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23D-140 98-100 HINCKLEY ST BP-2002-1055 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D- 140 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2002-1055 Project# JS-2002-1692 Est. Cost: $2554.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. ft.): 14549.04 Owner: MCGRATH JAMES E Zoning:URB Applicant:. Ed Corbett Jr AT: 98-100 HINCKLEY ST Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTON M A01060 ISSUED ON:5/30/02 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:p i C._if, THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc Si nature: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 5/30/02 0:00:00 1588 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo ,f l . Muse.nl ��a '; it) of Northampton Sat s of per It > 1q ,:'e '-.Cr , 4i� - .' , ding Department C b Cu /,Dweway �e;`y,i.,• "e,I -` ` ,', MAY 2 3 2002 � Il'�12 Main Street Sewer/Septic` olot .Av rlab, ty .4� ` ` Room 100 Wr/W�3yeyl l Av i�,I a,b�lipp.�� 44. "'_ i DEFT O%BUI.GItGINSPECTIOifiiorthampton, MA 01060 Two,Sets'of1StrUetura as S .- NORTHAMPTON, D . Torre 13 58: 1240 Fax 413-587-127? Plot'/Site"f la i. Other Specify K,. 4 F , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAM!' v ' SECTION 1 - SITE INFORMATION 1.1 Property Address: 9gzcôThis section to be completed by office 1l�i4114 Lf Sr/ Map Lot .. Unit Zone Overlay District Elm St. District_ CR District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 2.1 Owner of Record: G ' I ao we614.40-cw 71c1Q-e- Name(Print) Current Ma ,,nq A:1c1H-, Telephone Ls-8 /�42 V / Signature 2.2 Authorized Agent: 1 Name(Pri t) Current Mailing Address: °;� -�' 7 (r' -- _ filii) 5 )y/- c 7/ 1 Signature lephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS tern Estimated Cost (Dollars) to be Official Use Only completed by permit applicant Building (a) Building Permit Fee Electrical (b) Estimated Total Cost of _ Construction from (6) Plumbing Building Permit Fee — :1 Mechanical (HVAC) 5 Fire Protection S Total = (1 + 2 + 3 + 4 + 5) 2,5-5y Check Number lT 5-' This Section For Official Use Only — Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable) New House fl Addition Li ReplacemP� t Windows Alteration(s) ❑ Roofing Or Doors [�I Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding Other Brief Description of Proposed Work: Alteration of existing bedroom Yes _ No Adding new bedroom — Yes NI Attached Narrative 0 Renovating unfinished basement Plans Attached Roll 0- Sheet 0 a: If<TNew3house Td iiiri dtlition'to'existing{Housin' '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 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 ve` .• 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 as Owner of the subject propert hereby authorize __ to act my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, D)kffelkil\ ) (Q�6 - '- , 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. 1.1 gr2.6 i (.c R i3e n J+. Print Name Signature of Owner/Agent Date • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name ,C of License Holder : f R ) ) Cl�/ �` C(t)7 ycc License Number Address Expiration DFitc -5 /- "r 3 7/ 3 nt:ture Telephone r u. r.ecror x. »w»� �,r. .-,,�mK• =a...--n»+-rae..'A• "�(�' .'ri 7"�s, fit` a day tt�"kd' i9NReg sf iverai i$erMai eal em'ent Contractor.R xew tS r � w,ovi Not Applicable ❑ LC l'�e TT M.itiT // 4 Company Name Registration Number /s- ©y Address , Expiration Date ,__ t� *Ai M t Telephone � I—(4 S7J 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 1 No 0 11: = a ome.Owner*E empt 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 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 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 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 04 Open Space Footage 04 (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 x_ YES IF YES, has a permit been or need to be obtained from the Conservation Comrrtission? 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 Y S, describe size, type and location: ... , L V--IttA.1PTO G' Northampton 1 4��/ `� �6assachnsrtle' 4'-m DEPARTMENT OP BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 tr'-,' WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, FD)L)i t '-7-" Co RP e r- 1/41 R (li censcelpermi ttee) with a principal place of business/residence at: LI RC ) _-f PJCk AAryfiv,J. Mtn dic062d (phone#).5--e9i7 12-_ 7/ (bti eetici ty/state/a p) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: - (Insurance Company) (Policy Number) (Expiration Date) ( ) 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) (Expirati Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shoe;ifnrcY-cs.ry to Mello c information pertaining to all cocnrndon) XI am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:*sac be aware that whilo homoowners who employ persons to do mime .,e,construdion or repair work on a dwelling of not mecca thin throe)units in which the homeowner wide or on the grounds appurtenant thereto arc cot C..11y maridcrcd to be employers under the worker's compensation Act(GL152,1s1(5)),application by a homeowner for a hcctue or permit may cvidcaoc the legal darns of an employer under the Woricols Compomation Ad_ I understand that a copy of this atatcmmt may bo forwarded to the Dcpnrtmcnt of Industrial Aecidmtf Offioo of lora/ oos for the coverage verification and that failure to secure coverage under section 25A of MOL 152 can lead to the imposition of criminal penalties consisting of a fine of up to S 1,500.00 and/or imprisonment of up to one ycnr and civil penalties in the form of a Stop Work Orde-and a ' " firm of 5100.00 a day agaitntst me For dgzutmassl trio only Permit Number Z/—O Ma0 Lot# Signature of LioPermittce ?�e 7roposat— . �-�'�- .; , Corbett Home Improvement .4 Northampton, MA 01060 ,. -•1.��r� I.4I`1�. (413) 584-6571 J.e, '.ill' " c D it i.• :o.0 ..nott . , PkltPttti.AL(SU'BNfI'IEDTO • 1 ►� —I C(i PH(1NE ,yam l_��1g _tiA'iE / U\ /(�% ci ^' STREET X C) (A)Pt S 1tu`i.JCSIli Y - MR NAME 7 CRY,STATE,amul ZIP CODE 0,V A JOB Ll1CA f t /L�L) 4f�fS..4� •DATE f tF PLANS 1013 PH<SNF. We hereby submit specifications and estimates tier: 1ti5/Xi (Q i0a4)61,-,4t U A.,,,/ Alt �_ k• � , ,ti-r; �� -� i�- �r��_• �_ 6 / 5. (AT "# t-il/.:K,LI ) '/Fcc NS4Al( .� jON:b� ��'7 Lj.i/ i4>�cW a cv/ Lcd- Cr 6 4as,� 1= c�.+ 4 G�l��a. l = I /� 'hl1Z " X �// pore1)/V�j ��/4Lt/�/ni LT /7ISG ft/��lt �1 /i)=) / .„ ! j (i 1 (Jr)5 �7Ji Ak.;i1( j• oSi • 7./-I ( / , G� 3) 3/y 5'.7 'I2- 1/ Ex cr cZ� a3/' ,)L-l ' : 3 ( s7/Z lII1 973/97K 6-3 11 , ll,/si_e.. tA: / / 37:3/? 38% I,/ %1 - - (We (,Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of:, AS/ ollars(l�S/�j'� i/ Pay..to be made as follows:Ai ri\6 A.,.. _1 t.,.i..4 r j ,i; ii_vni ei oft i.,; oiiiii U C, t) All material is guaranteed to he as specified. All work to he completed in a work-like Wanner according AuthoriZxd ��!) r ti.smandar l practices. Any altercations or deviation front above specifications involving extra costs will he Signature .r�( .....„ '-- executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry lire,tornado Note. Thisproposal may be and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within das s Acceptance of(proposal-The above prices,specifications 21 1)2i L� are conditions are satisfactory and are hereby accepted.You are authorized to Signature ,./_ Ili G if do the work as specified. Payment willll he made as outlined above. Date of Acceptance: I -! fr — 0Signature