17A-224 (7) y��
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PROPOSAL
Jesse C.Montgomery eR°n°sAL MO'
JCM Home improvement SHEET NO.
46 Oak Street
Florence,MA 01062 DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT
NAME ADDRES'
Ct fY7
ADDRESS h
E/V�
DATE OF PLANS of
PHONE N ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of t"11
e-
n i" a f°
cx�f rtC £ey `
All material is guaranteed to be as specified, and the above work eo be performed in accordance witP5.the drawin and speco-
ca ns s bmitted for above work and c mpleted in a substantial workmanlike manner for the sum of t ve itrta
!. .¢. �n ��r 4 i~►7 i�°r Dollars ($ I "�-
with payments to be made as follows. j(, lD cry) ' ' =E' c,� � '`D
Respectfully submitted -'
Any alteration or deviation from above specifications involving extra costs ' f° E�
will be executed only upon written order, and will become an extra charge Per ;' a �,, � ���(
over and above the es' ate. II a e n contingent upon strikes, ac-
cidents or delaysyd ur ntrol. (fL�j_�,p p a >,/°
JJ Note—This proposal may be wjith
by us if not accepted within "
ACCEPTANCE OF PROPSDSALY _..
The above prices, specifications and conditions are satisfactory and,are hereby .acc pted. You: e authrir�ed Ao do the work
as specified, Payments will be made as outlined above. rr r
.
d Signature 6� t '
u
P
Date ''i �"`; I Signature
s? NC 3818-50 PROPOSAL
MADE IN USA
M T
ad �+c=sttcEfnsetta
s
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFMA AVIT
with a principal place of business/residence at: -gyp
Lt� (9a K �,5 t. e(Cj(tYj,&- V Of WZ (phone#)
(streeUci ty/stalrlri p)
do hereby certify, under the pains and penalties of pegury, 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 listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Numbcr) (Fxpiratioa Date)
(Name of Contractor) (Insurance Compauy/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Numl)�zx) (Expiration Date)
(attach addrt coal shed Ynccc-scs.ry to include information pertaining to all ooat"ton)
XI am a sole proprietor and have no one Working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that whUo homeowveta who cniplay pc To:n to do m*nntcnsne4 e='on or rcpnir uvtie ou a dwelling of
not more than Linea units in winch the homooavcr raidcs or oa tho grounds aM rtmani thcx- o arc o,X gcn�Y oomidcrcd to bo
employers under the Nwricci's axupcsz 4ca Act(GL152,s 1(5)�application by a homeowner for a Ucrnse cc perm t may cvidcaoe the
]cgrl ctz of an employer under tho Woricoris cocnpcns tl Acc
I ua&Tstrtnd that a copy of this siatemcni may bo forwwdod to tiw Dq)rtn� of Indu-,t iel Accid-n&Ofl-of L-1000 for the
covange vcr fic itioa and that failure to scatre coveraga utTdcr scdioa 25A of MOL 152 can lcsd to tha impos Oa of criminal pcaakies
oo¢sisting of a fine of up to S 1.500.00 and/or imprisonment of up to one year and civil penalti cs in the form of a stop Work Ord--and a
fino of S 100.00 a day atins2 me
Fcr dq ut trs�al uio only
Permit Ht1rIIb,--f _
Lot 4
Si t o t crmitfcc I]ice
SECTION 8=CbN5TRUCTION 5;ERVICES
8 1 Licensed Construction Supervisor: Not Appliicyable ❑
Name of License Holder: �eS � 8 077 7 10
License Number
�( b OaK Florence Md. 01062 a Ll o
Addre Expir ion ate
Sign r Telephone
m��n �� na""" ra Not Applicable ❑r.
Company Name Registration Number
dress {� Expir ioqDte
nCQ Q 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...... ❑
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
SE P,.R-O.P OSED0(TI D WORK h' k+aly o6l icable
ra r n ar s rav u r,a n,
`t'MWi"t� w#3'ir' .a? �"`
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: (mot L /-vol' ( p� �
�� r
Alteration of existing bedroom Yes No Adding new bedroom Yes No ��
Attached Narrative❑ Renovating unfinished basement Yes
Plans Attached Roll ❑- Sheet❑
otS" e" n-duo VIVA`d dditi ext It n oU-51ft 0colmple e h fill°loing•
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
SECTIONIa OWN ERAUTHORIZATION -70BE�COMPLETED WHEN
OWNERS AGENT QR�CONTRACTOR:°APPI:IES �'OR �UILdING 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 statem s and inf ation on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Vie, A �+�►e�
Print me
Sign re of /Agen Da —
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 ev 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/here ibe size, type and location:
D. Are any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413.587-1240 Fax 413-587-1272 e
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: ssecti-�
b
J Zone �svverla ist is k d .
EIm'St:DistrictCBD st ict "'
SECTION 2 - PROPERTY'-OWN ERSHIP%AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
I Signature
2.2 Authorized Agent:
masse -/'Am cxn�� Qc.K 611
Name Print) k Current Mailing Address:
Sig r Telephone
S . T10 3 - TI MATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by ermit applicant
1. Building �e oo (a) Building Permit Fee
2. Electrical J - (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) wo Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Comm issioner%Inspector of Buildings Date
v ,
F rn r :x BP-2002-0997
GIs#: COMMONWEALTH OF MASSACHUSETTS
ao CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002-0997
Project# JS-2002-1612
Est.Cost: $5000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JESSE MONTGOMERY 077410
Lot Size(sg.ft.): 6316.20 Owner: MCKEEVER JAMES P
Zoning.URB Applicant: Jesse Montgomery
AT: 198 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
46 Oak Street (413) 585-8482 O
FLORENCEMA01062 ISSUED ON:5116102 0:00:00
TOPERFORM 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 Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 5/16/02 0:00:00 1331 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo