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29-460 ...." ';,. aiJ- Ob) -22 • a13- �iSo-8 I..JL It I OL7 38 Graves S treet South Deerfi MA 01373 WINDOWS • SIDING • GUTTERS • ROOFING "Locally Owned and Trusted Since 1966" Serving the Entire Pioneer Valley CONTRACT Date 3i& y 1,, 20 I This agreement, between C /+ - Al ; C 14 6r ` l (Owner) of 4 c ,, sl V lA-h/ 13aid c r L0, ", c Y, , and (Address) JCORBETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS Phone Ss 8 z/ • O t' Of SPECIFICATIONS r GJ� , ,�ie.714e2 LA). t � 13 . x.. /A, -1 c td,o; i L✓► No C him — — Th.; rh 4 1,t:r s r),:..sr iAljt. aits -1y (pi 6.-Ak on the premises located at a total cost of � / a , 7 f 0 b With this order owner pays down the sum of $ 900 dl' Owner agrees on completion of said work by the Contractor to pay the sum of $ k ) e ye) dollars ($ ). Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70% of the total contract price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else. Performance of this agreement is made subject to labor strikes, fires, wars, acts of God, and the Contractor's ability to obtain material. This Contract constitutes the entire understanding of the parties, and no other understanding, collateral or otherwise shall be binding unless in writing signed by both parties. WINDOW GUARANTEE Manufacturer's glass is guaranteed for life from date above not to fog up between the panes of glass. All other parts will be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked glass after one year from date above or any damage resulting from neglect, abuse, or acts of God. Condensation build up on the glass is caused from high humidity levels and poor ventilation within the home therefore there is nouarantee that this condition will not occur. I n w i t n e s s w h e r e o f , I h a v e u n t o ' I v m y name this ) 4 ' day of J II L), 20 f '.1 / Ami by ■ o uthonzed Agent) �� (Co (Owner) g (Joint Owner) `' The Commonwealth of Massachusetts Department of Industrial Accidents r t Office of Investigations 600 Washington Street ?.:= ;' Boston, MA 02111 y. =` WWW.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization /Individual): Address: 3k C'.rta'e1 - i ee City /State /Zip:,_S,,, / , c,! 4.4A ®a.;3)2 Phone #: 4/.?- �6.r= a2.. F-g Are you an employer? Check the appropriate box: Type of project (required): l . 1 am a employer with 4. � I am a general contractor and I e loyees (full and /or part-time).* have hired the sub - contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. 1 Remodeling ship and have no employees These sub contractors have 8. n Demolition working for me in any capacity. employees and have workers' g y p y + 9. n Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. [ We are a corporation and its 10.[1 Electrical repairs or additions officers have exercised their 11.[ Plumbing repairs or additions 3. Fl 1 am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no • employees. [No workers' 13. ✓Other f'�rp [ comp. insurance required.] *Any applicant that checks box #1 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 - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. 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 un er t e ins and penalties of perjury that the information provided above is true and correct. Signature: Date: k- . / Phone #: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit /License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS o } 212 Main Street • Municipal Building �� -` Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. 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 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 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Not Applicable ❑ Name of License Holder : % ka ' 7 License Number at** �� s a�—T ` ,(20i. +7;11 t ri (.I /14A /213 >3 6 ti‘. / Y Address J Expiration Date f ... 'S sr • 44,e S . e Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ C e .e 6e—rr f ✓��isa.- ��. /,�� ir>.4 s / — .77'0f+4/ Unee 4 ei Registration at o Number Company Name g 3Sf (14c e %..-591 /€t 1(��1 J Al,47 IJJ>3 d' c2-J'- iy Address Expiration Date Telephone «•/ ?• II,s' aotki< 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. Eks Signed Affidavit Attached Yes ❑ No 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 1083.5.1. 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 - vear 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition ( Replacementdows Alteration(s) [ Roofing u Or Doors Accessory Bldg. 17 I Demolition n New Signs [0] Decks [C] Siding [D] Other [0] Brief Description of Proposed Work: pow, J Lf, nr(pyr a 111446 -, L✓, C' ✓4L, T) . ?O .C, dry �0 ,./ /C -PC 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 �S ��A„, 6," 4 , as Owner uthorize ♦ gent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my nowledge an. .elief. Signed under the pains and penalties of perjury. Print Name • Sionat e of •wnei Agent Date Section 4 ZONING �U |mmmau��mmp��m�c�oco��m�Tv��v�c|nm ' � Permit ' ^ ' ^ �9�� y �� Existing Proposed Required by Zonin This coluinn to be filled m by Building Department --------'-----'----�(---------------- r ----------------- Lot Size Frontage ---- --------- — -- ---'- - - - ----- ----------' Setbacks Front ---/ ---' --- ---- --- --- Side L: R: '__. Rear Building Height �--- �r---� _-- Bldg. Square Footage ' �� ---- --' - -- Open Space Footage (Lot area ininus bldg & paved parking) _ ---_ --- #vf Parking Spaces '--- ---- ----' Fill: � �. �� & Location) _ ^_____��__'___��__ A. Has a Speciat Permit/Variance/Finding ever been issued for/on the site? �� 0 NO \/ DON'T KNOW 0 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 Commission? Needs to be obtained /�� Obtained /~~\ Date , Issued: _ C. Do any signs exis �� tontheprnperty� YES \`~/ NO \^~/ IF YES, describe type location: ' ' D. Are YES /~~\ NO /~� ' \^� \�� IF YES, describe size, type and location: E. WH the coristruction activity disturb ring, gradingexcavation, or filling) over 1 acm or is it part of a common plon that will disturb over 1 acre? YES ( ) NO ("D �� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. RFC L ....,„ _ __ i Department use only ity of Northampton Status of Permft: 1 AUG 2 3 B llding Department Curb Cut Driveway Permi 212 Main Street Sewer /SepticAvailability -I Room 100 Water '/Well Availability DE n cC Tiuil . N.3RTHAM A 01060 t\((p am pton, 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 1.1 Property Address: This section to be completed by office 6 3 C 2c,s 1 V t r..,, Oct, c 1'.- 49,,LZ r , ` cam Map Lot Unit Zone Overlay District Elm St. District CB` District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: C/71e& C. 4 :cNp Name (Print) Current Mailing Address: y /.3 _r . Oe -70 (-- Telephone Signature 2.2 Authorized Agent: ~ %-) oh#tJ Cre4e -r n ,,R la ,s, nee/ 4. �Ti/v /,,.'.tt 14A Name (Print) / Current Mailing Address: / 1' / . • ` / _, ..".40 A /(IS. -• gib Signat ir Telephone SECT • N 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) 7 e�� s : Check Number }f - 90:3'C' This Section For Off Use Only Building Permit Number: I Date Issued Signature: Building Commissioner /Inspector of Buildings Date 63 CRESTVIEW DR BP- 2013 -0208 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 460 - CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2013 -0208 Proiect # JS -2013- 000339 Est. Cost: $1275.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN CORBETT 078297 Lot Size(sq. ft.): 10018.80 Owner: MICHON CHERYL A & ANTHONY W Zoning: Applicant: JOHN CORBETT AT: 63 CRESTVIEW DR Applicant Address: ' Phone: Insurance: 56 Dimock St (413),586-8712 LEEDSMA01053 ISSUED ON :8/23/2012 0:00:00 TO PERFORM THE FOLLOWING WORD` :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 gignature: FeeType: Date Paid: Amount: Building 8/23/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck - Building Commissioner