Loading...
29-568 No. 222893 Florence Savings Bank 53-7168 12118 85 Main St., Florence MA 01062 DATE September 03,2015 MONEY ORDER PAY TO THE \� ORDER OF $ 100.00 One Hundred and 00/100***********"*****************"************* DOLLARS MEMO NOT VALID OVER$1000.00 NON NEGO TI LE/ Customer Copy DRWER/REMITER ADDRESS No. 222893 D.,Y'_ 53-7168 12118 Florence S�Bank DATE September 03, 2015 85 Main St., Florence MA 01062 MONEY ORDER PAY TO THE ORDER OF CC' A-1">e ti AJ \A1Cat C j/� O /`- /—< A e'SA -fi/f'2t-a-7 71 $ 100.00 One Hundred and 001100*********"***'**"**********************'**" DOLLARS NOT VALID OVER$1000.00 MEMO �rJ/�,,F h iu%y F'Gl.n./,� .f �� ,--f✓—� DRAWER/REMITTER U ADDRESS - ADDRESS 11' 2 2 289 311' 1: 2 L 18 7 16881: 19800 56 7 5911' No. 222892 Florence Savings Bank 53-7168 121 18 85 Main St., Florence MA 01062 DATE September 03,2015 MONEY ORDER PAY TO THE ORDER OF — �_ One Hundred Fifty and 001100************'***"*"***********"*""***% DOLL S MEMO NOT VALID OVER$1000.00 NON-NEGOTIABLE Customer Copy DRA W ER ADDRESS ADDRE No. 222892 D�r'_ 53-716812118 Florence Savings Bank DATE September 03,2015 85 Main St., Florence MA 01062 MONEY ORDER PAY TO THE p c17- l 1 F'i r 1` $ 150.00 .ORDER OF �C:'�F�i_�..� C��r- it l'�,h ��= �A �—rA�'-�',� One Hundred Fifty and 00/100***** ******"************"***"******* DOLLARS MEMO NOT VALID OVER$1000.00 DRAWER/REMITTER U ADDRESS' ADDRESS 11■ 2 2 289 211' 1: 2 L L87 L68811: L980056759112 IMPORTANT FEE NOTICE: CHANGE IN LAW ABOLISHES CSL's HIC REGISTRATION FEE EXEMPTION. As a result of a recent change in the law (Section 80 of Chapter 27 of the Acts of 2009), the holders of Construction Supervisors Licenses are no longer exempt from the HIC Registration fee. CONSEQUENTLY,ALL CONTRACTORS,INCLUDING CSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A REGISTRATION FEE OF $150.00, AND A GUARANTY FUND FEE. (See instructions for Guaranty Fund fee schedule.) 16. REGISTRATION FEE ENCLOSED:$ / C5, - GUARANTY FUND FEE ENCLOSED: //���, - PLEASE INCLUDE TWO(2)SEPARATE CERTIFIED CHECKS OR MONEY ORDERS,ONE MARKED "REGISTRATION FEE"AND ONE MARKED"GUARANTY FUND."ONLY CERTIFIED CHECKS OR MONEY ORDERS CAN BE ACCEPTED.ANY OTHER FORM OF PAYMENT,INCLUDING BUT NOT LMTED TO PERSONAL OR BUSINESS CHECKS,WILL BE RETURNED AS INELIGIBLE.MAKE BOTH CHECKS PAYABLE TO "COMMONWEALTH OF MASSACHUSETTS." I hereby swear, under the pains and penalties of perjury, that all information set forth on this application and submitted in support hereof is true and accurate to the best of my knowledge. Further,I certify under G.L. c.62C,§49A, that I am in compliance with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting of child support re of Applicant If a corporation or partnership, position held. Date 11.LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,AND MAJOR OWNERS(10% OR GREATER OF OWNERSHIP)OF AN APPLICANT PARTNERSHIP OR CORPORATION,BELOW.USE ADDITIONAL PAPER IF NECESSARY AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS).PLEASE INDICATE BY AN "X" IN THE LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION I.D. CARDS.USE ADDITIONAL SHEETS IF NECESSARY. FULL NAME TITLE % OWNER ADDRESS SUPP.CARD 12. (a)HAVE YOU BEEN REGISTERED PREVIOUSLY AS A HOME IMPROVEMENT CONTRACTOR? ZYES NO (b) IF YES,PLEASE PROVIDE THE NAME AND REGISTRATION NUMBER UNDER WHICH YOU WERE PREVIOUSLY REGISTERED: NAME: y' ty ax/LS-,l/��_S` HIC REGISTRATION#: 13.(a) ARE YOU CURRENTLY OR HAVE YOU EVER BEEN AN OFFICER,PARTNER,OR CO-VENTURER OF AN APPLICANT WHO PREVIOUSLY APPLIED FOR OR HELD A HOME IMPROVEMENT CONTRACTOR REGISTRATION? YES /'No (b) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANT/REGISTRANT AND THE REGISTRATION NUMBER: NAME: HIC REGISTRATION#: 14. (a) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BY A REGISTRANT OR APPLICANT FOR REGISTRATION AGAINST WHICH DISCIPLINARY ACTION WAS TAKEN? YES-,/No (b) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICANT/REGISTRANT AND THE REGISTRATION NUMBER: NAME: HIC REGISTRATION#: 15. (a)HAVE THERE EVER BEEN ANY FORMAL COMPLAINTS AGAINST YOU WHERE DISCIPLINARY ACTION WAS TAKEN BY THE DEPT.OF PUBLIC SAFETY OR CONSUMER AFFAIRS,OR ANY COURT JUDGMENTS OR ARBITRATION AWARDS ISSUED AGAINST YOU? YES /"'NO (b)DO YOU OWE MONEY TO THE GUARANTY FUND? YES 1,�NO IF YES TO EITHER,PLEASE IDENTIFY BY DATE,CASE NUMBER,OR DOCKET NUMBER: THE COMMONWEALTH OF MASSACHUSETTS For OCABR Use Only. OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION Registration No: 10 Park Plaza, Suite 5170 dBoston , MA 0 2 1 1 6 Effective Date: Application for Registration as a Home Improvement Contractor or Sub-Contractor Expiration Date: S' (MGL c. 142A;201 CMR 18.00) 1. NAME OF APPLICANT: /c--A,Z7 (MUST BE EITHER AN INDIVIDUAL,CORPORATION,LLC,LLP,TRUST,OR OTHER LEGAL ENTITY) 2. NUMBER OF EMPLOYEES: / 3. APPLICANT TYPE: INDIVIDUAL _CORPORATION _PARTNERSHIP _TRUST (CHECK ONE---MUST BE SAME LEGAL ENTITY AS THE ENTITY IDENTIFIED IN#1) 4. SOCIAL SECURITY#: 0,51­2 -O 6S_0 FEDERAL TAX ID#: 5. APPLICANT PHONE#: 4/,?- ,S -i'cS C` APPLICANT EMAIL ADDRESS: 6. MAILING ADDRESS: _�e A.1 r = STREET CITY STATE ZIP 7. PERMANENT ADDRESS: /J-6) W 010 Q`r C_(6 JL f 1V L ./��'t STREET CITY ° STATE ZIP PLEASE NOTE THAT A P.O.BOX IS NOT ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS. 8. IF THE APPPLCCANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL SECURITY#AND TITLE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Instructions before answering this question): LAST FIRST SOCIAL SECURITY# TITLE 9. IF APPLICANT IS DOING BUSINESS UNDER A DB/A,PLEASE STATE THAT DB/A,AND ATTACH A COPY OF THE FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK: DBA NAME: 10. (a)DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION-RELATED STATE, CITY OR TOWN LICENSES OR REGISTRATIONS?_YES_NO (b)IF YES,PLEASE FILL IN INFORMATION BELOW.ATTACH ADDITIONAL SHEETS IF NECESSARY. LICENSE TYPE ISS Y LICENSE/REG.# EXP.DATE LICENSEE NAME CI 0 9,'27 Proposal Date: 7/22/15 Proposal Submitted to: Proposal Submitted by: Bonnie&Margaret Gruszeck Parsons Project, LLC 138 Overlook Drive General Contractor-Jeff Parsons Florence,MA 01062 150 Woods Road (413)584-9280(Home) Florence,MA 01062 (413)883-2307 (Cell -Maggie) (413) 563-1624 (Cell) (413)923-2024(Cell -Bonnie) PARSONS (413) 584-3652(Home) PROJECT Design• Remodel•Build I hereby propose to furnish the materials and perform the labor necessary for the completion of the following: - Permit: The homeowner is required to obtain the appropriate permit from the City of Northampton. - Preparation: The homeowner is required to remove any and all materials around the perimeter of the house. Demolition: Shingles are to be removed from the main house, garage and connection between garage and house,back to the original sheathing. Any shingles, felt paper and old drip edge is to be removed by the contractor. Plywood: All exposed plywood sheathing is going to be inspected by the contractor. Any damaged plywood sheathing is going to be replaced by the contractor. If any sheathing is to be replaced,the homeowner is to be notified of the additional costs for the materials and labor. Protection: New synthetic barrier is being used instead of standard 15 pound asphalt felt paper. Drip edge is being added to any perimeter surface on the main house, garage and connection between garage and main house. A layer of water and ice is to be added to all edges of the main house, garage and connectiong roof. Also,the back of the main house that has a 3/12 slope is entirely covered with water and ice prior to the asphalt shingles. Shingles: Shingles are going to be added to the main house, garage and sunroom. The homeowner is responsible for choosing the IKO Cambridge style architectural shingle color. All material is guaranteed to be as specified, and the above work to be performed in accordance with the specifications submitted for above work and completed in a substantial workmanlike manner for the sum of$11,375 with the payment to be made as follows: Payments to be made as follows: $5,500 Once job is started. $5,875 Upon completion. Contractor's signature:' Date: 3d i Any alteration or deviate rom the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the proposal. ACCEPTANCE OF PROPOSAL The above process, spe 4ficatio#s and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments to be iflade as outlined above to Parsons Project, L C. Owner's signature: Date: City of Northampton 212 Main Street, Northampton, MA 01 060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: r< o �EIVCF The debris will be transported by: 7-1-e c- �z The debris will be received by: Building permit number: Name of Permit Applicant A s-rs,1 s! T 8��0�/�` �i��✓Jr ,�1,�h--, �/C ter- Pal�_Sa�co� Date Signature of Permit Applicant City of Northampton Massachusetts -sus°nom sell, YT DEPARTMENT OF BUILDING INSPECTIONS ,t` ��• 212 Main Street • Municipal Building ` ,•T^ Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT F f Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her n supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which des or intends to be, a one or two family dwelling, attached or detached structures o such use and/or farm structures. A person who constructs more than one home in a two- year perod 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 occupancv 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 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street f. Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /oar, A c C �iC=�'—f- �JXI- Address:ess: /,1-6 --R-O City/State/Zip: i=CG e �> - � 0116 arL Phone Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. (] I am a general contractor and I mployees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 7 Demolition working or me in an capacity. employees and have workers' g Y P tY• 9. ❑Building addition [No workers' comp. insurance comp. insurance.T required.] 5. F_� We area corporation and its 10. Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.2 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sip-nature: QIL r a fL/ �-, Date: Phone#• 4✓,a.. .fl�,,? Of use only. Do not write in this area, to be completed by city or town offlciaL 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: S"e).v r ()If — C3 91- [ License Number Address n Expiration Date Sign Telephone 9 Registered_H°omearriprove'ment-Contractor __4���_ �� _��__ .�_�_! Not Applicable £ Company Name 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 of the building permit. Signed Affidavit Attached Yes....... £ No...... £ .11 T Home Oner_Egempt>ton 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 i i SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: S D.n/ S ()s' — 0,9R e ?.3 License Number Address Expiration Date clz/ 9/.7�— �t�� — 0 ¢ Sign Telephone 9 Redistered:Homeamprovement Contractor _ _ Not Applicable £ Company Name 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 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 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 I SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Zf Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [O] Other[0] Brief Description of Proposed Work: /�F/3►a:�E' of!J 1�11"C(,5'y A �j NFCAJ Si,li.v Alteration of existing bedroom Yes +✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rol( -Sheet . . _ _..- sa If Newhouse and or.additlon to°exist= houslnd.corriplete the followmt : 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 900 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 CONTRA TOR APPLIES FOR BUILDING PERMIT as Owner of the subject property her authori /OA ^✓ v' — — l v CS.v to a on my b alf, in all matters relative to work authorized by this ilding permit application. Sign ture of Ow er Date 1 {, ( 41 as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. r Signed gnder the pains and enalties of perj ry. v� Print Name �r Date Signature of Owner/Age t 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 3 Frontage Setbacks Front !—� Side L:` ( R:` 4 L:' _ R:I Rear 1 Building Height Bldg. Square Footage ice_ % Open Space Footage % (Lot area minus bldg&paved �3 �V_; —s LLLj parking) #of Parking Spaces 1--- ` Fill: i E (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW Q YES Q r ---- IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES Q IF YES: enter Book Page; I and/or Document#) 1- 1 ...� B. Does the site contain a brook, body of water or wetlands? NO (a DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained Q , 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 O NO a IF YES, describe size, type and location: j E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 9 acre? YES O N0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i _ i SF ter r pepartment use only r City of Northampton Sfatu$ofPermrt x " A �'� ' " Sr{^� 206 Building Department Crib CUtli7rrt�e4vay:�F2rrrttl s- i y3 £''�'' 1 •2k .. L 'H31�. n i r s �. .t 212 Main Street SewerlSepticAvailabilrty k s F ; i Room 100 Waterh/+fel�Avarlabihty F E ectric P N r,i . 'Northampton, MA 01060 Tw6 sefs'o>Structural Ptarrs { _7 phone 413-587-1240 Fax 413-587-1272 Plafis,te Plans ri , ; r " r T AMR OtE�e%5peotf��F �; �f r 1 r` ZP APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION Thts section to be completed by office 1.1 Property Address: _ •_ a ____.. .__.... ..... .....:_...; Map Lot Unit F4(©?C Zone Overlay Dtstrrct 'V c'�� �'i•� er©e Z z F EIm:St District _..: C8 Drstrtct SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT. 2.1 Owner of Record: /•�'� p �✓F2C61�/� ?) /?EVE Name(Print) Current Mailing Address: o,/_-? — 5—F4 ?.4G Telephone Signature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building _ �,,�„�p C ��i (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) Y(J 5. Fire Protection 6. Total=0 +2+3+4+5) A 1/3 7,5— Check Number This'Section For OfficW'Use Onl Date Building Permit Number: Issued: Signature• �. Building Commissioner/Inspector`of Buildings: Date 138 OVERLOOK DR BP-2016-0299 G1S#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 29-568 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0299 Project# JS-2016-000485 Est. Cost: $11375.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JEFFREY PARSONS 98275 Lot Size(sq.ft.): 20473.20 Owner: GRUSZECKI BONNIE&MARGARET M WYNNE Zonin : Applicant: JEFFREY PARSONS AT. 138 OVERLOOK DR Applicant Address: Phone: Insurance: 150 WOODS AVE (413) 584-3652 FLOREN CEMA01062 ISSUED ON.91912015 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 9/9/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner