12C-039 41 STERLING RD BP-2016-1309
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-039 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoa: windows replaced BUILDING PERMIT
Permit# BP-2016-1309
Project# JS-2016-002256
Est. Cost: $4100.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LOWE'S 049918
Lot Size(sq. ft.): 15681.60 Owner: WEBSTER DANIEL W&RUTH A
zoning:RI(100)/URA(100)/WSP(Ioo) Applicant. LOWE'S
AT.- 41 STERLING RD
Applicant Address: Phone: Insurance:
282 RUSSELL ST (413) 588-0270 WC
HADLEYMA01035 ISSUED ON:5/10/2016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 8 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 SiLynature:
FeeType: Date Paid: Amount:
Building 5/10/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
MAY 212 Main Street
f''1J
�.`` "' Sewer/Septic Availability
Room 100 Water/Well Availability
DEFT.
OF BUILDING orthampton, MA 01060 Two Sets of Structural Plans
NCRT�MPTON MA01� e 13-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
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
Ll I//yy�- ( r� Map Lot Unit
f-to�"rJ•�''C_ d Ub FJ'� Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: la
VIA
ame( nnt) A Current Mailing Address: —
✓t �fiC.� Telephone
Signature (4/
•��® "
2.2 Authorized Agent: �✓�" Vue-f 'ili
-��- v
� j
Name.(Pfiht) Curre Mailing Address.
nat Telephone
S TION 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
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 +3+4 +5) Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings 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 tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 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 Q DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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 O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacemenLAMndows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs or, Decks [Q Siding [p] Other[p]
Brief Reacriotion of Pro ose t
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the followina:
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 p r application.
Signature of Owner Da e
I° as Owner/Authorized
Agen her are that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belie
Signed under the pains and penalties of perjury.
Prin ame
r G�
ign ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:—r �/ \�.� ��W C��" 04��\�
License Nuer
v 13 0110 em R (o
Address Expiration Da e
' l()ature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registratio pNu ber
ddressa-
Expiratio Dat
Telephone
e��a
e
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 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 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
The Commonwealth of Massachusetts
Department of Industrial A ccidents
Office of Investigations
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Indi vidual):_ 'Volooni
Address: 15 ':3 b s,- ��) 9R,
City/State/Zip" O1UbZ Phone
Are ou an employer? Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors ❑New construction
2.❑ 1 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 me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its I0.❑ 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.Q Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13. ] Other - �J-(
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 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.
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: ca
Policy#or Self-ins. Lic. #: A1_V_,-o`100"7009%0((0k 75A0 I$ Expiration Date: SIM,
Job Site Address:Ll i %W4w-r &--�1Z0 City/State/Zip: �.' 01060
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. e advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance verage ver' cation.
I do hereby certify under pa' s nd penalt' of perjury that the information provided abovej�J ue and correct.
Si gnatut4 Date: 5A 11Z
Phone#: - 6 0 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#:
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: �it SZ— r 124) 'T, 010
The debris will be transported by: �T" ,1-F
The debris will be received by: " �'' PaPA-MAPA- YA 1207ZST
Building permit number: sops—gf Iu3
Name of Permit Applicant r �
Date Signature of Permit Applicant
• ® [CoNZcT# 0 0 0 9 7 3"
MASSACHUSETTS SERVICES SOLUTIONS INSTALLED SALES CONTRACT
LOWES AUTHORIZED REPRESENTATIVE NUMBER CUSTOMER
STORE NO STi5iET ADDRESS STREET ADDRESS `
CIN STATE ZIP CIN STATE ZIP
TELEPHONE TELEPHONE
DATE LOWE'S HOME CENTERS,LLC'S MA HIC NO.:148688 CASH MNO LCC CHREG
ARGE
FEIN:56-0748358 F7 � :�x-
This is only a quote for the merchandise and services printed below.This becomes an agreement upon payment Upon payment the entire agreement,including the specifically completed pages of this
document,the Terms and Conditions included with this document and any other addenda and attachments hareb,shall be nNerred to herein:wthis"Contract."
PLEASE READ ALL TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE.SIGNING.
INSTALLATION STREET ADDRESS CITY STATE ZIP
t
:.d
fJ4r
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NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to properly perform the installation of certain Goods,the Contract Price may include more
Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price
stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual
square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste).
By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may
not be refunded once the Installation Services are performed.
Contract Total '
Are permits required for this installation?:[c-4-Yes [ ]No *applicable tax included
NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract,Customer
acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure
from renovation activity to be performed in Customer's dwelling unit.
NOTE:If rotted wood is discovered during installation additional charges will apply.You will be given a quote qnd a change order
must be completed and signed by the customer for any additional charges. 4V4>' Customer must initial. A
'Any work or material not specified is not included in this contract.Any changes or additions will be at an additional charge for the material and labor.
PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where
Installation Services will be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and
interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the
photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purposerglClyding,but not limited to,marketing,
advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoing. ' Vit' [Customer to initial to the left].
Work is to commence upon reasonable availability of Contractor and/or any special order o qcu tomer made Good(s)which is anticipated to be
[fill in date].Estimated completion date is [fill in date].
Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial
completion date is as follows:
(if applicable,insert a statement of such contingencies).
IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full.
COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00:
[ .]customer to Pay in Full; OR [ ]Customer to use the following payment schedule:
(1)Deposit $ to be paid upon signing contract.Deposit should be 1/3 the total contract price;and
(2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's
to do one of the following(check appropriate box below):
[ )Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed;
or
[ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and
(3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction.
NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A
LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT
LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT-
IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION
AS PROVJDEDAN M.G.L.c.142A.
By: Date:
Lowes Rome Centers,LLC
B 71 -, _ate:
=;r Signature
THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED
BY LOWE'S PURSUANT TO M.G.L.c.142A.THE OWNER MAYBE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE
SECTION ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND
CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.
BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE
TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS
CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE.
WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS DAY OF
Lowe_i's_Home'Centers,LLC
Lowe's Authonzed a resentative er Co-owner or Witness
Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof.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.
55102 REV. 12/13
Flll°G COPY 0 2004 by,Lowe's.®Lowe's and the gable design
re
aregistered trademarks of LF Corporetion.