29-412 HOMEOWNER AND CONTRACTOR AGREEMENT
Required Notice. All residential contractors and subcontractors are required to be registered
with the Massachusetts Board of Building Regulations and Standards, unless specifically
exempt from registration. Inquiries concerning registration should be directed to: Director,
Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, Ma
02108(617) 727-8598.
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Required Notice: NOTICE OF CANCELLATION
The Owner may cancel this Contract if it is signed at a place other than the Contractor's
business address, if the Owner notifies the Contractor in writing of his or her intention to do so
not later than midnight of the third business day following the signing of the Contract.
YOU MAY CANCEL THIS AGREEMENT, IF IT HAS BEEN SIGNED BY A PARTY
THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE SELLER, WHICH
MAY HE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDED YOU NOTIFY
THE SELLER IN WRITING AT HIS MAIN OFFICE OR BRANCH BY ORDINARY
MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER THAN
MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF THIS
AGREEMENT. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR
AN E PLE OF THIS RIGHT.
ctor's i e Owner's Signature
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This Agreement is made this 3RD day of APrc + L , 2001, by and between Eugene Tacy,
doing business as CDT Construction, having a principal place of business located at 158 North
Maple Street, Florence, MA hereinafter referred to as "Contractor", and Kendra Mercier of 121
Sandy Hill Road, Northampton, MA, the Owner of subject property located at 121 Sandy Hill
Road,Northampton,MA,hereinafter referred to as "Owner".
WHEREAS the Contractor intends to repair the property located at:
121 Sandy Hill Road,Northampton, MA.
NOW THEREFORE, the Contractor and Owner, for the considerations hereinafter named agree as
follows:
That this Agreement shall consist of the Contractor's bid and proposal, the general conditions and
references contained herein, the drawings and work write-up, if any, and the specifications attached
1
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DEPARTMENT OP DUILDf�\'G INSPPCTIONS —
212 Main Street ' Municipal DmIding
Northampton, Mass. 01060
1V O RICER'S C O N'M E N S A TI O N INS>TR_A_N CF A h I1)A Vj-j'
(liccvscrJpermlttcc) __ __--
\t.qth a principal place of business/reside6ce al:
(sQr�tici ty/starc�z�p) -
do hereby certit):, under the pairLS and penalties of perjury, .h:l
(4 am -in employe: providing dic following workcr's comocns�;ion c v :-a^ c
I � � o c �yc for Inv
lui loyccs wor~` rlg on tills job
(P0U
( ) I am a sole proor,cior, general contractor or homeow-oer (circle o:�e) Lnd kve hired
the conic ac or-s listed below wk hive the follows-op wor�et s policies:
(iIIIID: 0� CO^l::?ci0") (111-Iimnc:z Coinoafiy/_j)o6c-, �rlLS71'r•_:) (t.?;i)Ii�lliQ:? DalC)'
(Nz mm of Con(raciof) Ctns,ffance Comoaa`•iPok—', Numccr) (Ex-mf iion Date)
(Name of Connacto,) (Ills-i c: C0mp20)•/P0L-C)' Num t) (E.,pimuon Date)
Ri me of Contractor) (Insurance Company/Pohcy Numb:) (E.raifation Date)
if nc�i.� to u i nfe�eu_oo P--"n ns to.1J oc�-e o )
( ) I am a sole propnetor and have no one worL-ing for me
( ) I am a home o\vuer performing all the work-"Myself.
NOTE:pica be' -irc LLI kt Jc bco cc.+ bo cmploy pc:z w do=< cc c m r rc-;,au.,ork oz,d,,cll^Z of
not 2o(�Lin 'sr_,.-ii'd in"Ind the bomooDcr rc,&o or oa the p-r) o zapurtc _ oce,d_-cd to be
cutploye-3 LL-Y Ltic,. 13 _lim Art(GL151✓n 1(5)),nppbc�uco by n hov wo, c fm c l,c:=:<cx Ps-n r y the
I of ea—,loyoc uod-dw Wo{elc C.ompomat�Oa Aec-
I uodcirtn d dw a Dopy of tluj mt®cn1 my bo fo,dnd to tbo pcportmcos of L i,i jLj Mode offioo of L:_for Lb,*
oovmsc vcl-LGnLOo 0.-.m t1t_t U- LXC to caatrc tovcrusc undcr soctioa 25A of MOL 151 cxn lad b tho�;t�xisiiioa of criminsl p<n.>liid
OOQ of 1 finc of up w S I-500.00-nN(X�Mriwoment of up to ooc ye tod a,,j pcn.Ilio in tx form of n Stop W ors;Ordcr and.
fim 0(:S 100.00 1 d-,y 0Y_
For dcp,rta,�1 u.c Drily
Pcrm t Numbcs
l,'/Lap",_ Lot
Si stun; Li�,�pc 'u � .-.. .
SECTION S 'CQ)ItxTRkJ SIiwRICS
8.1 Licensed Construction Supervisor: Not Applicable�❑
Name of License Holder C tl
License Number
Addr ss Expiration Date
Signature Telephone
NE" Not Applicable ❑i :y F f A
Company Na Registration Number
Address Expiration Date
��1 a Telephone -
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 derual of the issuance of the building permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
�:� r -���3am.e��O�wner,�xemut>ion
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 Massaohusetts 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
SECTION 5 DESCI2tPTtON OF''PROPOSED WORK(check all`°auolicable)
New House ❑ Addition ❑ Replacemeniindows Alteration(s) ❑ Roofing
Or Doors jV
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other [ ]
Brief Description of Proposed Work: J
Alteration of existing bedroom Yes No Adding new bedroom Yes v No
Attached Narrative❑ Renovating unfinished basement Yes /No
Plans Attached Roll ❑ - Sheet❑
sa, � Npw`house and,',,&-�Adfti n tozexi, Id- WOUStng, cbM§1cAdAhe folloWing_
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
SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
j 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
1, tz, , as Owner/Authorized Agent
hereby declare 41Bt he stateme s information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed u der a ns and penalties of perjury.
Pri N e
Si nature of ne en Date
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/Findin 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:
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
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3
4
DE Q WCEI thampton
L1 epartment
MAY 2 9 2001 n Street
71100
Northz mpt n, MA 01060
DEFT O wm -12 0 Fax 413.587-1272
NORTHAMPTON,MA 01060 A.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1''-SITE INFORMATION
Thisect�onto a cometedboffIce
1.1 Property Address: x s dx k
2NA <S C �l Maps ° ,Late' 3 r A Ct �
ai
£ F
Zone 0 erlay Distitct
'El St Disfrict
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ,
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
�.
me rint) Current Mailing Address:
Si ture Telephone
SECTION 3 - ESTIMATED;CONSTRUCTION'COSTS'
Item Estimated Cost(Dollars)to be Official Use Only
com feted 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 = (I + 2 + 3 +4 + 5) Check'Number
This Section For Official'Use Only
Building Permit Number:', Date Issued
� Signature:
Building Commissioner;/Inspector of Buildings Date
BP-2001-0985
GIs#: COMMONWEALTH OF MASSACHUSETTS
7 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:ROOFING/REPLACE WINDOWS BUILDING PERMIT
Permit# BP-2001-0985
Pro iect# JS-2001-1759
Est.Cost: $7500.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group: CDT CONSTRUCTION 130152
Lot Size(sq.ft.): 12240.36 Owner. MERCIER WILLIAM&KENDRA A
Zoning:URA Applicant. CDT CONSTRUCTION
AT. 121 SANDY HILL RD
Applicant Address: Phone: Insurance:
158 NORTH MAPLE ST (413) 585-8677 Workers
Compensation
FLORENCEMA01062 ISSUED ON:5129101 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF & INSTALL
REPLACEMENT WINDOWS
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 5/29/010:00:00 3751 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo