18-002 (10) iunrtn—�c:an.sc.�a '
ot�iertrl' yIl1;
y� m
,
• GLlillcd
:, e�ovc izael,aC:e;f ial Ii, section;SAVE for future reler_nc
;� �- 4weathsr 5hteid
CPD C-50-'A-17Z ,
Mudel'6tDe•Oauhle Kung op ralinp
Alum clad ihtrn'al Fzm_
:z y Argon Fill urille in Alf 5paze
EN.:RGY a_r�iDRi�t.A�iCE RATINGS
' .� U—F:=tlr Scl=Nc�G1}n Gttclf=_nl .
70
0r1 $
,.t ADD}i 1014AL FERFQRMAN E RATIKGa j
nulr_urxtv::nt - - na-L--_Ib:-71s tirpnc�st xt$C pnatutcc tt
(all l:Y Oln; .1.Jt pnf7lt'LIIt; t.T.(S.C.]L 1.'i.r:a t:.-t ert fatr m•.net bl.•:
Lrl ct cl rcnanulil rndlei!lnl�lc:J{t nArti t xri•-5�::
rni t,rfu:t v,t't act r:tt rt.i7Al ht el """t to.111,?.Zflc U..
ti ult nL�v4:::ni t:Unurl Ut t:,te jnluct)ert7nMni7 tole t:ru/°^•
vvx-niro.c rtl .
kern Ot e:u ttt(k�1-°
ETC-
(D
.+�s� teaet L• 21CS 1•tluuuxYOl tJ:t.t-sT
-
. � Imo' �J _ lrnlL 1r ':L•-'^t)tt L_:1 ,
a� a
U.i Yrr,.r..t ll•rV f.a.n••.r.!.._.:1V t_: .-
clt:n'
• _..�, .,;L;_1_ ; r1C'IS�uZtISF:5i4 - .
Nov 151501:16p p•1
HOME IMPROVEMENT CONTRACT
PLEASE READ THIS
r Sold,Furnished and Installed by:
branch Name:Basta North&South Dateta/__�c THD At-Horne Services.Inc.
d/bla The Horne Depot At-Horne Services
Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury.MA 01545
Toll Free 877-903-3768
Frderal to#75-2691460;hIE Lic#C 024;39:RI Cont.Uc#16427
CT Lie tt HIC0W522:MA Foie Improvement Canjncctor Reg.#126893
Installation Address: (CBS PtA;Q� C -. [)r; __ �iq�d iL 'r t A
City Stt to Zip
Purchaser(s): Work Phone: Hone Phone: Cell Phone:
1 Q 1
Hone Address:
(If different from installation Addreas) City State Zip
E-mail Address(to receive project communications and Horne Depot updates):
I DO NOT wish to receive any rnarketing snails from The Home Depot
Project Information: Undersigned("Customer"),the owners of the property located at the above installation address.aggress to buy.
and TED At-Home Services,inc. ("Tlie Home Depot")agree,.,to furnish,deliver and arrange for the installation("Installation")of
all materials described on the below and on the retcrenced Spec Shca(sa, all of which are incorporated into this Contract by this
reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(c(Hectivel).
"Contract"):
Job#: nom.. a wt<n,K•. Vroducts.. See shect(s)#: Pro' (Amrntnt
Roofing LJSitfin� Winduws Insulating
Gutters!Cover, Entry Dcxir, ❑ L1✓ $ �� �
Ratting Sitting Wlndrnvs Insulation `t//
❑Guucrs f Covers ❑Entry Doors ❑ $
Roofing Siding Windows. U insulation
❑Guncn,/Ccwers ❑Entry Doors❑ $
RooF.ng Siding Windows Insulation L' G%
❑Gutters/Covers ❑Envy Doors 11 S /*
4litdmum 25%Deposit of Contract Amount due upon execution or Ws contract. Total Contract Amount S �+
Maine Purchasers may not deposit more than one-third of the Contract Amount. 3 3 V
Customer agrees drat, immediately upon completion of the work for each Product,Customer will execute a Completion Certific:xc
(one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable.Mach Customer under this
Contract agrees to be jointly and severally obligated and liable hereunder.
The Home Depot reserves the right to issue a Change Order or terminate this Contract cr any individual Product(s)included herein.at
its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural
problem with the home,environmental hazards such as mold,asbestos or lead Iraint,other safety concerns,pricing errors or because
worts required to complete thejob was not included in the Contract.
Payment Summary: The Payment Summary #��D-7- included as part of this Contract, sets forth the total
Contract amount and payments required for the deposits and final payments Product(as applicable).
NOTICE TO CUSTOMER
You ure 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.
to the event of termination of this Cataract.Cnstotrer agrees to pay The Home Depot the crests of materials,labor,expenses
and services provided by The Home Depot or Authorized Service Provider through the date of termination,pies any other
amounts set forth in this Agreement or allowed under applicable lavv. 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 REMEDIES FOR RECOVERY OF SUCH AMOUNTS.
Ace taste and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and a Horne Du with rerard ro the Products and Installation services and supersedes all prior discussions and agreements,either
eral or written,rciating tri said Products and Installation.This Agn:cment cr:nnot he assigned or amaidoci cxcept by a writing signed
by Customer and The Home Depot. Customer acknowledges and agrees that er has read,understands.voluntarily accepts the
terms of and has feccived a copy of this.Agreement.
Accept by: Su 't y: r ` i
X 44 Ok B /J-(r—tSr X IU 1
i w Date Sn=cphe Itant's Sinarure Date
X o.
Customer's Sianalurc Dal Sale.,;Consultant License loo.
CANCELLATION: CUSTOMER MAY CANCEL THIS
AGREEMFNT WITHOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE HOME 3al 1
DEPOT BY MIDNIGHT ON THE THIRD BUSINFSS
DAY AFTER SIGNING THIS AGREEMENT. THE
STATE SUPPLEMENT ATTACHED HERETO
CONTAINS A FORM 1'0 USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
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:
The debris will be transported by: l✓�' �' �'`�`
by:
The debris will be re ceived
Building permit number:
j, 2-b
2-b
Name of Permit Applicant
10 . 7-
Date Sign-ature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
t 1 Congress Street,Suite 100
Boston,M.A 02114-2017
_ www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERAff=G AUTHORITY.
ADDUcant Information Please Print Legibly
Name(Business/Organization/Individual): � � /A!// ' t
Address: L" ;� A' �`
City/State/Zip:,//! ��� Phone E:
Are you an employer?Check the appropriate box: Type of project(required):
L�I am a employer with employees(full andior part-time).' 7. ❑New construction
2.❑t am a sole proprietor or nzmerhip and have no employees wor}ring for me in g. Remodeling
any capacity.[No worker'comp.insurance required.]
9. Demolition
3.0[an a homeowner doing all wo.'r m sc'f.[moo worker'comp.insurance rrequired]t
❑
10 Q Building addition
4.❑I am a homeowner and will be hiring contractors to conduct ail work on my property. I will
ensure that all connector either have worker'comocn;atioa insurance or are sole 11.❑Electrical repairs or additions
or*srietots•pith no employees.
12.0 Plumbing repairs or additions
S.�am a general conractor and I have hir-.d the sub-contractors listed on the z inched sheer 13.❑Roof repair
Toesc suo-coocactors have employees and have workers'comp.insurance.:
6 e are a corporation and its o.ucers have exercised their right of exemption per NMGL c. 14. Other
.�
jS
152,§1(4),and we have no employees.[No workers'coma.insuraa-ce mad-d.3
'A ny applicant that checks box#1 must also fill out the section below sbowing heir wor:ers'compensation policy information.
i Homeowners who submit tnis affidavit indicating they are doing all wor::and hen hr a outside connectors must submit a new affidavit indicating such.
,Contators that check this box mist attached an additional sheet showing tae rame of ae stircnnuactor and state whether or not those entities It ve
employees. If the sub-contractor have employees,they must provide the;: worae:�'comp.policy number.
I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ��� / ✓ j` �,/ ��t— �° " � �.
r f / ) ^/
Policy�or Self-ins.Lie.r: �/L�- Expiration Date:D ( � p
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(shorting 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
anAl or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine 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 ce�rii� and naltie erjury that the information provided above is true and correct
Sisnahtre/ Date:
Phone#
Official use only. Do not write in this area,to be completed by city or town offcciaL
City or Town: Permit/Ucense r
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Citv/Tovvn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
I
Contact Person- Phone
i
I
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable £
Name of License Holder: �11 C 71 2—'l
License Number
r
Address Expiration Date
iV6?27-rn11J1>
Signature Telephone
9 Re4istered Homeam roverrient Contractor _t Not A plicab
Company Name Registrati n Number
Address Expiration 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 building_pemit.
Signed Affidavit Attached Yes... 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 lan4 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 fdrin 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 pen-nit 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 Massachusttts 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.
i
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [] Addition Replacement W' ows Alterations) Roofing
or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks [p Siding[0] Other[0]
Brief Description of r ose L-, t� / J V 0
Work: �" �` /
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa if New house.and or.adtlit on to'exlsfinq.houslnq; complete the&1-f6 Ilih
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, 8 � 0 L-- as Owner of the subject
property n
hereby authorize _
to act.on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I U�-J'pw-p ��J04- , 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 t ains Fd penalties of per.
Print Name
{ l
Signa a of Owner/Agent Date
�
'
Section 4. ZONING All Information Must Be Completed.�Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This colurmi to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Rear
Building Height
Bldg.Square Footage 01�0
Open Space Footage %
(Lot area minus bldg&paved
#of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO '0 DON7 KNOW 0 YES 0
IF YES, date issued:F-=
IF YES: Was the permit recorded at the Registry Of Deeds?
and/or Document#
IF YES: enter Book Page
�� �� ��
B. Do�t���c�t�nabmo� ���wm�rorw�\�d� NO �� DON7 KN0Y �� YES ��
IF YES, has permit been or need to be obtained from the Conservation Commission?
Needs� beo�aned �� O�� �� �� b�e '
. �"� .~� �~� ' ..
|
C. Do any signs exist on the property? YES 0� NO 0
IF YES, describe size, type and location:
D. Are there proposed changes dditi 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading. vation.or filling)over 1 acre orind part ofo common plan
' that will disturb over 1acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required. |
i
/ |
i | !
YI�+IY,iryF�L�,+�fm�"City of Northampton .1y -W rBuilding Department 7 d PF a,! ( 7 //V'
o-+.!
212 Main Street SewerlSepttcAvaifabllity ~L u14rz
Room 100 Vlfater/VeltAvailabilFty' Y „
+i3
A�rrc=nu;�clr,ca;r+ - Northampton MA 01060 TwaiSe#s ofStructuraiPurrs
N06THAMFMN M1 i r 3 I�v r a M
pk�®ne 413-587-1240 Fax 413-587-1272 P1oJSFfe Plans € �n f i'I L�'�'�r�;F t is
ti w x r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This,secfiorr to be completed by gffice `,
1.1 Property Address: 22 r r..
r
r Map Lot Unit
--
1� �v �
1Zone ��'- ! � Overlay Dtstricf
_
SECTION 2. PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name rint Current Mailing Address:
Telephone
Signature
2.2 Authortzed ent:
Name(Pr' Current Mailing Address:
�'vl � -
all ture Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS. .
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (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 7 0
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissionedlnspector.of Buildings: Date
105 PINES EDGE DR BP-2016-0809
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18 -002 CITY OF NORTHAMPTON
Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateizory: Windows replaced BUILDING PERMIT
Permit 4 BP-2016-0809
Project 4 JS-2016-001362
Est. Cost: $40.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 67121
Lot Size(sq. ft.): Owner: MESSIER KATHRYN G
zonin"': Applicant: HOME DEPOT AT HOME SERVICES
AT. 105 PINES EDGE DR
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROVIDENCER102908 ISSUED ON.1211712015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 3 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 Sisnature:
FeeType: Date Paid: Amount:
Building 12/17/2015 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner