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17A-224 (8) ...� , , ,, nY: .�, F :- 3. "' ' -- >_..s PROP Wo. Jesse C.Montgomery - JCM Home Improvement 46 Oak Street Florence,NIA DIM DATE PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: K ,I q` .I ql4 �'lli '�l� Mary Ids r 'Nrti^ x S 'hw'I " I owr t OF PLUS I tv PHONE NO. ARCHITECT i IM�r - I MI iP?r r Ira w Ilr G V q,.f - ^�r 411 I I �I ;a F �w.wr 1 II i -'4 "�,. 1 III �Id ^ 1. s ° u >I I a a r � n I All material is gttt�tti id to be as specified, and the above vrnrlt to be performed in accordance et y ncJs ar,. sp ft- cations submits fiOr a worr►�tecf in a substantial wotkmahlike manner fi the°sum # � !± 0 �i n t `. C)oflars ($ } with payments to be made as follows, e`� �'�;� �� � �.: � k 4 o 6-7 01 i Respectfully submitted Any alteration or deviation from above S*fttions involving extra costs Will be executed only upon written order,a'nd will become an extra charge Per � over and above the estimate. All agg�nts contingent upon strikes,, ac- cidents,or delays beyond ur control. Note—This proposal may be withdrawn' ° by us if not accepted within -' days. a �" a t � u X � t pp yz� jml 10a are, ' Date s_ ' -~' Signature C--_— ---" " MADE I CAdanns U N USA A 3818-50 PROPOSAL i MADE I ' . ¢g1�PT0 '�O a 9 fl �x 1f N11rfilailiptell 9 6ltcsaacflttsctta c m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE rl ' AVTr -- (li permitter} with a principal place of {�busineesss/residence at: at. K � r�oreyiLx t t I- 01 662 (phone#) (s tmet/ci ty/stafr/a p) do hereby certify, under the pains and penalties of pegury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees worEng on this job: (Insu=nce Company) (Policy NumLxcr) J (Expiration Daze) ( ) 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 Company/Policy Number) (Expiration Date) (Name of Contractor) Gnsumce Compaay/Policy Number) (Expiration Date) (Name of Contractor) (Insulrance Compauy/Policy Number) (ExTirabon Date) (Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date) (attach additioaaf shed ifnoo�x y to include information pataiuing to all ooat nr_iors) 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 while hcaroowncta who employ pa-so=to do ma i..��cor '=oa or Icpair w ric on a dwelling of not mode than throe units m wtrich the homeowner rexides or oo the grounds appurtenant thtr t are oot wily comidcrcd to be calooyrrs under the woricct's coaTc=4on Act(GL152-m1(5)),application by a homcowncr fora lime cc permd may evidcam the legal etatua of an amlployec underthn Woukcc't Compomatiou Act I undast=d thrt a caopy of this rtatcmmt may be forwarded to tbo Dtputmcos of IodusUial Acadcat Offioo of Ins-"*for the coverage verification and that failure to secure covccago under scctloa 25A of MOIL 152 can lead to the imposition of criminal penalties oomisiiag of a fine of up to S1,500.00 smiler imprisotuncni of up to one year and civil pcnxi ics in the form of a Stop Work Ord-and a film o(5100.00 a day t&kinsi mr- Foc dm=rta uio only permit Number NbP11 Lot# Si o rmittce e SECTION$ CbNS'tRl7CTION:°5ER1%ICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �,1LJ ' � 07 7-1 1 0 License Number Add / Expirat' n Dat Telephone i Reg s e e� H a marriv'ementContracio ,E �x � �~ e� Not Applicable ❑ a� r._,�, ., Company Name Registration Number Address pt� Expira ion D to Telephone Cx 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 affic will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ : : 0mW- 4 �� % la in The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act 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 then 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 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 s ,•,... "�' w��" ''R .vp 3aa,„ b r C �Pr'E v, ECMION.,= DESCR PT IOF PROPOSED WORK cfy`' ck al] a hcable New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs p[ ] Decks [ ] Siding[ ] Other Brief Description of Proposed Work: II" �' n /�� �" G - IQ cl Alteration of existing bedroom Yes No Ad 'ng nei edr oom Yes ✓ No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0- Sheet 0 6� IfNew�housea�ndor..addition"•toy'"zstin �"tiousi'n' °:co`m'" lee t e:fol1owin�;: 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 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 OVYN10 AGENT,OR CONTRACTOR APPLIES POR-BUILDING PERMIT as Owner of the subject prope hereby authorize to ac my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date ��5 ? 9 &n-� as Owner/Authorized Agent hereby declare that the statem nts and OpArmation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the rypains and penalties of perjury. �`� ' ld yy4 u(yv'l of Print Name Signa re of Date 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 s A. Has a Special Permit/Variance/Finding e er 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 V IF YES, describe size, type and location: D. Are ere any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: r 40 4 City of Northampton Building Department 212 Main Street Room 100 a" 3Vtl 2 N rthampton, MA 01060 " -- le 41 587 1240 Fax 413-587-1272 oSlte " P. APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to)be comple# diiyoff�ce ." 1.1 Property Address: 4� 1 fn Lot tJ it " Zone" Overlay Distr�c � 7 7 l F1 ` Elm St.District".. . CBzDstrict" SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: ) SS ;`A G-49 Name(P i t) Current Mailing Address: Signat Telephone SEC ION'3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by ermit applicant 1. Building r" (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 Onl Building Permit'Number._ Date Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2002-0665 APPLICANT/CONTACT PERSON Jesse Montgomery ADDRESS/PHONE 46 Oak Street (413) 585-8482 Q PROPERTY LOCATION 198 NORTH MAPLE ST MAP 17A PARCEL 224 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid "— Typeof Construction: REPLACE 4 FRONT STEPS&REPLACE GARAGE DOOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included• Owner/Statement or License 077410 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved 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 Signature of Building icial 47 1 Date Note: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. k° BP-2002-0665 HI� GIS#: COMMONWEALTH OF MASSACHUSETTS &l7A— 4 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:Non structural interior renovations BUILDING PERMIT Permit# BP-2002-0665 Project# JS-2002-1037 Est.Cost: $1200.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JESSE MONTGOMERY 077410 Lot Size(sq. ft.): 6316.20 Owner: MCKEEVER JAMES P Zoning URB Applicant: Jesse Montgomery AT. 198 NORTH MAPLE ST Applicant Address: Phone: Insurance: 46 Oak Street (413) 585-8482-0 FLORENCEMA01062 ISSUED ON.1122102 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 4 FRONT STEPS & REPLACE GARAGE DOOR 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 1/22/02 0:00:00 1197 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo 7 ` . . .W f 1 _{� 198 NORTH MAPLE ST BP-2002-0665 GrS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 17A-224 CITY OF NORTHAMPTON Lod:-001 Permit Building Category Non structuW inte&j renovations BUILDING `PERMIT Permit# BP-2002 7Q665" Pipject JS-2002-1037 Est.Cast $1200.00 Fee:$25.00 PERMISSION IS HEREBY GRANTED TO. Const.Class: Contractor: License: Use Qrouv: JESSE MONTGOMERY 077410 Ivor Cgc.ft_1: 6316.20_ (hvner: M_CKEEVER JAMES P Zooning URB AA liv cant.• Jesse Mbntgomgry ATr 198 NORTH MAPLE ST Annlicant Address: Phone: Insurance: 46 04k Street (413) 585-8482 () FLORENCEMA01062 LSSUED QN- I2.2102 0:00:0 0 TO PERFO"THE FOLLOWING WORK.-REPLACE 4 FRONT STEPS & REPLACE GARAGE DOOR PQST THIS CARD SO IT IS b VISIBLE FROM THE STREET �I�W I�wiI1���PO�� M Inspector of plun'd ►g. inspector of Wiring D.P.W. - Building Inspector - Underground: Services Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame:, Gas: Fire Department FireplacetChimney: Rough: Oil• insulation: Smoke: Final: flf� Smo Final: o? d THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES ANDRGULATIONS. Certificate.of n si star Fee M : Recef ,Ng Date Paid Check No: Amount. Building 1/22/02 0:00:00 1197 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo