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44-090 (2) 94 BP- 2011 -0654 GIs #: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP- 2011 -0654 Project# JS- 2011 - 001064 Est. Cost: $16224.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 101962 Lot Size(sq. ft.): 74487.60 Owner: BERGERON LEONARD & MARY ELLEN Zoning: SR(100) Applicant: RENEWAL BY ANDERSEN AT. 964 FLORENCE RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919 -0900 WC NORTHBOROMA01532 ISSUED ON. 1126120110. 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 Sisnature: FeeType: Date Paid: Amount: Building 1/26/20110:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner City of Northampton Building Department 212 Main Street Room 100 Northampton, MA 01060 phone 413 - 587 -1240 Fax 413 - 587 -1272 APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I - SITE INFORMATION 1.1 Property Address - This section to be completed by office � Map Lot Unit A i Zane Uverlay District of EIm St. District CB District ' SECTION 2 - PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record Lenp Sc' L ,e rejA "I (,� L �' aencc �a �l[�T�✓�Cc ` � x(0(0 Name (Prin) Current Mailing Address: so� 0 Telephone Signature 2 Authorized Anent: U (S 3 Name (Print) Current Mailing Address: C 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 4e, 22 . 6) O 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) (a _ l i. Check Number 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 _ I Building Height J Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved p arkin g) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNO YES 0 IF YES, date issued:_ IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YE 0 IF YES: enter Book Page — i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW � YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q 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 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding [[J] Other [E] Brief Description of Proposed 1 � Y � Work: <e G ��� ��` �� , r, . � 1 I 1 ►. Ji c��� 5 \ �CG e_ Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa: I f New house and'or "additi on, o existinsa hous]n , c61 04 e:t6e:.f ©Ilcrw1 g 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? �/r - 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, e n ry Li C)LAe (-, as Owner of the subject property hereby authorize �lL , i to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner /Authorized Ackt hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my now e and belief. dig under.the pains and penalties of perjury. P 'at Nara Signature of Owner /Agent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervi Not Applicable ❑ Name of License Holder V; �Lt :l� f u�T 1 y ( l ( o 0 License Number Expiration Date Telephon , 9. Re istered Home I n roveinent Contractors Not Applicable ❑ Ile' I VIA lqq(0( Company Name Registration Number Address ����`` Expiration Date Telephone q ( - CC `1 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. -E Home Uv�ner Exe`mptioh The curr xemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families and to allow su omeowner to engage an individual for hire who does not possess a license, provided that the owner acts as su ervisor. CMR Sixth Edition Section 108.3.5.1. Definition of Homeowner on (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 tw ily dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs mohQhan one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Buildin icial, on a form acceptable to the Building Official that he /she shall be responsible for all such work performed under ttMilding permit. As acting Construction Supervisor your presence on they ite 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' Compe tion) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts Genera aws 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 the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts Gene Laws Annotated. Homeowner Signature Jan 06 11 07:12a Justin Kazmierczak 5087550278 P.6 10 06-s tit., Northburm.igl,, MA 01532 f &L WINI)OVVS, INC., n /B /A AMA flomc Improvement Contractor ,308; 919 - (1 100 & Fax: ; 7 74', j 987 -3013 Renewal Ucense # 149601 (Expires 1 /24/2012) byA ndersen. ✓ Federal "rax IU #83- 0404201 WINDOW I REPLACEMENT A.,&­., l'.� 1,u CUSTOM WINDOW AND DOOR REMODELING AGREEMENT buyerlsl Name Datr. of Afornomnnt Buyer(s) Street Address, City, Slate, and Zip Code E-Mail Address Homo Tolo honn Number Work Talaphone Number Buycr(s) hereby jointly and :k'verally agrees to purchase the products andJor services of J x L Windows, Inc. d/b /a Renewal by Andersen ( "Contractor - ), in aecordattca with the terms and conditions dc.s ribed on the front and llic rcwnsc of this aKrccmcnt and on the attached spxificulion shcet(s) (Collcetivcly, this "Agreement " Buyer(s) hereby agrees Iv sign n completion certifica after Contractor h completed all work under this k Total Job Amoun> � Estimated Storting Dote: Method of Payment: ❑Check Credit Cord ❑Cash 1 �� // OFinance Deposit Received (33 %): 5VOO Balance at Start of Job 133'%),51 Estimalod Completion Dow If payment is by Credit Cord, please fill out Balance on Substantia • },,b& 9d S — s' 7doll the Credit Card Receipt of Deposit Form Completion of J< 133% 7 Q By iniditling here, You acknl,wlc(Igc• Vial Ilia li,ilancc of SloxI of lnla and the l3alarice on Sula.stantial Completion Buyer Initial of Job r:uuuil be made h }' credit card :uxl nni,t be made by persnnal chick, hank check, or cash. Buyer(s) agrees and undetrstand% that this Ag reement constiitutCs the entire under%tanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that B l) has read this Agreement, understands the terms: of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. J & b Windows3. Inc. d /b /a Renewal by Andersen yer(s) Buyer(s) Bv- A��4�1� . i .Iliur nl I'r rII •I A anat;cr tii,�n• url , / 5i�,nalurc Print :Yana• of P r )Chet A'l unagcr Print Taint• Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD B USINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT ' e•c - -— — — — — — — — - ° -e — — — — — — — — — — — — NOTICE F CAN CELLATION NORCE-PF CA�VC 0�1 Dote of Transaction — You may cancel Date of Transaction I a:U 1 . You may cancel this transaction, without any penalty or obligation, within I this transaction, without any penal or obligation, within three business days from the above date. If you cancel, any I three bu clays from the above date. if you cancel, any property traded in, any payments made by you under the property traded in, any payments made by you under the Contra* of Sale, and any neohpble instrument executed I Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt I by you will be returned within 10 days following receipt by the Contractor ( "Seller") of your cancellation notice, I by the Contractor ( "Seller") of your cancellation notice, and any security interest arising out of the transaction will and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition Seller at your residence, in substantially as good condition as when received, any goods delivered to you under as when received, any goods delivered to you under this this Contract or Sale, or you tray, if you wish, comply Contract or Sale or you may, if you wish, Comply with the with the instructions of the Seller regarding the return i nstructions of the Seller regarding the return shipment of shipment of the goods at the Seller's expenses and risk. I the goods at the Seller's expense and risk. If you do make if you do make the goods available to the Seller and the the goods available to the Seller and the does not Seller does not pick them up within 20 days of the date pick them yp within 20 days of the date of r Nofice of YQVr NA9 Qt S9n� Wgn Yin m rain Yr 6mv of ionivilgtig Y QY mg rvtgin 9r 41mo Vr my vWs Jan 06 11 07:12a Justin Kazlnierc 5087550278 p.5 J A L Windows, Inc. d /b /a 104 Otis titrecl, Northbnrou AM 01 5 { Z Renewal Mn I IIC Lia•nsC # 149601 (expires (/24112) ]'hone 508.919.0900 • Fax 774.987.3013 redcral'['ux ID# 83.0404201 byAndersen. _ WINDOW REPLACEMENT nn AndcrKnComiNMN OF GREAT]:(( IV1A sst7s AND NEW HAMISME WINDOW SPECIMAnON SHUT Buyer(S) Namc Dale of Agreement oe O The Buyers) listed above hereby jointly and severally agree to purchase the goods nndlor services listed below, in a4ordancc with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREF,btIENT, of which this Specification Sheet is a part. WINDOW DECAMS 1, Contractor will Install a total of windows in Owncr's home, using the following individual quantities: Double Hung (DB) X F.quat Sash [] Cottage sash (1 /3 top, 2/3 bottom) ❑ Oriel Sash (2/3 top. 1/3 bottom) Casement (CW) Hinge right p Hinge left (.is viewed from exterior): ❑ Standard handle ❑ Metro handle r" Double Casement (CDW) ❑ Standard handle ❑ Metro handle --te Casement / Picture / Casement (CPW) ❑ 1 :1:1 or ❑ 1:2:1 ❑ Stand;trd handle ❑ Metro handle 2 Lite Cliding Window WW) `--Glidcr / Picture / Glider (GPW) ❑ 1:1:1 or [l 1:2;1 — Awning Window (AW) ..�- Picture Window (PW) [Say or Bow Window ' ratio Doors (sec separate Door Specification Sheet) 2. Yes ❑ No Qly of Windows to be Custom fit Rc'pti1CCMcnt: _ 3, Yes No Qty of Sills to be replaced by Contractor; 4. [M Yes No Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) Exterior casings: ❑ pine R( Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing tobe: [3 1lP law -E9 SmarlSutl'"' (? xCradit ble) ❑ Othcr If ufhcr, please spccil'y: h, Exterior color to hc: M White E] Sand E] Canvas r7 Terratone ❑ Ccxoa ]lean 7, Interior color to be: White ❑ Sand ❑ Canvas ❑ %'orratonc Pine [71 Maple [] Oak Note: Interior color can only be while, wood or :rams color as Kcrior. Wood intcrions need to finished by Owner. g. I lardwa white A Stone Canvas ❑ Brass E] EstatcHard wn,rc: Style: 9. ❑Yes Ne, Install lifts with Double 1'lYr Windows j,,., 10. Screens: windows to have: ❑ Half err ull screens Screeds r to bei j J Fibet�las• El Aluminum ❑ TruScenc GRI LLE DETAIISS 11. Windows have grilles: ❑ Yet ❑ No If ycs: ❑ Grille Between Glass (caw ❑ lZeniovablc Interior Wood (ivtw) ❑ Full Divided Light amu Qty Qty Qty Q Q - Qty' Qly: DH OH off OH CwrPlourn cruder Q Draw grille patterns above "Use additional sheet if needed Owner approved (initials): ( 1 ADDLTLONAL WORK DETAILS 12. ❑ Yes No Contractor will remove metal frames of windows. Qty of Units: 13. ❑ Yes No Contractor will install new paint - ready or stain - rcudy casing~, Intl for casing qty of opcninQs: Exterior casings qty of openings: ❑ Nine ❑ Maintcnancc -free material l4, ❑ Yes rl No Contractor will install new paint - ready or slain - ready inside or outside stops qty of openings: Interior stops qty of openings: Exterior slo s qty of openings: ❑ Pine ❑ Maintenance-free material I ,. Owner iq awre that Contractor does :not do any painting. Owner Irtitiais 16. ❑ Yes 9 � r { N Contractor will wrap exterior casings with almminum coil stock of color. Note. Wrapping may be required with storm window re moval; removal of storm windows will leave screw holes in casing. 17, Yes ❑ No Contractor will insulate, caulk and seal windows with 3 -point system to prevent water and air infiltration. 1 Yes ❑ No A limited warranty shall be issued to Owncr upon completion of the job and payment in full. I Yes ❑ No ftldjU ,cif — Contractor will secure any and all necessary permit The fee for the permit(s) Is not included in the Contract Price and a separate check is required at the time of Salo for this fee. 20. Additional job details: 21. �r I Yes F1 No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. i I I 1 91 Depart ema nt of In.dustr€al Accidents Office of InvestiOdans 600 Tashingtan &�-eet Boston, MA 02111 Tgarkers Compemsmdum ingurpnce .kmaavit Riders /Cants. -tars! lectraci /�'�ur�bers �Ihaz<t Qrr atflalz Please Piint Leabfy ae ( Business /Orgsnizati❑n/Indtvidnalj: ✓) Cl� 2C J G ! V �/ Yl ��E 1 Yl /state /Zip: /V Df� bo rol X15 �� phone yma MR employer? Check the appropriate bay: Type of project (required): - I am a employer with 0 D 4. ❑" I am a general contractor and I fi• ❑ New rmstracdon employees (fail and/or part -6=).* have hired fm sob- contractor I am a sole proprietor or partner- list ci on the attached sheet 7.0 P.emodeling slop and have no employees These sub- eontractars have g. �❑ Demol = bon warkZng far me m my capacity. w❑ bera' ❑❑ ap. insuran❑e. g ❑ ilhin addition a cor `?-o workers com in-- anc 5. El we are poration and its �- ' P I0 -7 Electrical repairs or additions required.] officers have exercised their I am a ham eov ner doing all work right of eremption per M= 11.❑ Plumbing repairs or additions myself. [No workers' comp. D. 152, J1(4), and we have no LIE Roof repairs insurance re imo ] t employees. [No workers' I3.7 Other comp. lusnrance required-] appfi it that checker b= ml must also im cat the section b=low sh—ing lhe r woti—' comp=sation policy ix� a ieowne s who submit this amdavit indicating they aR doing an wort- mud ffieahre outside oontcaet= Est s*E3h gnaw affidavit is icatiag such. actors thaE check tbic b= pm t attached an additional sheet shmwing tbt name of the sins- •:ontraetnrS and their wod=' comp. policy info nnatiml, arc ampluyer that is prvr ldieag workers' cdrrpensadan insm-ance for my emcplayees. Befaw "is the PuBry and jab site mace Compaay Name: :y# ar 5c;.f -ins. Lic. - 0 1 - � ' /�`{ E�iraiianDate: �� )'71r1 Site Afidress: �l � ✓�G� Q � City /slat✓ /Zip; � � � �:: uch a copy of the wQrk:ers' compematrdm po&y declmn adum patre (showing the p ®lacy nmuber and elpirmdam date). = recto e ooverage as required under Section 25A of MCL a. 152 can lead to the imposition of criminal penalties of a up $1,500.00 and/or one year imprisonment, as v7eI1 as civil penalties in the form of a STOP WORK DRDER and a fine p to 5250.00 a day a gains t the violator. Be advised that a copy of this state may be forwarded to the Office of ntigations of the DIA for n lsu ce Doverage verincaLimn. I hzreby eer' rcr er tyre pains anal penalties- c�,�perjury that the infor prorided ab a is trItre and cart ect n.a"tar Dab--: � �.j5clal use aniy. Do nut write in this area, to be catrzpleted by city or tawftz affic L City or Tu t(Lrcense # Isszng kgtht,rity (circle mne): Z. 3Qard of Health 2. Bnilding Dapar 3. C hy/Tvwa Cler -k 4. RL-ctracal laspector 5. Pinmbing Tins pector fi. Cdtluer - Cantact Phone 4- re al NMc arxrmtutctvr . Wood/Viinyl Composite Frame r l Rwg ��1'v Dual Argon Low E Glider ENERGY PERFORMANCE RATINGS U- Factor (U.S)A-P Solar Neat Gain Coefficient . t i . 034 • 0 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0.49: • f Manubabt.r sdpubt.. Ihat eww n tlnpc nanimm to appbahle NFRC pmmdum for d.b. 0 W whets pmduat ' padom m NFRC tatlny. an d dnntnaA tar.lCcad bt of tmvlmmmantal aand1hMw and a.praft pmduetrdta NFRC dr not neomm■nd eery pmduot.nd don notwwmd th. aulbhage of my pmduetterarry apadAo u.a. . Con.uttm.aubckuara F&nftnhtrotharpmduatp.rbmwm.b aft titan• 1 � • iNWW.tIrfC.O . DESIGN PRESSURE (PSh��� ' _ madam HS Lta C 2 00-00296313-006 ' Taled w A!MF A101AL -47 NAF34M mft h t.ra ama5nts.¢to thn CuaLle mad.rdr e Mwtf ora.0 da M.E.O., OX-0, k tEC.O. Alr InflWmthm mqulr.m.Ms YMMA Hatln wk O.rtlnratbn Pmpram. Renewal i b) ndersen - .rIK330V REPLABEKENT muAnamat.CnmpfiiR WoodAfinyl Composite IF , - Duo[ Arpon Low R shmr sLm Doable Hang . '100-00473b� 8--D10 ENERGY PERFORMANCE RATINGS U- Factor (U.S)/i -P Soiar Heat Gain Coeffipient t 0 29 0 ADDITIONAL PERFORMANCE RATINGS Visible Transmittanoe O m4 2 ' Yaauh�wd¢uW�c the lMar♦ sGn��m fanppfobY NFAC brOnuesinbp.rre� pnsfva padaeaaae� NFHC ralbpoew ersaaiel lerafrdea[daaeieramalasWieeerd aapaeie p�emias� NFpC daecaelr�s�maeE erp•p�adQeeid daecarWrrr lM aabb7gdemrpmduesfarrapa$es • ' Cartesad�a�rWreea lar etlrrpredC pafm�eea eleevoa . ' .. YPWIKSIIIGL� 45 otov-pp�7 - WAd LZ DESIGN PRESSURE (PSF VAMA IB gT H — LC25 RhA DB Sloped S:L DH • YN 7d�i ¢LNkS-0ZCAAYAII�,NlLklEtl67AfO� {Witmer aTmlu�r eol�misav tr . ' . • Maale:er eozradc N- E'C�Cf4iLEC.C.�FM®stet w '