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32C-218 (3) t Jt 1 "9 fa-aZ s a ,.d 9:4 t 41 0001 Manufacturer ThermaStarby Pella (R) RO Size= 31 1M" W x48 31" x 48" 1/4" H Product: Windows Frame Size = 31" W x 48" H Type: Double Hungs R Manufacturer ThermaStarby Pella (R) Energy Star (R) Qualified Products Only: Yes -I would 11111111 nreto view oily the units that are qualified for Energy Star (R). Energy Star (R) Zone: Northern Room Location: OTHER 1 Material: Vinyl Frame Type (Overall Width): Replacement Frame (3 1/4" OAW - No Fin) • ECEIVED 'es: 20 Series Sloped Sill Adaptor Yes -Included Head Expander No - Not Included JUL 22 20n Configuration: One Wide • NORTHAMPTON, MA 010t,C Frame Size Width: 31" . OF BUILDING INSPE Frame Size Height: 48" Vent Size: 1/2 Vent Exterior Finish: White • Interior Finish: White Glazing: Advanced Low-E Argon Gas Riled Yes - Argon Gas Tempered Glass: No Grilles Between Glass Type: 3/4" Contour Grille Pattern: Standard Colonial Top Sash Lite Pattern: 3W2H 'Bottom Sash Lite Pattern: 3W2H aniwair: 2 Cam/Keeper Lock Sets IHard Color White Screen: Full Unit Fibergl Screen J Des ign Performance: Standard Lead Time: 21 U-Value: 030 Solar Heat Gain Coeffcient: 0.25 'ventage Visible Light Transmission: 47% • N The Commonwealth of Massachusetts ..'7,•4 • Department of Industrial Accidents r Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /PIumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual):_ N o r 1 o vlc e / 41 e Address: e C(cy4. 5 C'a , 6-4 4 4, NA DI 0J City /State /Z ip: Phone #: x /13 — S6 00-2 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 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors 2. EZ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their Plumbing repairs or additions 3. ❑ I am a homeowner doing all work r 11. ❑ myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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 certify under the gins and penalties of perjury that the information provided above is true and correct Signature: • Date: 7 7 1 I /// Phone #: V 3 . St. 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: Phone #: Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR :110.11) ti Independent Structural Engineering Structural Peer Review Required • Yes 0 No I SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ...� I , cr.e-?_. . ... r. ,__ _ _ , _ G1.�t... c_fr- ` S e/ as Owner of the subject property f 4 . !� hereby authorize C� �C�..... - .. _,__m_ __.. b_. _ _. to al t on m .ehalf, in a tters elative to work authorized by this building permit application. _____ �' 0 .4". - - -, A T Date S .f Owner - Ajbli. 4.44 arcs ' __, __ , 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,._ Al e , 411 ot- ___ .1 e . _,if ._...._ ._ .._ -- _.. __ Print Name -_- _.__._..____._._.. - . .._.. .7/1-■-16)/ !( Signature of Owner /Agent D t SECTION 12 - CONSTRUCTION. SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder .444.. .... Q.id._s,di 17 IM e - %t iLi.i2P -,Y.`. - - G _ ° v4 C , 7 ...���. �M.a.,�� License Number Address Expir tion 6ate `i!_- TO - 3d 07 ,aw _ Signature Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG 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 ` 0 No 0 • Versionl.7 Commercial Building Permit May 15, 2000 . SECTION 9- PROFESSIONAL DESIGN -AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENSLOSE© SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): " _� _ Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility , Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address . _ Registration Numbe I Signature Telephone Expiration Date Name Area of Responsibility i Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address ._... _ .._._.. _ Registration Number _ _._._.._..__. i Signature Telephone Expiration Date 9.3 General Contractor _. ._._.,_._...__ ._..._.,_._ .__..___._...,.. ._.._._._.. . ---- _._.._.. —_ Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHA,M.PTON,ZONING _ , Existing Proposed Required by Zoning . This column to lie filled in by Building Department Lot Size Frontage Setbacks Front Side L:----; R L:' _. R: : $ Rear __ _ Building Height --- _ Bldg. Square Footage % "" LL Open Space Footage , % — • (Lot area minus bldg &paved o- parking) # of Parking Spaces € d ._._ Fill: i (volume & Location) _____ __..... A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 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 ' 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 , Date Issued C. Do any signs exist on the property? YES 0 NO 0 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 0 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 A SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 .. -- ; .•w v. CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs (g Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other E] li S Brief Description Enter a brief description here. .fins 4 /C , „ r e, !ems MCA 4 - (4, iv c, w5 __' Of Proposed Work 's a o/c:i icy s . ,. ge e— ,� i K k r �Ck . _ c,"d , ii , �C_ 5 enC' ..,a( r C'� °' ✓t SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly El A-1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A-4 ❑ A -5 ❑ i 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ' r ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I -1 ❑ 1 -2 ❑ I -3 ❑ i 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: i M Mixed Use ❑ Specify: l S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group < Proposed Use Group: '___..._ ____ Existing Hazard Index 780 CMR 34): `_ _, „,_,_,_ Proposed Hazard Index 780 CMR 34): '.._,.,._,__. .....,_...,_, .___.__ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) •1 ..__ ____,_„_._.._, _.._ 2 nd ' 2 nd 3rd 3 ro 4th _ _ _ _ 4th . ... ----- _ _ Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone _,_,______ Outside Flood Zone❑ Municipal 0 On site disposal system • Version1.7 Commercial Buildin. Permit May 15, 2000 City of Northampton -' RECEIVED ilding Department e i, 212 Main Street Se e• .,a®t '' '".r''''' , A f J Z 2011 Room 100 t ll U No hampton, MA 01060 - 'tt b 0 , I ns. _ ® phone 413- 87 -1240 Fax 413- 587 -1272 g _ + � � 3� "� f ax .� ;,��+,+ -�Y � x r, `�4 �'f P T. OF BUILDING INSPECTIONS � 4'( �` , * � sk � a 1 f ry NORTHAMPTON, MA 01 L Vm� �" ; -A ..� : , . " g , a ..... _- APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING II OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1.1 Property Address: ,�•� O�ynJ« ,S'7'Rkt 1 , Map 3o�C —a /S Lot 32C 2/ k Unit I S Tr 24-).0 i Ala /QT/ '1PT N m/3 - , Zone Overlay District _.: _..- _ . — . .__.-- ,..»._ = Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: -Tined - C /n7J4 mm Kzf/r+e�.:r�kj _ Name (Print) Current Mailing_ Address: » _ Signature .I Telephone y1, — S75 ? 2.2 AuthoA. ent: Name (Print) Current Mailil Address Signature ! Ems( /f_.....______.— Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant I. Building 6--01f2 t,(.) I (a) Building Permit Fee s 2. Electrical ______ _ (b) Estimated Total Cost of Construction from (6) _.._u._..... _ti_...._.._ -- . 3. Plumbing i Building Permit Fee 4. Mechanical (HVAC) ...____________ 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) Check Number 3D / / is3 S This Section For Official Use Only Building Permit Number Date Issued i/1 9611-t o Signature: Building Commissioner /Inspector of Buildings Date • File # BP- 2012 -0097 APPLICANT /CONTACT PERSON NATHANAEL ALMEKINDER ADDRESS/PHONE 66 CLARK ST EASTHAMPTON (413) 250 -3007 PROPERTY LOCATION 28 HOLYOKE ST MAP 32C PARCEL 218 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out q 9 , / '1 / .-' Fee Paid J'r ' w / < .,J l t�C Typeof Construction: INSTALL REPLACEME T WINDOWS & ADD KITCHEN SUPPORT BEAM & GENERAL REPAIRS tu / �^ / r--- New Construction tut b/ "� � '� /✓ _s y �J ✓� ! / 1, Non Structural interior renovations Addition to Existing, Accessory Structure Building Plans Included: Owner/ Statement or License 102079 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding _ Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management ,, , F.---- 0 - -- • 1'ti. • ! ela / /1" P 7.....dev, ././../ S . e of B i i ding Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. 28 HOLYOKE ST • BP- 2012 -0097 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C - 218 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0097 Project # JS- 2012 - 000152 Est. Cost: $8500.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NATHANAEL ALMEKINDER 102079 Lot Size(sq. ft.): 6621.12 Owner: KEATING BEATRICE J C/O JAMES P KWIECINSKI Zoning: URC(100)/ Applicant: NATHANAEL ALMEKINDER AT: 28 HOLYOKE ST Applicant Address: Phone: Insurance: 66 CLARK ST (413) 250 -3007 EASTHAMPTONMAO1027 ISSUED ON:8/1/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS & ADD KITCHEN SUPPORT BEAM & GENERAL REPAIRS - WINDOW LABEL MUST BE ON FOR INSPECTION 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: / 0 56— 212 ain Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner