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02-019 (8) Vim I Sidinr wipdo"'s Corbett Home Improvement R, ,,f III: i! Aft D :I Northampton, MA 01060 AWill"of, ll�s (413) 584-6571 Gomm 7 47' 1111 r, I B N1 T'M-r n To PATF/t/0'/ 22— o -Z- lltl��1?4771 f r, 1143 1 1( MON DATE(IF PLANN herchy suhl specifications and esonimcs for 4 t ,4L L- ' j�zz,vola�l t 000le 7N/,+i Cov, L -J �7) 4 F1 f c: c,,a L gc4Lo— s -4n rQec-QcL,-Q— E�ec+g-,,c Boxes ]),JS+p,4—L Ld hwm 1 6,) "10/0 W WC J rOPOSC hereby to furnish material,ITI(l lahm-collil III acolrdance with the aN)ve specificruums,f(irfltc sum of 1)-3 bfl"'os,7— \J �.,unrnol is y�uar,mteeil f to be as specthed All work io he c,mrlcted in;i w,rk-like in;mnrr i-,rtfm Au(tiori7xd AnY altercations or 0,,iotmil Irmll jJ,-, r,( InVol"Mg lXlr;l Coll,will he j S I gha I tre K�Med n),ur-n-ril en� dtfs,jnf I w0)becomr;m rx I r� (1jrgv over and oh,vv the All IM,le: Pus prol may be .,ereentrn L,conringrnt upon.strikes,ecci,Irna„r drlaVS hr v,�n1!,cur u,ntr,�l f)wore,,,r.,n�tire,nvnaq„Ir nrerssa 11"I'Lir-am, Our workff,are MIN,c,"tred by W„rkffwn ln,urimcc with(Irawl,by us if 1-t.1cceric-,WjjlIIII days � Cccptclticc m,C,ndttl"w are san"facu-'ry and are hereby accepted. 'i',11 are jul(litti-17c(l I,, Sigiialure- 11'r hate.d—'rkno,sjeclrled, Paylliellt will be Illadcla.,() Acceptance: C) Signature ¢SttAMp�, fia 835 AC4 ills rtt5 DEPARTMENT OF BUILDITiG INSPECTIONS INSPECTOR '212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT 4.a The State of Massachusetts allows the homeowner the right under 78OCNM 108.3.4 to act as his/her construction sups:%,iIsor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two fami -- divelling, 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 I I i UI Cf .Tort llalll})toil W o DEPRTMENT OP DUILD01\,G INSPECTIONS 212 Main Strcct Municipal Building 1_ Northampton, Mass. 01060 I WOTUCER'S COMPENSATION CISURANCE Al�I'D�AATj-I- \vlLb a pnicipal place Of bUSIOCSSfFCSidcncc ar. -- --- - y K�2-'L) S Nd 0 (phone:') ,S�By b�7f SQC t/C7t1/SI31LlZ]p) do hereby certify, under the pains and penalties of penury, -rat ( ) I am an employer providing flit following \ oricer's comoens-�jon cove�-2�e fof In, employees worming on ties job: ja5=-�= Comte) (Petit: ? -ter) --- (T :-pirz on DP-) ( ) I am a sole proprietor, geaeral contractor or homeow-oer (tide one) Lod have hired the coosactgr�s listed below wbo have the follo% 'S worker's camoe )aaon pcLicies: +II1I): Oi CO.^'^Cio"1 �jRR 7il CUtlD17)'J2 GIJC{ ?IUII1 C;) r_>:;)1i�L•^1 Dmc) - (Namc of Coocmaor) (lnsurzne Comoaati/Polie `tLncrs) (Expiration Dare) (Name of Coluraetor) (tnsZU-dne:. Ccmzan�•/Pot;c�' t�ib=rl (E�Pir tse� Date) (Namc of Contractor) (IAsuraacc- Comcarfy/POLicY Numbs) (E.xp r-,jo❑ Dart) (atut'�_A!i�oc�l c�.ifoccci,�-w c�'u�inforw.-'ion p._--u inns to.iJ mas-LO;�) I am a sole proprietor and bave no one worl;Dg for me. ( ) I am.a home owner performing all the work myself, NOTE:plea be cor e[>=c:..t:Dc tic vcr��t>o ax�lay DCioai to cr.:e.,00 c rgau +oric w.d..cl!_�of a.ot mete than L`srr-—0 in-!Dab the bornoo rncr reFid.a a ca the Qoua.-�,zapu.�trn_r;tbeco c-r we C,a:�1y oc�:d--c]w t� c�xploye-�ur -c the -=P---'-oa A,=(GUI 52-,.1(5)�:- LCIZoo by.hom�Oavc fee a bc.�-=a permit cry c.-rd=>oc LLB IcpS ctsS.of en-=Ptoy.c u &d dw W--k-.Gomp-om.y>oa?-I- I undc-rtvad�(>Dopy oI lhi.mtcmmi may b.fo.-+.girded to tb.p ,t aC tnc6ay.+ie1 r�ceide4�'QQoe oC I.�a+r�foe th. oovense vezjr-r_gjoo�Iltt C_ilut�sraz.+e bovrrase under soaion 23 n nr 1,tOL I S2 na lad to the�x?ozit�m orerimiasl peniltio camir..ixzu o(a fine aCup to 51300.00.rd/oc o(up w Doc year cod a�i1 pcn.lti r�ro tic focm o(a Slop WorE Order..ad. rim oCS100.00.ay cp.in9 me (j For b�.ruz���1 ux only 1�L7p: Lot SiPIZL-Irc of Li SECTION 8-CONSTRUCTION SERVICES f 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �it%/4„ ie U l�Q�iT� (, 6 V) 1�lJ License Number L4 5-� �AnplvtJ o oho y- 3- 0(S Address It Expiration Date /^^ (P 5 Signature Telephone 9 Reatstereil Ho'me"9iipiovernent=Contractor kirr �z � '=+ a ''b Not Applicable ❑ o r ee/a m vP-Ihef✓-- ZA0 669 Company Name Registration_N�E um e-�---""- LJ 1C!e e(, ' /,5--C iO Address _ Expiration Date /- Telephone_ 41—VJS%/ SECTION 10-WORKERS'COMPENSATION INSURANCE'AFFIDAVIT I(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. I Sioned Affidavit Attached Yes....... 1Y No...... ❑ 1 11*~���fHom�.O�w.:n`='e>r~F��ernptia 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-vear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Officials that he/she shall be responsible for all such work performed under the building permit. A.s 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.. SECTION 5-DESCRIPTION-OF:PROPOSED WORK(check-all-applicable) New House ❑ Addition ❑ Replacement Vyindows Alteration(s) ❑ Roofing ❑ Or Doors CA 1 Accessory Bldg. ❑ Demolition ❑ New Signs Decks [[] Siding ([ Other[01 Brief Descriptippn of Proposed ` / W ork:SV_5{oaf( —4�lf t1�r� I w oty $f 4-t,L \l (6& ( .S! Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet R_zesx" "!!F- S. •4`-'tNYFa�3P""" 3 c'y.`: z,u..sT �:� t .'"." .r.. .�'•a ?�-+ �.,r <7r i"nvpr z3- 'x,24:. sa if New"K01 ase n��o�acl�dit,o ,11"exlstln4liou'slng:_comptete..the�olloiring: 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 APPUES'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 I 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 ax Signature of Owner/Agent Date Section 4. ZONING All Informatibh 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 I Frontage i Setbacks Front Side L:` R:F L:' R I � I Rear �-- Building Height Bldg. Square Footage r� - I % Open Space Footage �-�1 % (Lot area minus bldg&paved parking) #of Parking Spaces I I Fill: I Il (volume&Location A. Has a Special Perm it/Variance/Fi rkdingever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW Q YES 0 IF YES: enter Book j Pag6 j and/or Document#1 } B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 Q NO IF YES, describe size, type and location: ' D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingyeZSpvation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES NO (^ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. gf� a u g u I Department f t �Oain Street i l l 1i om 100 rA SEP 2 1 LO I ort on; MA 01060 phone 413- 87-1 40 Fax 413-587-1272 li APPLIJ-dAt'&'A'�& ffi UCT,-p LTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING R SECTION 1.--SI7E--JNFORMATION a's « Thts sect on to<l�e;com )ddb 4-office�� 1.1 Property Address: n s G /'fy/A-y/ y'Jy/y���( IUM �J /,�/�/Y�i/ {, ��..p^,C..,,�at�'1n tg"'�a4 Yi-'" '2 •��"`R '�nat�°�,'�`t�" +F. .. ss i SECT[ON,2'-PROPERTY. OEFl NEIF SHIPIAUTHORIZED AGENT 2.1 O ner of Record: 9 h I e Z'ZZ wo 6 M-1 0—'� Name(Print) Current Mailing Address: Telephone�� Signature y 7 2.2 Authorized Agent: F GJ�aR�J T C'oRr �— �j�Z y �i PPc� sf N 40/\. Name(Print) Current Mailing Address: 71 Signature Telephone SECTION 3'-ESTIMATED'CONSTRUCTfOWG' OSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)':Building'Permit Fee 2. Electrical (b)-Estimated Total CosYof Construction from 6" 3. Plumbing _Building,Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3 +4+5) Check'Number TFiis Section For Official'lJse'Onl Building Permit Permit,Numtier .I'ssoed: Signature: r Building Commissioner/Inspector of Buildings Date 589 NORTH FARMS RD BP-2005-0332 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:02-019 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-2005-0332 Project# JS-2005-0438 Est. Cost: $7925.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot SizeSsa.ft.): 128937.60 Owner. CORBETT LAUREN A Zorir ;R .Applicant: Ed Corbett Jr AT. 589 NORTH FARMS R Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON.9121104 0.00.00 TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING & REPLACEMENT WINDOWS 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: Insuiatiun: Final: Smoke: Final: O tr THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATI OF ANY OF ITS RULES AND REGULATIONS. e Certificate of Occupancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 9/21/04 0:00:00 2407 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Corrvnissioner-Anthony Patillo