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13-032
'�/�r »riunnrrwefiS r/C`-F(/r nay'/rr.0//) a . ,:;.?ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only • ill- •ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to �;=_ ;" Office of Consumer Affairs and Business Regulation 'cr Registration: 148688 Type 10 Park Plaza-Suite 5170 - Expiration: 10/18/2013 Supplement 1 3rd Boston,MA 02116 LOWE'S HOMES CENTERS INC JAMIE SPOrFORD 136 TURNPIKE RD.SUITE 100 al-A—761.5-- S.OUTHBOROUGH,MA 01772 t _-- Undersecretary ' •t valid without signature W. (4,,,,a(4 ' _- _ -I 111ce of Consumer Affairs&Business Regulation License or registration valid for individul use only tid1. .. ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: __ i_; -7_ Office of Consumer Affairs and Business Regulation b:r registration: 148688 Type' 10 Park Plaza-Suite 5170 Expiration:P 10/18/2013 Supplement(and Boston,MA 02116 LOWE'S HOMES CENTERS INC WARREN COOKE e.--0-714- 136 TURNPIKE RD.SUITE 100 a�__- � �—_ SOUTHBOROUGH,MA 01772 Undersecretary Not valid without signature �Y Department of Industrial Accidents .' . Office of Investigations 4. s`= � 600 Washingtorx Street Boston,MA 02111 '�wes,0' www.rnass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/]Electricians/Plumbers A 1ica.nt•Infor..mation Flease l?rintt ___ ably Name(Business/Organization/Individual): • _ " .4. ai,o ,t t .i s ha Address: t._, 'Ff par City/State/Zip: Phone#: Mfr 3• g.�- a .. �., __ Are you an employer?Check the appropriate box:. 4. I am a general contractor and I Type of project(required): 1.g:;I am a employer with. 1 ❑ sue► employees (f:n and/or part-time).* have hired the sub-contractors 6: ❑New construction 2.❑ I am'a,sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship.and have no emplo ees These sub-contractors have y 8. ©Demolition working.for me in any capacity, employees and have workers' fNo workers' comp. insurance comp.insurances 9• ©Btxildirkg addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner.doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.'No;workers'comp. right of exemption per 1�IG1. 12.[]hoof repairs insurance required.] t c. 152,§1(4),and we have no l3. Other employees. [No workers' _ comp. insurance required.] _ 'Ally 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 contactors must submit a new affidavit indicating such. =Contractors that chock this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have etnployccs. If the sub-contractors have employees,tboy must provide their workers'comp.policynutnbcr. Jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: . .- * .d uvc..nce Q- Policy#or Self-ins.Lic:#: WC. 2040-Oda 8 OH- O a . Expiration Date: C[.a- 6 1 ").01 3 — Job Site Address City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data). Failure to secure coverage as required under Section 25A of 1v1G1.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. I do hereby certify under th'pain.- • •ui aloes of perjury r at the information provided above is true and Corned -. i s _lure' ".:.;0'.' 1��.r _ .,1/ . Dat . P hone#: � .; 32y Official use only. Do not write in this area,to be completed by city or town officiaL ' City or Town: Y 1'ermitfLicense# - ii ti Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical'Inspector 5.Plumbing Inspector ig 6.Other -, 4 Contact Person: Phone#: 4 -- . 4/4 d OSI 9464 saMO) « 5 a 447:2.4 40-20-E402 co 0 m > -a * < Z2 o m O o > -I r 2‘....)\ co o co co 0 ca h' * H m =lm D H < > p Z Z D <3 (p m _ rn ^ v m < -I , O i rn m z m 0 m Ilk) � m O D o il (n Z CD p C C m _ = rn O iii"� II m P -I 0 C) Z = O m D O v W CD Dm * ( m Cmm Z\ z 0 cnm0 -I 07 \ : CA Cn (n j] D c = O m °' Cl) z ojpm 0 < J 03 z =1 o m ` W > C > > m W w 71 0 m WZ � ∎� � n �° � -DI o m ) 7) m K p z m � (n O0 -Ic z Fri SOD < (nc > m CO p O • m ° _ r m O --I0I<� ! 0 � < rn wr zco -I o \ i— — m i DD D 0 > jm 17•03 n 0 ‘-..0 \ H o m Z 73 m -I z m m - DO 0 r = r J� m n(n m -< 1\3 33 > 0 r Cn 0 ZzO " > Z U) C < pmm \ W -Djm C) O W D _ c c m D O ■x N 2 m D m _ m m CO H m ao m % cn -i z v fir. m �i 1 wDc- ao ° z L' W mH = H DJ j —I OOm F Fri- 0 0) c z m G) -I m D cn < r' O m -1 H � m e - 0 / 0m O < m -` m Z ;' z 0 cramp D o � ) O m > Z -I 0 i 05 i m CD ' D w _ _ _ m 0 m =( Di ) > D * D (. ) -I -1 Z CO 0 m m m m ■ Z Z Z �0 Cn c .- > -0 m m m r DJ n 0 0 O m O z C a m < Z C > m m XI o m . V ' m m C Z DJ DJ DJ 55 H 0 m m m m 0 _ tin 00 0mv ) 0 -• C II (n C) c m 0 70 (ID O O rP -I z m CD C) .P (I N 0 0 00 .- w 'v SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:, 1i /7/4 L_ v (>s2 sl/f/f-d-/i /d 3 0 G 3 License Number 1/9 //2-"Se/ ST � wJ �02 �' /f d/ao� 9/6 �/ V Address Expiration Dat YAJ— ; -63d.y Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ 70/.v-S' M*6 (2/2..es" /V? P.? Company Name Registration Nu ber 1'6 /Gv ' Y /d g 73 Address Expiration ate 5(�v77/7362016/ /f c:57 7 2 Telephone/7 -) ke 0.126 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 build ing permit. Signed Affidavit Attached Yes lr�'d No ❑ 11. - Home 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 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(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 Wi ows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[l Siding [0] Other[0] Brief Description of Proposedp �" �� Work: it e.47—vE t' 492/1-C6'. E 1/1't l.:v 7; i� Owe__ t/d SAeuC ✓1,44. CIL-162 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If 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? 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 SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Di¢-iUZ 66E , as Owner of the subject property hereby authorize G//ACU 6. 5 to act on my behalf, in all matters relative to work authorized by this building permit as pli ation. ste Signature of Owner Date I, G �� , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains an penalties of perjury. Print Nam Signature of Owner/Agent Da e 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 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) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW Q YES 0 IF YES, date issued: IF YES Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW C YES Q IF YES enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q 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 t0 NO Q 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 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 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only r I City of Northampton Status of Permit: a ` Building Department Curb Cut/Driveway Permit JUL - 1 2013 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans -- ---- 4hone 413-587-1240 Fax 413-587-1272 Plot/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 lip/ ,l o 77/ 6 'S.7--- Map Lot Unit /IY Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1, -N7--&t14- ..r I z s° ViYAidZ7a ,6 sr 771-tokiPrd.11 Name(Print) Curr nt Mailing Address: E C J*l✓ i Telephone Signature 2.2 Authorized Agent: L 044/6,.5 .z iC p r/5.5, le ,..c.7- /¢40GE y1.4 ®/O 3-5' Name(Print) Current Mailing Address: `71/3 `3 f — 6-3,2 7C2 Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item 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 J1/Z3 6. Total = (1 +2+ 3+4+ 5) 67 . _ Q,' Check Number /18‘ This Section For Official Use Only Building Permit Number: Date Issued: Signature: 77/[ l / 3 Building Commissioner/Inspector of Buildings Date 414 NORTH KING ST BP-2014-0044 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -032 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-2014-0044 Project# JS-2014-000113 Est. Cost: $672.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: LOWES HOME CENTER INC103003 Lot Size(sq.ft.): 38507.04 Owner: WILLIAMS DANIELLE K Zoning: Applicant: LOWES HOME CENTER INC AT: 414 NORTH KING ST Applicant Address: Phone: Insurance: 136 TURNPIKE RD SUITE 100 (413) 588-0270 WC SouthboroughMA01772 ISSUED ON:7/18/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:REPLACE ENTRY 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 7/18/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner