10B-032 (3) enetgyslar.nrcan—rncan.gc.ca
i�; �1d1lled
Remove label.after final Inspection; SAVE for future reference
Weather Shield
CPO# 050—A-172 '
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NF RC Model 8108 Double Hung Operatinb
Alum clad Thermal Frame
rtNrr><7t�riearori.� 314 Inch Glazing
FWN t',taet:ta ZO—E .022 Low—E
t Argon Fill Grille in Air Space
ENERGY PERFORMANCE RATINGS
.
0.30 U F�ia1.7 Q S610 r��aln C6l:rrIClGnI
' SJi–P 1AelriclSl
ADDITIONAL PERFORMANCE RATINGS
Ylslble Imit nlllaace Cande6saii6n Resistance
0.40 0
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delcrmtalnq whsle pmdset sni+9T perbniumm NFRC songs srs delenolned br s
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1 any ploddcl and'doea
L�esult m n At tanra aa t h e rott abla4 01 uyy prodeet W 9"1 spedtc ua.
anutactutil,.e I tv 0r ether pmduct perlonrnce
Intormsaon,
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Masts or exceeds M.E-C.. C.E.C.,and (.E.C,C. Air itiminibn ne uiramen(s
(D P) " .(As�1 Nen CJS 4 AAUMMININDA ICIL5.2--17
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halt'E IMPROVEMENT CONTRACP
PLEASE READ TM
f ([� sold,Furnished and installed lay:
es
Branch Nam Bunton North dt 36oth Date:6114, .THD At-Home Services,Inc.
(VWa The Home Depot At-Hbme.Scrxices
Brage4}I+ivmber:31 and 33 908 Boston Turnp0w Unit I,Shrewsbury,MA O.I545
Toll Free 877-903-376$
Frtic ra)D#75�269W-ME 1-ie#C 021439;RI Cont.Lic#16427
CI'U.# $522;MA am,lmlxvvement Ccntractar Reg.#126893
lnshiAationAddress. 'fa I've— U.
, irtt n l05
City States Zip .
Pwchaser(81: Work Phone; Hounewome: CollPboner
Nome Address:
(If different front buWlatim Address) City State Zip
E-hail Address(to receive project communications and Home Depot updates);
❑I DO NOT wis4 to receive any marketing ernails from The Rome Depot
ti art, Undersigned("Customer'),the owners of the y]bested at the above installation address,agrees,to buy,
and Tl o- arnd Services,Inc.(`"17te Home Depot"),agrees to futrtis deliver and arrange far the installation("Installation")of
all materials described on,the below and on the referenced Spec Sheet(s),all of which are incorporated into this Cmtract by this
reference*along with any applicable Stare Supplement eu3 rgyment Summary attached hereto and any Cflahge Orders(collecively,
"Contract"):
job#! mskr ax,* A PrvdWCta: see Sheet A: Y 'ad+lmouat p
Roofing Siding %adomt .taiuladoo + / �r/J
8 ❑Gutters/Covers ❑Entry Doors❑ .j ,5f+ f( � �J�' {
Roofing Sidii:gndawg Lssulafian $
❑Guam/Covers ❑Gatry Doors ❑
ltopfina Siding L1 Windaas Insulation
L~ouaem t Covers ❑Entry Doors❑ "
Roofing LJ91cling windows LJ lnsWaenn
00utoess/Covers ❑Envy Dods
ylisoonam 35%Depoa of C000:sct Amatmt doe apm czm ttm of tltfs emrWacL Total Cmtraet Amount $ I
\%shrePtarhmm may uotdgmot mom am ouPOW eftbe ContradMnamt
Custortier agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate
(one for each'Product as defined by an individual Spec Sheet)and pay amy balance dui$sappliwele;�aatdt tbytt�t'rtadC°t55s
Contract agrees W lie jointly and severally
The Ho=: S`#Iie right to issue a Change Order or terminate this Conttact-o any individual Product(s)Included herein,at
its discretiom,if The Horne Repot or its authorized service provider determines that it cannot petfocm its vbf igations due to a structural
problem.with the home,egvironmental hazards such as mold,asbestos or lead paint,other safety concerm pricing errors or because
work required,to complete the job was not included in the Contract.
Payment Summary-; The Payment Summary 4 included as part of this Contract, sets forth the total
Contract On=and payments required for the deposits and final payments by Product.(.as applicable).
NOTICE TO CUS'TOWIt
You are entitled to a coupppl�etely fined-in copy of the Contract at the burs you sigd. no not sign a tomple4iao CerSficate(mate:
there 1s one Completion Cartirkate for each listed Product ass defined by individual Spec Sheets)before work on that Product
is complete.
In the event of termination of this Contract,Customer&grew to pay The Hone Depot the casts of materials,labor,expenses
and Services provided by The Bane Depot or Authorized Servke Provider thirp�gh the date of termination,phis any other
amounts set forth in this Agreement or allowed ud&r applicable law. THE 1TOME DEPOT MAY WITHHOLD AMOUNTS
OWED TQ THE ]RON11 DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS XADE, WITHOUT
LlNifi'TTNG THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
to ee and Authorization: Customerr agrees and understands that this Agreement is the entire agreement between Customer
and a Horne Depot wirb regard to the Products and Instollatitm services and supersedes all prior discussions and agreements,either
oral or written,relating to said Products and Installation_This Agreement cannot be a or amended except by a wtititlg signed
by Customer and The Home De".Customer acknowledges and agmAa that Cunt has d,understands,voluntarily accepts the
terms of and has received a copy of this Agreement.
A by- submitted
x tWl
's Signat Salmi naulta s Si ature Date
X Telephone No,� �3 636 53'd`�
Customer's Signature Date Wes Consultant License No.
CANCELED CI01V: CUSTOMER MAY CANCEL TSIS ins appac¢ute)
AGREEMENT wrmOUT PENALTY OR OBLIGATION
BY DELWERING WRITTEN NOTICE TO T E HOME
DEPOT BY MIDNIGHT ON THE TMM BUSINESS
DAY Ak'Tp:It SIGNING THIS AGREEMENT. THE
STATE SUPPLZMXXT ATTACHED HERETO
CONT'AVS A FORM TO USE IF ONE IS
SPECIFICALLY VRESCRIBED BY LAW IN
CUSTOMER'S STATE.
Ntyncm;ADDITIONAL.TERMS AND CONDFI ms ARE STATED ON TOR REVERSE SIDE AND ARE PART OF TWS CONTRACT
The Commonwealth of Massachusetts
Jf Department of Industrial Accidents
Office of Investigations
600 Washington Street
_ r Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� Please Print Legibly
Name(Business/Organization/Individual): �j .m i f tJ jL &Z!te �-f"'✓f"G�S
Address:
City/State/Zip: 30 3 Phone#: f7 7 `"
Are you an employer?Check the appropriate a: Type of project(required):
1.❑ I am a employer with 4. M I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees 'these sub-contractors have g. 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.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11,E3 Plumbing repairs or additions
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.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContractors 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: Mew W0,M e d ilf— :V-5/ (_.o ,
Policy#or Self-ins. Lic.#: W (2, 10 g g P2 Expiration Date:
hi�Job Site Address: s City/State/Zip
Attach a copy of the workers' ompensation 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 forviisuratLce coverage verification.
I do hereby certify er a pa' s pe allies of penury that the information provided abov is tr a and correct.
Signature: _ .� Date: _
Phone#: i
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: C Not Applicable
Name of License Holder: ' ���aC �71_2 _1
L— / ✓ License Number
w _
Address � _ �--�. Expiration Date
Signature Telephone
,9.Re"'istered 'Home.lm !: vement"Contr r; ; r Not Applicable able £`7�/ ,,,�
Company Name /� � � Registration Number
,AEld Expiration Date
s f��
TelephonOj�
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§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 pumit.
Signed Affidavit Attached Yes.... No...... £
11: Home Owner..Egempt on:
The current exemption for"homeowners"was extended to include Owner-occupied Dwellines 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 s-upervisor.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 ❑ Replacement W_j>�ows Alteration(s) ❑ Roofing ❑
Or Doors �] .
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks (M Siding[0] Other[0]
Wokescri tion o /
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a>If Newhouse and or addition to exisfincf'tiausin' complete 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 .
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
as Owner of the subject
property
hereby authorize
to act on my behalf,jn�allh �lativ ork au#horized by this building permit app( tion.
Signature of Owner Date
J/ as Owner/Authorized
Agent hereby de re that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed and pains nd penaJJ1Qs of per'
Print Name
Sign re of Owner/Agent Date
—
Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
Tliis column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
of Parking Spaces
(volume&Location)
A. Has a Special. Permit/Varia nce/Rnding ever been issued for/on the site?
x—� �—�
�
NO «�-�� DON7KNO�/ �_� YES �~�
|F YES, date iouedj '
IF YES: Was the permit recorded at the Registry of Deeds?
NO K � DONTKNOYY 'ES
�
�
IF YES: enter Book i Pagq and/or Document#I
B. Does the site contain a brook' body of water orvetiands7 NO 0 DON7KNOY 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained x�\ Obtained x ~��� Date�~� � ' .
C. Do any 6 ��signs exist on the property? YES �~� NO
IF YES, describe size' type and iocation:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe type
' '
E. Will the construction activity disturb(clearing, gradingexcavation,or filling)over 1 acre orioit part ofo common plan
' that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
^ —
N
- ' pepartment use only
k
ity of Northampton Status of Permit ;" '
D _
uilding Department Curt,Cut/Dri�ceway 1?ermtt x '-
JUN t 0 2014
J 212 Main Street Sewer/SepticAvairablllty '
Room 100 Water/1/ttelrA�allabtllty
G e No hampton, MA 01060 Two Sets afS#ructural Pians
Electric,Plumbing&Ga � _ 87-1240 Fax 413-587-1272 PloftSl#e Plans
Northampton,nM+
Other$peaty 1
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
767
Zone; Overlay District
3.....F .. ..
Elm'St.District ,- :..: GBDistnct=
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record;
Name(Print) Current Mailing Address:
Telephone
Signature
2`2 Authorized A ent: # �-`
Name(P j � Current Mailing A ��4.
26
Si ature k Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS.
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building C (a) Building Permit Fee
2. Electrical �/lv/ (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) Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector'of Buildings Date
I 111m, oil
42 GROVE AVE BP-2014-1322
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 1013-032 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-2014-1322
Project# JS-2014-002224
Est. Cost: $1293.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 67121
Lot Size(sq. ft.): 25351.92 Owner: CANBY COURTLANDT&NATALIE CANBY&HENRY CANBY
Zoning. URA(105)// Applicant. HOME DEPOT AT HOME SERVICES
AT. 42 GROVE AVE
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON.611012014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOW
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 6/10/2014 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner