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17A-272 (7) Proposal Page No. of Pages NEWMAN'S CONSTRUCTION 697 Bridge Rd. Northampton, MA 01060 1137 413-586-1093 PROPOSAL SUBMITTED TO PHONE DATE STREET JOB NAME 13,!g CITY,STATE and ZIP CODE JOB LOCATION o ti r, 2 s` tM ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for: �Tru� �z��STivl _��`%� _ ___� �Z�V�o✓L ��1��?-�S �M_ �I�J '� °�_ '✓•� 1� . L.u►n l,Vr»___�vz,l�_ �c __ o _f}�.� PrK�S �lU�s_ c�,�_if�j-� _U)Pff v ( arLyZi�4 ift-r _-Av2s 5, . 61(Ion vit } C, _n om zp 51 nt►21 C _b,V1A'Za&N r 1►1 v�T __ v t'X _Rt-W a(lvi"A 5t.)a-cec1.S - L vx►,�`�_uMn l -_ _c4J_Ri.i-_`CLa 5.ti t'_n 5 a __ c7u ,njt(_ __ yt2 __��RCM�_CgcR?c1 5 �,k► _�zS_ oa, v �2� _ L ,ot., 1}T _ >Lt �_ /i✓t 5k 9..0 LI—_. J V1� t�fR K).__ C _. 5_1' tom_ 0 __ _D2-�a"S _ �Vwovk ts.�&K_ - V.__m,0-D0L... 5.2c`` oZ c7 O® A 11 SP F&i4 .2t( vzoq� vL y r� i,,.) ����a t?-,o L)vv,, �t j m ar i�v, I ,wj BlP Vrapa hereby to furnish ma Aerial and labor—complete in accordance with above specifications, for the sum of: /Cj r n J` — C1 dollars($ -----21"!C7 Pa to be ade as follows: v+ 7P ' L .9,0 C As c Al All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications Authorized involving extra costs will be executed only upon written orders, and will become an extra Signature charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. Note:This posal may be Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if n Ccepted within days. Arreptanrr of Proposal —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature to do the work as specified. Payment will be made as outlined above. Date of Acceptance: V — Signature v C,ITY OF NORTHAMPTON, s° Construction rig Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work -=_- --- covered-by-a-Building Permit shall be disposed of in a-properly licensed disposal facility, as defined by M.G.L. c..111 § 150A. Address of Work: (0fl -- The-debris--will.be-transported by -v - - tc2m A-k/ The debris will be received at. - Signature of Permit Applicant _ Gate 17 3 Building Permit Number: 4� T SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ p Name of License Holder: e'S �b l O License Numbe M �s ASigna Q Expira' n ate a Telephone Not Applicable £ 9 Registered Home Improvement Contractor Com an Nam Registration Number 7/ Ilb Address Expirafion D e Telephone qL-i Q 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 Own'er.Egemption 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors F Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other(ED] Brief Description of Proposed tt Work: ►2i p Lcl- rl. OQ LJ Alteration of existing bedroom Yes No Adding new bedroom Yes No r Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a:`If Newhouse and or addition to exlsting ho usinq,'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 CV � as Owner/Authorized Agent hereby eclare 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 Nam Signature of O ne nt Dat , Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning Thl's column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces L--j (volume&Location) A. Has a Special Permit/Varians/Finding ever been issuedior/on the site? x-� NO �_/ DONTKNOVY ��y YES �~�x-~� IF YES, date issued:,: / IF YES: Was the permit recorded at the Registry ofDeeds? NO K ) DONT KNOW YES C) 7. �� IF YES: enter Book Pagej and/or Document# �� �� B. Does the site contain a brook, body of water orwetlands? NO ��x DONT KNOW �~� YES «�� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tobeobtained �~� Obtained x�\ Date |ssued. � «�� �-� ' C. Do any signs exist on the property? YES 0 NO )F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO xa� IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excavation,or filling)over 1 acre nrisit part ofa common plan ' that will disturb over 1acre? YES NO o IF YES,then a Northampton Storm Water Management Permit from the DPW is required. '' { department use only ' City of Northampton Status ofPermrt PK Q `•... Building Department Gtrr6 CuT/Dnveway Perrrs�t s ;r U �5' 212 Main Street Sewer/SepticAvaila'bll�ty Room 100 Water/VteiGAva�lability ' SEp Q rthampton, MA 01060 Twa Sets of Structural Plans phon -587-1240 Fax 413-587-1272 Ptof/Site Plans 1 Elecfrlc,Plumbi Uther 5peclfy ' North n 9$G APPLI A CO TRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION This section to be completed by office 1.1 Property Address: 13F O$e C , - Ma Lot Unit J Zone Overlay District C)vzf EIm S BDtect Ditrt w is SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: 07v ttc) i Q Name(Pri t) Current Mailing Address: Sig Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be 5-0 d Official Use Only completed by ermit 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=0 +2+3 +4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector'of Buildings Date 138 OAK ST BP-2015-0372 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-272 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-2015-0372 Project# JS-2015-000682 Est. Cost: $8425.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CYRUS NEWMAN 064690 Lot Size(sq. ft.): 18730.80 Owner: FIELD JOHN P&WENDA W Zoning. URB(100)/ Applicant: CYRUS NEWMAN AT. 138 OAK ST Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 NORTHAMPTONMA01060 ISSUED ON:913012014 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 9/30/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner