17A-272 (7) Proposal Page No. of Pages
NEWMAN'S CONSTRUCTION
697 Bridge Rd.
Northampton, MA 01060 1137
413-586-1093
PROPOSAL SUBMITTED TO PHONE DATE
STREET JOB NAME
13,!g
CITY,STATE and ZIP CODE JOB LOCATION
o ti r, 2 s` tM
ARCHITECT DATE OF PLANS JOB PHONE
We hereby submit specifications and estimates for:
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I ,wj BlP Vrapa hereby to furnish ma Aerial and labor—complete in accordance with above specifications, for the sum of:
/Cj r n J` — C1 dollars($ -----21"!C7
Pa to be ade as follows:
v+ 7P ' L .9,0 C As c Al
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 posal may be
Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if n Ccepted within days.
Arreptanrr 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: V — Signature
v
C,ITY OF NORTHAMPTON, s°
Construction rig Affidavit
In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work
-=_- --- covered-by-a-Building Permit shall be disposed of in a-properly licensed disposal facility,
as defined by M.G.L. c..111 § 150A.
Address of Work: (0fl
-- The-debris--will.be-transported by -v - - tc2m A-k/
The debris will be received at.
- Signature of Permit Applicant
_ Gate 17 3
Building Permit Number:
4�
T
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £ p
Name of License Holder: e'S �b l O
License Numbe
M �s
ASigna Q Expira' n ate
a Telephone
Not Applicable £
9 Registered Home Improvement Contractor
Com an Nam Registration Number
7/ Ilb
Address Expirafion D e
Telephone qL-i Q
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...... £
11: Home Own'er.Egemption
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.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors F
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other(ED]
Brief Description of Proposed tt
Work: ►2i p Lcl- rl. OQ LJ
Alteration of existing bedroom Yes No Adding new bedroom Yes No r
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a:`If Newhouse and or addition to exlsting ho
usinq,'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
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
CV � as Owner/Authorized
Agent hereby eclare 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 Nam
Signature of O ne nt Dat
,
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Thl's 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 bldg&paved
#of Parking Spaces L--j
(volume&Location)
A. Has a Special Permit/Varians/Finding ever been issuedior/on the site?
x-�
NO �_/ DONTKNOVY ��y YES �~�x-~�
IF YES, date issued:,: /
IF YES: Was the permit recorded at the Registry ofDeeds?
NO K ) DONT KNOW YES C)
7.
��
IF YES: enter Book Pagej and/or Document#
�� ��
B. Does the site contain a brook, body of water orwetlands? NO ��x DONT KNOW �~� YES «��
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained �~� Obtained x�\ Date |ssued.
�
«�� �-� '
C. Do any signs exist on the property? YES 0 NO
)F YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO xa�
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre nrisit part ofa common plan
'
that will disturb over 1acre? YES NO o
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
'' { department use only '
City of Northampton Status ofPermrt
PK
Q `•... Building Department Gtrr6 CuT/Dnveway Perrrs�t s ;r
U �5'
212 Main Street Sewer/SepticAvaila'bll�ty
Room 100 Water/VteiGAva�lability '
SEp Q rthampton, MA 01060 Twa Sets of Structural Plans
phon -587-1240 Fax 413-587-1272 Ptof/Site Plans 1
Elecfrlc,Plumbi Uther 5peclfy '
North n 9$G
APPLI A CO TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
This section to be completed by office
1.1 Property Address:
13F O$e C , - Ma Lot Unit
J
Zone Overlay District
C)vzf
EIm S BDtect Ditrt w is
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
07v ttc) i Q
Name(Pri t) Current Mailing Address:
Sig Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be 5-0 d 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=0 +2+3
+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
138 OAK ST BP-2015-0372
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-272 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2015-0372
Project# JS-2015-000682
Est. Cost: $8425.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CYRUS NEWMAN 064690
Lot Size(sq. ft.): 18730.80 Owner: FIELD JOHN P&WENDA W
Zoning. URB(100)/ Applicant: CYRUS NEWMAN
AT. 138 OAK ST
Applicant Address: Phone: Insurance:
697 Bridge Road (413) 586-1093
NORTHAMPTONMA01060 ISSUED ON:913012014 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 9/30/2014 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner