29-374 - -- -- -- - (Propvsat-:— - -
-- — r ---
Corbett Home Improvement
Koofkng
Northampton, MA 01060
Awnings
(413) 584-6571 ail„f��e
it lle l•,
< <;
NH11NE� C.�/ �� -Lit ll: j �
lOf3 KAN}}{
DA9I?OF f'LANti IUEi!'HON[-
.�. 'icr�h� suhu}it :���i�icalil>u.�dui estim.uc.N tilt:
tAC_ Sid/i✓z� �Y'�� ��� �/T�
zo
- _.. -
I
-iL �Z�,ni,'/llf✓ f -Dati,!2 —)Xn C'v' Y� �c•��t/t y�l�i �1��
57) t t,_� �C��,Ci r s����,_
jt ' ie
d� LiS�f �CCK L / �K 4XIC-I< J /e /-A)614r
i.
���1 .._1 k'I C� �'V t'l yl��.S ✓fl i�t I�� t �A.S %S��D ��i-3-L.
WC `1 I opose Ili CCI, lU(urnlsh Illik(ell"I;Intl lhl,ol-C.Nllhlelc ilk aca,l.lalic.c will,llle alri•vC�'IH CIIICnIIUII.a',}tiC the.Skull 01l nC/
}
111L 1111 I.,he Ulaile a.tc IlOws;{/j ,-)e
r.icncr�. Any i llerc.alw[Is i ird. All work n,he�ulnhleiril III it IS lIIV likr iueuurr.iC nlwg Aulllun zed
llicril to he as s lecil
. ., r Iry wlion tnnu ehnvc gx•ulic.ili,na iuvolvul}.rxtr.i a alt wlil he
ulkni'wrillrn unl<•rs,allot will h•cukue•an extra ch.irge,,rr:,nd.ihuvc Illy eslimale All
Hni lit m ulxm strikes,accideals nr delays heyond cur cuntrul_ Owuer to cam'lire.wnunlu Nt)(e: Ills Imilxisal may he
_
"y"I:,Urenre. Our workers are}ully u,vered by Workmen's('<,luhrnsnhuu Insur.ine,. wilhdrnwn by us If uiN accepted wlllun daps.
f.ce 1U11ce of(proposaf-Tile above pncrs,nheciticauuuv
hl-,,aic sauslaeftiry and ore herc by accepted YOU are nulluinzrd to Slguanlr( }
witi k...a ecifled. Paynlen will 'e made:Le Oullulyd ahOVC
-,t ,AcLeptance. G,�7 SlgIlaulre �j
Of �a�:fl al)i foil
�t.ssn[h nc r((a-
i =
DEPARTME1JT OP DU1LDf\C INSPECT1011S
212 Main Street ' Muoicipnl DuddinC
Northampton, Mnss. 0]060
`NOPIQ,IZ'S C0i)'>PENSATION LNSURA-NCF AhFIDA�g1 '
--�-%vi --
��.�itit principal place of business/residence at
O 760 (jhonc')
(suit/c�ty/stalc,zi P)
do hereby ceruf) under the pzlns and penalties of perjury, .h l
an employer providing the followim-, worker's comocnsL-don cove 2ge for Iny
ciuplovccs wor-�Dng on this job v
(u.uw-.-')= Coor,:w) (.POhc; Nt.L-.bcr) -----_ -(�';-piruon D2f!z)
( ) I am a sole proprietor, general coou-actor or homeourner (circle one) and have hired
the cones actors Lined below v;bo hive Lt e, oUowug ,vorke�s co=:Den-,,,-oon policies
G,!"I uc 0 CO. ,cror)
1
(N;me of CooITac7-m) -- (U1_sulanc: ComoaaviPolIjc,' \'u-Mcrr)
(Name of Connamo;) (Laswa.nc: Compan)./PoLiC) N;Itrb ) - (txpiraoq Date)
(Name of COGQ2C10r) (Iosufanc� ComDaay/PoLiCY Numbs) (Expuauoo Datc)
(eaie�:�!�::oeal c`-�cet it oceri�-� to ax!u�inloc-��i oo pmaiain��.11 coa'.r-0�)
sole proprietor and have no one worL-mg for me
( ) I am a home owner performing all the work myself.
NOTE:pl—be th,• LJc hccx)o—u-n tibo a�)lay r,w 63
not more tom. ` _ u W uaveb the kwruo -D<r rC�d�o[oo the pv..uu`tu_�z,-�purtcn_r_tbe-c'.n�-c o-x Ce _2y w t,
�tploye�uz%e the..ai;ds cc=, �,,w Att(GL1 52-p 1(5)). zppbc:tIj ,by . home --ie _Lam-a Pcrmn r I the
IcQ.I rL"of en�-L:Ployx coder dao Wocire,C q-,,�/,e
1 uad—n-and tha a oopy of th--t mcm—y bo f«�.vded to tbo pcgo«mmi of 1nd.wiJ/,cu dc�II�'OfL oo oC lrr�uzao for the
C0vCrx4EZC Vv'tCcatoo°Zld t1u Lt1tn W socwc bovcr3sc under suction 25A of MCL 137 cin lod to tba=P051;oo of-imia..l PCQ�IUcl
ooastsing of a rive of up to S I-500.00 ar4Vor im� of up to one yc end a�-0 pm.fua i tx form of a Stop Wofti Ord-sad a
fim of 5100.00.a•y.ptiast C3,-
F- k —,I u on y
PCfIIllI N1ID JC
/etl-3
L M __
S'9natljr,2 of LiCmsc&PcrntiuCC —�� F
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ryi or: Not Applicable ❑
Name of License Holder: � PJ� "trams 00 9SQ --
License Number
Address Expiration Date
Signature Telephone
9: a isferedHonie=_Itn rovemen ;;"Contra'ctor t.; Not Applicable ❑
C�ee e'-j 0/h� i U� /J (O 0 G? -—
Company Name Registration Number
q ,Q sue- S js_^U Ll
Address Expiration Date
Telephone t5— 4 6 5 7/
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...... ❑
............................................I........
.....................................................
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 persons 1
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
t �
SECT ION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
-
New muse ❑ Addition ❑ Replacement Alteration(s) ❑ Roofing ❑
Windows Or Doors ❑
Accessury Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] ^Siding ] Other [ ]
nption of Proposed TM5�4u_ ` / l
-. ::i existing bedroorn Yes _ No Adding new bedroom__-__,_ Yes No
t;r Narrative Renovating unfinished basement Yes No
tacned Roll - Sheet
ba If New:twusei:and or.addition:ta:existinq:housing.:,complete:thL fol4owinct:
-�uiiumg : One Family Two Family Other
e. -1i rourns in each family unit: Number of Bathrooms
�� garage attached?
,,,e,� Square footage of new construction. Dimensions
:)t-,r of stories?
a x heating? Fireplaces or Woodstoves Number of each
j, -onservation Compliance. Mascheck Energy Compliance form attached?
Dr construction
5tru'tio11 within 100 ft. of wetlands? 'fes _ _ Nc. unstruction within 100 yr. floodplain Yep - Nn
r oasernent or cellar floor below finished grade
contorm to the Building and Zoning reguiations� _ Yes No .
anh City Sewer Private well City water Supply_—
SECT-ION 7a - OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
)enall, in all ,-natters relative to work authorized by this building permit application.
Owner Date
as Owner/Authorized Agent
jedare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge anc
the pains and penalties of perjury.
1- ��'�1S
iUoV 3 03
^ v
` ^
)CCtiMn 4'
ALL INFORMATION MUST BE COMPLETED, 0r PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION
Existim, Proposed Required by Zoniri-
Building Department
-�,!ihacks Front
"S'quale Footage
()pen Space Foora-e
area minUs bldg&paved
A
Has u Special Permit/variance/Finding ever been issued for/on the site?
NO DON'T /\ YES
�--------- ---T------ -�--------
IF YES, date issued:_______________
IF YES: VVus the permit recorded at the Registry o[ Dceds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
3ocs [he site contain a brook, body or watt/ o/ wetlands? NO DON'T KNOW
YES
IF YES, has permit been or need to be obtained r/om che [oosemaUux Commission?
Needs bmbeobtained 0btained Date Issued:
- Do any signs exist on the property7 YES NO
IF YES, describe size, type and
O. T
here any proposed changes toormddihons of signs intended for the property ?YES ___
No
IF YES, describe size, type and |ocaboo:________�___.___-__- �
Department,use only.
V L S
r Northampton status of Perit � p
{� B� 14I Department 1lfd4C6t0rw y6P"efrn�tt � -
�� a i n Street Se"�iver/Sep�+e�A Vaila611� ° 2
C r �
Room 100 WaterJaNelAvalat�Cty
w 2(} rthampton, MA 01060 Two4Sets�6l Struc> ral Plans ��
phone 413-587-12 .0 Fax 413-587-1272 Plot/Site�Plans
;.
Other Specify
APPLIGIl� Bf� 0?'�AISTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I - SITE INFORMATION
1.1 Property Address: This section to be completed by office
71 F/®&, ,sj cc tq� Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
s'r'tYL
dlilr ��If
Current Mailing Address:
Telephone s"26 �7,
C��
2.2 Authorized Agent:
Current Mailing Address:
uarr�e Print) _
tgnature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Estimated Cost (Dollars) to be Official Use Only
completed by permit applican t
c (a) Building Permit Fee
:_,eczncal (b) Estimated Total Cost of
Construction from 6
un��Ging Building Permit Fee
ecnanieai (NVAC)
r��� ;protection
2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
----------
`,. w1mg Permit Number: Date Issued: ----
Signature:
Building Commissioner/Inspector of Buildings Date __
171 FLORENCE RD BP-2004-0540
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-374 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2004-0540
Project# JS-2004-0762
Est. Cost: $7500.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq.ft.): 13590.72 Owner: HOLLEY CYNTHIA LOUISE
Zoning:URA Applicant: Ed Corbett Jr
AT. 171 FLORENCE RD
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTON MAO 1060 ISSUED ON:1114103 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
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: ®/C'
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupangy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 11/4/03 0:00:00 2104 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Coirm:ssioner-Anthony Patillo