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31B-162 (10)
September 18,2006 Peter Post New Outlook Construction,Inc. 44 Massasoit Street Northampton,MA 01060 (413)427-7014 City of Northampton Building Department 212 Main Street Doom 100 Northampton,MA 01060 Dear Building Department, This letter is in regard to a permit application I submitted for replacing windows at 159 Elm Street,Northampton.With this letter 1 have included a photograph of the window to be replaced and a description of the replacement window.This is the only window of the proposed replacement windows that is visible from the street.1 he client wants to keep the exact same light pattern,grille,and trim style as the existing window. The Marvin replacement window number is CUDM020.The window has an 8 over 8 light pattern and will be the same size as the existing window. i Also, fiine dcv'S � c�r'91' Regards, 1 r' Peter Post VUHILv t1,,,FORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GS60UB-3663632-6-06) RENEWAL OF (GS60UB-3663B32-6-05) INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY NCCI CO CODE: 80411 1. INSURED: PRODUCER: NEW OUTLOOK CONSTRUCTION INC KING & CUSHMAN INC 44 MASSASOIT AVE 176 KING STREET NORTHAMPTON MA 01060 PO BOX 447 NORTHAMPTON MA 01061 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 09-17-06 to 09-17-07 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA m �— B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in �— item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: 0= SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 _ 4. The premium for this policy will be determined by our Manuals of Rules, Classif ications, Rates and Rating u Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 08-31 -06 WC ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: KING & CUSHMAN INC 26LPY 011458 The Commonwealth of Massachusetts LA Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anolicant Information Please Print Leeibly Name (Business/Organization4ndividual): N e i t) O tit}`o o K Co.,ri s+,-U C.}4 o i, 1 k'7 C. Address: MGSSaSD &?v--ee-F City/State/Zip: N 0 f Aqm&y n Al k 0100 Phone#: --1 1,3 -4 © 1 Are 'on an employer?Check the appropriate box: Type of project(required): I.YI atn a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity, workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp, c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *Any applicant that checks box 41 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: The Policy#or Self-ins.Lie.#: 6 J 6 D U S'366 3 g3Z-6 - 06 Expiration Date: Job Site Address: 15q F_Iai 54-re-e City/State/Zip: N y r A61M12h i ,AA 0 066 Attack 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 pa and penaldes of perjury that the information provided above is true and correct. Signature: �it- Date: t2 )o Phone#: 13 l q` 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#: SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor., Not Applicable ❑ Name of License Holder: ✓ �D Sk- t`)8 c3 3 G License Number 1'3 000 Address Expiration Date Signature Telephone Not Applicable ❑ N,ew OWtw©K (�oKS vicko�-r , {t'1C.j 1 140 Company Name Registration Number �� M�sSgsoi We e-+ q18 log Address Expiration Date 1Jo� a �tsl M 01,960 Telephr#ne ZT 70) SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDA T(M.G.L.c.1 52,§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 build' , permit. Signed Affidavit Attached Yes....... IV No...... ❑ I 11.- Home -O elr fxenwfl The current exemption for"homeowners"was extended t j include Ownerwccnnied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for ire who does not possess a license,provided that the owner acts as supervisor. MR 780 Sixth Edition 'on 10 U. Definition of Homeowner:Person(s)who own a parcel 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,attar d or detached structures accessory to such use and/or farm structures.A person who constructs more than one ho in two-year riod shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official, a forth acceptable to the Building Official.that he/she shall be responsible or ails h work ed r e n As acting Co,Utruction 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. j Also be advised that with reference to Chapter 152(Work�rs'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Mass4chusetts 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 res nsrbility for compliance with the State wilding Code,City of Northampton Ordinances,State and Local totting Laws :State of MamsachusdKs General Laws Annotated. Homeowner Signature i F.EB2M=_WS K folieck All sniirl"l) New House ❑ Addition ( Repladenien owe Alteretion(s) ❑ Roofing E Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs CtJ] Decks (p Siding Ctrl Other C Brief Description of Proposed Work: Replace 1 WI"Cl 6tts Alteration of eAsting bedroom Yes ✓ No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll -Sheet it a j 1;1Vli Y• '> curl';� iih1# . ]m W tiwililiCt.' �f 4t(m� is 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 Severer f�rivate well City water Supply LION?*--OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES,FOR BUILDING PERMIT I; as Owner of the subject property hereby authorize New oaf- c0 K Co r`S c j-�L-),, I VI C , to act my behalf;in to work authorized by this building permit application. L21.04 SigiiatUte of Date i, 'Pe'l't:` 1?o s f 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 penalties of perjury. Print Name :ten / tZ /06 Signature of owner gent D& Section 4. ZONING All Information Must Be Compte .Permit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: _ R: L:j R: Rear Building Height Bldg.Square Footage % f Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location)_. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW YES 0 IF YES,date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page Document#- B. Does the site contain a brook, body of water or�retlands? NO DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date issued: C. Do any signs exist on the property? YES 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 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,greding,lexc Lion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO er IF YES,then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton � � k ,s Building Departmentrl 212 Main Street Room 100 +V A�tr -Northampton, MA 01060 �;t ` i��" phone 413-587-1240 Fax 413-587-1272 APPLICATION"TO'CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-817E INFORMATION 1.1 Property Address: s$ctfon office 1 9 E l m S-�-r e e- map tot Unit N C r '�'tD.v�► p(v /� Zone Overlay D hict 01066 Eiar St. - SECTION 2-PROPERTY OWNERSFpPIAUTHORIZED AGENT 24 Owner of Record: 8 L'A I S-q E Ivy) S f-,''eC} Name(Pri Current Mailing Address: el 1,� 15-8 6- 1 7- a- ap, Telephone Signature 2.2 Authorized Anent: Name(Print) Current Mailing Address: Signature Telephone SECTION_3-ESTI"TFD CMTRt,&MON COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by rmit applicant 1. Building p_ (a)Building Permit Fee Sao. 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) SDO. p° Check Number This Section For'Offislal Use On Date Building Permit Number: Issued: Signature: Building Commissioner/inspector of Buildings Date File#BP-2007-0276 APPLICANT/CONTACT PERSON PETER POST ADDRESS/PHONE 44 MASSASOIT ST NORTHAMPTON (413)427-7014 PROPERTY LOCATION 159 ELM ST MAP 31B PARCEL 162 001 ZONE URB HD THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildin Permit Filled out Fee Paid Typeof Construction: INSTALL 5 REPLACEMENT WINDOWS&2 DOORS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 144100 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF032MATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission 0 5?tic Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. MSS ,.a BP-2007-0276 G1S#: COMMONWEALTH OF MASSACHUSETTS Mari:Blo&:31B-:462 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category windows replaced BUILDING PERMIT Permit# BP-2007-0276 Project# JS-2007-000420 Est. Cost: $7500.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PETER POST 144100 Lot Size(sq. ft.): 44431.20 Owner: ROTHER BRYANT P Zoning: URB HD Applicant: PETER POST AT. 159 ELM ST Applicant Address: Phone: Insurance: 44 MASSASOIT ST (413) 427-7014 NORTHAMPTONMA01060 ISSUED ON.911812006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 5 REPLACEMENT WINDOWS & 2 DOORS 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 9/18/2006 0:00:00 $25.001139 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo Ila '�ic}� 000 - no 9 � � e, �..b �S,41 9 sae--n (00p7hl 159 ELM ST BP-2007-0276 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 3 1 B- 162 CITY OF NORTHAMPTON Lot: -001. Pennit: Building Category windows replaced BUILDING PERMIT Pen-nit# BP-2007-0276 Project# JS-2007-000420 Est. Cost: $7500.00 Fee: 25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PETER POST 144100 Lot Size(sq. ft.): 44431.20 Owner: ROT HER BRYANT P 7.,,: ., *rljy T-i'. ..�^i�_':3wi� �rTCn .-•^CST AT: 159 ELM S7 Applicant Address_ Phone: Insurance: 44 MASSASOIT ST (413) 4 7-7014 NORTHAMPTON MAO 1060 ISSUED ON:911812006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 5 REPLACEMENT WINDOWS & 2 DOORS POST THIS CARD SO IT IS VISIBLE FR_OM THE STREET Inspector cf 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: 0 k THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATION -� Certificate of Occuoanc Si nature: FeeType: Date Paid: Amount: Building 9/18/2006 0:00:00 $25.001139 212 Maui Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo