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32C-287 (5)
---T ,, posuf=- -- - - _ Corhett Home Improvement Northampton, MA 01060 (413) 584-6571 'kOPOSAL SI'BMrT1ED TO / S PHONE] i y DAIF SIREEr JOB NAktE CRY.STATE,rwd ZIP CODF 1(IB LOCATION' DATE OF PLANS -J,17 Of-l� We hereby submit specifications and estimates for: / } /v//If I i e ( ')l'OPOSe herehy to furnish material and lahor-con,plele in accordance wish the above specificaliou,�.for the stun of Dollars(S � �� Payments to he made as follows: — j � o All nwtrriel is gu,irenterd to hr a..eprciGed. All work to h. o oniplrird in o work like u,.mner auonling Aulhonzeol e�xrunrld only up,�n,wrtllrn altercations will hrueuet.mmrz,r chorl�rcnvrrtend�aIho�-r ihr e•stiui deos1111 ill he sigtwhtrr agreement.contingent upon stri kes,accidents or delays hcy,rid our co III n I Owner In u,rrm lire,Iurnaflu Note: I'lus pngH,,sal n)aV he ,- and other necessary insurance. Our workers ore t'ully covered by Workiuen's('ornpensation In.surence, wuh,lrawt hy us it not aeeepled willu n Acceptance of Troposat-The above prices specificalio h., _ are conditions are satisfactory and are herehy aceepte,l-You are auhonzed to Signature � } do the work a.e specified. Payment will he 1Ia11c as outlined ahoy. --- [)ate of Acceptance: S,g)lalurc ;, E viii of �Rz #l�anl�tolt f Zc�.ntflnccfln _'` DEPARTME)JT OP DUILDI)�G INSPEC7I0)<'S 212 Main Strccl ' Muoicipal Bmldmn NDrlhampton, Mass. 01060 wORlaR'S CO)a)✓NSA770N C-'SURA-NCE AFFIDAVIT (li ccUSC:J frrnti tree) n a pfticcipa place of bUSI0--SS/reSldeOCC at. (SU�Uc�(y/State/Z]P) do hereby certify, under the pzirLs --ad pcii2hies of perjury, ;h2i { l I = an employer providing the followint wor4cer s colnncns-�ion cove Inc for my elLpiovccs wur�ang on tiiis job (LnnLr� Coo=,.,) (Pchc; Nt--ah'--r) -- — (r ,pirauor Date) i am a sole proprietor, genera] cootractor or homeovmer (c)-c:,,, one) znd have hired LI1e coo--actors listed below v;bo h2ve ehe ollowwg �VOFr -,t 'S G0[:]oen5-2oon po!Icles_ Inc oi,COOt7:'CiOf — --(Name of Coafmcto,) (lnsuranc` COMP'U)/PoLq iv;,sb ) (E;Pr::uoo Date) (1�2-mc of Contractor) (L s-uanc-- ComD ay/PoL cy Number) (ExpTluoo Dai ) tend-d?•;:oc>1 c'.xC J❑ceci>1 to me!ut'�in(or�joc Fxruiain�to.11 co¢�-.10-�) `� I am a sole propnetor and have no ooe wortatg for me } I am a home owner performing all Lhe wort; myself. NOS.Plcs tx ewuc +,,. { ]c bea u r�ubo employ pelC,.w d� -> ca �� c rcpau vOfK o c d— I of ant Mocc: L5r0 t--,(j to-tDch the bomoav oe ro do a oo the poa.aiy`� zap�ut.cti=r_'tbe-co e.'c o-x Ce>.-:.liv et d--d to be cszployc�u_ti.c Lh_—i—o _LOn Aci(GLI 5 2-3 1(S)� -.pptjc i oo try F-Tr'n r Y I c�J r.�u o f ca l o y x uod-cI-W or4rl.Co�'�c I undan>nd the>Dopy oI th--'L® m,.y bo foe N.v�lod-cI-pc,t,..ruz o(1.,mw�J/.>o daA'OfL oo of lru.v.ow(or th. ibvm�-e vcnricaloa and ltu LOL=c to cKUre,ovT uvk,cr ioetioo 15 A of MC)L 151 e I-J to the�-gx�i6Ow of a-miwl Pewlb� ooc--.�of a 6 of up to S 1-500.00"NtiV r n=pt-i of up to Doc ycsr cDd aril Pm J--w tx form of>Stop Work Ord-end . ftm of S 1 W.W c dsy'Pio.A me For dcp.rtn�=�u,c only G�<< e —off P eru t N un bcr sIGnZtUn of Licc7scclPcrmiucc �' ) Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor: Not Applicable ❑ Name of License Holder: .!' Ke/ O�►'t� ow 990 License Number X J) s - y--3o-l� Address Expiration Date Signature Telephone i 9. Re i e :Home Im `rovenlenton a r ;` r Not Applicable ❑ I Company Name Registration Number Address Expiration Date 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 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 buildine permit. As acting Construction Supervisor your presence on the fob 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 I ION_S-_DESCRIPTION OF PROPOSED WORK(check all applicable) Addition ❑ Replacement Alteration(s) ❑ Roofing ❑ Windows Or Doors 7G`( 5,ar, Bldg Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ oposed VAJ� 01.'JJ645 L-*Ow-f ;)edroom Yes No Adding new bedroom _ Yes No Renovating unfinished basement _ Yes No Sheet _r 1Yevv theuse and Qr addition to exist;itM housing;complete:the:tallowing. )r e Family Two Family Other each family unit: Number of Bathrooms attached? Dotage of new construction. Dimensions Fireplaces or W000stoves Number of each compliance. _ Mascheck Energy Compliance form attached? _ on :00 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain _Yes____No Lellar floor below finished grade_ ,o the Building and Zoning regulations? _ Yes No . City Sewer Private well City water Supply fv Ia OWNER AUTHORIZATION -TO BE COMPLETED WHEN +?S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject _ to ��at ers relative to work authorized by this building permit application. Date as Owner/Authorized Agent -;-J, me its and information on the foregoing application ar(2 true and accurate, to the best of my knowledge and penalties of perjury. 2 Section 4. 1,L 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 —ot �'ttr �etba�ks Front Side L: R L, R: Rear Hei<"11-it itii,i_ >yunre Footage -ipen Space Footage arra minus bldg&paved ari,inc ,I Spaces Has a Special Permit/Variance/Finding ever been issued for/on the site? NC 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 # )oes 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: I,c any signs exist on the property? YES NO :F YES, describe size, type and location: Ar there any proposed changes to or additions of signs intended for the property ?YES No T YES, describe size, type and location:_ _ City of Northampton Building Department 212 Main Streetw Room 100 ae a. it Northampton, MA 01060 7w S t�rU. 0a , �x ' phone 413-587-1240 Fax 413-587-1272 Plot� ►te �ans= � APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEM O * A L LLING SECTION 1 - SITE INFORMATION T is s i lotbd y offidla 1.1 Property Address: � t{?�F� 12C ��AmS S-( MaP Unit /��l Zone Overlay District Elm St.`District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1-Owner of Record: Name(Print) Current Mailing Address: Telephone / _ Q7 Signature �O // 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION 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) 0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 120 WILLIAMS ST BP-2005-0216 GIs#: COMMONWEALTH OF MASSACHUSETTS Mgp:Block: 32C-287 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0216 Project# 35-2005-0268 Est. Cost: $2250.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett 3r 116069 Lot Size(sq. ft.): 10497.96 Owner: JENKINS BEJAMIN J Zoning.URC Applicant: Ed Corbett Jr AT: 120 WILLIAMS ST Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MAO 1060 ISSUED ON.8124104 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS 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: FeeType: Receipt No: Date Paid: Check No: Amount: Building 8/24/04 0:00:00 2369 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 120 WILLIAMS ST BP-2005-0216 GIs#: COMMONWEALTH OF MASSACHUSETTS Man Block: 32C-287 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0216 Project# JS-2005-0268 Est. Cost: $2250.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use croup: Ed Corbett Jr 116069 Lot Size(sg. ft.): 10497.96 Owner: JENKINS BEJAMIN J Zoning:URC Applicant: Ed Corbett Jr AT. 120 WILLIAMS ST Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571_ NORTHAMPTONMA01060 ISSUED ON:8124104 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS 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: Q S Q.©y1 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA O ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvpe: Receipt No: Date Paid: Check No: Amount: Building 8/24/04 0:00:00 2369 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo