42-027 795 WESTHAMPTON RD BP-2017-0411
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:42-027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: SidinP BUILDING PERMIT
Permit# BP-2017-0411
Project# JS-2017-000684
Est. Cost: $143.00
Fee: $143.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN WALZ 060612
Lot Size(sq.ft.): 28662.48 Owner BLAIS RAYMOND&ROSEANNE RISER
Zonin : Applicant: JOHN WALZ
AT: 795 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
66 Bray Street (413) 592-2376 Workers Compensation
CH ICOPEEMA01020 ISSUED ON:9/27/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:VI NYL SIDE HOUSE ONLY
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: O1: 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 9/27/2016 0:00:00 $143.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
`M1
Department use only '
tii e City of Northampton Status of Permit
{"e�/is,..!'c-0, ;J.:P. Building Department Curb CufIDIiVeway Permit
4 y ,r'1i d`�r 212 Main Street Sewer/Septic Availability
p?"o Room 100 Watermsi Availability
P.
F�'i Northampton, MA 01060 Two Sets of Structural Plans
61 phone 413-587-1240 Fax 413-587-1272 PIoVSIte Plans
Other Specify
'PLACATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be completed by office
1.1 Sr odealu
h4ni,e 1- ;t -41- Map Lot Unit
FItrevcc r /444 6 106.2- Zone Overlay District
Elm St.District_, Ce DWrict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ko&G Vttle it
t�Sktrgr P?ar.y Ni,S 79 (Adcsi- Ltge afo.z led
Name(Print) Current Mailing Address:
Yrb -Lr -s1.2I Cr v<3 ,a744, c4 ?
Telephone
Signature
2.2 Authorized Aoent:
;TaIdn 1,0 t..4..)(4,‘ 2— (e4 dray 5+- C-1•..'coy0ee, fit/q
_
Name(Pen Cunent Meiling Address: 010 A b
>, e tiryLi' ?265
' Sig " Telephone
Telepho
SECTION 3-ESTIMATED CONSTRUCTION COSTS A..jjy 1 y'
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical _..—_- (b)Estimated Total Cost of
Construction from(6)
3. Plumbing --s. - Building Permit Fee
4, Mechanical(HVAC) 1
5.Are Protection _
6. Total=(1 +2+3+4+5) Check Number /Oiltw
This Section For Official Use Only
Building Permit Number Date
// //�/ issued, /
Signature\ /�� jjt 9- €97-e oa
` Buildding- omm /o/nerllnspector of Buildings Dale
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
all Existing Required by Zoning
This Coban to be Ailed in by
Building Dt adman
Setbacks Front i •
i
Side If i IC
Lamle
IiiiiiiiiirAWIR
IrllIl
i=Foot
Bldg.Square bid
i ■
Open Space Foal"
bid
#of Pazkia$SFraces
at. Ma
..
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW CO YES 0
IF YES, date issued: i
IF YES: Was the permit recorded at the k istry of Deed?
NO Q {1 00NT KNOW , YES 0
IF YES: enter Page r and/. Do. ment#
B. Does the site contain a br..k, body of water or wetlands? NO 0 DON'T KNOW Q YES Q
IF YES, has a permit ba-nor need.to be obtained from the Conservation Commission
Needs Co be obtained Q Obtained ;Q , Date Issued:
i
C. Do any signs a st on the property? YES Q I NO •
IF YES, d ribe size, ype and location: //
D. Are there y proposed hangesto or additions Dt signs intended for the property? YEt O NO O
IF YES/describe size, pe and location: if
E. Will ttte Construction actio dispirit(Peering.grading, acreavation,or filling)over 1 acor is it pad!of a common plan
that will disturb over 1 are .? 'FES Q NO I
tF YES,then a Northa .. . .tomo Water Management Permit from the DPW is required.
Di
SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all appliKablel
New House O Addition CD Replacement Windows Alteration(s) n Roofing 0
Or Doors ❑
Accessory Bldg. ❑ Demolition it New Signs Mg Decks (O Siding Mgr Other tat
Brief Description pf Propose
Work: Nal all V. at iii I S':.4-t01..S S-2ea Cc. c.4 t4
Alteration of existing bedroom Yes eft Adding new bedroom Yes grlio
Attached Narrative Renovating unfinished basement Yes 4---No
PlansAttached Roll -Sheet
Ea.If New house and or addition to existing housing, complete the following:
F
a. Use of building:One Family Two Family Other
b. Number of rooms in each family unit / Number of Bathro•ms
c. Is there a garage attached?
E Proposed Square footage of new constru :on. Dimensions a
E Number of stories?
f Method of heating? ,_ Fireal:.-s or Woodstoves Nu ber of eachg. Energy Conservation Compliance. MIMa -check Energy Co liars atta ed?
h. Type of construction
1. Is construction within 100 R.of wetter).%? Yes No. Is construction within 100 yr floodp=in _Yes No
j. Depth of basement or cellar floor bele nished grade
K. Will building conform lb the Building a ( Zoning regulation.? Ye No.
i
I. Septic Tank / City Sewer Private well _ City wer Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,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 or Owner �� Date
I. J a fit '1 1M)) LA—) cut I 'x---' 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.
Tis k.-t vJ vT) - l z
Print Name
7 La .3 ( i 4:.,
i Signature of cur/Agent _, ._... Date
SECTION 5-CONSTRUCTION SERVICES
18.1 Licensed Construction Supervisor. Not Applicable ❑
•
Name of License HWder:_�1 A4.4. L.. LUc ( `a_ 6 t, a 6 1 ✓--
'( License Number
SC _IL." t\f SrCi('x{.x ' = ..i te .i_ n ti c; C-1 Dolt f. ifid. / ' 7
Address Emiration Date
Signature (/ Telephone
9.Registered Home ImproyementContractor. Not Applicable ❑
i= ., v / 11 r, y / . (�,,, G. /t .A L C. 2
Company Nettie —y-- / Registration /Number
+� P< f t E4 ^t �.�i` sL.L.-�I, de k-/<! `� / 1 f I/)
Address < L. Expiration Date
`11' r Tetephone2'1 3'}42 437£
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MALL.c.152,§25C(5))
Warkers 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 Affdavit Manned Yes R/' No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dweain's 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 set
as supervisor.CMI4 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 congenial more tine one home in a tw_o-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,boll be
responsible for all such work performed wider 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 way he gable 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 Stateof Massachusetts General Laws Annotated.
Homeowner Signature
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 150k
Address of the work: 7 9 c Was -4- ina en r 740 km ed .
The debris will be transported by: ktyO h 1•' c ��. ✓:r S
The debris will be received by: e �P y I • c S e r v.• c e S
Building permit number:
Name of Permit Applicant Oln`t (a,) 1-4/ 4, ! z
`t la - tic.
Date Signature of Permit Applicant
The Commonwealth of Massachusetts I Print Form
-`i - Department of Industrial Accidents
Office of Investigations
-- 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Finvl Vinyl Inc,
Address: 33 Grattan St.
Chicopee MA 01070 C�
City/State/Zip: Phone#: t Q - 02 3 7 6
Are you an employer?Check the appropriate box:
1.0 I am a employer with 4. I am a general contractor and i Type of project(required):
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. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.t 9. Building addition
required] 5. ❑ We are a corporation and its 10,0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11,0 Plumbing repairs or additions
myself[No workers'comp. right of exemption per MGL
12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no
employees, [No workers' 13.&Other New S.4,y,j,
comp.insurance required] Se r ..7T 4 e 7'
'Any applicant that checks box PI must also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
tComractors that check this box must amched an additional sheet showing the name of the subcontractors 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 art 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.it: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereb
JDateJ 9 /a certify under the pains and penalties ofperjury that the information provided above is true and correct.
_
Sipnamre: '� 3 / C.
Phone#: / a 9.2 -ant,(v rg y `f r 3 c9.2 - c,t 3 B
,
°./llcfl ase only. Do notwrite in Mis area,to be completed by city or town official
City or Town: Permit/License#
Issnjog Authority(circle one):
1.Beard of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
r . .
04!68!2916 14:10NeiI S Neil Insurance Agency (FAX)14137316629 P.001/0131
fd CERTIFICATE OF LIABILITY INSURANCE 041441410:174)D,
THIS CERTIFICATE IS ISSUED AS A MATTER OP REFORMATION ONLY AND CONFERS NO RIGHTS UPON TIE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED eY THE POLICIES
ENDOW. TNM CERTIFICATE OF INSURANCE COES NOT COMMUTE A CONTRACT BETWEEN THE ISOUINO INeURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT; If the Certificate holder le an ADDITIONAL INSURED,the pegeydea)mat De enDWTeet R SUSRODATION IS WAIVED,cu}att to
the terms and conditions of the patty,contain palIci s may rniuIr0 an OndOnumont A statement On this corncob)does not confer rlphts to the
anMate holder In Stu of such eneenamemt*
PRDPUad NON&WS insurance Aponte/Ind ' - }i l DE lsklary P
SE2 Riverdale Stroute„.• .t D!7E2-4137M�.MPn(41S)731.8828
West Springfield,MA 01080 000 , dJSnel0ln$com
usuPRmAProIOMOCO/MABe NAM!
. gsv44 A, /UM Mutual'neurones Company An
mum .ChdStoplSF Cwson IRMO"s.
64 Yeoman Ave N3umOta,
Westfield,MA 01010
NI4nlrtee
COVEI{AGES CERTIFICATE NUMBER: REWBION NUMBER:
THIS I$TO CERTPY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN $SUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MTH RESPECT TO WHICH THIS
CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED EY TIE POLICES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS.
EXCLUSIONS AND COMMONS OF SUCH POLICIES.UMRS SHOWNMAY HAVE BEEN REDUCED D�SY PAID WPM
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CERTIFICATE HOLpiR CANCELLATION
Im«}.A«., I SHOULD ANY OF THEASORI DEICRMMtPOLICIES BE CANCELLED BEFORE
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t Fit air If Page No. of Pages
CHOICE Ile.NW YL PROPOSAL
33 Grattan Street
All home improvement contractors and subcontractors
CI-IICOPEE, MA 01020 engaged in home improvement contracting, unless
(413) 592-2376 specifically exempt from registration by Provisions of
Chapter 142A of the general laws,must be registered with
SubmittedRosanne Risher&Ray Biais the Commonwealth of Massachusetts. Inquiries about
To: _. _ _ _ _. . _ - - registration and status should be made to the Director,
'95 Westhampton Rd. Home Improvement Contract Registration,One Ashburton
Place,Room 1301,Boston,MA 02108 (617)973-6710
Owners who secure their own construction related
Florence, MA 01062 permits or deal with unregistered contractors will
be excluded from the Guaranty fund Provision of
MGL c. 142A,
PHONE DATE REGISTRATIONNO, . 112653 CT-REG.NO.0051540
413-627-5121 "7 cv�t1te 9-20-16 UCENSE NO. •060612
.meMAME,+m. LOCATION
WW �a .ut w(a-ate(1s and sssi�mm5 - �.t 5€1-.22s0
1:
i.e ilietr °f43ihQ instti anonaas a Dackeibr work perhemeel eche Maerwrs roue used:
2. Vinyl side house only using Mastic Carvedwood D4'Cedar Harbor Gray vinyl siding, Lifetime Warranty.
3. Install regular corner posts.
4. J-Blocks for all light fixtures,faucets,&dryer vents.
5. Install two Harbor gray rectangle gable vents.
6. Wrap all facia(trim)in Evergreen aluminum coil.
7. Wrap all doors in Evergreen aluminum coil,Anderson Bend.
8. Use Evergreen triple 4"aluminum soffits under all overhangs,
9. Install all new seamless Everest Green glitters&downspouts.
10. No shutters.
11. Strip house&dispose of waste by truck or dumpster.
12. Use 1x3 around on side chimney and install Used Red brick vinyl around chimny on side of house only.
.
1$. Replace one piece oZ rotted-�fecis beard on back ggable from soffit to peak on;g opposite chimney side.
WORK SCHEDULE
Contractor will not begirt t e won,or order me matertaiis before dna evrd May following the signing of this Agreement unless specified herein writing.Contractor mil begin the wort on or
about a months from date of signing.Darting delay caused by circumstances beyond Contactors control,the work will be completed witNn 1 year from date et signing, The Owner hereby
ae v,tdyus and agrees that the scheduling dates am approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of Nis Agreement.
WARRANTY
The Contractor warrants Mu the work furnished hereunder shall be free from defects in matdnal and workmanship for a pound of one year following completion and shall oomph was the
requamenb of this Agreement in the event any detect in workmanship or material;or damage caused by the Contractor,his subcontractors,employees or agents,is discovered waren
one year after completion of any lob including clean up,the Contractor shall,at his own expense forthwith remedy.recto correct,reohace.es coven to be remedied,tspeed,or mphacma
_
sash dos mei w MniLMacfNITANnaKOrnOflllneLr,ilxftur✓dwntl e55hatl'YbMM3ladYar9atbhRrAectim'—.
We Propose hereby to furnish material and labor —complete in accordance with above specifications,for the sum of:
Twenty-one thousand four hundred and ninety-five dollars and 00/100. 21495.00
dollars($ ).
Payment to be made as follows:A finance charge of Irte%per month(18%per annum)will be charged on unpaid balancers.
In additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency, the owner herein shall be responsible for
reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here.
33 7093.00 ) upon signing Contract; John W.Walz/Finyl Vinyl Inc
($
12 7/102 nn ies1 of marcrialc named ConrtapNrlaaegiwtwl Registrant
Grattan Street
(SSO )upon completion aiA� 33 Grattan
rrt
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