17C-163 (4) ;Prapatint Page No. of Pages
Y?""& W '
Quality Is Standard
362 Amostown Rd. •West Springfield, MA 01089
Telephone (413) 732-3788
PROPOSAL ITTED TO pH E DATE
2, C�aMOI✓ y13 586-77 To �o z
STREET IJOB-NAME
7
CITY, STAT AND ZIP CODE JOB LOCATION
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ARCHITECT F PLANS JOB PHONE
We hereby submit specifications and estimates for:
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BUYER'S RIGHT TO CANCEL
You may cancel this agreement or purchase by mailing a written notice to the seller postmarked not later than
midnight of the third business day after the date this agreement was signed.You may use this page as that notice
by writing"1 hereby cancel" at the bottom and adding your name and address. The notice must be mailed to:
(Name and address of seller)
_' /f// r propose hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
Ciuct Ifs t �Q V/QJC ost5 W► Lia Illy dollars
Payment to be m de as follows:
vvesw as ` Qe; . x60 V -2 'AAM X ot/•s
V ., & e of u3 i Ke s-S eqcj� F-v l' = y56
All mate ial is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specific a- Authorized
tions involving extra costs will be executed only upon written orders,and will become an Signature -
extra charge over and above the estimate.All agreements contingent upon Strikes,accidents
or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This proposal may be V
/�.
withdrawn by us if not accepted withi days.
7
>r
.Arreptanre of f ropogol-The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified.Payment will be made as outlined above.
Date of Acceptance: Signature
�� g (rLZfU of 'N[7z`#�j�i1lT�1�DlZ
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DEPARTMENT OF BUILDING INSPECTION'S
212 Maui Street ' Municipal Building
Northampton, Alv.ss. 01060
WORICER'S COMPENSATION INSURANCE kFFMAVIT
(';i�tinsrrJp�rnll floc)
�r.itli a principal place of businessJresiden(-e ate
W---SAW -;�,3 3 7� t
,r cucity, <1a,j i )
1
do hereby vertu}', under the pains and of r;erjtlry ttl<t?
( ) I am an employer providing the coverl�.e for Illy
employees worming on this job:
ice Company) (Polio;?,'umber) (Fapimtion Date)
O I a sole proprie general cony r_ctor or l:�omeowner (circle one) and have hired
the contractors sled below who I?ave the fell workers cor-�n°nsation Policies,
(Name of Contactor) (Insurance Connpany/Pohcy Nuln�---r) (Expiration Date)
(Name of Contractor) O-nsuiurcc ComDam/Y1OhcY Numi".r) (Expiation Date)
(Name of Contractor) (Insurailcti Company%olio: Numlxr) (F_xpiradon Date)
(Name of Cont,�-actor) (In_suranc:2 Comr,,:.:ryi OEC; Ntuntr�) (Expiration Date)
(a h a Sd�mal s cci f nccr_si y to i7clu6c infortnat x pa a n�_r to all o-r,ra��>r-.)
O I am it sole proprietor and have no one i,VorkL_ for me.
O I ant a home owrterperforininh ail the wor}: r.:r�self.
NOTE:ple-.ae be aware th-,_wylo hocncowir_tm"jo c: !oy s to c',) er rrpait"nk on a dwell.:e of
not ntocc than three units is uficii the homeowner rczid�or oa au a ct xocCJick to be�
Inzrployca un cr the%Y,3&s Act(GL152-�3 1(5)),r. ii c:by a horuot%T cr fora mtisc cr pclmit niey evidence the
legal antra of an o=ployor under tho woricore Corn{>analicn Act
I undcrriand flat a copy of this etatcnx at may bo fomftrdod to tho Dctx.r;amt of Indfu iel Acs&- fy Oflioo of In:ruanco for tha
coverage Vcnf c:11SOQ and that f_iltrre to_f==covcrngo under section 25A a*.IC3I,152 can lead to tha imposition of cram nal pcaaltics
-XnistmB of a tint of ttp to S1,500.00&nNor of up to cre) n�i civil pa aYtiu in dY form of a Step work Ocdc and a
f rto cf 5100.00 a day agsimt mr
For�;utrv?tal uio onfy
permit NUmbcx
---- l� -J03 Map;,_ —Lot --
y, Signature of Li T cruiittcc
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
A ress Expiration ate
Sign Lure Telephone
_
9 Registere'dHorrieIrriprovementContra`ctor Not Applicable El
Con-pany-Name I Registration Number
Address Expiration 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/f the building permit.
Signed Affidavit Attached Yes....... No...... ❑
z = SwF
, .
1. H mel0_wner.:Exemption
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 f(-,- which this permit is issued.
Also be advised that %vitl; reference to Chapter 152 (Workers' Compensation) and Chapter 153 ;Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts Gencral Laws ',nnotated, vou may be liable for person(s)
you hire to perform work for vou 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 -
J �
SECTION 5- DESCRIPTION OF PROPOSED WORK(check:all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing ❑
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding [ ] Other [ ]
Brief Description of Proposed Work: ie-i--"r_ ,_�'X�SI�>� _- o :"�
Alteration of existing bedroom —Yes __/No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes V No
Plans Attached Roll ❑ - Sheet ❑ /
sa. f Newthous'e�and'-or=�addition:to existing housing, complete the;following; PJA
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 ac of
my behalf, in all matters relative to work autnoriz d oy thi< building permit application.
Signature of Owner Date.
Cu- ' . A C!T p(�1Q!1_ ; s I,C J�: _, as Owner/Authorized Agent
hereby declare that the statements and information on th,- foregoing application are true and accurate, to the best of niy
knowledge and belief.
Signed under the pains and penalties of perjury.
iT --------------
Print Name - -_ ---- _- —
i /
Sig natur f Owner/Agen 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 perrnit 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 `S 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 l
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:
a
Deb@ dii
;.�itT-cltiJorthampton .erml
f , ttn Build+ng Department Curb C01 li7e a e=•r ' y
-�12 Main Street sealer/SeptLe: a a�6
rt �, n +��'��
Roorn 100 W erlWetl•1a
`�� 'f�7'orthampton, MA 01060 TwoSetsafStr c ra am
phone 413-587-1240 Fax 413-587-1272 Plot%Ste Plans
Other Specify
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
olk S f V)U-+
Map ' Lot �tlriit
Fim C-k-- Zone verlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) C' rent M jihng Address.
-- Telephone
Signature
2.2 Aut n ed Agent:
Name Wiint) hl iiiini;Address: ow v �
Signature Telephone
— - - -- --- ----------
SECTION 3 _ESTIMATED CONSTRUCTION-COSTS
Item s-,l ated Cost Dollars
_— = ;�
—b, errmt a ) to be
he Official Use Only
g
1. Buildirg Via) Building Permit Fee
2� FL,:ri;:a �O�'c7.t�C,� (b) .: :.timated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Number
This Section For Official Use Only —
Building Permit Number: ___.. Date Issued:___ _-----
Signature:
-----------------------------
----------
130ding Commissioner/Inspector of Buildings - —_ Date _ —
File#BP-2003-0642
APPLICANT/CONTACT PERSON COWELL CONSTRUCTIION
ADDRESS/PHONE 362 AMOSTOWN RD (413)732-3788
PROPERTY LOCATION 71 CHESTNUT ST
MAP 17C PARCEL 163 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
BuildinjZ Permit Filled out
Fee Paid
Typeof Construction: REMODEL BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included•
Owner/Statement or License 059111
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF f6IATION PRESENTED:
!/Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With 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 ommission
L6o
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.
BP 2003 0642
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0642
Project# JS-2003-1053
Est. Cost: $7800.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: COWELL CONSTRUCTI ION 059111
Lot Size(ss . ft.): 8 10 2.16 Owner: CHANDLER JOSEPH&PATRICIA A
Zoning:URB Applicant: COWELL CONSTRUCTI ION
AT. 71 CHESTNUT ST
Applicant Address: Phone: Insurance:
362 AMOSTOWN RD (413) 732-3788 WC
WEST SPRINGFIELDMA01089 ISSUED ON:1123103 0:00:00
TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM
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 1/23/03 0:00:00 MO $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo