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PROP
Wo. Jesse C.Montgomery -
JCM Home Improvement
46 Oak Street
Florence,NIA DIM
DATE
PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT:
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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
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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Note—This proposal may be withdrawn'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.
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MADE I CAdanns
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PROPOSAL
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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
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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