Loading...
29-339 (3) jv- :40413) 5 8 9 2 1 o d?,- FREE ESTIMATES a��-4931 W. M. BROWN ROOFING CONTRACTOR SLATE—ASPHALT SHINGLES— FLASHINGS—VALLEYS & GUTTER WORK Lic.#038426 P.O. 1 1 West cuJC vJ Hst-N'la'MA o or` Date. A i1......1..,..,al .o.l....................... CONTRACTCustomers name:... ....sg.aa.........7.a C.la...... t.Address: City.. AA- .x aZ................................State...Xal�a� ..................................................zip...Q1.ojaA The undersigned Contractor, agrees to furnish all materials and labor necessary for the work(specified below) on premises located at No.__9_1_A: iC. e,"' P,-�,�_,�( A= (Street) (City) (State) (I)(We),the OWNER agree to pay you the sum of: ��.� �++..+, ,,,,, ,.,d Dollars($ as follows:$_LA od, o,�) upon signing of this agreemented P. ACV G,b l Upon completion of said work(I)(We)further agree to pay the sum of$ �a.o n,a b SPECIFICATIONS FOR LABOR AND MATERIAL To be applied(or furnished)(or constructed)to following areas: Al- 0 ff�� Q 4 1J1w w Ten»/ d •QQ Owner further agrees that the equity in this property is security for this contract. This Contract shall become binding only upon written acceptance hereof by the Contractor or by an authorized Agent of the Contractor; or upon commencement of the work. The Contractor shall not be liable for any damage to the interior of the building and it is understood that the Contractor is not an agent nor a sub-contractor of any other corporation, and that no other corporation is a party to this Contract. This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise,shall be binding unless in writing signed by both parties. IN WITNESS WHEREOF the undersigned have hereunto subscribed their names the day and year first above written. Contractor ( usband or Purchaser) By 1, `�- i (Authorized A ) Nov . (Wife or pint Purchaser) _ren� . &i 3) -uq 3 , = , 2e�0—t g�1tAMPT0 Boo Gxf-� Of wart 11aillp#111 B e �xsaxthMSrtta' w DEPARTMENT OF BUILDrNG INSPECTIONS • . i 212 Main Street R Municipal Building 'o Northampton, Mass. 01060 �~ ' WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Ii censee/permi tt ee) with a principal place of business/residence at: l?7 We sq cqt, (phone#)A17 statehip) do hereby certify, under the pains and penalties of pegury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees worlang on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole props rieto 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) (Expimbon 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) (ExTimtion Date) (&Mach additional sheet if naxszuy to include mfvcrostioa pertxLm i to av oocttra ) (L�l am a sole proprietor and have no one wonting for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while homcovn3=who employ pczio=to do onj*+�mostrt=oa or repair work on a dwelling of not mote than thr-units in which the homeowner raids or oa the grounds appurtenant Ihacto arc not generally oomidend to be employers antics rho work&`&cmpcau4on Act(GL152_,s 1(5)),application by a homcoRVCr for a Gccnx or permd may evidcs oc the legal status of an amployer under the Workoet C.ompamation AcL I understand that a copy of this etatemml may ba fbrvrnrdad to tho Dcpwtm of Industrial Attidca&Offioc of Imurinw for tba coverage Wrificatson and that failtmo to waste eovemp Undcr scction 25A of MOL 152 can lead to tbo imposition of aimi penalises oomisiiug of a fine of up to S 1,500.00 and/or imptisoamccd of up to one year and eivt7 pcn&W es in the focm of a stop Work Ord-and a firm ors 100.00 a day agaimd tnc. For dal use only permit Number Lot# Signah of License&perulittee e c f SECT ONCONSTtRUCTION,SERVICES t 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder r License Number 1!77 6 SF%2 to Address Expiration Date Signature Telephone LIS.r-113 -.z r WARM grWrZei Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 107 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 affid 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)familie 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 buildinE 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( 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. ., " a � { , y �"k�' xwx` isr ' + � . SECTION$5 DESCRIPTIO Or,MROPOSED,WGRK3>tchWNI applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑- Sheet❑ 6a t" Newhouse" nd or ad it`ion to:e�crs"ting Housing, comp1`e d-tK&fol.l:owin' : 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 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 OW NERIAUTHORIZATION-TO BE,COMPLETED WHEN g11YNERS AGENT ORxCONTRACTOR APPLIES:=POR BUII bING,PERMft 3 r -,n.. 4 as Owner of the subject proper hereby authorize to act my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date _ � V( crcui-tom' 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. A car, VA Print Name (--"S:F, ft i3/ 1 Signature of Owner/Agent Date j 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 ever been issued for/on the site? NO 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: rip file- D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: �kp b,�!t 1,.zi;g3 i ty of Northampton tS U� 11 l5 ilding Department u e 12 Main Street er- • . .�„ {� .! L r NOV 1 3 2C01 Room 100 Nort ampton, MA 01060 ets 4113-587-1240 Fax 413.587-1272 Platlie s. DEP10F?UILGI'dG I NS �`���`�� N-TWMP10N.MA 01060 Ot e Sp�o�.,: .. APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTIONJ - SITE INFORMATION This section to be com Meted by off�cery ' 1.1 Property Address: 3 Elm St"District CB D.istr�ct SECTION.2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address:�r �--i Telephone Signature 2.2 Authorized Agent: XAIf_ r�ci tr.� /n we--/� ����tR�-lu Name(Print) /t ` Current Mailing Address. Signature Telephone SECTION'3 - ESTIMATED:CON STRUGTION"COSTS"' Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical `f (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 ection.For Official'Use,Only B�ildmg°Perrriif'"Number: Date Issued: Si,�nature : " - Ouilding Cor,missioner✓Ins"pet#oX of Built►raB yr—� A} K DR s BP 2002 0523 GIs#: COMMONWEALTH OF MASSACHUSETTS lap �`- CITY OF NORTHAMPTON Permit: Building Category: roofing BUILDING PERMIT Permit# BP-2002-0523 Project# JS-2002-0800 Est. Cost: $2400.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: W M Brown 038426 Lot Size(sq. ft.): 10410.84 Owner: FAGADA FOLA Zoning: URA Applicant: W M Brown AT. 212 ACREBROOK DR Applicant Address: Phone: Insurance: 177 West St (413) 247-9937 WEST HATFIELDMA01088 ISSUED ON.111161010:00:00 TOPERFORM THE FOLLOWING WORK:SHINGLE ROOF OVER 1 LAYER 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/16/010:00:00 MO $25.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo