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06-022 (6) R '�• 1 i w '1 t t ( t S � " Q�t1111cd ""'' ! P,:mev: Izbel,ahet fu,al ln;pecdoh;SAVE lot tulurc reler_nce � W eath:r Shlald �NF�'c CPD1 D50=A-172 , •t 8108'Double Hung Dporztinp Alum Alum clad Thermszl 'crams r�lrr�c�tta� .022 Low =.11a':3 Arpon rill Grille in Alt Space Ei�ERGY PERFORMANCE RATINGS 0.30 �—Ft_�tl spl�Y.:� L:ht Caaii;:nl •70 I 0,1 8 ' NSA-Pl I':�•lr,:l;11 ADDIT',1,DNAL P-ERFORMANCE RAT-INGS Y1tib1:1 aEr't1t:.—, Crnl::t:{itn Attittv:: � n L'nvlrtunr rtPulrtit hit Eta met tmbmt o +rP flt.bl, Hr H.pratttwrct br /.umianp •1,.dt pnittt rrt'tr, 1 Attu ctoaa.HFL.ntnJe rn d Ile r*tinll 6r t•t Is rd ¢I►I ttl4raMl Lt r•,n6tmt enl fq w1I rrndrtl a is %FFY.too.nl rtsan.+.rnd ' v,I pr•Gtiti w+Cim All►thnl hi tulWapr of++IT{pndect W.rtr tptdit wn. �srJN mrnuL:uni t itlnun bl ehtr tntveipc,,,, ++t1 mmmulm. kilt! of eatei/ H,'.L„ c,C„ tnS (.E.t:.C. 'U,IntiltrYtten P.outr.mtnit , (D A �� ItDtrU .( SI17CSCUtt l.twxvDl t-JLS.E-S) . pJ . � tom`, Sm.l t. I.twll+tDtl L:tl .� �LCI _ ttfA flllup'-tt ' � � � �' w_L•JS tf5t':a D{t1 Ia:1 �3 '35 V•1 Y..fl L•,rn•J f,t.,..•.,,1.•L-7V{= , ;_I_ 1 I101s U-1 f;Y•�ifl 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: The debris will be received by: Building permit number: Name of Permit Applicant Date Sign-ature of Permit Applicant Dec 1414 07:46a p•1 HOME IMPROVEMENT CONTRACT PLEASE READ THIS q Sold,Furnished and Installed by: Branch Name:Boston North&South Date:t �; THD At-Home Services,Inc. d/6/a The Home Depot At-Home Services Branch Number.31 and 33 906 Boston Turnpike,Unit I,Shrewsbury.MA 01545 To])Free 877-903-3765 Federal ID h 75-2698460;ME Lic ft C 02439;RI Cont.Licit 16427 ( CT Lic 0 HIC�.0565522;MA Home improvement Contractor Reg.#126693 Installation Address: �f, E60 e-$-i (z k% LJ 1�1 t t 116 1 ('rte-�I C_ i t4 -4 City State Zip Purchaser(s): Work Phone: ----Home Phone: Cell Phone: [ l ] [ Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑1 DO NOT wish to receive any marketing emails from The Home Depot Prelect information: Undersigned("Customer").the owners of the property located at the above installation address,agrees to buy, and THD At-Horne Services,Inc.("The Home Depot")ag-rces to furnish,deliver and arrange for the installation("Installation")of ell materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary aaached hereto and any Change Orders(collectively, "Contract"): Job k: iw—d n`r`^'",t P oducts: SM Sheet(s)# Project Amount Roofing LjSicling K Windows Insulation ,C�- Jin OGutter:>lCovers ❑EnuyDuas ❑ V�� $ ^f'7 Roofws Siding Windcros LJ insulation ►Y/ OGutteas I Covers ❑Entry Coss ❑ $ Roofing rjSiding 0 Windows 0 Insulation ❑Gutt /CON'M©Entry Doan© $ ers ? Roofing CSiding Ll Windows Ll insulation ❑Gutters i Cm-ers ❑Entry Doors Q $ i Mirimrau 25%Deposit of Contmet 4mouadue upon exceation of this;;;; ct' Total Contract Amount $ Maine Pumbasers may not deposit more than ooethlyd of the Conuwt Amount Customer agues that, immediately upon completion of the work for each Product, Custtnner will execute it Completion Cerdfluatc (one for eacdi 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 heromder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual R-oducL(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obli-ations due to a structural prohle:n wish the home,environmental hazards such as mold.asbestos or lead paint,othei-safety L;onccrrs,pricing errors or because work required to complete thej3b was not included in the Contract. Payment Summary: The payment Summary# ifibli-I " , inckidod as part of ibis Contract, sets forth the total Contract amount and payments required for the deposits ant final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled4n coPy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed 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 Home Depot the costs of materials.labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DMT FROM THE DEPOSIT PAYMENT OR OTHER PAVINIENTS NIADF., WITHOUT LIMFTFNG THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acc�tance and Authorization: Customer agrees and understands that t 's rlsrccment is the entire aw-cement between Customer and The Hrme Depot with regard to the Products and Installation service nd supersedes all prior discussions and ag:•cements,tithe: mal or written,relaring to said Products and lnstallation.This Agree t c of be assigned or amended except by a wridn.-signed b,,.Customer and The Nome Depot.Customer acknowledges and sign'es at C comet has mad,undo,stands,voluntarily accepts the tenns ol'and has received a copy of this Agreement Accep11 Subm ted by X X I t{U1 CJ ustionter's Signature Dne es uitant's Signature Dane X Telephone No. Customer's Si.-nature Date Sales Catsult:mt License No. CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE 'THIRD BUSINESS �-I( DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE 1F ONE iS SPECIFICALLY- PRESCRIBED BY LAW IN r i r.CTnmrR'4 tT.%Tv \ :i:rr:: vrrurtutu;'CUtrr[ vj 1tltlS'J't1ClIll5'LfCS." / Department of Iisdzistr'ialticcidet.:�'/' � _ y - OJJLCe Of IJ;Ye,Stl�a��``i� r _w , C071 reSS Et7'-°O�' 'J1Lte 100 - Bbstori�211Y-2017 �wts:nsassgov/dia 'Workers' Compensation'ID=tz-ranc_j.itldayit: Builders/Contracto;s�IectriciansltIumbers ADDUCanf lniormatiori,�_ _ ?s / f ppiee Print Linbly ° 1:.:ss/0.gz:.`:=:30Zr=di vi 6, zl): %' y �/r " 1 J //���`��/✓Y /C�� tJ%p: city/S� • . .• Are you an'eraploycr? Chc-}:the appropriate borr . T of Project(required}: � � Type • I i I am i cl��loy:r azt:1 �. � i a�a general conuacto;and I •��e•N conswctiori :-1plo full zild/or P' -:).` hzv:'rir:d t'.^.e'sub-coiz:acto:s ] W 1;31.:1 or,tre z-t.ached sheet: 7. 1:3 i�c�o cling I a a a solc'pr opri:ior or p :r- s Th:sc sub-core acto s nave g ]�cnoiition +✓J:1'�^ L7 ?']y cPJaGi )' 71J\':eS 1�i aYB'�'Dr}:L: G ] �u`17L7c OlilvA �'G V.'0.�:::5' COT1D:1%SL'i a.7:.. c0':p. '^uura.7:.:.' •• ° . .w: =e a co�orztica and its . 10.]�l:eL-ir or additi:�s �1;=?ai s 3.❑ 1 aom1a hG_-_0'rJ;:: 001I]S all :paL;o Oi a1^1t10^S r�seli• i15o'?5:!:_:s'.:e ?. ztrof er.t- ' ior MGL _] ?ooi 1:?, Sll*) 2ad �':hzv:no �/�i1: • e;n�Joy:_... j2�io wbri•::s' 13. 1 v-•-• z,>. fa o:::..,c._ .io�'o:iowshor.�,g: c� •'- -_ ':y info^;zvon. 'p.::y zopi._at�:_:�;• :is'o:x�'i :::�st :. 'work:; _::np:.�z:ion poi; . n wo:} z:d :s bait a n:w z^,davit indi: �g s .b• Who sn_ `is ztii z�;:indicz:ag :y -:doing z_ L^.: hi::ouuid::on :to:s Z-a:.,_ zr,zd i io-z1 sh:a snoa:ng ti::1,z n-of L sab-an�:c znd sue::wh:i:r or apt ntins hay: :7n:)I CA 7,hzv:_a ploy::s;uh:y mu,St^rovid I .77 mil ID.'OVL !;.=1 a J:✓Y:__7�1v0,-f:_ Sr GD, :JC,:SCiIOl I=:� I�P.S =IOV S t/_�01f y::,-d job. .1P jC,-12-Y L,71D'0j' i_.st�ar_:Co�cany 1��::::_•• Y �m ' .�� 4�-' .� ?olicy or Sei`-i^s. Li c. "' C� J �!I /// _xp-aacn Date:. Job Sit:.=,dc css: Ci y/StatJZi?: 65 �.ttach a copy of the workers' cculner.Satioa policy d:clzr (showing ation page (showi the pDli:y numb°r and =piration eat:). '-S r:OL'L^:d L']d:; S_:tion 23A of MGT :, 1 :?I] 1'ad to un MPOSStlOn 0I -1 p _1L':S of t ^•:'up to S1,b00.OD z�9/or o^:-year ?^sor..cat :s �'cll `s :ivil :aalca in ir.:iD-= of a STOP WORK ORD=R zzd a ^: of up to S25o.0o a day agai=st•tl::violate:. 3:ad�a:d that a :ocy >!: � fo.V?!-6=d to the Om:_ of of t'r s s` ^. t May inva ieatios of ^^:DL4 i:rurar_:,:ev::ae:.vc - I do i:_r_5y__:y> ..: , .:. a� ."s-rd c if crrj.�ry titct..._ :jor7lc��n D,-Dv;",d cbove is 1rie crtd tDrrcc_ Si n= - /l OJi:_ =1 z or Do .:Df)v-!e ... J1:S =, to bf:0r::,:)I:I!d 5y-:.y o,-:.own T own: 1.3ca:d Gi ''lam 2 ° D:�?r- t }'/1 own l._l:.-k �.�L-_..._'1 _3nc:tor S.?lunb=g T^s�_=tor =� Con`Z:t?erso:: ?hone n: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction S rvisor: Not Applicable £ Name of License Holder: License Number Address � Expiration Date fi oo Signature Telephone 9.Re istered Home Imp me t Contractor Not Applicable £ Company Na Registrati Number Add s �- J/1 , Expiration Date Telephone P 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 per ' Signed Affidavit Attached Yes..... No...... £ 11.1-Home Owner,Exemptioni The current exemption for"homeowners"was extended to include Owner-occupied Dwellinlzs 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 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 F--J Replacement W' ows Alterations) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [p Siding[o] Other[0] Brief Description%Pro i Work: JV Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If Newhouse anchor addition to exist r g housiria, complete the'tollawing: 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, le y'f"heir � as Owner of the subject property hereby authorize �� '%'Y �✓� to act on my behalf, i II m tters relative to work authorized by this building permit application. Signature of Owner Date I, �\ �� as Owner/Authorized Agent hereby de are that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. i Signed under t ins d penalties of p PrinAatureof er/A gent Date , � Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information - -° � Existing Proposed Required by Zoning 11iis 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 L------ #of Parking Spaces (volume&Location) A. Hasa Special Permit/Varance/Flmding ever been issuedfor/on the site? NO 0 DON7KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO K 1 DONTKNO 'ES ~� YY �_ IF YES: enter Book Page and/or Document#1 B. Does the site contain a brook' body of water orwetlands? NO 0 DONT KNOW 0 YES xr� IF YES, has a permit been or need tobe obtained from the Conservation Commission? Needs to be obtained ~��~� v_�Obtained �~\ Date Issued: � ' C. Do any signs exist on the property? YES ����/ NO v=��� 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 IF YES, describe size' type and location: { � E Will the construction activity disturb(clearing, gradingexcavation,or filling)over 1 acre orisit 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. E C E-W , , y � I]epartment use only , C JAN —6 2015 City of Northampton Status ofPermtt J Me f4. 1 is ! ullding Department ctYrla Gut/Dri�reay Permit 212 Main Street SewerlSeptiCi�k�aifa��lity� Room 100 Water/1lailAua3labilit Northampton, MA 01060 Twa Sets of 5#ructu'ral Plans phone 413-587-1240 Fax 413-587-1272 PIo/Ste Plans ' 3 -. F 3 Ottier4Specify`' a, ,,4 , APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This secfion to be completed by'office 1.1 Property Address: Map Lot Unit I, J Zone Overlay Disfrict Elm St D�stnct a CB District SECTION 2. PROPERTY OWNERS HIP[AUTHORIZED AGENT 2.1 Owner of Record: MLT Name(Print) Current Mailing Address: j '�°ei t � Telep one ®}— Signature 2.2 Authorized A e t: f2/4dPjP'D Name t) Current Mailing Address: gnaf5fe Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use only completed by ermit applicant 1. Building IL (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 46 EVERGREEN RD 110 BP-2015-0709 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 06-022 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2015-0709 Project# JS-2015-001372 Est. Cost: $2443.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 082485 Lot Size(sq.ft.): Owner: PAGE CLARENCE Zoning: URA(99)/ Applicant: HOME DEPOT AT HOME SERVICES AT. 46 EVERGREEN RD 110 Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON:11612015 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 1/6/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner