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17C-186 (2) PROPOSAL , 1 Date ,14,d4• W.4 01053 Sheet No. Proposal Submitted To: Work To Be Performed At: Name f Street l Street City State City State Phone Date of Plans Architect We hereby propose to furnish the materials and perform the labor necessary for the completion of Jr t s ,,,ri n ,� � �yt�`a.) �.✓:�_X..;�. i a rf �f` �+•' t G 1.1 J 7 _ /X i� � f�f.'t� i � a �,...i s / f � r •'".�f_,�l,'a' ,;�#� r f f ' {�. f1_ E � i.%'f�. -. .4 � /"�c�`�-t'�j�`'r.'";"�# All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and spe i€ications ubmitted f9r awe work and completed in . a substantial workmanlike manner for the sum of i 0.r j t` . z :i C" � .-'y C' g° �7� c a , .� _. Dollars [$ cc' ]. with payments to be made as follows: .? Any alteration or deviation from above specifications involving extra ,✓ costs, will be executed only upon written orders, and will become an Respectfully submitted extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry Per fire, tornado and other necessary insurance upon above work. work- men's Compensation and Public Liability Insurance on above work to be taken out by Note This proposal may be withdrawn by us if not accepted within P days.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. Payment will be made as outlined above. Signature ^> Date` r Signature 1WS FORM 3850 DUPLICATE MADE IN U.S.A. L O O CG#y of Wort4aurptart p Z s � �8lSAC}�liSttts - DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as iris/her construction sups, ,, :;or. The state defines"Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location �{ G1,zfil of �laril?zu Atoll �. � .. 6 Fi�csertclt[csllts ' •, P DEPARTMENT OF LJILDD1 G INSPECT-IONS 212 Main Street ' Municipal Building i�,'orthampton, ?,lass. 01060 WORICER'S COMTENI SA'z-z N INSUTZANCE A-FFIDANIT l� -----�e55C.-- `�do�`m��------------------- - %vllh a principal place of businesslrc:idenc at: Strc,ticit i .a:_./7j -- dO 11C1-i;J�' CCI'LLI}-. L'Ilac1 the p iiZS ;'.ild pCn it1C; Oi 7Ct�111�', i}lI!i: - I :III au cmpioyei prOVldln- t}1e ioll0',ViI?L '.':OI ;CI S COII�pCI1S?t]OI1 GOVC12',C tU" Iny elllployces worizng on this job: (InslranCti Compal3y) e'_ Numb-) ---- (ray rdon Date) j I am a sole proprietor, gen°ra con-=-'OF holl-,CO" DC:- (c:c!e one) and ",--n-e hired thc Contractors listed be.oW l:o (1`IC_LIIC of CmriLm lOr) (Ln_' :1C OIii^??if Otter lvitllilbcr) r?'; .•.:iG': DHt°) (N me of Coil tr c o:) -- ias� ;ncC Cow a�'/Pe!ic; Ntmtr r) :ratio, Date) (I"'amc of Contractor) - - ---_-_. -- --- 1C NL'SI]I} r) fix;, a.c Datc) - (Name of Cont*,Ictor) — (111S1Ii3Ilc Coln7 .y!Policr Date) _ l �. iLtl t. Ole '1!' .,L )f •' ',:" , _._.... .-!•: " n0 Oi?'C '•','�;: '�� t0; :i?�• 1 2111 <1 11011]e O%VI]C� NOTT:please be awsrc not uKcc th a thruo uniu in tcLdt or a;` �:::.s zo-•_r cram Lhcc e e2 n{jvrsally a: :`c,` :3 tl ca ploycs ucrxr t}r tw;}:�,cc z >:icy ,r (GL!S2�s!(5j`,• a;ic:;by a hni:ro.xr`cr r G cu cs legal cta4c of an csployx unu t`un We kefo i Cori;xr ition!.L I Iuidc--Ttand dl.!a cmy of this cIatci s•cuy bo fcx--,ioJ to 1I»IYtxirt-n -a of It u!riJ Atizl sits'OHSu of for llro oovcragc vaific-..lion and that failure to r-^ c Cot-T--E-ui 3: cciM 25A cd M,0l,152 c-Ln Inca to the imposition c;c r_i pcz:alt:- consisting of a fim,of up to S 1-500 00 t:t,'or I^nr;vy z._:1 ofi:p to rn_}-c:e:.-I civil rnzltio in t form of a Sic;, }'c-i.(h:=a:,d a frn a(5100.00 a d-sy ig-i6w1 m- Fcr ci�:ivnatal u.e cril}' i `� Ycrrnit Numtr.:r � I • ,}a rc cif i.ic JPcrnt;ttr:-:. - - .;,: ., , i t- SECTION 8 �CONSTRUCTIQN SERVICES 8.1 Licensed Construction Suu"peervisor: Not Applicable ❑ Name of License Holder : V 0774'8 License Nu ber , lo-'r Address Expiration D e Signa Telephone N ere :orn tn.r vermen :Contrac o= Not Applicable ❑ �css< �� �-� �3�a7Y Company Name Registration Number y �- 0. K 2 /D -/7 -015` Address Expiration Date Telephone SECTION 10 VIIORKERS'COMPENSATION INSURANCE AFFIDAVI f(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 i � r ' i SEGT�ON� ES��'TdON�OF��ROPOSED WORK check aff�a I�cab`le �� New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ,� Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: u'ct- e e-bo t ldm( a� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0• Sheet D S f.Y.ew- ou e -fl FORM- dit,ron to existing=housing:camp eMEM15fol1lowa.n: 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 Nc 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 SEC71©HZaY {311f1'NE`R EAU HORIZATfON ,TO BE COMPLETED WHEN OYIht1RSAT 02C�NTRACTOR APPLIES FOR BUILDING PERMIT :a ��. : I. as Owner of the subject property hereby authorize to act or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, as Owner/.Authorized Agent hereby declare that the stateme s andio06rmation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name - s ,y y Signature ner/ Aate 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 ev been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issu 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 i ... ... _. _T._.,.x..-++-.r-.•,e,:.-tee-_-._..._p ty bf Northampton } L ' - i ding Department i 12 Main Street : Room 100 � MAY 14 2004 �_ N�'r `iampton, MA 01060 r s L ^ phone 41t-587-1240 Fax 413-587-1272 ` APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION Th�ssec<7otx tare completed by pfTice 1.1 Property Address: w s Maps �Q�G�1 C /t'fly- �l K� Zone r ►erlay O�str�ct b g y k i y SECTION 2- PROPERTY'OWNERSHIP/AUTHORIZED;:AGENT 2.1 Owner of Record: 5�jr/fI OCdrnan Name(Print) Current Mailing dress: 4113- 4/ Telephone Signature 2.2 Authorized Agent: Z�se /`tan clmen Name(Print) _ Current Mailing Address: Ll Signature Telephone ON TED"CON STRUCTIO N COSTS Item Estimated Cost(Dollars)to be Official Use Only m feted 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(NVAC) 5. Fire Protection 6. Total = (1 + 2+ 3+4+ 5) C5 j Cam• Check Number This Section for Official Use Ohl' Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 50 CHESTNUT S" BP-2004-1138 GIS#: COMMONWEALTH OF MASSACHUSETTS MapBlock: 17C- 186 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: F-uildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1138 Project# 3` -2004-1706 Est. Cost:$2500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor. License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sg.ft.): ]?_806.64 Owner: REDMOND SHIRLEY A Zoning:URB ADDlicant. Jesse Montgomery AT. 50 CHESTNUT ST Applicant Address: Phone: Insurance: P O BOX 329 (413) 585-8482 O LEEDSMA01053 ISSUED ON:5117104 0:00.00 TO PERFORM THE FOLLOWING WORK.STRIP, PLY & SHINGLE GARAGE ROOF POST THIS C 1RD SO IT IS VISIBLE FROM THE STREET Inspector of m. )ing 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:0 K. F--;?/- C THIS PERM IT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLAT OF ANY OF ITS :'ULES AND REGULATIONS. 000 01 Certificate cf "'---cupancy t Signatur,-: FeeType: Receipt No: Date Paid: Check No: Amount: Building 5/17/04 0:00:00 2172 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo