17A-117 r
6.
r
f
063-A-044
07-75 DH
a
0500 Renovations
Double Hunq Vinyl
Argon/Law E SC
N" w� DS
with Grids
1-300-746-6686
RES 97
ENERGY PERFORMANCE RATINGS
U-Factor(U.SdI-P) Solar Heat Gain Coefficient
0 . 35 0 . 26
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 43
. fUnr,Orcnaar atlpuhEes ttat tNaaa ratlnQa conrorm to applkable NFl4C protWurM to aamrmr,Mp whoM -
pradlst partmvm.WK rattnpa are ditmm for a toad wt of N*Mmar w mmora and a
*Wk Product ft.Cormtt mawtactuWs Ibratum for other product pmlWnum Irdamom
Mnwvnhs.orp
i
i
EtiEN61'SEAfl f
uuit qualities for 6nergT star S
Regton(a) : Northern, North {
•� Central, South Central,
Southern
DP : +25/-25 2atD: R127J 00/GLis9 D9/9-R25
Test 312a7 48 x 80
Order #:3885118090001 50375 fiS
�/ie �omirr+.onr�eall� o��/�,aaaaclivaek`a t
Board of Building iiceuiatiuns er,d Stand its
- ;40ME IMPROVEMENT CONTP=TOT:
Registration: 126853
-., Expiration: 8/312006 i
Type: Supplement card j
THE Home Depot At-Home Servic '
RICHARD FALLONE
3200 COf3B GALLERIA PKWY#20 %(« a f'i:✓�Tt°�
ALTANTA,GA 30339 rAdm;aiytrator "`';
,. �r • ,DATE(MMIDDIYY)
ADDI ONAL INFORMATION ATL-000915907-02 02/01/05
PRODUCER COMPANIES AFFORDING COVERAGE
MARSH USA,INC. COMPANY
ATTN:ELIZABETH BRISENDINE (404)995-3568
OR BRENDA BOOKER 404)995-2594 E ILLINOIS NATIONAL INSURANCE COMPANY
FAX(404)760-5768
3475 PIEDMONT ROAD,SUITE 1200 COMPANY
ATLANTA,GA 30305 F THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA
100492-I P U S A-G W A-0 3/04
INSURED COMPANY
THD AT-HOME SERVICES INC.
DBA THE HOME DEPOT AT-HOME SERVICES,INC. G N/A
HOME DEPOT USA,INC.
2455 PACES FERRY ROAD NW
BUILDING C-8 COMPANY
ATLANTA,GA 30339 H
WORKERS COMPENSATION POLICY#5899476(TX) POLICY PERIOD 2-1-05 TO 3-1-05 CARRIER NEW HAMPSHIRE INSURANCE CO.
WORKERS COMPENSATION POLICY#5899483(TX) POLICY PERIOD 3-1-05 TO 3-1-06 CARRIER NEW HAMPSHIRE INSURANCE CO.
WORKERS COMPENSATION POLICY#5899478(QSI) POLICY PERIOD 2-1-05 TO 3-1-06 CARRIER AMERICAN HOME ASSURANCE CO.
CERTIFICATE HOLDER
FOR INSURANCE PURPOSES ONLY
MARSH USA INC.BY
Page
MARSH CERTIFICATE OF INSURANCE CEArIFICATENUMBER
ATL-000915907.02
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVI CEO IN THE
ATTN:ELIZABETH BRISENDINE (404)995-3568 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER TIE COVERAGE
OR BRENDA BOOKER 404)995-2594 AFFORDED BY THE POLICIES DESCRIBED HEREIN.
FAX(PIEDMONTR I COMPANIES AFFORDING COVERAGE
3475 PIEDMONT ROAD,SUITE 1200
ATLANTA,GA 30305 I COMPANY
100492-IPUSA-GWA-03104 i A STEADFAST INSURANCE COMPANY
INSURED --------
COMP:NY
THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY
DBA THE HOME DEPOT AT-HOME SERVICES,INC.
HOME DEPOT USA,INC. COMPANY
2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY
BUILDING C-8
ATLANTA,GA 30339 COMPANY
D AMERICAN HOME ASSURANCE COMPANY
COVERAGES This certificate supersedes and replaces,any previously issued certificate for the policy period noted below. 1
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
LTR DATE(MMIDD/YY) DATE(MMIDDIYY) LIMITS
A GENERAL LIABILITY IPR 3757 608-00 02/01/05 03/01106
GENERAL AGGREGATE $ 4,000,000
X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMPIOP AGG $ 4,000,000
CLAIMS MADE r—x-1 OCCUR 'OF SIR:$1,000,000 PER OCC PERSONAL d AOV INJURY $ 4,000,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S 4,000,000
FIRE DAMAGE(Any one fire) $ 1,000,000
B I AUTOMOBILE LIABILITY BAP 2938863-02 ADS 02/01/05 03/01 i06 MED EXP(Any one person) $ EXCLUDED
B X ANY AUTO TAP 2938865-02 TX 02/01105 03/01/06 COMBINED SINGLE LIMIT $ 1,000,000
B ALL OWNED AUTOS BAP 2938864-02_VA 02/01/05 03/01106 BODILY INJURY
SCHEOULEDAUTOS (Perperson) $
HIRED AUTOS BODILY INJURY
NON•OWNEDAUTOS (PeracuOenq $
X ELF-INSURED AUTO
PROPERTY DAMAGE $
HYSICAL DAMAGE
GARAGE LIA81UTY
AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY: -
EACH ACCIDENT $
AGGREGATE $
A EXCESS LIABILITY IPR 3757 608-00 02/01/05 03/01/06 EACH OCCURRENCE $ 5,000,000
X UMBRELLA FORM AGGREGATE $ 5,000,000
OTHER THAN UMBRELLA FORM I $
C WORKERS COMPENSATION AND 5899472(ADS) 02/01/05 03/01/05 X W ATU "
EMPLOYERS'LIABIUTY I TORY LIMITS ER
C 5899479(AOS) 03/01/05 03101/06 EL EACH ACCIDENT $ 1,000,000
E THE PROPRIETOR/ X 5899484 NY,WI IN 5899477(NY,WI) 02/01/05 03/01/05 EL DISEASE-POLICY LIMIT $ 1,000,000
PARTNERS/EXEC
E OFFICERS ARE: EXCL ( ) 03/01/05 03/01/06 EL DISEASE-EACH EMPLOYEE I$ 1,000,000
F OTHER WORKERS 5899475(AZ,ID,MA,MD,OR,VA) 02/01/05 03101/05
F COMPENSATION CONTINUED 5899482(AZ,ID,MA,MD,OR,VA) 03/01/05 03101106
D 5899473(CA) 02/01/05 03/01/05
D 15899480(CA) 03/01/05 03/01/06
DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE ExpaNTION DATE THEREOF,
THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 10 DAYS W4rTEN NOTICE TO THE
FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN.BUT FAILURE TO MAIL SUCH NOTICE SHALL IMP.&E NO OBLIGATION OR
LIABILIT/OF ANY KIND UPON THE INSURER AFFORDING COVERAGE.ITS AGENTS OR RENESENTATIVES.OR THE
ISSUER OF THIS CERTIFICATE.
MARSH USA INC.
BY: it x q A. / -
MM1(3102) VALID AS OF: 0241/05
HOML 51"OVElti ENT CONTRACT
S(2 Sold,Furnished and installed by:
Branch Name: Date: (� '�� CC— THD At-Home Services,Inc.
d/b/a The Home Depot At-Hbme Selvices
c 345A Greenwood Street,Wor6dater,MA 01607
Branch Number: t Job#: ' �, Fp� Toll Free(800)657.5182; Paz:508-756.2859
Federal IDs 75.2699460 ME LA.N C 02439 RI Coot.Uoit 16427
ii CT Lica 565522; MA Hama Improvemat Contractor Reg.tl126891
Installation Address: � c l A 1 � e ��� -.0 LQ l9 d
F
City Mate Zip
Parahaaer s: Last 4 Dieu of Driver's Idc.M&Exp.Mo/Yr: Work Phone: Home Phoac:
PAY ' T-U D s C>7 13) f ri
Home Address:
(If different from installation Address) City State Zip
E-mail Address(to receive updates and promotions from The Home Depot):
t
information: Y9VelYeu("Purchaser's,the owners of the property located at the above installation address,Offer to
contract with ome Depot U.S.A.,Inc.("Note Depot)to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Shoot#:A+I ,I 5[zil rFy ,inccrp orated herein by reference and made a part hereof.
Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it
cannot perform its obligations due to a structural problem with the home or because work required to complete the job
was not included in the contract.
DEPOSIT PAYMENT OPTIONS
(� �('� (Subject to fund wrificatloaaadlor creditappmvel.)
CONTRACT AMOUNT S�I r)3 1• CheekCabianChsckorUBPoctalSerimMoceyOrder
(Made payable to The Home Depot).
*LESS DEPOSIT $ t S 7? 2. Cw4tCeid!aad/urothapayn toptiom-CirdebaeBelow
Visa MasterCard Discover Arnenc "". .
BALANCE DUE �7 I
ON COMPLETION $ `�5 The Home Depot Home Improvement Loan The home Depot Crodit
AvatbdrieCrrdk.S
Mintinum 25%of Contract Amount due upon execution /",z
of this contract. Aectti:I'nsL ? ?►`L`f QAg ]P,xp.Date:
7Ssme o,It appear on MCI:_-_� .EI��(� —
Indicate Payment Method For •By my/oac rpawre below,Nm agreo t allow Hots Dopot to charge the above
BALANCE DUE ON COMPLETION:
5 � -"sed di[ d the dpit indictd
g8 c
n � 9q
bo de aSi Luce Daro
1�(V1 fj j 1�ta i '' HII or HDCC Authorization Codes
De asit Final Payment
# f�yy�,-?7 # �( 75
Purchaser agrees that,immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate
and pay any balancadue. Purchaser also agrees to be jointly and severally obligated and liable hereunder.
e m This agreement and its attachments,including any financing agreement,contain the complete agreement
etweea t PIP arties and can not be amended or modified unless in writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read ht. You are entitled to a completely filled-in copy of the contract at the thne you sign, keep
it to protect your rights. Do not sign any Completion Certificate or agreement stating that you are satisfied with the entire project
before this project Is complete. Law prohibits home repair contractors front requesting or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed tmder the contract.
You may cancel this transaction at any time rior to midnight at the third business day after the date of this contract. Bee Notice of
Cancellation for an explanation of this right. There wine a servlce charge equal to 25%of the contract amount if the job is
cancelled by Purchaser AFTER the third business day.
BY MY10UR SIGNATURE BELOW,VWE AGREE TO BE BOUND BY THE TERMS OFTHIS CONTRACT. [/WE ACKNOWLEDGE
RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELL.A,TION.
BY MY/OUR SIGNATURE BELOW, VWF UNDERSTAND THAT THE AGRFEMENT IS SUBJECT TO REVIEW OF MY/OUR
CREDIT!=IISTORY AND[AVE AUTHORIZE HOME DEPOT AUTHORIZED CONTRACTOR,TO VERIFY AND REVIEW MWOUR
CREDIT RECORD WITH.AN INDEPFNDE.NT CREDIT REPORTING AGENCY AND RELEASE THEM FROM AId, LIABILITY
INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. DO NOT SIGN TATS CONTRACT IF THERE ARE ANY BLANK
SPACES
SUBMITTEDBY: __T1tAkZ biuc_�4 Date: �b
X. s Consu a
ACCEPTED BY'. dl;_ Date:)1),- -Q
Homes+ er
Date:
Homeowacr
NOTICE=ADDITIONAL TERh19,CONDMONS AND WARRANTIES An STATED ON THE REVERSE SIDE AND ARY PART OF THIS CONTRACT
WLite-13M=a IFte Yeao,v-Quto:ner Plnk-Sala Coae+hant
c n�no r cry
S .d OOZE 13rN3Sb-1 ciH W1J6Z =S SOOZ .170 ��0
O¢Tt1AMp�O
,,.Cr it Of Narthalitp#n z
. I
� � �Glassacltxtsetfs
u„ni -
DEPARTMENT OF BUILDFNIG INSPECTIONS /=
INSPECTOR '212 Main Street • Municipal Building
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCNIR 108.3.4 to
act as has/her construction supc:-.-p,o.r. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or-two farm y
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 buil ing 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 backfll):
sonotube holes (before pour), a rouEh 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
L 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-tome
Date
Address of work
location
f
t ti
E (riff Ofl�c�rf11�111�fDIl -
A l E 31Rc4nrctIs,
DEPnRTMENi OP DUILDf>\'G INSPECrr01.'S -
j 212 Train Strcct - Municipal Building
Northampton, AT ass. 01060
WORICEI R'S CONIfPEIiiSATTO.N INSURANCE AFFMA- �I-1'
(liccusxlpermitfcc}
v.,ith a prirlcipaj place of businessfresidence at: -
IAD tbIF 0 bone-') qpj! �I-�
(==Uc i t•J/sta �7?
do hereby certify, under tlie.p?hs and penalties of per-ury, hai
I am an employer providing the follo%ving v,orlccr's cornocnsado, cove se for lily
emplovecs worocig on tills job:
CE l
j _ fa 'w ' n. 'S a live'A
(Irs-tzMnr-- Conner,) (PcLi Numb-c
i
( ) I a1n a sole proprietor, general contractor or homeowner (ci cie one) and have hired
the cona-actors listed below vybo have the 'oUow-jcR worker's caLnep_sadon pokles-
(�trsnc of Coal ac.or) Uris-uranc;: Coinoanl -fi'ouc; i,,uja-c:) (rtiJ1,1u^n D u)
i
I — _
(1`lamc of ContTaezor) Ms�n Comb_ aati-1polic; Nuznc_r) (Expirtion Date)
(Name of Conzmcic,) (Insur cz Compan)-/Policy- Number) (Expim6o❑ Date)
(Namc of Con<zacior) (Lnsuraa Comr..aay/Policy Numbu)
Daft).
(aC�Lii oralcd,if ncoca_�•to inG Gt iafocp+.a oa pe-tain:os to.1r ec --ra:-a) _-
( ) I am a sole proprietor and have no one worl3ng for me.
( ) I am.a home owner performing all the work myself.
NOTE:p1-..tx ewue tls .tij,hcmcawacn..•bo ccaplay peson3 to do tea.,uric a=.d.,r�-z of
not txxez 1�:L`7o:tmitx is���the boe�oawnc rczida oc oa t.bc rjo+sab z�puttca_.=tbe��z_z nor�—.lty xc:d.-oi�e be
ctploycs ua c the..ui c�cz�,c •,:on Ac (GLIl S2 1(5)) =pplin�oa by a bommaaa fc e hc-v a -mit M=y c idmcx c1:c
le-P!ctamc of r n c=Ployor under dl Wwki '.Coa3pom,l AA
t�adCSZaad tha a oopy oCthia-MI—Oa mny b.f---,ded to tbo D,,-,Ow of Ivduuic!ncodcav'OfL-of rrr=a+c.no.for th.
cnv'�-eiCctioa and rhet L-ikac to conuc Covet und--I Mioc 25 A of?.tQL 152 m tcd to the;=p=;boa cf eimir U peaaltic
coori:.i�g of V,,- zadfcc iy orup to oar y-,:r and cNil p=+pY o io 6c roan ora Stop Wort ordc aad a
G=of S 1
i For dcp..rta�=- u.c only -
perm1t Numb-7
Ad
t
t Curt of Li
SECTION:8-CONSTRUCTION SERVICES r
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
�:Reaste�edfome. npcaveitte Cantrait off � Not Applicable ❑
Comoanv Name T Registration u er -----_
Address i r Expiration Dalf
1-X rng.4� G 61LA7 Telephone*,
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAV'r(M.G:L.c.f62,;§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 permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
�� � t1I11
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 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
r
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all°applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing El
i�
Or Doors Jam`
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[O] Other[E3]
Brief Description of Pro
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa:'(U I Wd'ha ::comeetfaF(ar>�`":
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=TOBE.COMPLETED WHEN
OWNERS AGENT'OR CONTRACTOR APPLIES`FOR BUILDING PERMIT.
11 C -Fr �-- as Owner of the subject
property
hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit applicati n.
Signature of Owner Date
as Owner/Authorized
Agent hereby decla that the st temen sand information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed id penalties of perjury. '
Print m
Si at of Owner/A ent Date
'—
Section 4. ZONING All Informatibn 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
Bldg. Square Footage
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
'
A. Has a Special Pormit/Varunue/Fndi ever been issued for/on the site?
NO 0 . DON'T KNOW 0 YES 0 �
. . .
. . `
IF YES, date issued:;
IF YES: Was the of Deeds?
NO 0 DON7KNVVV 0 ,Ex
IF YES: enter Book Pagei and/or Documont#
�� ��
B. Does the site contain o brook, body of water urwetlands? NO �~��� DON7KNOVV �~� YES �~�
IF YES, has permit been or need to ba obtained from the Conservation Commission?
' Needstobeobtained x~� Obtained �~� Date Issued:«�� «�� ' .
C. Dn any signs exist on the pnoparty �� ��� YES �~� NO ^��
IF YES, describe size, type and location:
D. Are there any proposed changes toor additions ofsigns intended fo r the property? YES NO
IF YES, describe size, type and location:
E. Will the construction activity disturb grading,excavation,nr filling)over 1 acre oris it part o[o common plan
that will disturb over 1 acre? YES K ) r NO K )
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
y R ati
oft
iampton tat of Pen emu.
,3u Ididg- pprtment �►
212 Maier"$t0et
BOOM
- Northamptotl, .401060 r Sefso Sta rr ura�ans� k
phone 413,-587-12_4b Falk 413-587-1272 ?ItS�tttt 'Ian
pii PA aic,�
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1.-SITE INFORMATION
1.1 Property Address: _ This section to be completed`b�rof fi
Map Lot Unit
621-.2 d (� Zone Overlay Disfr�ct
,kElrtr St District.:,,
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
' wl �c2CG tlA.o10(°
Name(Print) Current Mailing Address;, G&v 4M
Telephone
Signature
2.2 Authorized A nt:
Name(P t) Current Mailing Address:
Hot 935.ia k2�
Signature Telephone
SECTI 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) 47,M r' Check Number
This Section For Officiat Use Only
-
Building Permit Number Issued`:
Signature: !'
Building Commissioner/Inspector of Buildings-- Date
22 CLAIRE AVE BP-2006-0421
G1S fl: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A- 117 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Catc,o,,: BUILDING PERMIT
Pemwit ft BP-2006-0421
Prnc JS-2006-0615
Est. C x;4730.00
Fee 52.5.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use C..., 11;_ HOME DEPOT AT HOME SERVICES 126893
Lot � ;,,•(sg. ft.): 9016.92 Owner: CATUOGNO MARY
zon , : '1:A Applicant: HOME DEPOT AT HOME SERVICES
AT: 22 CLAIRE AVE
� rtAddress: Phone: Insurance:
345 L ENWOOD ST (401) 935-2633 O Workers
Cor,,;,isation
W STERMA01607 ISSUED ON.1011812005 0:00:00
r '.I NFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS
PC, 'ITS CARD SO IT IS VISIBLE FROM THE STREET
oC Plumbing Inspector of Wiring D.P.W. Building Inspector
Service: Meter:
Footings:
Rw Rough: House# Foundation:
Driveway Final:
Fi Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Oil: Insulation:
Smoke: Final:
TV ` !`i:1ZMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ATN FITS RULES AND REGULATIONS.
Ce, ` ate of Occupancy Signature:
Fey : Date Paid: Amount:
10/18/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo