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I }(}t t Ir}1r�i7 :11'�i1} , 1 o; 41{11111 a,,,,i F1.1iii t!! t .5• t } , 3 �'i� � �i414,11;,.1� ��t..ti f} f Fz �, rf f}}�ait,rU-, S --i it t t i t�7i�}g�1}tijF} ,! y • i'i!1dp� .! •t• # iii;11e,! r 18-l5!l ty�� :� '.f t -. • � ,Yt E! t��tr�drl}la .f;23l{1�+i1�,�01{ii 1 . • ....\ R 11111/4 . r...t ' N ' 4"-LN.N.1. C � � .. .� ,..„ 4 ..._ It. „----'<_, _._.____>1 - . , ____ • :.v _ ._ _ _. .. . . , . . . _. ,. . , . . , . . ____ _ v. 1 _ , fi \ -. r 6661 g .)fV 'ill', ; 3 ' / ! ' 1 �� . SIGNATURES �._ By signing below,you agree to items A,B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance, that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. You,the Buyer,may cancel this transaction Buyer Date/6414k/14y at any time prior to midnight of the third 404//904 4,t �e--� business day after the date of this transaction. ./ .- P— 7 / See the attached notice of cancellation form Buyers A� Date **�� for an explanation of this right. ∎2 Seller retains an equal right to cancel. Barron&Jacobs Representative Da Designer/Salespersons Registration Numbers ❑ Cecil K.Jacobs MA HIC 100809 © Christopher R.Jacobs MA HIC 100809 CT HIC 0518617 CT HIS 0554397 Barron and Jacobs-Key Personnel Contact Information: Office Cell Home Office Manager:Sandy Scavotto 413.586.8998 President:Cecil R.Jacobs(Jake) 413.586.8998 413.250.2327 413.584.4447 Purchase Agreement Page 25 of 25 ,t.: The Commonwealth of Massachusetts Print Form _4 Department of Industrial Accidents ,=' Office of Investigations I _ r-- x,Z-1 1 Congress Street, Suite 100 � - ' ''r Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Barron & Jacobs Associates, Inc. Address: 70 Old South Street City/State/Zip: Northampton, MA 01060 Phone#: (413) 586-8998 Are you an employer? Check the appropriate box: Type of project(required): 1.n I am a employer with \3 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- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' g Y p Y 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.11 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 12.11 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: Webber & Grinnell Insurance Agency, Inc. Policy#or Self-ins. Lic.#: WMZ 8006365012012 Expiration Date: 03/01/44H 2-4..1m Job Site Address: '2.-0h V(\C \L.. c1 1?-A. City/State/Zip: f\ ev , CAPt 0\0l02-- 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. I do hereby certify under pains and penalties of perjury that the information provided above is true and correct. Signature: / Date:` IME Phone#: \b' . Kiel b 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Cr' 'i , 1 S\-0;4)lra:( 'Gwc..c1V s 6 0 L ) License Number o\ S St , to rkv.arn,p ,. Ginb 0 it / t o I �y Address — Expiration Date () 1-113 -5 - nit Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ �GY v s i OD S' 1 Company Name Registration Number .o a\ - CO 1z771H Address Expiration Date 7P( kwv`)NeN Y c r ry 6o Telephone `ik5 5X'6 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 L� No ❑ 11. - Home Owner Exemption 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 n Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [ J Siding[0] Other[0] Brief Description of Proposed Work: Enc toSe. ehcistivn C•ONjereel p�f 't.^ , 3, StANDae.. roOM - Alteration of existing bedroom J Yes 7( No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes )C No Plans Attached Roll -Sheet 6a. 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, •V 10∎Y Ytl �c \c IrM,flx Ar t{dam ( AA)aA2 , as Owner of the subject property l hereby authorize LY`Y�5'1�: ` ,�. �� bGY Y" f\"SSz-z=,e` S to act on my behalf, in all matters relative to work authorized by this building permit application. SCA biA\14^12GL "(`�,`'►r€ r '.r ` L5, -7' Signature of Owner ✓ Date I, ( Lc )j , 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. 0-425., C'F.0SOS Print Name .i7 I4 / /D (3 Sign.ii•Te of Swner/Agent Date Section 4. ZONING All Information Mist Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by �., (+ Building Department Lot Size G�000e_4. � 'r* cc j Akt Frontage Setbacks Front Side L: R: L: R: 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 DONT KN YES IF YES date issued: IF YES Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNC)N 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: 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. Department use only cE'v City of Northampton Status of Permit RE Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability c--------I 4 2® 4 ■ Room 100 Water/Well Availability N•rthampton, MA 01060 1Wo Sets of Structural Plans "'"`''ti''o,o 41 -587-1240 Fax 413-587-1272 Plot/Site Plans cEPT' AMPTON,M NORTH 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 1o3 MakyNc' ?.; c),c Map Lot Unit f,D�(r?,n,e, M Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: '\oY{� 60\\-- \ A�1Qxrly eL. O\w& 2-03 u,p� V-=■cnc, r�-.L-, cw:�nc., Name(Print Current Mailing Address: Q,U ktvti.4p"Q.,-A- f/1 5 1 Telephone Sigiature 1 J 2.2 Authorized Agent: C.hr; ic 1ve..r J a 4 _ v o\�& � S- . ,N D,..�-r ,,,,.,,pA Name(Print) Current Mailing Address: i-11 -51'._ `i`1� Sigiature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 75-.11 (7D3 (a)Building Permit Fee 2. Electrical V° (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) 7f1, (t)-() _ Check Number /7515" it 494/o This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1208 ,5 APPLICANT/CONTACT PERSON BARRON&JACOBS y9,---, ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 PROPERTY LOCATION 203 MAPLE RIDGE RD MAP 36 PARCEL 252 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out /7 /5.-- $02416 Fee Paid Typeof Construction: ENCLOSE COVERED PORCH TO 3 SEASON ROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 60475 3 sets of Plans/Plot Plan THE . I LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 5 RMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* 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 Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management opp, I- volition Delay Olir D ∎77 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. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 203 MAPLE RIDGE RD BP-2013-1208 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-252 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: SUNROOM BUILDING PERMIT Permit# BP-2013-1208 Project# JS-2013-001980 Est. Cost: $39800.00 Fee: $240.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(sq. ft.): 439084.80 Owner: OTTAWAY ALEXANDRA H&HARRY G NAULT Zoning: Applicant: BARRON & JACOBS AT: 203 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:6/24/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:ENCLOSE COVERED PORCH TO 3 SEASON ROOM 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 6/24/2013 0:00:00 $240.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner