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29-465 ��fitk-w 23 (1)J Cry,-0 posaf Vim: Corbett Horne Iniprovement Wirld"., Northampton, MA 01060 (413) 584-6571 L MOPOSALSUBMITTFDT070(r– J3 PHONE DATE STRFET o-3 0 r-,esJv,/,ew' J�tlL JORNAME CITY,STATE,and zu,(-Y)r)E F—Al A JOB 1-()('Al*l()N —S/1/;1 lon 11troM 7 We hereby submit specificationsan(I cstull;lles t(),-: 1) --tWSJRLL Sc�<'S' A'A&C-rTnlh 11Aleiw J uk'VT� )V&-Aj SfAM�-s-S g4t.-y iil a��v 5-1 N ;'Asal. Y-5 x 3)j-7ks'J,C 3z T- 750 'WC ('PrO P Me hereby to furnish material and lahor-complete III aLCor'lanct'willi the above specificaliorj.s,t(ir The soni of PayllielitS to be made as follows: 1 1.3 OeO(,)s /,— Dollars($ I All Tualerial All work to he c(1111plend in i work-h kt,man tier act ordi ng Authorized to-landardpracfices Anvalteruotions or cleviallori from ith—,specifications 111volvi jig exIn'c,,I,will he executed only lipo n written orders,and will becoll le Lill extra(')arp-over Lind ahovt�11 le e�t I male All agree ITIent.,c,nti agent Upon strikes,accidents t r delays heVo fill our control Owner to carry fire,torna(l, Note: This proposal stay he and(Alier flecessary insurance. Our workens are fully covered by Worknien's Compensation Insurance. withdrawn by Its if not accepted williln das Acceptance of C ,Proposaf-Tire above prices,specifications are conditions are satisfactory and are hereby accepted- YOU are authorized to Signature do the work is specified. Payment will he rilatle as outlined above Date of Acceptance: Signature e a � � e ttAM PT ?04 p 0 x Crzf�j of 9 6a�axcf)ttsrlte ' m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal 13uilding Northampton, Mass. 01060 / WORKER'S COMTENSAIION INSURANCE_, AFFMtk IT Fr - - - (1 i censer./permi tics) with a principal place of businesslresidence ate Ab le (s city/s�ate/z�p) do hereby certify, under the pains and penalties of perjury, that O I am an employer providing the following workers colnpeiisanon coverage for my employees working on this job: — "(Ln_surancc Company) (Policy Number) (Expiration Date) O I a1.11 a sole proprietor, general wntractor or homeowner (circle one) and have hirers the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Polic-y Number) (Exp ration Date) (Name of Coutractor) (Insurance Company/Policy Number) (ExplfliDon Date) (Name of Contractor) (Insuraa� Company/Policy Number) (Fxpua on Dale) (Name of Conti-actor) (Lnsura,ice Company/Policy Nuinbc_n Date) (nuadi arSlitic�sl s!rcct if n<ccsziry to inducSc ir$orrnati on pertaining co all cro�radors) I ain a sole proprietor and have no one working for me. O I am a home owner performing all the work myself. NOTE::please be aware that w nic h, t ,Aixrs'Abo employ pccsom to do C Y.n :C,oa cu repair woti:o-za a d«ci ng of not rno"than thtro twits in t;indi the lwukrouvcr rcaida or on the g,:,Qz ab appurte u r1 thcrdo arc not wally com;ckrccl to tx calploycrs under the-ockres ccY�icn Act(GL152,"1(5)),,application by a homeowner for a hccrue cc perm":mey evidence the legal ctntua of an amployoc un ur thn Workcet Cocupmzation A.d._ I underhand thst a copy of this a tcmcnt may bo forwardod to tho Dcpa tssr of lodusiriel Ac do&Offioo of In;�for ti", oovcragc vet ificaiioa and that failure to aca=covcrago undcr scctioa 25A of MGL 152 can lead to the irri4 -of a mm-tl prnaltics oomistiag of a.fine of up to S 1,500.00 ardor uu{risoasaiS of up to one year and civil prnsltia in d-form of a Stop Wort Order and a fi=of 5100.00 a day tpdnA Mc_ For dgn lfn use only Permit i`Itlmber Lot Slgnaturc of Li e ccnscr�Permitiee SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name e of License Holder : /- --- -_sly _ ___ --_ _._ — License Number - �dress Expiration Date S jignature Telephone 9 LRekis OJ Home l' NE ffient Contractor s ' ,�„ ,ION�, ......L " .,,�� Not Applicable ❑ Company Nam e Registration Number ff duress Expiration Date ___Telephone �By_ �- -- -- - --- _ SECTION 10—WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152, § 25C(6)) Norkers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit vill result in the denial of the issuance of the building permit. 3 fined Affidavit Attached Yes No ❑ --- 111 We Mf T 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 — :L=! 1 iUN_5_DESCRIPTION OF PROPOSED WORK(check all applicable) Addition Replacement Windows Alteration(s) Rooting Or Doors u. �i.;l; Den7olitiu New Signs ) Decks Sidui� Other �;�► 1 S I I��r s ��yl t��,N�� ,rs pi4q , ir e New house and or addition to existing housing,_compjete the following. L i ION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Fxisting Ilioposed Required by Zoning Fhis COILinin to be filled in lb� Building Depariment ot Size __Fr nlaL Setbacks Front Real- 1 Building Height Bldg. Square Footage % open Space Footage % I ,,, of Parking Spaces rHI (volume&Location) A� Hasa Special Perrnit/Var\ance/Finding ever been issuedfor/on the site? NO YL3 �______�_ IF YES, date issued: IF YES: Was the permit recorded at the Registry o| Deeds? NO YES ________ IF YES: enter Book Page Docurnent4 B. Does the site contain a brnok, body ofwo(e/ or weUands� NO DON'T KNOW YES IF YES, has o pornnit been or need to be obtained from the Conservation Cunirnissiun? Needs to be obtained Obtaincd _- _ __----- -- Date |ssued�_�__�__�'-�� C Do any signs exist unthe property. YES NO IF YES, describe size. type and location:---- D. A there any proposed changes to or additions ofsigns intended for the property ?YES __ No �� IF YES, describe size, type and location:--_-, 7� ��Ci[ rthampton S at sozf,Pe �Uilding epartment Curb Gu lD 212 Ma inn Street Se :.e fSe L,; 3 Rom 100 Wa erlWe Northampto MA 01060 Two Sets a, a - DEPT©f3U1L �,4 � �g1240 Fax 413-5871272 NORIHAM?10h,MA 010G Other�SpeFc fy --- f . ., 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 i Property Address Map Lot,: Unit L Zone Overfay District L Elm St. District CB District SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.4' Uwner of_RQcord: ,.. ,�,.rrer, r/ailng.AdUress 2.2 Authorized Agent I-D T Co K emv - f --fit - ---- - - �,;,,:. Curren! Mailing Address: S8 - S Telephone —_ - SECTION 3 ESTIMATED CONSTRUCTION COSTS Estimated Cost (Dollars) to be Official Use Only com leted b ermit a licant (a) Building Permit Fee (b) Estimated Total Cost of Construction from 6 Building Permit Fee I Gr Check Number This Section For Official Use Only _ Buriciing Permit Number._ Date Issued:_ - Signature: --- — Building Commissioner/Inspector of Buildings Date _, A. 23 CRESTVIEW DR BP-2004-0128 GIS#: COMMONWEALTH OF MASSACHUSETTS MM.Block:29-465 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0128 Project# IS-2004-0197 Est.Cost:$6850.00 ,Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Ed Corbett Jr 116069 Lot Size(sq.ft.): 11979.00 Owner: BEGLEY JOSEPH B&PAMELA C Zoning URA Applicant: Ed Corbett Jr AT. 23 CRESTVIEW DR Applicant Address: Phone: Insurance: 4 Reed Street (41 3) 584-6571 NORTHAMPTONMA01060 ISSUED ON.8 15103 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL SIDING, WINDOWS & ENTRY DOOR POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector . Meter: Un��i b:u�::,: z.:�• >h oc,tings: - Itougii: Rough: Ho'-se;l Foundation: Di ivewgy Final: Fina;: Fi,lal: Rough France: Gas: Fire Department Fireplace/Chimnay: Rough: Oil: Insulation: Final: Smoke: Final: Or g-a-G THIS PERMIT MAY BE REVOKED BY THE C!T Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS PULES AND REGULATIONS. Certificate of Occu an Signature: FeeType: Receipt No: Date Paid: C;ieck No: Amount: Building 8/5/03 0:00:00 2012 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Conunissioner-Anthony Patillo