28-046 (2) I
BILLTHE CARPENTER All home improvement contractors and subcontractors engaged in hon e
12 Finch Rd
Stafford Springs improvement contracting,unless specifically exempt from registration
Ct.06076 by Provisions of Chapter 142A of the general laws,must be registered
413-237-2709
with the Commonwealth of Massachusetts. Inquiries about registratio
I
Submitted and status should be made to the Director,Home Improvement Con
ep To: James BUCgda Registration,One Ashburton Place,Room 1301,Boston,MA 02108
77 Cahillane Ter.
r Florence,Ma. (617)727-8598
Work to be performed
at:'77 Cahillane
Phone:413-584-1513
Date: 12 June 04
We hereby submit specifications and estimates for work to be perforated and materials to be used:
1:Repair sills on rear of house
2:Remove existing siding and install new 1/2 inch plywood
3:Install new r-11 insulation if necessary($1200)
4: Install 4 new doublehung vinyl windows and 1 three unit picture window
5:Install heartland(hearttech)vinyl siding to entire house and cover all exposed trim with pvc coil
6:Install 2 new steel doors and I slider
7:XXXXXXXXXXXXXXXX
Do not do: N/A Construction permits:By Contractor
Work eduleto begin on: and substantially compleded by:2 wks
+y Warranty The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship fgseaiod of I yr following
completion and shall comply with the requirements of this Agreement. In the event any defect inn workmanship or materials,or damage caused by the Contractor,his
subcontractors,employees or agents,is discovered within one year after completion of any job,including cleanup,the Contractor shall,at his own expense,forthwith remeo
repair,correct,replace,or cause to be remeidied,repaired,or replaced,such damage or such defect in materials or workmanship. The foregoing warranties shall survive an
inspection performed in connection with the agreed-upon work.
THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE
CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN
APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL E
REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVEN IN M.G.L.a 142A.
Contractor:William Hayes Owner:James Bur da
NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PAR E TO ALTERNATI VE;DISPUTE SETTELMENT
VITIATED BY THE CONTRACTOItr THE OWNER MAY INNITIATE ALTERNATIVE DISPUTE RESOLUTIt VEN WHERE THIS SECTION IS NOT
SPEARATELY SIGNED BY THE PARTIES.
We Propose hereby to furnish materials and labor to complete in accordance with above specifications and the
terms and conditions on both sides of this Contract, for the Sum of$: Fourteen Thousand Five Hundred And Twenty Five Do
a: %($: 1000 ) upon signning contract:
b: % ($: 4000 ) upon demolitionof:
c: %($: 5000 ) upon 50"/0 completion: Name of sales representative
d: %($: 4525 )upon completion of work under this contract Authorized signature
ACCEPTANCE OF PROPOSAUThe above prices, specifications and conditionsare satisfactory and are hereby
accepted. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
You are u orized to do the ark a pecified.
Signature:
Date: Signature:
YOU,THE BUYER,MAY CONCEAL THIkPiANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF
THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.CANCELATION MUST BE
IN WRITING.
,a�
TtU►MA .. � + �
$ �xt of 'Nort4alltptoll z Z
� � � �ili s3sachusctts -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR '212 Main Street • Municipal Building
North unpton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup,;:-:i sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one dr two fami -
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 Ogulations. 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 your), 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
r
i
-tlwr pT t,
0
Qf
$ E ?�c3skchrrsc[Is' _
DEPARTMEITT OF BUILDD,�C INSPECTIONS
212 Main Strcet ' Tfunicipal Building
Horthampton, Mass. 01060
WGRICER'S CON'[PENSA7T0Pq MSURAhCE Al IqD,-,, (jT
(l i ccnscrlfxtml tt'cc)
,Vlth a principal place of businessfresidence at: ---- --
ph f v .1-� � �T�z��'! �J! (pnonc-') j,37
(su�tld ty/szat.cla p) '
do hereby certify, under tlie.p?-U' S and penalties of penury, ,hat
( ) I aun an employer providing the foil owinc-'%vorlcer's comocnsado;: cove:-a,c Cor my
emplovices worlong on taus job:
(Lsur-an=Cocra.m') (POUC7 NUMIDIC-r) --- (T :pir<tion Dare)
O I am a sole proprietor, general coo=cior or homeowner (c cie one) and have hired
the cool actors listed below vqr o have the follocvin2 worker's cac:I:)ensEaon policies:
(i+amc o.Copt-cto-) Ori--uranc Compo'n)-Pouci Nfum=<r) Datc)
CNamc of Coomcior) (1R7,UaRC:. aMD2-nti'I?01ci Nurnc^r) (Lx-Dir.::ion Date)
('Name of Coaaamo.) Cl-au-auc:.Compac)'/PoUq- N:tmb�r) (Expirsaoo Datc)
(N2mc of CAaaactar) (Insuranc� CompauyRolicy Numbcr) CE.xp t-,ioa Datc).
(an�G�..u:�oca.l bcc.if acccu�-w a�cly�iaroccu.-ioc PcrtniaiaS La'U coo;-toz)
ao a -sore proprietor and have no one working for me.
( ) I am..-a home owner performing all Lbe work myself.
NOTE:ptesc be.mire chL..'f o bcme�o.�,,. wto.=ploy pcocs to cU �.^` =--zc o r rcpaa work oa c d..ct -F.of
not tnoct tb�L--oe�,r in -.ch 1b.u,n11oV�+uc LL'71�o,oc Lb,U j,,6�pt:SLC01-�lam+LT DUX .�IfY oc—.d.-cd to tti _
ci:pl0yc3 und.—_Lb- Aa(GLA 52 z=1(S)�.=4Ptu=Eoa by:boa=-Da fc_tip_a Pa=h rz=y«idmcc tLc
Ic-&U n---of&n==Ptoyx undcrdto Works ',C.omgomaiioa Act
I„adcsS,ad tb.A a copy of thi,m bo fo�,i d t4 rbe t3cgn tcm c of lnaa—i J Ac d..&OMo roc Ib-
coveriSe veiletioa and that L-LILm to Lc=='covcryso uxVc scc d4ou 15A of htoL 151 can Icd to Ibe LzrPi .of main=1 P—hi-
00=i.lag of a fine orup to S 1500.00 sndfcc of up w coc yc-.r.od ci a pm>lja is 6c foam of.Stop Wort;Oran and a
fuss of S 100.00 i d:.y sp,ias Mc
For dep.ru --'I u,e only
Pc7mit I`It1IDt)Cr ---
_i g perMi-- �t S is
SiEnztturr ofLi�-Cc pcM-ittcc /
y
SECTION 8-CONSTRUCTION SERVICES t
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
„ g
� � Not Applicable ❑
9.Reaisfer'ed�lforne�mc'cgverrienf.CoMi"acfor - n �;�„
Y
Co me Na Registration Num er
13
Address Expiration Dat
T _��•y�l'��' q 0� Telephone !1 d
SECTION 10 WORKERS'COMPENSATION INSURANCE AF,FIDAVIT(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....... 2-' No...... 11
1.=Vome�QnerFga
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
i
Y
SECTION 5 DESCRIPTION OF PROPOSED WORK(check altapplicable)
New House [_� Addition ❑: Replacement�pws Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (p Siding Zal-10ther[0]
Brief Description o��Pr_o
Work: p= -CU�c� � �,�n /r►R&d2
Alteration of existing bedroom Yes C/<o Adding new bedroom Yes
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa_lfrN`evu-harrse�aitdor:� tlt ti��.t�ei�tstinet=�ioas�lct�:.cort<tpEete�th�xfoticiv�FCig:
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 BEICOIIVIIPLETED WHEN
OWNERS AGENT'OR CONTRACTOR 4PPLIES 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
as Owner/Authorized
Agent h reby eclare that the stateii end aninformation 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
Signature of Owner/Age Date �,
°
'
. '
Section 4. ZONING All Informati6h 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 bldg&paved
#of Parking Spaces
(volume-&Location)
^
A. Has a Special Perm it/Vahunue/Findi ever been issued for/on the site?
,���-\ YES ��v�-� '
�� ^���l 0]N7KNOVV '
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO K ]
IF YES: enter Book and/or Document#;
B. Does the site contain a brook' body of water or wetlands? NO 0 DONq KNOW 0 YES �
IF YES, has a permit been or need to be obtained from the Conservation Commission?
'
Needs mbeobtained �� ����d �� ��(���
x_~� �~� ' .
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: /
D. Are there any proposed changes tunr additions uf signs intended forthepmperty? YES NO�
IF YES, describe size, type and location:
E. VVU8muonmmo8nnacVvitydistudb(clearing,grading,excavation,nr filling)over 1 acre orisd part ofa common plan
that will disturb over 1 acre? YES ��K l NO K l
} ~~/
/F YES,then a Northampton Storm Water Management Permit from the DPW iorequired.
City of Northampton .� w ,
Building Department
212 Main Street
Room 100 �r evatta6ilFY � �
Northampton; MA 01060
hone 413-587-1240 Fax 413-587-12727
otSrte Izfani . a
a
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
Thlls,'tectiort.16 be completed by office
-77 cq K j I/t e To �- M �k L�t LIA-
Zane Overlay DFStrrct
Elfin SLAX
strrct CB DistrFCt
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT''
2.1 Owner of Record:
rT4 P S $vim'�,.,�'� 77 C°a 1, Ln
Name(Print) Current Whiling Address:
}'e�p A P-V
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
1 3
Sign' 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 fl (by 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: r
Building Commissioner/Inspector of Buildings Date
77 CAHILLANE TERR BP-2005-0325
GIS#: COMMONWEALTH OF MASSACHUSETTS
M ock:28-046 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:replacement windows/siding BUILDING PERMIT
Permit# BP-2005-0325
Project# IS-2005-0427
Est.Cost: $14500.00
Fee: $25.00 PERMISSION IS H. EREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: WILLIAM L HAYES 136439
Lot Size(sg.ft.): 10105.92 Owner: BURGDA JAMES
Zoning: SR Applicant: WILLIAM L IHAYES
AT: 77 CAHILLANE TERR
Applicant Address: Phone: Insurance:
12 FINCH RD (413) 237-2709
STAFFORD SPRINGSCT06076 ISSUED ON.•9120104 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING & REPLACEMENT
WINDOWS/DOOR
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 Si2nature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 9/20/04 0:00:00 792 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo