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11A-057 (3) 8 VILLONE DR BP-2003-0598 GIS ;{: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11A-057 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2003-0598 Project# JS-2003-0992 Est. Cost: $6900.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sq. ft.): 34194.60 Owner: WARNER EDNA M&DONNA GOLEC Zoning: URA Applicant: Jesse Montgomery AT: 8 VILLONE DR Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482 () FLORENCEMA01062 ISSUED ON:12/27/02 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT BASEMENT WINDOWS & STORM DOORS 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 12/27/02 0:00:00 1579/1580 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Status of;Permrt;Depat ea 's~ f 1 City'of Northampton -Building Department Curb Cut/Dve tay eK t � = Ott « 212 Main Street Sewer/SeptiCIA .arlabtj # a DEC 2 7 2002 :"Room 100 Water/Weliti r a•bility Northampton, MA 01060 Two SetskofStr cturaP an phone 413-587-1240 Fax 413.587-1272 Plot/Site Other Specify _ � APPLICATION TO CONSTRUCT, 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: IA h one Orli)e Map _ Lot Unit Le e..ck A/A/\ 01 0S3 Zone Overlay District f Elm St. District CB District 1 SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Don na. GolbeG 1c,, ce (571-- Lis /tj-f Name(Print) Current Mailin�Address: ap �L — Telephone Signature 2.2 Authorized Agent: Besse (XCM\ 4 6 Da k S4. F1 e7er./fi Name(Pri' � Current Mailing Address: o Sig�na r Telephone SE ION 3 " ATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Budding / 900 (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) l0 '7©0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 Open Space Footage 0/0 (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding e r 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 YES IF YES, has a permit been or need to be obtained from the Conservation Commissiari? 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 prope-ty ?YES No IF•YES, describe size, type and location: SECTION 5- DESCRIPTION OF PROPOSED WORK(check all.applicable) New House 0 Addition 0 Replacement Windows Alteration(s) ❑ Roofing 0 Or Doors �( Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]( Brief-Description of Proposed Work: \aee 13 0'"'') !x and /0 &xmM I—c.0rn.4-4 Alteration of existing bedroom Yes No Adding new bedroom Yes Attached Narrative❑ Renovating unfinished basement Yes /lo Plans Attached_39l1 0 - Sheet❑ 6a.'If.NewwhairSe a id:Or-'addition to existing mousing, complete the following: a. Use of building : One Family Two Family Other _ 131151-- 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. floodplai i 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 or my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, -Sesse M orrlel , as Owner/Authorized Agent hereby declare that the statements d inform>± n on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Mehynteei Print Name c� /C /7 02 Signatur of n ate SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: M Not Applicable 0 Name of License Holder : `��� e 777 Li I 0 License Number Lit 0 ©a < S-k-. cnc /14. /a i o 3 Addres Expira ' n Da 848 Si ure Telephone e -max ,.. ,. 4. _ ant a�: Registeretl-Flome+lmprpvement Contractor ,„ ��,_,�,;,�.,,�,�_�,� �a� , , ,�� `�h �;� Not Applicable 0 Se ie Nkc�n-\-I el /,3Yo?7y Company Name J Registration Number _ ( d Cc St /o/i9 03 Ad ss Expirat' n Date 1 t`C O(,C (4- Telephone J ec V 1 G' • 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 0 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 :hat 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 , . .. o..t ttM!p�0 a .: , �e (tt i 1 Northampton I _—* 9 � r .9: .a,aact(nsrtts. 1 DEPARTMENT OF BUILDING INSPECTIONS 4 _W 212 Main Street * Municipal Building _ Northampton, Mass. 01060 ' rr%'s WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, "S e / 4somer (lica /permittce) with a principal place of business/residence at: Life. Oct 14 '—Q C CsCCACC l4_ (phone#) . ec U U (stre.t/city/statrinp) 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) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)i(anad, ..oail ifnev'- ry to include infutna ion peztaining to all oodradon) ( I am a sole proprietor and have no one i'orking for me. ( ) I am a home owner performing all the work myself. NOTE:please be aware that while borrow nera who employ pc.-som to do maintenance,co:"-n:c=b er repair work on a ds clling of not more t sn thruo units in which the bomoowncr rides or cc the grounx+s appurtenant thereto ern oa Suu+lly considered to be employer,under the worker's cscapczzation Act(GL152,s3 1(5)),application by a homeowner for a Brix a permit may evidence rho legal morn of an ernployor under the Wocicda Corporation Aga. I understand that a copy of this ctatemmt may bo forwarded to rho Department of Industrial Accidents'Oflioo of Luau-Loos for the coverage verification and that failure to sure eoveragc t'fl(-r sociion 25A of MOL 152 can Icsd to the imrmition of criminal panty es oouaistiag of a fine of up to S 1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work.Order and a futo of S 100.00 a day against Me... For dgrutrsrczt'l aro only Permit Number _ - Map#ILot# Si tore f ermittee ) -- k PROPOSAL 11 - PROPOSAL NO. ,,,; Jesse C. Montgomery JCM Home Improvement a 46 Oak Street SHEET NO. - DEC 2 7 2002 ,,Porence, MA 01062 DA % 3/v2 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME:' - ADDRESS to—, �; r s ADDRESS 'Th t tCf Ur'1ve 1 114,1 of Qs3 DATE OF PLANS - PHONE NO. ARCHITECT 99E � 1- S73(-- 8795 We hereby propose to furnish the materials and perform the labor necessary for the completion of ,-L?), . c.2, -- ------- -- V f f? _ ,,J 7 C - L'✓1 b _ -- -_ ------_-_-- i • /c L4,1 I - __- s t--' 1, C — -- All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifi- cations submitted for above work and completed in a substantial workmanlike manner for the sum of 142 �O S €.:. - ,; Dollars ($ ' ) with payments to be made as follows. Respectfully submitted / o', Any alteration or deviation! from above specifications involving extra costs will be executed only upon written order, and will become an extra charge Per`s 6 I `: over and above the estimate. All s c ti ent upo trikes ac- cidents,or delays b and our co r � ttL r . Note—This proposal may be withdrawn / , � �- by us if not accepted within - 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. Payments will be made as outlined above. Signatuu,�.-a..- f -'u... (r1 l_ �C .� � '- zee,7 � cox¢ ;'io,ai . '` t'91 OZ.. Date Signature MADE a ems NC 3818-50 PROPOSAL MA IN USA