29-041 (4) a •
energyslaI.nrcan—rncan.gc.ca
M Qualified
Remove label.after final Inspection; SAVE for future reference
Weather Shield
CP OI 050=A—172
U746RCF Model 8108 Double Hung Operatinb
Alum clad Thermal Frame
lFtcYF,rrraf:.n 3/4 Inch Glazing ,
rwN c!miz ZO—E .022 Low—E
Argon Fill Grille in Air Space
ENERGY PERFORMANCE RATINGS
• 0.30 U—Fuler_ So, He ¢efi Coeltident
U 1 .70
P HleltirlS!
ADDITIONAL PERFORMANCE RATINGS
Ytslbtl:Tranin tlaaa Clmdeosztion Resistance
0.40 0
Yeavfaclurer elpulehs hit these pangs twbrnt to sppflcablo NFRC procedures for
ddermloing•hole ptodact energy pefognmrL NFNC rasnys are dalemdnad bra"
tsed set of eadronmanW cmdtaons and ssppWit prodatf sins,NFRC does not mvwn tnd
any prodritt and'does nit rt.•rent be suf4bl0q of pnodoct for any spedac unit.
Cantult msnulattarel's Atariturt lot olhel Froduet per -ante Womuaon.
www.ntru.o
Meals or eteeadf A7.EC„ C.F.C„ snd I.E.C,C. Air infiltration Fle ulrements
(DP) . (pSO Teved iA ANSVAAUAtNNWOA 10f CI—f7
H_LCJf 44XM _
tared to IIANAIWOUMIA
• . _ 1014 511040'-0S
H—CC75 titfXZ260(4X90)
TiS-7 •
Una Year%S'rryetrral Ps sale re,ASZY U%
ole:n
nr;zd7d�i—1 —1 1181SCM11HSTO
HONE IMPROVEWNT CONTRACT
PLUM READ TRI S
Branch Nam.BegffN fOtA Date:c.�to Sold,Furnished and Installed•'by 14 THDAt-tlotneSeivice$,Inc
dlbla The Rome Depot At-Home Service:
Branch Number:31 mail 33 906 flostom Turnpike.Unit 1,Shrewsbury,MA 4154`
Toll Free 677-902-376F
FodcrA.E)#75-2b9MO;ME Inc N C 02439;10 Cont.Lie#16475,
GT.11c,11 115$5522;MA,Home hnprovettteat Caatractor Reg.#12$$9'
InstaMation AddMn.- ` � 0-!�� , Q /• ! ► b{ 2
City State Zip'
P't wchsser(s): Work Phone: fiwne(Phone: Ceti£'hawt
C k
Hoare Address:
t1£different from Installation Address) City State Zip
1!-mail Address(to receive project communications and Home Depot updates):_
❑I AO.1vA�R-eviab-saxeoeiroc-mt�mat�et�g etnsil�-fxam�T'tse tio�Cte Depot... ..
t Information; Undersigned VCtstomer' the owners of the property Iooaoad at the alxrve Installation address,agrees to buS
Ad-Home Sm-vices,Inc.("T'he Hoare Depot's agrees to furnish,deliver and arrange fax the installation("Installation")e
all materials-described on the below and an the referenced Spec Sheet(&),all of which are incorporated into this Comteaot by thi
reftreno,alodg with any applicable State Supplement and Payment Summary attached hereto and any Change 0rdecs.(c6llk41vcly
"Cantraat"):
Job Aelbmw 5 e Shee S dl: I'tn eel A>novnt
ry �}r �y Rowing Siding ltidows Lj Insulation
�Gu mets I Cover9'❑ Doom ❑
Rootigg siding❑Entry winDodows Tnmalatiort 7 }
43 ❑r3rrticrm l Covers ors ❑
Roofing Elsiding El Wadows'Ll Tnsulation (r
❑CanterslCovers❑Entry Doors C1
Roofing Siding Windows Insulation
0t3utters 1 Covers.❑Entry Doors Q
INidnM;t5%Deposit of Cam Amount doe span eanrtion of this omtraM Total Contract Amount $
Maine Purcbmm may not dqm*mae than oqe-b of the CooxndAaamb
Customer agrees that, immediately upoi cotnpledon of the work far each Product,Customer will execute a completion certificate
(one for each Product as defined by an individual Spec Sheet)'and.pay any balance'.due, As applicable,each Customer under this
Contract agrees to be'jointly and severally obligated and liable hererrztder.
The Uome.De"rt sd'ves the right to issue a Change Order or terminate this Contractor any individual Product(s)included herein,at
its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a.structural
problem.with the home,envirowe�'ltal hazards such as mold,asbestos or lead paint,other.safety concerns,pricing errors or b@cause
wor}c required to complete the job.was not included in-the Contract.
Pdymtent Stunntgv: The Payment Summary# gl(.06 included as part df this Contract, sew forth the total
Contract amount and payments required for the deposits and 5ural paymenia by ProdUct(as applicable).
NOTICE TO CUSTOMER
You are etiti d'tl6 a compp,liwily rdjw-)A dopy of the Contract at the thue you rig►. Do not sig p a C IetNn-C-k1tificate(note:
there is one Completion Ce:rbffcase for eat Uisted Product as.defined by indlvlduial Spec£beefs)be%6,6A ob thet'rA duci
is ewltplete.
In the event of termination of this Contract,Customer agrees to pay The Rutme Depot the casts of=1ttriais,labor,expenses
and services provided by The Havre"t or Authorized Service Provider through the date of termination,plus any other
amounts set forth In this,Agreeinent or allowed under appl1cabile law. THE ROME f5MT MAY WITHHOLD AMOUNTS
OWED TO TIME HOME x1MT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LMIT NG THE ROME DEPOT'S OTHER REMt?,I]IES FOR RECOVERY OF SUCH AMOUNTS.
Aex�ts a and Au�: Custww agrees and understands that this Agmernent is the entire agreement between Customer
anti a amc Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either
sal ar written,relating to said Products and Installation.This Agreement cannot be signed or amended except by a writing signed
by Customer and The Home Depot.Customer acknowledges and agrees that 12 stn has read,understands,volutttt;rily accepts the
terms of and has received a copy of this Agreement
A cepte by: rr Submitted y: ,
Cus errs signature Date Sales Con tout's sluts Date
X Telelihm No.
Customer's Signature Date Sales Consultant License No.
CAi+1trE1 i,A�TDit1: CUSTOMER MAY CANCEL THIS (as appncablc)
AGRk'EME'NT WIT130VT PENALTY OR OBLIGIAMN �-- �,
DEPOT WRITTEN 1NOTfCI�THIRD THE HOME f'^ (`('',(,
Il>'POT SY 141T1►N1GHT ON THE TtTIRD BUSINESS t,',"!}
DAY AFTER SIGNING THIS AGUIM[vIENT. T»
STATE SUPPLEMENT ATTACHED " HERETO
CONTAINS 9r FORM TO USE W ONE IS �\
SP'ECrKCALLY MSCRIBED. VY LAW IN
CUSTOMER'S STATE.
NOTICE,AMMONAL T M9 AND CONDITIONS ARE STATED ONTIEE REVFR59 SIDE AND ARE PART OF THIS CONTRACT
The Commonwealth of Alassachuse s
Department of lndmstriai Accidents
Office f ice of Inmfigations
600 Washington Street
Boston,MA 02111
WW .Mass.gov/di,a
markers' mpensation insurance Affidavit: Bwtlders/Cap#ractt� ;/ 1 "tri i ��(j'lurab�r�
Co
Anplieau#Ialftirmafioiti Please Print Le ib
Name(Business/Organization) dividual):
Address: fit)-
CityfStatelZxp Plione#:
an)e-36:4 Zel�
At-e yn_ � �rer (i c�ttpropriate baggy Type of project(required):
4'. [�I auz a general contractor and I
1 am a eniip �er vsn � 6. ❑New constriction:.
employees( nidlor p tune).* hive hued the sub contractors
2.❑ I am a sole ra : etor or' er- listed on the attached sheet. 7. ❑Remodeling
p p These sttl- ntraetors have
S itric and have nc employees 8. E]Demolition
WOrkg,for me; an pa aoi employees and have workers'
Y P tY 9. ❑Building addition,
w [T,lo workers' pomp insurance :
comp.,insurance
_ required,] 5. 0 We area corporation and its 10.[1 Electrical repairs or additions
3.[] T am a hctpeowner doing all work oers leave exercised their 11.[]Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
c.:1S2, 1. ,anti we have no
insurance required.]t § ) 13.El Other
em P to ees,y: : o workers'
comp Tsurance required]
*Any applicant that checks box#1 toast also 64 out the section below showing Well wotkers'compensation policy information.
t:Homegwne�rs who submit thLS ai6davt indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such,
$Contractors that cheglc this box mustattachec!an additional sheet showurg the name of the sub-contractors and state whether or not those entities haves
employees; tf the sub-cantrac«ots haY etstployees,they must provide their,iYroarkers'camp Holey number.
I am an employer that r�provfding workers'Compensatron Insurance for my employees. `Below is the policy and job site
infarnitton, -
In
surance Company Name—{
it
Policy#or,Self-ins.Lic.#: - Ezptration Date:
R 2,
Job Site Address: J5 City/State/Zip:
Attach a copy®f the workers'cv:mpensahon policy declaration page(showing the policy number and expiration date).
Failure to sepuro coverage as required under Section 25A of IyIGL 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. $250.0.0 a day.against the violator.. Be advised that a copy of this statement may be forwarded to the Office of
Investigahorts,tjfthe DZA for insurance coverage verification.
3 1 clo loereby cerPafy to v e p ns tae o,j `erjr that the inforeesaadaon provided above is a an4 correct.
S1 a e. Date: °r L
"Phone#
Ofj`ietat use,vnly. Do not write in:thu area,to be completed by city or town official
City or Town: Perinit/License#
Issau►g Authority.(circle one):
1 Doard of'Healtli 2.$wilding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other' —
Contact Person. :.
Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction S ervisor: Not Applicable £
Name of License Holder: "✓v1�'"/``� - /`" ' ^��;�5✓/
License Number
-2
7,
Address Expiration Date
Me
Signature Telephone
9 `Re istered WeImpircimemen, Contractor ,;: ,. Not Applicable
1 .... .. . ......... _:...
Com an Nam Registration Number
A r ��' Expiration Date
hie, V Telephon�
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 OW. H&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 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 ❑ Replacement W' ws Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] r'Deckks [M Siding[O]'' —Other[13]
Brief Descripti f Pr OA)w)X� 0 &J14a&*-F �OWork:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa:If Nerrir douse'and.or:addie 7&e (1,aiouslng,'coinpiefe the followmct:
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
�I 4;ia
as Owner of the subject
property
dorz-p hereby authorize r 2°- �
�A-
to act lo�nmyy behal 'n all matters relative to work authorized by this building permit application
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and informa ion on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed u e pa' s and pena of pe'
uz)a -V
Print Name
S. ture of O er/Age Date ��"
. .
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Th.is column to be filled in by
Building Department
Lot Size
Setbacks Front
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
A. Has a Special Permit/Variance/Rmhng ever been issued for/on the site?
NO «—\ DON7KNOW 0 YES 0
|F YES, date iouedJ
IF YES: Was the permit recorded at the Registry ofDeeds?
NO ���K ) DON7KNOYY 0 ,ES '
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook' body uf water urwetlands? NO 0 DONTKNOVY 0 YES 0
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained x,� Obtained »�� , Date Issued:
�� ��
C. Do any signs exist on the property? YES «���� NO �^��
�
(F YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO «~-x
IF YES, describe size' type and location: '
E. Will the construction activity disturb(clearing,gradingexcavation,orfiUinQ)over 1 acre orioit part ofo common plan
' that will disturb over 1acre? YES NO K }
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
17r ' rrc F,
yl.'G' yv.9Gi f t ��Depat �ehuse only��. 1 +.f`l'�sa r,s y�}7# ij
(( — f City of Northampton status ofPgr
4 1 W �G,,q�aa�kp4a4 5rr sir � �y41 h ,e z
ti 1
C._ Y 1 Building Department � ri� u�t/Drttewa I?eFilt ut � I x S� LawLy �_
�h" uiiYp�St�t4 eii�ad',hbGf I�SL-tx. i .54r ,ti}nF+,l�,iL t ri �5 �'
i! 212 Main Street i Sey+e�rfS�e
411 pttc`P� alia ��rty�
♦{iV �'; b d � t�5.cyIi�+
Y�p7T 2 } •: Room 100 iwater to EFArtalla�illit�r
1� q}fit 9�-I30
Northampton, MA 01060 TWOISes"�f Stlirtur�)Pans* fF 5M7�+u`{' ati�N 71`'f �`Hhs
Electric,Plumbing&Cap b66'41 3'587-1240 Fax 413-587-1272
NOrtharnpton. ,: V 5 Mrzs""L�1 j lea 4ty gr15 �R �n�5 htl e hih ,r"`.
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE.INFORMATION
5 Th'ts section to becompleted by office
1.1 Property Address:
l� I L
✓/J/�� //�J/�J /�[/J �,'ilYlapi�ii i Oil iiL 'Lot } iFt 'I 1 U,I-t
i '�: r i
rlay Dist`r,ctr:�u,� 0
€ Zone A
i
Dw tract n .� a r CB District k.L.,,r,r' -
SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owne f Record:
j/
Name Print) �� C r t Maiiipg,�d e,
elephone
Signature
2.2 Au on d Agent:
Na e P' t) Current Mailing Address: J�y7J
r 7M ^�/-'
nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building 2__ 41 0 (a)Building Permit Fee
2. Electrical y' (b)Estimated TotaI Cost of
Construction from 6
3. Plumbing. Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) r v Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
59 PIONEER KNLS BP-2014-1268
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-041 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-2014-1268
Project# JS-2014-002131
Est. Cost: $13247.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 98785
Lot Size(sq_ft.): 11979.00 Owner: KAPITZKY JOHN E&PATRICIA R
Zoning: Applicant: HOME DEPOT AT HOME SERVICES
AT. 59 PIONEER KNLS
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON.512912014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 17 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 5/29/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner