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O co z O CD m y owco -vc ww -! omonm * om -im � �* cnmoocnm ` Cno -io Cl) � c) z * -izr -i -ocn -o c). a) m a a a m 0 o = o x� _ o x-a x m o_ ° x ° v,' ° �. o� m Div < m m O m = m 0 = u D N M.c5 co co c c o v = m -0 O = m = cM W p M = M n .. o W cg m N N g) z 0 -1 0 D m O m z sv O CD- < v * -° mcnanmo '-'- 5 = -°o CD o =. ° wo 0m = OOnnmO D.. a) m o CD = o co -- - m x A ZJ o 0 = m O i m r m -U z T� -1 w cn !,,, c Cn CD o = co m ,. . o x, m m m °) o :c) O -� D O CD - ocnm r-.cn Cr CO 50 ° ° . ° c cco m- u' - � m �� pD � �_ Dm � DO pk- CL .-0 CD � -Io �� � m m N. a ° DOS -� � z � 2cT W `' o 2. 3. 3 a = _ 0' QO CD m cD c? 0 -h -H > ; o ; O -H1 > -A cc, m o (/) N � nocQ Q Cw � v Zc2mpOn53Or o- n v m v Qg ., 7 ooQ 3 0 � 0 � zDmz�T co m y m m c zzm = rGG) orOK CO co m > � x 0 XI- mmXOzp� ri J Q .. w - * -1Nzo = D * Z � . . . . . . . . . . . . . . . . - - - ' • G) DZ -lzNr2G) p o lo ---1 m _ OG) O = � ._1 _ rm ,c 0 o m D C") m -{ zzm O ° '. r rD = mpcCncnXz = O 13 c-13- = >o m iCAzOK0zM0 - in ?rCD D Z -DIr- � mC) gym - N ZrOtn = = WmxD I V -I m m r 070 -T1 O z O. m Dmzc = Cnm � 0cz 0 rocn � mp -0 ,- 0) G) CD c -� -12Z � mrm - m n -G -GZZ vOZZ = ZZZZCnK * * z - zN -< N � a) C m _. mS� � z � OZ � m m 0 0 500m0000 -1 - > 00 ° m o m o N m O m W o � � o m o � w CD * 2Nno- n m Co Cn nND � oD � � Zm -+ � � -0 °o m � = 0 .< Co Omz -< � 03c0 O n 0 z Q - o z O m O - 2Z - c Z -1 › . z73Ow 3 v) G7 = - z 2 m ZK 1- > n O N = X m .< -1 0 1- > 3 c ZOoKX � m � in in --in - OGm ". - nmO v D _I < m 2J X3 z , z D > C/I < Oomm M W ZpZOD ;L7 � o o _lozc2ozo c 01... - `O -I � nUW i 2m > r2n �v K � D0 -�� om oZ0m o m m Cn c = , G) O m Cn W xi j > . mowm` -ii - 733) =1z -uD �oinm m o O O m z m D m D m c . m 1-O Cn � m O � = = Cn m G') W D � cil mini- o w °° OGOOo73rno 8O n o z m m c O G) 000mm -0 z q - Cnz �� � _1 r an = Doomo - 0 CD - * z = x -G � Dz m- min 0 -i0 `a c = off r.) zO ° * D * NC o O m o m r Z 73 s o g C C C o m 0 0 O 0 z e e n £ ■ S S k C ■ ■ & J G q / = c Z.CD 4 3 3 3 -0 = £ E = \ m C > 0 z / co co -1 s 0 / g > & f § 0 ' r ° a at Z q 3 / G Cr in /q > g• / \ d / ƒ 3 * 0 = f) S ) 2 _ m 2 / / \ k / \ 0 O. C _• 0 _. / \ = ^ C M m $ 22 -I ° m $ CD-I $ 0 z n . z ° w ° o z % > E O § & aL / ? =SI ) = \ E - 4t = / ° $ / / \ 0- 2 z T. \ .. % o = NI m -< / = 2 -0 = k � C) 0 = f O CD > / 0 § / 0 m 0 ƒ ® o ° U5 ® m CL -h * 2 k ƒ § / Oa 2 2 q \ \ / 2 \ � m0 z $ E � Cri» z b * o 0 » o o - omocW ® O 17000 > Cl) \ % k C ¢ § § 0. ° CD g g m a -1 0 a) -1 - x _..= © / / co E c ZZ c in# 7 z / -0 o m CD § q § ] % r 3 .. = _ B .. .D c E / \ 0 r / = m \ p 1-1'... D & w = o cn 5 m k > \ / f / \ = Co \ ® a. o -A e \ 0 > E k > ƒ \ ✓ 0. ƒ � C 72 > P 3 ƒ ) CO r > w 01 \ > -< 0 j E 2 Z - \II M m = CD 0 2 a) a) M 0 0 9 2 k O = a x x - o 8 o 5 .- .1, 0 e. E m n E A- # g cp (4 -1 > C 2 k r v Q 2 q I g % -0 -0 XI _ C a) m 2 m m k ° © ' n s 2 0 zm = .. > / » » F 0 0 0 $ / Co o / 0 k 2 2 / « / / 2 ¥ > To Whom It May Concern: I, Saner-- / ,4/4c , as property owner, give permission to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at ‘24 14 -- . Please accept this letter in place of my signature on the permit application. Thank you, Se/nett-a- L.ao Please Print Name % < ' ' , , 7 s /3 omeowner's Signature r ate PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 I L7O) 2 L 6L r vAly 01060 Subject: Disposal of Debris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc. in your Town will be transported to a dumpster at our main facility at 155 Main Street, Greenfield, MA. Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, PELLA PRODUCTS INC. John P. Benjamin Accounting Manager • "° The Commonwealth of Massachusetts ,-,..;,=-7=::.-'°�" :m Department of Industrial li .,._.t Office of Investigations �1 'k 600 Washington Street "'"� " Boston, MA 02111 --"-� " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricia /Plumbers Applicant Information Please 'riot Legibly Name (Business/Organization/individual):_ / _C_ if '.4 j._ , ci c, c"^S � J ioG _- Address: - — / '56 N „ �0 5 • t''c:f-( City/State/Zip:6 ft:-e0) ,'e ici Not-2 6 fie/ Phone #: -A7/./,-,; /7d -4)/. - Are you an employer? Check the appropriate box: Type of project i equired): l.R I am a employer with _ 4. U I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. [i New coast action 2.(JI am a sole proprietor or partner- - listed on the attached sheet. "7. n Remodelin,, r ship and have no employees ees These sub-contractors have 1 } Y n Demolit.iot working for me in any capacity. employees and have workers' insurance..t 9. 1 1 Building Odition comp.[No workers' comp. insurance required.] 5. n We are a corporation and its 10.E Electrical r-pairs or additions 3J I am a homeowner doing all work officers have exercised their 11.0 Plumbing r-pairs or additions myself. [No workers' comp. right of exemption per MGL' 12.0 Roof repai s insurance required.] 'I c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] ''Any applicant that checks box ill must also till out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they are doing all work and then lace outside contractors must submit a new acridity t indicatim such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not tho.!e entities lt,s,e 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 poll.y and job site information. , Insurance Company Name: 1/1,1 0 0 ti f_`r" _ /ri m Le rez1 0_ f_ . _ ' , c7f/C .C y Policy # or Self-ins.s. Lie. : CO� /7 A7 � �3. f� / c � .01 Expiration Date: 0l_ n/- _-_�"r Job Site Address: 2 // ((_ f/ l_apret ,,, City/State%Lip:_ ( 1--i i_ 1 r/ lt Attach a copy of the workers' compensation policy declaration page(showing the policy number and 'b piraticu date). hailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimit al 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 RDER 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 th ' Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true an. correct. A r' Signature: 1l,1. ( Jf aGx.,, Date: -/---) S / /._-- Phone #: `� �l I _ � _-› 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. Plunibin'r Inspector 6. Other Contact Person: Phone#: SECTION 8-*CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable £ Name of License Holder: Al i(� l l c c i Li(] ppLicense Number Nom t/r) S e, Gre-e1,1 U [ L I - l� Address ' Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable £ lL Tra(a)c± /Jo( - I L 22 -79 Company Name Registration Number /Sc h 1 Creen -MQ, MA- 61301 2y_/V Address Expiration Date Q.#74 C , Telephone q/3-77 -0 kSiS — 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 £ 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 a SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) 1-1 Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[DI Other ED] Brief Descri.tio o P oposed Work: i . .� am /ir: - ( 6;23 a '.l 104.0 � 1 ewe Alteration of existing bedroom Yes No Adding new bedroom Yes Attached Narrative Renovating unfinished basement Yes No No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family V 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, -Ca' n - F /6e240 , as Owner of the subject property " hereby authorize Pell - Prodfi -4 S I v c_ to act on my behalf, in all matters relative to work authorized by this building permit application. /as/3 ignature of Owner Date I, '--DAAA (/ l i _ , 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 and enalties of perjury. Print me /4/3 Signature of Owner/Agent 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 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 C DON'T KNOW C YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW O YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO ID 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. _ ry Department use only :- `'4 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability AUG -6 2013 Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans DEPT.OF BUILDING INS �j e 4' 3-587-1240 Fax 413-587-1272 Plot/Site Plans 0 NORTHAMPTON,MA 01a 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 Z‘ L o eL Loo-Q---- Map Lot Unit Zone Overlay District r-ifit 4 ) / 14/t4 010 6 o Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S ►r, A �4 I a2,� 7 4 ( (L l_6 I e6k ihkr ems, Name(Print) \ Current Mailing Add/r s: � � - �� V Ea� /*p Telephone Signature 2.2 Authorized Agent: 1)116.i k L11(te_ fOl Aa 1,c-cc-- tc(430 ,firtof G-re_ok1 ..'e . i_ . Name(Pr t 1 Ci I� Current Mailing Address:Kt9s t!� Lf(3--77 Z — 0 x,53 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 . / Oi eCVO 2. Electrical (b) Estimated Total Cost of 0 Construction from (6) 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection C' 6. Total=(1 +2+3+4+5) 26 OA , 00 Check Number 11 Poo i:36 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 26 LAUREL LN BP-2014-0134 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -056 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2014-0134 Project# JS-2014-000252 Est.Cost: $26000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 22999.68 Owner: ALBANO SANDRA F Zoning: Applicant: PELLA PRODUCTS, INC AT: 26 LAUREL LN Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:8/6/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & DOORS 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 8/6/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner