32C-158 (4) 7)The owner,upon signing this contract,represents and warrants that he or she is the owner of above
property.
8)Any problems or claims arising out of,or relating to,this contract, shall be delt accordingly with
arbitration or in the accordance of a judgment with a court having proper jurisdiction.
9)This agreement and the documents refereed to in this agreement shall be the entire,full,and complete
agreement between the owner and contractor.There are no oral agreements that are not included in this
contract.This agreement may not be changed or modified unless in writing and signed by both the owner
and contractor.
10)If a secured lender is being used, Contractor has the write to discuss disbursements with the institution.
Additional notes: �{,� WURk Ac, b%c Q,( E-�4 i N Cs-pm-+y-r ,
The undersigned understand and agree to each of the terms set forth above.
3 � z✓� ` �c
Owner Date
Contractor Date
This proposal may be withdrawn if not accepted within 30 days.
H.I.C. # 128305
-2-
Improveahome.com
David Nunez
41 Briar Hill rd.
Williamsburg,Ma.01096
413-268-3395
Contract
Date:
Customer Name: 7j�oo r (2,
Job Location: � lC (,SL�� 4LE.
M
1) We hereby propose to furnish all the materials and perform the labor necessary for worked described in
attached estimating proposal located at the above.address. Work will be done according to these
drawings and specifications.
2) All materials and work are warranted to be of good quality,free from faults and defects for the period
�ol`one-year from the day of the job's completion.The work will be performed and completed in a
substantial and workman like manner for the sum of. $ LJ 000, U
Payment arrangements as follows:
Deposit: $ dy !
1) 1';t W4,y Cv^,►P LGTr7 $ 1 -)�C)d, u
2) UpUA1 C %PCG7P0N $ 1 ac.Q
3) $
----------------------
Total of disbursements: $
3)Work will begin on or about 00 )and will be completed( 10 )days from the start.
W�NfJC �C1 orb"6
4)Owner to carry fire,theft,and other necessary insurance on above work. Public liability insurance to be
carried by contractor.
5)Owner may cancel the contract within 3 days of signing for a full refund Cancellation must be in writing
and received by contractor within 3 days of signing. A full refund will be returned within 10 days of receipt
of cancellation,unless work has already begun in which case work that has been done will be compensated
for with deposit all other Moines will be returned.
6)Any alterations or deviations from the above specifications will be executed only upon written change
orders and will become an extra charge over and above the estimate.Payment on change orders will be due
with subsequent draw unless otherwise specified.
- 1 -
�e Grxfil of 'Hart aillpf a1I 4
9 B �xsaxc{Tttactta' �.
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(licemsee/permittee)
with a principal place of business/residence at:
(phone#) 3 3
(6treet/city/=&2ip —
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy 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) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Po6ey Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional shore ifnwcnsxy to include inf«uiaLion pertaining to au codmct n)
(Y-),l 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 while homwAi=S who employ pawns to do mainlwanoe,construction or repair work on a dwelling of
not mote than throe units in which the homeow=resides or on the grounds appurtenant thereto are not gc xally considered to be
employaa under the woc ees compeus4ca Act(GL152 fs 1(5)},application by a homeowner for a license oc permit may evidence the
legal ov,h, of an employer underthe Wo&vet Compensation Ad
-
I understand that a copy of this statement may be fmvmrcied to the Deput ncod of industrial Aoddm&Office of Iasrresnoe for the
cove ago verification and that failure to accure coverage trader section 25A of MGL 152 can lead to the imposition of criminal Penalties
ooasisting of a fine of up to$1,500.00 and/or imprisonment of up to one ytw and civil pengNes in the form of a Stop Work Order and a
fine of 5100.00 a day tpirA tnc
For dcp=twnw tssa only
Permit Number
Lot#
Signature icensec/P ttee Late
SEdTION 8-CONSTRUCTION SERVICES
1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
E" .,,_ Not Applicable ❑
Company ame Registration Number
Address 1 Expiration Date
Telephone ��`73clr -cal
S�ECT,10 14=WORKERS'COMPENSATION INSURANCE AFFID"IT(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...... ❑
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
!
A
J D9SCRIEDON PE"_QPOS9P 0 I a It le
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: V1 C1"��
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
rP . .. x�: �� �,
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?
i. 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
SECTIQN 7'a- ?WNER AUTHORIZATION TO BE COMPLETED WHEN
►W RS AGENT OWCONTRACTOR 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 wner Date
MEN
(�1:1 . L 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 undbhe pans and penalties of perjury.
OL
Print Name
Signature of Owner gent Date
A
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
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 ev been issued for/on the site?
NO DON'T KNOW C 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 41 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. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
}
i ' mpton
?Yr,� 3 L111d tment
MAR 2 3 �0 reet
I
01,1110
r A 01060
DE,n i Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-SITE INFORMATION
T`h At � ftd� 5
1.1 Property Address: , r
r
�
LYR{y S f �✓i
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owr er of Record:
0 {'- r. /C.,C,
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
old 'y
Name(Pri Current Mailing Address:
;tQ F.. :,
Signature Telephone
SECTION 3 ESTIMATED NSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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
This Section For'Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings bate
J1 A,
13 KINGSLEY AVE BP-2001-0748
GIs#: COMMONWEALTH OF MASSACHUSETTS
la.Block: 32C- 158 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2001-0748
Project# JS-2001-1412
Est.Cost: $4800.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVID NUNEZ 128305
Lot Size(sq. ft.): 3920.40 Owner: SALOOM ROGER
Zoning.URC Applicant. DAVID N U N EZ
AT. 13 KINGSLEY AVE
Applicant Address: Phone: Insurance:
41 BRIAR HILL RD (413) 268-3395
WILLIAMSBURGMA01096 ISSUED ON:3126101 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 3/26/010:00:00 1208 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo