23A-225 105 NONOTUCK ST BP-2017-1328
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-225 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2017-1328
Project# JS-2017-002198
Est. Cost:$8064.00
Fee: 540.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN CORBETT JR 078297
Lot Size(sq. ft.): 6751.80 Owner: CLAY SARAH
Zoning: URB(100)/ Applicant: JOHN CORBETT JR
AT: 105 NONOTUCK ST
Applicant Address: Phone: Insurance:
38 GRAVES ST (413) 665-2286 O
SOUTH DEERFIELDMA01373ISSUED ON:5/16/20170:00:00
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: OI: 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 5/16/20170:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
..% , City of Northampton Status of Pemta:
1 c °> , `, Building Department Curb Cut/Driveway Permit
0i :, 212 Main Street sewer/septicAvailability
Room 100 WaterMtea Avaiabikht
;i Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
=
Other speedy
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 6P.- ( 7- ( f
1.2 property Address: Thiissection to be completed�+' by office
Map 61y 34 Lot J C7 Unit
/ OS //fop)o1vLIZ SlAt..)
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
CA
..,.. -.
I ACu.. a !-1AY -..... _ /Or .2/eAr0 1 tit rle .n 771l,ntne MA o%ti. i,:
Name(Print) Current Mailing Address_
/6- 9s5 1
Telephone
Signature
22 Authorized Mont:
•o/J.) C.-t tr: r c.; -i. Ti Rl el- - dit. OiS7/"
Name(Print) Current Mailing Address:
^113 . C2A-C, a?/li,
Signal Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electneat (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection ,r7
6. Total=(1 +2+3+4+5) a 6161/ o0 Check Number oto00)t 1140
This Section For Official Use Only
Building Permit Number: i7 Date
//////'' '' Issued:
Signature: , 4014 -, 5 Ve< 112
Buell -•Commissioner/inspector of auiNmgs Date
Section 4. ZONING AU 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 1,: K: 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 O DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
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 O
IF YES, describe size, type and location:
E. Wdl 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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors -
Accessory Bldg. El Demolition ❑ New Signs [CI] Decks [C] Siding(f7] Other[m
Brief Description of Proposed
Work: Re inn✓LRt to umrA r,ro- OvL a,] in 4•
P I i � j t- An/ ri,.,1a rv;n.de,yl
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 existing 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
a Number of stories?
t 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. ,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
11111111111
_ O !M a. ,as Owner/ uthoriz
hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my�ge
and belief
Signed under the pains and penalties of perjury.
.. 'i
Print Name
�4 • JA , : 7
Sign; f Owner Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder.- . \dH a �n2 r� t7-7)04-)
License Number
DJ 5P-Nv:alA,7 S. r\deer�rL ,ti
J e 7').2).7 6• u.6. a. I
Address //$ t, Expiration Date
- dp 7/ol_
Sign.19 (/ Telephone
9.Registered Home Improvement Contractor. Not Applicable 0
,..)drt. . /:.chs l�1 /60/9J
Company Name Registration Number
?A A(2i.i, 'r S. /s.AtiiLL 6 ac. da, S-
Address Expiration Date
Telephony/J F6•el9.1ca.
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 -tf
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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.CMN 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 he 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
City of Northampton 212 Main Street, Northampton, MA 01060
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: /0J A✓,9n.,:i vox
The debris will be transported by: Mit,4,
The debris will be received by: VA. ;Ley Ac-oyct;n�
Building permit number:
Name of Permit Applicant -To w,,, i;,r li ,-r
S• /6 / ail
Date Signature of Permit Applicant
Ilse Commonwealth of Massachusetts
Department ofIndustrial Accidents
.1111=a Office of Investigations
1--ants 1 Congress Street,Suite 100
Et* =;e�1_ Boston, MA 02114-2017
www.mass.govldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): �'( Orn /tvr, f v t s i
Address: ?,y 6-A.0
City/State/Zip:S. 4e z. ; i I>S Phone#: y,'3. s frc- /f'>/g.,„.
Are you an employer?Check the appropriate box:
I Type of project(required):
I.❑ 1 am a employer ycr with ❑ I am a general contractor and 6. New construction
employees(full and/or part-time).' have hired the sub-contractors
2.(g I 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'
[No workers' comp. insurance comp. insurance?
9. ❑Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.9 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs
insurance required.]t c. 152, §I(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
*Any applicant that checks box dl must also fill out the section below showing their workers'compensation policy infonnatinn.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tc:ontracmrs that check this box must anached 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 art employer that is providing workers'compensation insurance for my employees. Below is the polity and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie.#: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify an er the and penalties of perjury that the information provided above is true and correct
Signature: Date: S./F. i>
Phone 4: N/a - 6,(c. S S-9/
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Fx sj 1/ Y: ..• ,. u
. Y / �� J CORBETT 31 Y 1 cr �,Ls '' �, l/f
I orf HOME EXTERIORS J HIC#160143
iti j(, ) lashI
alas6s-zza6•413.sseall2 u.,r'Y CSL#78297
38 Graves Street South Deerfield,MA 01373
(�k S 3 J I i_I.�} f WINDOWS•SIDING•GUTTERS•ROOFING
A —r 7 1 l `Locally Owned and Trusted Since 1966
Serving the Entire Pioneer Valley
,C5? l Si_•ri"K.
CONTRACT
Date Ara.L j fr 20 ) 7 _
This agreement, between ,,SA,t•tn C,
._ _ ......_._.e/Aeter;(Owner) 1,
of
f41 0_ nl •LGi� ...:SJAFFA (A s) eA4 d1 , , and
JCORRETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS
Phone .$-.F,tt.. 94-6
a/
SPECIFICATIONS
--�a.4t ; (tet U _ +:a ■i e _ [ A
1Aa .^f-r - -aAir .....in ii/7 i n,
'?J (r✓+Nto.,.: apiTa Inr,to Xteetc f eree heel el i.ruS • .�.7' ti—Jdetritr
e4,22,2,2_," 6 e .mi_da.TV?1Ad Ti. w;�t Ma 2 trtt.�i'_V
" T .. n .-, —
(ALD_e? ice.•}...—_—... ..—on themises located at
pm �torn,al r,iY !)"nr ea r a total cost of Odl/ ¢.n
With this order owner pays down the sum of$_, .. 4 yq,st 3 C)G!J (l(1
Owner agrees on completion of said work by the Contractor to pay the sum of$ ... fir—rate2 $16y 00 dollars
($ ).
Owner agrees that in the event of any broach 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 I 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.Condensai•• td up on the glass is
caused from high humidity levels and poor ventilation within the home therefore there is no guarantee r tion will not occur.
In witness whereof,I have hereunto signed my name this ..,,,81-19 day of 4.4, n i ` 20 j'l`'
by
rum / Lrrz —..�
((/SF ncrw"Ul • ,ggent)
.Wong Owner) —