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22D-028
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Q. -n a E; CL o "N C H CD v � N CD D 0 v U) CO) CO) N (D (D <D <D fD N 0 N V! ® ;o X X :0 o 0 0 m m v V V 10 mmvz a) = 0) c o o T`c� c g Op 0 �D Q 3 x O cn k n! c = n -+ 3 CL n C1 (DD CL (D -i CD-IL z <D .. s � CD ID r- d CL A m Vi m = CD O A o `° Z 3 m `D O o w W o rr N CD C O CA Dn � CA w cn W v O CO w to a� fD K) N CD — cn 0 N Z m pF1 O NO GJ O A 7 �n V o N N N 7 tD 4t 0 w 0 C7 V CD 0 C77 O 4 v O CD I, To Whom It May Concern: 17 1UP Hi N 1TR -LI bFL , as property owner, give 1. permission to our contractor, Pella Products, Inc., to obtain a building permit for the installation of windows or doors in my home, located at Please accept this letter in place of my signature on the permit application. Thank you, Please Print Name Homeowner's Signature Date a F R 1 z E t 1 } E E - ;s PELLA PRODUCTS INC 155 MAIN STREET GREENFIELD, MA 01301 t Y� Subject: Disposal of Dobris The purpose of this letter is to certify that all the debris resulting from any project undertaken by Pella Products Inc_ in your Town will be transported to a dumpster at our main Facility at 155 Main Street, Greenfield, MA_ Pella Products Inc.is under contract with Waste Management of Massachusetts for the disposal of the contents of this dumpster. Very Truly Yours, FELLA PRODUCTS INC. Sohn P. Benjamin =accounting Manager The Corremo,nwerrlth of Alassacirusetts w Department vflndustrial Accidents — t Office of In vestigations 600 Washington Street Boslon, ]VIA 02111 = M www.tnass.govldia Workers' Compensation Insurance Affidavit: Builders/Cotttt'actors/Electrieia ! lumbers Applicant Information Please t Legibly Ni1r11C (Business!t�r6nnizntion([ndividtsa4}; �� i �� ,� 7r - Cit7/ tltte/l'rp: jFrac r? �� Jri F� U t Gt Phone 9: Are yon an employer? Check the appropriate box: — [� p y- 4. ❑ I am a general contractor and I Type of project uire,d): 1. t au»a ens to cr 4virh��_, employees (null andAw part-time).* have hired the sub-contractors n• ❑ New cons}cdciiot1 2.❑ 1 am a sole propriewr or partner- listed on the attached sheet. T ❑ Rentode{ii 811117 and have no employee~ These sub-contractors have l;. Demofitton i I �tiorking for lne ill any capacity. employees and have workers' ❑ [No workers' comp. insurance comp. insurance.! `. ❑ Building a*,lion cunt required.] 5. ❑ We are a corporation and its 10.❑ Electrical f:i�iairs or rdditions 1 y ❑ 1 ant a homeowner doing all work officers have exercised their l 1.❑ Plumbing 4..d airs or i_dditions i myself. [No workers` comp. right ofexernption per MGL `� 9 c. 152 � ) 12.�] Roof repi try insurauu:e re aired. .r §1 4 , and we.have no e.rllployees. [No workers' 11❑ Other comp. insurance required.] Any applicant Ihnt checks box N t nwst a{so rill out the section below shote,ing their workers'compensation policy information. Wnmcn•.tnc:rs who si6mii this ul'liduvit indicutiug they arc doing.all work and then tlim iwtsidc eonU'actors must submit a new al'rida tteti6 UIi Ld >uCl1. amt aciols that check this box must attached sat ac{ditiunal Chet shoeviug the mane of the soh-conu•uctors mid state whether or not thi ;antics 11-,we rntployees, li the suh-uxttt acwrx have amployces_they must provide their workers•comp.pulicev uuarlher. 1 um an ejnpluper that is providing workers'cotripens-ation insurance for nay emplr�yees•_ Below is the poi anti job site information. fnsuranct, t'onipany rl o U` Lc S� 7t _ 1 ri�i2 !'olicy ri or Sell' 'Ili. l.ic. #:_ ' 2 D ate:I�piration Date: ahSiteAddress: Ur1/ � CilyJSrate%Lip:��G`'� �� -�ltJ�6� Attach a cop of the workers' eor,li ens, policy declaration page(showing the policy number and .cpirsticn date). Failure to �•ccure coverage as required under Section 25A of NIGL, c. 152 can lead to the imposition of crim al penalties of a tine uP to $1,S06.00 and/or one-year iniprisonmeat, as well as civil penalties in the form ol'ar STOP WORN 1R.DEB,and a tine of Up to$250.00 a day against the violator. Be advised that a copy ol'this statement may be forwarded to ti Office of invcstications of the D1A tier insurance Coverage verification, I do hereht•certify under t/ie paitrs anil pen(rltles of'J)erjuri,drat the ijrformatiorn provided above is trite a carrec't. - / QViciat use onlp. Do not write in this area, to he completed bu My or town vfjicial. i City or Town. Permit/License# Issuing;Authority(circle one). I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. l'lumbin nspector 1 6. Other• Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable/ (❑ Name of License Holder: f)C l AC � C�L, 09 l 7- t License Number Address �r� Expiration Date �� A�1 Signature. ��"" '.' Telephone 9,Registered Home Improvement Contractor: Not Applicable ❑IY2 -272 Company Name I A Registration Number 9 ' Address Expiration Date Telephone 7 7� `" 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.....•. 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 he/she shall be responsible for all such work performed under the buildine 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 ❑ Replacemen�Windows Alteration(s) ❑ Roofing ❑ Or Doors [ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief Description of Pr posed Work: ,,. .CGaQ.�, ✓� �c� °� �t;�z� � �� (i �F.t� — So 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 existin housing- , com fete the following: 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. 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 �. V A FL as Owner of the subject property hereby authorize e ('0 d tti C4 S G to act on/I behalf, in all ma relativ to ork authorized by this building permit application. S ner Date as Owner/Authorized Agent hereby de are 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 Signature of Owner/Agent Date f 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 % 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 ® DON'T KNOW ® YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW ® YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES Q NO 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: j uilding Department Curb CutfDdveway Permit 2 2 Z�I ✓ 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability EIOCtriC,Plumbing&Gas Inspections rtham ton, MA 01060 Two Sets of Structural Plans Northampton. MA 01060 p one 3-587-1240 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 Ce v1 �� JL Map Lot Unit y Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: '5116LnOF lu T-R ur)FIL- T Name(Print Current Mailin dress: - 10,S- Telephone Signature 2.2 Authorized Aaent: Name(Pri t Current Mailing Address: G r w 1 a a�c UL !Z/-�-- -7-7 0, S7 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 7 Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of U Construction from 6 3. Plumbing U Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection L _ 6. Total=0 +2+3+4+5) -- 1'1 Check Number J This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 168 RYAN RD BP-2014-1093 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 22D-028 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2014-1093 Project# JS-2014-001868 Est. Cost: $2500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PELLA PRODUCTS, INC 091496 Lot Size(sq. ft.): 33497.64 Owner: TRUDEL STEPHEN A Zoning URA(100)/WSP(100)/ Applicant: PELLA PRODUCTS, INC AT. 168 RYAN RD Applicant Address: Phone: Insurance: 155 MAIN ST (413) 772-0153 WC GREENFIELDMA01301 ISSUED ON:412212014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 4 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 4/22/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner