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17C-074 . . Proposal v„,,,,,,,,„„ ---\ 04 Corbett Home Improvement ' -- 4 Reed Street '� Northampton. MA 01060 " ��t' I. 1,, lc I � (413)3 9q9'&47 :�� ,,,,,,: � (413) � HIC# 116069 CSL# 67450 �i,�...,:., PROPOSAL SUBMITTED TO Rf7 A- / / 114/21e(4, PHONES—gin— 1 DATE 8 -6 1 2— STREET 33 f l ei FJw JOB NAME CITY, STATE, and ZIP CODE F/V rfri fr JOB LOCATION DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: i 34A 14'LL AOO F ,a t 5 ) a R5c s 64 W R - Sarrze4 t . 6L+- f-�R ti rr� -eAeR fib' Lc Co u -tr .,-c.., 0/1/4.1 bO/ �. 1 r f f e 2 ow ', LYA -v�r 9 ■ A00/ D i c Y t tsk 012 .w'4ei Je f/ - 1.0)),--1 fvb�R Root � y( j , i A 1 go %-1 /Udi� . / ' .j' /wr 4 .r Necrw14.4 1) ite u t 2 shr- AS c5.4694 4 t, / RZO'r k `61t o N`I' �Ll e,�,f t& /() }:�C- f it - e 4.-.4 DORww -c- 4 -z-i, s�, Li) f ia► � Q.�cJc T 4 , S 4- - TX/1 - 5,1j D,' ecco L iz R, k Ica.. . D 02 17 . . . . . . . a5.. ficoe."-. .k.. . . e-. &-/2- . . ._ .. . . .. .. . ... . We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of: / - ?,;.7 °x I i.' 2-& �� !;11/12- Dollars ($ Payments to be made as follows: $ 9aa(.i' Deposit, S 52,6 Due upon Day of Completion All material is guaranteed to be as specified. All work to be completed in a work -like manner Authorized • — " according to standard practices. Any altercations or deviation from above specifications Signature involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or Note: This proposal may be delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our withdrawn by us if not accepted within daN s workers are fully covered by Workmen's Compensation Insurance. _C''..--). X. Acceptance of Proposal - The above prices, specifications and conditions Signature �-Cr �✓t �_.� are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Date of Acceptance: • / 4 City of Northampton ' ; � i ` ) Massachusetts ' } lc r d ni. ,W{ t i� t , e i . � , t + �' ' DEPARTMENT OF BUILDING INSPECTIONS .?s ± 4 ' 'k t `{ f 212 Main Street • Municipal Building J '�` ',Yn n Northampton, MA 01060 �s W '' tea... INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The Stvite of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her constriction 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 /footinqs (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 The Commonwealth of Massachusetts OMNI • *- Department of Industrial Accidents =SIM Office of Investigations 7-4a 600 Washington Street i t it m � Boston, MA 02111 4 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): 00R4 A0Y tly Rt119�,Y veN 4 Address: 14 5 f City /State /Zip: /UO(Z+kG M OLIN ,A. 0) U O Phone #: S& 17/ _ b 5 Are you an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 4. ❑ I am - a general contractor and I 6. construction employees (full and/or part- time).* have hired the sub - contractors 2- I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling These sub - contractors have ship and have no employees 8. n Demolition working for me in any capacity. employees and h$ve workers' 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] 5. n We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.__ Plumbing repairs or additions 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 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. 1 -52- 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 nder the pains and . • alties o perjury that the information provided above is true and correct. Signature Date: /z Phone #: C 62. 5 - - -- - - - 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • • SECTION 8 CONSTRUCTI6KSERVICES ^ 0 8.1 Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder : ET tkh ictb T . 00 0- '3� AC4 ( 7 L /50 ^ ' h am' R Q License Number R-e-ect S, i1 V a K n^(� ! r Li r - 3 Rol y Address Expiration Date ignature Telephone '� """' "ri '° 9' eqis deredi` :`f�i'o�i'e"`�"Im'rou�en�Canfra t ' , Not Applicable 0 ,. a ,.._,;, � , �� RCW F 1- 6tmer iinegm -er fiver r //d 06 9 Company Name Registration Number R-eed n.likapr4tAi Address Expiration Date Telephone .5 —. 6 )1 1 -657 / SECTION 10 WORKERS'COMPENSATION INSURANCE AF,FIQAVIT (AIIG I:^ c 1524;25C(6)), k4 . 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 ❑ f 1� 0 ` > wa 6 f 0 8 8,k ; 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 4 a � ( "g. • S ECTIO N 5 D ESCRIPTION O P ROPOSED W { kall n4 aPiiI � c u able)�N�;,,��n ,, z�( ' v ' ' iVi� %t 0��'�� U5w OMARN t� � 1��18 y1 1'.� ;, �47;'kRV � f "° 4�{ a`ri ," AI Il 'Y r �''� , y r,•, ,. �, ,t ;5iw�i�'.Y�`�h�� " �1ek , �j�' ��w rt,s ,i�l' m� .:l�ri ��� y 571fy "'�`' � ��n`�5 New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors D 7 " Accessory Bldg. n ; Demolition ❑ New Signs [0] Decks [0 Siding [O] Other [O] Brief Description of Proposed A ' I Work: 5 ! /' /09Cyr Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa` if f e.Ht h'nue:and4T ii: `add t nito existixi • f,® .I'owi.n 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? Firep4ces 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 t +• g X 44 ! , : 4 ' tt46di 't7"w.P t4.=041 �0 fr i 45 Sogi : �i-h�k'p1�3 f 5 .. SECTION 7a j e OWN Tk[ ERAUORIZATI '7, ABE lx COMP� AETED�U HEN f. OWNERSAGENTORCONTRACTOI APPLIES, th31NG PERIIIM � 4 1, , 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 TEDWR R D ' 1 " ; � , as Owne uth A orize d 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 pains and penalties of perjury. EDk/ iRD T. 6/ <YR Print Name Signature of Owner /Agent Date • 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 l! 1 - Frontage 1 1 1 I Setbacks Front 4 I I Side L:I 1 R: L:1 ( R:1 1 Rear ) 1 1 -__ _ _r Building Height ( I Bldg. Square Footage 1 ( 1 ' % 1 Open Space Footage (Lot area minus bldg & paved j 1 1 I parking) # of Parking Spaces 1 1 ' Fill: r_____________ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES 0 IF YES, date issued:) IF YES: Was the permit recorded at the Registry of Deeds? 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 Q DON'T 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 Q , Date Issued:! C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , , ' . n Npt,t i f a 'v '.''' I "k o Ia F ''41 ; liw W ���i.,a�l I f f , < �n I ,.17',,,,, ,Iii i ,. ar4 ,��� City of Northampton � 4 , � � 4 P b � ' f4'` F ''' t f w ' S' � `A" -. q :7 ■ Building Department d b �o�ljCl(I I `, � e " ` `4 �( F32 212 Main Street e ` ....-''' < , . \‘,..--- Room 100 �" � �+ q l � _ �.� 'sPE , c ,, iT 0 u I �� s � } ice ,. p1ioh,MA010 Orthampton, MA 01060 l w� �5 �d�S t ui , f fEt No m' phone 413- 587 -1240 Fax 413- 587 -1272 ,�, I k F #�;g @D (3 c 'T x '" I m{ s r : xll i A ,, t� '` yi .-- . -: 4: :ut+, .,,s �, r I f v z l h�t� ar w .1 . 't}s' 4 ° r APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING .0 1 -v .t , 1-'. l5 ia, r a�i 4 w .' SECTION 1 SITE INFORMATION t ; " F j , 1.1 Property Addr ess: A i ) { iTh is'sectionfto be co : by office F , p r PB 1 : fn k ` 0.n . { ', 4 0 iw , r l a�'d ,,. R" ^tip' y w ,a b [ 44.51Z41- t �h t T 7 '''+ l >33 G " P - 2l -e-t c� .�, , ^ , r " � )t "� o- t � t 2 4 , 4U �, yy ,t�,,3 IA; 1Zo jV � 2 t FN; t °t," � J + '6 , 4 t r c3.va +, . : ii"titi 4 t�, b,,� �� 4�" O ver�la D istr ct t nn, >i k l ~ki 4tAh i ii iii I i F i, i10 . ik s *Ppe`a � :� 0,!R 5 y ` ' 4 y � a ' ' ! d , ' 'Y of S':i t istr ct ....: � ; CB Dis Tic .� � � �+' F i t �t r"t '4: �t ,44;J° i' s e 4 SECTION 2 PROPERT OWNERSHIPIAUTHORIZED AGENT * � "~ [ 3 4'm' .Y ."k c a,It 'k 4g , nik14 .':# ra + q�. i i`S' � , 1. fi x k� k ��3, �7 + ,, i + �+ °.� { ,�,5 � .� 't^, „, ffP�?5�`�.I, 9. lin' 2.1 Owner of Record: R A- r Name (Print) Current Mailing Address: Telephone �,/ r Signature �� /J ,S 2.2 Authorized Agent: E DU o r, corgi -- J y �e� ; ivdR Aci/ne „/ Name (Print ..� Current Mailing Address: r _. Signature ../”' Telephone t' cr ? SECTION 3 CONS Item Estimated Cost (Dollars) to be rt f , n ,�' �� Official Use Onl ; completed by permit applicant . 1,« "k'F0,74 . ._ ,'., +>.,' J"1 , , , .r. 1. Building (a) Building.Permit'Fee 2. Electrical • (b) EStimated Total Cost of I .,,i'iConstruction from (6) `:`•,'„ g l d in g P Fe - 3. Plumbing . - Building' : 4. Mechanical (HVAC) , 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 3 ,r`C) Check Number ' , .. :=Thi Section For,Official'Use Only „ r Buildin Per N , " ' � + p .` I s e + Issue � Signature �- I ', mmissionedlnspector of Buildings Dat Building Co .: • 33 GARFIELD AVE BP- 2013 -0250 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C - 074 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2013 -0250 Project # JS- 2013- 000412 Est. Cost: $9250.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ED CORBETT JR 067450 Lot Size(sq. ft.): 12109.68 Owner: FOURNIER RAYMOND P & CAROLYN D Zoning: URB(100)/ Applicant: ED CORBETT JR AT: 33 GARFIELD AVE Applicant Address: Phone: Insurance: 4 Reed Street (413) 584 -6571 NORTHAMPTONMA01060 ISSUED ON:9/6/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: STRIP & 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 9/6/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner