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25A-160 _ _ � , ,;, F ��� ; { PROPOSAL Jesse C.MontgoMery PROPOSAL N°. JCM Home Improvement run 46 Oak Street SHEET No. Florence,MA 01062 DATE PROPOSAL SUBMITTED TO: ( WORK TO BE PERFORMED AT NAME d 'e ,i (iry— ADDRESS G Y"?/1 ( ,� x/77 ADDRESS f DATE OF PLANS /Jorl"kOLO, �'n ( � �'. of 0C' PHONE NO. 1-16 ARCHITECT Whereby propose to furnish the materials and perform the labor necessary for the completion of row 11 rt Y nq w fl � f ` /. 00 - r 4 el/"' G°mo t 4k q C> "'"... fr^ a� c`�t. � Q t''/7 f ��t °� 1 e cr r7 ✓t.�c ear" a - le O � ✓' >rP7 ca C /�?C K r r3 44,7 > off'$'; � f r n�, o r'" t✓t J c°r� r? �tsC" v l�'I �'!Cr!° ✓v C *r' Yh t c'ek. o All material is guaranteed to be as specified, and the above work to be performed in accordance ' h.the dr gs and specfi c '°ns submitted for abov work and completed in a substantial workmanlike manner for the sum of t ✓.S Dollars with payments to be made as fol low . t 5 pfd �.T ��� ��✓n�.,�t<'T�G'�t � _.. Respectfully submitted Any alteration or deviation from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreerygn contingent upon strikes, ac- cident,�,or delays be nd our�ontrol. I ?eA 3!'°� } � Note—This proposal may be withdrawn r G' by us if not accepted within° days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above. Signature C i pl ', Date Signatures - . 3818-50 PROPOSAL MADE IN USA A �'CZtMfPTO 9 fl of &Nart4 il ;� fott�x 9 B �asaschnsrtta' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSAUON INSURANCE i ' AVIT with a principal place of business/residence at: b 1 54, r[orZocic .. 61W (phone#) 4// 3 152Pa n W--d (str Ucity/statdzip) do hereby certify, under the pains and penalties of peon y, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: - (Insurance Company) (Policy Number) (Expiration Date) ( ) 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: (Name of Contractor) (Insurance: Company/Potiq Numbcr) (E pimtion Date) (Name of Contractor) (Insurance Company/Policy Numb-,r) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poky Number) (Expiration Date) (attach acct if necessary to include iaf rn oa pertaining to all oodradors) i ( I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:ptease be aware that whilo homeoxven who empiay pcz-som to do mau�cnance,cons ru�'on er I-V*f work,on a dwelling of not mocc than Ihtco units in which the homoow mr raids oc oa the grounds apputtenuA tha'do z-c no(gmcraEy consi&rc to be caTioyczs under the worms on:a QS as Act(GL152"1(5)�application by a homcow=for a uomse a pUmit may evidence the legal etania of an omployor under d'4 wocicods Compensation Ark. I understand that a copy of this aatcmrst may bo forwcvdod to tbo Deportment of Indust id Acci&�&Of oo of Ir---oo for tho covaagc vaification and that failure to scc=covcmp under section 25A of MOL 152 can Iced to tha iarpoa Ott of cr urinal pcmalties ooasisdag of a fine of up to S 1,500.00 and/or imptisonn of up to one year and civil penalties in tfx form of a Stop Wort;Ord--nmd a firm of 5100.00 a day against rite -. Foe&c,attrrrtst use only Pc,TInit Ntunbc-r ivfapl; r SECT,ON 8 :COrt��T4RUCT10N SERVICES 8 1 Licensed Construction Supervisor: (� ��/�" �-�(� Not Applicable ❑ Name of License Holder: ze ` v' \' � _ _ 077 10 © � / — License Number o��c e MA. 0l i% -�? iA b ©3 Addre Expiration ate 3 Sig e IVY Telephone Not Applicable ❑ 1311a 7Y Company Name Registration Number A ess ( /�/) /� ,l g� pJ� Expira on D to ,,(©reeicc 1 A• y t C 0 ' Telephone SECTION 1Q; WORK ERS':'C,OMPENSATION 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 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 r SE(" 10�N� DES�CR PTI0 T PROPjOSED1WORFC �cH' ck all-a" licabt .e w a+a roe :: ttr, ' ro w v 4M3k New House ❑ Addition 0 Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[r] Other [ ] Brief Description of Proposed Work:-gip � era p��`� �-►'d r(f roo o Vf• s yr�9l e V-,*'Alteration of existing bedroom Yes y No Adding new bedroom Yes No / Attached Narrative❑ Renovating unfinished basement Yes ✓ No Plans Attached Roll ❑ - Sheet E �f mazes - o dditioW.Me-xisti'nV,h siri . ,coo ptete. l.lo" i`n" : 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? 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 OWN ER'AUTHORIZAT[ON -TO BE COMPLETED WHEN OWNERS AGENTOR CONTRACTOR APPLIES FORBUILDING'PERMIT 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 Ue ()vY]�(' as Owner/Authorized Agent hereby declare that the state is and i mation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. / �M 6 so 1er-1 Print Na Signa of Ow r 9 D/, 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/Findirrver been issued for/on the site? NO DON'T KNOW V 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 D cument # 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 Com ission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES _ NO IF YES, escribe size, type and location: D. Ar there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: r City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 4 phone 413-587-1240 Fax 413-587-1272 r APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: �V C� mFP ► ! VIA 0� 06 Zone Overl`a Dist e# �r Y Elm St.'Distiictn. CB D ctfi _ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED'AGENT- 1 2.1 Owner of Record: Name(Print) Cur r nt Mailing Addres Telephone Signature 2.2 Authorized Agent: Z`e sse /`'lam �,,,'►�� 6 Oct k' S - '(a s'ifnc e 1W. Name(P nt) Current Mailing Address: Si ture Telephone CTION-3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building ,�r7� (a) Building Permit Fee 2. Electrical (p (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) 5 Check Number This Section For Official Use Only Building Permit Number: Date Issued:_ Signature:' Building Commissioner/Inspector of Buildings Date " 't`. BP-2003-0109 GIS#: COMMONWEALTH OF MASSACHUSETTS ; i CITY OF NORTHAMPTON ot:-0013 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0109 Project# JS-2003.0212 Est.Cost: $6500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 134274 Lot Size(ss . ft.): 10410.84 Owner: MILLER SCOTT D&DLANE E Zoning.URB Applicant: Jesse MontgomeLy AT. 19 BATES ST Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482 FLORENCEMA01062 ISSUED ON.7130102 0:00:00 TOPERFORM 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. 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/30/02 0:00:00 1429 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 19 BATES ST BP-2003-0109 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A- 160 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0109 Project# JS-2003-0212 Est.Cost: $6500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sn.ft.): 10410.84 Owner: MILLER SCOTT D&DIANE E Zoning:URB Applicant. Jesse M orftgo m ery AT. 19 BATES ST Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482 FLORENCEMA01062 ISSUED ON.7130102 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. 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:6 tx' THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT N OF ANY OF ITS RULES AND REGULATIONS. Oert.if e: Fee Type: No: Date Paid: Check No: Amount: Building 7/30/02 0:00:00 1429 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo`