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Barron&Jacobs Associates Inc. Contractor's For Office Use Only May-14
Design.Build.Remodel License Numbers: Agreement#
General Contractors MA CSL 030739 Checked by SS -<-%y-%4
70 Old South Street MA HIC 100809 ❑ Plot Plan included
Northampton,MA 01060 CT HIC 518617 ❑ Need Plot Plan
Tel.413.586.8998 ❑ Dig Safe white flags posted
Fax.413.585.8715 Agreement is: ❑ Cash
Email:info @barronandjacobs.com O ❑ Financed
O
Job Site Phone 413.586.2093
His Work
PURCHASE AGREEMENT Her Work
His Cell
O ORIGINAL(Designer's Copy) Her Cell 413.244.9518
❑ COPY(Buyer's Copy) Fax
Email
Name of Buyers: Betty Mitchell
Job Site Address: 56 Revell Ave. Northampton MA 01060
Mailing Address: SAME
(if different)
SELLER AGREES TO FURNISH AND INSTALL THE PRODUCTS AND SERVICES LISTED BELOW:
Prospectives,Proposals and Reference Drawings dated N/A may accompany this Agreement.
These drawings are prepared to assist the Buyer in visualizing the project and are not intended to be
construction drawings. Actual dimensions may deviate when actual construction takes place. Should
construction drawings be required by code officials,they will be prepared by the Seller at no additional
investment to the Buyer.
In some cases,items or objects are added to the prospective drawings for visual purposes only. These items or -
objects may or may not be part of this Agreement. The Purchase Agreement will identify items that are
included.
BRIEF DESCRIPTION OF WORK:
1) Provide AutoCAD construction drawings and produce 3D rendering of the project
2) Modify existing deck to accommodate new set of stairs and access to new ramp.
3) Build approximately 30'linear feet of maintenance flee ramp with Azek PVC decking material.
4)
5)
6)
Date prepared: 5.12.2014
Purchase Agreement
Page 1 of 13
F lip D A V I T
In accordairice vvithl Lh-- provisbris cA MG-f. c 4-0, U4, 1 ack'naviedge, 2S @
condition of the Building permit, ati debris resuitina fir-orl-I ccms uc4ion act-v--ty
governed by this Suilrdlnig Permit shall be disposed of 25
a-
(NIA?-,l'E OP P"Al—PLIT)'i
-fy ficen-sed sc.-W waste facifity as de-iined by, .5,-,;A.
a priop e,
D t S Lo-ri-a-z;.ure Tsjii 4.fsp a�
F Q�sF_I T L YVV N G :I F C,R-Mj T.1,C)NN:
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The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
- Boston, MA 02114-2017
y~'?' www.mass.gov/dia
`Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Barron & Jacobs Associates, Inc.
Address: 70 Old South Street
City/State/Zip: Northampton, MA 01060 Phone #: (413) 586-8998
Are you an employer? Check the appropriate box: Type of project(required):
1.K I am a employer with_\ k 4. ❑ I am a general contractor and I 6. ❑ New 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. XRemodeling
ship and have no employees These sub-contractors have g• ❑ Demolition
working or me in an capacity. employees and have workers'
g Y P Y• 9. E] Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 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' 13.0 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: Webber & Grinnell Insurance Agency, Inc.
Policy#or Self-ins.Lic. #: W MZ a®A(c,54 5 017-ol 3/N`(R Expiration Date: 3/I /tots
Job Site Address: �1. a. jk\)e— 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 under the a' and enalties o er'u that the in ormation provided above is ue and correct
Si ature: Date
Phone#• L+ —TIT
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-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: e`,� Not Applicable r
Name of License Holder: C H 570 f� R. U PCOSS -CS-060q16-
�7 License Number
!� OW SoutH STR&E? . bgvmffimm, MA No(DO 11, 1c), Qdl�
Address Expiration Date
o� 0413 -
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable F-
G P,RROQ 9 3A000S ASSoc i RIES ,'JMC 100909
Company Name Registration Number
�D 00 500+14 SI-Rer- f, NORTHAMP09, MA CW60 Cj ti
, 3—g014
Address Expiration Date
Telephone (43)5%(o-8q4%
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......
11. - Home Owner Exe mption
The current exemption far"homeowners"was extended to include Owner-occupied Dwellings ofone(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 ofthe 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)ofthe 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 ofMassachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing El
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding[0) Other[0]
Brief Description of Proposed
Work: SEE AIIACNf� COPT 6#- m t tffir T k 1 A \ -_ ��th�rG �� vCt�'1�
Alteration of existing bedroom Yes >0� 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
1,_ , as Owner of the subject
property
hereby authorize J RQ ON ( O
O& IA165, INC
to act on my behalf, in all m tters relative to work authorized by this building permit application.
Signature of Owner Date
1, 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 pains and penalties of perjury.
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 SAME S Ame
Frontage
Setbacks Front 24's 25'"
Side L: 15— R: Jr L: // R:_�f
Rear W t 701
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#ofParking Spaces
F ill:
vohune&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
aL
NO 0 DON'T KNOW MW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO U DON'T KNOW O YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO W DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property YES NO AM
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,qxcavation, 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.
� Department use only
�� —-- City of Northampton Status of Permit:
,;Building Department Curb Cut/Driveway Permit
14 20114 Ir 212 Main Street Sewer/Septic Availability
j Room 100 Water/Well Availability
Elect'Jc, Plumbing&Gas Inspection orthampton, MA 01060 Two Sets of Structural Plans
96ffdne 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
56 REVIELL -AVE Map Lot Unit
NORTH.AMPTA MA 01 OGO Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
SF-TTY (At%hftI a REVELL AVE. Nognk4w>yoP,MA Di0fo0
Name(Print) Cur nt ilin Addre s:
— I ,586. Oa3
Telephone
Signature
2.2 Authorized Agent:
GAW00 9 SACO26 PSGOOMES, VJC `�� OLD SOUTH SntEET,I�ORTHAMPVA),(4&010
Name(Prink Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building J d by (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) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2014-1200
APPLICANT/CONTACT PERSON BARRON&JACOBS
ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998
PROPERTY LOCATION 56 REVELL AVE
MAP 38B PARCEL 259 001 ZONE URBOOO)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tyneof Construction: CONSTRUCT HANDICAP RAMP
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 60475
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO MATION PRESENTED:
proved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
kdig Delay
ia Date
No te: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
56 REVELL AVE BP-2014-1200
GIS#: COMMONWEALTH OF MASSACHUSETTS
Man.Block: 38B-259 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: HANDICAP RAMP BUILDING PERMIT
Permit# BP-2014-1200
Project# JS-2014-002027
Est. Cost: $15000.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BARRON & JACOBS 60475
Lot Size(sq.ft.): 6751.80 Owner: GERSTEIN MARK H&BETTY L MITC
Zoning:URB(100)/ Applicant: BARRON & JACOBS
AT. 56 REVELL AVE
Applicant Address: Phone: Insurance:
70 OLD SOUTH ST (413) 586-8998 Workers Compensation
NORTHAMPTON MAO 1060 ISSUED ON.511412014 0:00:00
TO PERFORM THE FOLLOWING WORK.•CONSTRUCT HANDICAP RAMP
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 5/14/2014 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner