32C-309 (5) R
PAGE THREE
CANCELLATION RIGHT
You may cancel this agreement if it has been signed by a party thereto at a
place other than' the the address of the seller, which may be his main office or a
branch thereof, provided that you notify the seller in writing at his main
office or branch thereof by ordinary mail posted, by telegram or 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
explanation of this right.
TSO 1,11IS CONTRACT IF THERE ARE ANY BLANK S .ACES.
Homeowner )
Contractor
-----------------------------------------------------------------------------------------------------
NOTE IN ADDITION TO THE HOMEOWNER'S RIGHTS BY THE LAW, THE CONTRACTOR CAN REQUEST
ARBITRATION TO RESOLVE DISPUTESWITH THE HOMEOWNER IF THAT IS AGREED TO BY BOTH
PARTIES IN THE CONTRACT. IF THE CONTRACTOR APPLIES FOR ARBITRATION, THE HOMEOWNER
MUST DELAY ANY COURT ACTION UNTIL AFTER THE ARBITRATION HEARING.
OPTIONAL CONTRACTOR ARBITRATION AGREEMENT
The contractor and the homeowner hereby mutually agree in advance that in
the event that the contractor has a dispute concerning this contract, the
contractor may submit such dispute to a private arbitration service which has
been approved by the Secretary of the Executive Office of Consumer Affairs
and Business Regulations and the consumer shall be required to submit to
such arbitration as approved in MGL C.142A.
Contractor Homeowner1
Notice: The signatures of the parties above apply only to the agreement of the
parties to alternate dispute settlement initiated by the contractor. The owner
may initiate alternative dispute resolution when this section is not signed by
the parties.
A
PAGE TWO
Materials Contractor Will Supply-
Materials or Labor To Be Supplied By Homeowner(s) >Y c yL
IF CONTRACTOR IS DOING WORK FOR WHICH CONSTRUCTION-RELATED PERMITS ARE REQUIRED,
THE CONTRACTOR MUST OBTAIN THOSE PERMITS FOR THE HOMEOWNER. HOMEOWNERS WHO
OBTAIN THEIR OWN PERMITS FOR THAT WORK CANNOT MAKE CLAIMS TO THE GUARANTY FUND
OR BE ABLE TO OBLIGE THE CONTRACTOR TO GO TO ARBITRATION. THE HOMEOWNER IS
RESPONSIBLE FOR OBTAINING ANY SPECIAL PERMITS THAT MAY BE REQUIRED UNDER THE
ZONING BY-LAWS, CONSERVATION COMMISSION ORDERS, ETC.
Contractor will obtain the following permits:
Building Demolition
Plumbing Electrical
Gas Other (Describe)
Total Contra t ( in doll and
itten out in words)
cvnpayment o"f 5 2-61U.&V must be paid by this date 2-
THE CONTRACTOR MAY NOT TAKE PAYMENT OF MORE THAN ONE- THIRD OF THE CONTRACT
PRICE BEFORE THE WORK STARTS UNLESS A GREATER AMOUNT IS NEEDED FOR THE ACTUAL
COST OF ANY SPECIAL ORDER OR CUSTOM MADE MATERIAL OR EQUIPMENT WHICH NfUST BE
PAID FOR IN ADVANCE. DO NOT PAY IN FULL UNTIL THE WORK IS COMPLETED AND INSPECTED
Schedule of Remaining Payments:
Amount 9(2— At What Point*fy dU e' C�%?'Gcr�
LJ, v,a &--T7c),!\i
Desch} tionj An Contractor:By Con ractor:
lJ� ►J li i C�t'��
Description Of Any LieV107F Security Interest In The Residence As Part Of This Contract:
HOME OWNERS WHO DEAL WITH REGISTERED CONTRACTORS FOR WORK COVERED BY THE HOME
IMPROVEMENT LAW, MGL C. 142A, HAVE THE RIGHT TO REQUEST ARBITRATION OR TO SUE TO
RESOLVE DISPUTES WITH THOSE CONTRACTORS. THEY MAY ALSO MAKE CLAIMS TO THE
CONTRACTOR GUARANTY FUND FOR ACTUAL LOSES UP TO 510,000 IF THEY ARE UNABLE TO
COLLECT THOSE LOSES FROM THEIR CONTRACTORS. FOR INFORMATION ABOUT ARBITRATION
AND THE GUARANTY FUND, CONTACT THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS
(617) 727-7780
HOME IMPROVEMENT CONTRACT
This is the complete,agreeVent between the contractor the homeowner made on this
date V L-1 .3b�, 2 c cj
Name of Contractor: I C-4"A-/zo 14V _
Address: 29 l-f 1 C/c-y P 7 is� -
( may not be a post office box) J
Telephone Number: --5 �'Y- W72-
Name of Salesperson (if any) I, (-1^0-j ^vry
AS OF,JULY 1, 1992, ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS
COVERED BY MGL CHAPTER 142A MUST BE REGISTERED WITH THE STATE TO CHECK ON A
REGISTRATION CONTACT THE DIRECTOR, HOME IMPROVEMENT CONTRACTOR
REGISTRATION, ONE ASHBURTON PLACE , ROOM 1301, BOSTON, MA 02108,
(617) 727-8598.
Contractor's Registration Number Q (�
HOMEOWNERS WHO DEAL WITH UNREGISTERED CONTRACTORS CANNOT OBLIGE THEM TO GO
TO ARBITRATION AND CANNOT MAKE CLAIMS TO THE GUARANTY FUND UNDER THE HOME
IMPROVEMENT LAW.
Name(s) of Homeowner(s) 4
Address N CG Cz 4F r4-it r
Home Telephone: 5*- ---00 Work Telephone:
Date Work Will Begin: �� T
Date Work Will Be Substantially Completed: tl v —3
These dates may change because of delays in getting materials, permits, inspections,
weather conditions, subcontractors' schedules or other problems beyond the
subcontractor's control. The contractor agrees to let the homeowner know about any delays
immediately. Changes to dates, the work to be done, materials or price will be Wkitt en and
then initialed by the contractor and the homeowner(s), and attached to hi tract.
Description of Work by Contract r: �� ' �� r 6-,4--Z Cam'
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DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
(Iicenseelpermittee)
with a principal place of businesslresidence at:
21 > L�tt ��, fZd,2 (. '(phone#) �Z--
(street/ci ty/sta td2d p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the follollving worker's compensation coverage for my
employees working on this job:
(Nuance Company) (Policy Number) (Expiration Daze)
tb(Z 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:
P-aTtdAIJ�+cP
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
�f
(Name of Contractor) (Insurance Company/Policy Number) (Expiraton Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml sheet ifnccuz to include iu$orntstion pertaining to all ocatra rs)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be await that while homerntvesa who employ pczsom w do mltm .,.�„�constnution or rcpaswvric on a dwelling of
not tuacn than tbzto units in which the bomooavcr resides or on the wounds zppurtcnwt thereto arc not generally ooandcrtd to be
employ=under the worms compcasatioa Act(GL152,ss 1(5)�application by a homcovma for a Gccosc cc permit may cvidcnoe the
legal status of an omployer under tbo Worker's Componwajon Act
I understand chit a copy of this rEatcmrnt may ba forwarded to tho Depertmcnt of l-&L trid Awideo&Ofoo of[awrsnco for the
coverage wrificeioa and that failure to&==covrntgo under section 25A of MGL 152 cart lmd to the imposition of aimiul penabies
000sistM of a fine of up to S1,500.00 and/oe imp isoar: mt of up to one ytar and civil pemlties in the focra oCa Stop Wade OrdG wad a
firm of 5100.00 a:day me
ga. cue only
Permit Number
Mai Lot#
rr st of Licensedpermittee e
{x�, ECT ON xu Y'CONS4IRUCTION SERVICES .
8.1 Licensed Construction Supervisor: Not Applicable ❑�\
Name of License Holder : etc Pit N A/
9 / 4 License Number
1 ! 4 t�y 21 OR, t-Lcy2�� r-� 0502V?
Address � Expiration Date
��- Y/ 72--
Signature Telephone 7/11 12 o oL.
osee�mprm Not Applicable ❑
T;� IC M + JO r4 5
Company Name Registration Number
2g +lc 113677
Address Expiration Da
c Cs 1-14- Telephone_-5—? ���� 2 403
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 affid�
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... tif, No...... ❑
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)familic
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(.
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 a Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTIO SCR I FPROPOSED1WRIC c I a licab'le �
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ De oli0on❑ w Sil s Becks [ ] Siding[ ] Other
Brief Description of Proposed
Alteration of existing bedroom Yes _No Adding new bedroom Yes �_No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheety.,1
tf i?l.ew house a"h or a tlit"io"" § "dA ` lete#heyf0116W n a. Use of building : One Family*A_ 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. �Lb o Dimensions C Z
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Co liance form attached?
h. Type of construction CAIZ4 G k::S""
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 r OWNERAl1THORIZATION TO BE COMPLETED 11VHEN
OINE2S AGE�1T OItCONTRAC7OR APPLIES° ORBUILDING PRIVIIT
;r
seta-4 A as Owner of the subject proper
hereby authorize IC(�- �� �� N So r o S to ac
my behalf, in all matters relative to work authorized by this building permit*at atio .
Signature of Owner
(� yN O-A Qa h $60 A - as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
d M P Xi2 D/
Print Name
2 t�
Signature of Owner/Agent Date
i
{
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
. Y
I� la
� r......_.. i f Northampton
it ng Department r
�1 SEP - 5 2001 Main Street Se -
oom 100
Klartharipton, MA 01060 Sets
DENT OF aul
MQP,TR4M A�PW$ISPjObtt C T .587 1240 Fax 413-587.1272
pth r �ec
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
is sectiQn,tobe corrpletedby-,office
1.1 Property Address: y4- _
�N R'y _
f4 4 T hi A—. Zone Overtay�D�sfr�ct
Elm'St. District CB,3D strict
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT'
2.1 Owner of Record: (y
Name(Print) Current Mailing�d0o / 7
" Telephone
Signature
2.2 Authorized Agent:
Name(Print) � Current Mailing Address: 72-
�g`f `f/
Signature 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 = (1 + 2 + 3 + 4 + 5) Check Number e,97 d ...1
This Section For Official Use Only
BUildi ig PermitNumber: Date Issued:
a
Signature
Bu�d rikCommiss osier/Inspector of B4009gs,:;, Date.,
File#BP-2002-0250
APPLICANT/CONTACT PERSON Richard Finn
ADDRESS/PHONE 29 Hickory Drive (413)584-4172
PROPERTY LOCATION 21 HENRY ST
MAP 32C PARCEL 309 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildina Permit Filled out
Fee Paid
Typeof Construction: FRAME DET 20 X 24 DET GARAGE ON EXISTING FOUNDATION(ALREADY
APPROVED)
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 050848
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission
Signature of Building icial Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
BP-2002-0250
GIS#: COMMONWEALTH OF MASSACHUSETTS
;� + g CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: GARAGE BUILDING PERMIT
Permit# BP-2002-0250
Proiect# JS-2002-0387
Est.Cost: $11000.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group: Richard Finn 050848
Lot Size(sq.ft.): 12196.80 Owner: CICHY MITCHELL B&MARY
Zoning:URC Applicant: Richard Finn
AT: 21 HENRY ST
Applicant Address: Phone: Insurance:
29 Hickory Drive (413) 584-4172
FLORENCEMA01062 ISSUED ON.9/11101 0:00:00
TO PERFORM THE FOLLOWING WORK.-FRAME DET 20 X 24 DET GARAGE ON
EXISTING FOUNDATION (ALREADY APPROVED)
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:
"HIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
NY OF ITS RULES AND REGULATIONS.
ificate of Occupancy Signature:
'vve: Receipt No: Date Paid: Check No: Amount:
9/11/010:00:00 2759 $50.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo