Loading...
18D-053 80 DAMON RD#5302 BP-2008-0116 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D-053 CITY OF NORTHAMPTON Lot: -129 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# B P-2008-0116 Project# JS-2008-000183 Est. Cost: $1525.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq. ft.): Owner: GILMAN TIMOTHY Zoning: GI Applicant: Ed Corbett Jr Ai: i..t1 DAiviGN RD t4-v302 Applicant Address: Phone: Insurance: 4 Reed Street (413) 584-6571 NORTHAMPTONMA01060 ISSUED ON:8/2/2007 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: ©` Slq-0 7'�Q _" THIS PERMIT MAY BE REVOKED BY THE C OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL NS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/2/2007 0:00.00 $25.003528 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Department use only % of Northampton Status of Permit: at��ultlding Department Curb Cut/Driveway Permit .�� 212Main Street Sewer/Septic Availability r�� , (nI1 AFjoom 100 Water/Weil Availability ;'S,tA ` ALr , A 20`f 1orthamptgn, MA 01060 TWo Sets of Structural Plans ' phone 413 58V-12di) Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TfZCONS1RUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map /7 Lot 5.3 Unit /a1-9 6-b ,! I NA/ fioci 8 LN, 5 #3 a L Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ti' 6►1MA►.1 s Name(Print) Current Mailing Address: Signature Telephone (-4,43)(3a0 J•7/3 5 2.2 Authorized Agent: EDIdA-Rt 1- C C3 bRe-rr ,0 Reed s& A '-40d t 6)060 Name(Print) Current Mailing Address: CL/13J CS89- 6s7/ 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) /spt 5----` Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date • , s 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: 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 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 0 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 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, e avation,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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement endows Alteration(s) Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding[0] Other[Q] Brief Description°ofPro se ` f /j�� / Work: .LTf S Jf3L VI l I4/,/ (/ �19(.I't_ 4 /4SS. 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 .. Na. 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 ��� I LQ 41P 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 penalties of perjury. I ell-- Jr ---.-• • Print Name Signature of Owner/Agent Date • SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:�_/ Not Applicable ❑ Name of License Holder: L Jz, 3i2 7l i c. 067 71') License Number Reed Ni,j6/.1 , ®1o6o y-3-o8 Address__74% /3) (_5-(9/74] Expiration Date Signature Telephone 9.Restistered Home Improvement Contractor: Not Applicable ❑ Co& Berl" 4me �-1010vrme7T %ll>? 06 9 Company Name Registration Number -Ped<S-t IA )oG 6 5=/S=Off Address � Expiration Date • • Telephon(/%/ 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 $ 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 s1r'—a i=c S. l / Office of Investigations M�;'= ? 600 Washington Street a.., •6 • '� V." Boston, MA 02111 .ter %, - ',,'. •'...ta www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n/1 Please Print Legibly Name (Business/Organization/Individual):CL7(�82i T e IQJ' � �/ 1 tA. (0O-fc '..(- Address: y ke*P-Oi s 1" City/State/Zip:JUtll2441 i./AM- b1D6O Phone #: (4'/)5 Y 6 5-7/ Are you an employer?Check the appropriate box: Type of project(required): I.❑ 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.Cil I am a sole proprietor or partner- listed on the attached sheet. t 7 0 Remodeling ship and have no employees These sub-contractors have, 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.0 Electrical repairs or additions required.] • 3.❑ I am a homeowner doing all work right of exemption per MG L. 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#I 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. Contractors that check this box must attached an additional sheet showing the name of the sub-connectors and their workers'comp.policy information. 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an penalt' of perjury that the in formation provided above is true and correct. Signature: A4' Date: 7-3°- (57 Phone#:&AI)-S�y 6, Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/I.iceuse # Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone #: 01 C Pr))0/J Alf 3 -' 5-C") g i PrOpOSai Vinyl Siding l` Windows Corbett Home Improvement ��-� — • r Roofing ing mq Northampton, MA 01060 Awnings .- -`�4 DOOrs ��_ 1.I,,I��' (413) 584-6571 Canopies n Gutters A�(1 11 66 q l ' 067 4/ Shutters PROPOSAL SUBMr1-cED TtJ 'M GI 'M IN _ PHONE 0 --78, DATE adbN L, 07 SiitFET e J� J of to 04) S t c JOB NAME 1 CITY,STATE,eat ZIP CODE JOB LUCAIIUN 1Ale JO -2 J75' DATE OF PLANS LEI` 0.53 We hereby submit specifications and estimates for: r4II Li ,v hidelL VIAL"It )o � l/1 ri Low e S. Z d c CiN- -lb Wax. di illy�c. - /VU iii , Q l/MIAfiAi 6ro 31%/x 931 Hi 31 '/a. x /I'/a.. l j1;12-(4."2 "--- Te Propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: ,ll• s($ Q O Payments to be made as follows:AM,1O m �y, T fvLi k 11.0.4 (61.7) j// All material is guaranteed to he as specified. All work to he completed in a work-like manner according Authorized to standard practioxs. Any altercations or deviation from above specifications involving extra coats will he Signature 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 antral. Owner to carry fire,tornado Note: Us pro xvoal may he and other necessary insurance. Our workers are fully covered by Workmen's Compensation Insurance. will r u h us if not accepted witlun days. Acceptance of TroposaI-The above prices,specifications • are conditions are satisfactory and are hereby accepted.You are authorized to Signatu ' - do the work as specified. Payment will be ii de a.•owl' ed above. Date of Acceptance: v Signal re "