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05-024 (7) (proposal Vinyl Siding Windows Edward T. Corbett R::'Iit�, g "' 4 heed St. • Northampton, NIA 01060 �,vning, _ canopies tv (413)584-617 1 Goners Shuuers - o3 - � LOD 1 JIM 10, ,111L. Il ,"i I—a td i'ttinat"Ii i _ _... " c- ��+ fl __ I Plcase make checks payable 1O: Lldward I. Corbett \\r 11�-opo.e hcrch� I,t Iurnish material and lab"I onyilctc in aCrimlaIlCC with the ah—c :.nt the sum of. ollars($ �� a n,try ix made us(allows: �� t 1--,h I,, Si,,nature Now I hu may hr ��ultdrawnh� u,tl not acceptedwithin days Accep mcc of C,pt'opowif I'll,: aho�e pricey shcilifi y� u,.�;. .utcl cundititms are satisf,tctury un�l are helch,, t�,. ��t,�t l.tu are auth��rizeii to eke the ��ork ❑s spcci- . r., f':n ntcnl c+il! bc' m.u1c' as uullinrtl ahu�c. i.ti� , . ,\cceptanre Slgnalurc Q-.�IW-1 PLO B �aSE aCI(ISStl1E e � m DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building 'e Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFTDAVTT Q T e,0466777 d R (licensee/permittec> With a principal place of business/residence av S-j-, luc&V.4m N (phone#) /1957 ( city/sta-0zdp) do hereby certify, under the pains and penalties of pedury, 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) ( ) 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 Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/PoUcy Number) (Fxpimdon Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additiomd shed if nccus to iry}u infocrostion pcxtaiuing to all ooatractora) I am a sole proprietor and have no one worEng for me. ( ) I am a home owner performing all the work myself. NOTE:please be awatc that while homcowvcra who employ persons to do maim�eonstructioo or repair wotic on a dwelling of not nice"than throe tarts in winch the homoowvcr residca or on the grounds appurtenant thereeo arc oo(generally ooasidcrcd to be employers under the wockces coaTcmaticn Act(GLl52,ss 1(5)),application by a homeowner for a license or prima may evidcnee the legal o-w of an employer under the Workees Compenxtion Act. I understand dust a copy of this etatemciat may be forwasrd od to tho Deportm of industrial Aoci&-&Qtlioe of Insucince for the covaxge verification and that failure to aazare coverage under scc ioa 25A of MGL 152 can lead to tho imposition of criminal p=Wcs coaustiag of a fine of up to S 1,500.00 and/or imprisoanxai of up to one year and civil pcmltia in the form of a Stop Work otdcr and a fitter of S 100.00 a day tg&iml Inc. For&p al—coly Permit Number gip# --I at Signahrre of UcenseeJpermittm mte S +� t �`. SECTION 8''-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /� Not Applicable � ❑ Name of License Holder : (RJr7�V �O>�bf"��R. No7M02 p License Number 14 R'eleei S'J"" *30-011 Address Expiration Date &4low ?. Z�� 1 S Signature Telephone 9Reiseedtome r`tremen n ac or: °' "fix '_ Not Applicable �.� �.�,�,�,��.�� ..�. � �w. , ` �.._�t._ ._._N�._. ❑ CR&?T pm e. //4064? Company Name Registration Number - AE-L) s�— 5- /s- og Address Expiration Date Telephone 6671 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 SECTION 5- DESCRIPTION 0`F PROPOSED WORT (coo all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ I Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 6a I'fnNe�+��h�ous"e°"and:n'�r�add�t�on--t"o�existrng-tiou`sing ..compl`ete�"tlie_follawng: 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:A' N,T;.OR�GONTRACTOR APPLIES FOR BUILDING'PERMIT 1, 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, �1JWPItRI� T ObiZ{J£)-T- Jf, 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. F,DWR0e CJ �19 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. Ar there 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 i"ur ctl 212 Main Street S e Room 100 Northampton, MA 01060 T S s a phone 413-587.1240 Fax 413-587-1272 Pla fSlte a F O�erSpac p APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVrA . ISH A ONE OR TWO FAMILY DWELLING a SECTION 1 -SITE INFORMATION ; SEP 3 0 1.1 Property Address: �This section to{ mpleted by office C�-AD4 Pxjdoiio� AJ Map beedsZone Over ay istrict Elm St. District CB District SECTION,2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2. Owner of Record: 9(JAI 6(2h S — Name(Print) Current Mailing Address: SU — /^ 6 Signature Telephone 2.2 Authorized Agent: IAM&P, -7-' Cote Be?r- �� 1QE�� Sf' Name(Print) Current Mailing Address: 7 %.5'8 y- 657 Signature Telephone SECTION 3i- 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) �,S©d Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings ; Date 264 AUDjBON RD BP-2004-0357 GIs#: COMMONWEALTH OF MASSACHUSETTS Man:f3l .glt:as 424, CITY OF NORTHAMPTON Lot: -001 Permit Building Category: BUILDING PERMIT Permit# BP-2004-0357 Project# 35-2004-0513 Est. Cost: $3500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett 3r 116069 Lot Size(sg. ft.): 25482.60 Owner: KORZA RONALD W&KATHLEEN J Zoning:RR Applicant: Ed Corbett 3r AT. 264 AUDUBON RD Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON MAO 1060 ISSUED ON.9/30/03 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE GARAGE 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: FeeType• Receipt No: Date Paid: Check No: Amount: Building 9/30/03 0:00:00 2075 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo