The URL can be used to link to this page

23A-200 r �• �ce(gYlar.Arcs a—rncan.pc.ca • :� 2+iFlfitd Remov; fabel.aller rtnal ln-,peclion; SAVE for Mum relercnce Wealher Shleld 6PD1 050" A-172 NrRc Model 8102 Double Hung Qpe Alum ralinp Alum clad Thermal Frame 314 Inch Glazing r5+rgc lyz Z .022 Low—E r77:,u1(-,-- Argon Fill Grille in Air Space ENERGY PERFORMANCE RATINGS U—FL:Itr Soli H:zf Wn Coa(i�:nl 0.30 ( 1 .70 0.18 ru S A—Pl fhelri (I ADDITIONAL RERFORMAN,CE RATINGS r Ylslble 1t�ISrtf1!u:: LDnt(cot:�ien Fl:sislta:: 0,40 0 1'nv6tu Is rtpulI Ct h I I Ctct rn Lnpr tm brn to A.i pn ttb Is RF RC prod du rct b+ l.umiclnp vh■It podttl rl'tGt ptrbrmm:t.Ii FAC ntn,t rn is it n+ifnrIf br■' Lrrd =[A I■o rl+ ft W r gl me u+d s7 LJtt pnditi Crm RFP'-dou■01 rcty If a++I p+edu:I tI%Cd■tt All rt.mul he rjfiAiltCr of LMT prodoti W■rrt gttl I u.■, :xc+)I mcnuL:dnt't Sttnun Ut ehet pndutl pt'bnn•+ttt Inlom,11m. • vv.r,t,(rz.art h!t■!t or tt:■tdt 31,�C„ C.E.C„ ■rd t.E.C,:. /Jt inRtt r■lSon R.tl utn m■n!s 1D J 1Y�{f Itcedu SXSVLALW"%v DI n-Lt s tta� �' - lm■t,■ uYlMOtt t._tl Cf r U•1 6—,L.ki—i 1.A— •,i••tSiY(� J •. `-��-?-�— �— t !1O!SCG211fY.SiD • N• ' r•uy �u ,T V 1-Vu HOME IMPROVEMENT CONTRACT PLEASE READ THIS .t� Sold,Fished and Installed by. Branch Name.-Name.-13ostor North&South Date;t/! Furnished At-Home Services,Inc. dfWa The Horne Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID 41 75-2698460;ME Lie#C GM439;RI Cont liul 16427 CT Lie#EIC.0565522;MAi / a h»provement Contractor Reg.#126893 Installation Address: -�i- � � E1z)(pk Q 4,r A �lOt~�-_ City State Zip Purchaser(sj: Work Phone: Home Phone: Cell Phone: Home Address: (if different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing em ails from The Horne Depot Project rnformatiase: Undersigned("Castomer-� the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.(`The Home Depot")agrees to furnish,deliver and atnnge for the installation("Installation")of all materials described on 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'T .lob fi: ti--i P..r--,4 Products: Spec Sh s)#: Project Amount Roofing Siding 0 Windows LJ Insulation -j 20 ❑Ganers;Covers ❑Entry Doors ❑ Roofing Siding windows Insulation 4�T Cutters..Covets ❑EntryDoxs ❑ Roofing Siding vt'indows Insulation ,Gutters%Covers ❑Entry Doors❑ Roofing[3Sidin-g-0-W-in—do`u--.Tr3 Insulaton []Gutters,Covers (]Entry Doors ❑ Nniatum25%Deposit ofContractAmountdae upon execution of this contracG TataiContract Atnourtt $ ��C� Maine Parrbasers may not deposit more than one-third of the ContractAmoura Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized se vice provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in thee m Contrrarcrt., Payment Summary: The Payment Summary� L U9''l G� included as part of this Contract, sets forth the toted Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion CeriMcate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Prod act is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,pins any other MOWS set forth in this Agreement or allowed under applicable 12w. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE ROME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acce lance and Authorization: Customer agrees and understands&..at this Agreement is the entire agreement between Customer and T to a•ne Depot Hnth regard to the Products and Installation senices and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned of amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that er has read,understands,voluntarily accepts the terms of and has received y of this Agreement. Accep d b Submit X X C toner' ign tore Date Sales Cons is Signature Date X Telephone o. Customer's Signature Date Sales Consultant License No, CANCELLATION: CUSTOMER MAY CANCEL THIS (acapplicabte) AGREEMENT WITHOUT PENALTY OR OBLIGATION , BY DELINTRING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS i DAY AFTER SIGNING THIS AGREEMENT. THE:✓} �} ✓ STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. _ wte uinr,c�LCii cL:ci[ LI ltltlJ"J'llCllUS'L'Cf1.. / �� Departrnertt offiidustr•ial�ccide�.'J''/' ' Offcce oflr;vesti�aj �' 1 �on;ress �`tr ee"�Slziee 100 I U--w Bbston'�2114-2017 Workers' Comp ensatzon•ID=ts;rance.A- idavit: Builders/COI traCtoi-s/EIectricians/PIumbers AD�licant information' Please Print LeQibIv Tlat-n q-�-P• .essl0rgzrtization/I.ndividttal): AdcL-ess: City/State/Zip: ) L �� l Phone Are you an'employer? Check the appropriate boX' Type df project(required}: 1.0 I ant a employer with 4. DIII am a general contncior and I ern-ployees (full and/or part-time).* have hired the'sub-contractors 6• -0 New construction. 2.❑ I am a sole'propri efor or party-r- listed on the attached sh=t. 7. 7 kemodel rig ship and have no employe°s - These sub-contractors have" g Demolition wort--Lng for me'-n any capacity, employees and have workers' [No workers' comp:insurance comp. insurance,t 9. ❑ Building zudit,ca reoued.j �. We are a corooration and its . 10. ' �lec�iral repzirs or additions 3.❑ I am a homeow>tr doing all•worl: o5ccrs have exercised their 11:❑ Plu,nH.,repairs or additions right of exemption per MGL myself. [No workers .comp, n irstLance required.] t c. 152, §1(4)'; and•we have no I2 Roof.repzirs' employees. [No workers' 13i�Other comp. insurance required.] 'p ny appii:z�l t:.:checls box al- nli out the section below shoving thdr work:ts''comp-rsation policy infomat3on. t:7Dm:0 P.•n:rs who submit: is affidavit indicating they arc doing all wort;and then hire outside contactors must submit a new affidavit indicating su:h. IContmcto,-s tbzt chick this box must ariachcd an adL6oaal shc.t showing the ream:of the sub coma-tail and'stat:whether or not those:tint have :mploy::s. Yth:sub-eon actors have employes;,they must provide their work:s'comp,policy nntnb:r. I ant ail employer that providing worf:ers' conzDe�ISation iMurance for my'entployees. Below is the policy and j. ob site- • "LlIfprnlallOn. •' �_,' Irsura_rice Company Narnt: /li"- Policy T or Self-ins. Li c. "' VL-II�� D�9 expiration Date:. Job Site Adaress:_ City/State/Zip: %2ut Attach a copy of tha workers' compensation policy declaration page(showing the policy number and expiration date),. Failure to secure as rcouircd under Section 25A of MGL e. 152 can ]:ad to the imposition of criminal pcnaltis of a nne•up to S1,500.00 and/or one-year imprisorument, as well as civil p°nalrits in the form of a STOP WOFLF ORDER and a IInc of up to S250.00 a day agair-st•the violator. i3c advised that a copy of this stat-m=nt may be forwarded to the Omcc of Invcs6ga6ors of the DLL for insurance covcragc,vcrincation — . I do hereby cc � cr that the information provided above is true and correct. ZI EM a—rL,7c I / Dat- Phone Ofj ial--s^only. Do rot wr ire in Ills arc , to be completed by city or Lown ofJLCia_r. City or Town: PermitJLicense T Issuing Authority(circle one): y 1.Bozrd of E°alth 2. Building Deoz..-tir,ent 3. City/Totiti•n Clerk ;.Elt:,:ical insn^ctor S.Plumbing Inspector 6.Other Contact Person: Phone R: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: �-7 Z�� The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant ' s /r Date Signature of Permit Applicant r.� City of Northampton r Ss i Massachusetts y DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building `. Northampton, MA 01060 �s�1y" 7i1� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner 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 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 building 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 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 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) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations s 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone M Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' g ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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 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. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 $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 the pains and penalties of perjury that the information provided above is true and correct. Sip-nature: Date: Phone M 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.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable E�� Name of License Holder: license Number Addres Expiration Date Signature Telephone 9.Re istered Mo a Im` rovemeriYContractor Y ' Not Applicable £ CompanV Name Registration Number Add res ` Expiration Date T elephone 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 Ye .... £ No...... £ 11. = Home Owner�Exemb ion The current exemption for"homeowners"was extended to include Owner-occupied 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 108.3.5.1CMR 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.AAerson who constructs more than one home in a two-year shall not be considered a homeownerwho 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 all such workperformed under the buildingpermit. As acting Construction 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 Wind Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0] Brief ri t' ro o ed 44// A/ Work:: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.if New°house and"or atldtiori to ezistng houslng,`complete the foilowma: 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 Z'h�I, as Owner of the subject property hereby authorize to act on my behalf, in�ll matte We to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized I, Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. f Signed underjherpains a pies of pen A Print Name Signat wner/Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To liscall Existing Proposed Requfred byZoning , This column to be filled in by 4DBuildii e partm nLot Size Frontage -__.. Setbacks Front ----� r-- Side L:= R:?�.._.1 L:L...._._f R:= Rear Building Height Bldg.Square Footage � Open Space Footage % ___ _ (Lot area minus bldg&paved parking) #of Parking Spaces " —1 Fill: Iw._...____...w_.�..�......�.�.._..�. .,....._._._._..._.....�,�..w._.��......... �..._,.....,_._._...�...�_..._.wW,�..._.....€ 1 is (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q _— IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES Q 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 Q 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Qepartmeht use Only :� 4m ed::i City of Northampton ED ullding Department Fernrtif �_ N 212 Main Street m r Seyver/SepticAvi�iha`6�lity 7FMN,3 Room 100 Wat'e�lV�elE,Rvatla ity � 4 K S jNrthampton, MA 01060 4,1 hon 4587-1240 Fax 413-587-1272 aroN MA01oso OU7er�Speclfj/ Ri 5 y APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: r - 3 Elm.$t Distract CB Distnc. SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner C. of ec 6 emAl - rvzoa& Name(Print) .- Current Mailing Address: Telephone Signature 2.2 Authoriz A en . b, :�5_wk Name(Pri Current Mailing Address: S' ture Telephone G� SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Feb 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 Onl Building Permit Number: Date Issued: Signature: Building Commissioner/Irispector'of Buildings Date 5 SUN HILL DR BP-2015-0484 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-200 CITY OF NORTHAMPTON Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2015-0484 Project# JS-2015-000918 Est.Cost: $2251.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 92937 Lot Size(sq. ft.): 8102.16 Owner: COBURN CHRISTOPHER Zoning. URB(100)/ Applicant. HOME DEPOT AT HOME SERVICES AT: 5 SUN HILL DR Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401) 935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.1012812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 4 REPLACEMENT WINDOWS 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 10/28/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner