Loading...
17A-157 (2) 1haposai Page No. Of Pages NEWMAN'S CONSTRUCTION 697 Bridge Road NORTHAMPTON, MA 01060 (413) 586-0273 PROPOSAL SUBMITTED TO PHONE DATE �s y al.70 STREET I J!9§; ME 4 CITY.STATE and ZIP CODE JOB LOCATION oLiDC. L ARCHITECT DATE OF PLANS JOB PHONE We he reby submit specifications and estimates for. ................... _g+9_11K �EXX"$Z;T. 1AA-t__ .41-�f V�L- /_ On 7:� a 11 a I CA_WUP__..r_&Y_ 01iLAVU .( A-W.VIS _(W­14.111t.6 V-r ��._ �... �`.- .._......-.__.1.J _....-�?t.�.�E-....... .�•j1f.1R.._..C3C�.._....'Z'�!t!nc�'>>.�f�.t.�n.. __�.�1,^.._.2[.t.5.. .__.__ _ _...-. ... __. .......... L._ 3-0 AL .......... ................... ........ ... .............. VP Fropm hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: St dollars($Payment be m follows 1r__S All material is guaranteed to be as specified.AD 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. Ali agreements contingent upon strikes, accidents &=:yond our control.Owner to carry fire,tomado and other necessary insurance. Note:This p s Ly be are fully covered by Workman's Compensation Insurance. withdrawn by us it riot a=ccep within Arreptance of Froposal —The above prices,specifications and conditions are satisfactory and are hereby accepted.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. A�q,�, 31 04.E O 14 $ � �assac�ttsetts' Qt DEPARTMENT OF BUILDITIG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT Nce�iermitt=) with a principal place of business/residence at: tr►. (phone#)._ij - loci,S (strceycity/stairlap) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following wor'ker's compensation coverage for my employees working on this job: (Insurance Cody) (Policy Number) CLTiration ate) ( ) 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 Con pany/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (E)piration Date) (attach additional iboct if noccasary to ine}uda infamahon partaiaing to all oodr=fon) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pl= be aware that veWo bomcoxvcra who cmploy p rl=to do maintc=.cr,o=stn otion'or repair wont on a dwelling of not morn than throo amts is which the bomoa%v mid=or ou the gnwads apputieaaat ihercto arc not gtnerally ooasidard to be employers under the worker's compa=iion A t(GL1 appiicition by a homoowncr for a Ganse or permit may evidenoe the 1eg21 nitro of an employer under the Workees Compamatiou AcL I uadastand t).at a copy of this rutemmt may be forwarded to the Deport,,,, 2 of Industrial Ao idw&Oboe of Imunaoa for tba oovetxgo verificaiioa and that failtmm to sot m coverago uudcr saxroa 25A of MOL 152 can lad to tbo"imposition of ai=ul penaldcl oomts[ing of a fitx lof up to$1,500.00 a0Nor of tip to one ytar and eivt7 pena tics in the form of a Stop Work Order and a film ofstoo.o0&day against tt3e For&pntmed,I use Only + permit Number �06 r' SECTiDI4,B-,CONSTii;UCTION SERVICES 81 Licensed Construction Supervisor: y,, Not Applicable ❑ mme of License Holder:L a�1 eo-) 1 V Q t ma•(] C"s OLOq uq License Number Address ExpiratiAn Date C VL WIN nature Telephone r. :. Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone 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 affidavi, 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"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 r S iON D C � PR S D RK kcal > Iicabl` New House ❑ Addition ❑ Replacement Windows Alterations)❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( Other[ ] Brief Description of Proposed Work: 44 - 0 r? U`-i h"\Q �h t cin\-S. r�z i`a Cie r t? `� i co to — I ) Alteration of existing bedroom Yes__�C No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑•Sheet❑ "�ifNe�' "�o°'�'� �and��c���#"o'�i�"to` existing offing comp`le � h�-fo'tt ' nib. 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 Ni j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning'regulations? Yes No . 1. Septic Tank City Sewer Private well City water Supply SECTION 7a�OWNER AUTtIORIZATION-TO BE'COMPLETED WHEN OWNERS=AGENT 4R CO I'I2AGTQWAPPLIES FOR'BUILbINGPERMIT as Owner of the subject property hereby authorize to act o my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent hereby declafethat the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Si ned un er the ins and penalti of perjury. Print Name 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&LAcation A. Has a Special Permit/Variance/Firiding 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 Irom 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: thampton h � t u i bpartment ' �) 21 i� Street l .1.00 a or , MA 01050 phone 413-58240k Fax 413.587-1272 1 r ollu["r.,F;art(7"'11S p url n , cn ARPtICATroiT 'O CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION Th�sysecti fii�be comp iArd by office 1.1 Property Address: ti r „ t-- �n COX ylx f r y1 ' � . e' 1-MI h,J'�) y�^ J f� i ,1 ) C 1-y n c)i o Elm St. District SECTION'2-PROPERTY OWNERSHIP/AUTHORIZED.-AGENT 2.1 Owner of Record: L+ F i -Me r 1 FLx ra r cr-vs Qj. V-tgyr or_ Name(Print) Current Mailing Address: 21 Q® Telephone Signature 2.2 Authorized Agent: ao fwL.'r7 l t r,(Jr6/ 0-t-L1 f Name(Pint) Current Mailing Ad ss: ignatur Telephone SE ES TI TED CONSTRUCTIO O T Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ��, (a) Building Permit Fee 2. Electrical (b)Estimated 7i otal Cost of Construction from S 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) - 5. Fire Protection 6. Total =(1 +2+ 3+4+ 5) Check;Number Phis Section For.Official UswOnl Building<Permttlurnber' Date Issued-.' Signature: Building Commissioner/inspector of Buildings Date, F. BP-2004-0021 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category BUILDING PERMIT Permit# BP-2004-0021 Project# JS-2004-0036 Est. Cost: $8360.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Cyrus Newman_ 064690 Lot Size(sc. ft.): 28793.16 Owner: OLANDER FLORA R&EDWIN L Zoning:URA ADDllcant: Cyrus Newman AT. 61 FOX FARMS RD Applicant Address: Phone: Insurance: 697 Bridge Road (413) 586-1093 NORTHAMPTON MAO 1060 ISSUED ON.717103 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• Receipt No: Date Paid: Check No: Amount: Building 7/7/03 0:00:00 3809 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo