17A-182 (7) J CORBETT
31 .x �` y /�I' HOME EXTERIORS HIC #160143
•� 3 i 413-665-2286.413-586-8712 CSL #78297
t7C 38 Graves Street,South Deerfield.MA 01373
WINDOWS•SIDING•GUTTERS•ROOFING
"Locally Owned and Trusted Since 1966"
Serving the Entire Pioneer Valley
CONTRACT
Date , t, e2 JS- 20 /d"J
This agreement, between W Le <
�T
(Owner)
of /AJ �/ /�,/��'Jf ht. <)/tt�.� r' 0rtol e, , and
(Address)
JCORBETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS
Phone , 79-9�,/,��f
SPECIFICATIONS
642
�I r m 41
on the premises located at a total cost of 7/1
With this order owner pays down the sum of$ J
Owner agrees on completion of said work by the Contractor to pay the sum of$ �� �,/c�ra, v dollars
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70%of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject to labor strikes, fires, wars,acts of God, and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be
binding unless in writing signed by both parties.
WINDOW GUARANTEE
Manufacturer's glass is guaranteed for life from date above not to fog up between the panes of glass. All other parts will be
supplied free of charge for life. Service will be free of charge for 1 year from date above.Guarantee does not cover broken or cracked
glass after one year from date above or any damage resulting from neglect,abuse,or acts of God.Condensation build up on the glass is
caused from high humidity levels and r ventilation within the home therefore there is no guarantee that this condition will not occur.
In witness whereof,I ha ye hereunto 1 ed my name this S' ' day of r-f I�r,±b��L 20 l f
by
Vonthdc`toVqfAuthorizedAgent) (Owner)
(Joint Owner)
City of Northampton 212 Main Street, Northampton, Na 01060
Solid Waste Disposal A-f davit
In accordance of the provisions of MGL c 40, S54, 1 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 �� f�, f�1_��r^�z',
The debris will be transported by:
The debris will be received by: L z,,,,,
Building permit number:
Dame of Permit Applicant
Date Signature of Permit Applicant
City ' of Northampton
�s Massachusetts ti,5- 5 - fr-
f ;s DEPARTIVIFIVT OF BUILDING',INSPECTIONS x
212 Main Street • Municipal Building
-
..M ' Northampton, MA 01060
` - �W yeti.
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
Fshre 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 w ho constructs more than one home in a two-
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 i
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
i
• ' . The Commonwealth of Massachusetts
Department of Industrial Accidents
"G Office of Investigations
600 Washington Street
f Boston, MA 02111
1="f www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/IndividuaI):,,lj„�,,�
Address: ?k 62'M s:t1e,
City/State/Zip• ,7A &egt_,;,,1 ly4 Phone #: ),a�k,
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. E] I am a general contractor and I
r�—�/employees (full and/or part-time).
* have hired the sub-contractors 6. New construction
2.IJ' 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers comp, insurance comp. insurance.$
required.] 5. 7 We are-a 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 12.0 Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 11aOther
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.
$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 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 verif cation.
I do hereby certify nde a pains and penalties ofperjury that the information provided above is true and correct.
Si ature: �X
Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town offzciaL
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: )�N� l�t�A�j: 'rJ /b 3 �
License Number
i-_ e c ;al Q J_ /6
AddreV/// Expiration Date
!S `�
Signat/ Telephone
9 Reaistered_HromearriarovementContractor,; Not Applicable £
IPu B6S0/ 9__-�
Company Name Registration Number
Address Expiration Date
Telephone Se.<u-• d 14
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 Qwnero ; -e npt>ion
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 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacementll(indows Alteration(s) ❑ Roofing ❑
Or Doors �1
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding [❑] Other[❑]
Brief Description of Proposed /
Work: RrMov� t'X � �n! hllnxl d�� )J4dI�lLL Vlnl[' �FLAlts�l� ) Nl ^�Lr4!S s3� V" V/ycL'P.
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa if New hoase and oradditfon"to existing hoUting .complete Elie folloelnq:
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 TOR,BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
J4 �–j— 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.
Signed under the pains and penalties of perjury.
Jo
Print Name
Sign ur 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
Frontage
Setbacks Front
Side L:��"---;�I R:= LT I R:I i�
Rear
Building Height �I
Bldg. Square Footage j % �-
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 Q DONT KNOW O YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES Q
IF YES: enter Book j Page^�T and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: f
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location: j t
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 1 acre? YES Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
' I
j
pepartment use only' i
City of Northampton Staus,ofPerrnri �' "`
R Building Department Curb Cur�Drlye�vay Ferrrui s
212 Main Street SewerlSeptieAvalla�l(rfy
Room 100 N rthampton, MA 01060 Tw ME
13 587-1240 Fax 413-587-1272 up.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
- Thls ectlon to be comPI fed by offic e -r
1.1 Property Address:
bit-:..
-
_—_.__:__:_r_:=__-:;,_
a:'=D�
.' --..,.:_- - - - - —'
_ �.CB DiStnct �
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED;AGENT
2.1 Owner of Record:
I Sr a A-' �o r�L �.s A^t4_ S ),4 e-t)
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
,J Co die= aL, ,mil -S 1.4 , ce�� A4
Name(P int) Current Mailing Address: r`
Sign t e Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be w Official Use-Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical ..(b) Estimated Total'Cost of
Constructich from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) •q 1,0, 0 6) Check Number
This Section For Official Use Onl
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/lnspector`of Buildings: Date
187 NORTH MAPLE ST BP-2016-0601
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 182 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2016-0601
Project# JS-2016-001013
Est. Cost: $2400.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN CORBETT JR 078297
Lot Size(sq. ft.): 7187.40 Owner: TOWLES SUSAN E&ANDREA M ADAMOWICZ
Zoning. URB(100)/ Applicant: JOHN CORBETT JR
AT. 187 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
38 GRAVES ST (413) 665-2286 O
SOUTH DEERFIELDMA01373ISSUED ON:111212015 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: Date Paid: Amount:
Building 11/2/2015 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner