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18D-053 (3) 80 DAMON RD#5202 BP-2007-1140 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18d-053 CITY OF NORTHAMPTON Lot:-121 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2007-1140 Project# JS-2007-001826 Est. Cost: $1400.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. ft.):_ Owner: MATHIEU AMY B Zoning: (7T Applicant: Ed Corbett Jr Ai: bu LiAi:4ON RD ig.-2O2 Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON:5/22/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS POST THIS CARD SO IT IS VISIBLE FROM THE STREET p Building Inspector Inspector of Plumbing Inspector of Wiring D.Y.W. Underground: Service: Meter: Footings: g Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Insulation: Rough: Oil: ��qq-- Final: Smoke: Final:(9k 6 •af:©7 �dr ') THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA IONS. , ---- .4„.„,e,i,,,,,e' Certificate of Occupanc Signature: FeeType: Date Paid: Amount: Building 5/22/2007 0:00:00 $25.003454 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo •.. • Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit K; 212 Main Street Sewer/Septic Availability . Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 hr APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENdVATE"6R DEMOLISH A ONE OR TWO FAMILY DWELLING MAC 2 SECTION 1 -SITE INFORMATION 1.1 Property Address: ----- 1s sectlod to be completed by office C5b J) O,I 4P( e) Unit Zone 6velifisakr — Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A/11 A/WA i cc� Name(Print) Current Mailing Address: Telephone ce S //J/ Signature 2.2 Authorized Agent: ED/016D T (bR g rr Reed ©)060 Name(Print) Current Mailing Address: CM) sR9 6s-7/ Signature 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. 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) /Y/t� �.5�'Check Number 3 Ø't5 `_ This Section For Official Use Only c Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING Alt 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: R: L: R: Rear Building Height Bldg. Square Footage Vo 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 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW 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 it 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. 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 O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House 7 Addition ❑ Replacement indows Alteration(s) ❑ Roofing l l Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[O] Other[0] Brief Description of Proposed T___/ , , y 0111 / itfeh f f //_ , -'� Work: —'rNlj43Crl, I ll�! vac/[.CJG1/ 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 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 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 of Owner Date 6PheA- J f , as Owne• horized en ereby declare that the statements and information on the foregoing application are true and accurate,to the best of • •• edge and elief. Signed under the pains and penaltieslt of perjury. TQ'ffd 74SI Jr Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervis�or:-/ n ( Not Applicable ❑ Name of License Holder: L _Jt ' J 2 T idg_ (,r 067 vgc License Number Reed AJ *4J iv]4- 6/o(0 y-3-08 Address I Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ C©2 B3e77' Aarkit i►��r�ov�h %16 0 6 Company Name Registration Number 1 /.e d 454 N'IJ p 4 o)o�� S-1s=o8 Address / " Expiration Date Telephon0`7/ 8'7,6s7/ 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$r No 0 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations =321= ? 600 Washington Street '•.Satiter _r ; Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Legibly . Name (Business/Organization/Individual): kIi� e ��� A),46,64. JT Address: y ktokeoi 6 f" City/State/Zip: /UO 44iA ldi A'4- 01o6o Phone #: £QQ JOs85 6 SW 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. I 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. workers' comp. insurance. P tY• 9. El Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL, 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information. t Homeowners 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance fur ml•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 fin 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 an penalt' of perjury that the information provided above is true and correct. Signature: ,G�'�'G«f� Date: s---/t Phone#:(y/,0---c ' 4 Official use only. Do not write in this urea, 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 #: 7:::- Proposal Vinyl Siding dows ,. -'r =_+� Corbett Hone Improvement Roofing • Northampton, MA 01060 Doors �� 1.1 I`1� Awnings '.` 1' (413) 584-6571 Canopies i/j ic C ao,c9 sz,*es6. .e-/s-e) Gutters Shutters PaoposAL/ t..!/SI�►UBMITTED�TO 4 InA 4A f e (-J PHI INE`S���//3/ [DATE / )/ tt �Q Or? V ti tteET o Oil le � —}t 20 JIIB NAME CRY.STATE,and ZIP CODE /'� JOB LOCATION // �' DATE01'PLANS JOB PHONE --357� We hereby submit specifications and estimates for: --4.6}rra `i . Net thVolt \r-,,j(.4 t! NLAI.3 0 aciA I,,,,ilvv, G//ic/•�r Z9110- £r 1 -.a S . Lo oci %zr sc1- c. Ilia ‘.ei 4/s Za/o� o�ilk .. inter ,.l -tr/r ,v eo'4 - .al, IW c� - c/vc fi —XAsk_ ��-- ,9-jam IOU M r'a,/"s,1 Gk o,✓ P_ /o 4, poGitJsy ynye/ (4vl�L 4 3)3/1'X 1133// j) m let ki 3 x 3►J i 1 / i i7sA- , -oft. yx 3 y � We Tropose hereby to furnish material and labor-complete in accordance with the above specifications,for the sutra of: it„../,,,,,, ///►►►Dollars $ ) /VPayments to be made as follows /l d pi dive i�„ O) ))V L'Qa,/ All material is guaranteed to he as specified. All work to he completed in a work-like utanIIcr according Authorized to standard practiczs. Any altercations or deviation from above specifications involving extra oats will he Signature executed only upon written orders,and will becoute an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado Note: This proposal may be and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance withdrawn by us if not accepted within(—..?a ,lays. A Acceptance of Proposal-me above prices,specifications it./ are conditions are satisfactory and are hereby accepted.You are authorized to Signal do the work as specified. Pay tent will a made s outlined above. „ Date of Acceptance: � �i -/ Signature J