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32A-143 (12) 38 MAIN ST BP-2016-1089 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32A - 143 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-2016-1089 Project# JS-2016-001869 Est. Cost: $1975.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 99209 Lot Size(ssq. ft.): Owner: STEWART ENDAMIAN Zoning: CB Applicant: HOME DEPOT AT HOME SERVICES AT. 38 MAIN ST Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.•3/17/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT WINDOW 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 3/17/2016 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1089 tA.A*0 iN F t) o� G pp4' APPLICANT/CONTACT PERSON HOME DEPOT AT HOME SERVICES C ADDRESS/PHONE 24 SUNRISE DR PROVIDENCE02908 PROPERTY LOCATION 38 MAIN ST MAP 32A PARCEL 143 001 ZONE CB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid / Building Permit Filled out Fee Paid Typeof Construction: INSTALL REPLACEMENT WINDOW New Construction Non Structural interior renovations Addition to Existiny, Accessory Structure Building Plans Included: Owner/Statement or License 99209 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION PRESENTED: i/ Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay cz�� /L-ZL 'A i -g /,--, 1(6 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit May 15, 2000 Department use only ity of Northampton Status of Permit: BuildingDepartment Curb Cut/Driveway Permit _ 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability °o Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map p/� Lot /T-- Unit Zone Overlay District ___. _..._.. Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: olp Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address Q .--1 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 ! ff (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number b This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date Version 1.7 Coranercial Building Permit May 15,2000 SECTION 4--CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs ET�Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description 'Enter a brief description here. lw�571 LL 12V Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ElA-2 ElA-3 El 1A El lA-4 ❑ A-5 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 213 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ I Institutional ❑ 11 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: :... Existing Hazard Index 780 CMR 34):` Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 1 5t 1St 2nd _. 2nd 3rd 3d .. 4tn 4m .... .................................. ._........_.....__............................................................ Total Area(sf) Total Proposed New Construction(sf). Total Height(ft) Total Height ft _......_ 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public E] Private E] Zone Outside Flood Zone[] ❑ On site disposal system❑ i I Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING 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 DONT KNOW 0 YES 0 : IF YES: enter Book Page; and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ..... ........ Needs to be obtained Obtained , 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 0 NO 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. Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): _ _. Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): NameArea of Responsibility ....... _. Address Registration Number Signature Telephone Expiration Date _.. .. Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number `Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone I Expiration Date 9.3 General Contractor .,�y�� Not Applicable ❑ Company Name: Responsible In Charge of Construction q Address Signatuex Telephone i I I Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 I' t/ ,- , , 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 unde &pai and pe alties of perjury... G l Print Name Signatu. of Owner/ gent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor Not Applicable ❑ (� r� Name of License Holder: License Number Addre7g /M' Expiration Date Signat Tel pho e SECTION 13-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 0 4 t The Cornnzonwealth of Massachusetts Department o f Industrial Accidents Office of Investigations t ;r _ :t 600 TVashingtarz Street c Boston, MA 02111 _., www.rnass.govtdia Workers' Compensation Insurance AffidaNit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: _ _ FAre you an employer?Check the appropriate bog: Type of project(required); I am a employer with 4. ❑ I am a general contractor and I employees (full 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. T ❑ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9, Building addition [No workers' comp.insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions q � 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a naw 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'camp.policy number. I ain 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.Lie.#: 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 peijui)i that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# i 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#: i i The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Xnvestigations I Congress Street,Suite 100 Boston,MA 02114--2017 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (.Business/Organization/Individual): keme, CG &Iagwl_ Address: ?0:?, ��ST�',y �cr>—A)pi City/State/Zi o 16 -q � 6lk 0 _Y Phone#: & g�� Are you an employer?Check the ap ropriate box: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I 6. F-1 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 g, F1Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.msurance.� required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12❑Yof repairs insurance required.] t c. 152, §1(4),and we have no 13. er w employees. [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. tContractors 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. t Insurance Company Name: / � S � � 3 _ In — Policy#or Self-ins.Lic.#: W C, ®l�� (s� Expiration Date: M#. uZO Job Site Address: ° LJ U ! City/State/Zip: l� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expira 'on 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 certi nd�,JpVa' sries of perjury that the information provided above is true and correct Si afore: Date: <'` Phone#• 5_0 Z 6 C 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): j 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other i Contact Person: Phone#: Feb 1516 08:32p p.1 HOME WIPROVEMENT CONTRACT r PLEASE READ THIS "Tr0.�5rt �CV-h�vt"TVS -1'11�U6•�S a Sold,Furnished and Installed by: Branch Name:new England Uate _ THD At-Horne Services,inc- Branch The Home Depot At-Home Services Branch N'utnber:37 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01445 Toll Free 877-903-3768 Federal ID#75-2698460;ME Lc rt C tV4.39;RI Cont.Lic#16427 N P CT Lic H[C,0565522;14A Herne Improvement Cowractur Rem.#126593 Installation Address: �t i� J� a tti � �i 11K A- 0{06 c) City State Zip Purchaser(s): Work Phom; Horne Phone: CCU Phone: 6-K i N SZ�: Rte{C id I l I l [ Home Address: _ Of differettt from ins allation Address) - City State Zip E-mail Address(to receive project courmunic--tions and Home Depot updates): ❑I DO NOT wish to receive any marketing entails from The Home Depot Prosect information: Undersigned("Customer )",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 arrange 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(cellecti eiv, 'Contract" Job#: arc—A Rctlnbm) r Products: Spec Aee s rt: Prolect Amount Reofm '. g ❑Siding Vindows ❑tmulauan QGutnxs ICovers ❑Entry Doom ❑ oofinp Siding Windows ❑Insulation, i ❑GvtLm f Covers ❑Entry Doors C S Roofing Siding ❑%VindcA ❑-Invitatian ❑Gutters I Coven ❑Entry Doors❑� ❑Roofing 17Siding LJ Windows ©Inwlation []Gutter;!Coves []Entry Mors Fl Minimum 25 Fa Dem ufCo�Ammntdue upont:ceculionof th6contract. Total Contract Am Maine Purchasers not de mope thanorw-tlmdof the Contrad.Ammilt. t l 4 Customer agrees that,immedialely upon completion of the work for each Product, Customer will execute a Completion Certifcate; (one for each Product as defined by nn individual Spec Sheet) and pay any balance due. As applicable,each Customer under this Contract agrees to beointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any indi vidual Product(s)included herein,at its discretion,if The Nome Depot or its authonzed service provider determine;that it cannot perform its obligations due to a simctun d problem.with the home,environmental hazards such as"Id,asbestos or lend paint,other safety concern;,pricing errors or because work required to complete the job was not included in the Contract. Psyment Summary: The Payment Summary# � ��t included tis part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product{as applicable). NOTICE TO CUSTOMER You are entitled to a completely tilled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pray 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,plus any outer amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITTIHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE., WITHOUT LIMITING THE TIOMF DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Aulhoriration; Customer agrees and under:elands that this Agreement is the entire ngrcemetrt between Customer and"1'he Mume Dc pot with regard to the Products and Ins'tAlation seri ices and supersedes all prier di cussions and a,rcctnents,either oral or written,relatin.,to said Prtducty tmd dastultalicra.This Agreement cantttx be assigned or r;manded except by a nriling signed by Customer.incl The Horne Depot.Cus osier acknowledges and agrees that Ct,slmner h:r1 read,understands, voluntarily accepts the terms or and 11.s received a copy of this Agreemcnl. Accepted by- Sub XX �• O� -- Customer's Signature .1 Dose S es C ulaant'�;Siguatune Date Telephone No. _ Customer's Signal Lire Date Soles Consultant License No. CANTCELLA,TU) : CUSTOMER MAY CANCEL THIS (n apGtcahiei AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HON4R 1 / DEPOT BY MIDNIGHT ON THE THIRD BUSINESS , DAY AFTER SIGNING 'THIS AGREEMEMI. THE STATE SUPPLEMENT ATTACKED HERETO CONTAINS A FORM TO USE IF ONS IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER";RTATF._ March 10, 2016 1 request that you grant a modification to waive the requirement for control construction for the replacement window at 38 Main Street in Northampton because the work is of a minor nature, will not affect health, accessibility, life and fire safety, or structural requirements and is impractical in that the cost of the control construction is considerable when compared to the cost of the proposed work. Thank you for your consideration. "Mass Amendments, section 107.1 allows for an exclusion from control construction for this project". Respectfully, alf� lla2 Mike Bedard Home Depot 908 Boston Turnpike Shrewsbury, MA. 01545 THD At-Home Services, Inc. 908 Boston Turnpike• Unit 1 •Shrewsbury, MA 01545 Phone: 774-275-2139•Fax: 508-845-6076•Toll Free:800-657-5182 3/11/2016 stewart2.JPG rt hftps://mail.google.com/mail/lAnbox/1535c3c5134236ba?projector=1 1/1 3/11/2016 stewart3.JPG Nl 77, � x k { a2 �n 8 .T k Ct https://mai l.google.com/mail/M`nbox/1535c3c5l34236ba?projector=1 1/1 3/11/2016 stmart1.JPG hups://mail.google.com/mailliAnboYJ1535c3c5l34236ba?projector=1 1/1 • ��f:;tct'!� {��' ;necgYtit:nran—rncan.gc.ta � ,� -i z. _ - _ aja,a:a v(G Mibi cilC( Rriz t-13? 17:-, for f'J1UI2 f,fI'RC° •=�1 •.'�`-;--t i �?tti= CEJ- ,—�i� i Ai-Git F iff siifie E , ::.ti .zDB.... 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