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13-077
105 MARIAN ST BP-2016-1343 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma :Block: 13 -077 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 IUILDING PERMIT Permit# BP-2016-1343 Project# JS-2016-002309 Est. Cost: $2300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 98785 Lot Size(sa. 111 31755.24 Owner: PALLA BRENDA E Zoning. Applicant: HOME QEPOT AT HOME SERVICES AT. 105 MARIAN ST Applicant Address: Phone: Insurance: 24 SUNRISE DR Workers Compensation PROVIDENCER102908 ISSUED ON.511712016 0:00:00 TO PERFORM THE FOLLOWING WORK;INSTALL REPLACEMENT 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 5/17/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner ED Department;use only Ci of Northampton Status of Perwi t Fy Ldt� Bu ing Department Curb Cut/Driveway Permit Main Street SewerlSepticAvaiIability � q om 100 Water/Well Availability JortharrIpton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-127$ 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:byoffice Ma p Lot Unit MA��plu�N one Overlay District �Im Si.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 ri d A ent: Name rint Current Mailing Address: Y' ature Teleph ne SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 22 ,E (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 f- r Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incompl e Information Existing Proposed Required b Zon&g . This column tl9AC11jif 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 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES 0 IF YES: enter Book PagelDocument#i B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtainedQ Obtained , Date Issued C. Do any signs exist on the property? YES NO 0 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 0 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. 4 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacemen 'Windows Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [0 Siding[p] Other[O] Brief Descriptio of,P s d Work: 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 'fT, lrL as Owner of the subject property yy hereby authorize �" l to act on my behalf, in all mate to work authorized by this building permit application. Signature of Owner Date jagas 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. Signe e p s and penalties y. Prin Signat 07 Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su eryvisso,r:: r2l Not Appli able £ Nance of License Holder: / License Number Address �n ,_,,,/ Expiration Date Signature Telephone 9.Registered Home Im 'roveme°t Contractor: _ Not Applicable £ Company Name Registration Number Address Expiration Date r' a ephone 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 lie/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 I I I The Commonwealth of Massachusetts ink r� Delnartment of Ind zstrial Accidents �! Office OfInv�stigations 600 I Vashington Street ' — Boston, M4 02111 b� Y f� WWW.MassgovXdi®s Workers' Compensation Insurance Al'Tdavit: ]Buiidelrs/Contractolrs/Eiectrieians/]Piumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): Address: City/State/Zip: Phone#: 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 employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 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' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ 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.❑ 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. 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 d. 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 ofperjury 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# 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#: City of Northampton Massachusetts X pp r DLPARTHENT OF BUILDX1VG XJYSPECTIONS 212 Main Street o Municipal Building Northampton, MA 01060Th +� ti 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 I, ' �I 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: The debris will be transported by: The debris will be received by: Building permit number: Name of Permit Applicant 9V -P—P Date Signature of Permit Applicant 4 I I � Rze of Al-assaakuse& n i d 1 CON201 ah ztveef,S,—,Y-e 100 tt.:-r.,,A, 02-714-2017 rtr j9 rates govldAa r1�CF; .i� (3 ? usvu�L3Os Please Pte;Lp b 7 1'T + + {Susi,Mss/OrganizadoaadbiidiW): �eu:jdl'�'' - r }� } 1 Cs'rt�!_ ✓.>f+ Addass: IJJZ44:5` '+J to ris • You��a..:-�xLy.�j.9 frT'o{+?K'p'�'*a.(=^t zI ('box: 1 W 1 r, `'_}I am a Qenoral cofactor and I Type of project(regi retlj: Z .n s ems G;e_ %rte x 6. ❑New construction employees(Ml aslox paA-tine).~' hmve hired the sub-co=otois 2.0 I ons a sole promietor o3 partner_ listed on t-e attached sleet. 7- ®Remodeling i sl and lL9e�?o Ourvo ees These sub-Oontractors have $ P Y ❑Demolition 7eziting for3.,}T.e in any capacity. employees and have workers' i [IMG rrorf�e_s' camp.iEtsin-ance comp.irts,=ce' 9. ❑Buiiding addition ems,;,-e t�� 5. We are a ccrporation and'Tis 16.Q Electrical reps or additions 3.❑ m a homeowner doing all wo;� o"cam s have exercised�tei 11.®Plumbing repass or additions iMl scl 10 ,TIOrkerscamp. right ofenenption per MOI � � p 12.0 P. of repairs insurmce required-]s c.152,§1(4),rind we leve no 13.§emplo-ees. CRO Workers, 13. Other `--� comp.'Tete-required.] %.ny applicant that chccm bo,-.ki Must also BE out the sectio,War,,shovAng their viorkars'compensation policy information. f Romeovners-,,to sdomitihis muda?nt indicaing they me doing D silonk and then his:outsidc caawwwa must submit anevr affidavit ind'tcMing sTMIL +Contractors that cheer this ba x must ached ars additional siren shouting the pamr of the sub-coah=tor end steto whether or cot those eat ies have employers. z the sub-contractom have employce s,they mast pro Uc thdr vrajcr'camp.policy rmmber I L i^fdiZ e.iYployej-tbet-b DrP37jIA,;g iVOilters,cq t:vo—?Safion t7.S1'dmmCe fo 7,Sy Lri'3plovees. velo''!)is ffie policy and Job Site Insurartce Com an Name.-ii40 Policy r o=SeL ins.Lic. VV L I- ; err dry ci `, a-dont Date: Job She Address: �22 PfPj1M--) Ul City/Siate/Ziw � r zA aeh a Copy Of the workers'comperisation paizey declaration page(shoiftg the policy number and egpir on date)- v} Failure to secure coverage as required under Section 25A of lv-TT-c.152 can lead to the imposition of criminal penalties of a fine tap to$1,500.00 and/or one-year imprisomneLr;as well as cK penalties in the farm of a STOP VIORP ORDER.and a free of tzT to$250.00 a day against the violator. Be adirised that a cop f of this statement may be forviarded to the Of of Investigations of the DIr for insux-,mce coverage verification.. .l ea Iaercby iv e; 7 L,-,etf the s�©a,szafiojjP,avMa above is ft?w and som L : Si ^tura: —� Date: G v Phone g: 5-0 � 6, r) O,j ctaf use ovdy. Do of tprfte esz this crec;to he corwiefed by ca,�j or 8€atim ORMGl. � cy or TGim: ! ivUcanse#i Issuiag Authoraty(circle one): t ` 1.Board of Health 2.Eaaildi ag Dupnr ment 3.Cityffovin'Clerk u.M%.-trical Inspector 5.Plumbing L"s7ector ii.Other Coazinct Person. Elhone m: I S)Tonton Windows I L ! L•C:Oi?.`.L^ 1_ .ea"Gass Argon-LOjr- .NO Laf&inamd G 1! 1_ iI -e ode gGil!aAna-V„i!o-3.'S.,lr:i Acllo-Argar-Lo,i-E-Sin 17rt: ` 1rri ;.laminado-Con red@as CPD.SSP-A 290=2.00002 07-75 DH 'CE RATINGS ENERGY RMAN S ALUACION US NDINMENTO ENERGaETICO � �i U-=�Ciu' ' SulEf�lZatv.':fiiC3e:TC:BIii �� O.-)r) _ 'I . v._....__..0. �' _ i. i ADDITIONAL:PERFORMANCE RAT INI GS �! I EVALUACION SUPE41AENTARK DE RENDIMI-mNTO Visfbis Tra-tsmtmme 0.45 Bra i' i-1�,-"i•?l : v , y fi' Unit qualifies for El iB�GY —! I• -1 .,fi`' �`•;1"sl'; f .� S i ARG region(s):No:u.ern ! !�:;,iu/ l zL •i.l� _ ice! t Ptoi u7 Cental South Central ., ,y i�'=irif� 1 +`� Southam. I . r IND:Rain 00/Glass ProSolar/H-LC28 s-a � ii � ��. 251-�J.� Teslad Size:4E"x 80' I l r crr~a Prcdtict APPro:a::FL�,;1$7 1� " 1 f 1 �i .. apP!ica6le:est5tanca:d7s): A�ISlf ,lAht�iV�}11iIDA,i0;11.5.�9? AAYFVWD�i)PJCSA { i ;Cll[.S.JT440-05,AAtv'AtWD,.AA;CSA id I,1.S.?lA�k^ A440S i-0$Ca_na�Ian STp! II i 8358790101 00333 HS Ho*,starr! 84000941% ^u:- aal.-.a•3-:.'s.?i::'t:.____ �.�:^':.L"+.2•'... -:�,:3T•�G.:c?:is'.y:a:?:J:Y:?�s'i.i�,:'i j :T ,5/13/2016 The Home Depot At Home Services 4:01 PM Lead Detail-9248180 Customer Information Job Information Homeowner............ M/M Brenda Palla Sale Amount...... $2,300.00 Homeowner............ Product............... Wincore Entry Doors(8%) Job Site Address...... 105 Marian St NORTHAMPTON,MA 01060 Status.................. SalclMatcrial Ordered Branch................. Boston North ! SM........................ SM-Connecticut Unassigned County..................... HAMPSHIRE ISM....................... David Richter Billing Address.......... 105 Marian St 1 FS......................... Jason Timm i NORTHAMPTON,MA 01056 PC......................... PC Unassigned Measurer.............. David Richter Home Phone............. (413)626-2996 RIM...................... Russell A.Johnstone Work Phone.............. Ext ; OM....................... OM Unassigned Cell Phone................ PS......................... PS Unassigned Pager....................... PIN Installer................ IVAN KOSOBUTSKYY(KOS1002) Work Phone 2........... Crew..................... Ivan Kosobutskyy CREW 1 Cell Phone 2.............. Cross Street............... Sales Commission.................. Key Dates Sale Date.......... 5/1/2016 FUP Date................ Consultant Nam Term Date Slllj Como Pian Timothy Drost 100.00 Straight Commission Credit Date........ 5/1/2016 FPD-Customer....... RTP Bate _ ... 51412416 PostinstallDate... No Cross Ref#... 1-7318484904 Siebel Ord.. 106620 Start Date............. 6/11/2016 FPD-Home Depot. _ Inspection............ Marketing Final Payment Information I Referral Store............ R452-HADLEI' Base Store.................. 8452-HADLEY Source Approval Code 1... Visa ! Lead Source................ 0080 Store Associate-OLS 1... HD Store Associate.... Gruszkos Thomas 3 3 Assigned SC................ Timothy Drost — Appt.Generator...... Lead Generator.......... Installer Referral...... Payments Transmitted Received Tender Type Check# Payment Amt Payment Tvpe Deposit Date Entered by Entre Date Date History Date Time Lead Management Agent Status Appt Date Appt Time Correction r a M Lewis Material Ordered— o 5/4/2016 6:22 PM Erikka M Lewis Order Received-PSG 5/1/2016 8:00 AM No 5/4/2016 4:23 PM David Richter Measure Complete 5/1/2016 8:00 AM No Page]of 3