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17B-008 (2) Page No. of Pages Proposal NEWMAN'S CONSTRUCTION 697 Bridge Rd. Northampton, MA 01060 1045 413-586-1093 PROPOSAL SUBMITTED TO PHONE DATE rP V, �.; 5T'5-09-7 ST T JOB NAME Y — rz n- i\LXi f-- LL- CITY,ST T and ZIP C DE JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: 2--0 'J2�.vvAq\j 110 V7 Ck Y\ l l!�-��. 2.'�•�ST'(,v��' '��� r-4 r� � {Z f.mGVL `t�NuS J0 ,5 < �1_S_Fa( 1__ cc_�u.�-r c✓�5��►� Z- 5 kf-t� rz,_ 3X e. ✓, y}ill__ L,t; Vl'64 U0-,7- yk_ _5 a5 tot��z .` 5101- .ON" , at _ .`1.5 �...._i h5V.1l... {cn.6_L(,- _._vYiT-_�.C41P C.w..�_.UZ... �Y — 7106 ,'" y /0L" ' We propoSP hereby to furnish material and labor—complete in ccordanceewith above specifications, for the sum of: fZ t 6'j S H �li✓l�� 6/(W dollars($ Payment to be made as follows: CL t c� Cj� C a 1'1C J r 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 /`- involving extra costs will be executed only upon written orders, and will become an extra Signature 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 proposal be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepte it days. Acceptance 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 S �StU1MP , DEPARTMENT OF BUILDENG INSPECTIONS /= INSPECTOR 212 Main Street • Municipal Building Nortiu-unpton, MA 01060 , HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to act as its/her construction sup,. ."sor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 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 regulations. 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 pour), 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 } F E UI1�7 LSICTltl}i1111�Jt011 QE 31 s 7f nth atr tra' - —° DEPARTMEbrT OP DUILDr1tG INSPeCTlOTJS 212 Main Strcct Municipal Building ! Northampton, Mass. 01060 <j j n� T ,r7��;�r c �+7• �7 r��c�-m A � L�7�� { /��7 «'ORICCRIS COK L' NSA i OI MS LV1��� :�1'L'iJJ,1`rjq Pa T YY��.✓� -- - -. -- ,' (Il ccnsxJ{xrmj rice) V.,ith a principal place of business/residence at: F do hereby cerdi -, under dic.pams and penalties of penury.,, h.? ( ) I am an employer providing tfle follo%vine %vorkcr 5 comocns��Jan cove r2gc for Illy eluplovccs wor-ong on tius job: (IanLran Corer (Policy Nu-maixr) (c-:pi �t ora �} i ( ) I am a sole proonctor, general contractor or homeowner (ci cie one) and have hired the cone-aciors Gsmd below vqbo hzve the follo%viog workers comner!sadon pcbcies: (I+9lIl: Oi CO_^.0^CiOS) (In2ranc;: Compa1 'i'l our (E :)IFJuon (N:me of Coaa-aclor) (Insurance Comoanyrpolier Nuacrr) Date) (Name of Conrrdclo,) (Insurance Comnan}f%Ucy Numbu) (Expir:doo Datc) (Name o!tAatraetor) (InszlriQ Comt:auy/PoUcy Number) (Ex-pir-ddoo Darr} (ntlad�=duCOCJ sue'crt.irnccaa:y to incur iarorma_'ion pcztaia to.0 co=— o.-) { ) I am a sole proprietor and have no one woridng for me- ( ) I atn.a home owner performing all t.be work myself. NOTE:plcs.c be ew'xrc tr.,.Kt .le hcmeoµven K•bo c=praY P�.om eo eSo�•;�.,-..,..7 c�s:.e�ao c repair work ou a d.. U-Z of ao<most than tfsx t Ls to u3icb the ` �J� bomwwva'ttsdcs or _ "plOyt=-,t1aCG the K���...� oa t�Q'OVJ�1]�pti(tL'a.]Z7 tl�LT WC g'xallY CCCi:CS3C1j la tY m Aa(GLI32.=l(3)),=pprir_L6oa by a homeoa-=fw a lice cc pcsma zy—d—tre -=Play.<uo&r rho W orkela Compomatio a AeL I :adcszaod that a Copy of thin mtcmcai may bo f--,Ld d to tba C c,q msi of lad,=i.J Aond_&Off o0 of I.—y for tho ooverasc vcif mina and t1u LULL to so=rr)=vTrarI tdll 1,0 t oo 23A of h(GL I32 t3a lad to the Lm,xis cc of cim6J poaaltic coasi-smg of a Ciao orup to s i-Soo.00 and/or 6mprL�xmc=.or up to Coe y=and evil pmaltia is t5c form of a Ssop Work Order read a rim of S 1 00.00 1 d--y 1pj=tnc For dCp.r — t u, only - Pc-rmtt NumL-r Lot I' Std of Li-ccn- cfFcrrn LtcC J SECTION 8-CONSTRUCTION SERVICES 81 Licensed Construction Supervisor: Not Applic�ablle ❑ Name of License Holder:- t 5 j � . r�f�d l ' —" L-t tVO License Number Q,-A d ax- C 'Afb-7i �l�l l C Expiration batel Address Signature Telephone ' - ❑ Not Applicable , —+ Companv Name Registration Number A-4 - A 51z Address /� Expirati n Date n USDelephone O'dZa:� SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NI.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-near 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 SECTION 5-DESCRIPTION OF PROPOSED WORK check all applicable New House ❑ Addition ❑ Replacement Windows. Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[0] Other[p] Brief Description of Proposed r lore Work: f �! Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa Cf New yho@ and a� C Cfltialll "tc exis �r� ` iO�s�r c cot ip efi at a�vrrl g: 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 ,TG BE COMPLETED.-WHEN OWNERS AGENT-OR CONTRACYORAP 0'- ,LIES.FOR BUILDING 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 1, CW � �r„t (�,f as Owner/Authorized Agent here y d Aare 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 N me V Signatu Owner/Agent Date ^ — ^ ~ , 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 Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bIdg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Vahonce/Fi nd i ng ever been issued for/on the site? �� �� NO �~�� VV �~�� DON7KNO YES v�� IF YES, date issue& IF YES: Was the permit recorded at the Registry ofDeeds? ' �� NO �� DON'T VV KNO YES IF YES: enter Book Page' and/or Document#, ' �� B. Does the site contain o brook, body of water orwetlands? NO v���� DON7%NOVV ��� YES v��� � IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs tobeobtained v���~� Obtained �~«��\ Date' � C. Do any signs exist un the pnoperty �� ��� YES �~� NO v�� |F YES, describe size, type and location: _ D. Are there any proposed changes to or additions of signs intended for the property Y yB 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb .grading, excavation,nr filling)over 1 acre oris it part cfo common plan that will disturb over 1 unm? YES ��� ) NO ���) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ` s R1,1414. Qity of,Northampton Staff`s Vf BuRdina Department ur'x vltiDnyewa e � � 212 Main Street s septattlt � _ CT _ 'f08 Room 100 ite � IAatTa�rtt Northampton, MA 01060uuo Se1� �cfuFPtii � � ' phone_413 W 124 Fax 413-587-1272 fo Stte Plans,} % 2 x ttserecrfy �� �. �APPLlCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION'1--SITE INFORMATION 1.1 Property Address: Thissect'ar��to 6e~c©mpllefdd 6yoffice yy� �,r�c►c�(., QCi . nip Lat tit St."Distrtct .CB Distic rSECTION,2—PROPERTY OWNERSHIPIAUTHORIZED:AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Cpl ,.UPa ' _ L9q--A- Vry--, CA c. Name( rint Current Mailing Address: 6 _ k 41 j) SLo — Signat T lee phone SECTION -ESTIMATEDCONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ( (a)Building Permit Fee 2. Electrical .?(bp 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 - BP-2009-0397 GIs#: COMMONWEALTH OF MASSACHUSETTS 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-2009-0397 Project# JS-2009-000537 Est.Cost: $14200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CYRUS NEWMAN 142807 Lot Size(sq. ft.): 135036.00 Owner: HUTCHINS FAMILY PARTNERSHIP Zoning:RR(100)//RI Applicant: CYRUS NEWMAN AT. 444 BRIDGE RD Applicant Address: Phone: Insurance: 697 Bridge Road (413)586-1093 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON:101912008 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: 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 10/9/2008 0:00:00 $35.006163 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo