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11C-074 vu not ran,rnre unlb7 anal code lmae�un. Save labs tnr 14,l a ralzzn. C=da N C• LLJ � rnecgystar.pov ``° - . ®.OuaM1�dlAdm'rssililu - � `QIAOOV�.acos■ r e ens 't?T:zSF;dtrt�n AND-N-74 f Noodfvinyl Composite IF -- Dual Argon Low-E4 SmartSun P bduct Types Double Hung ( - EM'�GY P�FORNiSr�C� rZAi rival 1 t U-Factor Solar Heat Gain CoeT 0 .29 1 . 65 Oe2J (U.SJ4-P (MetrlclSl ADDMOt1AL PERFORMANC= RATINGS r \/i ibl -i-ran, t:;nce uarata.-aux atr7,+att�wi co a nor+y�caYt�m tr t xACwe�'RC G'��-°R ry een!r�9 erne[*oaXt , tom^=>;-rerRG r+''�4s are eaarR.+ca nor a►.eC srt a mw'oroe.vi cvax'a a�n a sxcnc[��3 see-. . 'r:-sr,ocrece�.+...,.:...--,-:�:-�ca;- s.:,..-._ .;.;r-�^�c'x;•a•:^ctaruy»saceuu . Ccrt u[rnarafxrvt*'T Rrry+r Mr eK� 7ii Arroer'sen Coroomt=4OZ L= . rarx sauac�s%a ..n c+.ro►x.r 3 . Standard Rating AlLuk"..`..Y-L &A 10 u Z5 21'-I tc-M stz,�k-�5t42 ' � x-.0-ti•:�+�..�rous Y..u�-c5 L*^H-�r:r , May 3015 09:33a p HOME I-MPROVEMEN-T CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Breton North&South Date:A5P J� TED At-Hone Services,Inc. dtb/a The Home Depot At-Home Services Branch Number:3I and 33 908 Boston Turnpike,Unit ],Shrewsbury,MA t)]Sd5 Toll Free 877-903-3768 Federal ID#75-2598450;ME Lic IF C 02439;RI Cont.lie#:6427 CT Lic#H1C.05555??:MA Hone Impms+aneart Contractor Reg.#126893 - Installation Address: b�9 F �-�? f- j,p od S City State Zip Purclviser(s): Work phone: Horne t'hunca Celt Phme: [ 1 [ 1 C 1 Home Address: (if different frorn installation Address) City State zip E-mail Address(to receive project commmitation.s and Home Depot updates): Q 1 DO NOT wish to receive any marketing emails from The Home Depot I'roiett IMon-pation: Undersigned('Customer"),the owners of the property located at the above installation address.agrees to buy, acrd THD At-Home Services,Inc..(`The Home Depot")agrees to furnish,deliver and arrange fer the installation("I»stalJatimr"}o- all materials described on the below and on the referenced Spec Shcet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Chars Orders(collectively, Contract"): Job#: n,.,aR.L," Products: Spec Shee s)lk ProectAmount p Roofing Siding Windows Imulatia / �(J ' - 14 D ❑cotters!Covers ❑EntryDoars ❑ t S 1-7053 Roofing OSidijig Lj Windows Inaalation []Gunzrs!Cmcm C3 Entry Dom 0 g [ 1 Roofin; L3siding 0 R'in&ms Ej Insulation ❑Gurers I Covers ❑Entry Doat's 0 $ Roarfrs Siding Windows El lnzrlation -- []Gutt_rs J Covers ©Entry Doors Q S 1111nimufti a%Deposit of Cortmet Amount due upunowulton of this contra& Tel Contract Arnount $ Marine ll um-briers may not deposit rotor than one-third of the Contract Amount ( pt Customer agrees that,immediately upon completion of the work for each Product.Customer will execute a Comp:etion Certificate ° (one for each Product as defined by an individual Spec Street) and pay any balance due. As applicable, each Customer under this Cam, Contract agrees to be jointly and severally obligated and liable hcrcundiu. The Rome Depot reserve~the right to issue a Change Order or terminate this Contract or any individual Prxaduux(s)included herein,at its discretion,it The Home Depot or its authorized service provider determines that it cannot perform is obligations due to a structural probicrn with the home,environmental hazards sucl as mold,asbestos or lead punt,other safety co nocm,&pricing errors or bemuse work required to complete the job was not included in the Contract Pavmeot Sttrmnatw: Tike Payment Summary # <QBCD4 e }� , included as pot of this Contract. sets forth the total Contract amount and paytnontS required fir the deposits and final payments by Product(as applicable), NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each fisted 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 cosh 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 DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER RE%IEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorizutirm: Customer agrees and understands that this Agreement is the ent rc agreement between Customer and The Home Depot with regard to the Produce and Installation s.-wires and supersedes all prior discussions and agnee;nents,either oral or written,relating w said Products and Installation.This Agrccttent canno fined nr amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agree.=Ihat corner as read.understands voluntarily accepts Jne terms of and has received a copy of this Ao cement. a Accc by: Sub S m c � 6 1 X 7 X %- Customer's ature Dane 17,s u Iant's Signature hate ph No. ` Customer's Signature Date Sates Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS tas.iPptw�ncr AGREEMENT WITHOUT PENALTY OR OBLIGATION . BY DELIVERING WRITTEN NOTICE TO THE HOME L DEPOT BY M. 11MIGHT ON THE THIRD BUSINTSS l V DAY AFTER SIGNING THIS AGREEMENT. THE l STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECERCAL.LY PRESCRIBED BY LAW IN The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information i Please Print Le ibly Name(Business/Organization/Individual): Address: City/State/Zip: �� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.F_�I am a employer with employees(full and/or part-time).' 7. E]New construction 2.F�I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp,insurance required.] 9. El Demolition 3.7'k am a homeowner doing all work myself FNo workers'comp.insura:: r:equired.l t 10 D Building addition 4.❑[am a homeowner and will be hiring coutractors to conduct ail work ou_),property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.F�Electrical repairs or additions p netors with no employees. 12.7 Plumbing repairs or additions 5. [am a general contractor and I have hired the sub-contactors listed on the attached sheet. 13. Ro re airs These sub-contactors have employees and have workers'comp.insurance.: v 14. Othe 6Q We are a corporation and its officers have exercised their right of exemption per MGL c. 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 contactors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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 employer that is providing workers'compensation insur�an/ccJfor my employees. Below is the policy and job site information. Insurance Company Name: ' , / Policy#or Self-ins.Lic.#: �/ �� Expiration Date: � Job Site Address: W "U"A� r City/State/Zip: �11 Attach a copy of the workers' compensation policy declaration page(showing the policy number 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 o> -year imprisonment,as vvcll as civil-penalties ir,the form of a STOP WORK ORDER and a flue of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify mtd naltiec erjury that the information provided above is true and correct Sienatur s Date: Phon-.21• 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 Contact Person: Phone'": City of Northampton Massachusetts ,f{S _ Mfr{ DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 5vb Northampton, MA 01060 s�'yY7�t INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The 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 regulations. 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 rough 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) will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations x 600 Washington Street Boston, MA 02111 www.mass.gov/dis Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F-1 Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. E] Building addition [No workers comp. insurance p' 10.E] Electrical repairs or additions required.] 5. [] We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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 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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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 Contact Person: Phone#: 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: ill be transported b The debris w : N Y The debris will be received by: Building permit number: Name of Permit Applicant N Date Sign-ature of Permit Applicant SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Sup isor: Not Applicable £ z–�- Name of License Holder: License Numb r P/z ,�3 —�—/k Address Expiration Date Signature Telephone °9 Re istered.Home Imp vement Contractor Not Applicable £ Company Name Registration Number 1 A � ` � ��- Ex tion Date 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 buil ' it. Signed Affidavit Attached Y ....... £ No...... £ 11: Home Owner'Exemption 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 Win s Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[0] Brief Descript'on o.Pr e Wor Qty k: Alteration of existing bedroom Yes No Adding new bedroo Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.`If Newhouse and or addition to existing houslnr�,icomplete the followlna 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 1 /� as Owner of the subject r property hereby authorize koj to act on my behalf, in all matters relative to wor uthorized by this building permit application. Signature of Owner Date f Jog ,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 un the p s and penalties of er' J Print Name Signatu of Owner/Agent Date n« Section 4. ZONING AIL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information � Existing Proposed Required by Zoning Tliis column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg.Square Footage Open Space Footage 0yo (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Permit/Variance/Finding ever been issuedfor/on the site? �~� x-� x~~\ NO �� DONTKNO� «�� Y�� ,� IF YES, date issued: � IF YES: Was the permit recorded at the Registry ofDeeds? NO K � DON KNOW YES ~� IF YES: enter Book Page and/or Document# �� B. Does the site contain a brook, body of water orwetlands? NO �~�� DONTKNOVY �~ YES �~� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained -��~\ Obtained »~� Date� �~� ' . C. Do any signs exist on the pnoperty �� YES «�� NO v�� (F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 |F YES, describe size, type and location: � E. V0U the construction activity disturb(clearing,gradingexcavation, o/filling)over 1 acre orioit part ofa common plan Mha�oi|/disturb over 1 acre? YES � ) NO K � ' ~~� ~_~ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ^ — - 5 t j1 1 Departmeht use only Mai 11f < ' oiy ity of Northampton Status,ofPmtt tl, fi ��d p,�i r':' Ee r 1 6 2 r B ilding Department Girla GuUl�rlsieviayPerrrtl# � ,;ons 12 Main Street Sewer/SepticAvalia6[lrty 1 c . E�ectrl r" Room 100 1Nater/1/IfelfAvatla�+hty --~ _. Northampton, MA 01060 Twa Set`s of Structriral Plans ERR phone 413-587-1240 Fax 413-587-1272 PIof/Slte Plans ' a �fi y Oder Spee+fyj ' APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION This sectiorr to be completed by office `: 1.1 Property Address: 0� Map 4 Lot Umt �� ~ :Zone Overlay District Elm St 'District CB.District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner o ecord: Name Print Cu re t "rig Ad fTel phone Signature 2.2 Authorized ent: Nam t) Current Mailing Address: 0 ignature / -elephone SECTION 3-ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only —completed by ermit applicant 1. Building U� (a)Building Permit Feb 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 116 FLORENCE ST BP-2016-0065 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I IC-074 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2016-0065 Project# JS-2016-000117 Est. Cost: $17253.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 082485 Lot Size(sq. ft.): 20342.52 Owner: CAHILLANE PATRICK J&BARBARA Zoning: URA 1002 Applicant: HOME DEPOT AT HOME SERVICES AT. 116 FLORENCE ST Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.711712015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 10 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 7/17/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner