Loading...
36-056 (5) PG R .Al24 4. is .. So d. Fumihed anp I i iaJIed lay, flra ch Name: Bostim D &tc: 2 Tl At s Horlu Scr ce Inc. •10, dlbla '11ac Depot A, i -Home Serttices 345� Grcenttortd Str;et Unit 2 Worcester, MA 01507 T� t Brandt Number: 31 roll Pr'ee.(M7()) 521 -5 2 , Fax (508) 756- 882 CI e ' 26 & j; Mk Lj . C't72439,' Tt7 Cant. Lit# 16427 # 55i5�2 i er facdctat lA 2 �yIA n f+nprdvetnwht CorimiC'tor keg. # 12092 5 n Installntu,is address: L ' f 11:(� { �/ ' 1 V ‘ Q7. city . . , State , Zip ; ParcbAscrts Work Yhoue: ktome.Olunsic; - ,C4'It ?hom ct [ '1 ' . I {C?0-1 1- r1149 [ 1 Home Address; T w (Tr di1"idrent from Installation. address) City ' State' `Lip E -mail Address (to receive,prciject eotum}uucatiprts and Home Dep,.,s updatai }, T LX) NOT wish to receive any miirltetiltg etuails front The,Flonte Dep l ri Inform Lion: t to t i aiyr Ct1 l "C:ustomer" n t. ,,:,Ines of ttte properra focdfed at',tbC,01:?6ve i'Asrallation address, agrees to b.uy, nd T7 At - Horne Suriices, Inc: ("The Horne Jepot"j.agrei„s tq,ldxnialt d Yu q,ag6l,irring ,f the :)t'1.st ttias1. lnstaUlatlon ") of reference, II m terish described t on the b.l le State Sarppletrieni and Puymett he (6), , .1oI;5rJ'tatoh std ialcoepcearcd [trio this Contract by this mmrayy attt }a 'he-reto'and .any Ch Orders el • ers `(dollecivy. 1_'.ontract" lob it r,,,e..,i Products: S i e Stratus Pr set Amount Insulation . , � t� GufteIs (�� —.LA W Vt [ / Co �ver.4 Denrry I)do2's _,. „,� '' ' ° �\' K.! I,_,Rwiling ['Siding LJ wwin CI insulation ; Gutters C E3Enm Doors �] :._ JkuotinK ❑Siding 1 WitatinV insular a • []Gutters / Cover; OEntry Uocus 0„ • Dkooling ❑Siding q 1Y,rmii'lvs 1nsuiaan0 QGurteri: / Covers ! Door � _.. minhairu 25% L)eronit et' Cont rent Annul t due upon Etel ti.lion of this toAp U . dotal. CGPW tt .4 ilruuit€ . • • Maine eonbasers may not detx' SIt more than one.thuil of the ContractAmnunt„ (' Customer agrees 'that, immediately upon completion of the work fovea h Product;' L'(igottiet:'*1 execute a'Currtplea'on Cirtiftcats ions for tact, Product as dctintd by nn individual Spec Sheet). and pay any balance due. Al Customer under this, Contract agrers tb be jointly and severally obligated and liable thereunder, The Horse Depotresetves the tight to issue tt Clialtbe Ordudr fcrrtiiilatc this Conant[ or any; irtd vtdueI Product(S) included herein, at its 4iscrotion, if The Home Depot or its authorized servi ,u l} ovi der determines that it ceenol ttti obligations -due to, a structural problem with the home, environmental hitir,ards.sucb as tnoid, asbestos or lead paint, .other ifet'y ci}tce"rns, pricing errors' or because r orfr required to complete the job was not iuclu1 cI tathe-Contract Pavmeut Snrnrnmry; The Payment Strtnmary # � •ev er ] 7 j included as .Ccnt, act Snk lurch the rata! Contract amount and pisyments required for the depo;btta and linal.payltient.s by Prodtict (I .pp able) NOTICE 'FO' CIJSTOMFAI You are entitled ta a r..om letely Pitted -Lr gutsy of the Contract at the time you alga Dt, rtoc srgit•u Comp! pn Ccrtiticate• (rote: • • there Ls one Completion 'ertitieate for each listed Product as defined by intti>ituat S g t :Sheets)•.befpre w or ['ott.that product, • is complete. In the event of termination of this Contract, Customer agrees to pay The. Phone f)epOt'the costa of, materials, labor,. expenses. and services peuvided by The Horne Depot or.Authorized Service ,Provider tbr$ttala [lid date of tertttlnation. plus any other • , am unts set forth in this Agreement or allowed ander applicable law. TI It CE'DE1'OT MAY wl HOLD AM OWED 'fO ) lj HOME DEPOT FROM THE lf1Ef'O PAYMENT OR OTrf$'R PAYMENTS MADE, WITHOUT LIMI'1'ING'i'FII:. HOME DEPOT'S OTHER 'REMEDIES FOR RECOVERY. or SUCH AMOUNTS. . Acceptance and Authorization: Customer agrees and understands that .thin .agreernent is the emir;; agreement between' Customer and The Home Depot with regard to the Products and Installation .ea`vi ;es and supertiedes all prior discussions and agreements, either oral or wrirteu, relating to slid Products and Installano . This Agreement.cruuasx be ays'igned - or. amended except by a writing Signed” ia> -omen and The Home Dcp. i Customer acknowledges utd agrees that Customer' read, understands, voluntarily accepts the term: of a3t0 lots reccit a Copy of this Agreement, r Accepted by: � ." Suhmrt/td ( b ` y. t �: L f;pri , . . Cusw o tC'tialu ry � Date Stiles -o'nsultani's gnattuc Date . Telephone No. customer's Signature Dace Sales Consultant License C :'aNCELLATIQ S: CUSTOMER MAY CANCEL '!'Ill.'+ (as apylicuble) • AGREEMENT WITHOUT PENALTY'OI2 OBLIGATION' • • BY DELIVEIt1NC WRITTEN NOTICE TO THE HO!IIL LtEPO'r BY 'MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SLCUNIiNG IHJS AGREEMENT- THE SPATE SUPPLEMENT ATTACHED HIER}'.tO CONTAIN". A FORM TO L :SE If' ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S !vet' rt(t a 1 inTI Y'/ J. TE ims AND CONDI'1LON., ARE STATED ON Till: itratILS.E SIDE A1v7D AJLL PART OF Tins CONTRACT 6.10.09 GS(; White - diancn Fier, Yellow - Customer Fink — Sdea Conautttant • 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 - - • • $ • • - - es that the buildin. de.artment be called to inspect work at various stages, which include foundation /footings (before backfill) sonotube holes (before pour). a rough building inspection (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-conj unction.,. to -the building_ ermitissued,_. 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 =t1.-=. ft Office of Investigations =I: •A 1— 600 Washington Stree "lcf " 0 Boston MA 02111 www.mass.gov /dia -Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly L Name ( Business /Organization/Individual): T 7f)2 (; /) . Address: C M �1 011Y City /State/Zip: Lc -7 �. -, Phone.#: ` 7 . _ Are y an employer? Check the appropriate box: Type of project (required): 1 1. am a e 10 er with 4. . D I am a general contractor and I mP Y 6. ❑ New construction employees (full and/or part-time).* have hired the sub- contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑ Remodeling ship and have no e.-Ioyees These sub - contractors have. .8. 11 Demolition for in any capacity. employees and have workers working g Y P tY- 9. Q Building addition [No workers' comp. insurance c -�P - insunn�e required.] - 5. D We are a corporation and its 10.0 Electrical repairs or additions 3. [� I am a ameewaer chine all work 9tic� havex.,ercisc_d_theit. _- 1 -1.0 -- Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Ro repairs insurance required] t • c. 152, § 1(4), and we have no employees. [No workers' 13. P.41 ther t .0 / f /� 4 E,35 comp. insurance required.] *Any app licant that checks box #1 must also fill out the section below showing their workers' compensation policy information. . t Homeowners who submit this affir1 2 vit: 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. Iam an employer that is providing worker' compensation insurance for my employees Below is the policy and job site information I c-- Insurance Company Name: \e1 fi 1 yy l "' iUiv -C , 1 VAS C 0 Policy # or Self-ins. Lic. #: - 1 /,_,9 15f Expiration Date: / Tob Site Address: 1 l WFp City /State/Zip:* - f f yyP 1/G,.- 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 cnrnmal penalties of a fine up to $1500.00 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. l8e advised that a copy of this statement may be forwarded to the Office of Investitrations of the DIA. for it I . ce coverage verification I do h ereby certify under e p , d pe s ' perjury that the information provided above_' rue _andicorrect __ - -_ Signature (r, [ iiittik Date: / 0 ii Phone #: 00/ / 3C 9- i - Ofcial use only. Do Ira write li f7iir area; to be eo`mpleled by city or town officiaL 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 #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supe "sor: Not Applicable ❑ Name of License Holder : 7 1'7 D ni vii' . 1 License Number All % , r2 _ _ 11' & �f IM d y/ / l u Addres00�1 ! Expiration Date JJJ /P /�/l4 4 _ .4 - Sign. ur- Telephone 9.: Req#steredHome' -tmp ouerr#ent_ anfra ` + ' � ,,. Not Applicable ❑ " o 1 83 Company Name n Registration Numb r 9 Address Expiration Date 00irreST'r " kt D) phone L /p! q 2 3. 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 buildin ermit. Signed Affidavit Attached Yes 4 No ❑ . v © ' 9 p O l i try: 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 r tO nances & e-. . r , r- al-Laws-Annotated. Homeowner Signature s SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement W lows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [E] Siding [D] Other [O] Brief Description of Proposed 1-frt-ict--. Work: 4.11 _ de.' - ' a/.. ,,.__J E. 1 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6e. ifkeii i6Il eail dor.aldiiiiiiiiO. ' ie' is ou§inci,,to 1plete.thelotio ul!'tq: 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? .7 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 e roni-ii4 t , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit applica ion. f ii / 0 Signature of Owner Date r i' I, II A G $j/ Q_._ , 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 and pen of perjury. ir'I�( j . ..'' Print Name / t . i --- tAg-*-- /Di/14y ___ Signature o owned' gent 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' _µ R..._A.. __ , L: ... R: Rear . ... Building Height Bldg. Square Footage % Open Space Footage (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 Q DONT KNOW 0 YES 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 ' Page and /or Document # ____.___.._._.._.•• 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 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 0 IF YES, describe size, type and location: Are there any o osed c ian es "to or a i o gi ns inter ad t `- ro p ert ? YES 0 NO 0 YP P '; g P P Y 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 (3 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • zait6a7t �� _ f�e�artme t:�se only � City of Northampton tatuso l erm Building Department G 212 Main Street seer' rsep#ailafly max h 4 Room 100 Northampton, MA 01060 T phone 413 - 587 -1240 Fax 413 - 587 -1272 P1� eufegsn, 3Y 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 Map ' ` Lot Unit r � 1�- Zone Overlay District ✓ EImSt. District CB <District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Rec - - - r 4 Pi_i_kar,g1---)‘ - 0! 1/0 11 A Name (Print) Current Mailing Address: 6 - )inttr4( Telephone Signature 2.2 Authorized •Am ; Name (Print) / /�I Current Mailing Ad ress: . °41 •4/4/ /1735;77/ Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building �0 (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) L DC)CY Check Number This Section ForOffcial Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of-Buildings Date a ' i D1 i BP- 2010 -0436 GIS #: COMMONWEALTH OF MASSACHUSETTS * 1t: 36 - 056 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- 2010 -0436 Project # JS- 2010- 000592 Est. Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size(sq. ft.): 12501.72 Owner: ALHASSAN SOFIYA Zoning: URA(100) / /WSP II Applicant: HOME DEPOT AT HOME SERVICES AT: 41 REDFORD DR Applicant Address: Phone: Insurance: 345 GREENWOOD ST (401) 935 -2633 () Workers Compensation WORCESTERMA01607 ISSUED ON:10/20/2009 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 10/20/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo