42-089 170 GLENDALE RD BP- 2007 -0088
GIs #: COMMONWEAL'T'H OF MASSACHUSETTS
Ma -.Bloc 42 - OS9 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2007 -0088
Project # JS-2007-0136
Est. Cost: $150000.00
Fee: $120.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use GroiT: AMERESCO 081332
Lot Size(sa. ft.): Owner: NORTHAMPTON CITY OF
Zonin SR/«P Applicant. AMERESCO
Li/33 86 - 7( W
Applicant Atiaress: Phone: Insurance:
111 SPEEN ST (508) 661 -2220 WC
FRAMINGHAMMA01701 ISSUED ON. 712812006 0.00 :00
TO PERFORM THE FOLLOWING WORK .- ERECT (2) 400 SQ FT CONTAINERS ON SLAB
POST THI C. ;� P Z l) SO IT IS VISIBLE FROM THE STREE
Inspector (," F' � ',1,'. 'g Inspector of Wiring D.P.W. Building Inspector
Undergr iid: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: _ ina1: 611 ? hp
AJ A' r Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: - Insulation:
J w
Final: S a�oke: ;° aeec.: 0 J -� � t � l � (..6(41J'
THIS PERCMIT �VIAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY Oh I' I'S RULES AND REGULATIONS.
r ��,�� Si
Certific ;;, nature: �;..�_ ���,nc.�r� s
FeeTy Date Paid: Amount:
Building 7/28/2006 0:00:00 $120.001662
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
City of Northampton
� Building Department ,
212 Main Street
r �n R 100 ,f
Room F
t
��p09 Nb th mpton, MA 01060
phone 41,3- 581240 Fax 413 - 587 -1272
``��
Tfo� TOj��N$TRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
_
SE TIO - SITE INFORMATION
1.1 Property Address This section to be completed by office
Map Lot Unit
(2 Zne Overlay District .
St District CB District
.SECTION ;2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
Telephone
elephone
2.2 Authorized Agent:
T skQ peel
Name (P ) Current Mailing Address:
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a),' Building Permit Fee
Cu
2. Electrical (b); Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) - VQ , ciz f Check Number S
This Section ForOfficiaf Use Oril
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings - Date
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A �
a
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 :1
Rear _ _.... ..._.
Building Height
Bldg. Square Footage r l_ _x
Open Space Footage -
(Lot area minus bldg & paved
p arking)
# of Parking Spaces
Fill: C"
volume & Location) -- A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES
IF YES, date issued:; �___.�..,_......�
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT 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 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location: "
....... _._.. . __. ....
D: ire Here an� iro ° os cfian es to or a ]Mons o s� ns inten d - tFie ro ert YES 0 NO 0
P Y• ?
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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
A
s
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replaceme indows Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (Q Siding [O] Other [a]
Brief Description of Pr9posed
Work: (a-Lt
Alteration of existing bedroom Yes ✓ o Adding new bedroom Yes — _.ZN o
Attached Narrative Renovating unfinished basement Yes ccc/// No
Plans Attached Roll - Sheet
sa: If, .146 lii6di aria or acfctfionM #o iezistlnd tious'Inp,:corriptete the fatltawtnA:
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 Ta.- OWNER AUTHORIZATION TO BE'COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT`
I, as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
`h,- ' It a_,Io as Owner/ uthorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of edge
and belief.
Sign d under the pains arolpenalties of perjury.
Print e
r.
Signature of Owner gen ) Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor (t Not Applicable ❑
Name of License Holder: �Ll �Q\ irwt�a� �
��� License Nu b
Ad ss Expiration Date
'51griature Telephone lg
9. RegisteredlfomeinprciiementGon #ractor ,.,,., µ... F .' 3 Not Applicable ❑
Company Nam Registration Number
Address Expiration Date
Telephone
SE CTION 10- WORKERS COMPENSATION INSURANCE AFFIDAVIT (M.G.L, c. 162, § 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...... ❑
_.The-current-exemption for _ "homeowners" was ext ended to_include Owner - occupied Dwellinss 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. CAM 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 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 iniuries 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
o afripton r finances; a e - o s Cenera-l-- Laws - Annotated.
Homeowner Signature
i
the Commonwealth of Massachusetts
Department of In dustrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1i is
- Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumb.ers
Applicant Information Please Print Legibly
Name ( Businesslorganmuon/Individual):
Address: S �a.�ut � fZ� � � A,(A -at y
City /State/Zip: Phone. #:� —
Are ou an employer? Check the appropriate box: Type of project (required):
a employer with 4 •. ❑ I am a general contractor and I
employees (full and/or part time).*
have hired the sub- contractors 6. ❑ New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet: 7. ❑ Remodeling
ship and have To en q) , loy ees These sub - contractors have. .g. [] Demolition
working for me in any capacity. employees and have workers'
clrran 9. Butt Q addition
[No workers' comp. in
comp—insu 0
required ] 5. [] We are a corporation and its 10. ❑ Electrical repairs or additions
a _ _ -- oc _ehavexer cis taeia`—
3. [] I- am- a- hemeawaer- tiema�� work - -- - -- - = �- -1?Iumbs�g repairs or additions
myself [No workers' comp. right of exemption per MGL 12.E Roof repairs
insurance required:] t c. 152, §1(4), and we have no
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.
fi
Homeowners who submit this affidavit indicating they are doing all work and the 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
in ormatwn. .
Insurance Company Name:
Policy # or Self-ins. Lic. #: `-( 3 (o f ��7 ( Expiration Date: �.
Job S ite Address: 1 �` �� K 0�✓ City /Sta&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 Section 25A of MGL c. 152 can lead'to the imposition of criminal penalfi
fine tip to $ I,,500.00 and/or one=year imprisonment, as well as civil penalties in the form of a STOP es of a
WORK ORDER and a fire
of up to $250.00 a day against the violator.: l5e advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification
and enalties o er'u that the in ormadon rovided_above is e_andc rrect.___ _
I do herehy ce under P p -- fP 1 -'T f p
Signature: ate:
Phone #: �o _
Official rise only: Do sot wine in tlts errors, — to be compfeied by city or iowrc offciaL
City or Town: Per-mitUcense #
Issuing Authority (circle one):
L- Board of Health 2. Building Department 3. City/Town - Clerk 4. Electric Inspector 5. Plumbing Inspector
- -. _
6. Other r
Contact Person: Phone #-
BAYSTATE WINDOW
87 SHATTUCK RD
HADLEY, MA 01035
(413) 549 -6824
CS 89485 / HIC 125626
CONTRACT
DATE: 6/15/09
PROJECT: BRIDGITTE HOLT
ITEM DESCRIPTION COST
INSTALL 30degree BAY WINDOW, PROJ —11" $3150.00
WH, VINYL, HALF SCREENS, Y9" FLANKERS
CONSTRUCT ROOF & FINISH W /SHINGLES
REFRAME OPENING — REFINISH WALL
RE -TRIM INTERIOR & EXTERIOR TO MATCH
EXISTING WINDOWS
GRIDS BETWEEN GLASS $125.00
PERMIT FEE $75.00
�j TOTAL $3350.000,,,,-
1
- DEPOSIT $ _f_�,_
BALANCE $
We hereby agree to furnish labor & materials — completed in accordance with
The above specifications, at above stated prices.
OWNER DATE 4 1 0 �
CONTRACTOR DATE
UNDERLYING DAMAGES WILL BE BILLED SEPERATELY