13-020 (4) BP-2022-0455
20 ROCKLAND HEIGHTS COMMONWEALTH OF MASSACHUSETTS
RD
Map:Block:Lot: CITY OF NORTHAMPTON
13-020-001
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0455 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOW/DOOR Contractor: License:
Est. Cost: 7860 SAM MACNICOLL 073044
Const.Class: Exp. Date:03/05/2024
Use Group: Owner: NORMA ROCHE
Lot Size (sq.ft.)
Zoning: RI/SR Applicant: SAM MACNICOLL
Applicant Address Phone: Insurance:
200 W HAWLEY (413)339-4362
HAWLEY, MA 01339
ISSUED ON:04/28/2022
TO PERFORM THE FOLLOWING WORK:
WINDOW AND DOOR REPLACEMENT
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
• ! >2 . CP 1 •
' 11
Fees Paid: $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
or 1-_-_-:rl-!a 1 `I w kz r Pa _-
Fi ECEIV t:
1
The Commonwealth of Massachusetts Q F 2 7 a 22
0 4 Board of Building Regulations and Standards FOR I
Massachusetts State Building Code, 780 CMR I 1„t I. (IPALITY ...1DEPT.OFigtgEDING INS DECTIONS
NORT PT ,
Building Permit Application To Construct,Repair,Renovate Or Demolish a —_._Rewse�L"iaz 4�'l�'IP mos° i- -- -
One-or Two-Family Dwelling
This Section For Official Use Only
Building ermit Number:@PP- A a• Y�d Date Applied:
ev)� Z5. /� lam y-Z7Z0zZ
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
20 45c14LG',��Q //E\94t. L1 ? i3 aCJ
1.1 a Is this an accepted street?yes x no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public CI Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2�.1, Owner'of Recor
Nat ko
c. -� AU OE 241 R rrl/p)1-6 .41 /44 A
Name(Print) City,Slate,ZIP
� 0-0 e I/ /a lie / /i his #2 4Q / 'G-v36y
No.and Street Te one Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alterat"" 99ion(s) 0 Addition 0
Demolition 0 1 Accessory Bldg. 0 Number of Units_ Other Specify:Wj 0
Brief Description of Proposed Work2: Q t.p/,Q/ ey44j.4-
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 7d•�, 3 6 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ` V ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. , , Check Amount. L ash Amount:
6.Total Project Cost: $ 7$� ` �l,(j (j' � g
0 Paid in Full 0 Outstandin Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C O730 V4/ !,
-cam M`t G,N I C ) !�� License Number Exp. Lion ate 7
Name of CSL Holder t ,(
� ^or '1 1 r 114 List CSL Type(see below) V
N. and et Type Description
No.and Street
//4 I, / £ r ,Al A O 133,1 U Unrestricted(Buildings up to 35,000 Cu.ft.)
City/Town,State,ZIP lr` R Restricted 1&2 Family Dwelling
M Masonry
C "3:) 3 /3 ! 3 C Z RC Roofing Covering
77 v WS Window and Siding
SF Solid Fuel Burning Appliances
al'✓� QS/C�Ny) L I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement 5 ement Contractor(HIC) / 227'I n 3 �y
Glv/C)4C-_ HIC Registration Number • 'on Date
HIC Company Name or HIC Registrant Na
No. ',�AA)L L V /1 c y/3J Sane des d b 14;4470�►4-R t'� �811•j
`/i9WL Eytreet ✓4/4 0i1 'i =y36�- Email address
City/Town,State,ZIP Telephone
SECTION 6: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 Issuan o the building permit.
Signed Affidavit Attached? Yes No .❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FORS BUILDING PERMIT
I,as Owner of the subject property,hereby authorize_SQ wi I"(4 G./v 1 C al.e..—
to act on my behalf,in all matters relative to work a o ' ed by this bui ding permit application.
AJO('m,q U�.a C �/1 j 0 '/ 2-7/i-2—
Print Owner's Name(Electronic Signature) ate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Q /'1il I RG Pf c0G.� y ...
Print Owner's or Authorized Agent's Name(Electronic Signature) D tc
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
,4 Massachusetts ..
t
DEPARTMENT OF BUILDING INSPECTIONS.� y. �+
M 212 Main Street • Municipal Building
jF Northampton, MA 01060 F �\A
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Q/by a // lep -\
The debris will be transported by:
Name of Hauler: ZD Q 1� r `te a tea, L Ain, G��iCY g?� i)(// (�
v�
(1/2V2-2--
Signature of Applicant: Date:
The Commonwealth of:Massachusetts
f, Deipartment of Industrial Accidents
• :� t;t 1 Congress Street,Suite 100
'•�•= • Boston, MA 0211,E-2017
www.mass.gov/diia
1lutken'Compensation Insurance.lf idasit:BuilderalUontradorsrl•:irctricianvPlumbers.
10 BE.E11.Ei)N 1111 I HE.PERMITI INC At"1'110111 11.
Applicant Information CC M` ' ,t Please Print l ibis
Name l Business organization hilts idual l: . Q it /� 4 G Ai/t!B Gl
Address:200 w A lj� d i3 q
City?State/Zip: //Aw L Y- 144 A- Phone#: q /3 3 3q-
Are Dos as i niployer'.('beek the appropriate boa:
Type of project(required)
I.Q I am employ.:with empiuyees I lull and or port-time I• 7. CI New construction
am a suk proprietor or ponnerslitp and hate no employees working for rtrc in X. DI Remodeling
am tapa.it!, (Vu wurkcn'euaip.ursunine reywrctl.j
9. ❑ Demolition
10 I ani a homeowner doing all wort.myself.rho worloas comp lnsura1Ke rt[lallot f
I 0 Q Building addition
4.0 I anTi a IoonAciw ncr and will be hiring eontra..4urs to conduct all Noels on in) prtip.rt t I w tU
ensure that all eolttraetun either hate%otten compensation utsurantx or are tole I I Electrical repairs or additions
propncton w ith no employees
12.0 Plumbing repairs or additions
sO I ant a hn-ncrat tonatretor and I base hired the subtiomt:actors listed on the anachcal sheet
I lase wb-tuntrxetom base employees and lust w irlers'ccenp.insurance 13CI Roof it`patrs
er
6.0 Vic arc a corporation and its officer.hiss,:e;etcised then right tit exemption per!steel.c 14" th
It_.;II 4) and we lute no employees.NVu workers'comp insurance required.I w' AV S Af'0)e12_,•Any applicant that thctks ova a I must also till tut ter',tenon below show mg then weat..zs eompcnsaitun policy information
o H mey%irn who sut,mii Itus at-litho it indseatina the!,are doing all wort and then titer'outside contractors axed submit a new affidatiit indiiaeing such
onira.ton.ttiat cheek this lion must atiathed an additional sheet shone mg tlx:name of the suh-comtractors and state whetter or nut those entities hysc
cmploscc, If the suh-.emtraetors Iv.c emTTph..ci,.ttict must pro.v+ide their v.ort.er.'cinnp pott:!.number
I am an employer that is providing worriers'compensation insurance for m)•employees. Below is the police•and job site
information.
Insurance Company Name.
Policy#or Sell-ins. Lie.#: Expiration Date.
Job Site Address: C►t} State:'Zip: _
Attach a copy of the workers'compensation policy declaration page(showing the policy number and eipiradon date).
Failure to secure coverage as required under MGL c. 152.§2SA is a criminal violation punishable by a tine up to SI.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 S250.00 a
day against the stolalor. A cops of this statement may he forwarded to the Office of Insestigations of the DIA for insurance
coseraue serificatton.
I do hereby certify under the pains and penalties of perjury that the in/ormalion provided above is true t nd correct.
Si neturc -�� Date- `,/.� 7
Phone r:: 3 C �� O.9--
Official use only. Do not write in this area.to be completed by city or town official
('its or 1 oss n: Permit+l.ieen.e a
Issuing:lulhorits Icircie tine):
1. Board of health 2.Building Department 3.( its:l own Clerk 4. Electrical Inspector i. Plumbing Inspector
h.Other
('unmet Person: Phone#:
AW CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDfYYYY)
`.-- 03/10/2022
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; If the certificate holder is an ADDITIONAL INSURED,the policy(es)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME
FIRESIDE INSURANCE AGENCY, INC. PHONE FAX
36 Shank Painter Road #10WC. xtr°'E IArc.Ho':
P.O. Box 760 ADDRESS:
Provincetown, MA 02657 INSURER(S)AFFORDING COVVERAGE MC*
INatmetA: AmGUARD Insurance Company 42390
INSURED
Sam MacNicoll INalrteee°'
Sam &Sam Building&Remodeling INauRoec:
200 W Hawley Rd INSURER D: _
Charlemont, MA 01339-9616 INSURER!: _
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
INDICATED. NOTWITHSTANDING 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDL SUM POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER ,jMMIDDIYY,v, f MMIDD/YYYVI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE ''$ 1.000,000
A X ' CLAIMS-MADE X 1 OCCUR DAMAGE TO RENT EO
PREMISES(Ea 00 urenpel $ 50,000
SABP242652 09/18/2021 09/18/2022 MEDEXP(Any one Person) $ 5,000
PERSONAL&ADV INJURY $ Included
GEN'L AGGREGATE UMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000
X POLICY I 1 T LOC
PRODUCTS-COMP/OP AGG $ 2.000,000
OTHER -.. 5
AUTOMOBILE LIABILITY CO MOLE UNIT $
Ea accidenB
ANY AUTO BODILY INJURY(Per parson) $
OWNED SCHEDULED BODILY INJURY _ .._
AUTOS ONLY .AUTOS accident) S
E--.AUTOS ONLY ..—.. AUTOS ONLY F a'NON-OWNED ccident PROPERTY
DAMAGE f
�_
_ FELLA�B _ OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE _ $
DED RETENTIONS $
WORKERS COMPENSATION PER I OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE , �R
ANYPROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $
OFFI GER/MEMBER EXCLUDED? N ,NIA. -- -- - --.
(Mandatory In NM) EL DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Add Itional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Norma Roche ACCORDANCE WITH THE POLICY PROVISIONS.
20 Rockland Heights Rd.
Northampton, MA 01060 AUTHORIZED REPRESENTATIVE
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
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Existing Room
132.00"
ANDERSON ANDERSON ANDERSON
RO Size=24 518"x 53 3/8" RO Size=24 518"x 53 318"
C145,400 Series Casement P4045, 400 Seres Picture Window-OW C145,400 Series Casement
RO Size= 48 112" 53 318"
Wall framing shall conform to IRC R602.3
Framing Details as per Figure R602.3(2)
Fastener Schedule For Structural Members Table R602.3(1)
27.21"
SAM & SAM
NORMA ROCHE - Window Framing Schedule Buildingloommommi
and Remodeling
�+ �
20 Rockland Hieghts Rd. Northampton, Ma. Scale: 3/4" License-CS 07044/Registration- 127780
= 1 (413) 339_4-362
,A} ,A) n co
VANDERSEN'"
SOLD BY: SOLD TO: 2/22/2022 CREATED DATE
Hamshaw Lumber Co Inc.HAM$HRW Green1123fiGreenfield,MA 01 ernardston ORd1-1164 LATEST UPDATE
LUMBER INC. Phone:413-774-6311
OWNER
John Gustin
Abbreviated Quote Report -Customer Pricing
QUOTE NAME PROJECT NAME QUOTE NUMBER CUSTOMER PO# TRADE ID
MACNICOLL MACNICOLL 1911568
ORDER NOTES: DELIVERY NOTES:
Item gty Operation Location Unit Price Ext.Price
100 1 Left None Assigned 5523.97 $523.97
RO Size=24 5/8"x 53 3/8" Unit Size=24 1/8"x 52 13/16"
C145,Unit,400 Series Casement,Installation Flange,White Exterior Frame,White Exterior Sash/Panel,Pine w/Unfinished Interior
Frame,Left,Hinge with Wash Mode,Dual Pane Low-E4 HeatLock Standard Series Argon Fill Traditional Trim Stop Profile
Stainless Glass/Grille Spacer,Classic Series,Stone,Stone,Full Screen,Aluminum
Hardware:PSC Classic Series Stone PN:1361537
Insect Screen 1:400 Series Casement,C145 Full Screen Aluminum Stone PN:1344048
Unit# U-Factor SHGC ENERGY STAR Clear Opening/Unit# Width Height Area(Sq.Ft) Comments:
Al 0.24 0.31 YES Al 14.4230 47.9610 4.80380
Quote#: 1911568 Print Date: 2/22/2022 8:24:46 PM UTC All Images Viewed from Exterior Page 1 of 3
Item gty Ope
ration Location Unit Price Ext.Price
200 1 Right None Assigned 5523.97 $523.97
RO Size=24 5/8"x 53 3/8" Unit Size=24118"x 5213/16"
C145,Unit,400 Series Casement,Installation Flange,White Exterior Frame,White Exterior Sash/Panel,Pine w/Unfinished Interior
Frame,Right,Hinge with Wash Mode,Dual Pane Low-E4 HeatLock Standard Series Argon Fill Traditional Trim Stop Profile
Stainless Glass/Grille Spacer,Classic Series,Stone,Stone,Full Screen,Aluminum
Hardware:PSC Classic Series Stone PN:1361537
Insect Screen 1:400 Series Casement,C145 Full Screen Aluminum Stone PN:1344048
Unit# U-Factor SHGC ENERGY STAR Clear Opening/Unit# Width Height Area(Sq.Ft) Comments:
------------------
Al 0.24 0.31 YES Al 14.4230 47.9610 4.80380
Item (3ty Operation Location Unit Price Ext.Price
300 1 Fixed None Assigned $645.55 $645.55
RO Size=48 1/2"x 53 3/8" Unit Size=48"x 52 13/16"
¢c
33g
,', P4045,Unit,400 Series Picture Window-CW,Installation Flange,White Exterior Frame,Pine w/Unfinished Interior Frame,Fixed,
Dual Pane Low-E4 HeatLock Standard Series Argon Fill Traditional Trim Stop Profile Stainless Glass/Grille Spacer
Unit# U-Factor SHGC ENERGY STAR Comments:
Al 0.22 0.34 YES
SUB-TOTAL: $1,693.49
FREIGHT: $0.00
LABOR: $0.00
TAX: $0.00
TOTAL: $1,693.49
CUST6MER SIGNATURE DATE
Qudte#: 1911568 Print Date: 2/22/2022 8:24:46 PM UTC All Images Viewed from Exterior Page 2 of 3
HAMSHAW LBR INC-GREEN-BPD
EXT SU EXTERIOR DOOR UNIT Printed on 02/28/2022 12:55:23 PM
Configuration: Quantity: 1
FIBERGLASS DOOR, SGL, LH, IS, 3-0, 6-8 HGT, DO692BLYPA, SGL BORE & 218
DBLT BORE, PREP JAMB FOR DBLT, SQUARE RADIUS HINGE, SATIN NICKEL ..._
HINGE, 4-9/16, COMPOSITE PRIMED FRAME, BRONZE COMPRESSION WS,
*ALUM COMP MILL SILL*, NO CASING, 3-1/2 HORNS
No Glass
a s
Image
' Q �
plEsaftsla
Patina
Please note the following:
$1626.50 (plus sales tax)
*Subject to availability and current pricing.
'
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