17C-023 (2) r - b.1.r 'V2 06'32PM CRTC CATALYST SUPPLY HART. PROPERTIES p�
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QUOTE /f. 1La3: 1r` ,Ev j��t 4 ;1
TO. JIM HARLCW MOPELTMS
73 MAIM ST.
A►lHTi>�R'C UA.01007 Qttot;t�DA ! 76423
Due, 10.2602
CusrQmet M SM763
TEAR DOWN=ST)NG 0UMEY ON 1.3 KING AVE.NORTHAMPTON MA.AND REBUILD USM NLrW LEAD
FLASNX0.BRICKS AND FLUE.
MASON CONTRACTOR WILL DISPOSE OF ALL OLD MATHRIAL AND SUPPLY ALL NEW MATStIAL,
TOTAL 31625.00
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QUOUd=VAU br 30&Ire.
Quattem imp by, Dom=Cla
HOMEOWNER WILL PAY MAWN CONTRACTOR ONE HALF OF TOTAL AMOUNT Ole BILL WM JOB
CONSTRUCTION HAS BEGUN,RMWNiNG AMMNT OP BILL V ILL BE PAID IN FUI L WHEN JOB IS COMPLMD.
BY SION LNG THM QUOT£YOU AGM A-W UNDERSTAND ALL THE ADM TERM AND COid=OW THAT AMY
TO TIM 105.A3 i ChANGES VAT AU TOM MAM Vft3T BE Ll1SMMED PRIOR TO CCN Tl.IJ=OX AND i
AGRED UPON BY CCNTL4,CrCX AND MAY ALX AFFECT'TIME FWAL PRICE. �
A FINANCE CHARGE OF 1 i/:%(19%ANN 4L RATB)VALL BE ADD&D TO ANY UNPAID BALANCE OVU 30 DAYS.
THANK YOU FOR CHOOSING WESTM MASS. MASONS
I
To acmt q Lau don.sign here and return
147 MW692 1W.
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DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
'WORICER'S COMPENSATION INSURANCE A t tIDAVIT
(LiccnserJpermitte�)
with a principal place of businesslresidence at:
do hereby certify, under the pains and oc alties of penury, that:
O I am an employer providing the following; •workeljs compensation coverage for my
employees NVOF ing on this job:
(Insurance Company) _ — --(Policy Number) -- - (Expiration.Date)
O I am a sole proprietor, general contnctor or homeowner (circle one) and have hired
the contractors hsted below who have the, followiflg worker's compensation policies_
(Name of Contractor) (Insurance CornD2n-iypolicy Number) (Fxpimtion Date)
(Name of Contractor) (Insuranc; Compaay(Policy Number) (Expiradon Date)
(Name of Contractor) (Iwuranc: CompanyfPolicy Number) (Expiration Date)
(Name of Contractor) (Inure Comp-Ii:y/Poky Number) (Expil-zdon Date)
(attach additional sit if ncresrry to iorh d&infrxmi:ioo pcsta aing t-,all Asa dcx3)
i
( am a sole proprietor and have no one :�,orking for me.
O I am a home owner performing all the work myself.
NOTE:plc:se be aNrare that w ,lc h xr co t1m ti r, play iii ;s hn ;,Ga n ounce co:^..r,:c„-cn cr tepau�os7:on a&Nell F of
not mcec than throo unite in which the larm—Dunccr midna or oa tab-pcu s aprurtcnaat thereo erc r>,<ccrxrally cave i red to be
cavloyrrs under the workce:t ce c satim.old(GL152,=1(5)),--fT- a ion by a homoowncr for a lice z,o<sonnet r:.•y CNidcnec tho
legal stnnha of an employor under tho worka't CompcCn.tioa Ad_
I unacrs d that a oopy of this slrtcm mAy bo forwrLd«i to tho Dcpart,rr of rndx ial Ac6& &Oflioo of Ir.•ucincv for tlho
coverage vezifieation nru5 flat failure to rxttrc covctngo htztd:r scciictt 25A of 2�1C}L 152 can lead to the imposition of criminzl penalties
coalutiag of a f oc of up to S 1,500.00 and/«irnPrisoarrx of up to on-)'car ar..1 civil prnalties in the f—of a step well+Ord--and a
fim 0(5100.00 t day&Pm:,A mc.
For d4=Itm rfal uio only
Pcrtnit Nttmbe_r oua-
Ouy-� Lot#
of csee/Pcrmittce �
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder —
License Number
_--
Addr Expiration Date
S ature Telephone
° yyew 9w,.P-ra ., .: o-c*_. k po-Ra
9 Registered Hom61hiprOvement-Coritractor, v�} Not Applicable ❑
Wesl erAl' -, Wf I33 a3`l
Company Name Registration Number
Address Expiration Date
Telephone S�u l X31
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...... ❑
1�1:yy ,�I3ome ®.wner�.Egemp.f><on
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 buildiniz 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 fo-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 [ ] Decks [ ) Siding [ ] Other [ ]
Brief Description of Proposed Work:
Alteration of existing bedroom Yes - No Adding new bedroom Yes No
Attached Narrative O Renovating unfinished basement Yes No
Plans Attached Roll 0 - Sheet 0
sa:If NeW..house atid:.or giddition to existing housing, c6mp1ete.the foJ1dWing_
a. Use of building : One Family _ Two Family.-------- Other
b. Number of rooms in each family unit: _ Number of Eathrooms
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
R. 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 O. CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize _to act or
my behalf, in all matters relative to work authorized by this ;wilding 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.
Print Name
Signature of Owner/Agent Date
T �
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 Parking Spaces
Fill:
volume&Location
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: --
a L
i}ylof Northampton Statusof4Perrrttt �;
rid ` Q2 9y,Ijiing Department CurbCut%Drveway
Nov 2'e21 Main Street Sewer/SeptrCA aflabl _ ."
J
Foom 100 Water Wel Avalabtl �
L OF su;t.wr I`', A thatr�pton, MA 01060 Two Sets of4SM c ral R a s
N�R1rt "r t` 240 Fax 413-587 1272 Plot/Safe Plans
Oth'er,Specify
APPLICATION TO CONSTRUCT, 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: / /7'
A Lip, `Map` Lot Unit
-�� . � Zone OveriayDis#ric#
OJ A-101 EImSt. District _ CB District
CSECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
7
2.1 Owner of Record:
Name(Print) �,:r nt Mail nc Adaress: ----
Signature
2.2 Authorized Agent:
Narne(Print) r Current Mading Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) stimated Total Cost of /
Construction from 6
3. Plumbing -_-- ----- _ - Building Permit Fee _
4. Mechanical (I-IVAC)
i
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
fig . _ �, BP-2003-0555
G1S#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot:-001
Permit: Buildin£
Category: BUILDING PERMIT
Pern-ut# BP-2003-0555
Project# JS-2003-0909
Est.Cost: $1625.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin WESTERN MASS MASONS 133234
Lot Size(sq. ft.): 17119.08 Owner: SHEBEK PETER M JR
Zoning URB Applicant: WESTERN MASS MASONS
AT. 7 BARDWELL ST - 1.3 KING AVE
Applicant Address: Phone: Insurance:
147 MIDDLE RD (413) 540-1959
SOUTHAMPTONMA01073 ISSUED ON:1216102 0:00:00
TOPERFORM THE FOLLOWING WORK.-REBUILD CHIMNEY FROM ROOFLINE
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 12/6/02 0:00:00 1403 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo