17D-079 (2) �
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J&J HOME IMPROVEMENT &
REMODELING CONTRACTOR Estimate
PO BOX 307 � DATE ESTIMATE# 1
WILLIAMSBURG MA, 01096 __ - _ _
413-268-3504 FAX 413-268-7029 8/28/2002 255
HIC#101176 CS079531 --- 1 --- --
NAME/ADDRESS
PHILIP BROCKLESBY #2
503 BRIDGE RD
NORTHAMPTON,MA 01062
I
- --- - PROJECT
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DESCRIPTION QTY -- -- COST — TOTAL - -
INSTALL 29 SQ OF SIDING ON BOTH THE HOUSE& 21 200.00 4, .00
1 200 ��
GARAGE WITH 3/8"BLUE BOARD BACKER.
COVER ALL FASICA&SOFFIT WHTIE TRIM&SOFFIT. 1 2,792.00 2,792.00
COVER ALL WINDOWS&DOORS WITH WHITE TRIM. 1 1,535.00 1,535.00
HOME OWNER WILL STRIPI11 THE HOUSE AND GARAGE.
PAYMENTS AS FOLLOW:$2842.00 DOWN,$2842.00 ON
'I
START,$2843.00 ON COMPLETION.
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Additional information to this proposal
All materials is guaranteed to be as specified as discribed above.
All work to be completed in a professional manner,according to
standards practrices.Any alterations or deviations frofn above
specifications involving extra cost will be become an extra charge
over and above the estimate.All agreements contingent upon
strikes,accidents,or delays beyond our control.Owner to carry fire,
torndo,and other necessary insurance.Our workers are fully cover
by workers compensation.
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ACCEPTANCE OF PROPOSAL
Condition of Proposal
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If payment isn't made in 15 days of completion,you will be liable
for all interest,penalties,le s es,court,ay elated
costs.
Signa re:
Date: T�.a v
permits not included.
Thank you for your business.
Total $8,527.00
Signature
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J&J HOME IMPROVEMENT&
REMODELING CONTRACTOR Estimate _
PO BOX 307 DATE 7 ESTIMATE#
WILLIAMSBURG MA, 01096
413-268-3504 FAX 413-268-7029 7/3/2002 247
HIC#101176 CS079531 - -
NAME/ADDRESS
j PHILIP BROCKLESBY
j 503 BRIDGE RD
FLORENCE,MA 01062
F
- - - -- - - -! PROJECT
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DESCRIPTION QTY COST TOTAL
I INSTALL 13 MASTIC REPLACEMENT WINDOWS WITH LOW 13 210.00 2,730.00
E GLASS.
INSTALL MASTIC REPLACEMENT WINDOWS MULD 3 225.00 675.00
;TOGETHER.
PAYMENTS AS FOLLOW12080.00 DOWN,$1325.00 ON
COMPLETION.
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Additional information to this proposal
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All materials is guaranteed to be as specified as discribed above.
All work to be completed in a professional manner,according to
standard=practi�es.Any alterations or deviations from above
specifications involving extra cost will be become an extra charge
over and above the estimate.All agreements contingent upon
strikes,accidents,or delays beyond our control.Owner to carry fire,
torndo,and other necessary insurance.Our workers are fully covere�
by workers compensation.
ACCEPTANCE OF PROPOSAL
Condition of Proposal =
If payment isn't made in 15 days of completion,you will be liable
for all interest,penalties,1 ers fe d rejapd
costs.
Signature•
ate:
. Q
permits not included. -
- i--
Thank you for your business.
' Total $3,405.00
- Signature
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4-t11A1dP�0
a . e, Grztr of wart 1ja ptolt
9 6 jl:isxrflttsrtta
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street e Municipal Building '
Northampton, Mass. 01060
WORTCER'S COMTENSATION INSURANCE AFFIDAVIT
with a principal place of business/residence at:
�a �k 3a) LJ ten, YVA 0 7b (phone#) de-"
city/statd2ip)
do hereby certify, under the pains and penalties of perjury, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insumnce Company) (Policy Number) (Expiration Daze)
( ) I am 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 Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Poky Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additioml sheet ifnacc to include mformstion pertaining to all 000frnct4rs)
(xf I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homcowvcrs who employ per;,a=to do uj it�coast actioa or repair worst on a dwtldng of
not mote than chino units is which the homoowncr residcs or on the grouads appurtenant thatto atz not g=acrzily oomidatd to be
employers under the w mk�s o=*C=saLoa Act(GL152,s 1(5)�application by a homeowner for a kcwe or permit may evidence the
legal atatua of an employer under the Wockeet eompomation AcL
I unda tand that a copy of this siatemrnt may bo forwarded to tho Dcpartmcos of Indsurrial Ac6d=&Oflioo of lasruwca for the
cov--y ge verification and that failure to✓cure covctago under section 25A of MGL 152 can lad to the imposition of crimir ptna cs
ooasisUn of a fine of up to S 1,500.00=Nor of up to one ytar and civil penslti es in the form of s Stop Work Ord--and a
firm of si P.00 a, y against mc.
ga dal uao:�::
Permit Number
gnature of Liccnseelperinittee d=e-
_
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SECTION 8"-'.00NSTRUCTION SERVICES'
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
Company Name Registration Number
R1 &�c 3a7 1✓6LU,A--S w� � d 0 L o4/o —
Address Expi a it to it ton Date
Telephone Ak--3S—d`(
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 Pe building permit.
Signed Affidavit Attached Yes....... No...... ❑
}j S I
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
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SECTYION'S-DESCRIPTION°OF PROPOSED WORK 4404411P palicable)
. ..
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[X} Other [ ]
Brief Description of Proposed Work: t,(,.kce%-%,, — 1A
1 14
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll D- Sheet❑
6,a,,If N.ew hods an Izorr adtlition`t eiristin liousin" corgi IM%the'foll°o`"win
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 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 71 OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNRSAGEN,T,O�R CONTRACTOR APPLIES FOR,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 9f Owner Date
l as Owner/Authorized Agent
her declare�thatthe statements and information on the foregoing application are true and accurate, to the best of my
kn edge and belief.
Signed under t e pains and penalties of perjury.
Print
Si f Owner/Agent Date
pf
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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 ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book _ Page 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. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
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of Northampton
1 ing Department
2 Main Street
AUG 2 8 20.02
Room 100
N rtha pton, MA 01060 e E'
0r Q'r '11n 1�gwo a 58 1240 Fax 413-587-1272 �t
r Sp
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.- SITE INFORMATION
This section to be_comp
leted by�offace
1.1 Property Address: � S
Ma p,
011160 MR nt
Zone Overlay District
Elm;St. District C6 District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED-AGENT
2.1 Owner of Record:
f
Name( rint) Current Mailing A dress:
Telephone
Signature
2.2 Authorized Agent: \ (�
��- c KniS`ac� _ yJ0
Name(PP t) Current Mailing Address:
Signature e ephone
SECTION 3- ESTIMATED''CONSTRUCTI'ON COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed 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 (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:,
Building Commissioner/Inspector of Buildings
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i
ff „ BP-2003-0198
CIS#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0198
Project# JS-2003.0362
Est. Cost: $11900.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Jeffrey Cranston 101176
Lot Size(sq. ft.):: 10018.80 Owner: BROCKLESBY PHILIP H
Zoning:URB Applicant: Jeffrey Cranston
AT. 503 BRIDGE RD
Applicant Address: Phone: Insurance:
P O Box 307 (413) 268-3504
WILLIAMSBURGMA01096 ISSUED ON:8128102 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & SIDING
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/28/02 0:00:00 625 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo