17A-140 (4) 063-A-038
40-45 DH
a
c 6100 Renovations
Double Hunq - Vinyl
Argon/Low E SC
SS ,
fai th Grids
1-800-746-6686
NFRC- 2001
µ ENERGY PERFORMANCE RATINGS
U-Factor(118.11-15) Solar Heat Gain Coefficient
0 .36 0 . 27
ADDMON&PERFORMANCE RATINGS
Visible Transmittance
0 . 44
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PoW Paeannmm NFRC tulips in dMnWrdd bra tied ak of a wkwantal wt-0, ads
spedAc poast aioa.Carart msa+aeoaara Rbrahra ioroM ptlduet pslaematra tnlotaelott.
WWWA*c sq
ENElW1f SOiR
Unit qualifies toc 19tu.r97 Stan
ategion(s): worth Central,
�.� South Central, southern
D� n IND: RL3a1 00/GLASS se/H—X30
V Test Size: 44 x 60
order 0:3744746030001 40260 HS
✓!t6 C:'d!lLYIlfL17IL/PIZLCI!• O �( IGP.l�6
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
U9 Registration: 126893
Expiration: 8/3/2006
Type: Supplement Card
THE Home Depot At-Home Servic
RICHARD FALLONE
3200 COBB GALLERIA PKWY#20 �
ALTANTA,GA 30339
Administrator
�LTANTA,GA 30339 Administrator
iiOV-1.1-2004 07:38PM FROM-HOME DEPOT 4135937001 T-052 P.004/004 f-480
i
-� Sold,Fumislled and Installed.by:
Branch N:tme:, �' Date: ( [! 0 THD At-Tdome Services,Inc_
d/b/a The Home Depot At-Home Services
345A Greenwood Sheet,Worcester,MA 0I607
Branch N amber: .fob##: N Toll Free(800)657-5182; Fax: 508-756-2859
Federal ID#75-2698460 ME 1-ic#C 02439 RT Cont.Lic#16427
CT Lic#565522; MA Iiomc Improvement Contractor Reg.9126893
Installatic n Addrt ss: C`b L' a I �t7Repe c _ �'"4q 0f L-)6"V
City State Zip
Purchaser(s): DtIver's Lit.#&Ex R.Date; ' Work Phooet Horne Ph nc:
�b ^CAP,)ALL <S oa �.� s "'`' a ( [)
Home Address:_
(Tf differe it from.T istallation Address) City State ,Zip
Project S1 Gforrnft)n: T/We/You('Turehaser' ,the owners of the property located at the above installation address,offer to
contract v iih Ilom,Depot US-A.,Inc,("Home Be t")to furnish,deliver and arrange for the imtailation of all materials as
described on the at niched Spec Sheet i#: 3c�_ _,incorporated herein by reft:rence and made a part hereof.
Home De pot rese rves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it
cannot pi Worm n s obligations due'to a structural problem with the home or because work required to complete the job
was not i icluded in the contract.
- DEPOSIT PAYMENT OPTIONS
1 (Subjoct to find varitication t nd/or credit approval.)
CON[LtACT AMOUNT $ / ra `� 1. Check,Cashiers Check arUS Postal SE:rvicc Money Order
(Made payable to The Home Depot).
*I ES!i DEPOSIT $ •2• Credit Card*and/or outer payment optrens-Circle One Below
Visa MancrCara Discover American Express
BAI..r ihTCE DUE
(PPi CON:IP)LETION $ �' 00 The Home Depot Home Improverment.)Laun The Home Depot Credit Card
Available Credit,$ (ErIL&HDCC ON 1)
*Minimum 25%of('untract Amount due upon execution
of this cont°act. - Acct9:7� V T rExP.Date:
OS-0 b0-9V9
1U1TrUffuo:)salts—KGId aaulolsn:)—ttoiloA aII3 goaejH—atnlM
�'St1Aa1P�.
Y Y
� � �4itasaac3�usetts ''
DEPARTMENT OF BUILDING INSPECTIONS /:
INSPECTOR '212 Main Street • Municipal Building 'o�y
Northampton,MA 01060
r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups:: ,s 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 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."
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 r',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 rouLh 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
r
goo cfct3 a0t�� 0-
'S LTf �L7L"f1��111�JfD11 -
9 J 8 31nsa itch nsrtla' _
DEPARTMENT OP BUILDDJ G INSPECTIONS
212 Alain Strcet DSunicipal Building
Northampton, Mass. 010G0
wOru<zl R'S CONITENSWIZON MSURANCE A1=,
-- ---- --- (liccusxJpertniticc}
pizncipal place of businesslresidence at: —
(sa-twt/ci it/statct�p)
do hereby certify, under die.pp.-ins --ad penalties of pcgury, .h:il
i. = an employer providing the followinc,Avorkcr s coinocnsaaon cove agc for Intl
emplavees wor>dng on tills job:
(InstLr�c Conp`m) (Polio:?�t:�r) (=:-pi �u r Datr_)
O I am a sole proprietor, general contractor or homeowner(c c;e one) and have hisea
the coon aciors listed below wbo have the ;oLowing worker's cocDt sai?on pokles:
(Nam-, Oi Co_^.t:-aaw) (jRstranc Ccinpan)-iPcUC{ Datc)
(112me of Colmclor) (Itinuanc: Comoanyjpo!ic; \iumcrr) (%aDir.:tion Da it)
(Name of Contractor) (Insura.acc Compan3-/PoL-q- Numl�r) (Expirraen Da1c)
(Name of Contractor) gjasu=cc- Comcany/PoUcy Numbzr) (Expiraao❑Datc)-
(anac3 ad-!i-,:ocst c'x-C. to it l info=m oa pctnia to atl mo✓-�v:�)
{ ) I am a sGlc proprietor and bave no one working for me.
{ ) I am.-a home owner performing all the work myself:
NOTE:plese be nM]n t1,,, e 6cmcowvc z u bo etx�lay pc acx to do m. a= I'Vrk 02 a d,,< -.`of
not moct thn ihm=rj in which the bomoowoc rcado oc oo the 17ound;r zppurtca.a.-tbe-ea a.:cot C=am. y occd.--vi to Lc
citploycs undo the .0 -k--.,;ca A=(GL152-=1(5)},ar^plicaE=by a bo=o%-=fc_Gc _oc pcmit rz=y c.dmcti trc
le7P1 cn_�,.of m c,Ployx under dio WockoeL Compoasatiou Ad
1 uadcztaad dL1 a copy of this mtcmcm away be focxurd ed to tbo Ccp-,—w orL,&.-,i j Accdc.&Olrioa or broncos for thn
covrra�c•cif clioa and tlLt L•iltac to scauc t:nvCM9c undC soa6oa 23A of MGL 151 eta led to tba imx2ifioa orcimia-ti pml-w=
ooau.:.¢cg of a Ene orup to s 1}oo.00 anCJor orup to ooc ytr znd civil pea+t'an in be roan of a Stop Wort;ordc nod a
ru>r o(S 109. a d--y aEain„-t tnc
Ford u.c on1Y
PCT=t HumL--r
Lot
)v�p�-- y ;
Signa rr of Li cnniuct e k
SECTION 8-CONSTRUCTION SERVICES x
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
u.,11 isteieil:ttortie In aravemeni xGontrac or t` '
� ��� ��..,, ��.�. �- �� Not Applicable ❑
Company Name Registration a/imb r - —- --
� �
Address Expiration Da e
`rVfIQQI (4' 0'7 Telephone
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 buildi5a2ermit.
Signed Affidavit Attached Yes....... No...... ❑
11 ,:Homyne E� rngi
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
f.
SECTION 5--DESCRIPTION OF PROPOSED WORK(check all applicableY
New House F_] Addition ❑:. Replacement Windows Alterations) ED Roofing 0
Or Doors ®`
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [[] Siding[0] Other[[g]
Brief Description of Proposed
Work: c t.�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa I.f NeW,-house a' d o acttlltiaa rto exrstiiici fioas ncr.:cainpCete.the fa�f(ou�r� c:
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
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 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 the pains and enalties of perjury. '
Print N
Jn
C
Sig tur of Owner/A ent Date
Section 4. ZONING All Informatibil 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 f
Setbacks Front
Side L:" R:` L R:
Rear
Building Height
Bldg.Square Footage i j % -
i
Open Space Footage %
(Lot area minus bldg&paved
parking)
r
#of Parking Spaces
Fill:
(volume'&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES Q
IF YES: enter Book Pager and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES 0
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 0 NO Q
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 Q
IF YES, describe size, type and location: 1
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES . NO Q
i
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Depat€tse otal "
f North,h,am ton status of Permt t' ,
r "ding Department
__ -------- `� 12 Main Street Segue SepUo pa,
tlitti
oom 100 er/We Avsarabtlit 5 � :
NOV 2 4 2004 N pton; MA 01060 TiaioSefs�St uctraPlansa
phone 41 -587 1240 Fax 413-587-1272 Ptotts4tans'
L_ _ _ S Othecspectfy z .
APPLICATION_� ,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to be completed by office
1.1 Property Address: _
Marx Lot [Jnit
Zone Overlay District.,
EIm=St District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
5T ov%il,
Name(Print) Current Mailing Address:
1413 7—[r)11'2
Telephone
Signature
2.2 Authorized A ent:
Name(Pri t) Current Mailing Address:
Signature Telephone
SECTIO 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=0 +2+3+4+5) ^'7` Check Number
This Section For Official Use Only
Date
Building Permit Number.' Issued:
Signature:
i
Building Commissioned]nspector of Buildings Date
215 CHESTNUT ST BP-2005-0626
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 140 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-2005-0626
Project# IS-2005-0834
Est.Cost: $1758.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 23870.88 Owner: CARRELL JUDITH B
Zoning Applicant: HOME DEPOT AT HOME SERVICES
AT: 215 CHESTNUT ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401) 935-2633 O Workers
Compensation
WORCESTERMA01607 ISSUED ON.11130104 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: Receipt No: Date Paid: Check No: Amount:
Building 11/30/04 0:00:00 4962 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo