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31A-172 The Coinmonivalo eth , iWaas cluisetts• t` f • , :___..,,, .:;,..,:i:..., -� Departinent.af lndustraal *0010 r Office of riz veshgatto zs x • 1 � _ 600 Waslungtoit Street ,$ o ` BOSIOtI� L1IAQ�Ill s l t as _ . Workers' Compensation Insurance; A ffi:da vIt Bu tltrsXobtttactorsI1;rectrzeraiis lumb A s .licant Information r T?lease•Ef of Legib1 t Name ( Business /Organizati ontlndnidual) $;_. ® _ - G 1- __.,.._ .e Address: / rj c 1.l' i City /State /Zip :6 t c /r1 1V14 0'.1.: rhoDe4.. `` , ' 045 Are you an employer? Ch the app "b ropriateo '' e. 44 ro G lj uirc : 4 1 amp: eneiaY oontracttsr and L p... J 4 1. [ I am a employer with.` g employees (full and/or part ' time): have I ited'th& suh_ COrittact¢i_S • - I & v consfruehoir 2. ❑ I am a sole proprietor - or parts_ er.- - listed t e atta re.,0:§_ii et.; I 0 Rrirr'p 1 1m . ` ship and have no empto$!ees Thes ub- .oxit tors fra_ve- `' - 0 i' # ; working for me in: any. capacity., tmpro es`at3t'b`lTa�+ i orkerrs [No workers' comp. insurance p istYi :lit -' !, ' i t%.> t u on, required.] 7 ` W 4 t coigorati'o And s c._ c., ._ K6P., _ ratlditio 3. ❑ I am a homeowner doing all work officer hav efc1se t/feeir" - , a . ;Q,p`.lu iit re "pairsf-or additions. 4 [No workers' comp. f. T t i ght of - xenlp e r: ' CI I ` to - r � myself. Q p R insurance required.] t c. 152 §I { }, analvea3e =ria ., emplo [No workers 'Q . -. c - ® - camp iisuranee tequire3`j� tl ` X.( ' o-r - s +Any applicant that checks box #1 must also fl( out the ;sectaon,below'showingt workerr c c i i l i p e n atio 0olil : fo n tion- -„; 4 Homeowners who submit this affidavit uidipatmg they ara dDmgall ver:1 - plii itto..aNct - dtpr iig trrxuct4 davi �ndicai ng seclk_ IContractors that check this box musf atta "an additiQn A hr -ef, 11Pwiirg lenaz bf the suWjlf a`CtIV t s_`Iat$ ets.[°z[a lt t"#fts_Cga lli ige 4 a employees. If the sub - contractors h ye emplojyces they i0 prOrcle ieg,r Norll Fpm pv�t iut r1d , t 1 am an employer that is prdvcdirig worket3x -c6rrtpertsatrb"`rciii.vura c ef,6'r,.my ;vLo, cgs ]#' t¢ry�jr.;�t e d Q6 i f e' information. . _ ji. Insurance Company Name: 7 `-f e-' // , : ®® 'rr?1 ,`:7Y1 :; Policy # or Self -ins. Lic. #: (.. ( /} r.) Cl . '4W3 - _ - : -.. / , - Expiiatron.Date _ -,, J 07. 479 it Job Site Address: 52 Ma i n ar 1,A. .eit /State %Zip :; OC� y�lll pib'l tc A. Attach a copy of the workers' compensation policy declarattott page (showing the Isolicy number and esplration date). 6 t �`� f„ Failure to secure coverage as required under Section- GL c' g2 o f can leadfio tliennino ition ofcrirninahpenai1hes of-a �/tCJ fine up to $1,500.00 and/or one year "-imprisonment ;as well._ ci ilfselialties i. xh.e fozm cSfa sIo 9 r ap t3RIi13FR_aniJ a "fine of up to $250.00 a day again violator. Be advised_that a copszi y this statemer nay oe:fonvarded fo the; Oflico of r Investigations of the PIA for.-insurance coverage verification; . 1 I do hereby certi der the pains and , enalties o er u ihat the:ut ormaho rovrded above : ts {rue:arid correct Y � P fp r l Y :.�, P, S i _nature: � _� I L _ � �A / Date: , Phone #: C - / . _ . Official use only. Do not write in this area, to be completed by city or triwn off oral. 4 i. City or Town: Per # _ _ . . Issuing Authority (circle one)": 1. Board of Health 2. Building Department 3.: City/Towit Clerk 4_,,Electrical Inspector 5. P-lumb1i%g..Insp 6. Other :, _ - Contact Person: Phone.# ` AP To Whom It May Concern: I, F1 p A/K A&ARN O , as property owner, give permission to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at 52 /}'A ( a RD- . Please accept this letter in place of my signature on the permit application. Thank you, FRAN AIPRfio Please Print Name fJ1 Az CO Homeowner's Signature Date 4 t . # s r a • + $ • 8.1 Licensed Construction Supe Not Applicable ❑ Name of License Holder : Do \.) 0 ' [ q License Number 55 f`A ►n Crreen eA8 r1G- di30 ( L3< ( Address Expiration Date Qb C� ( �h- t� z 3 p Signati7fe Telephone t ittigigt dfl i .:aa . " a , . � Via.. *. 5; ttO Not Applicable ❑ � cr.c 1P- 20��C 1 1 Z27 9 Compan Name / Registration Number M a c • CI c �-e n � M G 0 13 b 1 3 .) [ Z Address Expiratio r5 Date C) Q» k C, tLJ 09, Telephone '^T'1 r . 57 z f' p��4. i F to S 4n <- 3e .V' i3�+"C E RKE �� OW S ,1 ESL �� : F� � r riff '; v + s�.r`3,,w`..: ° ''` 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 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 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 v of & • SE ?{ - a2 a x :Ui. 4 4 � .� i.. c > 7R '� f t t.. ."7 S�� j�� •L G riggrpESCRIPTt Nt itE?RaPOSEDiWORK (chec 11'65614 ,OC ' N' a f€ - V354 .M N, P.,W f , S ,M1M. 4 W( 010St xZ F Ct. ,∎.° i ' :RetV7 '. ..4 4 ., ,. .>rn�.,v \ � .w,�.r. _K> ; § .fi.. ,. ' zo.,ad. '.o�S'J, '? 1 �.. n ,_,c i.,%,5L : G. 'a ' +' _, a kW i New House I I Addition I 1 Replacement Wjfldows Alteration(s) I kir Roofing ( I Or Doors Accessory Bldg. 1 1 Demolition 1 1 New Signs [D] Decks [❑ Siding [D] Other [D] Brief Descri.tio of Propis-d . Work: ► - 1 1 a • 1 , \ 1 1i'n1 Cj• N O 4 Alteration of existing bedroom Yes /No Adding new bedroom Yes No V Cha Attached Narrative Renovating unfinished basement Yes I/ No Plans Attached Roll - Sheet CIl, 1a; 8X1 ;. : II3.E}x © f .C}, . ,O " 11 *I#l: ®;_ a. Use of building : One Family ■ Two Family / Other b. Number of rooms in each family unit: e Number of Bathrooms t c. Is there a garage attached? i L S d. Proposed Square footage of new construction. Dimensions e. Number of stories? 3 f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 0Q,Qcf.C.2 Celt • 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 1✓ ec=cd ut a i X> M �W- > lZ-} W r- f , -1 _ `r« " ''� ..�`yi'"v Y ' s ,�r n* �, ^" SE I:VR s IIV{IER+iaTtIV Tf 0:0 C) -4 10X1 FAV. � t ..„ct', � •+6 kq`r;z`y'u �„� -, kr� 3�a^F "-�5 � a .e ,r s.. Y�' rive WW* .ia 9 ,01gi i s RP : V' � LOFM.1 y _...... {.z�.�. _._. .. - .. ..,. .s�.s. . �? sk- .'�..`.uG_1na.:S�...�Ew�__t i ce++- ..... .:�f....>.aa...x..:. ,.. a ..v.... I, [ ran F- A b C,t r (VD , as Owner of the subject property _ 1 hereby authorize ? 6 LlA-? V C'7 } 1, lv C— to act on my behalf, in all matters relative to work authorized by this building permit applicati n. S em,emiiiiiiilniefilli.C6ion:iiimmimitt_______t_i 1 Signature of Owner D ate I, V QvI D fl 0 ?CU_ LL A_ buC, 1 NC_ , as Owner /Authorized Agent hereby declare that the statements and in ormation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. IDa.■i 0 h', i Print Name �. �n l/ \ C�vV 1Ak 4 f )--7 I 1 Signature of Owner /Agent Date r, 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 1 1 1 Frontage 1 1 1 1 1 Setbacks Front 1 1 1 Side Li 1 R: 1 L:1 1 R:1 1 _ Rear 1 1 1 1 1 1 Building Height 1 1 1. 1 1 1 Bldg. Square Footage 1 1 1 1 { 1 1 1 1 1 Open Space Footage 1 1 % 1 1 1 1 1 1 (Lot area minus bldg & paved .arkin. # of Parking Spaces 1 1 1 1 1 1 • • Fill: (volume & Location) A. Has a Spe ial Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was th permit recorded at the Registry of Deeds? NO DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document If B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES 0 IF YES, has a permit been or nee 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 C IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO e IF YES, describe size, type and location: 1 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 0 NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. , v I SW __ ity •f Northampton a 'o °ermat • t• uiIs g Department C Sr. tJO .� a rs rir 1j 21. Main Street •om 100 Ow s = `� t pion, MA 01060 va +'' o c ism ��� •%�' - one 587 -1240 Fax 413- 587 -1272 Stt a -ter r f e z x . �, .-�� � � �,x. ��x'SyMa���'��, �. �. r� 1���`• }�, :t�i3i�� a. , APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SE �M1Sl �1OI1� e roe ample ®�• f 1.1 Property Address: N �+ N•' • r I W V �3� w %4r 2 �@ FfE� Yv G/ 2.1 Owner of Record: Fran k kbacno %c L �k' Q QRCA Fl Name.(Print) � Current Mailing Address: Set S i q (1c Co n T C Telephone Signature 2.2 Authorized Agent: P LAP D U CTS / rvc .1 ( S. 1 EN t E Lb J Name (Print) ., Current Mailing Address: O C Signature Telephone ,y'x2Y' T 4'tHr',':a? xs'�^t+,�`pY'' Y •,..d'�,o�3."'tt� l' ' "3a �-# <' u i S C I�t +3-3 } ESzTfMA?TED�CON,SzTRtJ�ION _^ OSlsS' Item Estimated Cost (Dollars) to be ' ;3�K �Q�ifs�'ctaSresCYr�y completed by permit applicant g 13, 0 1. Buildin 2. Electrical Es aa�€� 3. Plumbing f1® ng" j5' �e� ` 5 4. Mechanical (HVAC) , r<h zips 5. Fire Protection 6. Total= ( +2 + + + Thjs�Sotrord� # ftflnir` �2 2 L?�te 8uildsngt'errrjst Nurribei zfssued ri '~ 6 ✓ t Sgnatur: L ... . - ... - .... . . uitd7rloass�fln �<` ` �7ate 52 MAYNARD RD BP- 2011 -0902 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 172 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 -0902 Proj ect # JS- 2011- 001473 Est. Cost: $13700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 7492.32 Owner: ABARNO FRANK E Zoning: URB(100)/ Applicant: PELLA PRODUCTS, INC AT: 52 MAYNARD RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON:5/4/2011 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 5/4/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner 52 MAYNARD RD BP- 2011 -0902 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31A - 172 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 -0902 Project # JS- 2011- 001473 Est. Cost: $13700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 7492..32 Owner: ABARNO FRANK E ?, ,r,,.: ERR. I 00, / Applicant: PELLA PRODUCTS, INC AT: 52 MAYNARD RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772 -0153 WC GREENFIELDMA01301 ISSUED ON :5/4/2011 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: / r Final: Smoke: Final: (k 6 ' / — / [ 'Y" \ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE • ..ir i :I /4,&tpu4.4- 4100Y • Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/4/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner