Loading...
18C-169 (2) RECEIVED 11 11 DEP1 % l_C J a ;�LJFONS p U NCEITHAMPION. MA 01060 • • • Prospect Woods Homeowners Association, Inc. Board of Directors Ruth Barton `;a d e :gain Mary Lynn Brersnyai /David i €;rshipsj `aye Harris Edward Hennessy, President Christine Dippolt, Vice- President Donald Paimisano, Treasurer Jane Winnie, Secretary 18 July 2011 Northampton Building Inspector The Board of Directors of the Prospect Woods Homeowners Association has given permission to Jane and Bob Winnie, 63 Hatfield Street, Unit #2, Northampton, Massachusetts to have Thomas C. McCarthy General Contractors, Inc. replace three (3) windows on the back enclosed porch area of their unit. If there are any questions or concerns, please feel free to call 413- 586 -3461. Sincerely, Donald Paimisano, Treasurer of Prospect Woods Homeowners Association CC: Board of Directors of PWHA • HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough buildinginsnection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 41,!, :=141=%,'" Boston, MA 02111 • ' www.mass.gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name posineestorganizationandivomo: Address: , • City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project (required): 1 1. 21-I am a employer with GI-. 4• 0 I am a general contractor and I 6. 0 New construction sub employees (full and/or part-time).* have hired the -contractors listed on the attached sheet. 7. 0 Remodeling 2. I am a sole proprietor or partner- These sub-contractors have ship and have no e,.wloyees 8. 0 Demolition working for me in any capacity. er:Tloyees and have workers' • 9. Building additiOn [No workers' comp. insurance - comp.insurance.T: required.] • • 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. [ I am a homeowner- doing all work officers have4xerc-ised their 11.0 Phmibing repairs or additions myself [No workers' comp. right of exemption per MGL 12.Ej Roof repairs insurance required.] t • c. 152, § 1(4), and we have no employees. [No workers' 13.1j 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. - 1 Contractnrs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employe. lithe sub-contractors have employees, they must provide their workers' cotnp. policy number. lam an employer that is providing worlcers' compensation insurance for my employees. Below is tlzepolky and job site information. Insurance Company Name: • Policy # or Self-ins. Lic. #: DT/ration Date: • ' fob 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 SectiOn 'of MGL c. 152 can lead to the inTOSitiani of crirninal - penalties of a fme up to S1,500.00 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 InveitiiitiOns Of the Da for airtrance coverage verification I doj eeby cirtifr under the pain' s.and penalties of petjury that the informatiO nprovid.ed_abovelsince_ccrutcorrpri Signature: • Date: • • Phone #: . . . Official use only. Do not write in this a to be completed by city • City or Town: • Permit/License # ' Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical,Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: . , ML v-+ r iIYL.LF\ Cm rCMMH� I I'YC 1 , 41J ....7G1 ..+..• i U i 'ROOUCER (4 13)527 -5520 FAX (413)527 -5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Int . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Campus Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 Rebecca Kubosiak INSURERS AFFORDING COVERAGE NA1C # INSURED T 0111x5 McCarthy General Contractors , Inc . INSURER k General Casual ty 24414 3 Broderick St INSURER B: ^� Easthampton, MA 01027 INSURER C; INSURER O; INSURER E: COVERAGE. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO' POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER , a , , ` , . , p , LIMITS y GENERAL UABIUTY CCI0395169 02/1 2011 02/10/2012 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 11 PRP�p (Fa 0„,,,„„„., ) CLAIMS MADE OCCUR MEO EXP (Any ono Person) S 5,000 A 1111 PERSONAL & AOV INJURY $ 1,000,000 ■ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000 , Q00 a POLICY 721: n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ee ate,dent) S IIII ALL OWNEO AUTOS BODILY INJURY ■ SCHEDULED AUTOS (Per person) ■ HIRED AUTOS BODILY INJURY (Per accident) II NON -OWNED AUTOS - T PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ I ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ r T EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S ■ OCCUR W CLAIMS MADE AGGREGATE $ $ _ DEDUCTIBLE $ __ �! RETENTION $ $ WORKERS COMPENSATION AND CWCO395169 02/10/2011 02/10/2012 1 TORY I ANDS 1 T • EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L, EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes. Oescrlbe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT S S00 , 000 OTHER DESCRIPTION OF OPERATIONS !LOCATIONS/VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS RTIFICAT 'DER LLAT►O SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSI ING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, gUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER. tTS AGENTS OR REPRESENTATIVES, :c : c : cSSamp'I e'Ira t: AUTHORIZED REPRESENTATIVE _ _ _ . �A/ Rebecca Kubosiak /BECKY �R�R� ACORD 25 (2001108) FAX: (413) 527 -6893 OACORO CORPORATION 1988 TOTAL P. ©1 2011 -03 -13 21:55 1413 527 5970 Page 1 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not ► Applicable � ❑ Name of License Holder : ✓ "' /OA L /1 V k � 1' ( 4 05 0"� Q C / License Number Atioito,eitZ Address Expire ion Dat eA4 1/1C t i--- > SY V/ Signature Telephone 9 „Reg tereMiett a tall t'n e#tiatit kin aet ; w „Zi u 2W , Mi : Not Applicable ❑ Company Name ” Registration Number 3 e 4( 7, C 4r vve Address / / Expiration Date / C am[ � Telephone S ` �� (1 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.GL. 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 O No ❑ 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 1083.5.1. 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 building 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 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replaceme jndows Alteration(s) Roofing ED Or Doors �9� Accessory Bldg. 0 Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0] Brief Description of Proposed s Work: le (0 1°_ J "vu l�'W cY mac% s f vx) f 4 -t / tv e-v✓ Alteration of existing bedroom Yes No Adding new bedroom Yes A. No Attached Narrative -- Renovating unfinished basement Yes No Plans Attached Roll - Sheet Oft txi+11rW1ia: 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, ✓ AW , as Owner of the subject property hereby authorize / / 6- .�-S e, /*c 1 u to act my in all m ers relative to work authorized by this building permit application. Sig t of Owner Date 1, 7A011h4.s e d"lP (.;L ) , as Owner /Authorized Agent hereby declare that the 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. S el). ( 1/ Print Signature of Owner /Agent 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 1 . _ l - -. m 1 `1 Frontage ° __ z Setbacks Front ! i Lmj Side L: i R:' ' L: .._. R: µ J ' _ . _ 1 Rear I Building Height Bldg. Square Footage 1 7" i % 1 I Open Space Footage (Lot area minus bldg & paved i 1 i 1 1 1 1 a. parking) # of Parking Spaces — ~ (volume & Location) i i ' = I 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 DONT KNOW 0 YES 0 IF YES: enter Book i 1 Page! 1 and /or Document #;* B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: ! j D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO ! *t 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 Q NO 9;4 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. _ ., . .� , E T OF BUiLDIN INS M � -� City of Northampton � ,� � �p xr� �� � � C r ?.ti, ''', ' Building Department" _ ��� �. -` r ___ 2 2 Main Street A _ ' ZQ�� I Room 100 Y 1 N rth. mpton, MA 01060 >: . '� *- s DEPT . OF s r o , NORTHAMPT, 1. ,;,;, t -58' -1240 Fax 413 -587 -1272 ; .. s W ,, . , 4 L < A xe A _ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: /} yy- 1 F i tcrC S T T . L ) � w i � 4.4 map Lot U nit d A., 1e - r L et— p ` �O^-■ Zone ' Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ie6 Z e%4- 4 s A-pve w.1 .nr 63 i )i re-Tr'eid sT i u 4- # Name (P 'nt) Current Mailing Address: is . /4 6 �� Li2c,t e Telephone � Signa 2.2 Authorized Agent: ntt, it e. e(as 4 y 3 ffd6cLe -ie le It 17, '111.x. fee, Name (Print) Current Mailing Address: �� 4 4 ;f , -, 2 - ,s -- tvl Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Le, `e ° (a) Building Permit Fee 2. Electrical L (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) ' R / (r3 f S • & - 5. Fire Protection _6. Total= (1 +2 +3 +4 +5) r .1/0, Cd Check Number ( This Section For Official Use Only Date Building Permit` Number: 8/ 2- — '7S Issued: Signature: / 7 za ( s I Building Commissionerllnspector of Buildings Date aikt- Visit www.marvin.com for pending patents. Do not remove this label prior to inspection and save forfuture reference. © 2010 Marvin Windows and Doors ® Registered trademark of Marvin Windows and Doors. Part #19980498 MARVIN Windows and Doors �^ I Built around you': ENEFGY STANt'Qualified In Highlighted Regipns U.S. grCev Ills i Illh energystar.gov II, llM1ill V i - sirs 3 / u aw 4 ENERGY STAR Qualified j& f j W S ZONE N, NC, sc {/ ` Clad Ultimate Glider V ." RePti& Aluminum —Clad Wood Horizontal Slider 11116" 10 LOE 272 ARGON Q� National Fenestration 3.1mm LoE 272 1 11.5mm argon 1 3.1mm J VV Rating Council® cIr CERTIFIED ENERGY PERFORMANCE RATINGS U- Factor (U.S.II -P) Solar Heat Gain Coefficient 0•30 0•30 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0•52 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a fixed set of enrIronmental auditions and a specific product size. NFRC does not recommend any product and does not warrant the suitability of any product for any specific use. Consult manufacturers literature for other product performance Information. www.nfrc.or Meets or exceeds C.E.C. Air Infiltration Standards ■ WINDOW &DOOR Hallmark Certified MANUFACTURERS ASSOCIATION W D M A Licensee 1$407 -H- M anufacturer stipulates conf ormance wwwwdma.com to the applicable standards 15105090 1 ZW9200 Al This product may be covered by one or more of the following patents: 0487,012 0497,304 5,115,596 5,120,094 5,125,442 5,212,921 5,448 6,141,913 6,672,009 6,779,580 6,938,373 6,964,290 7,182,119 0594,732 0595,110 7,552,562 7,591,106 7,631,465 7,743,814 0620,347 0621,255 7,788,851 and Canadian Design Patent 103,677 103,678,7,877,945 mar