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28-024 (2) Aim TNoposa ., • Vinyl Siding Corbett Home Improvement Window is g Northampton, MA 01060 Awnings (413) 584-6571 Canopies // Gutters L&`P /, 'I�7 Shutters PROPOnsALmm,a-IED7Y) [fC_- /��� Yt PHONE DATE U -z SMIEk-t'l/` {j J�t�l'+ll�J'L /l. JOBNAME CfrY,STATE,and ZIP CODE SUB LUCATIUN ��++ DATE OF PLANS JOBPHON6J/3ML We hereby submit specifications and estimates for: lJM I 6L411 A0 -mac Gl b fic n ovAex All o i -c-4-At n/Jut W o AW, 6S, AJ' O U l:. .�'ni5 / t � . d•J - Uv� Q �� 4r '�c,� r t S 'f3Sk S aS/) —, ALI CWe TropoSe hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: PollaCS�. 3 DSO Payments to be made as follows:A ,b MLN!f y j]d&w , ,+ yw!_ u�i/il All material is guaranteed to be w specified. All work to he completeol in a work-like manner according Authorized to standard practices. Any altercations or deviation from above specifications involving extra costs will he Signature executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado Note: This prolx1sal may be and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days. Acceptance of TropoSAf-Tine above prices,specifications are conditions are satisfactory and are hereby accepted.You are authorized to Signature _ _ do the work as specified. Payment will be made as outlined above.. L Jj Date of Acceptance: IC 7 L C� Signature O a a $ Crz f NL'rt11aill7fail 9 Basartchnactta m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 y WORTCE,R'S COMTENSATION INSURANCE AFFIDAVIT �Ic (licenser/permittee) with a principal place of business/residence at: - IT /V '-hN rHA ©/0 (sty t/ci ty/staie/zi p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job. (Imsurance Company) (Policy Number) (Expiration Date) O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the folio.'Dg workers compensation policies: (Name of Contractor) (Insurancc Comparly/Poticy Number) (Expiration Date) (Name of Contractor) (insurance Compmy/Poticy Number) (Expiration Date) (Name of Contactor) (Insurance Company/Policy Number) (Expimdon Date) (Name of Contractor) (Insurance Comoany/Policy Number) (Expiration Date) (attach additional sheet if ncocmuy to mchidc mfocimtion pertaiaing to all aatc�n) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be awuc that while homcoµtxrz who ciiplay pc-: to ai maiatcaancc,ox= Lion or repair Work on a dwtc g of not mo"than thaw units to whidr the homooever raidej or oa the grounds zppurtcnaai th tt-z ere oo(Scncrally comidmd to be employers under the work s o=V=Tsatioa Act(GL152,"t(5)�r- pvUaban by a hoaioowocr for a 6=15c cc permit may evidence the legal ctahia of an employor under the Workcez Compensation Act I uadcrt d thii a copy of this ctatcmcni may be forwarded to tho Dcpe meat of Indudriel Aoci&=&Offioo of Imucanco for the cover- g verification tend that failure to s,==oovttnga undx socuoa 25A of h(GL 152 can lead to the impositioa of aiminsl penalEcs oomistiag of a fax of up to S 1,Soo.00 and/or ixnprisoaax of up to one year nerd civil pcnaltia in the form of a Stop Work Ordc and a fine o(5100.00 a day t&&i331 MC- For&WM--si —o°Iy Permit Nwnbex Lot 4 tgnature Qf L" ermittm e SECTION 8-:CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : ppp(((((( J�n Q License Number y-3 - Zppc - Address Expiration Date Signature Telephone nom„ ° .,.ALA i Not Applicable. ❑Zrrt9precd m or _ Company Name Registration Number I/ 1461 sT Al`'f`^-/ Address Expiration Date Telephone,Sy7"G w 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...... ❑ 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 SECTiON3,5 DESt'RIPTION,OF PROPOSED WORK(check all applicable) �. �.. , v>. New House ❑ Addition ❑ Replacement Windows' Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ) Siding[ ] Other [ ] Brief Description of Proposed Work:sv//o Ol�F Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet❑ 471 fSNE-Wlf —Use'rSffd or. a'ddition`to`existin ``Housing 'co`mpleteithe followin 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 OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT"OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1. 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 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. 2tz/­aei - _ Print Name ignature of Owner/Agent Date 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 Puking Spaces Fill: volume&Location s A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 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: Ik rthampton S al sot P r B 'I i epartment Curb Cit t 15 l --� I n Street i ( 0 100 Wa er/We va t- 1 } (�d'i�.#ha,i o , MA 01060 Two Sets of r a )hone 413-581 124 Fax 413-587-1272 Plot/SitePans r Ci n`S Otlier Spec�ify � APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Pro_ert�Address: This section to,be,completed 4n'office, 076 nDo i -,I �� Map Lot Unit G Zone Overlay.D�stnct Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: cE- 1�1E"l �6 i eZ G o.t�o.J� k)ye Name(Print) Current Mailing Address: Telephone �GG��,p/ ;0/ Signature O (p _ 2.2 Authorized Agent: _jo_ (bxt3e47-- Si? Name(Frint) Current Mailing Address: 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. Elecmcal (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) —'5'0 Check Num� This Section For Official Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date • f : G 4' I� *lEI I;DR z BP-2003-0391 GIS#: COMMONWEALTH OF MASSACHUSETTS sj BI©ck:2g. OZZ4 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0391 Project# JS-2003-0660 Est. Cost: $5350.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin: Ed Corbett Jr 116069 Lot Size(sq. £t.): 17946.72 Owner: KIELBOWICZ ALICE Zoning: SR Applicant: Ed Corbett Jr AT: 26 O'DONNELL DR Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MAO 1060 ISSUED ON:10116102 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/16/02 0:00:00 1746 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo x a 26 O'DONNELL DR BP-2003-039 GIS#: COMMONWEALTH OF MASSACHUSETTS Map Block:28-024 CITY OF NORTHAMPTON Lot: -001 Permit: Buifdin£ Category: BUILDING PERMIT Permit# BP-2003-0391 Project# JS-2003-0660 Est.Cost: $5350.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq.ft.): 17946.72 Owner: KIELBOWICZ ALICE Zoning SR Applicant: Ed Corbett Jr AT. 26 O'DONNELL DR Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MA01060 ISSUED ON:10116102 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:Q/C G 47- 3 p- O a THIS PERMIT MAY BE REVOKED BY THE CIT OF NORTHAMPTON UPON VIOL OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu an -"' Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 10/16/02 0:00:00 1745 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 6