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24A-001 (5) o � alinfag BP-2005-0553 GIS#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A) Category: BUILDING PERMIT Permit# BP-2005-0553 Project# JS-2005-0726 Est. Cost: $5590.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: John Corbett 104000 Lot Size(sq.ft.): 14418.36 Owner: GRAB JOHN M&MARY M ET AL Zoning: URB Applicant: John Corbett AT: 43 HATFIELD ST Applicant Address: Phone: Insurance: 56 Dimock St (413) 586-8712 LEEDSMA01053 ISSUED ON:11/3/04 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: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 11/3/04 0:00:00 2044 $25.00 212 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 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability NOv _ 3 2004 hampton, MA 01060 Two Sets of Structural Plans phone 13- 87-1240 Fax 413-587-1272 Plot/Site Plans Other Specify —tP cl, R4lE�R10Nelitf CT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Lot Unit _ Zone Overlay District l (/')//`e (":.L c' Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: jr_Aii - -1-c Grp 6 4 S /Y4'i rr r LA Se Name(Print) Current Mailing Addres � _ 76 • Telephone Signature 2.2 Authorized Agent: dh ,!3 r SQL! S 6 a/h'tOLI4- S1 Gw S y1�111� Name(Print) Current Mailing Address: ature 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 I (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 Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Informatibh 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 1 ' Lot Size Frontage I ii Setbacks Front i i ! I I. Side L: R:1 L: R:I • Rear Building Height f -I • i--j Bldg.Square Footage % ' I I Open Space Footage (Lot area minus bldg&paved !L_____2 1 1 l l 1 I parking) . #of Parking Spaces Fill: -- I' —_ (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 0 DON'T KNOW 0 YES 0 IF YES: enter Book j Page' ' and/or Document# i B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW Q YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained Q Obtained © , Date Issued: 1 i C. Do any signs exist on the property? YES Q NO 0 f IF YES, describe size, type and location: j ! D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO O IF YES, describe size, type and location: 1 1 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 Q , NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. R ` f SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ , Replacemen Windows Alteration(s) n Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [I]] Decks [C] Siding [0] Other[CA Brief Description of Proposed --- , / Work: S c ALL V!iik/YL `e01.4*- 44e i.2))/teC.te C C) (�./ L a ' s- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet = r .: .,i,. ,�: ,i--��_ �., s... �......,.� ".....ems •-.fix rr,-,:fir. sa,If Nevi houseYa�aav -addif ai tii2iii sttntfiou`iiiiii o iGiiie.tt a fo[foiilnact: 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 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 I, VF0 u "'-' 'r 4 8-4-t ,as Own /Authorized) /A-695-31ereby declare that the statements and information on the foregoing application are true and accurate,to the best o my knowledge arm belief. Signed under the pains and penalties of perjury. ' Jv1i`./ r,1a-C\---- Print Name /Q/. h Signa of Own Age Date 7 • SECTION 8-CONSTRUCTION SERVICES i 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9L.Re—isfe t'i Home:)`mpcaverrten Ooritract'or e lq , t k Not Applicable 0 Gf__„1/ cl a,. wG rL • /d Company Name Registration Number �La AtWidCi4- Sl e`ic36 Address Expiration Date AS 41/9 /OS Telephone to "T/�— 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 Cl No 0 IT::10111e7 wnertmcernanon 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 r .4„.. -3. ' ,..: ..',.ik'• ,S'0 if f 1 I * . it.,.k vl..•,.' 4,,,,,,,,v ,011,447' i I t WINDOW WORLD ...•,/ H1c#104000 4,,,,..k'...4„. 4.• ::,'"-p, 4, /i ck. 56 Dimock St. 1 ,' - ..k. r ,,.:.,,,11. • , Leeds, MA 01053 Telephone 586-8712 CONTRACT 1),, e' 0 r,1 '''4' ft: 44 20 __0..Y „.. This agreement., between , L ..."1 ,,,,-,ji 8,,, r...., of____ 12 11 f , and WINDOW WORLD ().1: I,I:F1).s, .11.-1,,S"SA( lit!Si:1-I .S. •': ,!,- - 1 tie 671,. .11 14:AI ioNa.: . ,...... ......._. , _sr! iii,4.4, .: / 11, ,, ..,, ‘,..0,-.. i.:,. i.tt,.. i.• . ,s...t..., id, ....i : ,. ,„ 4,, Xi..,r4 Asi' C. - ,. ,14,:, ;, ., , •'. et. I ,. -, .._ ............... . ................ a). 4(r"4/it /Irv .- L'' 4 " ' A: '' ' ' 4' /1 ' ' 1 • _,—_- _ ._ _ ..............„..._ r' ....„.,.., ....1t--.T.i 0 t..0(t, Ats.aid, :,,1 .c. r 1 ,.. s-sk -1.-it: , • , 1,,, ,... , 6.,‘ ,,,..., 1 : ,-, z, . , 1,.L ____„..._... _ . ......__...._.........„ (,$),.. 00,.,A4. -..— , ..,...—„...., .........—...- -- . , . .... ..._.....„....„— . . • on the premises i.,,-.1ted:it ''''l 3 ...tiAt t, ,:',gt. ___ With this Ortter 141,,,,icK.r 1 ivi cioN4 I: ! .t. .4,1- 1 - _.......... Owner ayreta on t ott,c,:ettoo ot ,....10,1 0,,,itt,, to) thi. t-„,,,i, .. ,,,, ..,• 0.1.1 'I.! •_. , i _. dollars ($ 1 • Owner agreeS thal. ili c, siy h I r 44,14 kry • ° • i . 4). ,4; Ce 40411 contract price bcaue vnl replactincot wr10 , nte rot.,,,,,v!,„.,,II, • i .,', .;', ‘2,1 ,,,,,,„4,ii.'re.• PerfOrMalit,C Of!h)i, Aert`ernstItt 1, inutie not)rt-..t `,, i,iiltdr ,ntio,!,,, tires war.. 4,I, ••' - , ••, ,,, ,j •,hr, 4 ,,•f•u-;4,,I, 4 ,, I, Ality to obutin material. , This t'ontract vOrv.litutes flw c!lui k• whit's,f quit.ty of cb, partle . and n.• ort,'; or `k • ,'.I. •: -1 .-. . ,t.-toi , i ,)therkose SIMll be binding,unless in wnting igileil by l'oth pal uo. WIN11()W GUARANTEL wind,. shortd• Ft.,,,, t:,p.,:n mitred far,...0‘,r.u,,0'0117 dAte. kthci yc rum to fog up tt,I,,k,r,-:,!hi'r,1.1.; k 1„,),1,qi , it other parks will be supplied free 01 charge los lite Sr‘ie w ill be fK:..,ll,..1)aryx !kit 1 year front,iats.al..cry,-- i, :,,t3n1,',-.1,,k1-.c‘.,1 '.Cr biokcii Or cracked glass after 90 days from(hue above ot any f.jmnag.:••a Alit r4.. i.or' ilegt,,vt,;show, or do,,.,1 t.,•,.i c'of,•1,,,;‘,.,too bulk up on the glass is caused from high humidify lc A,0 IS 4in4i po,,I vi:inilka ',I; %law,(he hon,c thrtefori: Iii're Is no 0,.:AIntet. ,l'i.,! !ins i;c1ndi to will not occur. In witness whereof,I have unto sig*ii,y name lim j (... iiii-N of 0( i , . ,-:.1 , ,.,,_ ___, '(La I by 11,1,-.A.,„,- , , e" ,.kA....k.,,I(:••,, v.-LA t--(.4-- f tor ij. ' hrized ' ii)- ((Avner - ------ .7oiu Owner) • .• • / o0.5 tCA-Xr pTo r.. • � ` , �I�•t`E (rii- of IoLf!7 mpton I _ ij £ �Zcsatcc1 n,ctta' • • DEPARTMENT OP BUILDING INSPECTION'S 4 212 Main Strcct ' Municipal Building Northampton, Mass. 01060 ra'a" WORKER'S COMPENSATION CNSURANCE AITII)A\f' I, — ,� or 11 :r-S (C • (li cc-aspermi ttcc) w th a principal place of businessfresidence at: J ®rdLIOCiC S( — S /'/41/ CY/GSA (phone:') lr 271 -- (sv>wtJci ty/sZa1Lfri p) do hereby certify, under the pains and penalties of perjury, thai • ( ) I am an employer providing the followine v.'orkcr's compensation coverage for my • employees worUng on this job: (L.s r-nc Con.-zany) (Policy Number) r :-piratfon Da`) ( ) I am a sole proprietor, general contractor or homeowner (ccie one) and have hired the contractors listed below who have the following worker's comoensaton po iciest • (Name of Contractor) (In uraa nt-,-: Colnoany/PoUCi Num :) [ri:piruio? D1tc) (Name of Cootractor) (Insuranc. Company/Policy Numb-er) (Expiration Date) (Name of Cot>,saclo:) (Insurance Company/Policy Nvumlx:.r) (Expiraon Date) • (Name of Contractor) (Insuraacc Comrztry/Policy Numly;r) (Ea-oirtion Date) . (atlac3 Z-d..ltiocal elcct if c c.-,try to mcu4o-iafocm on pertaiaia6 to.11 ono?-soya) a sole proprietor and bave no one world.ng for me. ( ) I am-a home owner performing all the work myself. NOTE:pt.-.a be cwirc t. v tJc bccoco ocrs a.bo ccuploy pcsoei to ct3 rt;szu.sort oa a dwtfl i:of cot mccc tl_a t'3oe tai'ar in usydi the botnoownc raids cc ca the croundr appurtcosa tbeeo LT oo4 gtr.11V cock.vi to be eiiploye� the w j -14cc Ara(GUI 32sa 1(5)),c.pplicition by a bocticoo.-oc for a licz=cc ix,,uit rr_•y eaidmec the log:t1 ct-' •of to c14;11oy.c under dro Woaicoet CompomaiipQ Act._ 1 uadest+ad the a copy of tbic catemcca may bo focw.oc.d to tb.Depart post of I •r,iei Accld oti OtLoo of 4uu+ooa for tb.° covc-ttse ro tf cope. d that Eiltat to some'cover. t,,-vl--section 23 A of htOL 152 as 1,.d to the i,rAt ioa of=imicul pa,.itica coaai.lctg of a fax of txp to S I,00.0o andlor Coo:prizocozo4=1 of up to ooc yor a od civil pr atia io 6c form of.Stop Work.Ord=avid* frim o(S 100.00,thy cga.iaA tpc For u•c only Permit Number /d Lot# S igna LiccilscrJPcnnittcc e O moo ` " ti$ ;..( .ztp of iwt1iaiit*#�n • I- /, $ 4=!, .,% „ j1Ra558Cltusetts vsep "w DEPARTMENT OF BUILDING INSPECTIONS /, INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 . e' HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups: ..i:or. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill), sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection-The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper - permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location ,- f