17A-121 (4) 54 CLAIRE AVE BP-2019-1171
GIS s: COMMONWEALTH OF MASSACHUSETTS
MV.Block: 17A- 121 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categom Siding BUILDING PERMIT
Permit s BP-2019-1171
Protects JS-2019-001900
Est Cost:$5160.0
Fee:$60.00 PERMISSIONIS HEREBY GRANTED TO:
Const Class: Contractor: License:
Use Group: JOHN CORBETT JR 078297
Lot Size(sp.ft.): 10759.32 Owner: BOYLE HELGA R&BRIAN R BOYLE
zoninx RI(t01)/URA(101V Applicant.- JOHN CORBETT JR
AT.- 54 CLAIRE AVE
Apel cantAddress: Phone: Insurance:
38 GRAVES ST (413) 665-2286 O
SOUTH DEERFIELDMA013737SSUEDON:4/22/20190:00:00
TO PERFORM THE FOLLOWING WORK:APPLY VINYL SIDING TO UNFINISHED AREAS
OF HOME
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$0 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:
FeeTvve: Date Paid: Amount:
Building 4/2212019 0:00:00 $60.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
S r ID IN6-
DeparbneM use orry
City of North mpt n of ermit
Building Dep rtm nt Cu Cug 'vwmy Permit
h 212 Main tree APR 1 2 201 r Availability
�( Room 0 w I Availability
` Northampton, A d P Sets Structural Plane
uaom',imepe
phone 413-587-1240 92rF16.PAA 01site I I.ns
Other specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION P (q l j/-71
1.1 Property Address: This section to be completed by office
S--/ CLa;/Lc Aytnvt- Map /7,4 Lot
/=1 oft"a e- Zone Overlay DlsMct
Elm SL District CS District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
&e.i rA /Boat a SH Cot A • t- fleltzA,e
Name(Print) Current Mailing Addressi
tri], r )r6- oa€N
Telephone
Signature
2.2 Authorized Apert:
T u f C,A4,i) ZR / 1 ( llrn ) io( ,fie e)T>J
Name(Pani) Current Mailing Address:
SignatW Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
than Estimated Cost(Dollars)to be Official Use Only
completed by permit 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) - 6e. 0o Check Number o23c{
This Sectlon For Official Use Only
Date
Building Pennd Number: Issued: q
Signature: y- ZZ'Zal
Building Cammisaonerlinspeoor of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(aheck all applicable]
New House ❑ Addition ❑ Replacement Wirrdows Alterations) ❑ Roofing ❑
or Doors O
Accessory Bldg. ❑ Dernoliaon ❑ New Signs [01 Decks 117 SidingBo OUter[EQ
Brief Description of Proposed, t
Work' Asoo-. L-., 1/ C1�C ��oy' ,t A n'_ e a," h
Afleration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
w.N New house and or addition to existing housing. Complete the following:
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?
In, Type of construction
L Is construction within 100 It 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
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l ,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 Cw er Date
1 , as Ownerl uthonzed
ge ereby declare that the statements and information on the foregoing application are true and accurate,to the best of e
an lief.
Signed under the pains and penalties of perjury.
c
Print Name
Spnafu Apes Date
SECTION a-CONSTRUCTION SERVICES
8.1 Licensed Construction Suwmisor: Not Applicable ❑
Name of License Holder: T70h • 6n 6 "4y' >8a 9 >
License Number
4V4 r�,,4! 1w 013")3 F .ic• R ao
Atltl E,,ani ion Dale
Spn Telephone
9 Reoistarad Home ImorovemeM Contractor: Not Applicable ❑
JryH (� 6 TT Are,iNS
Company Name Registration Number
Z3-- 5702h r h r4/ 6xY n;e,n1 6, dr: tLe
Address Expiration Date
f Ate ar,:.z M1b Telephone J(f6`A 7/
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(Ill 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 pennit.
Signed Affidavit Attached Yes....... ❑ No.......
City of Northampton
5 -
•9 bfassachusetta
IffiP,N�T QI!• aeralca =s1?Zls:mss
212 Main Stmet •Municipal Building
�— NoiNampton, !W 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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.
The debris from construction work being performed at:
SH G2"
i n L t
(Please print house number an street name)
Is to be disposed of at:
VALLe- Racvcf - /Z- VnA%MGn1p�G/
(Please print name anion of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
y aa.
Signature dfmit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
\ The Commonwealth of Massachusetts
ulkirken'Compennation
Department of IndustrialAccidents
I Congress 1,Suite 100Boston, MAA 0202114-20177lv w.massgov/dia
Insurance Affidavit:Rudders/Cmtmetors/F.Imtrieians/Plumbem
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant I t tiPlease Print Leelbly
Name(Bminess/OrganirstioMndividual): J / / 1AIP1`
Address 't$ In s go
City/State/Zip:S. ire+t.... Phone#: Ni7 e F,< f 7i 1
A-,a an employed Cheek Oe appropriate boa: Type of project(required):
1.❑Iw a employer with__ emph,,ea(fidl ardor part-tooe).• 7. [] New construction
2.QIamasolc PropriotororparmershipaMh mcW]Wmsw ing formai 8. ❑Remodeling
any capacity.[No workers'comp.insurance required[
3.❑laa homeowner doing all work myself[No workcrs'corop i... rgwred It 9. E]Demolition
m
4n am a homeowner and will Is hiring wmractors b emducl all awak on my propMy I will 10 E]Building addition
u talallenntrxtms either have wmwns
alrse'cnpem a ..'are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5❑I am a general a>ntrutor and I have hired the subcontractors listed on the attached sheer 13.�Roof repairs
These sub-centrectors have employees aM love wohers wrap.inor.:
6.❑we meacwanattonand its officers have cumisedavir right ofexan ion per MGLe 14.Q(hher V/A 4 .5;'zn
152,O(4),and we have oo employees INo workers'comp.irosuracee tsawhedl
`Any applicant that checks box ql mast also fill out the section below showing then workers'compensation Policy Informarvat
I Nora—who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a mos affidavit indicating such.
IContracton that check this box most attached an additional sheet showing the woe of the sub<ontaalr a nM sate whether or nor Nwe entities have
.PloYces. If the subcmwetors have employees,they mastprovi their workerscomp.Policy number.
I am an employer that is providing workers'rompensadon insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.it: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy deelarotion page(showing the policy number and expiration daft).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisomnent,as well as civil penalties in the form of a SI OP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hneby certify a�n/dJ/f}a ins and penahin ofperjury that the information provided above is true and correct.
Signature, A/-/ Date: Al.&A, / 9
Ph #: yHi > S SSG E2z 2
Official ase only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Lieeose#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
./ COR13ETT
r HOME EXTERIORS IIIC #160143
413-bas-2286-.41-586-11712 CSL#78297
38 Gmvcs Saes,Seuds Deerfield.MA 01373
WINDOWS•SIDING•GUTTERS•ROOFING
"tawny Ouved and Tmn Siece 196e'
serving she Entire Pioneer Vaney
CONTRACT
Date ':C iiwzGlr /0 20 /
This agreement,between
.%iI n•y C �-
-! r1A (owner)
of Sir CL< Aytn. , and
(Address)
JCORBETT HOME EXTERIORS. SOUTH DEERFIELD, MASSACHUSETTS
Phone -5-&Z o A$'/
SPECIFICATIONS
n
.ir`Twt_r_ &"9tL V)nY+- SI/.(.In.� T ��s .., yy(r /wnrns /"j-/
a.. >L1Ln^ ri✓i,-,T :� ,�..2.. o:..�.w SJ): -`♦-z 1 �✓_.!.YI w
C,.,`.1'U—T...y( /tr-i/,rt4i 4 ClAec G -!r. In.e.r�
y t
on t11C'plermses hheawd-sit Sy 6z a, L Ajc e)J e- a total cost of �t /f/.Y�
With this order owner pays down the sum of$
Owner agrees on completion of said work by the Contractor to pay the sum of$ 3, 64,_ OO —dollars
t$
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70%of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject m labor strikes,Tues,wars,acts of God,and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding,collateral or otherwise shall be
binding unless in writing signed by both parties.
WINDOW GUARANTEE
Manufacturer's glass is guaranteed for life from date above not to fog up between the panes of glass.All other parts will be
supplied five of charge for life.Service will be free of charge for I year from date above.Guarantee does not cover broken or cracked
glass after one year from date above or any damage resulting from neglect,abuse,or acts of God.Condensation build up on the glass is
caused from high humidity levels d poor ventilation within the home therefore there is no guarantee that this condition will not occur.
In witness whereof,1 have In o signed my name this /10 day of 'If r'i /x.Q:en 20
by /67
ahrructoro vt rorize Agenr /v/ e
Dint er