17C-182 (2) PROPOSAL -
CDT Construction PROPOSAL NO.
158 North Maple Street
Florence, MA 01062 SHEET NO.
(413)585-8677
DATE
NAME ��`� �c� j�G- ADDRESS
ADDRESS` r^
wv,, DATE OF PLANS
PHONE NO. PHONE NO.
We hereby propose to furnish the materials and perform the labor necessary for the completion of
All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and
specifications submitted for above work and completed in a substantial workmanlike manner for the sum of
` \ 1 �
Dollars $ �'�
)
with payment to be made as follows. .
0�t't""" pe ully submitt d
A60altyation or deviation from above specifications involving
costs will be executed only upon written order, and will become Pe k
an extra charge over and above the estimate. All agreements
contingent upon strikes,accidents,or delays beyond our control. ate=This proposa rYthdrawn
by us if not accepted wi i days.
ACCEPTANCE OF PROPOSAL
The above prices, specifications and conditions are satisfactory and are hereby accepted You are authorized to do the work
as specified. Payments will be made as outlined above. 11
f' :s
Signature
Date Signature
PROPOSAL
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$ 6 �rrsaac{Inactts'
DEPARTMENT OF I UILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPIENSA`zTON INSURANCE AFFIDAVIT
with a principal place of business/residence at:
(phone#)
(st=Ucity/staW2iP)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
e loyees woriang on this job:
I _
k1am an 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/PoGcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach ad&tioail shod ifneccssary to include informatioa patainiog to all ooatra rs)
( ) I am a sole proprietor and have no one worlang for me.
( ) I am a home owner performing all the work myself.
NOTE:p(eaw be aware that whilo homcowncra who c aptoy pcxzom to do maiatcaiucr,O=tuaioa or repair work on a dwclliag of
not morn than thruo units in which the bomeowncr resides a on the grounds appurtenant therdo arc not gcncuny ooandcrtd to be
-nPloytra under the worka'S campcnsatioa Act(GL152,ss 1(5)),application by a hocnoowner for a tiecase or permit may evidence tho
legal stanrs of an employer under the Wodcoea Compomatioa Act
I und=%t=d that a copy of thin rtatcmmt may be forwarded to tbo Dcportaxui of lndu�d Accddo b'Of oc of Insvr*noo for the
coverage vaifiadioa and that failure to secure cownTo trader Soctioa 25A of MOL 152 can lmd to tbs imposition of--fi l Penalties
ooasisting of a fine Of UP to S1,500.00 MNOC imps-isoameai of up to one ymar and dvr7 penzweS in the form of a Stop Work Ord-and a
firm of 5100.00 a day against ma
For depatmmtat LLfe only
permit Number
I&p4 Lot#
Signahtre of Licenseelpermitt ee e 1
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: — ` \'L ('
License NNuumbe'r
Address Expi—ra ate
igna re Telephone
e SOME= Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
EGTION10'WORKERS' COMPENSATION INSURANCE AFFIDAVIT
. ; ,
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida�
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
1
T r� 54 .
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes -No
Plans Attached Roll 0• Sheet❑
fit: a ivri � . .,n :o:E .e 61't -:II
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 t
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
-., 3 ��
LJ O x[Z Wil 0 C� D WHEN
as Owner of the subject proper,
hereby authorize to act
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owner/Authorized Agent
hereby de are 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.
trinName of ne /Ag Date
fi
•,o„ a
Section 4. r`
r..
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:
i
.Ar•
City of Northampton
Dng Department
Main Street
Room 100
AUG - 3 2001 N pton, MA 01060
phone 41 8 -1240 Fax 413-587-1272
DEPT Of BUILDING INSPECTION
4n
APPLICATI CT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�SE�lON�1z 51TE�fNFOR�IVIA�t'°ION
1.1 ProRerty Address: C
:Elmamq t D►sc ,�
tf t C
SECTIbNi2 PROPERTYtOWNER SHIP✓ALITHORIZED?AGENT
2.1 Owner of Record:
Lv -XS m �'l
Name(Print) Current Mailing Address:
Telephone
Signature
2 2 Authorized Agent: _'I
(.Print) Current Mailing Address:
Sig a Telephone
5Ef�dtf -E5�1IfA'TEDCb5ThUGT10N COST5
Item Estimated Cost(Dollars)to be 0 T,
completed by ermit applicant
1. Building (a)'Build ng PerM,11,6
2. Electrical (b) Estimated Totat'Gost.of'
Construction•.from. 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) 1,Check Number
This Section For;Off1c1 al.11seOr11
'..3 .y 3
a Is uer
�ll
Dat s
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t � �: m�S� nr,� pOr{?f�CSli1l111g5k ,�.., a� m, »,.
,s
28 PLYMOUTH AVE BP-2002-0132
GIs#: COMMONWEALTH OF MASSACHUSETTS
-1 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:roofing BUILDING PERMIT
Permit# BP-2002-0132
Project# JS-2002-0196
Est. Cost: $11410.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO
Const.Class: Contractor: License:
Use Group: CDT CONSTRUCTION 003666
Lot Size(sq. ft.): 161 17.20 Owner: JEFFWAY LOUISE E&ROBERT W JR
Zoning:URB Applicant. CDT CONSTRUCTION
AT. 28 PLYMOUTH AVE
Applicant Address: Phone: Insurance:
158 NORTH MAPLE ST (413) 585-8677 Workers
Compensation
FLORENCEMA01062 ISSUED ON.8131010:00:00
TO PERFORM THE FOLLOWING WORK:STRIP, PLY & SHINGLE ROOF
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Deuartment 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 8/3/010:00:00 3927 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo