44-092 Page No. of Pages
Vropwqat CT.REG.NO. 0621848 VISTA HOME IMPROVEMENT COLOR WIDTH
MA REG.NO. 162058 2003 Riverdale Street
West Springfield, MA 01089 INSULAI ION
Toll Free: 1-888-597-2323 • Local: 413-382-0249
FAX: 413-382-0241
Proposal Submitted To Homeowner Work To Be Performed At
Name Street ---
f v ,
Street City
-------- State ---- -
city _ w_ State _ __ ---- _- Date of Plans
Date Telephone -
We hereby submit specifications and estimates for:
Date work will start _ Date work will be completed
- _— ---- -
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the
above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein
This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by
Workmen's Compensation Insurance.Homeowner agrees to pay for all work as set forth below. If the homeowner defaults,homeowner agrees to pay all costs of col-
lection,including reasonable attorneys fees,in addition to other damages incurred by contractor.An 18%per month service charge will be assessed for all payments
not made within 10 days of due date per the schedule below:
WC Pr0)l09C hereby to furnish material and labor-cornplete in accordance with the above specifications,for the sum of:
Said amount shall be paid as follows:----,----
Note:This proposal may be withdrawn by us if not accepted within days.
YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE
DAY OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.(SATURDAY
IS A LEGAL BUSINESS DAY IN CONNECTICUT.)THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES
ACT AND THE HOME IMPROVEMENT ACT.THIS INSTRUMENT IS NOT NEGOTIABLE.
Signature of Contractor or authorized representative:____
*([/We)have read the terms stated herein,they have been explained to(me/us),and(1/We)find them to be satisfactory and hereby
accept them.
Signature of Homeowner(s): X, _ .'_...: ?_:__ __..__ __ : :_:._ X_
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SECTION 8-CONSTRUCTION SERVICES 7
8.1 Licensed Construction Su ervisor: Not Applicable ❑
Name of License Holder: Zu 1l AS S
License umber
Address Expirati n Dat
13 S8 — c
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
Comuany Name Registration Number
�� � -f Ck,) - ( 1112d
A ess Er
r 1? 2 ation ate
C Telephone`1/17 J��"cGi` 9
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 buildine 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 apolicable)
New House ❑ Addition ❑ Replacement endows Alteration(s) 0 Roofing �]
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[:3 Siding[0] Other[d]
Brief D scription,qf Prop ed _
Work: C
�v bedroom m � \ � ��
Alteration eJus ing es 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 followin :
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? V 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
as Owner of the subject
property `
hereby authorizer\
to act on my behalf, in all matters relative to work authorized by this building permit application.
� &oll
Signature of Owner Date
I, `r1 Q_ e\J 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 penalties of perjury.
\ ca Yl
Print Name
liq
Sig re 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. Hasa p cial Permit/Variance/Finding ever been issued for/on the site?
NO M DONT KNOW ® YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW ® YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO yy DONT KNOW ® YES
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 ® NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES a NO O
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 q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
8 214 4� City of Northampton Status of Permit:
�!tMAY Building Department Curb Cut/Driveway Permit
&Gas{n`Pections 212 Main Street Sewer/Septic Availability
E lectric,t{umr'n'r TIP,. C C106 Room 100 Water/Well Availability
L-----
_.-- � �— Northampton, MA 01060 Two Sets of Structural Plans
phone 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
VICC Map Lot Unit
� lures V'A A- Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) �' C en Mail dress:
IC� � ,e Telephone
Signature
2.2 Authorized A ent:
r v �-- '' �` e rid m�
Na (Print) /Current Mailing Address:
lure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
942 FLORENCE RD BP-2014-1173
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-092 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-2014-1173
Project# JS-2014-001982
Est. Cost: $3380.00
Fee:$35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VISTA HOME IMPROVEMENT 106156
Lot Size(sg. ft.): 31276.08 Owner: DOUVILLE MARTHA J&RICHARD L JR
Zoning: Applicant: VISTA HOME IMPROVEMENT
AT. 942 FLORENCE RD
Applicant Address: Phone: Insurance:
1346 ELM ST (413) 382-0249 WC
WEST SPRINGFIELDMA01089 ISSUED ON.51812014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT 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 5/8/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner