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25C-231 PROPOSAL 1-- (C0 M - ( l Gft �' 1 Na W ry , Z7 H /Lkofy °' 4 �„� aid t. „ Date suiviriY ,24?// Sheet - Na J Proposal Submitted To: Work To Be Performed At: Name 4 p1Ne: 6 9 Street 1 S-3 Q 14 e 4 — cI' f reet /:�? /44 / 0 % - City NO2 i rl �1 j a/Y Nn r9- 0/0 G� City ' -' /f i, et'' State 41 R. G / bl4 State �= Date of Plans Z1-0 Nig". / f 2O // Phone . -F 6 - 7/-3 a- Architect ", 1 ---- " , rY n/ "We hereby propose to furnish the materials and perform the labor necessary for the completion of C Or L�� 0 fY IM- ,4 6- Li- % cl c$' 1.� /nr 6- * — ,' 7 / + C J % _ N <i .1- dory YN /4-, ,- * , 2 c .f u 1_.,T 0 F' ' ; 6 , c <v .v 77o bn 14.11 N D 0 '.►s 47-7,0i;),/‘/ 4" rO C s� ;vc/2 ? 1,- m j a,Y, ,___ >j I ? c y►A. c i•= 40/=)- C ,0 S LO //YG / A % 1-- ‘&7./.,0c. v `t '7-) 1° cJ.eC- /- J E- iv a'44) S' / r� / � (s ,q of � ' C 4 L- 0 A, ,R s -----/ l - 13g- U !2 o M tf%9►i✓'`1 ivtM1,LI .S'etc -at" i ry / M 0Vic /led ,9-t r ',4 r2 i- ( sI / C- t ',-c 4- /rr , s'! 11`LL, ,,) % I} K =: '7771 Ac t-1 i'0 _ f ® ✓X7 y}� R c - M u ✓'> s v- re Er ..;) 2-. c / ();/' , - r.1 t- -1 L _S' ? £ ) L� c- . J -s N E 1 6 / KA_f t cr /UH s& Fr - r - C/J &il 4- ' Aire '7 (..1 'r c= , 41 N 6 I %.p, r+G- .� f' /`^/t C i 1 ft0 1 c l_.lit ( , /c7/�t ,/,-; \ C Iv 2. /&O F LoOR -CR ce3 pc, 0, f 5 s jt/� -lam Re PL 4-= f./ t r!f t- v 4.4- .SG All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of p o iv N W a" ti c c�T .% cr ,c' / nr t..-! ($3 0 ©, d71 ): with payments to be made as follows: lT (/ Pd N S /-s F` ci J C 0 htf A/ P v 12-01 1 A- 7-S. a 2 4 L- Y►ti 4 i 7 ?rc't 4-1- ,4-' L � d t cr Any alteration or deviation from above specifications involving extra . costs, will be executed only upon written orders,_.&nd will become an Respectfully submitted a_Q_ extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry Per O W K &-� fire, tornado and other necessary insurance upon above work. Work- men's Compensation and Public Liability Insurance on above work to be taken out by '' 4 ;. ; Y6 Lc-�' -t- . CCI.P1 ote —This proposal may be withdrawn by us if not accepted within l®. days. ACCEPTANCE OF PROPOSi ---- -�, The above prices, specifications and conditions are satisfactory and are h - - .y accepted. You are authorized :s I , the work as sp Payment will be made as outlined above: sign• ure _uA.... ��.�... � '_.e,_.. TOPST FORM 3850 ORIGINAL LITHO IN U.S.A. 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 fantily 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 ofNorthampton wants person(s) who seek to use the home owner exemption, act as their own constructrpn 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 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 Date Address of work location T s • i i ., The Commonwealth ofMassachusetts Department of Industrial Accidents • , Pk ! el _ Dil . = i= * 1.10 ' O of lnvestia ations • a rr_ 600 Washington Street • Boston, MA 02111 www.massgov /din . -Workers' Compensation Insurance Affidavit: Builders/ Conti• actors /Electricians/PInmbers - . Applicant Information • Please Print Legibly Name (Bu siness /Or ganiation/Individuat):. - 4 F1 i" fl e w T - Jo .t1' • . • • Address: 2. I i ift L, , 1 . : • - l • City /State/Zip: f Lo ft .. t. - . - k P #: f �f � � T . Are you an employer? Check the appropriate'box: .Type of project .. m a eneral contractor and I '• P ] (required): . 1. Q I am a employer with 4❑ I a g 6. ❑ New construction employees (full and/or part-time).* have hired the sub- contractors 23: I am a sole proprietor or partner- . listed the.attached. sheet. 7. ❑. Remodeling . ship and have a loyees These sub - contractors have. .8. 0 Deiaolition . . working for -me in any capacity ea Ioyees-andliave workers' - [No workers' comp- insurance -.con p• msuranr._ #'= .`s ... .. re ed 5. ❑ We are a corporation and its 10.Q •Electacai repairs or additions q�. cers ae • . - Plumb T 3. Q I am a homeowner doing ill work Offi hV cised their 11 r Q mg repairs or additions myself o workers' co right Of exemption per MGL ms's (N conc. 12:0.koofrepairs • _ • insurance required] t • • : ,c; 152, *1(4); and have no • ,_ .. employees; [No workers'. 13.4 Other gr6 At 4 ,. S( / Cr - comp. insurance required}.. . ' *My applicant that checks •box #I= naist.also fill out the section below showing theirworkere-coinpensatien policy information_ • • . • . • t Homeowners _who submit this affidavitindirating they are doings]] work and then. hire outside contrrctois must submit a new affidavit indicating such. IContsacto:s that check this box mustattached an additional sheet showing the name of the subcontractors and state whetier•ornotthose•entitics have • employees. Yale sub - contractors have employees, they muse ptrovidt their waiters' comp.po1icy numbs ' • : lam an employer that is providing workers' compensation insurance for my employees Below is the policy andjob site information. . Insurance Company Name: 6 A M • Policy # or Self ins. Lic. #: Expiration Date: Job Site Address: J- 7 .M )C 6 � ` l) A i City /state/zip:' I+Ill. Of 0 6 , 0 . • Attach a copy of the ,workers' compensation policy declaration page'(showing the pohcy number and expiration date). Failure tb secure coverage as required utter Secii&i 6fMGL c 152' can lead - to the iumposdion of'cnn ina1 penalties of a fine up to $1,500.00 and/or one -year imprisonment; as well as civil .penalties in the form of; STOP WORK11RDER and a fre 2.- 250.00 a day against the violator Be advised that a copy of this statement may be forwarded to the •Office of , . YiVesInaitions oftheDIA far iasisranee coverage verification r , _ ._ r , : ... . firo heels certi - u e pains, d p. f perjury thai the information p rovid oV - .°r aper ' _ . y s o .. _ . •__ / . . &&ante_ _ Date, • 6 . ! . Phone #: / Lt/ 3 J $.- • • 6 #O'__` • . .. • . • - i l cial use on Do not write in this area, to be co ` . Off • y. mpteied by tidy or town official City or To ku: Permit/License # Issuing Authority (circle one): .'1. Board l #h 2. Building Department 3. CitylTown Clerk . 4. Electrical,Inispector 5. Plumbing Inspector • 6.Other Contact Person: of Hea Phone #: A • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ,�� /� Not Applicable ❑ Name of License Holder : ,` I G• -'l O it 11i lu License Number 43 E L .S 0 /0,37 - RY Address Expiration Date Signature Telephone 7 /0 za 3; RettisterediHatne lmlxraveinefr tta-ri ra ctt "r � •: , > rY i ; agiit ti ..:_ Not Applicable ❑ Company Name eTh Registration Number Vi M 1 /3 g Address Expiration Date 4-tick-o2 G Telephone l 2_y6 7 — 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 ❑ 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 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 ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [E1 P S i Other [01 ge Brief Descriptiop of P o p osed Work: act' Air( zoz S pT 041.- J01Ni- 9'T .S7, DIE 1T "/rjiv /55 13RtJ -S1 � Alteration of existing bedroom Yes %S. No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes b No Plans Attached Roll - Sheet sa .lvetfu for s S. o ai "ddi c� 6 titi q fia ili % 6iiitit iftit 160 a. Use of building : One Family . Two Family Other b. Number of rooms in each family un : 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 Ta - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT '- AN rI t G c' L_ , as Owner of the subject property ,p hereby authorize /c 4 I1 = i F" t to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date i v rI 2.3 ZQ / K 0 / - , 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. 14 to ts® -c 3 Print Name Signature of Owner/Agent Date �1 d ■ 3 2,7/I . . 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 te yt T `_ ®' _ -•.` A !M t3 _ ( a 1 —m Lot Size _ -_ Frontage • -- Setbacks Front 1 / Side L L 2l R: 25 11 L � R: — _. i ____ Rear E i Building Height 13.; 1 i Bldg. Square Footage i'J % 1 i 1 i Open Space Footage (Lot area minus bldg & paved !z.° t:l Li .,..a , ____,i , I "— 1 parking) # of Parking Spaces T °" Fill: I i�..� (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW e YES 0 1 IF YES, date issued:; i IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES 0 IF YES: enter Book Pag ' and /or Document # _ B. Does the site contain a brook, body of water or wetlands? NO • DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO 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 e 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • City of Northampton St ®f _ Building Department, 212 Main Street Room 100 Northampton, MA 01060 phone 413 - 587 -1240 Fax 413- 587 -1272 a f e ��x APPLICATION TO CONSTRUCT, ALTE ' ENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by, office 1.1 Property Address: /57 411.19 4'6 % Map Lot ,: Unit IV 2 Tj f , , r' fro a hn C? t i' 6 Zone Overlay District Elm St District CB District SECTION 2,- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: tF M s Cr-q 3 i FS.3 I3(' I ®G c' N Name (Print) Current Mailing Address: - 1 / .- #e — 7/ Telephone Signature 2.2 Authorized Agent: I c:ti - pR Fur/ s i 1 in Name (Print) Current Mailing Address: J Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION! COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 10-4.,2) (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) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/inspector of Buildings Date 157 BRIDGE ST t BP- 2011 -1119 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C - 231 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- 2011 -1119 Project # JS- 2011- 001798 Est. Cost: $3400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RICHARD FINN 050848 Lot Size(sq. ft.): 5837.04 Owner: GOLOB ANNE Zoning: URC(100)/ Applicant: RICHARD FINN AT: 157 BRIDGE ST Applicant Address: Phone: Insurance: 43 ELM ST (413) 548 -6240 () HATFIELDMA01038 ISSUED ON:6/30/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: REPAI R 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 6/30/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner