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17C-113 Troposa! 9EPJ— -00Z Vinyl Siding Corbett Home Improvement Roofing Northampton, MA 01060 Awnings (413) 584-6571 Canopies / Gutters / Shutters PROPOSAL St.IBM[7TED TO C�j ^ 'ei✓e �� PHONE V J 63 9-3 DATE 020 Q STREET S' JSd/v ,7(/'�i JOB NAME '�- �eCfTY,STATE,aal ZIP CODE JOB LOCATION DATE OF PLANS lO6 PHONE We hereby submit specifications and estimates fix: Veld /©ue4 -111 b'V- o0/C S ��✓ (c S. GCr t I repw e_ I VA-//e ",T wQ 9 Iropose hereby to furnish material and labor-complete in accordance with the above specifications,for the sun of: ? Dollars($ �✓ �a ) Payments to he made as follows/I/,, All material is guaranteed to he as specified. All work to he completed in a work-like manner according Authorized to standard practices. Any altercations or deviation from above specifications involving extra costs will be 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 proposal may he and other necessary insurance. Our workers are fully covered by workmen's Compensation Insurance. withdrawn by us if not accepted within days. ,acceptance of Troposal-The above prices,specifications are conditions are satisfactory and are hereby accepted.You are authorized to Signature do the work as specified. Payment will be unde as outlined above. Date of Acceptance: AA" Signature 0:=T0 / 0� Gl it� Jaf wart 1Ja111ptell �RSf RC{1RSCIIS DEPARTMENT OF BUILDDT G INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licensee/pezmittec) with a principal place of business/residence at: cd S",f AJ -�(Ow p'l (phone#) (street/6 ty/sWd2P) do hereby certify, under the pains and penalties of pegtuy, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Date) O I am a sole proprietor, general contractor.or homeowner (circle one) and have hired the contractors fisted below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expimtion Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compaay/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach adriticaii s.>xct fncccnuy to ioc}ude information pertaining to all ocrr'ractors) i I am it sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that vii o homeowixrs who employ petzom to do maiutcaance,co:r actioa or repair worst on a d A,-l g of not morn than three units in winch the homeowncr residca oc oo thr P.Tnttr><;.s zppurt,t tai thG cto a not Ca)a-illy co¢sidcrcd to be eazployrrs undo the work&s ocsr�on Act(GL152—"1(5)),application by a homeowner for a ricer=or permit they evident the legal tutus of an emPloya undcrthe Wockoet Cotnpmsation Amt I understand that a copy of this ctntcmcot may be forwarded to tho Dcganmcnt of I'd iL�ial Acadazt�offioe of lnsursoco for the eovaage vcrificltioa and that failure to&tarn coverage under scctioa 25A of MGL 152 can Icad to tha imposition of criminal pe &WCS oomisting of a fine of up to S 1,500.00 and/or irnpriso:mcnt of up to one year and civil pcnaltia in the form of a stop Work ordtr and a firm of 5100.00 a day against me— F,,dcpzrtu eli use Drily Permit Number Lot Signature of Lice:nsceyperrnittce e a SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : a License Number iiv- ,3 o Address Expiration Date Signature Telephone efred�me ement�gntrctor �"" "� " Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 issuanci of the building permit. Signed Affidavit Attached Yes....... No...... ❑ {11. ame.OvvneExemptn The current exemption for"homeowners"was extended to include Owner-occupied Dwellinjzs 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(ch#ck�all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ DemolitioDemolition[]n ,,, New Signs [ ) Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed WorkAhW Q l,f�i✓i v} f,� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 . Sheet 0 6a "l fxNewhousexancior7aidition".to'existmg.hdusng, complete tlie'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 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. Signedy nder the pains and penalties of perjury. Print Name Signature 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 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: t "£it of Northampton S i L i�ding Department ° I_., r 12 Main Street li - �^0? Room 100 a a U�'- or h mpton, MA 01060 Sets A a A I phQne_ -58 -1240 Fax 413.587-1272Plo IdS�te � nF"IltiiNG INSPECTIONS Qt1 r Spe i �a D.. ," FPL ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This sectior`to be dompl&,td_43 by office 1.1 Property Address: LAP MaP totem Unit Zone Overlay Distnct� t - Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED'AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone S`��- / 307 Signature - 2.2 Authorized Agent: ca Y A4 Name(Print) 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. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 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 1 44 STILSON AVE BP-2003-0019 GIs#: COMMONWEALTH OF MASSACHUSETTS Map.-Block: 17C- 113 CITY OF NORTHAMPTON Lot: -001 Permit: B u i I d i nQ' Category BUILDING PERMIT Permit# BP-2003-0019 Project# JS-2003-0048 Est.Cost: $3300.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor., License. Use Group: Ed Corbett Jr 116069 Lot Size(sq.ft.): 11979.00 Owner. BENEDISUK MICHAEL S&JEAN L Zoning.URB Applicant: Ed Corbett Jr AT. 44 STILSON AVE Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MAO 1060 ISSUED O)V:718102 0:00:00 TO PERFORM THE FOLLOWING WORK.-SHINGLE ROOF OVER 1 LAYER 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:0 K ;7, /l, p THIS PERMIT MAY BE REVOKED BY THE CIT F NORTHAMPTQ.N UPON VIOL ON F ANY OF ITS RULES AND REGULATIONS. "'' Certificate of Occupancy Si nature• Fee Type: Receipt No: Date Paid: Check No: Amount: Building 7/8/02 0:00:00 1653 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo