38B-002 (16) 24-25 PAQUETTEAVE BP-2006-0644
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-002 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: windows replaced BUILDING PERMIT
Permit# BP-2006-0644
Project# JS-2006-0945
Est. Cost: $8679.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 106722.00 Owner: WALLACE GgRARD R&JEAN M
Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES
AT. 24-25 PAQUETTE AVE
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON.12/13/2205 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:
FeeType: Date Paid: Amount:
Building 12/13/2005 0:00:00 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
City of Northampton .Pegnt
6
Building Department ,
212 Main Street S e E
Room 100 ` yell t
Northampton; MA 01060 vu etso�S3ran �� x
phone 413:587-1240 Fax 413-587-1272ON
Poslt�'tan
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
Thrs sectron to 6e completed lay office
b x
Mapp Lot" Unit
a ya S P�L4ek Rx- Zone Overlay Distract
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Punt) (Current Mailing Add re s:
qI?��`3
Telephone
Signature
2.2 Authorized Agent:
e1' 3(/-�- 3
Nam (Print) Current Mailing Address:
= �33
nature Telephone
SECTION 3-ESTIMATED"CONSTRUCTION COSTS
Item - Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total,Cost of
Construction,from 6
3. Plumbing Building,Permit Fee *5x��
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) CheckNumber
This'SectiomFor Official Use Only
2ite
D
Building Permit Number. [sot ed:
Signature: r
i
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Informatibh 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
Lot Size -–
Frontage
Setbacks Front i
Side L: R. L:' Ra
Rear
Building Height
Bldg.Square Footage % _—
Open Space Footage % --� j
(Lot area minus bldg&paved I
azlcin
7-;
#of Parking Spaces
r
Fill:
(volume-&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
N0 0 DONT KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES 0
IF YES: enter Book Page; and/or Document#:
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES I0 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? YESQ r NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check alF appwicablel
New House ❑ Addition ❑:, Replacement Windows Alterations) ❑ Roofing ❑
Or Doors ME
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[O] Other[I3]
Brief Description of Proposed �.-{y� .♦-
Work: h a� a�1�I/a
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa`-�f New=hotise an a dd tWhA is-fiff4boW02"t ft oi(aur�x u:
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--TO1 BE COMPLETED WiEN
OWNERS AGENT OR CONT:RAETOR APPLIES FOR BUILDING-PE MIT +
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.
Signature of Owner Date
I, ILI (�.t,'1 C�"l! {`�'l Icy)`'C 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 Na e
c a
Sig=re of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES „
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
R istra on jNu—m e-r
CompanyName �
Addressj Expiration Date
y 1 4NI- Lo k�6i--Telephone 61
SECTION 10-WORKERS'COMPENSATION INSURANCE' - IETAVFi"(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...... ❑
Mm
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
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i
1
A Crif trf �\TcrIrflIzalli 31011
4 £ .51:stwchnsctIs' _
DEPAR ME1-Fr OP BUIL.Dr,\1C INSPECTION'S
212 Alain Strect ' rlunicipal DuRdin
Northampton, ATass. 01060
\VORCEIZ'S CO'i IUENSA'TO.NMSURA..NCE A=1 A-V"IT
( c
(11 ccn.s�.lpermi tfcc)
%virh a .prisrcipal plat-- of businessfresidence at: -- --
"q,&2'7 OK.��ch1.�l `Srt � Q!! gaZ(phone-')
I (SCi=uci ty/stauln P3
I do hereby certify, under Clic.pains and penalties of perjury, hal
(warn an employer providing the follone'Nvorkcr`s comc)cnsZ:J*on cover^-- for inti,
etnplovecs v.,orlong on L u's job:
i
f
Q.amr-n= C rte ) (P0Ucr K. r) (r=;gtr• o Das}
{ ) I am a sole propr;etor, general contractor or homeov' Irmer (circ:e one) and have hired
Lhe contractors listed below c-rbo have the folio V'mS worlkees compen_taison pokiest
(i+1117^
Of CO:'.`_:-FciGr) (1nslrancz Co117rpanTPI Gbc-, D.-Itc)
1
(Nzc of Concr3aor) (Insaranc: ComDaz-v/Pollc-v Num -Cr) (-Expirrion Date) -
(Name oC Connaclo;) (LISurancr- Coznllany/PoUcy Numbzu) (Espimdon Dam)
(Name of Contractor) (Laairanm Compaay/:Policy Numb-:s) (-Htpirdon Datc).
{aui:�t:d.�ocii c'�cc,if accczer-,xo c>�ud~iararty.-i oa pc-via�ns w.11 Dote-.r�;�)
( ) I am a sole proprietor and have no one worL-,Log for me-
{ ) I am.a home owner performing all Lbe work myself.
NOTE:ply..be 1tr 0-*-,t ,Jc hcmCO-'D=uiao captcry pct-.oax so dz rcpair-Ork m.d-, Is,:�of
not txra:tb.:n t
-1 in Winch the bomoowvd raid.cx cc 1E..U uz zr"'Pvrtca='�.2be�a c.:ax C=,-Uy oec-:d.-oi to l c
pio c-vnc a the a=p_,=tioa Ac:(GUI 51�1(5)�:.appUcttioo by a bomco-=fc x!i�^v a'pe^mit n:_y-id—the
1eg.I--anti of ca ca=Play,uodcr dsa Woh ,Cacpam,s ion Ac;_
I vndca�„od t >oopy of tbi. m y bo foc-.ded b fibs r,}cpanmecit of I.oeSszric!lv.+ 6.=Y Olm-of taaa- foe tb-
cov—cc—iLc%ioc and th:.t L-J=:to tc=rc'co%—Cc tarda socxioa 23 A or MOL 152 cau lmd to the i=1Ptaa6oa of criminal pcz-tW<=
a—s.iaa of a tint of up to S I-S00.00--Afor or up to oac yc-.r L'ad cvi}pmxhic ig 6c fcwm or.S1cp Work Ord--Lod a
fl=of s 100.00 t day t
PC-= NumL--T —
x7t afLir�c IPcrmiuc e
ts !
¢TtSAMPl.
,.(rztg of 'Northalliptan
Z
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DEPARTMENT OF BUILDING INSPECTIONS
`S
INSPECTOR 2112 Main Street O Municiral Building
Northampton, MA 01460
,r
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 78OCMR 108.3.4 to
act as his/her construction sup<:r .,•isor. The state defines "Homeowner" as, "Terson(s)
who owns a parcel on which he/she resides or intends to be, a di eortW6 farru�-__
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 buil&ng department for-the City of Northampton wants-any person(s)-who-seek to
use the home owner exemption, to act as their oven 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)
I will call to schedule all required building inspections necessary for the building permit
issued-to me
Date
Address of work
location
f
I
Sold,Furnished and Installed by:
Branch Name. Date: _ THD At-Home Services,Inc.
d/b/a The Home Depot At-Home Services
945A Greenwood Street,Worcester,MA 01607
Branch Number: Job#: ` Toll Free(800)657-5182; Fax:508-756-2859
Pedant ID#75-2698460 ME'Lic#C 02439 RI Cont.Lich 16427
CT Lich 65522: MA Horne Impmvvmeut Contractor Rey#126893
Installation Address:
N>ac� W'
ta_)fq t ti a,_� R,F_A l-s kA 4a Ai.xl__,CityStale Zip
Parchaser s: Lot 4 Di is of Driver's Lk,-#&Rap.MlYr' Work I'honc: Home PMse:
Home Address:
(If different from Installation Address) City State Zip
P t[ r r : 1/We/You("Purchaser'% the owners of the property located at the above installation address,offer to
contract with Home epot U.S.A.,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as
described on the attached Spec Sheet I{:k_),2.44&x � ,incorporated herein by reference and made a part hereof.
4� ;:1.44n x,53
Home Depot reserves the right to cancel this contract If,upon re-inspection of the job,Home Depot determiner:that it
cannot perform its obligatiolts due to a structural problem with the home or because work required to complete the jab
war,not included in the contract.
.D1IfrOSIT..PAYMENT OPTIONS
^ (Subject to fund vedfrcation and/or ciedit approval
U. L Cheek,CwbicnCheokor US?odml$ecvict Mon yOnier
CONTRACT AMOUNT S (Made payable no The liome Depot).
*LESS DEPOSIT S �� 3 2. CmdilCard'anorotherpeymuloptions•CirclaOmBelow
^1
Visa etCud iscover American 6xprow
BALANCE DUE n
ON COMPLETION The Home Depot Hake Improverrc
rat Loan The Home Depot Credit Card
;.tll4+ !r9*NtA ._ al?9lSli
Mlnirnuto 2s is atComrset Arnotmtdao upon exeoatfoti' joW.Sg�,3)4
htscontract. BxP.Due:
ft
Name w it appears os card:Indicate Payment Payment Method For *By mylour sfanaturo below,Ilwe agree toallow Hou*Depot to charge the Above
BALANCE DUE ON COMPLETION: le forth.deporit,ndicsred.— �)
5'fJ tJ ?� OOG?J 18 3' tO Cardfioldtir's Sign-Iwo - Dam
0-7 or HDCC Authori2AHou Codes
�OE�- #
Purchaser agrees that,immediately upon satisfactory completion of the work.Purchaser will execute a Completion Certificate
and pay any balance due. Purchaser also agrees to bejointly and severally obligated and liable hereunder.
Entir men :This agreement and its attachments,including any financing agreement,contain the complete agreement
between t e parties and can not be amended or modified unless in writing m a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before you read It You are entitled to a completely fillsid-In copy of the contract at the time you sign. Keep
it to protect your rights. Do net sign anyy Completion Certificate or agreement Plating that you ata satisfied with the entire project
before this project is complete. Law protribits home repay contractors from requesting or accepting a Completion Certificate signed
by the owner prior to the actual completion of the work to be performed under the eonlract.
You may cancel this transaction at any time prior to midnight of the third business day eller the date of this contract. See Notice of
Cancellation for an explaaatton of this right. There will be a service charge equal to 25% of the contract amount if the job is
cancelled by Purchase,AFTER the third business day.
HY MY/OUR SIGNATURE BELOW,IAVE AGREE TO BE BOUND BY THE TERMS OF PHIS CONTRACT. VWE ACKNOWL.F.DGE,
RECEIPT OFA COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION.
BY MY/OUR SIGNATURE BELOW, 1/WE UNDERSTAND THAT 'THE AGREEMENT IS SUBJECT 'TO REVIEW OF MY/OUR
CREDIT HISTORY AND YWE AUTHORIZE HOME DEPOT AUTHORIZED oomTRACTOR.TO VERIFY AND REVIEW MY/AUR
CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE'I'HEM FROM ALL LIABILITY
fNCURRcD FROM INADVERTENT OMISSIONSOR ERRORS. DO NOT SIGN!THIS CONTRACT IFTHERE ARE ANY BLANK
SPACES.
''''��' t� '��k l�- • u3'o�
SUBMITTED BY:
Cons ir'1 t >3 ,dj
'ACCEPTED HY-�� _ Da:e F/" 4/7-
-` F:omeowner
Date:
• Horneowaer
NOTICE:ADDITIONAL TERMS,COND1T IONS AND M'ARRAP[TIES ARE STATED ON THE REVERSE SIDE AND ARL'PART OF THIS CONTRACT
0.'hira-Brarxh Pile Yella.+-tVeomar Pinl-Sala Consulusr
5-17-05 C-SC
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