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24A-073 �?��n �so�1�� � s�o1-� ���N� �� . e �� - � � � �.� �� �� If ('situ iy��g rl�� t Ir4�i' '�� r �i� s �� � 4 { � 1 I �,�� i 1 III 4�� .., � ICI 16 �'Y �..�'^''�„� sil l { r4i ���� �il �� €�. I �'�3 �� � �, f k „4 Y�_. "' � I,L 4 f I�Ijii�i�V u > ��. f �� t .k ,. 'ii ..._ � t � ,. "�, ' s s k;!'.; r ,. � ,., � �, >� � r� _., �i u rm r �f i� � � Y � y .�`� i N �, w;� .. n a.a ns>*k'. ,�. .. kY;. �. y is xd +=,. >. .. ,� n.., , r,�� , �,�. ��. Ise m g: �i KF %P K v u' :40 59 W4Hd 3M , " ;�txi" `5... i A c. a u r i + •, sn- S� lsu�1� &Y Y f � ioV1 Y a ,s aaq, t y t � r. f ± Y � g { 4 of E-V(s&TI N C r P i%! �CCJi:?�i PC 'u' [i I tit: ,pri�`cfiw'ioris of i�'!`GL c � §54 j. condlon of Vie eiljll.-Jinq permi[, all debts resuln:f governed by Its Builnir!❑ Permit shall by dispo E,,J of 21. \lA-L, 1, EY 12�a ,. . ( l � f d i i c L'iJpeFly hwen`ed soNd Ly _DS fefinei_ by '? az1. /V } I _ .TNT D-.. TYPE THE FOLL4, :_.,:_r ii .rR Sim; . N. I t r _ y ?-f P�st`r-?�� �s✓� ;J�]L�.J J ?-;J�SOi1, _� r-�L _ i soft -5 ��►nPt�N±MA t d cd c: r',1Q7.c 'L171. J3fl!1^�1. ^4GC?aA !In,im n ! SIGNATURES By signing below,you agree to items A,B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. C. You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third business day after the date of this transaction. S 2� /1 See the attached notice of cancellation form Buyer Dad for an explanation of this right. Seller retains an equal right to cancel. jm , Barron&Jacobs epresentative D e Designer/Salespersons Registration Numbers ❑ Cecil R.Jacobs MA HIC 100809 D Christopher R.Jacobs MA HIC 100809 CT HIC 0518617 CT HIS 0554397 Barron and Jacobs-Key Personnel Contact Information: Office Cell Home Office Manager: Sandy Scavotto 413.586.8998,x100 Vice President and General Manager: 413.586.8998,x103 413.250.6677 413.665.91 t3 Chris Jacobs President:Cecil R.Jacobs(Jake) 413.586.8998,x101 413.250.2327 Purchase Agreement Page 29 of 29 i SIGNATURES By signing bt low,you agree to items A,B and C. 00 NOT SI N THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternati e Dispute Settlement(Arbitration Clause):The Seller and the Buyer hereby mutually agree,in advance,that in the event of dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration se ice(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signin this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a I inding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversation!, statements and agreements,expressed or implied,between the parties,their agents or representatives. You,the Bu r,may cancel this transaction Buyer Date at any time p for to midnight of the third i business day after the date of this transaction. See the attacl ted notice of cancellation form Buyer Dad for an expla tion of this right. Seller retains an equal right to cancel. Barron&Jacobs Aepwresentative D Jesi ner/&les ersons Registration Numbers ❑ Cecil R Jacobs MA HIC 100809 ❑x Christopher R.Jacobs MA HIC 100809 CT HIC 0518617 CT HIS 0554397 Barron and J tcobs-Key Personnel Contact Information: Office Cell Home Office P 4anager: Sandy Scavotto 413.586.8998,x100 Vice Pr sident and General Manager: 413.586.8998,x103 413.250.6677 413.665.9113 Ch ri s Jacobs Preside t:Cecil R.Jacobs(Jake) 413.586.8998,x101 413.250.2327 Purchase Agreement Page 29 of 29 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 < Boston,MA 02114-2017 www massgov/dia NVorkers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Leeibly Name (Business/Organization/Individual): Address: o pltp So(ym 5T2V1' �O UI,MRDO ,MCI 66 City/State/Zip: N(j9l-4A_N_Q'[7U), h 01660 Phone#: (113 z;26-�q q Are you an employer?Check the appropriate box: Type of project(required): 1V I am a employer with IL—employees(full and/or part-time).' 7. ❑New construction 2 I am a sole proprietor or partnership and have no employees working for me in 8. remodeling any capacity.[No workers'comp.insurance required.]3.O I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9 emolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property 1 will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGI.c. 14.❑Other 152,$1(4),and we have no employees.[No workers'comp.insurance required. Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby tfy and 'the pain nd penalties of perjury that the information provided above is true and correct. Si nature: Date: 1¢ Phone#: Cu1 Jg�QB Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: C IS—M RER Cw r r)GQ q 9 5 License Number OLV SOMI im A 11 lb/?016 Ad ress Expiration Date ignature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ IPARROW 9374COSS S©cl , INC, 100 209 Company Name Registratm Number �0 om som s ke X102 -� IPtoty�M('� a3 of Address T Expi ation bate Telephone(A1 5% ,sill 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...... ❑ 11. - Home Owner 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 shalt 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 buildine 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [j= Siding[p] Other[❑J Brief Descri tion of roposed kEMOD� e\A&71N6 K1�LJ-GN'> Coklvea' - � Work: ". &OT� rI &D D -1 "o Alm 9&Q 1&NT IN ftD Na/ ^v►i N► OLK. Ac, Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _ No Plans Attached Roll -Sheet 6a. If New house and or addition to existina housing, complete the following: 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. Masscheck 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 I, rye as Owner of the subject property 't hereby authorize 13 h0,R W �0 p�3 kogS Assoc wym, �N c to act on my behalf, in all matters relative to work authorized by this building permit application. See, RAC-L Or IN Signature of Owner Date VC as Owner/Authorized Agent liereby declare 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. Print Name Signature of Owner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size S"- NO GNMJe SAA-k OW66 Frontage SW'V N4 WAA66 Salto!?` NO GWAWS Setbacks Front Side L: R: L: R: Rear Building Height 5A mG SHN1� Bldg. Square Footage 54KE % 5AM Open Space Footage % (Lot area minus bldg&paved 5A e parking) #of Parking Spaces Me 5AkE Fill: 5A Aq — 100GNA,NGtS S - NOCLIM61ES me&Location) (volume A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW 0 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 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: E. Will the construction activity disturb(clearing,grading,,eyavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. W E Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterJWell Availability E 80tric,Plumbing&Gas inspe:-iicns Northampton, MA 01060 Two Sets of Structural Plans Northampton, MA o10 0ort '413-587-1240 Fax 413-587-1272 Plot/Site Plans 6. Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: -rp �t- This section to be completed by office (,�g MSSSbI�C s/�1/�� ` /�/� Map Lot Unit Nd RTH M PTOW i' + lJ I VVJ Zone Overlay District Elm St.District CS District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: DOID ,> htrN &�NGLE 52;1:r U0Q111(F,MP'Cdu,M Name(Print) Current Mailing Address: �C.SL► Telephone Signature 2.2 Authorized Agent: BARKow & 5kog,,�, ASSOCIArES,1W, 20 OLD SOA 5—T9z "( , N0MNDQQW, M Name(Print) Current Mailing Address: Cgll SS6- �qq Signature V Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building b Ot (a) Building Permit Fee 2. Electrical , (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) -` 1 5. Fire Protection 6. Total= 0 +2+ 3+4+5) (¢ �' Check Number d This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1363 APPLICANT/CONTACT PERSON BARRON&JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON01060(413)586-8998 PROPERTY LOCATION 48 MASSASOIT ST MAP 24C PARCEL 073 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN&CONVERT DARK ROOM TO PANTRY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: J� Owner/Statement or License 60475 3 sets of Plans/Plot Plan a �drYi THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF( MATION 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 Commission Permit DPW Storm Water Management De on elay Sig a o B tl i g 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. 48 MASSASOIT ST BP-2015-1363 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-Block:24C-073 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2015-1363 Project# JS-2015-002485 Est. Cost: $116851.00 Fee: $702.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BARRON & JACOBS 60475 Lot Size(sg. ft.): 16117.20 Owner: GENGLER DAVID W&KAREN M OLSE Zoning: URB(100)/ Applicant: BARRON & JACOBS AT. 48 MASSASOIT ST Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413) 586-8998 Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON.711012015 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & CONVERT DARK ROOM TO PANTRY 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: FeeType: Date Paid: Amount: Building 7/10/2015 0:00:00 $702.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner