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17C-316 (7) Renewal `_ �. byAndersen. .'M WINDOW REPLACEMENT an AndersenCUmpany To Whom It May Concern, Enclosed is a permit application package for a project we have been contracted to do in your town. Thank you in advance for receiving this package by mail. As we work in every town in the state, it greatly helps us in our process. We have also enclosed a self addressed and postage paid envelope and would request that when the permit application has been processed, that you would mail it back to us. Enclosed for you review in this package is: ❑ Permit Application ❑ Home Improvement Contractor License ❑ Construction Supervisor License ❑ Proof of Insurance ❑ Proof of Energy Efficiency Rating ❑ Signed Contract from customer ❑ Permit Fee (if accepted at time of applying) If you have any question regarding this application please call me at (508) 919-0992. Best Regards,, Mary Elle Rudsit Permit Coordinator 104 Otis Street 1 Northborough,MA,01532 Phone(508)919-0900 Fax(508)919-0903 Website:www.renewalbvandersen.com R� re al . .+'.'• rltAnnrr�stt+' . i w�aiNFaras# Wood/VinylComposlleA'arne Cbua� Dual Pane . Ar0*f1 Low E . Casement RES4l i ENERGY-PERFORMANCE RATINGS. U-Factor (U.$)/1-0 Solar Neat Gain Coefficient 0 ..33 0 , i ADDITIONAL PERFORMANCE RATINGS. Visible TiansTnittance' rt anuf Arir ApAos Out Ihur iallnps conlon.to appllosbl�AERC piocrdures lot•dahmkIrq whole product pirfonAa ce.•OC relAgs ate oettrmlMd for a bad-Setif eovlronTeplal eondl6oru end e ' 'specific Product stn.Consult miftubcluier's i(istelur!:f. Other product piRormance inlorinllbrC • ' - r� 1 1 Design Pressure(PSF) . • A /� - .ate. .�..� • • ■ _ - © 1 4WM rMp//e1Nl (�0•MlMY9.00t �MN�RI r ■V- . +T•.1rr•.•Aw1•t•••�hrred c. t��.n11t.�1.N•d.r4" �.std r•�IIt1I/4�W/r1e11►,.,1/Z•ar:-•7 . Meilt or eteNds M.E O,.,t,E,0.,L LEcC.6_Arinrllli�bon gepulrertitnls WDrtf1 flellmesk Gettl(INllan►toonm re al N.FRC. . .AYANDHIt.RN' Wood/Vinyl Composite Frame rlauyrjaieliestralron Dual Argon low E Glider; ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient Gn34 130 , i ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 .111149 Manufectunr stipulates that Mete(frogs conwnn to appdce4WNFRC procedures br ea/arrnining wholeproducl p•rfonnencs.NFRC retln9s am deteoolned for a ns W set o(anr)ro—htal conddlons and•spectnc Product she ,y - j NFRC does not nco—pond any product and does not w"nl the I.A belty at any product(o(any spwlpc tue. Consults anugsdun(s Mt•ratun for other.product paMmwnci lnlom+at!r. fro i s 1 i DESIGN PRESSURE(PSF) ra v MiaMe �iWsisn HS - L C 2 5 100-00296313-006 ' � sated m Ats A llll .S.'47 or NA[5-01. M.o(nclury Ai u Ito atn occ to tAe s nenaras . I Meats or exceeds M.E.C.,C.E.C,H I.E.C.C.AY(nIN(lretba ngUft Mend WOMA Ns"(h CenMcewn P(oprxh.. ie NFAC WoodNIpyl Composite Frime Wtk►p CarrslA OUdI• Arpn low E Picture . ENERGY PERFORIi AKE RATINGS 11=Factor(U.S)%I-P , _° Solar Heat Gain Coefficient ' 32 -' ' .1 -2' ' ' -, 0 ADDITIONAL PERFORMANCE RATINGS visible Transmittance 5- 3. ' IA.naberue..eywl..r•��N.•.PwM•�nMrn'N yipy 1'I^C►Fe•�rws ry h'ArpY��M�+V/n rv.i - •' ' M�+r»h...MMC��M IdM�F'.1 la•k.r�.�N aV�err1►�W.:nr�Km.MN}q•.M.M!"`{.V NrAce+..e.l^ewr.wrnlN+r�nlwlg//w1�.1.rwq�Ma�F/��rrM/ua�,vn�'i..Ki.v... - � � . .. . 'o.q+uMq..w�w.+�+N.ntuw l•r+M.r�n1�.+'.gm...i..�M!rry:�. - _ t)ESICN PRE3SUWE•(PSFi . 5®: 00-00229854-02-i �Iu r e r v w 03 M•►u��.... .MO6o..OM! c:co-AjrjlM +.nw� +n�WOrrAl1.M+!�o.*Mr.Fr► Mtn - Window Agreement-Page 1 of 2 J&L Windows,Inc.,dlbla 104 Otis 8t,Northborough,MA 01532 Renewa I MA Home Improvement Contractor (506)918.0900•Fax:(309)9194903 �/ L166nsa#149501(Expires 112412010) Customer Service:1900)573.7606 + er' m Federal Tax ID#93411404201 WINDOW eRPLACRMeNT •n AnderkY G-�pkH Product Manager: DG-4=1 WindoW Agreement Contract Date: Homeowner("Owner")'s Nam a): AIC.Aml, Street Address: y r-, C /Town: State:Mr1 ip: 0)0 Home Phone: 1 1 5i44'__529L Work Phone: -Z"I'll Job Site Address if different): E-mail Address: Materials to be provided and work to be performed by Renewal by Andersen("Contractor"): Contractor will furnish and install Renewal by Andersen- pp oved materials to the following specifications: 1. Dots on which Work is SChe uled to Begin: Expected Date of Substantial Completion: 2. Contractor will Install a total windows in Owner's ome,using the following individual quantities Double Hung(DB) 11Equal ash ❑Cottage sash(1/3 top,2/3 bottom) ❑Oriel sash(2/3 top,1/3 bottom) Casement(CW) Inge right E-Hfitge left(as viewed from exterior):lawndard handle ❑Metro handle Double Casement(CDW) ❑Standard handle []Metro handle Casement/Picture/Casement(CPW) ❑1:1:1 or ❑1:2:1 C7Standard handle []Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑1:1 A or ❑1:2:1 _Awning Window(AW) -4- Picture Window(PW) _ y or Bow Window: 3. Yes FNo Windows to be Custom Fit Replacement: 4. ❑Xes of sills to be replaced by Contractor: 5. es Wincl5lws to be New Construction Full frame(includes new interior&exterior casings): Exterior casings: 915ine ❑Maintenance-free material ❑Factory applied 908 Fibrex brickmold 6. Glazing to be: ILYHigh Performance ❑Opor If other,please specify: 7. Exterior color to be: ❑White ❑Sand 9,0emas ❑Terratone 8. Interior color to be: ❑White ❑Sand &Canvas ❑Terratone ❑Wood Note:Interior color can only be white.-Wool or same color as exterior. Wood interiors need to be finished by Owner. 9. Hardware: hits ❑Stone Canvas❑Brass Double Hung: Install lifts? ❑Yes ❑No 10. 17 yes ,UptContractor will remove metal frames or grilles. #of Units: it. es IR% Contractor will Install new paint-ready or stain-ready casings. Inside or outside stops#of openings:_ Interior casing#of openings: Exterior casings#of o ❑Pine ❑Maintenance free material Owner is a that Contractor does not do any painting. Owner initials 12. O Yes B'No Contractor will wrap exterior iaasings with alu co' stock of color. Note:Required with storm window remo emoval of storm windows wiV I ave screw holes in casing. v 13. New windows to have: ❑Half or creens Screens to be Fiberglass ❑Aluminum 14. Windows to have grilles: ❑Yes o If Yes: ❑Grille Between Glass(GBG) ❑ Removable Interior Wood(INTW) ❑Full Divided Light(FDL) Grille patterns: B DH DH DH DH CW/Plcture Glider CPW or GPW "use ad,oi0onal sheet if needed Owner approved(initials): 15. s No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. is, ❑No A limited warranty shalt issue to Owner upon completion of the job and payment in full(see reverse side). 17. es ❑No Building Permit—Contractor will secure any and all necessary permits.The fee for the permit(s)is not included in the Contract Price and a eparate ch k is quired at the ' e of sal for this. 18. Additional details: rVR 1`-1 Sr ,e ti 19. MA4ifis ❑No Owner has reviewed the Additional Terms and Conditions governing this Contract on the reverse side, including Owner's Three-Day Cancellation Rights pursuant to MGL c.W§48,C.140D§10 or c.255D§14(See Section 25 20, Total Contract Price:$ 15-2 Regular Retail Price:$ All available discounts applied: No 21. Deposit(1/3):$ paid by❑Cash ❑Finance (Account#:/U'�`�G75 t>y 7a7 f- 1 Seco 1/3)$ to be paid by Cash at start of job on (Estimated start date►. Fi (1/3)$ to be paid by Cash at completion of job on (Estimated completion date). 22. es ❑No Owner agrees to be present on the final day of installation for final inspeotion and to deliver final payment. No final Dayrrient shall be demanded until the contract Is completed to the satisfaction of all parties. NOTICE: All home Improvement contractors and subcontractors must be registered. Any inquiries about a contractor or subcontractor relating to a registration should be directed to:Registration Division,Program Coordinator,One Ashburton Place, Room 1301 Boston MA 02108 Tel: 617 727-3200,Webalts:htt :llwww.mass. ovld s The parties hereby mutually agree In advance that should a dispute arias regarding this contract,Contractor may submit such dispute to a private arbitration service that has been approved by the Office of the Consumer Affairs &Business Regulation,and Owner shat be required to submit to such arbitration as rovided in MGL C_ 142A. Contractor Signature: Owner Signature: r If YOCIL NOTICE:The signatu of the pa a above apply only to their agreement to alterna a disput asoiution initiated by Contractor.Owner may initiate alternate dispute resolution even where this section is not signed se rately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES J&L Windo vs,Inc,dlb/p Renewal by Andersen By.( , .� P snag r Owns 1 ature r �f Procluc Manager(Print Noms Owner Signature White—Renewal by Andersen Yellow—Installation Pink-Homeowner The Commonwealth of Massachusetts Departinent of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA'02111 wwwanass govldia Workers' Compensation Insurance Affidavit:Bull.ders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N4ne(Business(Organintion.adividuap: 24 n P,t. Address: 'City/State/Zip: Phone#:. (""awl ' t10 .Are you an employer!Check the appropriate bo= Type of project(required):_ ' 1.3,i am a employer with 0 4• ❑ I am a general cos�lractor and I 6. ❑New construction employees(fu11 and/or part time).* have hired the sub-contractors 7, Renzodclin 2.�] I am a sole proprietor or partner- Listed on the attached sheet.t i; ship and have no employees 'Ihne sub-contractors have 8. Demolition working for me in any capacity. worlxrs'comp.insurance. g, Building addition [No workers'camp.insurance 5. ❑ We arc a corporation and its' 10.❑Electrical repairs or additions required} pincers have exercised their 3.❑ 1 am a$omoownor doing aII work right of exemption per MGL I1.❑Plumbing repairs or additions myself[No workm'comp. c.152,g1(4),and we have no 12.[3 Roof repairs in *�*+ce required.]t, • employees.[No worhrs' ' 13 comp,insurance required.] .[�Other *Any applicant that checlm b=#r1 must also Hill out the section below showing tb,*workers'compensation policy infix on. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eontmaors must submit a new affidavit h icatmv such. xCotit<actora that check this box must attached ea additional sheet showing the name of the sub-contractors and their workers'comp.policy inf'aamat oa, ram an employer that is providing workers'compensation insurance far ' employees!. Below is the policy and job site. information. Insurance CompanyNamc' +. �" /`/efl�CCfJ� 148urellic�-- Policy#or Self-ins.Lic.# Expiration Date' Job Site Address: �"� �d H J S �- City/State/Zip: N m e e AM b l ola 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.132 can lead to the imposition,of criminal penalties of a nine up to$1,500.00 and/or one-year imprisonment,as well as cM penalties in the form of a STOP WQRR ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be-forwarded to the Office of Investigatioas of the DU for insurance coverage verification. f do hereby c rti fy under pain and penalties o rjury that.the information provided above is true and correct ' Siz Date: ' Phone� ����✓ •�/ 1�©�d Q ; Official use only. Do not write in this area,to be completed by city nr town official. City or Town. PermitUcense# 1 Issuing Avthority(circle one): L Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector f 6.Other ` Contact Person: Phone 0: ACORD,,, CERTIFICATE OF LIABILITY INSURANCE DATEIUMAI°"""' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC 0 INSURED Renewal by Anderson INSURER A: Hartford Insurance Company J&L Windows,Inc. INSURER B: Hermitage 104 Otis St INSURER C: Northborough,MA 01532 INSURER M INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER DATEI&g&W POUCY EXPIRATION LIMITS B GENERAL LIABILITY HCP 507 404 09/07/2008 09/07/2009 EACHOCCENCE S 1000 000 COMMERCIAL GENERALLWHILITY PREMISES Ea o=mmvel f 100,000 CLAIMS MADE ®OCCUR MED EXP(Anyone person) S ---_ 5.000 PERSONAL A AOV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY PRO. LOC A AUTOMOBILE LIABILITY 35 MCC XD 6390 10101/2007 10/01.2008 COMBINED SINGLE LIMB f 1,000,000 ANY AUTO (Ea 00=wt) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY ' S (Per parson) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per acddont) PROPERTY DAMAGE S (Per acaaam) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THAN EA ACC i AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FI CLAIMS MADE AGGREGATE f f DEDUCTIBLE f RETENTION S S A WORIMS COMPENSATION AND 35 WEC PP 1444 02/1712008 02/17/2009 wC STATU• 9TH, EMPLOYERS'LUUI1UTY ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 500.000 OFFtCER>1AEMBEREXCLUDED? E.L.DISEASk-EA EMPLOYEE S 500,000 SPEC B oS.IAL dasciba PRO wider 00 VISIONS below E.L.DISEASE•POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wRrnzN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 04POSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE S. /J C�I�I�r may, AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 s M assachusett s.- Depar tment of Public Safety Board of Building Re!-ulations and Standards Construction Supervisor License s License: CS 99255 Restricted to: 00 SCOTT PHILLIPPI 58 D STREET WHITINSVILLE, MA01588 Expiration: 6/7/2011 ('u nunis sit ner Tr#: 99256 Restricted to: CO 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: %VM-Mass.GoVlDPS �1 e �o�rUnzanu�eal� a�,/`�aaoac�u�aetta Board of Building Regulations and Standards lugHOME IMPROVEMENT CONTRACTOR Registration:. 149601 Ex:p�ratiori 124/2010 Tj+pe Supplement Card :r RENEWAL BY ANDERSOt+L__, SCOTT PHILLIPPI _ 104 OTIS STREET NORTHBOROUGH, MA01'532 Administrator SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicablea❑s— Name of License Holder: () -T t 1 Q t Cj " ILicense Number l t7 L -� '� S Sip NvC-�- 1 u M A C)(S3�- (, I -� ` lI Addre s Expiration Date -&R", 1_�q - -- o Signature elephone 9.Rigistirid' fir; r n Contractor,- Not Applicable ❑ Company Name Registration Number AcicliVi Expiration Date F Telephone ,] 0 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...... ❑ 1 L - H©me O wner 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 W' doves Alterations) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[!]] Brief Description of Propose Work: te ce- W Y�t�t2t,;� N� S-�y�t�v✓Gt( ctin S Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet Oa. I NO house an&"6 r addition to,exWthia housin com late 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. 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 property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. ignature of Owner Date I, as Owner/ 'uthor e hereby declare that the s ate ants and in ormation on the foregoing application are true and accurate,to the best of my ledge and belief. Signed under the pains and penaltie of perjury.( Print Name i c,-� Signature of Own /Age Date Section 4. ZONING All Information 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 LotSize E. ._ ...... _._._. L.., _..... ... __i �_. .... ... _.,.,..,,, Frontage 1 m ... ..................... . ........_ Setbacks Front Side U, ....._ R. ..__ ' R:, ,._......? . Rear j i..._.. . ,,,( Building Height Bldg. Square Footage ; % l Open Space Footage (Lot area minus bldg&paved L parking) #of Parking Spaces Fill: i l ... L , volume&Location L _ ._..._. .......... ., A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES Q IF YES, date issued:, ­­,""I'll, 1 IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW 0 YES 0 IF YES: enter Book `;, ' Pagel- B. and/or Document #, Does the site contain a brook, body of water or wetlands? NO 0 DON'T 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:J C. Do any signs exist on the property? YES Q NO 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: `. 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 Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. f ""'op ttt only City of Northampton ## t f Pert lk f , Building Department t✓ti*Cu a Prmlf 212 Main Street f '� r f , ���,1Sep , �� ", Room 100 � � !!AVt �` �� ��s Northampton, MA 01060 � of tru�t�i���n� phone 43-587-1240 Fax 413-587-1272 PC 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 by office 14 1 l erCS4 _C--)2 Map Lot Unit 1" t. O Y - V1 C•-r— U ( U(r D zli Zone Overlay District Elm St.'District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C10 °�`` 1�(1; I rs5+ 1,2 r . .,ry1�4 6i,66� Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: (� mcl-r�'l +���c,� Name(P int) Current Mailing Address: cs0 � - ctLCi ��t 1� Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 1 y (a)Building Permit Fee 2. Electrical gt (b) Estimated Total Cost of Construction from 6 3. Plumbing (D Building Permit Fee 4. Mechanical(HVAC) (j 5. Fire Protection 6. Total =(1 +2 +3+4+5) 5 Check Number This Section For Official Use Only Building ermit Number: Date g Issued: Signature: Building Commissioner/inspector of Buildings' Date BP-2009-0315 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cate og ry: BUILDING PERMIT Permit# BP-2009-0315 Project# JS-2009-000426 Est. Cost: $15246.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 149601 Lot Size(sq.ft.): 31973.04 Owner: MILLER NAOMI zonin :g UFA Applicant: RENEWAL BY ANDERSEN AT. 48 HILLCREST DR Applicant Address: Phone: Insurance: 104 OTIS ST (508) 919-0900 NORTHBOROMA01532 ISSUED ON.912312008 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: FeeTVpe• Date Paid: Amount: Building 9/23/2008 0:00:00 $35.006473 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo