36-059 (5) 13. COMPENSATION. That for the consideration named herein, the CONTRACTOR proposes
to furnish all the materials and do all the work described in, and in accordance with, this
Contract for the sum of$Six thousand eight hundred and seventy-five /100 dollars
Upon completion of this agreement, the PROGRAM will provide a Deferred Pavment
Loan not in excess of$6,875.00 to be applied as final payment for the completed
rehabilitation work. The balance of$$ 0 shall be paid by the OWNER(S) to the
CONTRACTOR.
14. EFFECTIVE DATE OFAGREEMF.NT. This AGREEMENT shall not become a Contract
binding upon the parties connected until these parties have properly signed this AGREEMENT
and the CONTRACTOR for the respective deferred payment loan has received authorization to
proceed.
15. All contract prices are final. They are firm quotes, not estimates. No changes will be
allowed on the work as bid unless authorized by the PROGRAM.
1 h ALL CONTRACTORS agree to abide by the Material and Performance Standen&
6wner's Signature Date
Owner's Signattur/e� Date
82 o 7 -/ QS
Contractor's gignature Date
Director—Council on Aging Date
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` DEPARTMENT OF BUILDO\TG INSPECTIONS _
INSPECTOR 212 Main Street • Mui ic;ipal Building
Northwripton,MA 01060
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HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as has/her construction sup :-Z-',,or. The state defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two farm
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
home owner."
The building department for the City of Northampton wants any person(s)who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and eegulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before your), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection.:The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
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AJ E -qZasancflncclIs'
d DEPARTMENT OP BUILDC\10 INSPEC fogs
212 Main Strcct Municipal Building
Norlhnmplon, Mass_ 01060
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«lOMCCR•S CONIfPENSATION LNSURANCF AIr,I'LT)A.�
i
----_.---
\trith a principal place of businessJresidencc at: --
411-1' Aria►—_11i/I R� Gl�i!/�i,�lbu�,v� mA•(phone') a&�73_V
(srr�t/ci t•7/stalcl�p)
do hereby certify, under the pains :md penalties of perjury, hat
I .
( ) I am an employer providing the follo%ving''worlcer's cocnocnsabo, cove uge for In)
elnplovees Worlong on tilis job:
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(iasunan= Coopam) (Polio:Nu-m cr) (r:"pir2tior,Dace)
I
O I am a sole proprietor, general contractor or homeovw'ner (ci cie one) znd have hi-red
the conu-a fors listed below who have the `olio%v*MP, worker's comnen_,,a6on policies:
ONarII: Oi Con.tTzlaor) (Instraltt;; Ccinpan)-Pi oUc-, ���U171L<�) -- (I"-?;J1rdL•Q3 Datc)
i .
(Name of Cootracior) (lnsu-ncc C-ompan}vPolic} Date)
I
(N.me of Connacio,") Gmsuranec Compan y/Pogo}' N:mbzr) (Expiruoo Datc)
(Na.mc of Contractor) (Insurance ComrzQy/Poticy Ntunbci) (E:cpirdon Daly) .
I (ansG�l 1S'lrirv�1 r'�cct.ifncr�v«tt,ax!u�iafvc-maaoo pCtn.inias to.1J ocm--�n:-a) -
CYl rietor and have no one wor4dog for me.
I am a sole prop
( ) I am,a home owner performing all the work myself.
NOTE:pl=-se be awue[bz •L-jk .vho a :Pl ry Puma io rgair work co c d.•<Il_C of
ON @oct th in Whs the mid.or oc the p-asnc..s+ zppurtea_r tb.--�LT ax a=.d=ni w be
eitployc-u=e--the .ui cf cY-•+'ea Are(GLt)52=1(5)1,L;VU hoc by a homwava for c bc5 or Permit rr_y--id—t1_c
le�a1 n-^,of ea a.�loyx under tLw Wortiole Comyomeyion Act
I--desiaad tbA x Dopy o(thi.cta moos may bo foa-ocurded to tba Degartmeat of Indussicl Aco&.&OIL—of 6, —foc tb.
oovazse vcireztioa aid 0h1 L iltac to cenuc covcrab, under uoe cc 25 A of MOL 152 c=lad to the i=P=i6oa of aimia3l peaa$i=
ooasiLrzg of a rise of up to S1}oo.00 endfor i$pri r� of up to aue yur end ci j Pmehia io the focm of.Slop Wort;Orde end.
f=of S 100.00 a d_y Lpdast QY-
{ Foe d,artae=^�u,e Daly -
I
Permit Numtxr —
1`�p°-- Lot
i Sig=htrc of Lic crmittcc —Uat-e j
SECTION 8-CONSTRUCTION SERVICES f,;
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Holder: yurc"1 3
License Number
�� �►iCG✓ /�' tY�l. /,r/dII,'a'w�r b"q 6
Address n� Expiration Date
3a'.1i W . a 69 '73 �
Signature V Telephone
Js eg�stei'etomema>�ovemerifvi�tiaco Not Applicable ❑
lc3 vat.
Company Name Registration Num er -—_
0-& rJ coV0,-,-,+ 7- 7- e&
Address Expiration Date
y�/ �t�lA✓ /Tr�l (.c.�j1114 elephone Z 73F?
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 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 under this permit.
The undersigned"homeowner"certifies and assumes responsilnIity for compliance with the-State Building Code,-City-o f---- --------
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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SECTION 5-DESCRIPTION-OF'PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [eJ Siding[0] Other[CI]
Brief Description o Proposed
work: saga Aetna
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
s ':4V�evu:1fiousgAn` 46i ddWi6i x><stiar io slng orgptetettae o iowIno: —
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. Masscheck 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 APPUIES FOR BUDDING.-PERMIT
1, 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, f3v��� c Ic'7 F1 J�.lt�/1 ,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. '
L�Ay► v\sr,-A
Print Name
Signature of Owner! ent Date
'—
Section 4. ZONING All Informat-j6h Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage 7-
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume,&Location)
A. Has a Special Perm it/Vahunce/Findi ever been issued for/on the site?
'
NO 0 DON7KNOW D YES 0 �
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO �~��
� uvm / m,uvv ."S
IF YES: enter Book Page: and/or Document#
�� ��
B. Does the site contain a brook, body of water orwetlands? NO ����, DO07KNOVV �~� YES �~�
IF YES, has permit been or need to be obtained from the Conservation Commission?
-
Needs tmbeobtaloed ^~~* �bta�ned /~�` OateXysued'
x��' \�� ' '
��
C. Do any ggnsexist on the pnoper�? YES v_� 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 D
IF YES, describe size, type and location:
E Will the construction activity disturb grading,excavation,or filling)over 1 acre nrisd part cfo common plan
that will disturb over 1acre? YES NO ���
`�'
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
City of Norti;iampton r _�
Building Department �
212 Main Street
Room 100 e .. '
Northampton; MA 01060; bCa7as "�
phone 413-587-1240 Fax 413-587-1272 NORM,
ca
APPLICATION TO CONQ-rR'UCT,ALTER, R DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE,INFO_RMATION
Th office
1.1 Property Address. ) is'sect�on to be co[npteted by
[�
JUL 1 9 2U U 5 lx -
"''')
h +; Zon Overlay Distract
___ �EiinSt°Distract." ^ ' CBDi"strict
SECTION 2-'PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
goo ,S'2�2
Telephone
Signature
2.2 Authorized Agent:
1) qv 1d P,a,fix_ 'Zo Gv is l'bu r�
Name(Print) Current Mailing Address:
Q67 73V
Signature v Telephone
SECTION 3-.ESTIMATED CONSTRUCTION COSTS (p.,7 ;27,
Item - Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building — (a)Building Permit Fee
2. Electrical J (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
This Section For Official Use Only
Date
Building Permit Number Issued:
Signature:
Building Commissioner/inspector of Buildings Date
File#BP-2006-0073
APPLICANT/CONTACT PERSON David Johnson
ADDRESS/PHONE P O Box 390 WILLIAMSBURG (413)268-7389
PROPERTY LOCATION 17 REDFORD DR
MAP 36 PARCEL 059 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT TEMPORARY RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 055903
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With 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 Co ion
,;O;�00'04 000,
eg
20 0
Signature of Building Official 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.
17 REDFORD DR BP-2006-0073
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-059 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0073
Project# 35-2006-0098
Est.Cost: $6875.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: David Johnson 055903
Lot Size(sq.ft.): 12501.72 Owner: HANDFIELD JANET
Zoning:URA Applicant: David Johnson
AT. 17 REDFORD DR
Applicant Address: Phone: Insurance:
P 0 Box 390 (413) 268-7389
WILLIAMSBURGMA01096 ISSUED ON.7126105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT TEMPORARY RAMP
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• Date Paid: Amount:
Building 7/26/05 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
'REDFORD DR BP-2006-0073
#: COMMONWEALTH OF MASSACHUSETTS
13lock: 36-059 CITY OF NORTHAMPTON
'01
Building
Category_ BUILDING PERMIT
Permit# BP-2006-0073
Project# JS-2006-0098
Est.Cost: $6875.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin David Johnson 055903
Lot Size(sq_ft.): 12501.72 Owner: HANDFIELD JANET
Zomng:IJRr1 igpficant: David ,ohnson
AT. 17 REDFORD DR
Applicant Address: Phone: Insurance:
P 0 Box 390 (413) 268-7389
WILLIAMSBURGMA01096 ISSUED ON.7126105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT TEMPORARY RAMP
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:Pe L'e�— cv 6
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Insulatica:
i:augic: Q; n
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CI
f,/ TY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.///
Certificate of Occu anc . .. � Si nature: f f
FeeType• Date Paid: Amount:
Building 7/26/05 0:00:00 $50.00
212 !Psis Sire i ?Ho„P
01111 587-! .4(�. Fsx.: (413)587-1272