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17A-142 (6) ,�. r ._ t ;.,+.� wry ' ,,- 4.t_� wit,,� I ,,; . PROPOSAL"' %"" e. xifKoo laq PROPOSAL NO. ��f�OMtC �J�d�j�t40tCrttEnit A 0, 3� SHEET NO. Zee& 01053 DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED Al NAME ADDRES G�tn C � ADDRES DA TE OF PLAN ,I S PHONE NO t ARCHITECT We hereby propose to furnish the materials and perform the labor necessary for the completion of C u., ter C OC4 r-C t _ • d t/ra Uvn n i v1(J h r" C 4 C o r o CJ, r CAL r(f C 1'7 Ct 10-71c, rlwC 5C cN All material is guaranteed to be as specified, and the above work to be performed in accordance witfa the drawings nd sped cations su mitted for above work and completed in a substantial workmanlike manner for the sum of t e dr 7 +� Dollars ($ ' ) IF with payments to be made as follows. / 5 l 7` .t�0 c� "tn 14- 0 .. iC>, .-3o b. Ci ( rrY c'l,F 04—_ 3 �2 SD, of .Tom Respectfully submitted !=Jf Any alteration or deviation from above specifications involving extra costs r will be executed only upon written order, and will become an extra charge P � /1 over and above the estimate. All agreements contingent upon strikes, ac- � C cidents,or delays beyond our c trot r /f Note—This proposal may be withdrawn i f ` by us if not accepted within �1 days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work' as specified. Payments will be made as outlined above. i Signature /' late 't Signature IN A 381850 PROPOSAL MADE IN USA PROPOSAL I- J/`1 r ggt+�+arPT ,, e Crify of Nazthalli tart z � � �Gi lassact<usctfs =' � DEPARTMENT OF BUILDI],,'G INSPECTIONS INSPECTOR 212 Main Street • Municipal Building Northampton, MA 01060 r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNlR 108.3.4 to act as }:is/her construction sups: ,i sor. T he 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/footings (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 .0 fib Dy (1�zit1 Of {a�CSSAC11176Ctt5 (j _— m DEPARTMEM-F Of' DUILDD�G INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WOPJCER'S COMTENSAUON INSURANCE /-FFEDAV1_T :CCIlS"_u�fCrlAliiC^} — th a principal place, ofbtlsiresslr :idenc 1 (o L94k rl)honc'=} Ci1';fi>i=L':i?p) CIO 11C1'eb}' CCl�lf}' UIl("IGI" UIC E)i:L7h, C:ilCl l?Cil lucC O! O I am an employer provitiin- the follov,,Mn -, :.orr:er S Corrlpensatioll Goverage for 'Illy employees working on ttlis job: - (Lmsu c:� Compam,) (T-,cli"?ti'tLntxr) ---- (Fxuir:aonDzte) I am a sole proprietor, zttl-tral CO:)TW C,Or o: t C)Oieo,:vicer (circle Oct) ant, tla.e lured the coratractom llSted be.ow"tlhc iii � the ,-o' 4�OrkP�S GOiI1 ns-a,iOr1 (' la-mc of conLmctor) (Name of Contactor) -- (I'as-d7ancC Corl?pa, v/PG!iC- Nt!rlrfr) — tlon Date (IName of Contractor) 1_- } PGLc, i�tunrf r) x;. :nc ;ab,-) t ---- -- __�.,---------- _-------- Con -actor) (Insuruic Corn* r Pohcy T�iuml;*) il.;:ri :tia: Date) ("!I:1G7=.dri'CYa1it._�..;�..rr�-.i^:;n•-_-L.,:.-:.-:-r:.:ar:^;� ::r;' .l 1 (V)<lull a sole pro}?[1C:C7i ii-1'1 have, no 011 Ur�fii` for Inc. I ?ill a home ?TOTE:plc..sc tx Awar c lts: . not utc<e 1h--z]threo uui a in t f ei r or a;-1, cr rt thee-- t tx:<Ce r1a12Y err.: ;:c cZ'•ployca u_ti:cs Qr-wc;};n'a ca:�---;ati�n t�r:(GL!52�_E S)1 �-tier. y ... ._ ' •::=- hnt:icol� rr`:ar a Lccu cr p:rz::;. krtic legal etzius of an xaployx under 4`.n Wcv4 er■Co,2.;>a-_.+.lion�-cc. i I ur dc-staad dial a copy of th u date,-c!¢:ay to 1!»fY_txi tern of ItuhuLricl A6&.:Y Ci aoo of for tix mvcra�vrrif ciioo and that fa.ilurc to:-z;.::c mt��„ur.�;.c�,irl:S A of?.tGI.t 52 rzn lead to itx imposilia�of c:�i.:1 peraL'::s i cvmuti�g of n fur of up to S1 500.00 e;tJ x i-:ririu t :, of,up to c,. }-. r.-.1 civil perultict in d<ti;nn of n S!r,,"V z.(h-a:1 a fr 0(:S 100-00 a day m.. _ F,ctq=utnrrtsl uic crity i _ lath F SI=CTON 8 YCONSTRUCT.ION SERVICES RA 8.1 Licensed Construction Supervisor: /� !IT Not Applicable ❑ Name of License Holder : �` e� 077 LY Z 0 License Number (o �w K 5�, ��vr��t�� /�/�- OtO6 ,2 i Os Address �p Expirat" n Dat `//3 S���fT.� Signa Telephone - Re . ere :'ome m uernen.�:Contract Not Applicable ❑ Qomp%�ny Name Registration Number 0 (37V 3�9 fl �9 os Address Expir tion D e Lfe �'1 ®� 0 L5�3 Telephone SECTION 10 WORKERS' COMPENSATION I!% NGEAFFIDAVIT(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...... ❑ 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"homem-mer" 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 1 SECTIOI+»a7'OOFPROPOSED�IlORK check ail a IIcab{e ' O New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ nNew Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: S 1 rf d 1 � �S 3 ) r r s Alteration of existing bedroom Yes No Adding new bedroom Yes No / Attached Narrative D Plans Attached Roll 0 • Sheet 0 Renovating unfinished basement Yes ✓ No 6a„ ff'e. v se redo a�tlditl�on taexistin #�osin com" }etNe olovw�n g P 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? 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 SECTS©1�t�7a"�0YfINEf3�UT�0RIZATI0N TO BE COMPLE'f,ED YVHEN 0kYI(Ef3S�/�GE T ORCONTRACTOR APPLIES FOR,BUILDING PERMIT <•: I, as Owner of the subject property hereby authorize to ac; on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declare that the stateme s 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 Signat Own gent to I AV I Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION I 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 issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Iss 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: - - l of Northampton �k . ulloing Department 2f2 Main Street APR 1 6 2C '"Room 100 (� ; .Ro . N ton, MA 01060 phone 413-587-1 40 Fax 413-587-1272 `,W APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION This section„tolieompteted by o#frce 1.1 PI OPerLY Address: a '5; "0 go t o�U1CC / O/06D D�stncr _ SECTION 12-PROPERTY OWNERSHIPJAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone J O Signature 2.2 Authorized Accent: Name(Print) Current Mailing Address: Signatur Telephone ESTIMATED CONSTRUCTION'COSTS Item Estimated Cost(Dollars)to be Official Use,Only; completed by ermit applicant 1. Building ago �,.(a) Binding Permitfee 2. Electrical (b);Estimated Total'Cost of ;Construction from .6 3. Plumbing Building Permit Fee 4. Mechanical (NVAC) 5. Fire Protection c� 6. Total = (1 + 2 + 3 +4+ 5) 7 Check Number This Section For Offildal Use Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 201 CHESTNUT ST BP-2004-1051 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A- 142 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-1051 Project# JS-2004-1575 Est.Cost: $7000.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: JESSE MONTGOMERY 134274 Lot Size(sg.ft.): 25482.60 Owner: WIGHT NANCY B zoning_URA Applicant. Jesse Montgomery A7: 201 CHE51NUT 5T Applicant Address: Phone: Insurance: P O BOX 329 (413) 585-8482 (� LEEDSMA01053 ISSUED ON:4129104 0.00. 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: x,heal. D r S-- Al THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu an Si nature: J FeeType: Receipt No: Date Paid: Check Nos Amount: Building 4/29/04 0:00:00 2137 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo