49-027 716 PARK HILL RD BP-2010-0128
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49 - 027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0128
Project # JS- 2010- 000151
Est. Cost: $4912.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 79714.80 Owner: SOTO HECTOR S & IDA S
Zoning: SR(100) / /WSP II Applicant: HOME DEPOT AT HOME SERVICES
AT: 716 PARK HILL RD
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401 ) 935 -2633 0 Workers
Compensation
WORCESTERMA01607 ISSUED ON:8/3/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plutnbing 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 8/3/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
Department Ilse only
City of Northampton Status of Permit:
Building Department Curb Gut/Driveway Permit
212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two 'Sets of Structurai Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Piot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
/ a Map Lot Unit
ff ) \
6 ] I Zone Overlay District
Elm St District CB District
SECTION - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
_ _
Name (Print) Current Mailing Address:
f (21 i1 ✓s( Telephone
Signature
2.2 Authorized Agent: r
Name (Print) / Current Mailing Address:
v
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Buding 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) ��� / _ Che ck Number to 6
This Section For Official Use Only
Date
Building Permit Number: Issued'
Signature:
Building Commissioner /Inspector of Buildings 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 .. «_
Frontage ..e..
Setbacks Front��"
Side L:....... R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW C YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
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 (..) NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 1 1 Roofing 1 1
Or Doors E'
Accessory Bldg. ❑ Demolition C❑ New Signs [DJ Decks (lam Siding [D] Other [pj
Brief Description of Proposed---, p z i i "
Work: - , I%Y 1 c, 1) i4) ), (/`1 / CA 1J t - ) ,i `�` ne1ot�d'i '"L'' kit ,i0
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roil - Sheet
6a. If New house and or addition to,, 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?
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, %E' r. (1 pi J , 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 i Date r'
I, (� f�`i) •�, n as Owner /Authorized
Agent hereby declare that hhe statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under,tky pains and penalties of perjury.
f ' t�' t L /`) '
Print Nagle -
'79 1.1
Signature of owner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
i I
p }
Name of License Holder : `.� t f . i rrk (i # l � i ,/ l/14 • t r
License Neer
Ie - 147% r, C'1 )
Address Expiration Date
Signature ) ' Telephone
9. Registered Home Improvement Contractor:. Not Applicable ❑
Hip-
Company Name Registration Number
') Viz ,3 I I . -
Address Expiration Date' r'
.i) t`a t x ; .lephone 1
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 C3' No ❑
11. Ilome Owner Exemption
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 shalt 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 O State and - )vocal — ZorfingLaws=and -Sr usetts-General Laws Annotated,
Homeowner Signature
The Commonwealth oplassachusetts
f Department of Industrial Accidents ,,
,r l p Office of Investigations
I �� d - 600 Washington Street
sa
\rS.. ,, ANA K , 0
4 Boston, M4 02111
' www.mass.gov /dia
- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: k. ' , 11.. 1` .
City/State/Zip: . i
Ci w ,�°' -
�' P d 1 ,r)t,{'� 0, 7 Phone
e r
Are you art employer? Check the appropriate bog:
1. Type of project (required):
4. I am a general contractor and I
�'I m a mith
i l
2. ❑ I am a sole proprietor or partner-
6. ❑ New construction
emplo e ( fait p anwd/or part - time).* have hired the sub- contractors
listed on the attached sheet. 7. ❑ Remodeling
ship and have I o. r .loy ees
These sub - contractors have Demolition
8. ❑ Demourron
working for me in any capacity. employees and have workers'
`No workers' comp. insurance comp. insurance.,- El Building addition '
required.] 5. n We are a corporation and its 10.[] Electrical repairs or additions
3. officers have exez_c;sedt?ezr - - -- -- 1 Plumbing repairs or additions
n I am a homeowner doing -all work 1
myself [N o workers' comp. right of exemption per MGL 1 Z [] Roof repairs
insurance required.] t c. 152, §1(4), and we have no , '
employees. [No workers' 13.0-Other , L! iilli '(A '
comp. insurance required.]
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
ZContractors 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 t
Insurance Company Name: f �, , ^ !
or Self-ins . Lic. #: '.----2,2/1/ r ,
Policy � t Ex piration Date: , ./ e)
Job Site Address Lr � 'e- , 'k) i y' J City /State /Zip:' (,;'t (. irj -
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 51,_500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a ne
of up to $250.00 a day against the violator. Ele advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify untie the pen did pe allies of perjury that the information provided _above is true .
rid correct
r ter-- -4
Signature: -Y
�. 1 � ma. ) _ _ ' _ Date: �° _ �
Phone #: CJ / ( i ', ; - /
Official use only. Do not write in this area, to be completed by city or town ofcaL
City or Town: Permit/License
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector_
b. Other
Contact Person; Phone ff:
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 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_Theinspection_prmess requires that the buildina department be called to
inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (beforepour). 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 theluilding_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
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Staid, l~nittiiahed and fa/Milled by: ,
Brandt Narrie, I:ttstota D if-' ' ' 'PIP g,t- L;rmc $ca - 'i. ; 'A. Inc
d a The }itotte z At I1otr SCrvtt
p45Ac"iteett rood,' t cr rintt 2, Wor ster MA .01607
Brankh. Nttqufwrt 3I Toll Free (80Q) 65 -5182; Pax ( 756-88.3
redo i lif#t:'75-269g46, lift Lic # C 0,431,' E I Cult. riot 16827
cr c l 65az; l;.h 1t#tc`jn: prrivarn nt Conte141xr Reg # Un 043 I
Inatallatiun Address ,,( s ° 2 k I i F i , (•t ,sLL. 3 ! q fi i r t 0.
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Pure6amarlsh gr � � , d
k brae: 'Home Phone; Cell Jk Rhone:
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hlame Addsexs
(If different lrpm installation Addre a) . . - C i Cy into Zip
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and TIED At Rom 5srrvices. Inc, ., "The Dottie epent ") 'i ec ip,,�tr oS , t, tlebecr'and 'atrtangc f6I tbse' n&4�ilf Linn (`XrtstnIlittiond'y of
all rnsuerials deacaibedl on, the below and an the reiftrettcrid Spec Sbtei, vsA,ail .f 5114 arE:iiinorp-r ited tno this iktritot b gtu8 ) 1 le .. it reference, along with, any applicable Suter Supplement 0.p,4 4 Ptijmcixt unr suit' a ,t,/Che htet ait ally Ch6ngo t C d& C- 1 tcottectavel ,
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tuttttt& . �GGx CRE . � ■
miu'mam n 19e[ "44 cif c4"tiai .A14trrnit tl tart alter,
Maine Pnrchnsets may not deposit moms than.wee - ` ' T �f ' ' ( On ' ,,t r: lti�rtlrX
t'.4,1t�?d�it.
Customer agrees that, immediatel, upao ontpiatim c.trst azii "a uct 'Cit�t�6it ftttll,e'xe ` ate A t>t loliat,;C'crtdi to
{one for efif di Product a S defined by an ryrtlis tc ` l a tj pay hit li arise 4 ne A;s g 1tGable a cit`CtistoYAer under tins
cot tract txgreex to be joiutTy and scvC4izllilc,ItCS11i47lifiic }t"crOuiitt8r' � , . ,
The Horne Deprat reSGxt'cs the right to x.*iuF a C ts #;l i# t6prikteitgftis tangs t, gtr an iA'0ev1d. 1 Pr1X1t 1 t.9 In^1teS0d;
it& discretion. =iThe Horne Depot 'or to authciti s Xi ceprr r± tterittits. -a tlyat/f, itYtruAtip rf!,+t3Zi<rts .o6lt atxn4,,,dite 16 IC-11 4d .
problem wi ?1t the home, CnvtronrneuZel h #ist1rela , 4 4 tigb t: +B or ; k d p44t elide& saf0t cntICOtn5 ,Pri4'in, et'rots nt
Work required to cotyaplkte the job 'was not i llft ; t( jri n th "L z rt s ' '
Pa nt Stttt y:::. The Pa tent # , m
� 3'!i �' > t ,>tU,httlell ,45 ‘part 4 P t '_ C ' oRtt'at, ? , ,tC,t ` otth Y#ae ,rot
Cc+tAtiact axnntint arta pliymeats miInirnd for the.40poSits attcL1 payitnieitroil Pctell* Iir ,;tppilti^,rbbfe,S , .
tNOT1C r`'I.tS" `t;e'3I44t '
Yoh *re entitled to °a completely fltled-ia etitpy rartlee C ntit�a t at tnw:�tirne'yolf sE i +` d leaf 4rgrra C om C rtlikalt frisitm:
there is one Completion Certificate for each 61.sted'ProitercJ.ap dertitodrbv ind ttati bSp a i`ihactst bef e'vwvza„J' that , Pit'4440,
in complete.
In the event of tcrnihatai;ton of this Cat.0 ct, Customer Agreeg try pay Die Home peput., the,ioi,ts of mate/WS, labirc, cxlien
and services prosisied by The home Depot or Authorized'Sexvine Provider Herres tt tht date of 1Crotioatiryn, Pins any other
ianmutit><,ct forth in this Agreement or allowed owlet- atipJ((atate J. THE -kt.OM DEPOT MAY WITHHOLD AMOUNTS
OWED TO THE DOME DEPOT FROM THE Miects1 r PAYMENT OR , OTHER PAYMENTS Mrt;UT:, WITHOUT
LIMITING THE HOME DEPOT'S OTHER 12E:w1Ep1Es 1& RECOVERY OF SUCH AMOUNTS_
Accep tance anti Authoriaa iitrn: Customer agrees and understands that drts _ is the entire a ,°eura nt besw-een Cr,ordor
and Theo ewe Depot with regan7, to thn Peotiuots and InstallADM eartiioas and supersedes ail prior chscus &ions and agreements, either
ctrl Or written, relating to Said Products and lnntailation. This Agreement cannot be assigned or amended except by a writing aignod
by Co miner and The Home Depot, Customer ackarowledgea mod agrees that Customer has read, understands, voluntarily aooept/ the
terms of and has received e copy of this Ag, eeni nt.
Accepted jr S , • . r" ,
nicr's Stgnatur, - D .'
ate Sales Consultant's .ignaaure 0 e,
E ,__, l' i phone No. .., ..d. ... — �
C•utitonxr C s Signature Cate
Sales Consnttant. Licona , No. , . �_.
CANCELLA.T ION: CUSTOMER MAT CANCEL TIIIS t;i, app}icsbte;,
A ;IlE-EMENT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING 'WRITTEN NOTICE TO TfiE HOME ;y
DEPOT BY MIDNIGHT ON T'HE THIRD BUSINESS '
DAY A.lfTER. SIGNING THIS AGREEMENT. 'TIDE
STATE SUPPLEMENT ATTACHED THERETO ,
CONT AIN'S A FORM TO USE IF ONE IR
SPECIFICALLY PRESCRIBED BY LAW ES
CUSTOMER'S STATE_
NOTICE,. ADDITIONAL TERMS AND COhit)1'i'IONs ARE sTA'1` t, cot THE RI.,, AND Mil PART OF THIS CONTRACT
5- 118.08 c - SC Whim - Drench -RAe Yellow - Cugior or , Plnk.- SeRes Consultant: