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11A-057 1 8 VILLONE DR BP-2008-0119 COMMONWEALTH OF MASSACHUSETTS N iw A-057 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-2008-0119 Project# JS-2008-000187 Est. Cost: $18800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Cyrus Newman 142807 Lot Size(sq.ft.): 34194.60 Owner: GOLEC DONNA W&CHESTER C Zoning:URA Applicant: Cyrus Newman AT: 8 VILLONE DR Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:8/3/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:ST R I P & SHINGLE ROOF 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 Occuplcy Signature: FeeType: Date Paid: Amount: Building 8/3/2007 0:00:00 $25.005749 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo • • Department use only City of Northampton Status of Permit Ruilding Department Curb Cut/Drivewav Permit 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 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION r ( C4 This section to be completed by office 1.1 Property Address: Map Lot Unit 11 ervz AUG - Zone Overlay District LJ i 0 05 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (\fit+ C1yS4er ( le c yc)1 S�r; r 4�-. f O('eA�,ce, Vona OV n7 urr Name(Print) Current Mailin Addres Telephone Signature 2.2 Authorized Agent: I'2S a�-- tP Tin. I(/ �. i/or,�{u/rtt�l , Po 0i0�f) Na a(Print) Current Mailing Address: illSignature Telephone SECTION 3 -E -MATED 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 'J 6. Total =(1 +2+3+4+ 5) %B j_ Check Number ; J This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Date y 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 _._ _ I ! i3 Frontage Setbacks Front • i j • Side L:__- - R: • L:1 R: I I I I 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 Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? Askiild 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 0 DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs to be obtained Q Obtained © Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: l D. Are there any proposed changes to or additions of signs intended for the property? YES © 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 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ISECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) I New House ❑ Addition [] Replacement Windows Alteration(s) n Roofing (4 Or Doors +"'� Accessory Bldg. ❑ Demolition ❑ New Signs [OJ Decks [I= Siding[p] Other[CI] Brief Description of Proposed / �t c i Work: i 1- C'.K__V-sh r15 Q I e n et) hi,10, .:` , f v t /! •&5pl7n u- l'ia riolf j Alteration of existing bedroom Yes U No AddingJ new bedroom V Yes NoJ . Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ,�.,. z �,,. �r. ,�: .,, ,.. .• l � � ,�^,.,� -�,_:.•,-�-sue'<�,� ,. M,-r .: 6a`If New=house artti=t3i adiiitrar to existinsl tiOaiiiire. i e riaTtatrQwrnq: 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. f. 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, C Y A/ Zkk.) ,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 pans and penalties of perjury. :::ta::: erk' e SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 1 Name of License Holder: f"l.`) �-_� . Mill) ) L+- C3 log LC°1O License Number (aar dci Cc! . N git&I o , i11� Doom L- 1 - 0C\ Adess Expiration Date ( LI)5) 52,,-aZ3•3 '^signature Telephone 9 Reiistered'Flome fmtsaerttenteottFaefoi:: Not Applicable ❑ Luz eq- CompanyrNa end ( ,` )c)--1 Registration Number 014' g Y)(i(3 Q 17d. 740-A J 1L t ,,..� Address Expi tion D�aate Telephone ;3) o-ta3 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 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 if ' .. �•CtVJrpT - O ,". � " °e (rill of Northampton 1. — a — a 4 �taa.wrl)nulfa' �,T 11— co DEPARTMENT OP BUILDING INSPECTIONS • _ i l 212 Main Street ' Municipal Building 1�'orlhnmpton, Mass- 01060 err`''" WO-RTCEIZ'S COMTENSATION ENSURA/‹.E AFFIDAVIT ,F. C/22- (ir ccn scc/pernu ttcc) with a principal place of business/residence at: tIQEl-r;cive t'lNO (!;hone:')k34, > (sl�rrt/drJ/slatclrip) do hereby certify. under the.pains and penalties of per-jury; ihai .•'' 9() I :m an employer providing the following worker's comocnsadon coverage for my l it employees woridng on this job: is I.0 . (Insu!nc Company) .. (Petit:ItitL-ai?cr) (r�pirvor, tDace) ( ) I am a sole proprietor, general coon-actor or homeowner(ci cie one) and have hired the contractors listed below who have the following worker's comner1_tadon policies: r - (Name of Contractor) (In.Ruanca Company/Policy Numrc:) (t�•pir uon Dntc) • (Name of Contractor) (Insaranc Company/Policy Numeer) (E±piraiion Date) - , f; - f (Name of Coluractdr) (lnniran=Company/Policy N•,mb••r) (Exoiraon Data) (Name of Contractor) (Insurance Comoaoy/Policy Number) (E.N.TAration Date). (.aaeh Ai:oeaf excl if aoo=l.-y to cedes&inform...doo pesta.ia;as to.tl corr-Gqs) - ( ) I am a sole proprietor and have no one woridng for me. 1 ( ) I am.a home owner performing all the work myself i NOTE:ple�te be aerate tb4 wblic bemao iven who cmplay pczora to r17 r.+r.-.•.vim --.:eaao a ryas work co.dwcUis.r, Oaf[Dote the dote L"1C.t to.0bicia ibe boecoowoce=des or co tlae crouocd appurtca lbe'C.r1 LT cot c^x-4ly oc sido d to be capioycs`lade the s je c-,-p --tiaa Act(GL1 SI.a 1(S)),apple roc by.bome000cr for.bc=ac ec fed r' cvidcocc the legal elute of s.a err.,loyx wader rho Wor{cdr Comopo¢fatiea Act. I aado-rs..nd that a copy of thi.a t.te.t may be for..ard.d ua the Dep.-m.0ot of buiur-rid Aeode 3 Offae.of trox.00e fat the covers<beif etior sod thi C.iltat:to scrum teoverago topolc soctioa 2.5A of MOL 152 an Ied to the i=vmmoa of cimiaal pca+lties eomi:.iag of a fix oft"to S 1,100.00 autdror impriz.ocazcat°Cup to ore ycr sod ct i pca.hio is etc form of.Stop Work Ordc-.ad. ri=of Si 00.00.dsy t�iaa me -. Fa Ckp•.,.. ,r u.e*city /� Pcrtnil l'Iu bcr V tap tAl H I. Sigma f Liocos=/Pcrmiucc e -- - PROPOSAL NEWMAN'S CONSTRUCTION 697 Bridge Road NORTHAMPTON, MA 01060 . (413) 586-1093 Ci6 1 4/S I G O. PHONE DAT- TO: ., e.fit ' 0 0 V('Ck C G U.C JOB NAME/LOCATION ,., �.► v ; r 5pi Y1_c • 'C10 F �-S Yl�� 1nf.Si__ ac�2 7 \I, ))6NL' -e, Lv€D5 JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: 6712...p. -N 5'i JlV y €2.S CC) C.0c r=�0,6 k. 21.vm ., b Oo e ir. Qc t'h`• 0\0 5 t v75tdI / 2 U� S 6.t.) 14-ii;R(..uvvti N U )� ��► � � L d►� f'►LL t�QK�5 �' L, `-1—r151-&)\ ..-cL ts.2<j- tZrOczke,la A EaUfS irn `lq\\E 5 , pi~-'c 5t '0e-- i;- CIS I 1 ' n5 co atocxyvvklyli- v) m i( -) 5 4 / 7Ga2� 0 i/ Rio-,.9i•r�ii 5 vx_Pcf S __77451-al( AC.,um,'0U 04 ,STIAD i Lon-LL P iq51,1 t',,, S t(95 iZf v.D '705f'd.ff pLUuir'4c ;h 511 -5ti4t-i' in fir°fz Ct)ices tt5 p `LeR.f._&. Cof Slot a+ ,f,cia L 5 k i 0 5 T .1. Ro Lvs-F if)5A (1 30 YYz A,/tcNnft ckxa 5�t'� \zs co �t t-i �2� eft- f�12I_ 4- e � P-1•0T Lc0 la vt_ ‘(.., be. c.1,00Se4\.) CI 2.-4--‘4_lc:10 5, tt_. d Q Stai i.2.1 (lc 1" .$..) ..-.;vz_v_ WE PROPOSE reby to furnish material and labor—complete in accordance with the above specifications,for the sum Cf: L l pC� I'/G�/'� 15*A) o rJ3�hr;' !-j c✓rE s2e �`�dollars($ I T) FOCj: ). Payment]tq be made as follows: A2/7')r4 7' _04)iil el) .0b 13c2)E3 o Ct 4oe._ tr.,/ :)..,-,4,704-h,,..)V All material is guaranteed to be as specified.All workc t41be com in a professional manner according to standard practices.Any alteration or Hon above specifications Authorized involving extra costs will be executed only upon written orders,and will become an extra Signature charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal a be workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accept hin 6'a days. ACCEPTANCE OF PROPOSAL—The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment win be made as outlined above. Slgnatu Date of Acceptance: i/o / Signature PRODUCT 13128T FOLD AT(,..)TO FR COMPANION 771 DU-O-VUE ENVELOPE. 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