17A-278 ENTER DATE OF TRANSACTION
NOTICE OF CANCELLATION
You may cancel this transaction,without any penalty or obligation,within three business days from the above date.
If you cancel,any property traded in,any payments made by you under the agreement,and the Contractor of your cancellation notice will return with any negotiable
instrument executed by you,in ten business days following receipt,and any security interest arising out of the transaction will be canceled.
If you cancel,you must make available to the Contractor at your residence,in substantially as good condition as when received,any goods delivered to you under this
agreement;or you may,if you wish,comply with the instructions of the Contractor,regarding the return shipment of the goods at the Contractor's expense and risk.
If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty days of the date of your notice of cancellation,you may retain
or dispose of the goods without any further obligation. If you fail to make goods available to the contractor,or if you agree to return the goods to the Contractor and fail to
do so,then you remain liable for performance of all obligations under the agreement.
To cancel this transaction,mail or deliver a signed and dated copy of this Notice of
Cancellation or any other written notice,or send a telegram to
(NAME OF CONTRACTOR)
at
(ADDRESS OF CONTRACTOR'S PLACE OF BUSINESS)
NO LATER THAN MIDNIGHT OF
I HEREBY CANCEL THIS TRANSACTION.
(DATE)
(OWNER'S SIGNATURE) (OWNER'S ADDRESS)
(Two copies of this form to be attached to the Residential Contracting Agreement)
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RIGHTS TO CANCEL
The Owner may cancel this agreement if it has been signed by the Owner at a place other
than an address of the Contractor which may be his main office or a branch thereof,
provided that the Owner notifies the contractor in writing at his main office or branch by
ordinary mad posted,by telegram sent or by delivery, not later than midnight of the third
business day following the signing of this agreement. See attached Notice of Cancellation.
HOMEOWNER
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
s Signature Date Signed
Contractor's Signature Date Signed
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As an alternative to arbitration, both parties may voluntarily agree to have the matter settled in the appropriate Small Claims Session of
the Trial Court of Massachusetts. Such an agreement must be put in writing and signed by both parties. If either party does not agree
to submit the action to Small Claims,the arbitration clause contained herein shall be in full force and effect.
UChristopher Hillebrand
Owr/er's Signature Contractor's Signature
XIH. WARRANTIES
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of one
year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or
materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered within one year after completion
of any job, including cleanup, the Contractor shall, at its own expense, forthwith remedy, repair, correct, replace, or cause to be
remedied, repaired, or replaced, such damage or such defect in materials or workmanship based on Residential Construction
Performance Guidelines for Professional Builders and Remodelers The foregoing warranties shall survive any inspection performed in
connection with the agreed-upon work.
All warranties for equipment supplied by the Contractor under this Agreement shall be those given by the manufacturers of such
equipment,which shall be and are hereby passed through directly to the Owner. Under such manufacturers'warranties,the Owner may
be required to register or mail in a warranty card or other evidence of ownership and use of such equipment in order to activate such
warranties. The Owner's failure to mail in or register such documentation, which failure voids the manufacturer's warranty, shall not
create any responsibility for the Contractor to warranty such equipment.
This warranty gives the Owner specific legal rights, and Owner may also have other rights, which vary from state to state_ Under
Massachusetts's law,sales of goods carry an implied warranty of merchantability and fitness for a particular purpose_
XIV. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that the Owner should not sign this Agreement unless and until all blank sections have been filled in or
marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are
attached hereto.
XV. COPY OF AGREEMENT TO BE GIVEN TO OWNER
This Agreement is governed by the laws of Massachusetts. It must be executed in duplicate, and an original signed copy hereof given
to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal
to the Owner of a copy thereof. This Agreement,including the Exhibits attached hereto,constitutes the entire agreement of the parties
with respect to the subject matter hereof.
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Contractor will be responsible to Owner or any third parry for any property damage or bodily injury caused by Contractor, its
employees or its subcontractors in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry
insurance to cover such damage or injury.
VII. SUBCONTRACTING
Contractor agrees that, notwithstanding any agreement for materials and/or labor between Contractor and a third party, Contractor is
responsible to Owner for completion of all work described in this Agreement in a timely and workmanlike manner.
VIII. CONSTRUCTION-RELATED PERMITS
The following construction-related permits will be necessary in order to complete the scope of work included in the Agreement:
Building Permit
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction-related
permits. The Contractor shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory,
permit granting or inspectional agencies,authorities or individuals.
Notice: If.the homeowner obtains his or her own construction-related permits for the work described under this agreement, the
homeowner is hereby advised that in the event of a dispute,judgment and nonpayment of the contractor, the homeowner will not be
entitled to make a claim to or collect from the guaranty fund established by Chapter 142A of the General Laws.
IX. MODIFICATION
This Agreement,including the provisions relating to price(Section II)and payment schedule(Section III)cannot be changed except by
a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice
of Cancellation(annexed).
X. CHANGE ORDER
Change orders are additional items contracted subsequent to the signing of this Agreement, the cost of which is not included in the
original design and specifications stated on the original scope of work (see Exhibit I). Upon agreement of a change in scope to the
original scope of work, a change order form(see Exhibit Ell) shall be signed by both parties. Any additional charge established by the
change order shall be due upon signing of the change order form. Each change order shall be treated as a separate contract and
completion of those items specified in any change order shall not be grounds for withholding any other payments specified in this
Agreement. All change orders are subject to an administrative fee of$75.00 per change order.
XI. COLLECTION FEES AND FILINGS
Interest of 1.5% per month will be charged on past due accounts over 30 days. Should collection proceedings be instituted for
payment, Owner agrees to pay reasonable attorney's fees, court costs, and other costs incurred. There will be a$25.00 charge for any
returned checks. While no security interest is created by this Agreement,the Contractor shall have the right to file a notice of contract
and a statement of account in order to create such a security interest to ensure that payment is made as required hereunder.
XII. SETTLEMENT OF DISPUTES
Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, shall be settled by arbitration before one
arbitrator administered by the American Arbitration Association(AAA)under its Construction Industry Arbitration Rules and judgment
on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. In all other cases,the fees will be split
evenly by both parties.
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A
more detailed description of the materials to be used in performing the work is contained in the Scope of Work attached hereto as
Exhibit I.
U. PRICE
Contractor agrees to do all work described in Section I for the total price of$$17,812.61 with supplemental items to be determined at
a later date with USAA.
III. PAYMENT
Payment will be made as follows:
$17,812.61 due upon completion with signed COS
Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit) of more than one-
third of the total contract price or the total amount of all deposits or payments which the contractor must make, in advance, to order
and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater.
Contractor reserves the right to bill each line item in the contract that has a price associated with it independently from all other line
items. Payment for each line item, which has been satisfactorily completed, is due upon receipt of invoice from Contractor. More
specifically, Owner agrees to not withhold payment on any item, which has been satisfactorily completed due to his/her complaint(s)
with any other item(s).
Upon substantial completion and receipt of payment# the Owner and Contractor shall assess the completed work and establish a
"Punch List" of remaining outstanding items. These items shall be recorded on the form attached hereto as Exhibit II and the Punch
List shall be signed by both parties. Upon completion of those items,the final payment shall be due. Any other item that subsequently
comes to the attention of the Owner or Contractor shall be considered a warranty item and shall not be grounds for withholding of final
payment. Any punch list item(s), which cannot be completed whether due to dissatisfaction, lack of available materials or seasonal
delays shall have"fair market value" assessed and shall be removed from the scope of work and the total price shall be reduced by the
"fair market value"assessed to such item(s).Final payment shall not be withheld for such items.
IV. COMMENCEMENT AND COMPLETION OF WORK
Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified
here in writing. Contractor will begin the work on or about and,barring delay caused by circumstances beyond
Contractor's control,the work will be completed by .The Owner hereby acknowledges and agrees that the
scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of
this Agreement.
V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED
The Contractor may not require payments to be made in advance of the times specified in Section Ill (Payment) above for the reason
that Contractor deems itself or the payments to be insecure. If, however, Contractor deems itself to be insecure, Contractor may
require, as a prerequisite to continuing the work described herein, that the balance of the payments under this contract that are in the
control of the Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for
withdrawal.
VI. INSURANCE
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A.RS. Services,Inc.
38 Crafts Street
Newton,MA 02458-1449
(6I7)969-1119
RESIDENTIAL CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
A.R.S. Services, Inc.
Notice: All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt
from registration by provisions of Chapter 142A of the General Laws,must be registered with the Commonwealth
of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract
Registration, One Ashburton Place,Room 1301,Boston,MA 02108. All construction techniques, methods and standards of
quality are to be within allowable tolerances as noted in the National Association of Home Builders,Residential Construction
Performance Guidelines for Professional Builders and Remodelers.
Designated Registrant's Name:
Registration Number:
Salesperson's Name:
This Agreement is made on between A R-S. Services,Inc.
(DATE) (CONTRACTOR)
of 480 St James Ave Springfield,Ma 1109 (113)272-0101
(ADDRESS) (PHONE NUMBER)
hereinafter called"Contractor"and John Dillard
(OWNER)
of 55 Oak Street Florence MA 01062 (413)586-9595
(ADDRESS) (PHONE NUMBER)
hereinafter called"Owner".
I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Contractor agrees to perform in a good and workmanlike manner all work detailed below. Such work consists of the following:
Replacement of damaged chimney
A more detailed description of the work to be performed is contained in the Scope of Work
attached hereto as Exhibit I.
DETAILED DESCRIPTION OF MATERIALS TO BE USED
Materials to be used in performing the above-described work consist of the following:
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Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE
Revised 7-2013
Fax # 617-727-7749
www.mass.gov/dia
The Commonwealth of Massachusetts
Department of Industrial Accidents
w
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
5,4�e www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):� S Sr,,-wu _Th L
Address: Jr CreFfff srrrrf
City/State/Zip: Alewror, ^4 1 0?`l r r Phone#: Z-)/_7 .2 -)2 O/o
Are you an employer? Check the appropriate box: Type of project(required):
1.Xr I am a employer with 10 0 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance. 9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other C"h,M Rtpy,•).
comp, insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Names
Policy#or Self-ins. Lic. #: �� m'Z.W 19�00&Z Q 3 Zq 1,3 rp-- Expiration Date: Q 12
Job Site Address: 5-S- O w lk- ,SZE City/State/Zip: &r—r.e. ,^4 4 01V 6 2
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerd der th ains andpenalties ofperjury that the information provided above is true and correct.
Signature: Date: 7—2 2-
Phone#: 1-11 o3 2-7z-010i
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Signature of Owner Date
-rrr;,t 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.
Print Name
71211,-1
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable �
Name of License Holder: ,,t Spa bovri n C S I p�1 j1
License Number
PO .BOA L NVA p�p� i - 6, 19
Address Expiration Date
0L® L
Signature Telephone
9. Registered Home Improvement Contractor:
Not Applicable
f}t�'S S�r.-��c� �Dc�uQ 5�b6�cs��v
Company Name /0� L/ 31,
Z-1 to Sr ?an+l hit Registration Number
Address
71?T1?o/L
Telephone 4//l 2 72-0/o/
Expiration Date
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....... ol' No......
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows eration(s Roofing
Or Doors
Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding [ ] Other[ ]
Brief Description of Proposed
Work: �'hi-t'' ,,L /1'trJy•�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No Plans
Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following,
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 APPLIES FOR BUILDING PERMIT
1, -704. GIs,^ as Owner of the subject
property //��
hereby authorize A r D 5 sYrW+V• to
act on my behalf, in all matters relative to work authorized by this building permit application.
Section 4. ZONING All Information 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
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. Hasa Permit/Variance/Finding ever been issued for/on the site? NO
ON'T KNO YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T K 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 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common
plan that will disturb over 1 acre? YES
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
��7 Department use only Status
,—�-- of Northampton of Permit:,
f Iding Department Curb Cut/Driveway Permit
�. 2 Z 2014 2ij ain Street Room 100 SewerlSepticAvailability
North mpt n, MA 01060 phone 413- WaterNVell Availability
Electric, Fiumbing&Gas In ion 0 Fax 413-587-1272 Two Sets of Structural Plaris
Northampton, MA oloeo Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
t1.1 Property Address: This section to be completed by office
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
204, to,-114 .A SS �Jglc sfirrscf
Name(Print) Current Mailing Address:
4)17
Telephone
Signature
2.22 Authorized Agent: A
Arf S-t✓L(�fJ L� Tq J /`✓t
Name(Print) Current Mailing Address:
/-//J ,272 U!o 1
Signature Telephone
SECTION 3-ESTIMATED 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 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
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-0098
APPLICANT/CONTACT PERSON David Sabourin
ADDRESS/PHONE P O BOX 1737 WESTFIELD (413)272-0101 O
PROPERTY LOCATION 55 OAK ST
MAP 17A PARCEL 278 001 ZONE URB000)
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: REPAIR CHIMNEY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 103157
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
/Approved 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 Commission Permit DPW Storm Water Management
moll ' Delay
A/4"
Signature of Building O ficial 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.
55 OAK ST BP-2015-0098
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-278 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: chimney rebuild BUILDING PERMIT
Permit# BP-2015-0098
Project# JS-2015-000165
Est. Cost: $18000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: David Sabourin 103157
Lot Size(sq. ft.): 12240.36 Owner: DILLARD SHANNON COKER&JOHN W DILLARD
Zoning: URB(100)/ Applicant: David Sabourin
AT: 55 OAK ST
Applicant Address: Phone: Insurance:
P O BOX 1737 (413) 272-0101 () Workers Compensation
WESTFIELDMA01086 ISSUED ON.712912014 0:00:00
TO PERFORM THE FOLLOWING WORK:REPAIR CHIMNEY
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:
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 7/29/2014 0:00:00 $55.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner