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37-083 (4) Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. I Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub - contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self- insured companies should enter their self - insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit /license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future per nuts or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114 -2017 Tel. # 617 -727 -4900 ext 406 or 1- 877- MASSAFE Revised 7 -2010 • Fax # 617 -727 -7749 www.mass.gov /dia The Commonwealth of Massachusetts Print Form Department of Industrial Accidents ` c Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114 -2017 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): 2. / c / , . 4: / f Address: City /State /Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am 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 listed on the attached sheet. 7. El Remodeling 2. ❑ I am a sole proprietor or partner- ship -and have no employees These sub - contractors have - 8. 1 1 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.$ equired.] 5. n We are a corporation and its 10.n Electrical repairs or additions 3. I am a homeowner doing all wor officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.n Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.111 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. 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 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 certif under the pains and , enalties o , erjury that the information provided above is true and correct Signature: � � / ®ff� _ , 4 .i / ! Date: Phone #: 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 Contact Person: . s Phone #: • . MAMMA• .W ... ... r.*. A a € Dam: irtoa0121 1:42 AM Pugo:s of 2 ./"1 ALLE•WC OP lo: CM ` i C w ... - CORD CERTIFICATE OF LIABILITY INSURANCE f °" � „' "" 1153 CI MPICA1N IS ISSUED AS A MATTER OF INFORMATION ONLY MID CONFERS RID 10HT11 UPON IRE CERIIRCATE HOWER 1145 CERIIPICAIE DOES NOT APIRIMIAINILY OR NEOMIVELY AMEND, 11X11/NO OR ALTER VIE COMMIE AFFORDED M THE POLICIES gOLOW. MS CINIIRCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT EE1WEIEN WE WRUNG INEUtt0R)Sj, AU11401412ED REPRESENT/TM OR PRODUCER, Ate INE CER71PICATE HOLDER. . 1c ` 1• -. :.�., - an ,, .1. - ' f `. , Pe. , min b •'."... - . ir' - ' -: :. fir; •It. e ■ be theism tad cesdklens et the peke, esildn polfelee nay requite en endowment. A etetons.nt on thlo serdEeab does not celdlf dghts b the oenflosto holder in Sou el mob andere noore(). mom Wake* i R ro node b a 811 $1104211.23114 i _... 1052 dfi.Sorg* onto gy once man A : Netlone, Grange Mutuil 14716 mum Anstate W$t7WW$ LLC mwtnell A : . 4273 CHNIP sII Avenue Unit B4 Rocky IMB. CT 08017 NNI11Ee C : NINMle O : DIP: COVERAGES _ 11FICATE I ER: REVISION II 1 : THIS 10 CERTIFY THAT THE POL RAN US E ■ BELOW NAVE BEEN ISSUED TO THE Newt NAdED Awn FOR TM! PORGY P14100 vows. NONw 11TANDNO ANY NE CUIREMEM, TERN 04 GON0ITION OF ANY CONTRACT OR OTHER DOGUMINT WrTH RESPECT TO MUCH TINE CERTIFICATE RAY SI 150U1D OR MAY PERTAN. THE WSURANCE AFFORDED EY THE POL1C115 DESCRIIED HEREIN ED SUBJECT TO ALL THE TERIB. E71CWel01IS AND CONDmCNB OF RUCH POLICIES. LIMITS BROWN MAY HAVE SEEN REDUCED SY PAID CLAIMS. U M nee or mum= 11111111 _IMO Pstcv IUeMdI rrgv n ABM uuns noon mom mat oonewor OE , / 1.000.000 A ocesietcNl = KAM MPI01151 O27DI112 02101113 UrIMUlt E:. N.«I 8 000,000 nu — Iran 1AOE El nom IMDEHPMIySyM,pry 1 10,060 X By AMANI *WNW PERSONAL II XN WM 1 1.000,000 QINERAL ADSRESATE 4 2.050,000 OEN%0011UEGATE WOE APPl1ESPEE t*ODUCTS• COMM, AN .1 Z,000,000 POLICY S LOC s ~ AIMIDOSaiWaAlTr ■ ' 0011dw1 .5.- -- ANT MID soave Iwo tine now I W D .••••• — � D O MKT KIM? ea MdIMq $ •""" HOEDAYTQS AUTOS E PROPER I ■ I 1 UNRFUNUAR DCCeR EACI OCWIIN:NOE . I _.. — =hew I C AMIMIADE ASQREQATE 4 i>m Isitto mat yy� FR. 4 AANDIti'IMIIIW UMW/ a . 1t RY 1 I E� so imemnomminumnumNINI OXBOW Y Q N P A E l EACH ACCOEHt 8 OFROBLINASER Ft. MAMIE • EANNIN:WWI I tl new powwow 0/ONWAtIOHIINer P EI. DISEASE -Pax-rum I maw= Dr optimum LACAIDYI WEIadLE, 4b. sh ACOOD It AMAN O Numb. I IN AIM„ DNNrpies N wNNON► CERTIFICATE HOLDER CANCELLATION r TO%%OM NIOULD ANY 01 /NE ABOVE DESCRIED POLICIES SECANCILL805EPORE 1141 EXPIRATION DA15 1110 01, NORM RILL MI MUMS W To YIlhoRt R May Concern ACCORDANCE WITH THE POLICYFROVg10N5• AUTHOR12EO NWASSINTA1VE 4;24 4;/ . . • 1586,2010 AGGRO CORPORATION. Al rigM, wnrvsd. ACORD 2$ (ZO10105) The ACORD mini end logo ere registered marks of ACORD M C ;ie Wolgvntoweveceit4 cif /..aaozeitade, Office of Consumer Affairs and Business Regulation �' -- 10 Park Plaza -Suite 5170 Boston, Massach setts 02116 Home Improvement Cotor Registration "`""�' ,1 Registration: 143147 0: - 1 5 A - - :" i:::::: , - ; Type: Ltd Liability Corpor i ;' - � :: , ' u � , !('• Expiration: 6/21/2014 Tr, 224482 ALLSTATE WINDOWS L. LC. t «' ...�, ' ` M ;; RONALD WANAT (" 1 Y; " ` _� , 72..:::-.-1 - ` ; ' 1 1275 CROMWELLAVE #B4 �- s . -- , ROCKY HLLL, CT 06067 y ` -'- ' .1-Pr' I . ." "Y U pdate Address and retara card. Mark reason for dotage. s. -- 0 Address ❑ Renewal 0 Employment 0 Lost Card seA m a 201.1-05111 • 4 1 7S �tomweA Ave., Ba ALLSTATE WINDOWS, LL CT REG. 57396. ocicy Hill, CT 06067 MASS RE .57 6. Tekphane (860) 571 -8752 CONTRACT The nndetsigeed, property Owner(s), hereinafter called the "Owner", do hereby contract with and awhasize the nndetsigaed Contractor, hereinafter called "contractor" to furnish the necessary materiels and labor to instal and place the improvements listed below. subject to the following tetras and conditions Owner .'Yn ARK. I n a4 n° " ?,;Z 7--. 36, Da h _ �2D l.Z-- Street H a b Husband work Phone Wire r t i � G'r. due' /57 - si w 01 City, Job Location Double Haag Windows Picts n diar '2 -Litt Het 3-Lite Slider Casement Window ' Doable Cerement 3-Lite Casement 44.1u Casement Bow WinWindows s Bay Window Awning Window Hopper Window Garden Patio Dow Entry Door Storm Door dolor n4Mle =late ? Low-Saha Argon r Qss� Chida 'ifs i Speci f /. ,let.e.i, -" 11 e,57-.4.. ).6, 't i ! p...Gc.2S Ashul�`7. ► Cash Price t .XA.oT/tda► i I v`fyl, /lid. Wasacv z O(�(' l )6 Deposit Given Today —9 Diu 4. L/P ' zcAs w o l. ca e' G trrr y ��q� ` � " Deposit to be Sent by Mail $ vf �i 7 c 14/0/1401A25 V t?e &eta s % �- ©� > Payable at Start of Job a ' r .,., 7'�° Payable on Conviction S� I ?- Cam Lu. .� `s• — Amount Financed $ c ' rc: -.,t s = .tat s 1E, .. • 1 --K- 4 . 5 r i 1 .rte S+. - De"" 571.715 co ' 2.J.� dztauDesli2.. ti's / D '7 . t L& ) L p ,'F* D "Tarl *vo/9/ .- ,Z$6 Owner Is responsible for rec oo of alarms, painting and/or staining. "Approx." Starting Date 4111,8` 2.4 L .?-- Ono- workmanship warranty. Owner responsible for permit, if applicable. "Approx." Completion Date die �, � L z,r_ agreed - 1. It is agreed that 5096 of the total consideration hereinabove named, pine a reasonable attorney's fee, if said 5096 is not paid immediately upon demand, stud' be and the sane hereby declared to be liquidated damages due and recoverable by the contractor in the event of any breach of this agreement by the Owner before any of the work provided for herein, (other than the delivery of materials) has been performed by the contractor. 2. It is agreed that concealed conditions that are uncovered during construction ere not the responsibility of the contractor. Owner will be ootified of any additional costs associated with addressing any concealed condidan. Hazardous materials removal/or disposal is not the responsibility of the contractor unless noted. Conditions not specifically stated herein shall be governed by established trade customs. 3. It,is further agreed that the owner agrees to accept delivery of materials &dice notice from contractor of the installation date. However. contractor shall no be liable for any delays caused by war, riot, strikes. acciden*s. availability of materiab, acts of God, mother causes beyond its control. 4. It is further agreed that should the owner transfer or encumber his premises or any part thereof or should said premises or any part thereof be destroyed ( damaged by free or otherwise. said promissory note shall be come due and payable forthwith. 5. It is further agreed and understood that if any monies due are 30 days or mover past due, the account is subject to a FINANCE CHARGE by a "periodic rate" of 1 546 per month which is an annual rate of 1896 or the maximum allowed by law, whichever is less. 6. It is further agreed that in the event of any breach of this agreement by the owners) hereafter named. the owners) than be liable to the cantracterr for ere costs of collection of monies due, including but not limited to teasooable attorney's fees and cowl costs. 7. It is further agreed that this contract contains the entire agreement of the patties; that an prior negotistioas, agreements and understandings have been merged in or sup:medal by the contract and that no representations, wstraatles or understandings of any kind shall be binding on either party unless incorporated in wtidng in this contract. 8. NOTICE: ANY HOLDER OF THIS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSE'S WHICH THE • DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT UMW) OR WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR . HEREUNDER. 9. Owner will provide at least three feet of clearance at each window to allow for installation and parking convenient to that entrance of the residence. Contractor is not tesponaible for moving funnitme. dis onnecting/teconnecting wine, removing/ replacing window treatments. caverineg floors. If installer is not able to work because owner has not prepared work area, work will be rescheduled at contractor's convenient and a $100 fee wits be assessed. BUYER ACKNOWLEDGES RECEIPTS OF AN EXECUTED COPY OF THIS AGREEMENT All contracts subject to office approval. • Buyer BY 7/014'14'41 . Boyer tin _...._......._ ............. =�R re ■ _........__-..__._..._._.».............»....__.......... .._..._.............._......._ .._. _......._. 2012 Jul 10 8:11AM HP LRSERJET FAX P . 1275 Cromwell Ave, #E3-4 ALLSTATE WINDOWS, LLC Toll Free (800) 387-9901 Rocky HiN, CT 06067 (860) 57143752 Fax (860) 571 -8937 July 17, 2.012 • Meadowland Condo Association Attention: Patricia Taylor Re: Replacement windows for Mark A Jordan at 266 Grove Street 1)24, Northampton, MA 1. Concerning replacement windows for the Jordan residence, the work to be done will complement the integrity of the home 2. All windows are made with virgin grade vinyl, all welded construction for corners on frame and sash. Windows will have Low E glass with Argon gas as per Massachusetts requirements, and will have grid pattern duplicating the look of the existing windows, 3. The window size will fit into the jarnbs as they exist. We are removing the top and bottom sash and the plastic tracks. We insulate around the new window frame and seal with caulk, secure with four (4) 2-1/2" screws. The last step, we will install new inside stops (wood trim). All exterior trim will remain as its present appearance. 4. These are replacement windows, so the existing trim on the inside and outside remains as is. 5. Regarding permit, as stated in our contract, homeowner is responsible for permits, painting and alarm reconnection. 6. We are a BBB registered company with an A+ rating Should you have any questions, feel free to call. My cell phone number is 860- 299 -6202. Sincerely, 7e 40-•-vam-ea.. Allstate Windows, LLC Ronald 1-1 Wanat, its manager Enclosines: Massachusetts License BBB Accreditation Certificate of Liability Insurance • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) 1 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 ❑ 1 1. w Home Winer 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 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 nd Local Zoning Laws�nd State of Massachusetts General Laws Annotated. Homeowner Signature ' �iQ 7 -71 SEC11ON 5- DESCRIPTION OF PROPOSED WORK. (check all malleable) New House ❑ Addition ❑ Replacemertdows Alteration(s) ❑ Rooting ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0] Brief De� riptippn of Proposed Work: ?0/ /9/r /V� (s4z Pir,Vf /A) /A) 4' 77) 5 GO//// A 7 h)/N4 i I.c Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. t l to :% !i! • ok * * °* 1 e ' 154 s • tfi$i' U0.11amyi_ " a *AA L!: 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 . 1. 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 4 5- l� _ C I j .4./ . _ , as Owner of the subject prope I . hereby authorize Lce to act o behalf in all matters relative to work authorized by this building permit application. L4-1.- d CI >2_, xi< Sign re of Owner Date 1,` A . �� , as Owner /Authorized Agent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and elief. Signed under the pains and penalties of perjury. Li 5/9 W. /)ave,, 4 Print N- e // :+ _ di - D !' go2 Signs re 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 Depattment Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parlcmg) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Findin 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 OA YES 0 IF YES: enter Book ' Page and /or Document # Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Q , Date Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: Le-Ria„1�(,� l 0, �SP 17 1/1 2 //1// Wit/2,S - ? 4J9_ D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 6. IF YES, describe size, type and location: E. WII 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 I NO e IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Depat use Only ; '_ City of Northampton Status of Building Department Curb ; Out!OnvewayPermit ; j I 2 1 2 Main Street S# eri Ptio'Av lability , 3 ?01Z 1 v� ~ Room 100 W � A aW rvoar a- H,,,- . ( orthampton, MA 01060 Tr Sets of Sri Pl r °'AO7 h`dne 13- 587 -1240 Fax 413- 587 -1272 R m et S py APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELUNG SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be � eted byoflice 402 Map U Lot Un (�� „� (fie l�l�/ 'Si Z Overlay District /4/ C -< / ii) 7 // / i I / L C / Elm Si. C trio CB District SECTION 2 - PROPEOWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: it /. <h /77. (',�, -ez.1 , shiPi. , 95 '9R6y Name (Print) Current Maili A ddress: a yi3 S , � .B -4” -._ Telephone Sure 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by�....1 permit applicant - 1. Building .c ..? . U V (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) \ . j q • ICY Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: ��6 7 ` / Building Commissionerllnspectorof ' Buildings Date 266 GROV ,.,r BP- 2013 -0125 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block - 083 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catego:v: v !ow replaced BUILDING PERMIT Permit ft RP-2013-0125 Project if . 2013- 000205 Est. Cost: 3.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Clan Contractor: License: Use Group ALLSTATE WINDOWS LLC 143147 Lot Sizc( , Owner: HYDE BARBARA A CIO MARK JORDAN Zoninpi Applicant: HYDE BARBARA A C/O MARK JORDAN AT: 266 GROVE ST Appli; ;:. ess: Phone: Insurance: 266 ( ST #24 NOR is , IPTONMAO1060 ISSUED ON:8/3/2012 0 :00 :00 TC .°'. ' .' THE FOLLOWING WORK: INSTALL REPLACEMENT WINDOWS POST 'T" 1 . 1 1 1 ) SO IT IS VISIBLE FROM THE STREET Inspcc r 5in4g Inspector of Wiring D.P.W. Building Inspector Uncle r Service: Meter: Footings: Rout,' Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THI:, f' 1\IAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY ' .1ULES AND REGULATIONS. Certify' ` 7Ccupancy Signature: Feel' Date Paid: Amount: Buil(' 8/3/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner