42-014 (5) 254 WEST FARMS RD BP-2019-1320
Gls#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:42.014 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cateeev,window replaced BUILDING PERMIT
Permit# BP-2019-1320
Project# JS-2019-002131
Est Cost:$8308.00
Fee:$63.00 PERMISSION IS HEREBY GRANTED TO.
Const.Clens: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sa.R): 19994.04 Owner, HEIHSEL LAURI A&ROSEMARIE J BRODEUR
Zoning: Applicant: RENEWAL BY ANDERSEN
AT: 254 WEST FARMS RD
Applicant Address: Phone: Insurance:
30 FORBES RD (508) 919-0900 WC
NORTHBOROMA01532 ISSUED ON. 0:00:00
TO PERFORM THE FOLLOWING WORK INSTALL 3 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 5/23/20190:00:00 $63.00
212 Main Street,Phone(413)587.1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
DeparMent use only
City of Nort am o permit:
Building De art ent Cu Driveway Permit
2t2 Main Stre t MAY 2 0 2019 ., ns plic Availability
Room 100 er all Availability
Northampton MA 7 Se of Structural Plans
phone 413587-1240 Fax°4 ' 47,1, sA?j Sit Plans
ecify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO LL
/FAMILY DWELLING
EO
SECTION I -SITE INFORMATION v P1
1.1 PropertyAddroa: , L L This section to be completed by
once
254 West Farms Rd. Northampton, MA 01060 Map Lot Unit
Zone Overlay District
EIm SL District Ca District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Lauri Brodeur-HeMsel 254 West Farms Rd., Northampton,MA 01060
Name(Print) Current MallinAddress:
413-563-1005
See Attached Contract Telephone
Signature
2.2 Authorized Apent:
JAIME MORIN 30 FORBES ROAD NORTHBORO,MA 01532
Name(P' Current Mailing Adtlress:
508-351-2277
Signet Telaphona
E ION 3-ESTIMATED CONSTRUCTION C
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8,300 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from e
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) 8,308 Check Number
This Section For Official Use Only
Building Permit Numb r: Date
Issued: p
4142
Signature: �✓-Z�J-�) I
Budding Commissionlerfinspector of Buildings Date
<I .n
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in b,
Building Depadmmr
Lot Sim
Frontage
Setbacks Front
Side L: R: L: R: -...�
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bid,a pvcd -----�
isiniong)
#of Parkin Spaces ---
Fill:
volumealacauo
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW Q YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DOME KNOW O YES O
IF YES: enter Book 'L Page and/or Document#
B. Does 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. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
IF YES, describe size, type and location: C _
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it par of a common plan
that 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-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteratloni ❑ Roofing ❑
Or Doors IM
Accessory Bldg. ❑ DentolNion ❑ New Signs [0] Decks [O Siding[[3] Other[[3]
Brief Description of Proposed
Work: Replace 3windows
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 addition to existing houi complete the following:
a. Use of building :One Family Two Family Other
b. Number of rooms in each family ung: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
I. Method of heating? Fireplaces or Weodstoves 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
1. 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
I. Lauri Brodeur-Heihsel as Owner of the subject
property
hereby authorize JAIME MORIN
to act on my behalf in all matters relative to work authorized by this building permit application.
SEE CONTRACT 5/15/2019
Signature of Owner Data
I JAIME MORIN 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.
JAI ORIN
Print Name
5/15/2019
Sgnatu of enAgera Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holler: JAIME MORIN 90125
License Number
30 Forb_quir7Rd. , Northborough, MA 01532 10-06-20
Aptlreas F�iralion Date
508-351-2277
Sig luy Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 FORBES ROAD NORTHBORO,MA 01532 12-22-19
Address Expiration Date
TelephoneSOR-351 -2277
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IA.D.L.c.182,§2SC(8))
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....... n No...... 0
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 hive 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 torsos 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 he/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)ofthe Massachusetts General Laws Annotated,you may be liable for persons)
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 Caws Annotated.
Homeowner Signature
�\ The Commonwealth of Massachusetts
Deportment oflndus(rlalAcchfenu
I Congress Stree4 Sulu 100
Boston,MA 07114-2017
eeww.mass.gouldiu
ulkAl' Compenmtlon Insurance Affidavit:Bu1WedCoovacturr/FLrtriciao✓Plumbere.
TO BE FILED WITH THE PERMITTING AOTNORITV.
A
Name farnueew wos, vlcdividual):Renewal by Anderson
Address :30 Fomes Rd.
City/StuelZip:Northborough,MA 01532 P6we 0:5"1-2277
Ars ymm saeuYVY rte t seypnadur be Type of projat(required):
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Afornadon.
Insurance Company Names dtl Repnbga hnlaellee Cd
Poliryf or Sdf.im.Lie.M: MWC31431500 Expiration Due: 10/1119
lob Site Address: 254 West Farms Road Cty/Stad2ip: Florence, MA 01062
ARCM a Copy of We workens mo pematioo policy dedantion page(showing the policy cumber and eapl ndra chisel.
Failure in acute coverage is required under MGL c. 152.525A is a criminal viclulon punishable by a fin up to 81,500.00
and/or one-yw impr uxurcut,w well m civil Penalties in the form of a STOP WORK ORDER and a lint of up to 5250.00•
day ag.res the vwluor.A copy of this ssuemem may lir forwWN to the Office of I.,.,i aiom of the DIA for insurance
coverage venfiwi
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Cis,we Tow.: Permlf/IJceuae s
lading Authority(circle one:
1.Board of Heaith 3.Bundling Deparuvent 3.Ciryaow.Clerk e.Electdral mspecror S.Flo mining l.spector
6 Other
Course,Perso.: Phone.:
'� sage 1 aE 1
ACEMBA CERTIFICATE OF LIABILITY INSURANCE
11 1 l0/O3/3010
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: Hung cedNlrate holder IS an ADDITIONAL INSURED,the pollOy(W.)must haus ADDITIONAL INSURED pmvtslons or be endorsed.
If SUBROGATION IS WAIVED,su61e0 to the W.8 and conditions of Me policy,c Main pWlcks may nquks an andoraement. A statement on
MIA catMcate does not confer rl hts to the ceHlBcate holder In Ilau of such ondon fur s.
FABOUCER
Millis Of a U aorta, Inc. ;
O/O 36 Caatury Blvd jAry;-m-[n..l-0]]-HS-D]B '� a. 1-BBB-96] 3A0
P.O. Box 305191 EJYL e[[Sfleetea6v1111600a _.
NaaDvilla, IS 372305191 USA a%MIBYNNi01pp WYf9PWE XAc.
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INSURFA E'
W9USSAF:
COVERAGES CERTIFICATE NUMBER:Ma317760 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANONG ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES MENOMIEE)HEREIN M SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND OONDITIONSOF SUCH POLICIES.LIMITS SHOWN W Y HAVE BEEN REDUCED BY PM DAMS.
WNI'i T7%WYWMMICE -..MOLSULRi. ��, LIMITS
% COMlAML0ea9tMIMBMrY EAcnWcuwexrE t 1,000,060
aWNsawDE ❑% OCCUR 3 wo,oa6
A MSOEXP s 10,006
SHIP 31u61 10/01/2010 10/01/1019 PBTBdIK6AW WJUW a l,ae6,o06
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TGis Voids sed Raplacb e[evioualy ItsuM Certificate Dated 10/O1/3018 %ITa ID, 178391089.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ARGUE DESCRIBED POLICIES BE CANCELUFD BEFORE
THE FJIP MN DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCOPpANCE WIIN THE POLICY PROVBM)N9.
/,unlorUiEORFPRESEJIrATIVE
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01988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo am registsred marks of ACORD
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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: 254 West Farms Rd., Northampton, MA 01060
The debris will be transported by: Renewal by Andersen
The debris will be received by: Renewal by Andersen
Building permit number:
Name of Permit Applicant 2P
a Morin
5/15/2019
Date
tufa of of Permit Applicant
Renewal Agreement Document and Payment Terms
IAMdersen. dba:R.u..ralbyAnder—ofEoaloe Laurlerodeur-Helbsel
Legal Name:Renewal by Andersen ILC 254 West Farms Road
r�I HlC#170810 Florence.MA 01062
wweaw n rvn 30 Forbes Road I Northborough,MA 01532 H:4135631005
Phone:SM-351-22001 Far:(508)M-70721 r1cab05tonbookingOandersenc0,p.core
Buyers)Name: Lauri Brodeur-Heihsel Concoct Date: 04/30/19
Buyer(s)Street Address: 254 West Farms Road, Florence,MA 01062
Primary Telephone Number: 4135631005 Secondary Telephone Number:
Primary Email: BroheihOgmaiLeom Secondary Email:
Buyer(s)hereby jointly and severally agrees m purchase the products and/or service of Renewal by Andersen LLC d/b/a Renewal by
Andersen of Boston("Con¢xtor"),in accordance with the terms and conditions described in this Agreement Document and Payment
Terms,any documents listed in the Table of Contents,and any other document attached to this Agnomen[Document,the terms of which
are all agreed to by the Napat[ and incorporated herein by reference(collectively,thu"Agreement").Buyer(s)hereby agrees to sign a
completion certificarm after Comeactor his completed all work under this Agrccmer.
Total Job Armoric $8,308 By signing this Agreement,you acknowledge that the Balance Due,and the Amount
Financed most be made by personal check,bank check,credit cud,or rash.
Deposit Received $2,769
Balance Due: $5,539 Estimated Start: Estimated Completion:
Amount Formord: So 8 weeks 1 day
Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on
the date in which we complete the technical meauremenrs.'Ihe installation date that
we arc providing at this time is only an adical We will communicate an official date
and time at a later daft.Rain and eaueme weather arc the most common ausa for
delay.
Nota: 430/19 MCB342 $2769;Start 1/3 $2769;Sub Comp 1/3$2770
Buyers)agrca and understand that this Agreement wnstimus the entire understandings between the parties and that there are no verbal
understandings changing or modifying any of the terms of this Bement No alterations to or deviations from this Agreement will be
valid without the signed,written consent of both the Buyers)a s Carna r.Buyer(s)hereby acknowledges that Buyer(r) 1)has read this
Agreement understand the terms of this Agreement,and has received a completed,signed,and dared copy of this Agreement,including
the two attached Notice of Cancellation,on the date first written above and 2)was orally informed of Buyer.right to cancel this
Agreement.
NOTICE TO BAYER Do not sign this contra if blank You arc entitled to a copy of the contract at the time you sign.
YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT
OF 05/03/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER SEE THE ATTACHED NOTICE OF CANCELLATION ATION FORM FOR AN
EEXPLANaA IOyN OF TrvalyAndonaHIS RIGHT.
dra:Renee-.I by Andeuen offlomon aeyv(4)
1q17A N elb�"— '
Signature of Sala Person Signature Signature
Mat Broso Lauri Brodeur-Heihsel
Print Name of Salo Person Print Name Print Name
UPDATED: 04/30/19 Page 2 124
Renewal Itemized Order Receipt
byN Ider$en. dba:Nenewd by Andersen ureoseon butl erotleurNtlheel
11901 Name:Renewal by Andersen LLC 254 West Famn Fund
HIC 1170810 M. ,MA D1e62
......
.. ..�..... 30 Forbes Road I Northborough,MA 01532 H:0135631005
Plane:50&351.22x11 Fax:(509)966)0)21 rbzbostonbooRYpeandersencorP.rom
11001st DETAILS:
101 Livingroom Window: Gliding, Double, 1:1, Active/Passive, EJ Frame,
Exterior White, Interior White, Glass: All Sash: High
Performance SmartSun Glass, No Pattern, Hardware: White,
Screen: TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, III Clamshell interior trim
102 Livingroom Window: Gliding, Double, 1:1, Passive/Active, EJ Frame,
Exterior White, Interior White, Glass:All Sash: High
Performance SmartSun Glass, No Pattern, Hardware:White,
Screen:TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, III Clamshell interior trim
103 Study Window: Gliding, Double, 1:1, Passive/Active, El Frame,
Exterior White, Interior White, Glass:All Sash: High
Performance SmartSun Glass, No Pattern, Hardware:White,
Screen:TruScene with Exterior Color Match, Full Screen,
Grille Style: No Grilles, Mil Clamshell interior trim
WINDOWS:3 PATIO DOORS:0 SPECIALTY:O MISCO TOTAL $8.300
® Renewal by Andersen it committed to our eustomeri safety by
tnmplying with the rules and kad-tafr work praatirn spaded by the EPA.
UPDATED: 04/30/19 Pape 3 /24