36-048 '
~
Troposaf _ _
(413) 584-6571
PkOPOSA,LSiTBM=DT0jArji-S6" -)w'AL'jSd'j PHONE DATE
'�TREET JOB NAME
CrrY,STATF-and ZIP()ODE JOB LOCATION
We herehystihinit specification,,and Csfilimics 1()'-:
CkOPOSe hereby to furnish 111aterial and labor-complele In accordance with the abovespecifications,for Ilit,sum ot:
Dollars CS LIZ-)
Payments to lie made as follows X)'� M Valv oc"IM/0
All miuvrial is gwirmileed to he as specified All work to he completed ma work-like manner�'comling Authorized
tostandardpructices Any altercations or deviLition front�ihovespc�iticatjolis 111%'olNing extris costs will he Signaturc
execute,I on)y upon written orders.and will become an c x1ra t liorge over and:ihovv fl ic est in wte All Note '11u.�projx)sal may lie
an(f other necessiiry insurance, Our workers Dre luliv covt!red 1,v Workmen's Colul't-11-thill I[IsUmnce willidrawn hy Lis if not accepled willun
IAcceptance of Troposaf-The above pruce.',Specifications
are conditions a e satisfactory and are hereby accepted You are authorized to SignatUre
do the work as specified. Payme5litwill lie made mimthned abovc
Date of Accep(ance: Sipiatur
Corbett Hole Improvement K„",,,
Noi-Va'ich'p"'to'n", MA 01060
(413) 584-6571
)16 16
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PRoPoSAI,SI'Bmrrm �4/vczll
+-, - .2 S
S-1 (Q JOB NAME
-, 2- IJ --Tle
(rTY,STATE.m.1 ZIP CODF -2- JOB LOCATION
DATY,OF PLANS lUR PH(INF.
We hereby submit specifications and estinmics tor.
TY, �10 C—SC, 1-4-bL L ,)Cl
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(We (propose herehy to furnish material and labor-complete m accordance A,jll)the above Specifications,for Ilic Num(if.
)6) 71
payments to he made as follows
All All work robe Authorized
a;r r�
1—Tandard pmutice,,. An altercations or deviation froin ahovespecific"tions involvirig extra casts will he Sig[[ if
executed only upon written orders,and will become in)extra charge over.tml aht)vethe estimate All
agreements contingent upon Strikes,accidents or 6elays our Lonlr,l Owner 1,c;irr�'tire,1,rri�jdo Note: 'I'lus proposal may he
xW(t1her rwce,ssary insurance. Our workers are fulh,cm,•red by Workmen's Ctmipt-nsiihoil lfisurance withdrawn by lis it not acc:vpled W1111111—do-
Acceptance of Troposaf Jlw above prlccs.specification.
are conditions are satisfactory and are hereby accepted. You are authorized to Signature 44"
do the work aS,Specified. Pa I III he mad ,i,outlined above.
Date of Acceptance:
Z,v tr
LX
(rail) of �Cl� f��i111�Jt011
1 J E }li3 Acll ncrlt6 _
o DEPARTME11T OP DUILDD�G INSPECTIONS —�
212 Mcin Strcct • Nfunlcpal Building
Northampton, ivfcss. 01060
�1,10P-ICLIZ'S C0M:PENSATI0N MSURANCE AI FMAVIT
-
�rn a prrnapaJ Disc, of busioess/residenec st
r t r
(su�tic�ty/statc�z�p)
do hereby certify, under the pp-IRS and penalties of perjury, ?hst
( I an eroployer providing the ioUowine workcr's Colnocns-,Io� c for my
rruployccS wor�Dng on Oils job
(1�sur�C-- Cooc cv) (Pc Li c-,, Nu r) -- ( :piruor Dzlc)
I am a sole prounetor, genera] cootTactor or homeowner (circa, one) aid have hired
one con ac ors listed below v,�bo h2ve the following workers coF-oens2aon po!!ctes
�_ � - � COIt1P:Lil '/�GLC �'�UITI C•=;; �!=`,U�iU'.:Or. ��:11C)
�t\ dIlC of CDOUT C,0r) - (lnsirance Comoa-aviPolic-, �'uz-Dc^r)
(:N"= of Coal-ac-la,) — —(I71SllTanG C0MP2-0)1P0Lcq (Expr::uo9 Datc)
-- J1 amc of Coou-actor) (LDSufanCti Comaa- yfpol cy Numb) (L-.xpts-aboo DaLc)
(cc�ch _rl'!,:;oc>1 c'.k-cr if ococs. to mc..�ud;inlofn,._i oo perwa:n�to.1J
( I am a sole prop
nelor and bave no ooe worming for me
( 1 I a- a home owner perfon=g all the work myseff
NOTE1 plc be--a th+-+,'l )e boarowmr).,t o employ 1,w 63 e-ws1 c��.=�.�o c rrpau++roric o�.d++ell_^.�of
cnt mo«ter.L`x—L-atj in\t-ticb the Lwcooc,w r do o oo the �a.uy`� z ,r.rrtcn._r�tbeeo�z ox���11y o_�cr:d i to be
crtplorc unC'.0 t_hc An(GLI 52y 1(5)},:_ppLiatioa try .h-,T vn fm:Lc=--.cr rlc tT n a y
cgJ nu or— .rp1 oya undcf caw Wo�41.1r Co¢ipon-.rson/.d_
1 uo-& r+.od dbd>Dopy of thu ovy bo fog.- to d to tbo Dop�of omoc or l—Tor the
covcri Sc va-L5 :31ioo nM Lh t LiJum W ccrurc bov ri-, c undor sccuon 15A of 1.(GL 151 can Iod to the--g)m ioo of criminal pcn was
ooaysiug of a rioc of up to S I,00.Do cr,dor impriwvmc a 0 C u p to oa yc3r end avj Pz I-,ia C,c roan ore Stop Work Order end.
(iro 0(5100.00 l ay LEainA me
For dcn.nm�u.c only
E crawl NulntrJ
SiGnatun cf LiccnSCCJYcrmittcc
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sup1grviso r: Not Applicable ❑
Name of License Holder : .J� �/ 1ad2a z!:7� 00 9 SO
License Number
LJ 30-0 y
Address Expiration Date
Signature Telephone
9. Re i home Not Applicable ❑
0zkL // (12 0 q
Company Name Registration Number
Address Expiration Date
I Telephone Z/
i
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§ 25C(6))
i
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 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(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 1UN 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
JU-1,t Addition ❑ Replacement I Alteration(s) ❑ Roofing
Windows Or Doors
y 61cly Demolition❑ New Signs ( ] Decks [ ] Siding PV1 Other [ ]
i
)nosed;;y"' �1� _ �1
Z NE / 7_,CV.� �i Of�G✓ "�'L����!���iY 4 � �i j�C y1 N j�� 54 1
uer�room ___—_Yes_- No Adding new bedroom Yes _ No
Renovating unfinished basement __— Yes No
Sheet
New hlouse and D�addition to existing:housing;comol6te�thL*-.follo wing:
_. Jne Family Two Family Other
r; .?ach family unit:__ Number of Bathrooms
attached?
,,age of new construction. Dimensions
Fireplaces or Woodstoves _ Number of each
Compliance. _ Mascheck Energy Compliance form attached?
00 ft. of wetlands? Yes _ No. Is construction within 100 yr. floodplain _--Yes _No
n cellar floor below finished grade
the Building and Zoning regulations? _ Yes No .
ity Sewer -_ Private well City water Supply _—
JN 7a OWNER AUTHORIZATION -TO BE COMPLETED WHEN
RS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
to
arters ~elative to work authorized by this building permit application.
_.. — ----- Date----------- -------- —
as Owner/Authorized Agent
'atements and information on the foregoing application are true and accurate, to the best of my knowledge and
end penalties of perjury.
Section 4.
:\I.I_ 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
f01 L
�Ctharks Front
Side L: R:
Rear
!si(ig S�{uare Footage %
opcii Space Footage %
sinus bldg paved
of E'arklne Spaces
l
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?
DON'i� KNO'%N _ YL:
IF YES: enter Book Page and/or Document #
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: _
: . any signs exist on the property? YES NO
YES, describe size, type and location:_
Ark there any proposed changes to or additions of signs intended for the property ?YES
No
F YES, describe size, type and location:
r
h _ City of,ho thampton �ti�sQ � i4�' �:y
Building Department Cbr#� ravwaj
APR 2 9 200 Z'146 Street r�
Room`,100
Northampton, MA 01060
:phone,4, 3-587-1244-JFax 413-587-1272 Ploi�S1tP�P�a�s
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section o:be completed by office
1.1 Proaerrty Address:
Map Lot Unit
Zone Overlay District
Elm St.'District CS District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
j�/w
Name(Print) Current Mailing Address:
Telephone
Signature t�
2.2 Authorized Agent:
Name Print) Current Mailing Address: �7
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by
_permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from b
j ;. Plumbing Building Permit Fee
i
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4+ 5) W Check Number
This Section For Official Use Only
Building Permit Number: Date Issued: -
Signature:
Date
Building Commissioner/Inspector of Buildings
S
28 WINCHESTER TERR BP-2004-1073
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-048 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-2004-1073
Project# JS-2004-1597
Est.Cost: $13671.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq.ft.): 14418.36 Owner: DONALDSON JOHN P SR&SANDRA
Zoning.URA Applicant: Ed Corbett]r
AT. 28 WINCHESTER TERR
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAM PTON MAO 1060 ISSUED ON:4130104 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF, INSTALL SIDING &
DOORS
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:
FeeTvpe• Receipt No: Date Paid: Check No: Amount:
Building 4/30/04 0:00:00 2259 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
28 WINCHESTER TERR BP-2004-1073
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-048 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buiidinti DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2004-1073
Protect# JS-2004-1597
Est.Cost:$13671.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groun: Ed Corbett Jr 116069
Lot Size(sg. ft.): 14418.36 Owner: DONALDSON JOHN P SR&SANDRA
zonirs:TJ Applicant: Ed Corbett Jr
-.n ,.,� ,.•• ,t PER
�
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTORMA01060 ISSUED ON.413 0.00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF, INSTALL SIDING &
DOORS
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 Deaartment Fireplace/Chimney:
R-ug I: Oil- Insulation:
Final: Smoke:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIO OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu an Si nature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 4/30/04 0:00:00 2259 $25.00
12 °tiro Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
y