23D-182 Page one of one
►,)posat
Windows — Siding — Gutters — Roofing — General Home Improvement
38 Graves Street, South Deerfield, MA 01373
413-665-2286 /413-586-8712
HIC # 160143/ CS-078297
JCORBETT
HOME EXTERIORS
PROPOSAL SUBMITTED TO: PHONE: EMAIL: DATE:
Matthew Jarrett 413-455-4323 4/11/15
ADDRESS: ADDRESS WHERE WORK IS TO BE PERFORMED:
14 Nonotudk St,Florence,MA
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR
Installation of 18 vinyl windows with the following specifications;
New construction units— low-e argon glass—foam wrap insulation — half screen—6/6 grid
configuration in glass—white/white— Lifetime warranty—J-channel and nail—
Addition: - Exterior of new construction windows to have a 3.5"casing on sides and header along
with an exterior sill. —Additional cost of$1,980.00
Additional complimentary items—fix base flashing on chimney—Rear gutter— loose shingle
Remove existing siding and install new vinyl siding to entire home— all exterior surfaces to be
covered with vinyl and/or aluminum trim where necessary—style and color to be chosen by customer
Install a foam board against the entire exterior surface of the home for additional insulating as well
as providing as a moisture barrier— Full cpverage
Dumpster on site ptpac ► '�,�4d, CCU Total cost: $21,364.00
Additional cost for front and side doors; �A«�G'�
Front door: Thermatru's FC906 in Black Nickel—Cost of door plus $400
Side door: Thermatru's FC1646—Cost of door plus $400
J Corbett Home exteriors only uses proven quality products)
All manufacturers'warranties apply. Contractor supplies additional 1 year warranty for parts and labor
PAYMENT TO BE MADE AS FOLLOWS: 30%DEPOSIT/30%halfway through and balance upon 50 pletion.
All material is guaranteed to be as specified.AN work to be completed in a workmanlike
manner according to standard practices. Arry afteration or deviation from the above AUTHORIZED
specifications involving extra costs will be executed only upon written orders, and will SIGNATURE:
become an extra charge over and above the estimate.AN agreements are contingent N CORBETT
upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and NOTE:THIS PRO SAL MAY BE WITHDRAWN BY US IF NOT
other necessary insurance.Our workers are fitly covered by Workmen's Compensation ACCEPTED WITHIN 20 DAYS.
Insurance.
Acceptance of proposal The above SIGNATURE:
prices, specifications and cornditions are
satisfactory and are hereby accepted.You rued to do the work as specified.
Payment will be made as outlined above. ,r ' SIGNATURE.`/"J�
DATE OF ACCEPTANCE: t( �l
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: ;4/ /V0n 0 116)e SNP L
The debris will be transported by: ! 2 o"I '; l i
The debris will be received by: _�S LA (A),.
Building permit number:
Name of Permit Applicant J619 4e-
Date Signature of Permit Applicant
City of Northampton
j�% Xf/♦ � ' Massachusetts
lY Y LL DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J� b
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Chuck Miller
Building Commissioner Assistant Commissioner
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her
construction supervisor. The 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
1, 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
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: Gr,,a�V t- &7;n e e i
City/State/Zip: z t 0 3'?3 Phone #: Y/
Are you an employer? Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
,(employees (full and/or part-time).* have hired the sub-contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have
employees employees and have workers'
g, ❑ Demolition
workin g for me in an capacity.
9. F-1 Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. We are a corporation and its 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.[`Other '4 c>
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
S.
I do hereby certify Zunderlie andpenalties ofperjury that the information provided above is true and correct.
Si ature: Date: S
Phone#:
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:: Not Applicable £
Name of License Holder: �_�f _( s��(I 1�r -> 4E-t "'i t+,
License Number
�K "tee e ) e �7 �' € 114
Address Expiration Date
S e9
s na re Telephone
9 `Regisfered Home Im"rirovemen#Contractor u: ,_„ , „ , ':.. .._ Not Applicable £
Company Name Registration Number
6711 Oful,-2
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 affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... £ No...... £
1L - Ho-me Owner'6mption'
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 buildinE 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_
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding Other[O]
Brief Des nption of Proposed - /� /
Work: Ae-r 14>✓L dV/n Gu�3 ^f� ht^ 1 r,Ll lZC'w tLJL��"1 Aama
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa Ifi Newhouse and"or'addition to existingµhousing;complete the followlna:
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. Masscheck 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.
1. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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
2 as Owner Authorize
ge'fifhereby declare that the statements and information on the foregoing application are true and accurate,to the best of my riowledge
and belief.
Signed under the pains and penalties of perjury.
. d ,
Print Name
Sig tur wnqCAgent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department'
Lot Size i I
Frontage
Setbacks Front r
t
Side L:!__— R:-L—J L: ' R:=
rr---------��
Rear
Building Height ( —
Bldg.Square Footage `r %
Open Space Footage t %
(Lot area minus bldg&paved _`
parking)
#of Parking Spaces — --_
Fill:
(volume&Location) I `
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW Q YES Q
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
-7.
IF IF YES: enter Book I Paged and/or Document# f
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: I j
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
�rf3eparfinent
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s.�,pnr err ya
I�I
MAY 2 Main Street Sewertse ttcAvalra5il�ty
!' 2 Z �i� �`Room 100 ;WateriUtFetAvatla6111t
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N rfi pton MA 01060 Two s�f�s of Strukr;Ta1 PtaPs
Electric r - t s -1240 Fax 413-587-1272 P[otrSit Plank
r �! rp r1 , -� k
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01 OaO .Oder Spec�f' F
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Y
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to pe completed by office'
1.1 Property Address: ---'
Ap,..GEC ) 2" MaP Lot Unit
-
Overlay District
Elm St=Distrvct CB:.Distnct
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'4 T 1 py
Name(Print) Current Mailing ddress:
y1 a , s�-- /3 :�
Telephone
Signature
2.2 Authorized Agent: c /� ,
J d M n ��.� v 1 r? :!?Ay!j �l jr ca► .� �!'Er 1'�c1�
Name(Print) Current Mailing Address:
1/3 . S'A'E 3-
Sig t Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (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) 0 Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/In.spector of Buildings Date
14 NONOTUCK ST BP-2015-1166
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23D- 182 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categ_oa: replacement windows/siding BUILDING PERMIT
Permit# BP-2015-1166
Project# JS-2015-002187
Est. Cost: $21364.00
Fee: $70.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN CORBETT JR 078297
Lot Size(sg. ft.): 10715.76 Owner: JARRETT MATTHEW
Zoning.URB(100)/ Applicant: JOHN CORBETT JR
AT. 14 NONOTUCK ST
Applicant Address: Phone: Insurance:
38 GRAVES ST (413) 665-2286 O
SOUTH DEERFIELDMA01373ISSUED ON:512212015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 18 REPLACEMENT WINDOWS &
SIDING
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• Date Paid: Amount:
Building 5/22/2015 0:00:00 $70.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner