17C-256 (4) ti�lldt,w:.
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Corbett Home Improvement
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Northampton, MA 01060
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(413) 584-6571
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DAIE OF PLANS JOB PHONE
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'A, i,�,c�;yy submit sperilications and estimate" li)r:
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-�E r jyt O�OSf Hereby to furnish material and labor-auuhlete ill accordance with Ilse ithuve slreeificatiuus,for Ihr cunt of [�
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Ite Made as lollitw.c:
1 .,,i • r.,�.u:raueed In he,ev sprcitie�l- All work w he cunlilleted is n work-like❑amacr❑ecnnhag Aulbttnzed •�
.i. lua.hces. Any allerc L,Iwns or deviation Irmn.ihuve shecilicalinn,e urvulvyng extra ends will he Sig,aMIIC
c 'c upon wrilien orders,wul will hecuua nl extra ch,jrge over and ihnvr the csi mmit . 111 Note❑IingeW upon st rikea,ucculrnls ur del }�heyoml nor nadir L Owart d rr 1'din r ru.d�
Iltis hrolxisal play he
ccc osnry ulsuranec. Our workers arc lully covered he Wnrkwen's(�Inhruy;itinu 111"m nrr wilted ntwu by us t(uol accchlcd wJtluu days.
- I
cccptance of Cj)roposa[-Thrahovelmces,sdxcific;utous �J
an - ��1iti�uis are.ruI,lacfory awl are herehy'teec•Irle((. You are aulhnnz�<I I�� Slguawrr
k-111C)tc11. I'ayll ill he ma le:reyu�ltued above.
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building �7
Northampton, Mass. 01060
WORI�R'S COMTENSATION INSURANCE AFFIDAVIT
(li censer)peruii t t ec)
with a prncipal place of business/residence at.
( Ucity/statrJ�p)
do hereby certify, under the pains and penalties of penury, that
O I am an employer providing the following workers compensation coverage [or my
employees working on this job-
(lnsuranc-c Company) (Policy Number) (Expiration Date)
� ) In 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/Policy Number) (Expiration Date)
(Name of contmclor) (Insurance Compauy/Policy Number) (Expi-mion Date)
(Name of Contractor) (Insurance Compan}/Policy Number) (E.,,�piradon Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
m
(a[tadr icSdiUa�il duct vF nccczvey tD include uifocrnsti o«pertaining to all oa4raciors)
I afn a sole proprietor and have no one working for me.
O I am a home owner performing alt the work myself.
NOTE:please be awarc that while homc0w2xr3 who aapjoy pazom w c7o na ntcasncc cz.r=c:ca or repair wu[k on e d«c 1 ag of
not moce than[limo units in utvdr the Iw N-Dcr rraida cr oo the p owa+i zppatcnant thereto uc nee I e xrally o003:6crcd to be
employer3 undtr the wo kes ccmpcmat;en Act(GL152,ss 1(5)),appli-ation by n hotnco-rrr for a Ii.rnse oc perm"mey cvideenoc the
legal ctaars of an ozuploya under ttso wockcet Corv{wnzs-taon Azc
I undcrc d dirt a copy of this ctat.cmcat auy bo forward[ J to tbo DcVxi tmmt of Iodtiutriel ADc d-d-lr Offioa of Inaranoo for lbo
eovesage wriacatioa and that faiiure to aeatre covecaga under stcdoa 25A of MGL 152 can Imd to tha imposition of criminal penalties
coasisti of a fine of up to S 1,500.00 anNot un{xiwrmxal of up to one yr_u and civil pc W6C3 in dx f«m of a Stop aloft Ord--and a
firm 01S 1 00.00 i day a&umt mc.
Foc usb only
Porwt Number ----
Lot
Signahu-c of Liccnseelpermittee a£e
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder AEDWA
License Number
--
�ddress Expiration Date
gnah:re Telephone
R'eistered N6 me1m1M eme`65C'ontr"actor•'"''" ""
xk'dN 'r *`, Not Applicable ❑
Mi. i v.
le&—T `
Company Name Registration Number
°41 -----
address Expiration Date
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6))
�Aorhers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavl-,
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No ❑
fll {..� some ®,w a <emgpt 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 ror 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 persons)
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 —
t iUN_b- DESCRIPTION OF PROPOSED WORK (check all applicable)
Addition R Dlacem �{j t Windows Alteratiun(s) . ! Ruoting
Jl Derrrvlit�unL. New Signs i Decks Siding Other
L(it
ii Nuw house and or addition to existing housing complete the following:
ju
"��en � t �� cellar ilu_� �r.!u � isrcu Fr�ide
�i�, i'j
I �Itt AHI vd i(
L�;i iU,N is - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
00iz e>&)'T- J R, _
L C'o�e t3 --r7- Or
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
1,01 Size
Frontagoc _
Setbacks Front — —
Side L: R:
kear
i
Building Height
( Bldg. Square Footage
Upen Space Rootage
tLut area minus bldg&paved
' parkins) �
d of'Parkin r Spaces
Fill:
,volume&L,ocaUOn)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO _ DON'T KNOW Y E S
IF YES, date
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book — —__ 2ge _ 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. Ar there any proposed changes to or additions of signs intended for the property ?YES
No
1 F YES, describe size, type and location:______-_____
_ City of Northampton Sat sof_P -
<-` Building Department Curb Cu 1 C�7s
212 Main Street Se. r%Se 11 ��
Room 100 Wa erlWe
f 64,bampton, MA 01060 via Setslo
uy f
s, iii e 4' X87 1240 Fax 413-587 12.72 Plo /Sete P an
Other'Specify`
t
APP 0Ilis, 1C4, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I - SITE INFORMATION
Pruperty_Address This section to be,.completed by office
rn �(j st Map Lots 1111 Unit
1�11� Zone Overlay;-D�str�,ct."
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of-Record:
XvX — --- ----— -- ._ -- --- --- -- -----
.,urient Vailinq, Address.
2.2 Authorized Agent:
Current Mailing Address:
----
� en�:�.; F, telephone
SECTION 3 ESTIMATED CONSTRUCTION COSTS
Estmiated Cost (Dollars) to be Official Use Only
completed by permit a licant
(a) Building Permit Fee
--- ------- ------ - ---
(b) Estimated Total Cost of
Construction from 6
Building Permit Fee
I I
3 4 '� �»>��_ i Check Number
This Section For Official Use Only _
E3uncr,nF; permit Number. Date Issued:..___ — --
", Signature: ------- —.
Building Commissioner/Inspector of Buildings Date
MARS ST BP-2003-1145
CIS#: COMMONWEALTH OF MASSACHUSETTS
. � If CITY OF NORTHAMPTON
Lot: -001
Permit: Buiidinci
Category_ BUILDING PERMIT
Permit# BP-2003-1145
Project# 35-2003-1806
Est.Cost: $6560.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Ed Corbett Ir 116069
Lot Size(sq. ft.): 22389.84 Owner: BRILL ELISSA
Zoning:URB Applicant: Ed Corbett Ir
AT. 46 NORTH MAIN ST
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTON MAO 1060 ISSUED ON.6113103 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOWS
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: Receipt No: Date Paid: Check No: Amount:
Building 6/13/03 0:00:00 1962 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
46 NORTH MAIN ST BP-2003-1145
GIS#: C ,J1'YIma iLTH OF MASSACHUSETTS
Map:Block: 17C-256 4 C-fY OF NORTHAMPTON
Lot: -001
Permit: Buildina
Category: BUILDING PERMIT
Permit# BP-2003-1145
Project# JS-2003-1806
Est. Cost: $6560.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sq. ft.): 22389.84 Owner: BRILL ELISSA
Zoning:URB Applicant: Ed Corbett Jr
Ai 46 NORTH M UN ST
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAM PTONMA0 1060 ISSUED ON.6113103 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
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: Q
Final: Smoke: Final• e k
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLA OF
ANY OF ITS RULES AND REGULATION JJJ
Certificate of Occugancy Si nature: I'
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 6/13/03 0:00:00 1962 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo