Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
28-051 (3)
fNllawCM ltC r e a 1 NtadoriatEntnlratbn WoodNinyl Composite Frame Dual Pane Argon Low E ® Casement RES97 ENERGY PERFORMANCE RATINGS U-Factor (U_S)/I-P Solar Neat Gain Coefficient on..33 0 0 . 3 ADDITIONAL PERFORMANCE RATINGS, Visible Transmittance 0s49 rprldrmance stipulates that these ratings conform,to applicable NF RC procedures for•determining Whole .NFRC ratings are determi ned for a fixed set of environmiptaf conditions end a ct site.Consult manufacturer's literature for other product performance inforinallon: -www.nhc.or.9 ,e i .T o 1 Design Pressure I - Mkr.M Ary.rrti•n; too=notneasS-oae .awlnol I e•wt••wren rtlrvl•t••••n1•n••nri c• M•�►►il<r.l.•t•M.N•. Tltt.d t.1Mea/4.MJ/MMq 4 tOtrZ.d.V Meets or exceeds M.E.C.,Gt,E.C.,3 LE:C.L.Alr InlfltratIon Requirements WCM4 Hallmark Certiriettlon Program I ' i Jan 02 2007 15: 26 JF`#McKeone#Ins 734 662 8101 P. 2 ACORD„ CERTIFICATE OF LIABILITY INSURANCE 09112/2006 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeon ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeon Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 9 Y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P_O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIL iF INSURED Renewal by Anderson INSURER A; Hartford Insurance Gom n J&L Windows,Inc. INSURER B: 104 Otis St INSURER C: Northborough,MA 01532 INSURER D: INSURER E: COVERAGES k THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE PDUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW, MSR D'L POLICY NUMBER POLICY EFFECTNE POLICY EXPRATION LIMITS B GENERALLABIITY HERS856850 917106 917/07 EACH OCCURRENCE i 1000000 COMMERCIAL GENERAL AABILITY PRE M ES Ee oocurence $ 100 000 CLAIMS MADE ©OCCUR MED EXP(Any one person) S 10.0W PERSONAL&ADV INJURY i GENERAL AGGREGATE $ 2 000 000 GEN'L AGGREGATE LIMB APPLIES PER: PRODUCTS-COMPAOPAGG S 2,000,000 POLICY FI pFIO LOC A AUM""OGILE LIABILITY 35 MCC XD 6388 1011105 10/1107 COMBINED SINGLE LIMIT S 1,000,000 ANYAUTO (Ee•xldenq X ALL OWNED AUTOS BODILYiNJURY SCHEDULED AUTOS (Per perfon) i HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Peramdenq i PROPERTY vAMAGE $ (Per ecddenq GARAGE LIABILITY AUTO ONLY-EA ACCIDENT i ANY AUTO OTHERTHAN EAAOC i AUTO ONLY: AGG i EXCISJUMBRELLALABILITY EACH OCCURRENCE i OCCUR FI CLAIMS MADE AGGREGATE i s DEDUCTIBLE i RETENTION S i A WORKERS COMPENSATION AND 35 WBGNC8861 1/1107 1/1/08 WDSra,T- oTH- EMPLOYERS'LABILITY E.L.EACH ACCIDENT E 500,000 ANY E.LDISEASE-EAEMPLOYEE $ 500,000 d000rbe 6elaw er 8PE IAL PROV910N$ E.L.DISEASE-POLICY LIMIT i OTHER DESCRIPTNJN OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUING M MFR WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL Z IMP - O OBLIGATION OR LIABILITY OF ANY KIND UPON THE MRER,ITS AGENTS OR RESEN SU ATNES. GRIM REPRESENT T1VE ACORD 25(2001108) 7 QAC ORDtZRPORAT ION 1988 C712 Board of Building Regulations and Standards License or registration valid for individul use onlY HOME,IpApROVEMENT CONTRACTOR before the txpiration date if foundTeturn to: Board of Building Regulations and Standards RopiSl Mahon }149601 One Ashburton Place Rm 1301 ; icRlr �lon 24/2008 Boston, Ma.02108 Type P'rivale Corporation RENEWAL BY ANbAiSQN ,f JOHN ESLER 78 TURNPIKE ROAf WESTBORO, MA 01581 Administrator Not valid without signature fee �Oo�r snovuriea/b�C o�/�aoaae/ureeCt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbo'.-C'S 074251 Brrtlt� p$I 963 007 Tr.no: 8556,0 R"�� r� JOHN K ES LER 78 TURNPIKE RD WESTBORO, MA 01 B:ty-3 Commissioner Information and instructions Massachusetts General Laws chapter 152-requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hue, express or implied,oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However, the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to.your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (I.LC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or-Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pern Micense number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Arvicrri 5_��_nc ,, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. i d 600 Washington Street* Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PRA tI�Q.( h(A AqJ01-22-ell Address: ph6 -h t:7e�" City/State/Zip: A IMp h0v - Phone#:�� Are y an employer? Check the,appropriate box: Type of project(required): L I am a employer 3 C 4. El am a general contractor and I with 6. ❑ Yew construction employees (full and/or part-time).* have hired the sub-contractors 2.IM I am a sole proprietor or partner- listed on the attached sheet t ? Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.[__1 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 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"F f i l�K"CI�E -� � Policy#or Self-ins. Lic. #: ,� W �`-I �o�t�l_— Expiration Date: Job Site Address: K City/State/Zip: l 0Mmee t' �f 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 ce d and penalties ofperjury that the information provided above is true and correct: S1 ature: � Date: ' a 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 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: V �✓� 1 0 l ic 115I/ ---------------------- License Number Addr s -- � Expiration Date - -- -------- -------- `� 1 -`-� ------------------ ignat - ure Telephone 1 F @S fIO�tt '111 �OYAtlY�11 �%O!ltFitC1r ,.....r .,.�c:Via;kS ., .. 4 . Not Applicable ❑ ------ �� L-- - - � ---------------------------- --� C------------------ Company Name Registration Number 104 0411-6 Address } / Expiration Date ----------------------a I (�-Telephone �`t _0 Zot SECTION 10 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.1,52,§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 buildin ermit. Signed Affidavit Attached Yes....... No...... ❑ x �z VIE ". 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 ❑ Replacemen indows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ J Siding[ ] Other[ j --------------------------------------------------------------- Brief Descriptio of opos2d z Work: Alteration of existing bedroom------Yes---- 'No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement -------Yes No Plans Attached Roll -Sheet $ ,,.© M1�i �S'+`.X �Rw � r Y -3`s� '>'�'.�'�.# \SeX � ;� `�'�x's w •e�r'a'f,3'"� w? � nl�r l? �#fti � ' co It i�iu l�l tx Itlr e, FAA �13ail III, 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 -_-----------------Mascheck 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 "SrECTION 7a•OWNER AUTHORIZATION-TO BE.COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ----O_Qd --L ------- as Owner of the subject --------------------------------------------------- property ( ,! f hereby authorize _J(Qh— --1._6!'1tr- ---------------------------------------- to act on my behalf, in all matters relative to work authorized by this building permit application. ---- q . --------------------------------------- Si n ure of Owner D; to - � ► nL�r------- _ as Owner/Authorized ,_gt�nt hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my nowledge and belief. Signed under the pains and penalties of perjury. ---Jt _E51tr--------- ----- ------------------ ------------------------------------------------- Print N e 1"f l_ _6 1 ----------------------------------- ----------- Signature f Owner/Agent Date Section 4. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning 'rhis 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 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO —LeZ DON'T KNOW YES IF YES,has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are ere any proposed changes to or additions of signs intended for the property ?YES _ No IF YES, describe size, type and location: City of NorthamptonP Building Department 212 Main Street 1 Room 100 Northampton, MA 01060 }� hone 413-587-1240 Fax 413-587-1272' P � APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be coplat� Fy off�ct3 1.1 Property Address: Lot l�nEt one _ Overlay Distftc# t T Eltrr; t:;QistrictF GDistrlCt °� z - SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -------------- Name(Print) rr adiog ress -- _ �V------------------------------ Si ature 2.2 Authorized Agent: ict Ja -n---- r'-------------------------------- --�r�_- --- i _ Nam?(Pr- Current Mailing Address: -------------------------------------------- (—K ) 1 -©4 0------------------------------- Signature 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 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 a BP-2007-0732 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2007-0732 Project# JS-2007-001114 Est. Cost: $3995.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 149601 Lot Size(sa. ft.): 12632.40 Owner: DOSTAL JAMES M&NANCY L zoning_SR Applicant: RENEWAL BY ANDERSEN AT. 624 RYAN RD Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919-0900 WC NORTHBOROMA01532 ISSUED ON.112212007 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 2 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 1/22/2007 0:00:00 $25.003524 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo