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29-554 (9) 385 RYAN RD BP-2015-0180 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-554 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT DOOR BUILDING PERMIT Permit# BP-2015-0180 Project# JS-2015-000319 Est. Cost: $2008.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size(sq. ft.): 19994.04 Owner: CHAN WILLIAM T&HIGY WAN Zoning-: Applicant: HOME DEPOT AT HOME SERVICES AT: 385 RYAN RD Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.811112014 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL REPLACEMENT PATIO DOOR 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 8/11/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner Jul 30 14 05:42a p.1 HOME IMPROVEMENT CONTRACT PLEASE READ THIS 3�]QQ Sold,Furnished and Installed by. Branch Name:Boston North&South Date:� THD At-Home Services,Inc. d1bla The Home)Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 TO Free 977-903-3765 Federal ID#75-2698460;ME Uc S C 02439.RI Cont.U(:h 16427 Cl Lic K HIC,0565522;MA Home hnprovctrcru Contractor Ree.4 126893 Installation Addrem. __.._s z�.-!�&Atsl R22-_ � } (n"44 l� City' State Zip I'mehaser(s): Rork Phuue: Home Phone: Cell Phone: i i Home Address: — (If different from Installation Address) City state Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Pro set Information: Undersigned("Customer*),the owners of the property located at the above insta)lauon uddress,agrees to buy. an THD At-Home Services,Inc.('"The Home Depot")agrees to furnish,deliver and;orange for the installation ("1nistallatW)of all rnateriots described on the below and on the referenced Spec Shcet(s). all of which arc incorporated into this Contract by this reference.along with any applicable State Supplemvytt and Payment Summary attztched hereto and Any Change Orders(collectively, 'Contract`): Job 11: (tia i attrrmto P odru�i: Spec Sheet(s)4: Pra'eet Amount [Rrrofing Siting Windowl Insulation S "a NO ❑Guctecc!Covers ❑Entry Dow, © � Roofing Siding -Windows 7r_4wWannn $ [Cutters?Cavcrs ❑ErrvvDoors ❑_ Roolin Siding WSncows Inaudatiun OCunerx/Corers []Entry Doors© ' Q if, Roofing Siding yvindows Insulation $ I ���� ❑Graters t Covers ❑Etury Doors ❑ 1 Minimum?Z%lkptaitolContrac4Anrwmtdre uponraeration ol'tbiscontrad- Total Contract Anutunt g �C IrMfine Purdinsm rmy not deposit nrmx than�INrd orthe Contract Arrrtnrnt. 2_C-Cx_!) Custoter agas T that, immediately upon completion of;he work for each Product,Customer will execute a Completion Certificate Aw (one for ettdt Product as defined by an individual Spec Sheet)and pay any bo.ance duc. As appik4ablc.each Customer under this Contract agrees to be jointly and severally obligates and liable hereuncier. The Home Depot reserves the right to issuce a Change Ord;r cm-Terminate this Contract or any individual Prcduct(s)included herein.at its dicretion,if The Home Depot or its authorized service provider deternunes that it cannot perronu its obligations due to a structural problem Mill the hhone,environmental hazards such a-s mold,asbm(v,or Iced paint,other iafcty concern;,pricing errors or hecaoie work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# L19 6)1 � included As part of thi6:Contract, scis forth the total Contract amount and payments rccluired for The delwnits and final poyrrents by Product(as applicable). NOTICE TO CUs,rONIER You are entitled to a completely filled-in copy or the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion CcrtMeate for each fisted Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract.Customer agrees to pay The Hame Depot the casts of materials,labor,expenses and services prodded by The Horne Depot or Authorized Seri-ice Provider through the date or terniinalion,plus any other amounts set forth in this Agreement or allowed under applicable law, THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE PUP'OSTT PAYMENT OR O'T'HER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOTS OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Autborization: Customer agrem and understands that this Agmernem is the entire agreement between Customer and The Home Depot with regard to the Products and Inslallatian services and supersedes all prior&scnisions and ag-rcernmu,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended mcept by a wrLLrr-,iigned by Customer and The Home Depot. Customer acknowledges and Agrees that Cust has raid.understands.voluntarily acecpts the teams of and has received a copy of this Agivemcnt. Acceptelhy: ,� Submittc }{ (,I y U I \ t" C X tit f s� Customer's Signature Dale Sales so is Signature Date X Telephone No. ____� Customer's Signature Date Sales Consultant License No. . CANCELLATION: CUSTOMER MAY CANCEL THIS r"'t'rrK,t'i`' AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME � � � ���_5�a DEPOT BY NUDNIGHT ON THE THIRD BUSINESS DAY Ai TER SIGNING THIS ACREENIE1rT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORIA TO USE IF ONE 15 SPECIFICALLY PRESCRIBED BY LAW IN City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 S 150A. Address of the work. � _ The debris will be transported by: �� P � The debris will be received by: Building permit number: I�-3- Name of Permit Applicant Date Signature of Permit Applicant 2� The co.,nrno,bEweah�h7 cc; OffzC'e o nvestigatao�es _ 600 Washington Street _ Boston, M-4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant Information Please Print Le4ib1_y Name (Business/Organization/Individual):, CJT Addres�y City/State/Zip: t - b 303 Phone#: Are you an employer? Check the appropriate lynx: Type of project(required): 1.❑ I am a employer with 4. [1 I am a general contractor and I * have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time). 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, ❑ DemoLtion working for mein any capacity. employees and have workers' y ❑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.❑ 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 checYs 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. :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: 1 v Policy#or Self-ins.Lic.#: W�! 0 / -/ /0 / g Expiration Date: 2 5� 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 _ InvestiQations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: — Phone#: Off cial 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#: City of Northampton r5�5 Massachusetts ti. h, f 4�' Y DEPARTMENT OF BUILDING INSPECTIONS r - t 212 Main Street • Municipal Building Northampton, MA 01060 �SIjY S�L��O INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." I 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 regulations. 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 rouqh 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street f Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: 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 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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.❑ 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. tHo meowners 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. Lie. #: 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 pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 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 M SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S erviso / Notable j;1W Name of License Holder: �r License N e�r Address ��. � , Expiration Date Signature Telephone 9.:Re istered Home Im'ro ement Contractor: Not Applicable £ c7 I � Company Name Registration Number s it 'on Date 2_ © Telephone�W P FX 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 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 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 Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[a Siding[O] O/ther[0] Work: es r iPrcpos j A /v ) !� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa. lf-Newhouse and:or"a'ddition to existing.houslnq, compiefe tfie fallowing: 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 b'a'h as Owner of the subject property hereby authorize to act on my behalf, in matters to work authorized by this building permit application. Signature of Owner Date 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 pai�nd alti es of p71.2vf' -P e Print Name Signature of er/Agent Date ` r^ Section 4. ZONING AIL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning TIiis column to be filled in by Building Department Lot Size Rear =j Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved 1-71 % I—--1 #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? n O DONT KNOW 0 YES 0 |F YES, date ioueUd. � IF YES: Was the permit recorded at the Registry ufDeeds? NO �e `~�K ) D N0YY YES IF YES: enter Book Page and/or Document# B. Does the site contain abrook, body of water orwetlands? NO 0 DON7KNOYY 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ��«~� �� Obtained x�\ Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, typeand location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe type ' ' . i -__--_-___-_________.______-_____-� E Will the construction activity disturb(clearing, gradingexcavation,or filling)over 1 acre orioit part nfa common plan ' that will disturb over 1acre? YES NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ._ � �..,� k Department use only City of Northampton `5#a#us ofPermrt i s 1 h r Building Department Gtrrb Ctt/onyeuray Perml# l �1 20`r i 212 Main Street ;SewertSepticA�a�ra7�llrry 11 Room 100 �IVaterMteilAvaila6lhty - i orthampton, MA 01060 Two fiefs of 5#ructural Flans lectric,Plumbing&Gas In ection Northampton, MA of 9ne 3-587-1240 Fax 413-587-1272 RIdVS1t0gP1dn s ' Other 5pemfy , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION 1.1 Property Address: Thls section to be completed by office Map Lot Urnt Z.:one Overlay District .Elm St ,Distract .;. ,CB District ': - `_ . SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner ofy Record: A� �"}v i�r = IA '9 Name(Print) Curren Addre� -� Telephone Signature 2.2 Authjurized ent: / ��` � , 1 /� Name n Current Mailing Address: Si nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building �/7 j (a)Building Permit Fee 2. Electrical (! (JCa (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection dg 6. Total=0 +2+3+4+5) t + Check Number J This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector'of Buildings Date