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10D-006 f` '�Qy 2C10 PROPOSAL © �, PROPOSAL NO. Jesse C. Montgomery MRJCM Home Improvement SHEET No. 46 Oak Street Florence,MA 01062 DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT NAME ADDRESS ADDRESS ,�} 7 -7 r^ ol 0 DATE OF PLANS HON 10. ,r�-;a�^ty ARCHITECT G!V to#urr>ish the materials and�grfarm the labor necessary for the completion of W71 t'i q o7 vecr "? SIR . C ; /'' -'-IrCt t c� 1-5 art Q to / b , S t r`, fC`m {,-7:5 Aev r t'>' ' p / t..s Cf,-rXl e Jvz4 o C CJY? tom're 4 c,sn s 1 � 1 /' ' W f . . ✓Vie W ve-n r it e± ✓P l t 7 f 5 r ( Cc C;Pj Ca_ t e C SAN Wd?/ �"" u 5 t,ocar `mac r7t�c a SS / r -1`5' fj ' J' env✓ " " t. 5 > L"';C. t f �t'� ✓wcl All material is guaranteed to be as specified, and the above work to be performed in accordance h,the,draw' gs and spec t- cati s mltted for above work and completed In a substantial workmanlike manner for the sum of l t-c a f ('��j �...._..,_.._..R--.A -�. ----__..�.�_ Dollars {$ ) with payments to be made as follows. e ., s/ + c� � c fir-- Respectfully 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 abo the estimator All a ents contin ent upon strikes, ac- cidents,or cloa beyond o c tr, P� ,l Note—This proposal may be withdrawn !f " by us if not accepted within* da ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby Accepted. You ar as specified. Payments will be made as outlined above. f Signat Date. Sign �TtWfPTO a fl Crzf�I of 'Nartijuilt}Ifnit A 6 filx5%HC[lnsttts DEPARTMENT OF PUILDD\TG INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S CO-MPENSATION INSURANCE., AFFMAVIT t with a principal place. of busil)ess/resid/ence at. (stme(/cityistaic�-t�p) do hereby certify, under the pains and penalties of penury, tha?: O I am an employer providing the followlm7 workers compensation coverage for illy employees working on this job: (Ins lea Company) (Polio;Number) (Expiration Date) O I an a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the fo11o•w,Lrig workers compensation policies: (Name of Contractor) (Insuranc-c Company,Toliey Number) (Ea-p,.m6cn Date) (Name of Contractor) (12surance Comi)ain,/Pollc'Numb r) (Expiration Date) (Name of Contractor) (Insurance Coml:anv/'Policy Numtxr) (f .iration Date) (Name of Contractor) (Insurance Comp_n}'/Policy Ntmmber) (Etnirlioa Date) (s[Lictt adliticciil r±rcd if taco-vlti.o i�c}u<z is foccni:ioo patainiug.�ell o�c'rad:;;r ) I tun a sole proprietor and have no one :vorking for me. O 1 am a hon7e owner pelforining all t11e work myself NOTE:plenae Ire attiare tiv�w{nle txm�a�4zr_ra�tvo enplay�aom w d�rr�irtcaanc�a,:...rudion cr repair��ori:on a dtlling of not niece thzn[lute units in wLdl Ux thus z putts: n!lh reo t-C pct Ccrrlcrally ox---:d-rcd to be ealployc3 under the tvuriin's crn�x zat rn.1 Y(GL1S2ys1(5)),rpp(:r men by a homcou7rr for n l clue or per u: wy-^der cc the legal etntus of an employee under the W<A'LC'e Coaipanatian t� I undi r j nd chit a copy of this"atancat mwy bo fxw rd< i to tbo D-qp,t r--,f Offioo for tlm covgage vcrifieatioo and that failure to:!acre 001rx-ago under stctloc 25A of MfGj,152 can Ic-.-d w the imposition of cr mci+l pcnalbies ooulitting of a tint of up to 51,500.00 arocx i rpr tvxirr up to or,-}ta a_,i civ l perultia in d<form of Or&--and a fimc of S 100A0 i dsy tpui tw _ For dry-:suiYit11 use mly GJ Permit Ntunbcr _ ----------I( _.` �� --"- r; Si tun of crlPecuuticc - — ATE' --— SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder :__ c, _ 77411 o — License Number Address Expira ion Zate Sign r Telephone _ns - ti 9 R'e"gtster'e i;Home Imiaveinent Coriti•actor „ „_ Not Applicable ❑ Company Name Registrat Nmber Address ,(� ,1 / pp Expir ion D to cgewpr ° ( 010,6 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 affidavi, will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ O'ifs Rya" ": omen � "ef gempt]<on 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 f-rom time to time, during and upon completion of the work fro-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 y i SECTION 5 DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) El Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding [ ] Other [ ] Brief Description of Proposed Work: ;7 rP__ _�/1C Sf h�" �_ ` a�� ` Alteration of existing bedroom _Yes V No Adding new bedroom Yes No Attached Narrative ❑ Renovating unfinished basement _ _Yes _`- No Plans Attached Roll ❑ - Sheet❑ 6a. If New.:'house and=.or'addition t_o'existing,housin7 complete'ahe followini : a. Use of building : One Family Two Family —_Other b Number of rooms in each family unt:___ Number of Bathrooms _ C Is there a garage attached? d. Proposed Square footage of new construction. _ Dimensions e. Number of stories? t. Method of heating? _ _ ___ Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. - _ __ Mascheck Energy Compliance form attached?.__ __ __ In. 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 cr my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date _ e � as Owner/.Authorized Agent hereby declare that the state nits ants formation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the opains/and pena ties of perjury. Print Name %� �i C) Signatur wne A e __ _ D e 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 ver 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 Do ument # 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 Com fission? 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--_--- - ---ely fl Northampton Status Bulliir Department Curb Cut %Drove."ova yy y1 ,Y P I : Ic NOV _ Lain Street Sewer/SepticA ai abi. ' Room 100 Water/Well Avaalab lam ton, MA 01060 1wo'Sets 6Q t —M an (Ft t tan t' ". 10587 1 40 Fax 411-587-1 -2 72 Plot/Site Plans � � OtheraSpactfy APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be,completed by office Map Lot nit Zone Overlay District _ l Elm St. District__ CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: LAwrenre &0 Name (Print) � flail�nSAddr ss: , Signature 2.2-Authorized Agent: Ll U6 Name(Pri vent Mailing Address: -- --*3--,5?57 - d'j Sign re Telephone —- CTIO STIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by_permiLappjicant 1 Building `5S (a) Building Permit Fee 2 Ele,--_rical (b) 1�timated Total Cost of Construction from 6 3. Plumbing � Building Permit Fee i-1 Mechanica! (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 89 WATER ST BP-2003-0454 GIS#: COMMONWEALTH OF MASSACHUSETTS MapBlock: 101)-006 CITY OF NORTHAMPTON Lot: -001 Permit: Building Categ_or�L. BUILDING PERMIT Permit# BP-2003-0454 Project# JS-2003-0769 Est. Cost: $5500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sq. ft.): 12196.80 Owner: BOULEY LAWRENCE F Zoning:URB Applicant: Jesse Montgomery AT: 89 WATER ST Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482 0 FLORENCEMA01062 ISSUED ON:1114102 0:00.00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 1 SIDE & SHINGLE OVER 1 LAYER 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: 64k '10'da 41�4-p THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 11/4/02 0:00:00 1539 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo