11C-026 (2) t
PROPOSAL
Jesse C.Montgomery - psA�Noy
JCM Home Improvement.
46 Oak Street SHEET No.
Florence,MA 01062
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME ADDRESS
" e. iT)
ADDRESS
DATE OF PLANS t(
AC 7 101
PHONE,NO. r AR ECT
We hereby proposed furnish the materials and perform the labor necessary for the completion of a,V J C t`1 �7"�"
Ct
V!`! /IJCr'I+j rr gorc- C{ SIC Y
1_/X
x_ . ,---
,..-•�
i-1 G d l•. t �. .';r.. 1...,: l./t S !. - .—,q( M
/ r
L i r.:_ 1 Y �" ("r Yb"]l'1 c:� r` 4 l �! r-+,:,e, ! L s✓ /t 1.
t \ A v Il_'LA,,.
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings, and specifi
cations submitted for above work and completed in a substantial workmanlike manner for the sum of
Dollars ($ _ )
with paymen s to be made as follows 'r
r^ `
i
e
Respectfully submitted I `�` 4 1 :•t _ 'i
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per q -1f: '
over and above the estimate. All agreements contingent upon strikes, ac- 4•.
cidents,or delays beyond ur control.
2, Note—This proposal may be withdraw,
i > by us if not accepted within day
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the wo
as specified. Payments will be made as outlined above.
Signature �*
Date C��. � �t.° Signature
C 381850 PROPOSAL
MADE DE lN IN USA
L6
X5
Cb
' I
it
i
I
- LIB
1
i
II
II
I
l
I '
I
it
11l
lil
I
I
III,
I
i
<z
U4 CC"
ff
1
. I j ! � ! I � i' I I �
lit
113 '.
n� '..
wil
771,
n
�\
.b
H
a.
,
S= } r
T
fl
� 6 ��rsaxchtcsctte'
'm DEPP.�?TML'VF OP BUILDI]�G INSPECI'10NS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S CONIPENSATION INSURANCE APMAM
(h ccnscrJperm i ttec)
\lth a principal place of busiuessJresidence at:
(phonef#)
(strt"Uci ty/state/zi p)
do hereby certify, under the pains and penalties of penury, that.
( ) I am an employer providing the following workc�s compcnsauon coverage for Iny
employees working on this job:
(Insurance Company) (PoI C7' (Fapiration Date)
O I a-1 a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the coltuensation policies:
(Nerve of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Numt,2r) (Expiration Date)
(Name of Contractor) (Inawanc'� Comp'myiPolicy Ntuvber) (Expuation Daze)
(Name of Contractor) (Insuuance CompaIly/Policy Numbu) (Lapirztion Date)
(em azh a<i it on al slxct tfnca ry to include inforuU!ion pcstaining to all om7adoa)
(",/I am it sole proprietor and have no one working for me.
O I am a home owner performing all the work myself.
NOTE:please Lx nwarc that w ile iocncowixtz wt�o auploy pc zom to cb jrac cuncc'co r n cs repair w o on a d icll rig of
not¢tore thin thtco units in wf�ch the hanxonvcr residcs or oa ttie you xh,ppur nAxli tl"do ere rte(&malty ooasickrc to be
czploycs undo the worker's ccx�ica Act(GL152,a 1(5)),nppticztion by a homcowDcr for a ticrnx a Permit may cvidcmc tic
legal antra of an employer undertho Woricocj a Ccttnpomati Ad
-
I uadcrrtind that a copy of thug ctatcmcut may bo forwarded to the D,:V rtr:r sf of d Ac &=lfy OfEi of In`+`r'°`°for ti'
coverage va cafioa and that failu=to segue covcmgo umk-r scctioa 25A of INIQL 152 can Icad to the imposi m of criminal Pcaaltics
eoaustmg of a fine of up to S1,500.00 acrlfoc imprisoaaxat of up to one yw a ri civil penalties in tf-f—of a Step Work 0rde-z and a
fine or:S 100.00 a day a&ticast cnc
fFor Sg3ut m��uie only
/ _ permit Number
Lat#
Si ` of ermittm e
SECTION:8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : MCCA kulm e 1^11 07 7,4-//0
License Number
q6 e,-xc 1421.0i 12�013
Address Expiratio Date
AVA
Signafv Telephone
9
Reif sered;'Home:Irrtprovement_Contractor
W b a _ ae. . .� ,. .�. Not Applicable ❑
Company Name Registration Number
Address Exp,ration 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 issuance of the building permit
Signed Affidavit Attached Yes....... ❑ No...... ❑
Home,Owner xExem`pt>ion
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 y
SECTION 5- DESCRIPTIOWOF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding [ ] Other [ ]
rief Description of roposed Work: i ltl ' . lA" A wS Q 7 e t.S' r«� °�rc13 ` /y,
A ration of existing bedroom Yes _ No Adding new bedroom Yes No
Renovating Attached Narrative Cl g unfinished basement Yes
Plans Attached Roll 0 - Sheet
sa.If"New h'ou"se=and',or`additio o existing housing, com leteAhe followiii
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.
Signed under the pains and penalties of perjury.
JP int N We gna 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 Joe
Frontage
Setbacks Front if 0
1
Q
Side L: �� R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
arkin )
#of Parking.Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Findi ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the 7tr 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. Ar ere any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
MW
r �
orthampton Sa�tu�s ofP it
it I Department Curb-Cutlpruewa
a i n Street SewerlSep�IC A ai
?t�!fort om 100
VVa�rlWell Ava Jab a "
SEP 1 ton MA 01060 T o Sets of S roc ra any �� ;
7-1 40 Fax 413-587-1272 Plot/Site Plans
DEPT OF BU INGINSPECTIONS OtherSpeclf 5
NORTKAmii YA 01060
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 Pro pert ddress:
Map Lot Unit
5 Cpl osly Zone Overlay District '
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name :rrent Mailing Ad 6-e,ss: –7
( t) -- L — ! �� —
Telephone
Signature - --- —
2.2 Authorized Agent:
I Name rint) Current Mailing Address:
Sign ure Telephone
SE ION 3 -E TI TED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
om leted b ermit a licant
j 1. Building tJW (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 = (I + 2 + 3 + 4 + 5) I .Check Number
This Section For Official Use Only
Building Permit Number: ez Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2002-0308
APPLICANT/CONTACT PERSON Jesse Montgomery
ADDRESS/PHONE 46 Oak Street (413)585-8482 Q
PROPERTY LOCATION 4 STOWELL ST
MAP 11 C PARCEL 026 001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
Typeof Construction: CONVERT 10 X 14 SCREEN PORCH TO 3 SEASON PORCH
New Construction
Non Structural interior renovations
Addition to Existing_
Accessory Structure
Building Plans Included•
Owner/Statement or License 077410
3 sets of Plans/Plot Plan
5 THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF MATION PRESENTED:
Approved Denied
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commi
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
r
4STt)1MI,ST BP-2002-0308
GIS#: COMMONWEALTH OF MASSACHUSETTS
:
; i: 11C-rigs CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Catecory:Non structural interior renovations BUILDING PERMIT
Permit# BP-2002-0308
Project# JS-2002-0468
Est.Cost: $7000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JESSE MONTGOMERY 077410
Lot Size(sq.ft.): 8494.20 Owner: MIENTKA GISELE M
Zoning:URA Applicant: Jesse Montgomery
AT: 4 STOWELL ST
Applicant Address: Phone: Insurance:
46 Oak Street (413) 585-8482 ()
FLORENCEMA01062 ISSUED ON.91211010:00:00
TO PERFORM THE FOLLOWING WORK:CONVERT 10 X 14 SCREEN PORCH TO 3
SEASON PORCH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Lb
Footings: QI 14"
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 9/21/010:00:00 1058 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo