25C-124 (3) WINDOW WORLD H.IC#104000
55 Dimtck St.
Leeds, AAA 01053
Telephone 586-8712
CONTRACT
tis agreement, betwet"i ._.....�d
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Az�d,ras) "
WINDOW WORLD OF IIEEI): , HASSACHUSETfS.
Phone
SPECUICA11ONS
a total cm( oI
...... ..�y�rl,. .3�..,n..�-.^._-}-..�-�-.....-... ..a#P�. ,�:..�.S ,j..:..:n)�J '..J., Je%f.•A ,}e.�.,aZ w-]�„--.._... 'a3S'��^Fr-^ � ,.�... Teb..F.a.z-e�".'e.l�i i✓t� ...�.i.t •f �.'q ....,
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in the prernise located at_-
With alts ordv.aWMT pays dawn the%utn
owner arees on Completion of sail work by tilt Contra ttar to pay the sum of$ .__.__... ... _w .,._....
.
Owner agrM that in the event of any btea h of this
agieerient by him after he will t>asy
price because vinyl replacetrtent wkluhaws aur custtta"'ensured 7U� +,1 the tcrtat cc,ritta:.t
attd rtaaclrr fat'owners home and will fit no liote el.,x
Performance of this agreement is made subiect to labor strikes,fires, wus,aM of God, anti the C..ontract0r's to"htain
material,
This Contrut constitutes the entire unticrs[c►riding of the parties, and no catlttsr �ollaieral or trtlierwiSc shall he
binding unless in writing sipetl by htrth parties.WINDOW GUARANTEE
Wtrtdow Wo dd',glass is parxitteed for 20 year-,from date at+ove not tti fog�betwt;�ii the panes ut glass- All othet parts will
be--uppliedfree of charge for tile. S-t'vtce will tte tiler;of 4:harge fur t yea from dAte tthttvc. t�uaran�� cit.�eh n,at c.ouer htoken cat r.:ac°kt�ci
glass after 90 clays frwarrt date above of any damage resulting from nef l t,abuse,Or acts of God- Coni#erisation build up on tttt:g1a;�is
t ausecl(torn high humidify levels and ptxrr Netttaliaitrn witlun the hutnt erefim°rt�re i'�nc�f;tiarant ttr.tt rites csatttlitttrn writ ntit uc t.ixr.
In witness whereof,I have herjurtto htgn my name this,,,,„- a}'of
m W nn7YtY�ttsr q t rizeai
_ .._....._...m... _.......
a
rzty of Wart amptIIn z r
$ � �Gi Iassxchuseffa =
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DEPARTMENT OF BUILDI TG INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building %�44
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup(r•,,i sor. T he state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two fafflTy___
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 any 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 f,,egulations. The inspection process requires that the building department 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 conjunction to the building permit issued, and that 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
j
41 tLAtf nT r-
p Ur�L�i,a p
Lx
8 �6 �. C71rf��i3111 f011 _
ti (r i f 3 qf ----
Ig J E � $la�anthattlfa' _ —
DEPARTMENT OP BUILDr,,,,C 1NSPECT101.'S
j 212 Alain Strcct Municipal Building,
Northampton, Mass. OIOGO
WORKERS CONIPENSATZON MSURANCE AFM- AA71-1"
\VILh a principal place of businessfresidence at: - —
I -
�� /y�aC.I� si �,e�-1S /� o✓as` (thonc') � � 71
do hereby certify, under thc.pi'ins and penalties of pegury, h:l
( ) I am an employer providing tl1° following''.vorkcr's comocnsZoo, covem9C for lily
etnplCyccs wor'bng on ties job:
I
(Insuraz=Comp=v) (PCtic.Ku-mbccr) -- (�:pirtior. Dal:-)
( ) I am a sole proo6ccor, general contractor or homeovr-ner(c c:e ore) and lizve hired
the cona-actgrs listed below who liave the following worker's comoensaaon policies:
i
i
I
I (Nam-, of CO:1(:71CZ0r) Ons:ranc: Comoan vPobc, '
} ' '\Ilnl__:) (—I-�:JIiJGQn DalC)
(N:m c of Contnaor) (Insurance Comoan-v/PoUm \UME-:r) (ExDD aeon Date)
(Name of Con>raaor) (Insur-ane; Compan}'/poliq. NLlsbu) (Expir6oa Date)
I
(Name of Coacractar) (Lasuran�. Comcany/PoUcy Numbs) k' x
pindon DatL) .
(a(1�. :d.•t,::Deal aScd,tr acc�a_-�•to anew tarofIDiloa Pcta_iaing to all -
i
i am a sole proprietor and have no Coe wor dog for me.
( } I am.a home owner performing all the work; myself.
NOTE`:Pl=Ls_e be emtt L.::wt .leb6�e�mr_�o�µ�ve�ra..-ho cm�laY Pesom�n 6� -•;•-•�-,•,,•• csse�oo r n�aa•+•oric oa.d..c.(t_g of
arX @CCt tb�t�K�lJ la lea. ch(lk wal)o[+�+ua 1 4i .Of 00 Ib,Vvu 6 ZgPuj1--M=Lhc:C LT ocK C=.Zy 0.^C:d."DC is LY
c:zVIcyc-s unt'.c tbc--s��..,� c.Aa(GL'1 52=1(5)} =gpLinboa by a boa=-=fcr_lice_or permit c=7 c�-idco=LL-c
1cgp.l n, or cn—Play-uadcr a,.o W.-k e.comgacaa;oa Aa-
I uodciiaad tha a copy of hin mtcmma may be foc---i d to tpw Dcpanmmt of Ind urr ci Acodco&OfG—or Lr�rat Lb-
c0vcl"s v iCcxzioa and Uu L•ilm-r to uauc to c,,Se trod--soczioa 23A of hiQL 152,=l=d a ti,i=polkioa of aimi2A pcmluo
ooaxisirz of a Sac orup to S1y00.00 andlot orup to woe ye-.r=d aNil pcm ptia in d5 form or.Stop Wort Ordcr amd.
rI=of S i 00.00.d:y r.p.inst me
Fa dp-i= 'u,e ont7
�- Pcrmtt NUML--r —
�°�.�� Lot " .
signaw Lio scc/permiticc a -- J ¢
SECTION 8-CONSTRUCTION SERVICES i
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
9 e ste`i¢i I cnie m°ra a ie``
fag, a 1 -11,-R-MP A Not Applicable ❑
/B VOc�LO
Company Name Registration um er - —_
Address Exrirafioii Date
Telephone=M
SECTION 10 WORKERS'COMPENSATION INSURANCE AFEIDAVLT(M.G.L.c:152,i§2SC(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...... ❑
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-vear 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
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f..
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors �.
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [C3] Other[O]
Brief Description of Proposed
Work: �Lra--S 1 /4 l� �l �- :(� ( ' /1 v-c- '
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 to existing housing- 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.
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
1 , as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
as Owne uthon.
PC6ent Aereby declare that the statements and information on the foregoing application are true and accurate,to the best of m nowledge
6nd belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of OwLnJ Agent Date
4
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.
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Section 4. ZONING All Informati6h 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
Rear
Building Height i i
Bldg.Square Footage 17--i F-7 %
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume*Location)
'
A. Ha's � a| Perm it/Vahonoo/Findi � enerbeonissuodfor/onthasho?
N0 J DON7KNOW 0 YES 0
�
IF YES, date issued:!'
IF YES: Was the permit recorded at the Registry ofDeeds?
��
NO �� DON-r umuW 0 'ES
IF YES: enter Buuh Page: and/or Ducument#
'
�� ��
B. Does the site contain u brook, body ufvvaterorwetlands? NO v���� DON7KNOVV �_� YES v_�
IF YES, has permit been or need tn be obtained from the Conservation Commission?
^
Needs tobeobtaiued x~~� Obtm�med �-� Oete [ssumd'
v_� «^~� ' �
C. Do any signs exist on the property �� ��� YES v�J 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 grading,excavation,or filling)over 1 acre orisd part ofo common plan
that will disturb over 1acre? YES r NO K }
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department.use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton; MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR 6 MgLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map Lot Unit
Zone Overlay District
C--" 'r Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ,2
Name(Print) Current Mailing Addreu:_� 7/ 7
Telephone
Signature
2.2 Authorized Agent:
o & s s
Name(Print) Current Mailing Address:
nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
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
Construction from 6
3. Plumbing Buildir=.g Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number 3
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature: r
Building Commissioner/Inspector of Buildings Date
212 BRIDGE ST BP-2005-1067
G1S#: COMMONWEALTH OF MASSACHUSETTS
MU:Block:25C- 124 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2005-1067
Project# JS-2005-1456
Est.Cost: $628.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: John Corbett 104000
Lot Size(sq. ft.): 7187.40 Owner: TEMPLIN CHRIS
Zoning.URB Applicant: John Corbett
AT. 212 BRIDGE ST
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:5/3105 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 5/3/05 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo