17A-301 (2) I
Troposal Vinyl Siding
Corbett Home Improvement
Windows
ofin s
R
� Roofing
Northampton, MA 01060 Doors
Awnings
(413) 584-6571 Canopies
Gutters
Shutters
PROPOSAL SI IBMrrrFD TO P1-10 DATE q o/
S"IRIEEr C JOB NAME
CrrY,STATE,atxt ZIP WDE JOB LOCATION s i
DATE OF PLANS JOB PHONE s/r}' ?i✓J
We hereby submit specifications and estimates for:
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Ve Cpropose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of:
Dollars( L )
Payments to be made as folkiwW0 A(?W-a,j ( 21 AdA- AWCL � �/ /'�i i,/)�. ns✓
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All material is guaranteed to be ac specified. All work to he completed in a work-like wanner according Authorized
to standard practices. Any altercations or deviation from above specifications involving extra ants will he Signature
executed only upc)n written orders,and will become an extra charge over and above the estinate. All
agreements contingent upon strikes,accidents or delays beyond our mutrol. Owner to carry fire,tornado Note: Thus proposal may be
and other necessary insurance. Our workers are fully covered by Workmen's ConTensation Insurance. withdrawn by us if not accepted willun days.
,acceptance of()P1'opoSAf-Tlte above prices,specifications / l / � <
Ci
are conditions are satisfactory and are hereby accepted.You are authorized to Signature O
do the work as specified. Payment will he made as outlined above.
Date of Acceptance: Signature
B �aSfACllttB[!!fr
of 'Wart4aillptou
e
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATTON INSURANCE AFF'IDAVTT
(iiermittee)
with a principal place of business/residence at:
`� /� _ .-✓ d� (phone#)
(street/city/stalr/ap)
do hereby certify, under the pains and penalties of pedury, that:
la
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
( nsurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Comrpany/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addi6oml shelf if noccssary to inchule infvtmafim pertaining to all ooat ma )
(L1111/I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that v6lo homeowners who employ persons to do m intcmncc connection or repair work on a dwelling of
not morn than throe unit+in which the bomeowocr resides or oa the grounds appurtsnar#thereto ate not wally ooanderod to be
employe a under tbo vmc kegs ocmQcas oa Ad(GL152.ms l(5))�,application by a homeowner fora liaise or permit may evcda—the
legit etatw of an employer under the Workor'a Compemation Ad.
I understand that a oopy of this uatemmt may bo forwntdod to the Depwuacrd of rzdusfrial Aocidm&Office of lzmui for the
coverage verification and that failure to aocure coverage under soejon 25A of MGL 152 can lead to the imposition of criminal penalties
oomisting of a fine of up to S1,500.00 andtor of up to one year and civil pcn&Wcs in the form of a Stop Work orbs and a
fimo of S 100.00 a day against ma
=Map4Lot
Signature of LicenseelPermittee
S CTION,8=,CONSTRUCTON SERVICES
.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
._., M, - Not Applicable ❑
...... .-` PP
4 91/,� 4�9
Company Name Registration Number
L-1 s- /S v z
Address Expiration Date
Telephone 6 b-J-21
SECTION 10-1N.QRKERS'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.
igned Affidavit Attached Yes....... ❑ No...... ❑
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
;Ir
U91.0110KO F "O I I`c ble
New House ❑ Addition ❑ ReplacemenV4indows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding Other [ ]
Brief Description of Proposed Work: q Vit✓4/ all,tYl
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
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. Mascheck Energy Compliance form attached?
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 OW'Et�A1JTHOR1ZATlO I -''TO Blr'COMP ElfD WHEN
OWl+I aS AGENT d Ct)l 1"RAO CJR A PLI S'P R BUILDINO PERMIT'
I, 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
I,
rid 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.
igned under tbe pains and penalties of perjury.
Print Name
-22-e) J
Signa ure of Owner/Agent Date
Ab
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW 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 exist on the property? YES NO
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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413.587.1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1;-SITE FNfORMATION
1.1 Property Address: a �hisi
k"q
u�
nM � F
r
SECTICIN 2-PROPERtTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record.
Al 5ZZjeZ1_ tA
ame(Print) Current Mailing Address:
ss 9�L__ __2
Telephone
Signature
2.2 Authorized Agent:
E6/ & V 57—
Name(Print) /'' Current Mailing Address:
'�5 CoSi/
Signature Telephone
EGT,ON 3 ofIMki ELF GONS7'RtJGTION COSTS
Item Estimated Cost(Dollars)to be 'Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Feei
2. Electrical (b) Estimated Total Cast of
Construction from: 6
3. Plumbing Building!Permit!Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4+ 5) f Check Number
This Section Official Use Only
Building Permit Number: Date Issued:
folk
Signature,
8u ldingzQ;om6lssIgner/1rispector of Buildings Date
125 HILLCREST DR BP-2001-0747
GIS#: COMMONWEALTH OF MASSACHUSETTS
*Map:Block: 17A-301 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:replacement windows/siding BUILDING PERMIT
Permit# BP-2001-0747
Proiect# JS-2001-1403
Est.Cost: $14000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sa.ft.): 21 867.1 2 Owner: SWIDER ALAN C&LOUISE P
Zoning:URA Applicant. Ed Corbett Jr
AT. 125 HILLCREST DR
Applicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMA01060 ISSUED ON:31221010:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING & REPLACEMENT
WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/22/010:00:00 1174 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
125 HILLCREST DR BP-2001-0747
GIS#; COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-301 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:replacement windows/sidin BUILDING PERMIT
Permit# BP-2001-0747
Project# JS-2001-1403
Est.Cost:$14000.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor: License:
Use Group: Ed Corbett Jr 116069
Lot Size(sg.ft.): 21867.12 Owner: SWIDER ALAN C&LOUISE P
Zoning:URA Annlicant. Ed Corbett Jr
AT. 125 HILLCREST DR
Annlicant Address: Phone: Insurance:
4 Reed Street (413) 584-6571
NORTHAMPTONMA01060 ISSUED ON.31221010:00.00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING & REPLACEMENT
WINDOW
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Final: Final:
Rough Frame:
Gas Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: OK 7—/;1 -O/ li
THIS PERMIT MAY BE REVOKED BY THE CITY F NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
'004e
Certificate of Occupancy si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 3/22/010:00:00 1174 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo