22D-067 Integrity WOOD - ULTREX DOUBLE HUNG
Windows and Doors
ELEVATIONS - WOOD - ULTREX DOUBLE HUNG UNITS Not To Scale
1 - (559) 2 -2 (880) 2 -8 (782) 2 -8 (813) 2 -10 (884) 3 -0 (914) 3 -2 (985) 3 -8 (1087)
0' 1 -101/2 (572) 2 -21/2 (873) 2 -81/2 (775) 2 -81/2 (828) 2 -101/2 (878) 3 -01/2 (927) 3 -21/2 (978) 3 -81/2 (1080)
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+. y. 1 -91/2 (548) 2 -1 1/2 (848) 2 -51/2 (749) 2 -71/2 (800) 2 -91/2 (851) 2 -111/2 (802) 3 -1 1/2 (953) 3 -51/2 (1054)
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NOTE:
When ordering 6 9/16" jambs, add 1/4" to width and 1/8" to height for Rough Opening, Frame Size and Masonry Opening
These windows meet National Egress Codes for fire evacuation. Local codes may differ.
Imperial and metric dimensions are shown. Metric dimensions are in millimeters.
All units viewed from exterior.
® Represents units that are
certified for Impact glazing
with a wind zone 3.
Project Description
121 Florence Road
Florence MA 01062
Marlene Morin
Rear Bumpout:
Removal of existing units and installation of three (34 1/2 x 48 1/4 ") double hung
replacement windows by Marvin Integrity (Model IDTH3848) on rear side of house.
New windows to be fiberglass clad exterior, wood interior, Low E 366 glass (U
Factor .27- SHG .24), Energy Star certified. Windows trimmed out with pine
casings and extension jambs, stained and polyurethaned.
Kitchen Windows
Removal of existing units and installation of 1 Andersen 400 series awning window
and 2 Andersen 400 series casement windows with Low -E4 glass, purchased by
homeowner. Windows trimmed out with maple casing and extension jambs.
Stained to match cabinets and polyurethaned.
Rough openings flashed with Grace Vycor window wrap.
• The Commonwealth of Massachusetts
Department of Industrial Accidents
s +„ Office of Investigations
-.i 600 Washington Street
Boston, MA 02111
• www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): ) � ev) 'Z-e
Address: 4 Cho . Qii gq5 i t-41 4 vn 't
City /State /Zip: �uS� " [lcivn�lra� ►''f 0 02 ;yhone #: e j ` /b` 0
Are you an employer? Check the appropriate box: Type of project (required):
1.0 I am a employer with 4. 0 I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. New construction
2. MI am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub - contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
9. Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
Y P 12.0 Roof repairs A'rit-°f - t - a r
insurance required.] t c. 152, §1(4), and we have no A„f:.�fv J S
employees. [No workers' 13.[ Other
r Ott ewe comp. insurance required.]
*My 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.
tContractors 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
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date:
Job 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 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.
Signature:" Date: l ao
, lCi
Phone #: ` 3 7 Lf 9g
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
r,....., „. n,,,.. ,.... D{....... 44
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Su rvisor: Not Applicable ❑
pe
Name of License Holder : I hi 4'1 (,f ry)1. l7 f % F��
License Number
tv 1 4' 7 7:2 1 gA 1 0/ 2_
Address d it) 2 -1.. Expira 'on Dalt
41f3 3 } gigue'
Signatur Telephone
( ell !L
9. Reslistered Home Improvement Contractor: Not Applicable ❑
Company Name 1 Registration Number
CC S / -- 5 - 1 1() / ao it
Address
/ t_ / l Expiration Date
-S V i�. .. k1 f ( l 2 - 3 Telephone I t ( 3 3 ` I/ ! d ea'
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 g_ 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 be/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 ❑ Replace endows AReration(s) ED Roofing ED Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [CO Decks [p Siding [O) Other [C;
Brief Description of Proposed /+
Work: �rts/& it / or/ O-� Lott. X 4, / 474e4- oJ 4 ".1(X--
Alteration of existing bedroom Yes )( No Adding new bedroom Yes /• No
Attached Narrative Renovating unfinished basement Yes �_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 X 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
+�T I AA4 / f f° y(� `'�` r ✓1 , as Owner of the subject
property
hereby authorize gets ` 4 wi r n (?/ �/•—
to act on my • alf, in tters/relative to work authorized by this building permit application.
Sig • • /. , ' Date v ` , ) ` )
1 Rtn a nn ( - , 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.
Print Name
Ai 2f 4•
Signat o 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
Frontage
Setbacks Front
Side L: R L: R
Rear
Building Height
Bldg. Square Footage °Io
Open Space Footage °lo
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location) -
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
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 O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
r F 2010 212 Main Street Sewer /Septic Availability
g Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
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
1 2.I 1l o/l v► C e /Ztl Map Lot Unit
00 /evi.ct Mil Zone Overlay District
6062 Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
/HQ ItAt I 12 11 J!o /trtc.t Rm„. Fio.e#t o/a6z
Na • (• %nt) / Current Mailing Address:
Al/ / . / L- / ZbAt i_. Telephone
Signat re
2.2 Authorized Aaent: %In( aon i., 6 • - ci7 (4.a h S� gs,1 / a 14' /4-
Name me ( P • t) Current Mailing Addrerss:
iihat---R---- ` ft 3 - 3 9 -9g 24
Si a re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS I
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building CI. <,�. ( ) (a) Building Permit Fee
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) e L" t"1 --' Check Number ylqy
This Section For Official Use Only
Date
Building Permit Number:, Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
BP- 2011 -0237
GIS #: COMMONWEALTH OF MASSACHUSETTS
lylap :Block: 22D - 067 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0237
Proiect # JS- 2011- 000400
Est. Cost: $5800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BENJAMIN GREENE 96066
Lot Size(sq. ft.): 302742.00 Owner: MORIN MARLENE A
Zoning: URA(100) //WSP Applicant: BENJAMIN GREENE
AT: 121 FLORENCE RD
Applicant Address: Phone: Insurance:
47 Chapin Street (413) 324 -9826 0
EASTHAMPTONMA01027 ISSUED ON:9/16/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL 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 Signature:
FeeType: Date Paid: Amount:
Building 9/16/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner