jn phillipds auto glass invoice 45 CAHILLANE TER BP-2018-1250
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 35- 126 CITY OF NORTHAMPTON
Lot-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category she BUILDING PERMIT
Permit BP-2018-1250
Proiect 9 JS-2018-002226
Est Cost$7900.00
Fee: S65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group HOMETOWN STRUCTURES98186
Lot Size(sa R.): 10541.52 Owner. GABRY STEVEN I
Zoning: Applicant. HOMETOWN STRUCTURES
AT: 45 CAHILLANE TER
Applicant Address: Phone: Insurance:
627 SOUTHAMPTON RD (413) 562-7171 WC
WESTFIELDMA01085 ISSUED ON:5/3012018 0:00:00
TO PERFORM THE FOLLOWING WORKTREASSEMBLED 13.5X24 SHED
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 Deaartmenl 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:
FeeTVDe: Date Paid: Amount:
Building 5/30/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1250
APPLICANT/CONTACT PERSON HOMETOWN STRUCTURES
ADDRESSIPHONE 627 SOUTHAMPTON RD WESTFIELD (413)562-7171
PROPERTY LOCATION 45 CAHILLANE TER
MAP 35 PARCEL 126 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvneof Construction: PREASSEMBLED 13.5X24 S D
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included
Owned Statement or License 98186
3 sets of Plans/Plot Plan
TH�j FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
s_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�Dellaayy1
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.
HE
yr am On Status of Permit: Department use only
F
Building De art ent Curb CutlDriveway Permit
L „ . MAY 2 32INTgain tre t Sewer/Septic Availability
+ ! Room 00 Water/Well Availability
.s' MA 1060 Two Sets of Structural Plans
�ax 13-587-1272 Plotlsite Plans
Other Specify
APPLHIATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SF E INFORMATION
1.1 Property Ad tress. This section to be completed by office
Map t; Lot / z Unit
45 Cahilla a Terrance, Florence, MA 01062 zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Steven Gabrq 45 Cahillane Terrace, Florence,MA 01062
Name(Print), Current Mailing ABEress: 413-522-5662
i
X
Telephone
Signature
2.2 Authorized got 4)'4
Glenn Martin(Hometown Structures) (�a7 .5.�.,}Jsunn ><c:; A4,
Name(Print) Cunent Mailing Atltlress:
G sw_ V13 %y-71
Signature Telephone
SECTION 3-ES "IMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 7900 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Constmction from 6
3. Plumbing Building Permit Fee T
4. Mechanical(H VAC) r,-
5. Fire Protection
6. Total=(1 +2 3+4+5) 1 Check Number /pZ
This Section For Official Use Only
Building Permit IN tuber: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
skw" @
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
WILL tatvn SfrftL�ttdLS. Con
$PCti D 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
I his column m be filled m by
Building Deparmmnt
Lot Le 10542
Friorrage 104
Setb cks Front 80
Side L R: L27 R:55
Rear 7
Buil g Height 11.5'
Bldg. Square Footage % 324
Open Space Footage %
Uta' minus bldg&paved
ruin
k of arkin 5 aces
Fill:
Ivolom &IncatioN
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF ES, date issued:
IF ES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
1 YES: enter Book Page and/or Document#
B. D es the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. I o any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. A e there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location:
E. ill the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
t at will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-D SCRIPTION OF PROPOSED WORK check all applicable
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doom O
Accessory Willi
il ❑ Demolition ❑ New Signs [o) Decks [M Siding DZ3] Other[[7i
Brief Description Of Proposed deliveryofpmassembledaccessorystrucNre(13.5x24)
Work:
Alteration of em ting bedroom_Yes XX No Adding new bedroom Yes XX No
Attached Narrati a Renovating unfinished basement Yes * No
Plans Attached Roll -Sheet
Be.If New ho se and or addition to existing housing, COrn tete the followin
a. Use of build ng:One Family Two Family Other
b. Number of r oms in each family unit: Number of Bathrooms
c. Is there a g rage attached?
d. Proposed S uare footage of new construction. Dimensions
e. Number of ones?
I. Method of h ating? Fireplaces or W oodstoves Number of each
g. Energy Con ervation Compliance. Masscheck Energy Compliance form attached?
h. Type of congWction
I. Is constructs n within 100 ft.of wetlands? Yes No. Is construction within 100 yr. Floodplain Yes No
I. Depth of be amen,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-O NER AUTXORIZATION-TO BE COMPLETED WHEN
OWNERS AGE OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, )r,�" ? "-G-c-n �z�'�y' as Owner of the subject
property
Hometown Structures
hereby authorize
to act on my beh in all Patters relative to work authorized by this building permit application.
o , 7
v
Sign un of D "e (/ Data - / —
I, ( [L' ,(NV �4,^ at lyse �.�(. S fw c4�.rty) , as Owner/Authorized
Agent hereby de tare 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.
a term I I, ' '-
Pent Name
Signature of Owner gent Date
SECTION 8-CONSTRUCT! NSERVICES
8.1 Licensed Cipinstruction Su ewisor: Not Applicable ❑
Name of License Holder Andrew Kurtz
License Number
295 Bronth y Road, Huntington, MA 01050 CS-98186
Address Expiration Date
8-3-2019
Signature Telephone
413-562-7171
9.Reithitened Home Improvement Contractor; Not Applicable ❑
Comoanv Nam! ~ Registration Number
M -So f Ac,.p .1 kd 159772
Address Expiration Date
CL c t c I�
17)f9 D Telephone V/�:Z"Jbxe- 7/ / 5-27-2018
SECTION 10- RKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8()
Workers Compe isation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of tl a issuance of the building permit.
Signed Affidavit dtached Yes-.....1T No...... ❑
I
i
® Cmgnmwea MF.1 Maesac M1uaetts
9oartlOnN,Budding
udtlinq Requibl,on s and 9Slan
tlams
.., ar-salon Supe-, say
CS-098186 Eaprtes 08103.2019
ANDREW D KURTZ
296 aROMLEYRD t�
HUNTINGTON MA OWN
Commissioner ✓^" ��
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration '
Reoistration'. 159772
Type: Ltd Liability Corporation
Expiration: 5272018 Trp 419291
HO ETOWN STRUCTURES -
AND EW KURTZ ----
627 OUTHAMPTON RD
WE TFIELD, MA 01085 - -
Update Address and return card.hark reason for change"
Address Rencsval Employment Lost Card
Once of 'ansnmer:\ttnlrs&Business Regulation License or registration valid for individual use onh
HOME MPROVEMENTCONTRACTOR before the expiration date. If found return to:
Reglat don: 159772 Type: Office of Cause.or ABa it,and Bus iness Regulation
Expir on: 5272018 Ltd Liability Corporate 10 Park Plaza-Suite 5170
- Boston,NLA 02116
HOMETOWN STRIJ CTURES
ANDREW KURTZ
627 SOUTHAMPTC q RD _
WESTFIELD,MA 0085 Late rsecrcear, Net valid without signature
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
'
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant nformation Please Print Legibly
Name (Busin ss/Orgmization/Individuap: Hometown Structures
Address:627 Southampton Road
City/State/Zip: Phone #:
Are you an eni player?Check the appropriate box: Type of project(required):
L21 I am a employer with 15 4. ❑ I am a general contractor and I 6. E] New construction
employee (Poll and/or part-time).* have hired the sub-contractors
2.❑ I am a so] proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and I ave no employees These sub-contractors have g. ❑ Demolition
working or me in any capacity. employees and have workers'
[No work rs' comp. insurance camp. insurance3 9. E] Building addition
required.]I 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself o workers' comp. right of exemption per MGL
insurance required.] ' c. 152, §1(4), and we have no 12.E] Roof repairs
employees. [No workers' 13.❑✓ Otheraeeessory structure
comp. insurance required.]
"Any applicant that ecks box#1 most also fill out the section below showing their workers'compensation policy information.
f Homeowners who bmit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that the k this box most attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sull-connectors have employees,they most provide their workers'comp.policy number.
l a u an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site
information.
Insurance Company Name: Berkshire Insurance Group
Policy#or Self-i is.Lic. #:AWC-400-7028459-2017A Expiration Date:11/27/2018
Job Site Address 45 Cahillane Terrace City/State/Zip:Florence, MA 01062
Attach a copy at the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure atsverage 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 1 day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of he DIA for insurance coverage verification.
Id o hereby cera under rhe ains and penalties ofluni that the information provided above is true and correct
Signature: � ' "i .'w. Date 5-1-2018
Phone#:413-56 -7171
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 H alth 2.Building Department 3. City/Town Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other
Contact Pers n: Phone#:
i
ORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
1 INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800)876-2765 NCCI NO 26158
POLICY NO. AWC-400-7028459-2017A
PRIOR NO. AWC-400-7028459-2016A
ITEM
1. The Insured Hometown Stuctures LLC
DBA
Mailing add, ss: 627 Southampton Road FEIN: '_"'6332
Weslfiefd.MA 010850000
Legal Entity yps: Limited Liability Company
;nor a,ouplaces not hown above: See Location
2. The policy pIrs'Liability,
rind is from 11/27/2017 to 11/27/2018 12:01 a.m.standard time at the insured's mailing address.
3. A. WorkerCompensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states ted here: MA
B. Employ Insurance: Part Two of the policy applies to work in each state listed in item 3.A.
The limils of liability under Part Two are: Bodily Injury by Accident $ 100.000 each accident
Bodily Injury by Disease S 500,000 policy limit
Bodily Injury by Disease S 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications.Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Classification Premium Basis Rates
Code Estimated Per St 00 Estimated
No. Total Annual Of Annual
Remuneration Remuneration Premium
I
INTRA 3371167
INTER SEE CLASS CODE SCHEDULE
Pialmum Premium 5 500 Total Estimated Annual Premium 516,806
GOV GOV Deposit Premium $17,549
STATE CLASS
-MA 2802 State Assessments/Surcharges
57 6.303.00 x 4.5600% 5743
'nis policy,including all endorsements, is hereby countersigned by '�(-:---/--'� — �— 11/28/2017
Authorized S:gnaluie Date
Service Office: Berkshire Insurance Group Inc
is Third Avenue P O Box 4889
Edington MA 01803 Pittsfield, MA 01202
'ic 00 00 01 A(7-11
,coves copyrighted Mal flat of the National Council on Compensation lnauranre,
el With its permission.
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30-year architectural 2 x 4 rafters 16" on
shingles over 1/2" CDX center with collar
plywood roof sheetin ties 4' on center
exclusivedetailing, t t � �� fir►
painted eaves,
and wood corners
double 2 x 4 top wall
plate, 2 x 4 wall studs
16" on center
double 2 x 6
a
header over doors
pressure treated floor
5/8" DuraTemp T1-11 fastened withsystem, 4 x 4 rails, joists 12"
galvanize _ — -----onrcenter, !r-pfywoad —
latex paint - or 1/2" CDX with vinyl
4. . « /
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HOMETOWN STRUCTURES +
627 Southampton Road "Mi.
Westfield, MA01085-1329 $,55-M-1v- r .
(4131562-7171 DrtlerDale .rJ 1 -1
www.HometownStructum.com stimated Completion:Date y. U' <Ks 01-)
8111 TotraX'v Gabr`/ Notes
Address S- Cc R:llane Tuna Sat off«K" p-Je o ' hofe
Fox<�, MA 6/nfo>
BhonerrGelIPhore9 .c)a?-fib b1
Email Address yy
py OuoT"W in-t1 J ❑ MOO
J In-stock Display Shed
1,Y To Be Custom Built Bade Colo. Say Cal"
him Color LJ I,1'tt frim color. 4Mits
[ Delivered Fully Assemnletl ;x.«es!mwaexo,,,wx,.�,r»„mw (Muex swan .-,m.a,:,va.�m ov
ZI Modular J Modular ' go"Call" DwCaror
:J Built on-Site Comers
Comer. WA,`!!-
Size I3"0. x 2Y SOFFIT CHOICE tFor aeu F,pIaM 6Me onlvl
SOFFIT NewEnpla�Sryla Onlyl JYentmp Vircyl wn�e
J New England Series OSald OumTempr-ll"gO ❑Yeminp Viva)sem
31 Keystone Series J Eco�orre Series JExvoxw saner Taia eearw�
O Aluminum sa@veraa oox Base Price $ -1 f.
Code
�e ;id�c, �`I' Door Adjustment $ - RUL)
_ k S
Window Adjustment $ — 3U
Shingles Windows ROMP D B'a4' J 5'x4J 54'x4' )0 4) 'X $ 1 Sy
U Dual Black _U 16x36•
J Eanhi Cedar _0 24'x36
J Dual Gray _0 36x36' Loh J4'xFr 04'x10' 06x.12' ❑ $,_
JDual Bra. —036x38'
❑ Weelhenwad 36x 40'
Window Boxes ❑ Wood Dt6' 030' $ .
❑
:k Harvard Slate ❑ Vinyl ❑ 24' ❑ 36'
Cl Charcoal Cray Color
Shutters :3 Wood Calor/Detail $
enp Edp '_ w JB I Gods Dw 06 J Vinyl
Single DoorD'c Door -F/uo� '�i3is g"'UC $ f 140
Nfidnl 43'x' Width '
Tyra ro�ile TypA
Kansan Tremae S$ $
Grids: JW OB Grids. AJW JB
emees_ JSm. JSlr,p eiroes. JSrn. JSuap {.Site Preparation-pad sizelexjectm1¢eeya1ua1r., $ q?.0 tiT
J& 0nrwidth Road Pemdt free $ VO n,T
Leading Menhaden ProMu I, Ista. o
sui $ "7,559.4(
Haller Truck Sales Tax $ 0
Z TOTAL $ 't,9bp-
Depit $ 31-
lS
- 7, 413. ' S'
os
s 'Balance $ SS
r X
Cuswncer Sign are
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