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Jesse C. Montgomery PROPOSAL NO.
JCM Home Improvement
46 Oak Street SHEET NO.
Florence,MA 01062
DATE I
1710:2
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
NAME ADDRESS
1 �C4
ADDRESS
DATE OF PLANS
PHONE NO. r ARCHITECT
We hereby propose to furbish the materials and perform the labor necessary for the completion of
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All material is guaranteed to be as specified, and the above work to be performed in accordance w h e drawin nd s ecifi-
cations submitted f r above work anq completed in a substantial workmanlike manner for the sum of ' '" '�o Q r?
V it1 , ,ruck &CL l��-f' j -----1..... ___._ ..,. Dollars ($ � C, }
with payments to be made as follows. Lam'' S� -5 `` - ° kit �
f espectfully submitted
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the9 esti te. All a eenjents contingent upon strikes, ac
cidents,qr delays be and `r control. C i '^ P `+ r'
;, �' �. �-- I Note—This proposal may be withdrawn
by us if not accepted within days.
f
µ CCEPTMCE OF PROPOSAL r
The above prices, specifications and conditions ale satisfactory Arid are hereby+ accepted. You ar o ' ed to do the work
as specified. Payments will be made as outlined above.
Sighatur
Date / Signatu
NC 3818-50 PROPOSAL
MADE IN USA
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DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMTENSATION INSURANCE AAFFMAVTT
� Jesse wi, c�e
(li permittee)
with a principal place of business/residence at: r (� Oo ,
k �7 �C�l�e✓)C e MA. 0)% (phone#} ( 3'' `'�` yt(J
(stmet/city/staielzzp)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees worming 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) (Inure c Company/Policy Numkr) (Expiration Date)
(Name of Contractor) (Laurance Compam/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Numb--r) (Expiration Date)
(a[Iath additicaal ihcc(if ntocniry to include Mfontution P,:.rt ring to all ooaf r3)
i
( Ka-M 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 whilo homeo"ncra who employ pc za u to dD mat atcaau cc rust' or rcpnir woe oo a d�vdl ng of
not prom than LLrco units in wfrich the honbowncr rtsidcs or oa the uouzxb appurtenant thuctD arc rxX gcrxtally oocoidcrcd to be
eatployrrs under the woricrr's compeasatiea Act(GL152,n 1(5)),application by it homco-ner for a UccWC ex permit may cvidece the
legil ctaau of an employor uoder the Woricola Compensation Act
I und�d thst a copy of this ctatemmt mAy bo forv+nrded to the Dcpart.,d of Accidntf Offioo of Ir:n�for thf
cove-agc vaifict oc and that failure to sown covcmp under s4xt on 25A of MGL 152 c n lmd to tha imposition of cri ninal penalties
comisting of 1 fine of up to S 1,500.00 and/or irnpri3otrma of up to one}stir and civil paultia in d1c foan of a Stop Wor1C Ordcz and a
fim of S 100.00 1 day against rnr-
7 ._... Fp(:-.:rrnit tttxrd�l u*c mly --
/ Number I,ot 11 -
Sig to i crinittcc D tie
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SECTION 8x-CbNS RUCTION SERVICES
8.1 Licensed Construction Supervisor: / Not Applicable
Name of License Holder: V'•, ®7< Y`
/
License Number
3
Addres ExpiratioK Datuf
Sign Telephone
Not Applicable ❑
Company Name Registration Number
tq Oak 5} ��ar� � - y ,Os Address p h Expira ion D e
Telephone ��U VFL
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...... ❑
ITS
mori'u, q-
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
SEf TiANiDSCRftIONOIF PROPOSEDIWORK cti�eckallLa` licablen
D a
.1 Wllar'
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks 1[ J Siding[ ] LOther [ ]
Brief Description of Proposed Work: .4ls « �GCe�'►err' 4 N �,t,c,-.— arld loU h4 t( AJC w Vt;b_74_
Alteration of existing bedroom Yes 14 o Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0- Sheet 0
•• i" a"d o "�ddJti ff41 )(i"s'tin�h uo s'ing c e e th tlo�" ui :
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 MIT
APPLIES FOR::BUILDING PER
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
�e e �A('/Y✓l as Owner/Authorized Agent
s
hereby declare that the statemen nd info 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.
now CIY7 e
Print Name
Date
Signatur wne t
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: _ __—
r s .
t
City of Northampton
Department
2 ain Street
m 100
JUN 2 0 2J rthtl ton, MA 01060
phone 5 40 Fax 413-587-1272
it
APPL2AIICI '1dCY0 NPPfRUC LTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION:1 - SITE INFORMATION
^5 z" t Il�s 5ecti 4 aar-al
1.1 Property Address:
p(`�✓1� e �� �,. Zone k h - Ov rla lstric
Elm Si.'District GCB Distr ct
SECTION'2_- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record::"
CQ CX-
SST
Name(Print) Curr nt � at
M ng Add s
,
Signature Telephone
2.2 Authorized Agent:
e S.5 •-n oti tf(p Oct k f
Name(P int) Current Mailing Address: �`
Sig ur '�c l 3� L �G.
Telephone
SECTION.3 TIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed b y ermit applicant
1. Building f D0
(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
' BP-2002.1141
Wo N
01 0GIS#: COMMONWEALTH OF MASSACHUSETTS
fiiaiwak* CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2002.1141
Project# JS-2002-1837
Est.Cost: $3100.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grogg.— JESSE MONTGOMERY 134274
Lot Size(sg. ft.): 12806.64 Owner: GOYDA MICHAEL F
Zoning.URB Applicant: Jesse Montgomery
AT. 135 OAK ST
Applicant Address: Phone: Insurance:
46 Oak Street (413) 585-8482 0
FLORENCEMA01062 ISSUED ON.6121102 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF & INSTALL GARAGE
REPLACEMENT DOOR
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 6/21/02 0:00:00 1384 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
cm
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Classic�Jir,,�l DH
Ided
UIIH
National Fenestration 0016-01658656 0005
Y-03 30 712912002
Rating Council
•Energy savings will depend on you specific climate,horse and lifestyle
•For more informatfoy call 603622.4232 or visit NFRC's web site at
wwwift.org
pain 2 ,fbte
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�oeffi�,.en± ansmittanrw,;
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3 . 2 . 4
Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining
whole product energy performance.NFRC ratings are determined for a fixed set of environmental
conditions and specific product sizes.
135 OAK ST In J02-1141
GIS#: COMMON ,, .;ALTH OF MASSACT'l. t TTS
Map-Block: 17A-254 CITY OF NORTHAMPTON
Lot:-001
Permit: B u i l d)ng
Category: BUILDING PERMIT
Permit# BP-2002-1141
Project# JS-2002-1837
Est. Cost: $3100.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin JESSE MONTGOMERY 134274
Lot Size(sq.ft.): 12806.64 Owner: GOYDA MICHAEL F
Zoning:URB Applicant: Jesse Montgomery
AT_ . 135 OAK, ST_
Applicant Address: ~ Phone: Insurance:
46 Oak Street (413) 585-8482 O
FLORENCEMA01062 ISSUED ON:6121102 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF & INSTALL GARAGE
REPLACEMENT DOOR
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 Deaartment Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:Ok'
rl err;
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate Of OCCU anc re;
Fee Type: Receipt No: Z Date Paid: Check o: Amount:
Building 6/21/02 0:00:00 1384 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo