36-232 (8) A r,
. � I�� t � �oetQyslar.nrcan—rncan.Qc.ca "
ri ! r t
:1� tht allttcd
Hemovt label.atter i1naI Inspection; SAVE for future reference
Weather Shield •
CPD1050--A-172
NFRC Model 8108 double Hung Operating
Alum clad Thermal Frame
3/4 Inch Glazing
n�trq C�t�:,a ZO—E .022 Low—E
Argon Fill Grille in Air Space
ENERGY PERFORMANCE RATINGS
U-Fulat solar Ht:a!r Cot 1=1111
0.30 1 jo 0,1
ADDITIONAL PERFORMANCE RATINGS
Y1z161e Trrrttmtllaoa Con,leesztien Rui:tantt
0.40 O
H'"v Is a SU laI tip U Ittt htl At" to angt tnabrm to►gplleabia NF RC prccedu cc br
dtiumtolnp •halt pmdttt nirpr perbnnmeL HFAC r+ingt art daurrntna/ br a`T
Lzad tzi ti andrunmcnw rmdifont and s�ppwic pp,vdaci dart. NFRC does tot rerwhmmd
NT Ptoduci Lnd'doet not a IM11l III eutlabluv ofa1r�pradoct fxv a�sp edac uaa,
C�atull mmutacturt(i Alantun lot tihet pmduct Ptrbnnantu Intonnaton.
www,tltrc.o
Mlatt or esceedt M.E_C., C.E.C.,t_ 1.E.C.C. Air IntlltralSon R- uiramenit
(DP) ��5 ,entdtn ixslre,nuu+m>YDA IWLS.1
N-LC73 t4Z79
+ 3 `- tmal to 14 N111YD4 tlGCa "
(raj rte° -.- IC1fl S21A4p^OS `
N-UJS 1111MAN"ISM
U•t Y.rf�4ryabN radars a.r.fu 151Y(St
olezn '°
rrJlFi'id7E;-1-- 1 110ISC'GU11NST0
Apr 0715 05:38a p.1
HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Furnished and Installed by:
Branch Name:Bostou North&South Date: t/ THD At-Home Services,Inc.
d/bJa The Horne Depot At-Home Services
Brandt Number:31 and 33 908 Boston Turnpike,Unit 1,S'rewsbury,MA 01545
Toll Fret 877.903-3768
Federal ID#75-269841x7;NIE Lic#C 02439;Rl Coat.Lic#16427
CTR�L,,icy�#HIC.0565522;,lA Home Improvement Contractor Reg#126893
Installation Address: 1-"1�f o L-e S,L - MA
City State Zip
Purchaser(s): Work Phone: Home Phone: Cell Phone:
Home Address:
(If differew.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 emaiis from The Home Depot
Project Information: Undersigned('Customer"I the owners of the property locate]at the above installation address,agrees to buy,
and TH At-Home Services,Inc.("The Home Depot")agrees to furnish.deliver and arrange for the installation("Installation-)or
all materials described on the below and on the referenced Spec Sheet(s),all of which arc incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Suntntary attached hereto and any Change Orders(collectively.
"Contract`):
job*,. P oductc: Spec Shm(s)#: Prrqect Amount
Roofing LjSiding MWikows Insulation
❑Gunen/Covers ❑EmryDonts ❑ F3( �,3�t�j S `�2--Ci =
Roofing LjSiding 0 Ntndows Insulation
❑Gatters/Covers ❑Entry Doors C3 S
A—
Roofing LISiding Windows Ll Insutaikm $
❑GuticrsICovers ❑Ewry Dom F1 l J
RnUrng LJSiding Windows Ll Insulation $
❑Guuers/Covers ❑Entry Dixvs ❑
Minianan 25%Deposit of Contract Amount due upon exe cation orthis contract. Total Contract Amount $
Maine Purchumm may not deposit more than one4hird of the Contract Amount.
Customer agrees that, immediately upon completim of the work for each Product,Customer will execute a Completion Certificate
(me for each Product as dc(incd 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 I''able hereunder.
The Home Depot reserves the tight to issue a Change Order or terminate thi:Contract or any individual Product(s)included herein,at
its discrerim.if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the hoine,ewyironmental hazardi such as mold.nsbemos ur lead paint.other safety concerns,pricing errors or because
work required to complete the job was not included in the Contract.
Payment Suminary The Payment Summary # [0Sf>1q t , included as part of this Contract, sets forth the total
Contract amount and payments required for the deposits and final payments by Ptoduct(as applicable).
?NOTICE TO CUSTOMER
You are entitled to a completely tilled-in 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 Deport the costs of materials,labor,ettpenses
and services provided by The Home Depot or Authorized Service Provider through the date of termination,phis any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AIVIOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY"OF SUCH AMOUNTS.
Acceptance and Authorization: Customer agrees and understands thou this Agreement is the entire agreement between Customer
and Tire Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either
oral or written,relating to said Products and installation.This Agreement cannot be assigned or amended except by a writing signed
by Customem and The Home Depot.Customer acknowledges and agrems that stonier has read,understand~,voluntarily accepts the
terms of and has received a copy of this Agroement.
Accepted by: ,� Submi ed
Customer's Signature Dime Sales C T s ignature Date
k Teleph
Customer's Signatture Date Sales Consultant License No.
CANCELLATION: CUSTOMER MAY CANCEL THIS iasappticvbtet
AGREEMENT WITHOUT PENALTY OR OBLIGATION 1
BY DELI�TERING WRITTEN NOTICE TO THE HOME a
DEPOT BY MIDNIGHT ON THE THIRD BUSINESS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
City of Northampton 212 Main Street, Northampton, NIA 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 Signature of Permit Applicant
t •
The Commonwealth of Massachusetts
= Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
t•vww mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
1 Name(Business/Organization/Individual):
72 1-2
Address: y� �� ;
City/State/Zip: c Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
l.❑1 am a employer with employees(full and/or pan-time).` 7• ❑New construction
2.❑lam a sole proprietor or partnership and have no employees working for me in
any capacity, [No workers comp.insuraninsurance required.] S. [] Remodeling
3.❑1 am a homeowner doing all\cork myself. [No workers'comp.insurance required.]t 9. ❑Demolition
4.❑I am a homeowner and xvill be hiring contractors to conduct all work on my property. I will 10 ❑ Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions
pr �)rictors with no employees.
12.❑Plul
V1 bing repairs or additions
5. am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers comp insurance.: 13.❑R of repairs/)`
6.7 We are a corporation and its officers have exercised their right of exemption per NIGL c. 14. ther �I�j " /
��
152. 1(4),and we have no employees.[No workers'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.
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 emplOaher that is providing workers'compensation insurance for rr_y emplohces. Below is the; I
in fi,rvnatiorr.
Insurance Company Name: ,
Policy#or Self-ins. Lic. #: Expiration Date:
Job Site Address: � City/State/Zip-
Attach Piumber
Attach a copy of the workers' compensation policy declaration page(showing the policy and expiration date).
Failure to secure coverage as required under MGL c. 152, �'25A is a criminal violation punishable by a fine up to 51,500.00
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. A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance
coverage verification.
I do hereby ceitrfy ride�h air pen tics of per'ur rfonaation provided above is true and correct.
Signature:z � ��`�
� Date:
2 _s,
Phone`: 44/
Official use only. Do not write in this area, to be completed btu city or town official.
City or Town: Permit/License#
Issuing Authority(circle,one):
1.Board of Health 2.Building Department 3.Cite/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su ervisor: 1 Not Applicable Applicablee E
Name of License Holder: dV C..,-7
License Number
Address Expiration Date
�l ,
Signature Telephone
9.Re istered M'ome lm'rovement Contractor: Not Applicable £
Z1�13
Company Name Registration Number
Add es Expiration Date
A s �o
Telephone
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 permit.
Signed Affidavit Attached Yes.... No...... £
11' - Home Owner.. xemption
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 W' ows Afteration(s) ❑ Roofing ❑
Or Doors .
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [O] Other[Q]
Brief Descriptio v/La
Work: [_ ✓ ��'J�
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a,Jf Newhouse and.oir addition to existing housing, compete the following:
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
I_ Owner of the subject
property
hereby authorize 1 �1L L7
to act on my behalf, in all maters 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 pain and penalties of perjury.
Print Name ZA-�2_�_
�/
Signatur Owner/ gent Date
. ^
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existina Proposed Required by Zoning
Tl�is column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
�
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved L......
of Parking Spaces L=
(volume&Location)
A. Hasa Special Permit/Variance/Fl riding ever been issued for/on the site?
' � �-\ y~�
��
NO k~-\� DONTKNOW �� YES
IF YES, date issued:1
IF YES: Was the permit recorded at the Registry ofDeeds?
NO K ) D
��
IF YES: enter Book P a g and/or Document#1
�� ��
B. Does the site contain a brook, body of water orwetlands? NO ����/ DON7KNO�/ �~y YES ��,
-
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained �~� Ob�ained «�� Date
�~� �~� ' � i
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES - NO 0
/F YES, describe size, type and Location:
E. Will the construction activity disturb(clearing, gradingexcavation,orfiUinQ)over 1 acre oriuit part ofa common plan
' that will disturb over 1acre? YES NO Kl
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
^. '-
_ Department use only
City of Northampton Status ofPermrt "
Building Department Gurh CutJDnve�vay Pernit#
cl� 212 Main Street Sewer/SepticAvairabElrty
Room 100 !Nater/UrtellAva3labll�ty S
o�z4 Northampton, MA 01060 Two Sets of Structural Plan
phone 413-587-1240 Fax 413-587-1272 i?tofls�te Plans
:Other Specify'
PPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE,INFORMATION
This_section to Pic by....,
1.1 Property Address:
Map Lot Unit
e -
Pee
n' � Zone Overlay District
r�
0i i
Elm St Distract CB Dist1ct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: �� �� P)APIP70 /��� � , .mil L
Name(Print) Curren tvtaili g Addr�,
Telep on/e =�
Signature
2.2 Au"rizedAcient.
Na (Pri Current Mai lid/ng Address:
Si ure 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 (Gr (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 Off icial Use Only
Date
Building Permit Number: Issued:
Signature: —
Building Commissioner/Inspector'of Buildings Date
12 DIAMOND CT BP-2015-1042
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-232 CITY OF NORTHAMPTON
Lot: -001 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-2015-1042
Project# JS-2015-001989
Est. Cost: $2206.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 082485
Lot Size(sg. ft.): 46609.20 Owner: DIPILLO STEVEN W
Zoning: Applicant: HOME DEPOT AT HOME SERVICES
AT. 12 DIAMOND CT
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON.5 1112015 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 5/1/2015 0:00:00 $35.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner