25A-135 + Page No. of
Proposal Pages
NEWMAN'S CONSTRUCTION
697 Bridge Road
NORTHAMPTON, MA 01060
(413) 586.1093
PROPOSAL SUBMITTED TO PHONE DATE
STREET t� JOB NAME
P ` Y• r h `i CJ�^
CITY,STATE and ZIP CODE JOB LOCATION
f 'n
J
ARCHITECT DATE OF PLANS
J08 PHONE
We hereby submit specifications and estimates for:
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P VrapM hereby to furnish material and labor— c mplete in accordance with above specifications, for the sum
dollar
Payment to be �de as follows:
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices.Any alteration or deviation from above specifications Authorized
i na
i
involving extra costs will be executed only upon written orders, and will become an extra g -- —
charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire,tornado and other necessary insurance. Note:This propos may be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accept d within d
Arceptancr of proposal The above prices,specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above.
Date of Acceptance: /� Signature
R� ti� Crii ofTnIAl1a111pfoil
R(7
4 J�476A(h rlL(((6
DEPARTMENT OP BUf(1Df)\TG INSPECT-IO1 S
212 \lain Strcct Municipal D(jilding
Northampton, MaGs. 01060
WORIQ:R'S CONTENSA'nON INSURANCE AhFU)AVTj'
(ll c�uscrlfx rrn;tuc) --
pith pru-tcipal place of business/residencc at.
Q-8 ();hone::'; '
- (stTt/city/stuc_/np)
CIO hereby eel-ufj;, under the pairl_S and penalties of pc jute :.hal
an employer plovidin- the followil s coMocns_:"]on covci :c For im,
employees Wot-,Mau, on this job
(Poiic:
( ) I awl a sole proprictor) general contractor or honleoty-ner (cuc;e oee) a,]d have hired
the cones actor s hs ed below who hive the followmp- ,vor'.11,er s Go .nens2tion po!icieS�
Datc)
(N;F-ric of Coorrzctor) onswanc: Compal)y/Policr \u�crr) ���iraio❑ D2te)
--
0'3me of Conndcto ) --- (Itisuranc Coml7an}(PoLc� v;nrtt ) iI_-x pir tioo Dntc)
------ -------------
( \'Lc of annmc,r) (Instttarc Comr 1]}/I'ol:� 1�t�. } I) (1 �<�tion D,Ac)
( ) I am sole proprietor and have no one working fol ame
( ) I and a home owner perfonuillg all ti)e work myself.
NOTY:plc Lew-are oa,.":Jc 1w cV=plof pc:om to d���i :v2�cY=-s c rc-aa.�ori�vo r d..dl�z of
ant a:.�cc",=Lm uni'd in u'L;cb tbz t�nryraa-r rrsid,�a oa the pYrl:i��z; �:icr.�r_thcco r,�t� �:UI w tti
c olc}c�ua -r th . i _lim itit(GL15Z�l(S)�:ppt n ion try e 6o n o ;rs fc:c c p,'ma n_y
IcS.j c aau of cn-_-lovx undc du W-'L e, �Ad
1 d,-i r copy of tbi,a>tcm�at m.y bo to d- f l w�.J/,teGcnti OtLoo of lrnuz000 for ttm
covc�,sc vcriG clioo a.�d th_t f-ju c to soarrc covcra&c irxl.�lcr scuion 25 A of l.(OL 152 an Irsd to tb.;v^i, Itiw of c:--d pcneltio
rirr_of up to S 1 500.00 erxl/or ulq-zuau—c of up to otx_)car t-M civil pml-jo Ln dY form o(e Stop Work Order end e
CM--0( d_yip-1w1ar_
u-ail).
i1cimit Nt111)tJC7
S ,nature of l,ictns_cJPctnititicc u3Ce
r
SECTION 8 CONSTRUCTION SERVICES
Licensed Construction Supervisor: ` Not Applicable ❑
�
Name of License Holder: C\-1 IQ:!) �(U IVe11orin&An C-`) CA 12Q LDG
License Number
tiloi tzwa
Address IV Exp—iron Dt
Af
1
Signature Telephone
. .. ., Not cable ❑
n. Applicable
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....... UL 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
5- SCRI 10 OF PR POS OK chec II a licable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing �.
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: 'SAY x.iS-Ei A« (CYO as MQSGC.,r'i cam, L41b rQ � end,&a
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑- Sheet❑
N, ft 11
.,,. .w `` o 1 i
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?
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,-OWNIFR AIITHORIZA'TION ,TO BE COMPLETED WHEN
OwNtOSAGEN"T'OR CONTRACTOR APPLIES FOR 13UILDING PERMIT
fug w I I)N A as Owner of the subject property
hereby authorize � m(�!/h�Ql )� to act on
my behalf, in all matters relative to work authorized by this building permit application.
U W
Signature of Owner Date
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.
igned under the pains and penalties of perjury.
Y
Print N e
Signature of 0 Date
r/Agent
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 OC 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:
�:� �
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p tment
` r �NgpING1N S reet `
ORtU1MPTON, 0 � �
TM �Nort �am on MA 01060 y
L_p h.ot]s 41 40 Fax 413-587.1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
This section to bornPltecl rffls
1.1 Property Address: '
�5 yF
w �ln � s
Zonererly Dlstrict
Eim St District" � CB l3istrlct�,,„, ". .".. .
SECTION2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMA'T[b 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 TotalCost of
Construction from 6
3. Plumbing Building Permit'Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) 1 LA Check Number
This Section For Official Use Only
Building,Permit Number; Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
t
BP-2001-1000
CIS#: COMMONWEALTH OF MASSACHUSETTS
53 ft .:- CITY OF NORTHAMPTON
Lot:-001
Permit: Buildinq
Category:roofing BUILDING PERMIT
Permit# BP-2001-1000
Proiect# JS-2001-1790
Est.Cost: $1475.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Cyrus Newman 064690
Lot Size(sq. ft.): 4617.36 Owner: HEYWOOD THOMAS H&SANDRA A
Zoning URB Applicant: Cyrus Newman
AT: 17 GLENWOOD AVE
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093 Workers
Compensation
NORTHAMPTONMA01060 ISSUED ON:614101 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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 6/4/010:00:00 2702 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo