17C-129 (8) OWNER-CONTRACTOR AGREEMENT
Northampton Housing Authority
I ti t aoOy �� �
This Agreement, made this/5 day of 'T0ber,, " v
by and between the� on � An Housing Authority,
hereinafter called the "Owner", and hereinafter called the "Contractor",
Witnesseth, that the Owner and the Contractor, for the consideration hereinunder named, agree as follows:
Article 1. Scope of Work//: The Contractor shall perform all the work required by the Contract Documents for
64 - I B lP prepared by /W t'' a weys�c�y� �A00S1v\G A%A!1 acting as, and referred to in these
Contract Documents as the "Arehiteet".o�e.T
°—
Article 2. Time of Completion: The Contractor shall commence work under this Contract on the date specified in the written
"Notice to "Proceed" of the Owner and shall bring the work to Substantial Completion withincalendar days of said date.
Damages for delays in the performance of the work shall be in accordance with the Conditions of the Contract.
Article 3. Contract Sum: The Owner shall pay the Contractor, in current funds, for the performance of the Work, subject to
additions and deductions by Change Order the Contract Sum of:
ev���OySla-N6 - �yC_\A V,^T�_q---& dollars($ , >00
Article 4. The Contract Documents: The following, together with this Agreement form the Contract Documents and all are as
fully a part of the Contract as if attached to this Agreement or repeated herein: The Invitation to Bid, Bidding Documents,
Contract Eorms, Conditions of Contract, and Specifications; the Drawings; DHCD publication known as the Construction
Handbook; and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the
Conditions of the Contract shall have the meanings designated in those Conditions.
Article 5. Alternates: The following Alternates have been accepted and their costs are included in the Contract Sum stated in
Article 3 of this Agreement: Alternates No(s) e
Article 6. REAP Certification: Pursuant to M.G.L. c.62(c), §49(a), the individual signing this Contract on behalf of the
Contractor, hereby certifies, under the penalties of perjury, that to the best of his/her knowledge and belief the Contractor has
complied with any and all applicable state tax laws.
Development.
In Witness Whereof, the Parties Hereto Have Caused This Instrument to be Executed Under Seal.
*CONTRACTOR OWNER
me of ontrnator ame of ousiag^tnnonty
S4A ,, le MA BY: _
ress flamean
BY:
ame and Seal
Witness: + t J V9W/W1�/Jtw� Attest:
* If a Corporation, attach a notarized copy of the
Corporate vote authorizing the signatory to sign Contract.
NHA
OWNER-CONTRACTOR AGREEMENT
$1,000-$9,999 Page 1 of 1
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DEPARTMEI-rr OP DUILDD\G INSPPCTio? s —
212 Main Street ' Municipal Building,
Northampton, Mass. 01060
`VORXIR'S COKPENSA-MN, CatSUR -NCF Al, , A�rlj- .
-
1�,'a-�-�-p(-1�G�-p3�--p�-dr� nfhiici�PC�fIrTC���I:— _ .
( ( city/st=/zip)
do hereby cerdi ,, under dic p?-M' --ad penalties of perJury, :hat
6, m an employer providing die followinL ��-orkcrJs comocnsado , covemsC 'or lny
empiovecs worljng on this job`
l'
(Insur-� onr�v) (Polk:Nu.aubcr) (T_:piralior,Dar^-)
O I am a sole proprietor, general contractor or homeowner (ci:cie oee) and have hired
the coouactors listed below wbo hive the ;o[lowing workers coLoensadon pcticies:
(i+Illll. 0. C -.l:�ctorl (InRranc.c COIADIT7)'/PGhCi ?�ti1Q1^r7) �'-Jlij:3on Date)
(Name of Contractor) (Ins-aranc°. ComDao-wPolier Nunccr) (E.D rziion Date)
(Name of Connaci ) (Lasuranec Compan)•/Pol-q- Number) (Expirs000 Dale)
I
(Name of Contractor) (Inure-- Company/Policy Number) (Expiration Date).
(nlliG?] :ior�.l zSoG ifaoc�csiry co¢icu�mfbc=v600 pcnaiaing to.L
O I am a sole proprietor and bane no one woridng for me.
( } I am-a home oNvner performing all the work: myself.
NOTE:ple_sc lx ew^ue ttii�+•t Jc bemc .avcta w.bo cmplay p=aw eo do�x:•-+,-. o-,x cas,:wx0 Cr MPQir work w.d-• Il -g of
DU(@OCL ll_.D(7V.t-11•J la It.�y� Q�j�IX 00 LbC(�'W�G]2�plitleiL•t1111CG'D LT oo(COC-.tlly o- r.d=to be
oitploycs un,e ttx cc�-a Act(GL1 k-=1(5)}•npptiation by n bomeoaD=fcr e Gem_oc Pamh r=y eridm d--c
Icg21 n-n.,of as—Ployx uod<r d1 work: e,cocpooaaZioa Amt
1 undartaad the a oopy or t6i.—'—may bo to cbo Dcporimcat of l d—c id Acu&.&om—or Itcur•aoe for th
oovc�veilc='ioa='d that Liltae to t00=)=vcrnse uadcr 3.o ioa 25A of MOL 152 as led to the tMPOS600 of cimioA pcaillico
ooaux,xZ of a fuK of up to S l.5o0.00.rWcr ijmisoom¢ orup to ooc yvr e-nd avi1 pavltia.L,form or.Stop Wort Ord-end a
ru=0(5100.00.(i'-y apiaa me
r. For only
�UL -- Perm it Number
map.,__ Lot Sigpa of cUcc e J •
Y
Version 1.7 Commercial Building Permit May 15,2000
SECTION 1,0,'S ItUCTCfRAL BEER REVIEW(780 CMR L1011)
Independent Structural Engineering Structural Peer Review Required Yes No 0
SECTION'11;.`OWNER AUTHORIZATION-TO°13E COMPLETED:_WHEN`'
OWNERS-AGENT,OR CONTRACTOR APPLIES-FOWBUILDING PERMIT
I {
as Owner of the subject property
3
hereby authorize 'to
act on my behalf,in all matters relative to work authorized by this building permit application.
I
Signature of Owner Date
I, E 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.
{
i
Print Name
Signature of Owner/Agent Date
-SECTION 12.-CONSTRUCTION:SERy10ES ,
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:! I
{ License Number
Address Expiration Date
i
Signature Telephone
SECTION 13-WORKERS'COMP.ENSATION INSURANCE"AFFIDAVIT,(MG.L..c:1,52,§2?C(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.
Fs-ignedAffidavit Attached Yes 0 No 0
r
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESS10Ni4L DESIGN AND CONSTRUCTION SERVICES FOFtBUlLDINGSAND STRUCTUREStJ�tECf`:TO
CONSTR UCTION CONTROL PURSUANT T0:780 CMR 116COT17 AWING MORE TH3ANr35;OOQ ENCL05ED SPACE)
9.1 Registered Architect
Not Applicable ❑
Name(Registrant):
tRegistration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
1 �
Address Registration Number
Signature Telephone Expiration Date
€ I
Name Area of Responsibility
l I
Address Registration Number
Signature Telephone Expiration Date
t {
i
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
I
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable❑
Company Name:
Responsibl In Charge of Construction
Address ` r,
e —J
Signature I T 1 phone
� A -
Versionl.7 Commercial Building Permit May 15,2000
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
i ii
Frontage
Setbacks Front
Side L:' R:= Li i R: =
Rear i
But7dg HeIgIff
Bldg.Square Footage %
Open Space Footage % --€
(Lot area minus bldg&paved
arl in )
#of Parkin Spaces
Fill:
(volume&Location) I
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued: i
c
IF YES: Was the permit recorded at the Registry of Deeds?
NO "0 DONT KNOW 0 YES 0
3
IF YES: enter Book I Page! and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
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 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 ` NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version l J Commercial Building Permit May 15,2000
SEETION4- CONSTRl1y�LONSEt1;ESfOPROJECTLESSTHAN35,000
G1uBIGEETOF 1=NCl:QSED
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs El Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑
Brief Description lEnter a brief description here.
Of Proposed Work: J�?CG' � ch: ���1 N �'fC'1 S�c
.SECTIONS USE=GROUR�'ArID�ONS�RU'C1�Ot±lF.�YPE�w -� ,, ,
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A,1 ❑ A-2 ❑ A-3 ❑ 1A
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ _ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H Hi h Hazard ❑ 3A ❑
1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility Specify;
r
M Mixed Use 0 Specify:1
S Special Use 0 Specify:
9 _
COMPLEFE TINS SECT IOI�fFFXISTING BUILDING UIDEkG11G=RENQ�ATfONS, #DD I ftC)NS AiVI]iOR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34):1 Proposed Hazard Index 780 CMR 34): i
SECTION 613UILDINGIEIGI�TAWDAREA, Y
r _...,a. ��. ���y a •�x �, -try -,.,
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION s4=
Floor Area per Floor(so
1 St 1 St k
2nd 2nd
? >a+
a
3r0! b! 3 ;
4
to
4m # i 4 � -
Total Area(so I F Total Proposed New Construction(so i+ T
AWN-
Total ' 3ytt.w,
Height(ft)
Total Height ft I
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Information: 7.3 Sewage Disposal System:
Public ❑ Private F] Zone`�� Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Version 1.7 Commercial Building Permit May 15,2000
,n �J City,of Northampton
Building Department
r X12 Main Street
r >n
Room;100
Northampton, MA 01060
phone 413-58T-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
'SECSION_.�_SI7E"INFORMATIOI�C`
-
-"-Property-Address:
'M k Tf is ectran t ie cocnpLetedb office_
lVt�f I' its'
!:(rvi
Oask
O�+
U�rerfa} Dtstncu '
�4 Lq�'/ �' i •.. �Qtstn• " ��aCB D4sfric� "�°`� °T�"�}`,*`s.
_'SECTION 2 PROP OWN__, S P! UTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
F
{
Signature Telephone
2.2 Authorized Agent:
I I
Name(Print) Current Mailing Address:
Signature Telephone
SECTIOt+3-ESTIMAT'ED•CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be 0fciat";Use 1p
/completed by ermit applicant
1. Building } Via)Building l?&Mlt,Fes i
2. Electrical ! (b)Estimated Total Cost of`
_. _ Construction from 6:,
3. Plumbing s Bmldirtg Permit Fee
4. Mechanical(HVAC) I }
5.Fire Protection
6. Total=(1 +2+3+4+5) Check,Number
This SectionFor OfNc aCase�n9
Buildu1gkP.ernaWX--ter• "`Date
-
r
Signature:
Building Commis''siorier%Irispecfor of Bgildings Date
• y
137 HIGH ST BP-2005-0534
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 129 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-2005-0534
Project# IS-2005-0702
Est.Cost: $10500.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: M D M ENGINEERING INC 072493
Lot Size(sg.ft.): 125452.80 Owner: NORTHAMPTON CITY OF
Zoning:URB Applicant: M D M ENGINEERING INC
AT. 137 HIGH ST
Applicant Address: Phone: Insurance:
51 SAWMILL RD (508) 949-1616 WC
DUDLEYMA01571 ISSUED ON:10129104 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 Sisnature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 10/29/04 0:00:00 3164 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo