32A-216 (2) JCORBETT
14M. HOME EXTERIORS HIC #160143
413-665-2286•413-586-8712 CSL#78297
38 Graves Street,South Deerfield,MA 01373
WINDOWS•SIDING•GUTTERS•ROOFING
"Locally Owned and Trusted Since 1966"
Serving the Entire Pioneer Valley
CONTRACT
Date ,M/ay 20 /3
This agreement, between 77kt- COr,e(orn i r C 7.241.A. ) I rJ r\
1 (Owner
of 6 9'-- 1 ��rn awry ) e(r�-C,c,e, ion—fikr,+(a ) c�r1 /✓t!� , and
(Addy ss)
JCORBETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS
Phone �//3, q.-. 3 S'/3
SPECIFICATIONS
Apply �� ., r0�►� �C�/r'r rn�,!1 .rItyr kopn - % e nr
�ns1�L[
/04 : iiv)✓L S: r<in e eAnfit b:■ tnt1'r, ( Le(1(
ALL jArc , kL ts,,t S £j,tL bF /*:4'9)/11 (,),Tl V,RyL- t j L Lin..'p,e/,..� !LJ
Act (FvLt r eve rtL%Cj- ! Li,.-,/.t c ea.n .. ,OVA I r✓i %p ✓/!tr/L. Li/,+,tl.tc_.
/1_1 e.1,4_1 `.e.a 1_ �1 t Utni c /J.i� .4 e. ,s a,L L E 'r'
t 1/ti ?lat �4�L �t. n� p 1 ,�(
i f"Y c ljt_ILL IA;reN s l e A;0.711 iJ>LI ner,.0 Th !J C_ Reire4t/,t_ pLYtt /i.. 1 ff fell,n1J
e_ •1/1474,°t ,i1,, f. 711, c- r) Ae, - ;in.c nLL 1-, /$i Fie?wPG� At/:/Mhrfl rf!/t
hc. Na n,+LL G/- f y Gcrti�7.t l,To
1,eA -„ . � y - a -c —
on the premises located at C°) - 9 Porn,Lacy I t•ft2t c& a total cost of* a,g- •,rr•) c,e,
With this order owner pays down the sum of$ 'e'cit ci
Owner agrees on completion of said work by the Contractor to pay the sum of$ / 3,170, �/>1 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 year 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 have hereunto signed my name this ' day of /I,4y 20 /2
c4__, Cif
by •r _
Con tor o Authorized Agent) (Owner)
(Joint Owner)
City of Northampton
9. < �`.. ��ti,.n :SIG,'
7, Massachusetts w- ��'_ cr.
DEPARTMENT OF BUILDING INSPECTIONS ,r ". I, m
' 212 Main Street • Municipal Building yva;> z'
I Northampton, MA 01060 sst ,j ~�
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
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 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 home owner."
The building department for the City of Northampton wants any 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 permits 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
EVEI •. NNW. Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): j C, /10,0,,,1 c £X� c' t; (
Address:
City/State/Zip: So 07..* bee2 ")e°z.r( fit (1)1-'2 Phone#: Ali - 742_.
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
____,employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2. I am a sole proprietor or partner-
These on the attached sheet. 7. ❑ Remodeling
These sub-contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers'
g y p h'• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. (i We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.❑ 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-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 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(showing 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 as 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.
o hereby certify and the i and penalties of perjwy that the information provided above is true and correct.
Signature: Date: 17
Phone#: 1->1 ? - �'� 121 a-,
—Official-use only.--Do-not-write-in-this-area,-to-be completed by city or town official
City or Town: Permit/License#
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#:
J
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: , 6iN Cain AF ) 0 ` d c q 7
License Number
3k �)7dtivC 71t 771 �:47 A 0 I.e t 6 u16• j Y
Address Expiration Date
Sign, Telephone
9d Registered Home Improvement Contractor . - ___ _.._._ . _:Z__. ,,: _ Not Applicable ❑
C64 e�'r )4.0, c- /CO 1'1
Company Name Registration Number
•
_ Address Expiration Date
Telephone t1/7
SECTION 10 WORKERS'COMPENSATION INSURANCE-AFFIDAVIT(M SG L c
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
it Home Owner-Exemption
The cm-rent 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) n Roofing Fl
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [0 Siding IEV Other[0]
Brief Description-of Proposed t
Work: r. ..00ltLt V'...►L S>4.n;tg r,),7) fda..Y, hki q
Alteration of existing bedroom Yes / No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
-.w.-=,..-->... y.M.--.,.� ..� _...- . :,.,. ...._.<.,,`;- ..+gym ,�..m, .....,..-, .�.:,....-----•-_.,.-. �r
sa. if New house and or addition 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
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
I Al a A'a , as Owner uthorized
ereby declare that the statements and information on the foregoing application are true and accurate,to the best of mywledge
an. .elief.
Signed_under.the pains an d penalties of perjury.
'..Z d,I .v .i.,t 4/d
Print Name o
Aaf ,r�i�7_s X'l7• l3
Sig Fif OwnerC•gen Date
•
.,
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by'2'oning
This column to be filled in by
Building Department
Lot Size s ' i I ;
Frontage
Setbacks Front --f i
Side L:` t R:` L: . R:'• I
Rear
Building Height k 9 i y
Bldg. Square Footage i 1 i r % i
Open Space Footage % - - ----- --- -
(Lot area minus bldg&paved , 1 1 I ( 4
parking)
I I
#of Parking Spaces
Fill: €i
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page. E and/or Document#1 1
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: 1 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 ; • NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Departmemit use'only
City of Northampton Status of Permit
CC C `, Building Department Curti Cut/Driveway Permit p.
�G.�t-�v � 212 Main Street Sewer/SepticAvaiIablllty'
Room 100 Water/WeII Availability
JUN t 2.013 N rthampton, MA 01060 Two Sets of'Structural Plans n
phone 41 ' 587-1240 Fax 413-587-1272
PIOUS'
ite
•
=Ui_pip;G INSPECTIONS
Other Specify
�•HTHAMP •�,.-:
•TION 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
6 • v)() Pe)r.e. �Q A&ti�t Map Lot s Unit
Zone ' Overlay District
Elm St.District CB District
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED.AGENT
2.1 Owner of Record:
chi r<<'- T c yin (Tim ')) )v!-n
Name(Print) Current Mailing Address:
<9i?— 6 94r- 34),2
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be OfFcial Use Only -
completed by permit applicant
1. Building (a)Building Permit Fee ' '
2. Electrical (b)Estimated Total Cost of
Construction
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection _
6. Total= 1 +2+3+4+5 d�
j,�, Check Number •'
This Section For:Official Use Only ""
Date
Building Permit Number - Issued.•
•Signature. _ - _ = _•
Building''Commissionerllnspector of Buildings Date
69-79 POMEROY TER BP-2013-1217
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A-216 CITY OF NORTHAMPTON
Lot: -000 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-2013-1217
Project# JS-2013-001991
Est. Cost: $25350.00
Fee: $151.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN J CORBETT JR 78297
Lot Size(scp ft.): Owner: CHARLESTOWN CONDO ASSOCIATION
Zoning:URC(100)/ Applicant: JOHN J CORBETT JR
AT: 69 - 79 POMEROY TER
Applicant Address: Phone: Insurance:
38 GRAVES ST (413) 665-2286
SOUTH DEERFIELDMA01373ISSUED ON:6/17/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL 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 6/17/2013 0:00:00 $151.80
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner