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29-198 (4) i Proposal Vinyl Siding .1 64 _ # t Corbett Home Improvement Windows Roofing 4 Reed Street Doors '� Northampton, MA 01060 Awnings (413) 584 -6571 Canopies ' .•11 I. �,l �� �� 4 Gutters HIC# 116069 CSL# 67450 Shutters PROPOSAL SUBMITTED TO /JPWN 114 4. CV Ge\) PHONE ay-S:5 DATE Al ol y / a0io STREET 3 J duet-jock' QR, JOB NAME CITY, STATE, and ZIP CODE r i j k gte C. !{'{'g . 0 16 4 Z JOB LOCATION r DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: 0 - F S-M -t.(_ P N 4 y \ iwlI Nw3 pooh& Al I,h No/ olds I 7Z / S / cis �_ VI rvti I Ai W /NC/O1! /' lS ROOM , "T, rS71194—/.. L p c )v f /i 4h/ UNI P 4 DL. Am, ii&.ts, 41-C wiw5/vv✓ s low- e 6-145s w 1, --1 A-KI,od 1*s . 3d )64-47.1; 9 f3 p a 7s = a ao o . Aw,JNG W 1 N�tJrr ` 33 _ : 41 aRa s 1 Vy 4 /a a iii if9al 7 7 L -- . t. Me kA is1 //l�A � gd Po cNva - eh� -ed do yz, . O ier .v-r a1 v!►v I $ ' 4)9 t S7Arl 9Id Shim e A - �S LL 4 rut" ' s id / d t e>,r Ally A-Shc / -K Aw ( .S.s1l ARJ/°adoo OVerh S Aveacd ljc t Pi a4ci V0,� 1 m r; / *coi 4' Ai& /e/A. Co lL✓i-4 /-I44,iIvh Cor(,tIack, Alfa 6414 Ue.rrs Se,,ck.vr f3 IOc KS M,! Lc ck ii n ✓74cles - L✓l/feigh /I I'##M R t"s 444 ff "ava c e / 154 c ,Trs4iv ss 4c is 4/ ,dtrwi✓s arts. 44754- , 5P 1ott IA S-A1U 'rex- 430 tS dRm ;fin /0 /Sd We Propose hereby to furnish material and labo complete in accordance with above specifications, for the sum of: Y 3 ) - I I. //7-- Q Dollars ($ ) Paym g nts to be made as follows: $ M D eposit, $ � Due upon Day of Completion O. 8'r ?-7-/a e All material is guaranteed to be as specified. All work to be completed in a work -like manner Authorized according to standard practices. Any altercations or deviation from above specifications Sign a ture 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 fire, tornado and other necessary insurance. Our withdrawn by us if not accepted within days. workers are fully covered by Workmen's Compensation Insurance. i titx_tyka r l■-. --- "' —' n Acceptance of Proposal - The above prices, specifications and conditions Signature C9 �! 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: i 1/ �// • NI a.Nachu.ctts - Department of Public S.tfct '1 ilp • Board of Buil(liou, Regulations and Standards Construction Supervisor License . License: CS 67450 . EDWARD T CORBETT JR 4 REED ST . NORTHAMPTON, MA 01060 �i - -- — Expiration: 4/3/2012 ( tnnmi..i Tr#: 29225 faeianasaapun 09010 VW 'NO1dWVH12JON • r ''' 1S 43321 b i 21r 11382100 02!VM03 1N3W3A021dW1 3WOH 1138bQ0 V80 Z10Z /51/9 :uol ;ertdx3 � :edA1 690911 :uol ;e� ;si6al �; , � 21O1,0Vti1N001N3W3A02IdWI 3WOH ; .% - -1 ' r v t uoge n�3a ssa7uiir�}„ �amnsuo o aar i n17�'' J '�'1I �/ /� ) �/ JJ O The Commonwealth of Massachusetts Department of Industrial Accidents - h _ a Office of Investigations' 600 Washington Street ' Boston, MA 02111 www.ntass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): _r : / Olt ;4 li 4.441ibi Address: ] Rid I- , City/State/Zip: lV OPJ 41C }7IJ✓ /t919 6)060 Phone L // J 5 l 6 SW Are you an employer? Check the appropriate box: Type of project (required): 1. U I am a-employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part - time).* have hired the sub - contractors 2. I am a sole proprietor or partner- listed on the attached sheet. i ' • ❑ Remodeling ship and have no employees These sub - contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised then l0.0 Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MG L. 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' 13.0 Other comp. insurance required. *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating 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 additional sheet showing the name of the sub - contactors 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 (shoving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well us civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify under the pains a penalt' ' of perjury that the ln/orn:rttion provided above is true and correct. Sign _ature: e fr*-4, /• ___ _ . _ __ Date; ) — /e ) Phone #: ' Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit /t Jcense #_ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /'Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: ___ .___.. Phone tit , , SECTION 8 CONSTRUCTION SERVICES 8 .1 Licensed n ru ion rvi 1 Not Applicable ❑ P � r�2I `T c_ 1r 067 y6 Name of License Holder : 1 q Reed szE N lz»l me 6 - � O „, -....: ' 74 wpn °rf Address / Expiration sate - /1(?) 6 R9 4 / 4 . .s - ' .. 7/ 11-3 - 20 L2- Signature Telephone 9 Registered Howie imbro merit Contrecto ' ` "'' , ,w!, .. . Not Applicable ❑ a ye Ct, 2 Ben' e �M xovcmeAcr 1 6 a6 9 Company Name y A S4 N iJ MA 0106° Y® Address xp ration - � // 8 y166 ---.. _ Telephon�7 SECTION 10 WQRKERS.S'CQMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. . Signed Affidavit Attached Yes 7 No ❑ 1 ' ' ame Own E xe r n tian The current exemption for "homeowners" was extended to include Owner- occupied Dwellines-e$one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possesa 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 *tends 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 bulldine 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 WQRKIghilikialgalgaBlit) New House [D Addition 1 ,..._ Re �lenernen Indra Alterailon(s) I Roofing Or Doors Accessory Bldg. ❑ Demolition � - - � New Signs VII f)eake ►I:: ;] Siding ] Other [DJ grief Drip;igqn of Pr posed de w3 ,� Work: -./...A; 1>F11 Vi ivy/ Rei � w3 l4 /L( v " /i t-c?i, J�i.? 1.. \hail . - -C_4'; Alteration of existing bedroom _______ _Yes No Adrliii now hndruoni Yee No Attached Narrative Renovallnp unllnlshed tnrwernnnt Yee No Plans Attached Roll - Sheet 6a. If jigichaltilliaidingh..ilginilltillthitiglIOWILISL a. Use of building : One Family Two Family t Jlhcar b. Number of rooms in each family unit: Nurnbrn of I:ierlhrnnnna c. Is there a garage attached? d. Proposed Square footage of new construction._ IJnuunelnnn e. Number of stories? f. Method of heating? ___ 11111)111(31k of Wnudetovee Number of each g. Energy Conservation Compliance. Minis( hock f run ily r:unipllancn form attached? h. Type of construction i. Is construction within 100 ft, of wetlands? Ynn 1`11) In cniietnu,hou within 11)0 yr floodplain Yes No j. Depth of basement or cellar floor below finished grmuln k. Will building conform to the Building and Zoning IHgulellnnn'i Yeti No I. Septic Tank City Sewer Private well rally wi tar Elulmply 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 Indium WO by Ihle building lrnrnill ript:dlcatlon Signature of Owner hill, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII "T I L I , j ,i'- -i 1 .619.1e.444- .._) . (` -.. _, as Owne I ' horized en ereby declare that the statements and Information on Ilro hi nilnluli ntipillr:mill in am iron and accurate, to the best of , .^ =dge ad Wbelief. Signed under the pains and penaltie of perjury. irdi14 7 Sk Print Name r � � � � /"� /1 2 2 - 1 6 Signature of Owner /Agent I inlmr r , t 4 Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to he filled in by Building Deportment • Lot Size Frontage Setbacks Front Side L: _ R I.: ._ -__ It:.-________ Rear 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 0 DON'T KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES � ...� NC) 0 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, gradlni, e avatlon, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO f IF YES, then a Northampton Storm Water Managornant Permit from the DPW is required. ' apartment urle on y City of Northampton Status of Permit: Building Dapartnmrit Curb Out/Driveway Permit 212 Main Street epwter /Baptia Ave ileblpty . Room 100 WIlit.IYWNll AvalIabllity '" Northampton, MA 01000 Mots of Structural Plural 0 2 3 piiiiie 413 - 1387 - 1240 Fax 11111-5117 12 PloUUlte pions rather Bpeoify APPLICATION TO COtiSTRUCh', ALTER, REPAIR, RENOVATE OR LEMOLIS11 A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Addres %: TTh s section to be completed by office 3/ Ov - \cum -A`. �I0 Map _ - Lot Unit Zone — , Overlay District Sim at. District__._,- ._____ _ CB District____ — _.— SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Roc r4: Name (Print) l.unaul Melling Aikitoat — - Iwleplinnr+ Signature 5 5 - 3 2.2 Authorized Agent: . A '' # 4 et _ 3a Li k'tke s' Ar' , J No ©)0100 Name (Print) Current Mailing Address ( / / .) `.;`& J - 6,s---7/ Si I Hl(1ilume SECTION 3 - ESTIMATED C9NpTRVCTION COST$ Item Estimated Coat (Dollars) to bn Official Use Only __,.....__ 2m)iplotec( bayiiel(t)It 1. Building tit) Building Permit Fee 2. Electrical (b) Eetitnated total Cost of (.1on$ rtlo, or1 from (6) 3. Plumbing Uulit;linp Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 1 + 2 + 3 + 4 + 5) / C)O t.hsuk N■ltlti)et — ,,' Th1!_$vPliun r r'.OI#!al- r!i_UIP Only Date Building Permit Number: Iriauerl Signature: Building Commissioner /Inspector of Buildings Date 1 V $ 31 OVERL.KOA. ` ; BP- 2011 -0479 GIS #: COMMONWEALTH OF MASSACHUSETTS tic: 29 ` MS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2011 -0479 Project # JS- 2011- 000785 Est. Cost: $13000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED CORBETT JR 067450 Lot Size(sq. ft.): 17728.92 Owner: YAKOVLEV IVAN P & DAWN LUCIA Zoning: URA(100) //WSP Applicant: ED CORBETT JR AT: 31 OVERLOOK DR Applicant Address: Phone: Insurance: 4 Reed Street (413) 584 -6571 NORTHAM PTONMAO1060 ISSUED ON:11/23/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & 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 11/23/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner