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03-029 (2) .. 1 L•J N N CO O U u N N 1...■N: \CU x A� 0 co M .. w r M z 2 x d et _ . 11 --r LO r (Ni cf) In N N In N Cif a) 0) CV N CO 0 0 . In 1 N ( 4 N 2ce Et 0 qga a co co 0 © 0 CD a- N c= , M cc ui _ 0 m cc 0 0 Z (0 O r CO CO CO In (Ni N 0 In -1- O Lo c\I 6 M CO 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 age. s or representatives. 'way val6 You, the Buyer,may cancel this transaction Buyer Date 91'444 at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form Buyer Da for an explanation of this right. G / " Seller retains an equal right to cancel. Barron&Jacobs •epresentative D,te ********************************************************************************************* Designer/Salespersons Registration Numbers ❑ Cecil R. Jacobs MA HIC 100809 E 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 15 of 15 Z. tric- groviF,i,oris at ML c 4 , c.',oridton of flis Building permit, ar debris re---,:isTinTs aideil by this Permit shaii be (ispns-,--d of fd OP EAC.L1LITY") Sjd cic faaity nn Dy C 43g. 13 Sig7a2Tur,=-_, L.7 T I) . of) PIT,IPP-1_1,:.--,.-,4..vp To r--,;F Di3PCISF=D oF„:, (FROP5i-?.Pi • L•H The Commonwealth of Massachusetts Print Form Department of Industrial Accidents - s Office of Investigations i1 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.go v/dia `Yorkers' 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.XI I am a employer with (2- 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. 7. [1:1 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. 11] Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4), and we have no 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. t.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. WMZ 800-8006365-2013 Expiration Date: 3/1/2014 Policy#or Self-ins. Lic.#: Job Site Address: 591 C-o(- 5 teteAvew ROB t•r✓te:NHAMPTct.) , OA- City/State/Zip: c ftTK AIM f'Tcn)j 1-41/9 eI 0 lc 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 the aims and�ena perjury that the information provided above is true and correct Signature: Date G / 1i Phone#: '4'l 5e4,- Q, 9 9 g 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: CAA R15faPN4 R. .J/cCtP'S C'- - fPC?476- License Number 7e' L%IA> Stit)Tt1 �;.�� - 1 JO Rzi-i ilief 'J Mfl 2l t2t 0 ii- 10. 14 Address j Expiration Date x � X413 - 5� , €99?, Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable El e 4 s oN • 3fk< a5 AS5OCtATi 5 l�)G. 1VO f)09 Company Name Registration Number 1 u O L b 5c v-'C1\ saw T' wife(M ftiv19-To 1�: 1 Mit f�i C(c C t;7, 2. - i4- Address Expiration Date Telephone_ 4l'3 - 5`' 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 ❑ 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) n Roofing IT Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks an Siding[El] Other[❑] Brief Description of Proposed , Work: 1R V'- PVCK1V46r `+" RN1-ING`3- 13�1t.D NEV/ D'GCk .1Se r-13'!,;' A-pp i3(c w40 3 411RS Alteration of existing bedroom Yes No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement Yes k 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 Psi 16- of 15 Cafr 121GG . I)T 5e4.T1 on) F3 , as Owner of the subject property hereby authorize 43A 1-24200 JPrCCA S to act on my behalf, in all matters relative to work authorized by this building permit application. S •• r 15 of" 15 HCc+RtcEMell,`T j S£CticN $ Signature of Owner Date cA-Y tz l sT c P i p. 1N C-0 S , 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. to" :5 Ot.C.a45 Print Name /3 Signature of Owner/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 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 DON'T KNOW C YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T 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 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 Q , 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 0 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 O NO el IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: GeveD Building Department Curb Cut/Driveway Permit • R� 212 Main Street Sewer/Septic Availability 9 2013 Room 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans p1NG`MAO 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans gu1� pE NgRTNAMF-os 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 5qi C CL'eS rACArOw. Ftp Map Lot Unit Nott-ril Atl PTv N3, M P O) ‘,0 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: reiciZ ANb Kote>lt.M 1'C 5qt COLES $4EA 't>w 12Cf vie KitJ-6191 ; Name(Print) Current Mailing Address: I-1Ft c ATTACHE' It6Ktt6EfAet r. s •f 41.1.5 fef-'0779 SECTIOIJ 1a 1?\GE. IS of IS- Telephone Signature 2.2 Authorized Agent: f3tIRAol3 4_ ,3 AcCV,S 70 oi-p SC-t.tti STYte.ETt Wcr`rrt:twtf YcAt3 M(}ciefrc Name(Print) Current Mailing Address: 4 cc te,99e6 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 19;3 cQ (a)Building Permit Fee Total Cost 2. Electrical (b) Construction from (6)of 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) t0 l 5. Fire Protection 6. Total = (1 +2+3+4+5) ISO) Check Number /75; r X050 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2013-1227 GIB APPLICANT/CONTACT PERSON BARRON&JACOBS �y-4 N I ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 LL�� �� PROPERTY LOCATION 591 COLES MEADOW RD Q 901` MAP 03 PARCEL 029 001 ZONE RR(100)/WSP(100)/RI(32)/ THIS SECTION FOR OFFICIAL USE ONLY: ppoit"0. PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out �] ,g�" Fee Paid ` 5'02l WSz Typeof Construction: REMOVE DECKING&RAILINGS&CONSTRUCT NEW DECK 6 X 14 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 emolition Delay /- Signature of Building Of icial 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. 591 COLES MEADOW RD BP-2013-1227 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 03-029 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit# BP-2013-1227 Project# JS-2013-002016 Est. Cost: $30000.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(sq.ft.): 281049.12 Owner: REITT BARBARA B Zoning:RR(100)/WSP(100)/RI(32)/ Applicant: BARRON & JACOBS AT: 591 COLES MEADOW RD Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:6/24/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REMOVE DECKING & RAILINGS & CONSTRUCT NEW DECK 6 X 14 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 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner