31A-123 (7) 19 FORBES AVE BP-2021-0052
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3 1 A- 123 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 PER MIT
Permit# BP-2021-0052
Proiect# JS-2021-000081
Est.Cost: $10400.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BRIAN WORGESS 106973
Lot Size(sq.ft.): 10018.80 Owner: BIDWELL DENNIS P& MARY ANN KELLY
Zoning:URB(100)/ Applicant: BRIAN WORGESS
AT: 19 FORBES AVE
Applicant Address: Phone: Insurance:
680 BAY RD (508) 680-6271 SOLE PROPRIETOR
AMHERSTMA01002 ISSUED ON.7/20/2020 0.00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 11 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 Sianature:
FeeType: Date Paid: Amount:
Building 7/20/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
. ,�L Department use only
ate__r Cit of Northam flt?E � V/— L� atusPermit:
Building Department C rb C t/Driveway Permit
f ! % A � 212 MainStreet JUL 2 Q 2Q20 S wer/$eptic Availability
iy. 1'•
, I
Room 100 I ater ell Availability
Northampton MA o S is of Structural Plans
<` phone 413-587-1240 Fax"'4 SPECTI,Ptot/Siie Plans
r.naofoso
her Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: J This section to be completed by office
�l J/'(I 1� 2 �V Map Lot t �3 Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
N e(P 'nt) Current Mair g Address:
117.1—� Telephone
Signature
2.2 Authorized Agent:
�� IJ r/wt'�i3 T' l4 0 looms
Name(Print) Current Mailing Add ss:
6.9 L'i (�� 61?4p -62 z -1
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building —fit,
00 (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee (7
4. Mechanical (HVAC) I
5. Fire Protection
6. Total = (1 +2 + 3 +4 + 5) 01D Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: /
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement W;ipdows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [0] Other[p]
Brief Descr tion If Proposed
Work: t�L ,CC. R tAAda ird L� l �3 #"J I A L ee-o t QGe-W1,e44 �S
Alteration of existing bedroom Yes_�Tlo 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
as Owner of the subject
property V
hereby authorize 114 ',r1/ri a-ri— �/ �'Z"i�"'
to aqt on my behalf, in Oniditers relafive to work authorized by this building pe it application.
'Z"
Signature of Owner Date
I, 9`%-P..r., as Owner/Authorized
Agent hereby declare that the statem is and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed underthe pains and penalties of perjury.
Print Name
Signature of Owne Agent Date
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable El
q
Name of License Holder: IJ (a1YV .1• �O�'G� s' C5 — I d�
License Number
GI'o Bow �.�. w�ll.rs wt� a oo -z 313/ / 7 t
Address Expiration Da e
,&.9 •
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
0r'" a^J 1 (,V 7-0 --7-
Company Name Registration Number
10A
Address � �../ Expiration Date
S�Telephone �" "''Z'F'
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....... av/ No...... ❑
City of Northampton
cr
Massachusetts
1. ! DEPARTMENT OF BUILDING INSPECTIONS
Q 212 Main Street •Municipal Building
Northampton, MA 01060 11
Debris 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.
The debris from construction work being performed at:
/ I Fo(6c-s.
(Please print house number and street name)
Is to be disposed of at:
gr'ta4 Woje-55
� W1
(Please print name and ldfcation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
60 tIJ4��
Signat e of Permit A90TIcant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
o I Congress Street, Suite 100
Boston, AIA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aimlicant Information Please Print Le ibl
Name (Business/Organization/Individual): I or G
Address:
City/State/Zip: O(aOZ Phone#:
Are you an employer?Check the appropriate box:
Type of project(required):
1.E]I am a employer with employees(full and/or part-time).* 7. ❑ New construction
2. am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10E] Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1.❑ Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof p
Roof re airs
These sub-contractors have employees and have workers'comp.insurance.:
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other
152,§1(4),and we have no 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.
: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.Lic.#: 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 MGL c. 152, §25A is a criminal violation punishable by 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.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 perjury that the information provided above is true and correct.
Signature: i/ , Date: 4Zilc)
Phone#: &Vr��OD D `L
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#:
.� •
F, C S J�.-•
IAnde I Andersen Windows-Abbreviated Quote Report Andersen
Project Name:Mary Ann Kelly
Quote#: 568 Print Date: 06/24/2020 Quote Date: 06/11/2020 iQ Version: 20.0
�ealer: - - - .- -- ----_- Customer: Brian Worgess
Address ._— _-------- —_--
Billing
Phone: Fax:
Sales Rep: Christopher J Skiathitis Contact:
Created By: Trade ID: 011783 Promotion Code: I
Item City Item Size(Operation) Location Unit Price Ext.Price
0008 1 TWI 2'9 1/8"x 5'1"-8 Deg(AA) 2nd H NE Bedroom center $ 616.99 $ 616.99
Existing Opening Size:2'9 1/2"W x 5'11 1/4"H Unit Size:2'9 1/8"W x 5'1"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0-30, SHGC:0.32, ENERGY STAR®Certified:No
0007 1 TM 2'9 1/4"x 5'1"-8 Deg(AA) 2nd It NE Bedroom left $ 616.99 $ 616.99
Existing Opening Size:2'9 5/8"W x 5'11 1/4"H Unit Size:2'9 1/4"W x 5'11"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STARS Certified:No
Quote#: 568 Print Date: 06/24/2020 Page 1 Of 5 iQ Version: 20.0
Rem (]ty Item Size(Operation) Location Unit Price Ext.Price
0011 1 TWI 2'9 1/8"x 5'0 7/8"-8 Deg(AA) 2nd fl NE bedroom right $ 616.99 $ 616.99
Existing Opening Size:2'9 1/2"W x 5'11 1/8"H Unit Size:2'9 1/8"W x 5'0 7/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northam
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
0004 1 TWI 2'9"x 5'0 7/8"-8 Deg(AA) 2nd fl Office left $ 616.99 $ 616.99
Existing Opening Size:2'9 3/8"W x 5'11 1/8"H Unit Size:2'9"W x TO 7/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
0006 1 TWI 2'9"x 5'0 7/8"-8 Deg(AA) 2nd fl Office left center $ 616.99 $ 616.99
Existing Opening Size:2'9 3/8"W x 5'1 1/8"H Unit Size:2'9"W x 5'0 7/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northem
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
Quote#: 568 Print Date: 06/24/2020 Page 20f 5 iQ Version: 20.0
Item oty Rem Size(Operation) Location Unit Price Ext.Price
0005 1 TWI 2'9 1/8"x 5'11"-8 Deg(AA) 2nd H Office right $ 616.99 $ 616.99
Existing Opening Size:2'9 1/2"W x 5'11 1/4"H Unit Size:2'9 1/8"W x 5'11"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STAN Certified:No
0003 1 TWI T3 1/8"x 5'11 1/8"-8 Deg(AA) 2nd It Spare room center $ 691.54 $ 691.54
Existing Opening Size:T3 1/2"W x 5'113/8"H Unit Size:3'3 1/8"W x 5'1 1/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northam
U-Factor:0.30, SHGC:0.32, ENERGY STARO Certified:No
0002 1 TWI 2'9"x 5'11 1/8"-8 Deg(AA) 2nd fl Spare room left $ 616.99 $ 616.99
Existing Opening Size:2'9 3/8"W x 5'113/8"H Unit Size:2'9"W x 5'11 1/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
-- - --------------- -----------
Quote
---.Quote#. 568 Print Date: 06/24/2020 Page 30f 5 iQ Version: 20.0
item oty – Rem Size(Operation) _ Location _Unit Price Ext.Price
0010 1 TWI 2'9"x 5'1"-8 Deg(AA) 2nd It office right center $ 616.99 $ 616.99
Existing Opening Size:2'9 3/8"W x 5'1 1/4"H Unit Size:2'9"W x 6'11"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
0012 1 TWI 2'9 1/8"x 5'1 1/8"-8
Deg(AA) 2nd H spare room right $ 616.99 $ 616.99
Existing Opening Size:2'9 1/2"W x 5'113/8"H Unit Size:2'9 1/8"W x 5'11 1/8"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No
IT—i7,— 0001 1 TWI 2'11 1/8"x 4'5"-8 Deg(AA) Stairwell $ 727.75 $ 727.75
Existing Opening Size:2'11 1/2"W x 4'5 1/4"H Unit Size:2'11 1/8"W x 4'5"H
400 Series
Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-Eh)
Full Insect Screen,White
Viewed from Exterior Zone:Northern
U-Factor:0.31, SHGC:0.31, ENERGY STAR®Certified:No
Quote M 568 Print Date: 06/24/2020 Page 4Of 5 iQ Version: 20.0
Item Qty Item Size(Operation) Location Unit Pdoe Ext.Price
Subtotal 6 972.2
Total Load Factor Tax(6.250%) 435,7
Customer Signature 2.065
Grand Total
7407.
Dealer Signature
All graphics viewed from the exterior
Rough opening dimensions are minimums and may need to be increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or
other items.
MIPMM"Wl
Ask to see if all of the products you purchase can be upgraded to be ENERGY STAR®certified.
MAMM
This image indicates that the product selected is certified in the US ENERGY STAR®climate zone that you have selected.
Data is current as of November 2019.This data may change over time due to ongoing product changes or updated test results or requirements. Ratings for all sizes are specified by NFRC for testing and certgication.Ratings
may vary depending on the use of tempered glass or different grille options or glass for high attitudes etc.
Nexia is a registered trademark of Ingersoll Rand Inc.
Project Comments: -
Quote#: 568 Print Date: 06/24/2020 Page 5Of 5 iQ Version: 20.0