ . _ / D
l _one :(i - /[. ) `!1( . {.? 7 j
-..7* a L?ise_Jnb..__DO IWr i1% completed by city or town official -
II
City or Town: Permit/License # ,,
Issuing Authority (circle one): i t
I. o.: ! _v •• n _ C . ;T.... Clerk l i �.. a. ,r - Plumbing inspector d :( )1 cl:t -. L' y .7 r ti' Electrical Inspector �. Dl
.1 t11 Lt' �11M a1� _ ii r,. i v u r-i.:.
i
6. Other
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
) J
Name of License Holder : 1 �� % t , _ _i . J\ f; ', i) r' c • It ; u'
License Number
Address ' - ' Expiration Date
n 1
Signature Telephone
S. Registered Home Improvement Contractor._ , Not Applicable ❑
Company Name Registration Number
n,
i • _I » l.r. _I `3_7 f' li✓
Address Expiration Date
/\!(."-- ' ( i(1',•�1 Telephone?-it C �t
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. - Dame _Owner Egim1F1%a>t
The current exemption for "homeowners" was extended to include Owner- occupied Dwelling,s 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 -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 Addition Q Replacement Windows Alteration(s) n J Roofing
� II Or Doors ❑
Accessory Bldg. u Demolition E New Signs [D] Decks [❑ Siding [D1 Other [DI
Brief Description of Proposed
Work:
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 additioii 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
•
, 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, C. 3 •
, as Owner /Authorized
Agent ereby 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.
Print ame
4 �--- ( 7 ' , ye 7
Signature bf Ovn r /Agent Date
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 tilled in by
Building Department
Lot Size ,_ .- ____._.__..__
Setbacks Front
Side L: R: _ _ L _ R p_
Rear
Building Height
Bldg. Square Footage %
Open Space Footage _ %
(Lot area minus bldg & paved
oarkine)
# 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 Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
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 Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
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 t,urnrrron plan
that will disturb over 1 acre? YES Q NO Q
IF YES, then a Northampton Storm Wafer Management Permit from the DPW is required.
i ` i I ;pity of Northampton Status of Permit:
.. ..
$i.li!ding Department Curb Cut/Driveway Permit
, -
}212 Main Street Sewer /Septic Availability
JUL 1 3 2009
: ,. Room 100 Water/Well Availability
orth mpton, MA 01060 Two Sets of Structural" Plans
,phor10; 3 -58 -1240 Fax 413- 587 -1272 Piot/Site Plans
, ; 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
3 - DE it h 5 /. Map Lot Unit
Uf / �
J` � ` ! f � Zone Overlay District
/l` Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
L/(
r t: S .J M et, L,' ')C')CZ. ' 1 � , ) I, -( 11 r i d�(;C- k ) J ., t , ! L-Kt
Nam (Prin Current Mailing Addr
Signature Telephone
SECTIO - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be T Official Use Only "
completed by permit applicant
1 . Bu i �^ 0 0 (a) Building Permit Fee
�oG F+' la .
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection I/
-- ( -
6. Total = (1 + 2 + 3 + 4 + 5) Check Number / 7%
This Section For Official Use Only
7
Building Permit Number. 6 7 t: 1// 0" c9c2 ` � Date
Issued: 2 i t lC`t
Signature: E' . '?
— - 9 -- . p ._ � g
Buddm Commissrorter /lrzs actor or im(dm s - Date
5n; ` BP- 2010 -0037
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 243 - 019 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- 2010 -0037
Project # JS- 2007 - 000936
Est. Cost: $10800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NEWMAN'S CONSTRUCTION 142807
Lot Size(sq. ft.): 23173.92 Owner: WOOD WILLIAM L
Zoning: URB(100) / /WP Applicant: NEWMAN CYRUS &
AT: 55 DENISE CT
Applicant Address: Phone: Insurance:
697 BRIDGE RD
NORTHAMPTON MAO 1060 ISSUED ON: 7/13/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP AND RESHINGLE REMOVING THREE
LAYERS
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 7/13/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo