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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understand and agree to each of the terms set forth above. 3 � z✓� ` �c Owner Date Contractor Date This proposal may be withdrawn if not accepted within 30 days.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