29-525 I
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ROPOSAL
CDT Construction PROPOSAL NO.
rook 158 North Maple Street
Florence, MA 01062 SHEET NO.
(413) 585-8677
DATE April 9, 2001
NAME ADDRESS
Jerry Battey 19 Gregory Lane
ADDRESS 19 Gregory Lane
Florence, MA 01062
DATE OF PLANS
Florence, MA 01062
PHONE NO. PHONE NO.
We hereby propose to furnish the materials and perform the labor necessary for the completion of
Propose to install new drip edge throughout.
Propose to cover entire roof area including garage with 25 . yr.
IKO Architectural shingles (color of choice) .
Propose to install 2 inch soffit vents and continuous ridge
row, vent.
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
Dollars($3, 1 00 0 0 )
with payment to be made as follows. F'r `'
$1 , 700 . 00 to start and balance due upon completion.5% � �` /? (9'9 '12
Respectfully submitteek Any alteration or deviation from above specifications involving grab C-
costs will be executed only upon written order, and will become P '
an extra charge over and above the estimate. All agreements
contingent upon strikes,accidents,or delays beyond our control. Note—This prop21 fFlaWith• awn
by us if not accepted within •ays.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby acc .ted.You are authorized to do the work
as specified. Payments will be made as outlined above.
ei* Signature ( C 1■
Date c,i` ( ct Signature
PROPOSAL
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.0"fcrA7"111::Ali""a'.�'— DEPARTMENT OF BUILDTNG INSPECTIONS _ L____,.7........
212 Main Street ' Municipal Building
Northampton, Mass. 01060 r'
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(IicenseeJpermittee)
with a principal place of business/residence at:
j 'X IC) C, 'k , Ct _ (phone#) °Z(0(-)1
(street/city/state/rip)
do hereby certify, under the pains and penalties of perjury, that:
V) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
•(Insurance Company) (Policz Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) ` LL (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whilo homeowners who employ persons to do tmitn'nxn,construction or repair work on a dwelling Of
not moon than throe units in which the homeowner resides or oa the grounds appurtenant thereto arc not genially considered to be
employrsa under the worker's oompncsation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the
legal states of an employer under the Wodcor'a Compensation Ace.
I understand that a copy of this rt.r..n•.,t may be forwarded to the Department of Industrial Accident.,'Office of Insurance for the
coveragr:verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties
oomisting of a Erne of up to S1,500.00 andtor of up to one year and civil penalties in the form of a Stop Work Order and a 1
fine of 5100.00 a day against me.
Fa-departmental use only
pe"rmitNumber
MaPii Lot rr
y
ignAture of LicenseefPe later
• t .
Io
* �
5ECT�ON SON T U��O I otiF1
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: �C ��'1
License Number
01
Add Expiration Date
Signature Telephone
'
® 41 ., h, ,, fr; Not Ap p licable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 WORKERS'COMPENSATlONIINSURANCE IFFIDAVIT(M.G;L c.152,§1,5C(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
M •
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4.
0 e C Oi ®F P OP•SED WOR chec 1 Sae aIr ble '
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing e
Or Doors ❑ _
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: \k- `7=.1n \it._
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
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. Mascheck 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
T'ON ' DOWNER AU1'HORIZAI,`ION;-°TO BE COMPLET I? WHEN
1 RMG,gPa PrccONTRACTOR APPLIES FOR�BUILDING PERMIT
, 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 `- _ , as Owner/Authorized Agent
hereby reb 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 pain and penalties of perjury.
Print a 1-
Signa I - of 0 4 er/A ent Date
0,4P. '
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage r
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 t DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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. A_ rgithere any proposed changes to or additions of signs intended for the property?YES_
No
IF YES, describe size, type and location:
r4
City of Northampton .(
Building Department � r €
212 Main Street
Room 100 � ` )€
Northampton, MA 01060 _
phone 413-587-1240 Fax 413-587-1272 1 �
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r ^
SECTION 1-SITE INFORMATION
1.1 Proper Address: This section to be1completed„��rf`�e
Map La'tr-1g tlt �
l r, \ �
Eim.St District ^ 6 Distr t
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
e)--' Q•11\
Name(Print) Curt Mailing Address
Telephone
Signature
2.2 Authorized Agent:
Na• 'i int) Current Mailing Address:
Signa . - r Ilk Telephone
SECTION,3-:ESTIMATED CONSTRUCTION'COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (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'`
p
This Section For Official.Use.Only
Building Permit Number: [ i 0/-`^C 0 Date Issued:
Signature: ��� Z � � Ca
Building Commissioner/inspector of Buildings C e
BP-2001-0904
GIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2001-0904
Project# JS-2001-1630
Est. Cost:$0.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: R4 CDT CONSTRUCTION 003666
Lot Size(sq.ft.): 5837.04 Owner: BATTEY JEREMIAH A&SHEILA D
Zoning:URA Applicant: BATTEY JEREMIAH A & SHEILA D
AT: 19 GREGORY LANE
Applicant Address: Phone: Insurance:
19 GREGORY LN Workers Compensation
FLORENCEMA01062 ISSUED ON:
TO PERFORM THE FOLLOWING WORK:RESH I NG LE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building \.J/d v 3712 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo