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44-085 (3) 23 WESTHAMPTON RD BP- 2012 -0591 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 44 - 085 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit # BP- 2012 -0591 Project # JS- 2012- 001008 Est. Cost: $2022.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 100962 Lot Size(sq. ft.): 21083.04 Owner: PRAK KEVIN Zoning: SR(100) //WSP II Applicant: HOME DEPOT AT HOME SERVICES AT: 23 WESTHAMPTON RD Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341 -9401 Workers Compensation WORCESTERMA01607 ISSUED ON:12/20/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT 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: FeeType: Date Paid: Amount: Building 12/20/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner , -, , , , ,4.— a r t r e eq �� h s .. i r-- ' -i RECEIVED ity_of Northampton 0 zef e uilding Department �er , .. ,l r ui .., + , DEC 1 9 2011 212 Main Street ��� w -Room 100 :,, [ ill rthampton, MA 01060 I i * - r_, ° t y, ,, ' - t tl� _ D": 4 0- 587 -1240 Fax 413 - 587 -1272 r,�i- �� Ifs: ` 1 k6 X4 - °,s_. , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH. A ONE OR TWO FAMILY DWELLING E Y " SD' s autivt'Fi I' t , _V. �a.�, =414 r. mares R 1 1.1 Property Address: al, , rte `" : ` :. --r i " u ,� ::. y .ri r 1-,'"X-Ii" _ 7 '''',1-4,--,-; s„.:."---':;"f-4-11 c N--' S ! 3- ,_•4.0..' , EC.TIa " ROPERT OWNERsHIPiAU -T fOI E m GEN < t. �`� i h. -' s�` -�` `�'* ' .»� 5y v � � r..,��, �* �+X '"��qi ca.•Ofa a - n?,? _ 2.1 Owner of Record: ` / We Name (Print) Current Mailing Addres e-e. 6al t - 0 t - Telephone Signature 2.2 Authorized :!E t: A . 0 r i j ?e/i .i -oft . 29t 444 '' IL • 4 Name (Prin/ Cu,� err Sa i l ing A dd % ss : gal / .t.� i.4 -. . 6-a- Signature Telephone ECTION ",= STIMATED CONS.TRUCFTION CO t Item Estimated Cost {Dollars) to be t i " ,. -- IT ,wt„, � ' ,,, ,, • completed b • ermit a • licant t � h 7 k'"_. , r a F?� 4 w ; 1. Building ° - -, % 1 r P 2. Electrical s ,�.,, ,.. k 1 , x 4 14a o a o 4oY , v^ r"'r�+'"S.;J O Af C' t-, ' ,.. �`- of wr,�r.a t s � �` Ko c6Y p l r,,"t) ex.� �, u �� � ` � e 3. 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A. • • .., ... t Section 4. ZONING. Ali Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 1 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ' 1 1 1 1 . ,. Frontage 1 11, 11 . I Setbacks Front 1 1 1 1 1 1 Side L:1 1 R:1 1 L:= R:1 1 1111 J[;. , 1( ,,-._,....._. BPadinglicight -___ _ _ , . . 1 _ 1 „. _ .._ : 1 1 11 Bldg.. Square Footage 1 1 I I % 1 1 1 I = - - OpETSfriailootage -- - - --- - - - -% :: z---------='= - -- ---- -.7:7 (Lot area minus bldg & paved F 1- 1 1 1 1 1 .aricin.) - - # of Parkin: S . aces 1 1 J 1 , . Fill: .1 — . Lo (volume & cation) 1 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 - ) IF YES, date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? _ NO 0 DONT KNOW 0 YES 0 IF YES: enter Book ' l Pager and/or Document # I B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES C) --- - IFYES,_has a permit been.or_need to be_obtained from the Conservation Commission? - - Needs to be obtained - 0 Obtained 0 , Date Issued: 1 YES (D C. Do any signs exist on the property? 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 0_ NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • fi a Ta ' �', er " z '� t ��x h.,,.��Y "'4FYh �'�w � EC< Tit ®?NI` DESCRIPTI a PEOF ROPOSEIYWORtfi'a 'hec alf� • • lica le 751' „ New House ❑ Addition [1] Replacement Wi. •ows Alteration(s) ❑ Roofing Or Doors r. Accessory Bldg. n Demolition ❑ New Signs [0] Decks [0 Siding [01 Other (01 Brief Description of Proposed Work Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet = 1 �, 1y ,r,Ye.r2F`e16r=1`-�; • r;l d �o �F'3 . ;i1 f ®.J�� `.,.�• ®F n = , µ -7 s 7a;` p,n. ), Use - of bwlding 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 I. Septic Tank _ City Sewer Private well City water Supply "AV g GQ a �: o , 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 , as Owner /Authorized Agent hereby declare tha the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. _Signed-underth and pe • • perjury. _ TIF Print Name 440 4 . _ _ Signature of • er/ • gent + Date I w�. --�5 �1 ti� �'�''uC^� ,ate w.x�w c,3'�7.1a�*y ,�,�'t- �•n'�I 53 'SEC=TION` 8 CONST UCTIQt ,SERVICES V M+. 8.1 Licensed Construction S pervisor: Not Applicable ❑ Name of License Holder : Cc (C rfb 1 00'11-1- License Number � �► A - ou~tl40l r►.-., . b1b73 Address Fpa r Expiration Date [� / Signature Telephone t�g 'stets 4 ,L-Teimer c oweme antcadio $ :` Not Applicable ❑ © Company Name Registration Number ',Address ■ _. ._. _ . Expiration Date >I /-' atali/ ) / / p .� �� �• ele hone C :T a IfiF'" + VFl R ERS. {YIl1fFa TI'Q WAlil, Cs S s m € _ Workers Compensation Insurance affidavit m be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildin ermit ` - Signed Affidavit Attached Yes No ❑ 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, Siiith 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 , o n which there is, or is intended to be, a one or two family dwelling, attached 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" - the Building Official, on 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 refere iee to cliaptez=152 -( Worker`s' 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 Sion ander thus 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" ofMassachusetts°General L aws Annotated - Homeowner Signature " -- -- - -,_. - - - • The Commonwealth of Massathusetts ,� Department of Industrial Accidents 4 :t Office of Investigations ; w . ' 600 Washington Street � : rte ' Boston, MA 02111 ';--� ww».mass govldia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information PIease Print Legibly t Name ( Business /Organization/Individual): 'I/' Address: 2�i ( 1yCQ R City /State /Zip: A. en4 0O3 1 Phone #: . ` O 7 I'- Are yo n employer? Check the appropriate box: Type of project (required): 1. I am a em�o�er with (9,..) 4. 0 I am a general contractor and I 6. 0 New construction — employees (full and/or part-time).* have lured the sub contractors 2. ❑ I am a solepropnetor or partner listed on the attached sheet 7. 0 Remodeling _ — have - no and hav no employees . These -sub- contractors: have _ 8. [] Demolition working for me in any capacity. employees and have workers' . 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required.] uire 5. 0 We are a corporation and its • 10.0 Electrical repairs or additions ] 3.0 I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions right of exemption per -MGL myself. [No workers' comp. 12.0 R epairs c. 152, 1 4 and we have no employees ept4, insurance required.) t e O r 13. Other -. :[No workers' : ,..._ 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. 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 t sub - contractors have 'employees, they must provide their workers' com policy umber. �'P cy I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site .information. . . (--------- 6 Insurance Company Name: )\ 1 re g Policy # or Self -ins. Lic. #: 0!)1, Expiration Date:: . — --Job Site Address: - City/State/Zip: b iil i, . / %i Attach a copy of the workers' compensation policy 1aration page (shoWing the policy number and a tion 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 - 1; inst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of th • i ' , r insuranc 4 , overage verification. . — TY hereby ce - y under ; . , fd p pe # !ties ofperjuty that the information provided above is true and correct. _. -- - - i _� —_ Date: �. Si g a'..: —woo( ■ , . /� � _ , _ Phone #: t (� 17 a( &O — - Official use only.- Do-notwrite -in this area, -to-be completed by cioror town-official City or Town: Permit/License # __: _Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Towr. Clerk 4. EIectrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone #: - City of Northampton - - ........, ( Att:-Li: ' ',. Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 'Al , Itet 212 Main Street • Municipal Building Northampton, MA 01060 00 • ,-.--:-.; ---,.--- INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusells allows the homeowner the right under 780CMR 10&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 intendslo 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 budding 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 ins • ection if re. uired and a final buildin • ins • - ction. 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 hthmeowner 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 ------- --I,--- . ____ _ _ _ _ __--_-_._. _ _ _. _ understand the above. _ (Home owner /resident's signature requesting exemption) 1 will call to schedule all required building inspections necessary for the building permit issued to me. Date - Address of work location , - . . • BONE IINPRONT CONTRACT PLEASE READ THIS Sold, Furnished end Installed by: )s}anch Nye Boston Date: THD At -Home Services, Inc- j 4 / / t 1 d/b/a The Home Depot At -Home Services 345A Greenwood Street, Unit 2, Worcester, MA 01607 Toll Free (800) 657 -5182; Fax (508) 756 -8823 Branch Number: 31 Federal ID 475-2698460; ME Lie * C 02439; RI Coat, Lice 16427 CT Lic + M HIC.05655522; MA Home Improvement C tractor Reg. if 126893 Installation Address: C kb }1�l 1�7r1N.3 R [! t � Ol 4 City State Top Pttrehase ts): W.rk Phone: Home Phone: Cell Phone: �► ' ll h [ ] [ 131 564 . Ol C 1 [ ) [ l [ Home Address: (If different from Installation Address) City State Zip E-mail Address (to receive project cottisnunications and Hotta Depot updates): D 11)0 NC)T wish to receive any marketing etnails from The Home Depot Prole a Ins °ozsrsair p: Linda-gig/ices ("Customer"), the owners of the property located at the above installation address, agrees to buy, and T1-113 At-Ho= Services, lac, ('"Che Horne Depot") agrees to furnish, deliver and arrange for the installation ( "Installation ") of all materials 3tscribed or, the below and on the referenced Spec Sheet(s), all of which are incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract "): 5 L S � b Do.. .1 Cnv . cy Doe's 0 ‘'1A G _ ❑Roofing [Sidin Windows Qinsutation `1 , Lithinas I Lovers De ntry pools i ' t 'f -°-/Y 1 , „ ❑R0 t ng [Siding 0 Windows ❑ insulation l OGutteis / Covey ©Fiery Doors in f1 ¢ Roc1 no fSidine (7 Windo re insulation 3 DG meta / Coven [Entry Doors U ` Minimum 25% DcPusigoreeldragt Armunf dug updtaoeeatltmoidesrent' Total Corrtr act Amount $ 1, t tw a-a ;Tin lot dot Tat+. tomone4*ird AftheCeroVr t.AMtat�t 4 `Acct ..ems ...__;_..... . _ _. ....... -nil. C'iivr me gre ^ - rb�e. =lt3fiel ;vteSa capon completion or the work for cu:r: reO.+u�l....P�s4.*..... (o tie f.,r each Product a; defined by an individual Spec Sheet) and pay any balance due. As applicable. each Customer o ' this 1-...,,, -. . be iO ri" arid obligated cever� iy o and liable hereunder, ,, :,..,ut�t a e. n l., b ? f - i rft' k. V....i .�- �.. : ;x� .. :.^ ., ....... r . - • prOttt 11 with the home, tnY?L9ninet4i,'t 6a :roc. . _ ..' • work rrnttired to complete tyre 'oh was ogee included in the Contract. Sorcrmsrv: The Payment Summary ary # ' _, iuciuded as part at thin f'�nrrgr}: atnctTt and payments required for the deposit& mite Tina: p yinCi r NOTICE TO CUSTOMER V''; are 4y41ilwri to a rontoie>;e1v filled-in copy of the Contract at the tinte you sign. Do tent !lga a Completion Certificate (note: ' ,..� C �.1 - tN_a!? C eriutreare for et1Clt listed Product as darned uiy t:tutYleitpap 3� .Jn4:4:eS1 "ilCfuic }'6 \)0. €s v� u'is. s . .. -1;_.. is coIGpMaa. • _ _ __ • .-f - rirrir .trp of firer Conttn4t, L'.ttsfnmer aureas [u Ih*y ,.Ti e t[ts:4.. 1. :E.p■t kht 11.,r:4 ;, £ _.._I1 and cera provided by The Home I>epot tar Autito;itted Servux ay:e ` ' wets t:. w....l.adt.ir• -, m e On' ( P'rurttiee ttra� it... e-1 r . - ___. _. _ . ..,, + r... tt »i t low 1-ttF stetryiR DEPOT MAY WITHHOLD AMOUNTS . e:= - s , rtri r•rrii3T[2 VtvithI+i't• yi_ U:It,. Ytt iiSUt • ._.. . -x Tit #3:A- a4 ^A+f sal NUet _._ _ K.tuLV vt..i'i.A ilr. •r•ar.. :.:. . _ - . V... s c , - t- ,,. --- v r l 1177.4 • i ° . 4 ± ^ , . . 7 ! " ^ 1 1 ! . . 1 , a inn €'rP.rfrr Rv� a?•1 "Yil 5iPi iL Yr :t: u�:vill(;, v n rs root lostaltatitm services and sunerseaes au prior discussions u „a uteri ugt.ccaucat, eon. , in a }w $r�r! _.r or written relating to sain PlAitivtb and instal lnia Atri ceineae c nifty + ma c.+ d tr. en:cod `r tr.-cept k - - , -11 1 ,“ 1 !?, sLtF,fn -n ...... - ..�, :r k �: ,ivenrroa¢ ano aurees 'that CuviOuiG. ..as ; a a ! 1 Tip ,t 3C "1 " the - ' :. ^_4py 01 WAS AgfeetD®nt. .- . • Customer'sSitnieurre Date ( f = paa :y +: n• Customer's Signature Date Consultant License No CUSTOMER MAY CANCEL NCE MIS I (as applicable) %at4a re,i�niaulS: �.uir�r.a MIS -v«w -, +'.. nr- ±T •. Y mr nx> r' rr a TrlYiv BY Uk tM a.iW Whitt IstiAai..k: iu it7u isc3n,e, DEPOT BY MIDNLGIIT ON TIIE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE aTF. ST?PPI.EMENT ATTACHED HERE'T'O SPECIFICALLY PR SCRIBED BY LAW IN CUSTOMER'S STATE. „ O ICF2.; AIf TIf)NAL TEEMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT