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25A-083 (4) 15 COOLIDGE AVE BP-2016-1051 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A-083 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1051 Project# JS-2016-001780 Est. Cost: $23998.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MORGAN HOME IMPROVEMENT INC 105987 Lot Size(sq. ft.): 12501.72 Owner: NETTO MICHAEL J&LINDA L Zoning: URB(100) Applicant: MORGAN HOME IMPROVEMENT INC AT. 15 COOLIDGE AVE Applicant Address: Phone: Insurance: 54 RACIOT AVE (800) 354-7660 WC WEBSTERMA01570 ISSUED ON:2/29/2016 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 2/29/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner E _Ei\�ju rfinV 66....E '1!! ll�No hamptonPe �..-. ,_5.i ;P=ji= l^I.�gy ,:a: " --._ .v:v: :itr—::; . f�{a:uviel:l A:i,�_i..::F�..l--:FEB 2 Q g D partment ;Club Cur/Driyeiay PemMaiStreet00 100 UV .�EF pto , MA 01060 Two-ySefesafStrtt�ctr,Fai Fiarrs r iJg, a94T � y" .:;, , p - .4 Fax 413-587-1272 P[of/Slte Plans _'17F,! '�` , ' I r h ' J il,,. - II L 1 '- I + 5 I 11'I -1 i' J( �. -L 1,Ill lC 1 .is Other Speclf� FI P �� Ylrr t�I --_:..__...�L:a:.-=.._::.::..::...___..._.._...m_- .r; .�ssr �'r'.�:;;t=;rc_ .c;,,tsr,_s.=. APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION This section f be complefetl by office _ 1.1 Property Address: a r C a0L t �f b 9 vc umt IVIa L } 0/060 Zq�e Overlay Drsfrtct EIrtSt DletnctTt r w ' SECTION 2.=PROPERTY OWNERSHIP/AUTHORIZED.AGEN:T�- ' 2.1 Owner of Record: y0277jlyh7aj O✓Ari Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: \ \ 3 Soli �OLl:.r(n-;-f-J Name Z Current Mailing Address: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only com leted by permit applicant 1. Building ,Zs (a).Building Permit Fee'95 � , 2. Electrical .(b)Estimated Tota i Cost of Construction from fi 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number 42 This-Section For Official use'Only Date Building Permit Number: Issued: Signature: Building Commissioner/lnspector'of Buildings: Date ~ , � Section 4. ZONING AR Information Must Be Completed, Permit Can Be Denied Due To incomplete Information Existing Proposed Required by Zoning THs colunin to be filled in by Building Department Lot Size Frontage L Setbacks Front Rear Building Height Bldg. Square Footage YO Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has aiPerm it/Variance/Rriding ever been issued for/on the site? x-� x—� NO �- DON7KNOYY �~� YES \�� |FYES, date issued: IF YES: Was the permit recorded atthe Registry ofDeeds? / NO 0 DONlKMuYY YES ' IF YES: enter Book Page,, and/or Document# �� B. Does the site contain a brook, body ofvvaterorwetlands? NO ^��y DON7KNO�/ ��/ YES IF YES, has permit been or need to be obtained from the Conservation Commission? r—\ �-\ Needs to be obtained �~� Obtained �^� , Date Issued: �~� APSC. Doany dgnsexist on the property? YES ��/ NO \�y IF YES, describe size, type and location: D. Are there any proposed changestooraddidonsuf signs intended for the property 7 YES 0 NO IF YES, describe size' type and location: j E. Will the construction activity disturb(clearing, gradin avaUon.orfiUing)over 1acre orisitpart ofacommon plan (hn��U)dia�urbnver1m�e7 YES [ } NO � � ' ^�/ IF YES,then a Northampton Storm Water Management Permit from the DPW is required. � | . � ' | � F CTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition 0 New Signs [0] Decks [M Siding [0] Other[0] Brief Descr!ptign of Proposed Work: RC-f tb •v�r�4� s ;c��ct-� ���= JJy; i /!� c kMfi,, Nam PL41 A141, tUZ'-e 'y2 b 4i' youy, Alteration of existing bedroom Yes No Adding new bedroom Yes No `tgAF Attached Narrative Renovating unfinished basement Yes No co e_0 Plans Attached Roll -Sheet sa. if New,house and'_or:atldltlon#o existtn 'trousln' coni fete Elie followin`" 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 I 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, ('c-0 J,,pA 1?57J as Owner/Authorized Agent hereby declare thafThe statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the ains andpenalties of perjury. Print Name h � � Signature of Owner/Agent Date SECTION 87 CONSTRUCTION SERVICES 7 8.1 Licensed Construction SupervisoNot Applicable £ p Name of License Holder: /n� 9� /�1�7�( � 7n/dam' -�� l Q t(, - fob r License Number �y ( .9ci0 d(A- i�lt 3frr�l 9 d tali evr? Address Expiratio Da(e Sig ature Telephone 9 Regisfered Home lmproveme t.Confr3ctbe _t ;_ _.. _: __...�_ ._.. Not Applicable £ ly7L9 le b 4A) Company Name Registration Number Address Expiration Date oo 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 permit. Signed Affidavit Attached Yes....... £ No...... £ 11 Home Qwner 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 i 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, I The Commonwealth of Massachusetts Department of Industrial Accidents i� Office of K. Investigations x 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /Y)d-�ZJ,3,1.j 140r.176- Address: 4piri6-Address: Ao ( So07-1Y ZtZXGc t�� City/State/Zip: A), Phone #: -34--. `- `7C,G Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 3 4. F-� I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑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• Demolition working for mein any caPacitY• employees and have workers' 9. ❑Building addition [No workers' comp, insurance comp. insurance.$ required.] 5. F� We are:a corporation and its 10.0 Electrical repairs or additions 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 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.g Other Za- )&FA/I/4 L 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. $Contractors 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: C/-(A,ZN IA K- 1A),r0R­ZVL , b&Vc- LAIC, Policy#or Self-ins.Lic. #: (v JYU lK F)::,(f S©7-r q/ Expiration Date: Z,1/3l 7 Job Site Address: /S C grLi�(,C At, , City/State/Zip: NOIZT�(Io,7 0,00 ^1 0)M O 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 nder the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#• tqco 3VY- 76(1 U 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/Towu Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ��. City of Northampton k Massachusetts r , 1 DEPARTMENT OF BUILDING INSPECTIONS �* 212 Main Street • Municipal Building Jj. fib' Northampton, MA 01060 ss' ..���. INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT F e State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her struction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which she resides or intends to be, a one or two family dwelling, attached or detached structures essory 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." 1 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 Iunderstand 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 I' i 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: fS eo(p(-- Ac�E �r r �•����J; The debris will be transported by: OT-1 Hg0L The debris will be received by: (.x.59 Building permit number.- Name umber:Name of Permit Applicant Inoy4A) tea<�c i,"���v ?c,� Date Signature of Permit Applicant Year House Built ° �� PEOPLES PRODUCTS, INC, lesProductswindows.com W � ! � www.PeoplesProductswindows.com OF THE HR40 WINDOP www.HR40.com 252 Hartford Avenue MASSACHUSETTS AGREEMENT Newington,CT 06111 tem a{ CT Lic#532341•MA Lic#158194 //, Thousands of Satisfied Cus/tome�r�s./! 1-aoo-3 - 660 NAME:// j/ ''� PHONE�H)1%�� J4 1 -L�DATE: /e n' /Ci (w) The undersigned Contractor agrees to furnish all material and/or labor necessary for the work(specified b*f;ZF cated at No. city�lCiL�.�'✓�W71 State Cl.� ecifications of Work: `/°C { , ,/ CIIs rice D it f 1C7c� f�1 �_ /- P •Installaff n I ti 5 ry���y able on Com ton S z gems cr} Bala Financed 5 i Total w f� 'L 4 an amount financed,finance charges Specifications of Materials:(type,brand,grad L. I are disclosed in flnanc ing documents or / •✓i - n � r ❑YES ❑NO I would like to receive product updates and specials via email. emailadd4 Reconnecting of alarms,painting or staining is buyers responsibility, Start Date: Completion Date: Contractor Service Guar�rftee .. 1 Year Manufacturer Warranty Coverage. . . . . . . . . —Year(s) It is further agreed that performance of this Agreement is subject to labor strikes,fires,wars,acts of God,ability to obtain material or k%orkforce and to any other circumstances not reasonabh,within the control of the Contractor. It is further agreed that this Agreement contains the entire agreement of the parties;that all prior negotiations,agreements and understandings have been merged in or superseded by this Agreement and that no representations,warranties or understandings of ny kindl be binding on either party unless incorpglrated in writing in this A n NOTICE: HOLDER OF IS CONSUMER CREDIT CO TRACT 1 DEFENSES WHICH 7HE DEB COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WITH THE PROCEEDS HEREOF,RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. al , f/ Dated at al ,his /ei day of 0 BY 0/,- 7 11 fly uthort j Owner Salesperson's Name:- / '-Z'/� joint Owner Required Permits The following buidling permits are required. It is the obligation of Contractor to secure such permits as Owner's agent: (List required permits) NOTE:Owners who secure their own permits ordeal with unregistered contractors are excluded from the Guaranty Fund provisions of MGL c.142A