08-012 836 NORTH KING ST BP- 2011 -0877
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map :Bloc 08 - 012 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Siding BUILDING PERMIT
Permit# BP- 2011 -0877
Project# JS- 2011 - 001435
Est. Cost: $24197.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: YANKEE HOME IMPROVEMENT INC 89442
Lot Size(sq. ft.): 12719.52 Owner: STOWELL MARSHALL L & PATRICIA
Zoning: HB(100)//RI Applicant: YANKEE HOME IMPROVEMENT INC
AT. 836 NORTH KING ST
Applicant Address: Phone: Insurance:
82 INDUSTRIAL DR UNIT 2 (413) 584 -8318 WC
NORTHAMPTONMAO1060 ISSUED ON :412912011 0:00:00
TO PERFORM THE FOLLOWING WORK: REPLACE SIDING
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 4/29/20110:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
_ Department use only
D ity of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit
212 Main Street Sewer /Septic Availability
0126 Room 100 Water/Well Availability
N rthampton, MA 01060 Two Sets of Structural Plans
�DWGINS 41 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
MA 01090
Other Specify
APPLICATION 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
816- J40R H Map Lot Unit
N nY A y P7Z'5 , 4, A-IA, Ohb Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Current Mailing Address:
4/3 - --556 -- 2
4n1 60AITWiC 7 Telephone
Signature
2.2 Authorized Agent:
�/.�NKE� HC'MC Tiy��%V«ul�F'�t17 B2 ZuyluS� /,q� .��2. LAM�O�� MA O �Cl�d
Name (Print) -. Current Mailing Address:
ignature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building c� (a) Building Permit Fee if
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 +2+3+4+5) Check Number d
This Section For Official Use Onl
Building Permit Number: Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
'.
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 by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg & paved
p arking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES 0
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW W YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained I Obtained 0 Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
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 Alteration(s) ❑ Roofing ❑
Or Doors I]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [X] Other [0]
Brief Description of Proposed
Work: /R OV eXr 5 t / /AJ6 S11)11/G .4^i60 REtL' AC4 kJJ'7'N 1JCW
Alteration of existing bedroom Yes No Adding new bedroom Yes X No
Attached Narrative Renovating unfinished basement Yes X_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
I, t4RZ5f1144 STc)r.+/ELC
as Owner of the subject
property
hereby authorize YAtiIkC< 40ME �iC�Di/C/�IEit!% G f(,�� o�VA1
to act on my behalf, in all matters relative to work authorized by this building permit application.
D/V CoN7 r
Signature of Owner Date
I, Yrl�tiC' E AMC Or_'ctitCN�N7 ' cZ - 7�' 42217 e0AJ1gAf as Owner /Authorized
Agent hereby declare that t e 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.
Print Name
2d I
ignature of Owner /Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder C 5 -00
License Number
62 riyDvs'TP-tAC U2. AkRr-IAHyw oAj + MAr 01c666 .3 •tf- -2c1,2
Address Expiration Date
'k3 -31 52ig
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ygAJ4-_g /-Acme MINT / 6 e 5 e3 y
Company Name ff Registration Number
$2 xN , 0-- '5T / *4- VA!. �La�rHA�/ cn./ MA c?to6a 8 °7 -2c/2_
Address Expiration Date
Telephone q & 3 `/ f - *3 2S!
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....... No...... ❑
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 hire 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_ person 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 buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion ofthe 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 may be liable 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 State of Massachusetts General Laws Annotated.
Homeowner Signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
kl# Boston, MA 02111
www massgov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Aualicant Information Please Print Legi
Name ( Business / Organization /Individual): 6i4 KEE iettc_ l+�tr�oygl-yuT' — 6ega je17 R<3 ,jaw
Address: lP_ zW1vE
City /State /Zip: 11ld lAwrolv' MA . 0/ Phone #: �1 i3 3Y/ 5 Z S 7
Are you an employer? Check the appropriate box: Type of project (required):
1. Z am a employer with F 4. ❑ I am a general contractor and 1 6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
2. F I am a sole proprietor or partner-
listed on the attached sheet. $ E] Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
officers have exercised their 10.❑ Electrical repairs or additions
required.]
3. ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs
insurance required.] t employees. [No workers' 13.❑ Other
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 their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: &;CwAilr= 5/4
Policy # or Self -ins. Lic. #: �j�� 3d- / �/ Expiration Date: I e Z Z l` i J
Job Site Address: S' Atae7'N kl,("6 57 - eo�ezt i City /State /Zip: J1WN,9MP MA atoG
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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Si ature: Date:
Phone# 3 '3tf! -
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 #:
YANKEE HOME IMPROVEMENT, INC. All home improvement contractors and subcontractors
- MA# 160584 CT# 0673924 CSL# 089442 engaged in home improvement contracting, unless specifi-
821NDUSTRIAL DRIVE, NORTHAMPTON MA 01060 cally exempt from registration by Provisions of Chapter 142A
1- 877- 88YANKEE 1-877- 889 -2653 of the general laws, must be registered with the
- 413- 341 -5259 Commonwealth of Massachusetts. Inquiries about registra-
tion and status should be made to the Director, Home
Improvement Contract Registration, One Ashburton Place,
Submitted Room 1301, Boston, MA 02108 (617) 727 -8598
To:
(� ADO rT (G I L-, G 1
P — o' V`nkm'''t r n f
_ �IL��"o�e
` r DAT I � - I:? /10 CELL ONE �I,s _V0 1 9 - 7 2
We hereby submit specifications and estimates for work to be performed and materials to be used:
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WORK E LE
ooibeain the work or order the materials before the third day folbwing the sigr�ng of tlds Agreement tmtess ctor w�i begin the wak on or about
admoviledges
O (dace3. eamng delay gauged by car>ces beyond contractors oonaot me worx w;a be meted by (daze) - me ow<►er Hereby
and re t the sct+eduting dazes are approzertate and that such delays that are not avoidable by the Contractor inducting, ed to strikes. Acts of God. shortages of mated-
shall comply
with the requirements of this Agreement !n the event any dated in workmanship or materials, or damage caused by the Contractor, its subcontractors, employees or agents, is discovered
after cleanup, the Contractor shall, at its own expense, forthwith remedy. repair, correct, replace, or cause to be remedied, repaired or replaced, such dam-
age or such defect in materials and workmanship. The foreQ*m warranties shall survive any iron performed in connection with the agreed -upon Work-
We Propose here fumish that and labor - plete in accordance with above specifications, for the sum o
j
�! U dollars ($ 0 id/
Payment to be macK as follows: A Z � ) C? -7
%($ 2�� � ` i ii uponsignning g contract-, YANKEE HOME IMPROVEMENT INC. (, c
Name of Contractor/)esignated Registrant
7 % ( ) upon cornpiewn of � W� 82 INDUSTRIAL DRIVE
Street Address
% (S LO g� fSQ upon oompietion of S'KI r' Z" NORTHAMPTON, MA 01060 413 -341 -5259
city/stale Phone
�e c$ l o 99 9so shall be madeforthwith upon 160584
completion of work under this W15� 1 4 Re No.
a
Notice: No agreement for home improvement contracting work shall require a down Name of Salesman
payment (advance deposit) of more than one -thin of the total contract price or the
total amount of all deposits or payments which tf fp contractor must make, in advance. Authorized signature
to order and/or otherwise obtain delivery of special order materials and equipment,
whichever amount is greateL
Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon
signing, this proposal becomes a binding contract. You are authorized to do the work as speafied. Payment wiA be made as outlined above.
You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the Seller, which may be his main office or
branch thereof, provided you notify the Seller in writing at his rosin office or btartch by ordinary mai{ posted, by telegram sent or by delivery, not later than
midnight of the third business day fot{owing the signing of this agreement Please refer to the Notice of Cancellation that accompanies this contract, con-
tents of which are referred to above and incorporated herein by refererx:e.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
SignatureDate ./ -3 - - / t o Signature Date
k'_ 4 1 : �