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36-184 (7)
908 BURTS PIT RD BP-2016-1326 GIS#: COMMONWEALTH OF MASSACHUSETTS MM Block: 36- 184 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2016-1326 Project# JS-2016-002290 Est. Cost: $6076.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 082485 Lot Size(sq. ft.): 258746.40 Owner: DOLE CHARLES S&ELINOR L Zoning: Applicant: HOME DEPOT AT HOME SERVICES AT. 908 BURTS PIT RD Applicant Address: Phone: Insurance: 5 RIVERVIEW DR (401)935-2633 O Workers Compensation NORTH PROVIDENCER102904 ISSUED ON.5113/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 9 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 Siznature: FeeType: Date Paid: Amount: Building 5/13/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner iJ. Department use only r ity f Northampton Status of Permit. . MAY 6 r uil ng Department Curb Cut/Driveway Permit 21 Main Street Sewer/Sep tic Availability pEprOFT MA0100 proN oom 100 Water/WeII'Mailability woRlw� Northampton, MA 01060 TWO.Sets of Structural Plans phone 413-587-1240 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 This section to be completed by office 1.1 Property Address: Map Lot Unit Q� rF Zone Overlay District q Elm St.District CB;'District- SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C wa.f.,g fir- M Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized ent: 0--,► � Name( ri Current Mailing Address: Signafure 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 4. Mechanical (HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date .1 f' Y Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Iniiimplete Informatign Existing Proposed Required by Zoning This column t'be filled in b Building Department 4 _.._ 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) m _.. ..._. ...... .__....„ __..,._, .._. _ ...... . ... .:.. A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES 0 IF YES, date issued:, ............_._._......_................... i IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW Q YES 0 IF YES: enter Book Pageand/or Document#' B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , 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 0 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 0 NO 0 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 ❑ Replacement VVWows Alteration(s) Roofing I Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[O] Other[O] Brief Description of Pro Work: l'V 21- 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 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 as Owner of the subject property hereby authorizeir/�1J to act on my behalf, in 911 matters relative t work authorized by this building permit application. Signature of Owner Date 1� f I, 1 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 and r the qqns and penalties erjury. Print N e ' —)t46 gen nature of Owner/ADate / SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suoervisor: Not Applicable £ Name of License Holder: � r4�v�� License Numb Address ? � Expiration Date Signature Telephone ,� 9-Registered Home Im'rove ent Contractor: rte,,,..- Not Applicable £ Company Nai � Registration Number �rw 6 Expiration Date Telephon4o)�2 _ 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 buildi rmit. Signed Affidavit Attached Yes...I. £ No...... £ 11. Home 0wherll. -Home Exemption) The current exemption for"homeowners"was extended to include Owner-occupiedOwner-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 theresponsible for all such work under the buildin��ermit 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 Comm-onweafth of Massachuse& Department ofInduytrialAeddents Office of Invesfigafiom I Congress S&ee4 Safte 100 Boston,MA 02114-2017 urwiv.mass.govIdia Workers'Compensation Insurance Affidavit:Buffders/Contractors/FIectricians/Plumbers Applicant lhformalion Please Print Le 'b Name(Business/Cq-ganizadonadMdual): 9C-1171-I& �a J Address: qQ 712 City/State/K'p 6 A-0- 01,515 Phone#: 57r0- 4?b.9 6, Ara you an employer?Check the a# ropriate box: Type of project(required): i-El I am a employer with 4. 1 am a general contractor and I 6. F-1 New construction employees (full md/or part-time).* have hired the sub-contractors 2.F1 1 am a sole proprietor or partner- listed on the attached sheet. 7. 7 Remodeling ship and have no employees These sub-contractors have 8. EJ Demolition workingfor me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp.insurance comp.insur=0 rtmuked-] 5- We are a corporation and its 1 O.M Electrical repairs or additions 3.El 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 Rreplurs f - I Yo insurance required.]t c. 152,§1(4),and we have no employees. (No workers' 13. tier comp.insurance required.] ``Any applicant that checks bon#I MUSt also fill out the section below showing their workers'compensation policy infi3nuation. t Homeowners who submitthis affidavit indicating they are doing all work and thea hire outside contractors must submit anew affidavit indicating such. lContractors that check this box must attubcd an additional sheet showing the name of the sub-cordructurs and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I arra an employer that is providing workers'compensation bun7wicefor my employees. Below Is the policy andjob site infornration. Insurance Company Name: —,5 klgl-j / 6W445 - ;j'77 Policy#or Self-itis,Lic. : Exph:adon Date: Job Site Address: City/State/Zip: w tion daft Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp tion date). Failure to secure coverage as required under Section 25A of M(3L 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 time 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. der to pains p Ido hereby clerq% ��n)�, �Of, erfury that the informadon provided above is true and correct Signature: Date: Phone 9 Official use only. Do not write in this areag to be completed b, .1 city or town ofjklal. City or Town: Permit/License Issuing Authority(circle one). I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person; Phone ff: Simonson Windows _65f0G `vantanl;pointe L cu ,-;t~ ass croon Lo, No Larninaled Class ';lit{:h vi ds en�zi ;—edbol-guiPoma-4rr?I!o-3.'3 rnm vidrio-Argon Lc.-t Sin `�' :id-C laminado Can rejlllas CPD.SBP-A-44-2,042-00002 07-75 DH ENERGY PERFORMANCE RATINGS EVALUACION Dc RENDIMIENTO ENERGETICO U=act r SalarHeat Gain Coeacient 0.20 1 .66 :, 0.24 ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEIVIENTARIA DE RENDIMIENTO Visible Transmittance 0.45 Unit qualifies for ENERGY STAR(®ion(s):Nari<:ern. `! North Central,South Central, fyf .:;zfJ.V •. Sout.ern. STC.29 rr fi�t•flC4: IND:Rain 00/Glass ProSalar/H-LC25 DP-.+25/-25 Tested Size:48"x 80" Ronda Product Aaor ova:'FL5167 Appticabie Test Standardisy ANSI/AAMA/NVVVVDA 101A.S_2-97,AA1 iAMIDMAICSA 101A.S.2/A440-05,AAMAIvVDMAfCSA 10 A.S.2/A44M8, A440S t-09 Canadian Supp! 8858790./01 a0333 HS Howard 6400094A 5.*1..r'•V:-�':... ....-i:� .�.vG.78 SSI•-J, .-...»..CO: :��3 p.2 May©416 05-.52a HOME IMPROVEM ENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by; Branch Name:NewEngland DatcdJi—t&" THD At-Home Services,Inc, djVa The Home Depot At-Home Services Brunch Number.33 909 Boston Turnpike,Unit 1,Shrewsbury,IVIA OW* Toil Free V7-903-3768 Federal ID#75-1698460;ME Liu 9 C.',,2434;RI Cont.JO 16427 V,Lie 4 CD56i522THome Iplovement Cow A m actor P cg.#126893 I . Installation Address: Fh MUoeUawtoka� City State 11) Work Phone: Home Phone: Cell Phone. Home Address- (if different from installation Address') City State Zip F-wall Address(to receive project currinunicotions and Horne Depot updates),- U f DO NOT wish to receive any marketing entails from The Home Depot Project information: Uadorsigned("Customer"),the owvrbcrs of the property located at the above installation address.agrees to buy. and Tl ID At-Home Services,Inc-("The Rome Depot")agrees to lunnish,deliver and arrange for the insta'jation(-Installation")OF all materials descAbed on the below and on the rv.*rencied Spec Shect(s),all tti'wbadh are incorporated into 11ris CortracL by this reference.,along,.Ytth any applicable State Supplement and Payment Surntriary attached hereto and any Change Orders fcoffcctiively, "Contract"): Vroductst 5)#: PrQiect Amount Roofing WindwA.'; C]1-isulation []Curers?Covers UEnEry Dom r-1614 �)b 4:,:�-7(. O-Roormg CSIdir-z E]1Vindows Ej fasdution [];utters,Gorcrs L7EwtyI)oDns 0_--- URoormg[Siding [T41'—indr)%iv-s70-1ri&ulati0n oGutters J Covers DEntiv Door,[I__ F-Roofing —ding L Ifliahnum 28"1.Dqmk orContractAynount due upon execution of this Contract Total Contract Amount Maisie Purdiasers may mx deptisittriorefimn one-third of1heContradAniount. Customer agrees thary immediately upon corripic4ion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as refined by an individual Spec Sheet)and pay any balance due. As applicaWv,each Customer under t17is Contract agrees Lin be jointly and severally obligated and liable hereunder. The Horne Depot:serves the right to issue a Change Order or terminate this Contract or any individual?rodLCt(S)included herein,at its discretion,if Tile U0111C Depot Of its 40horized.w-Tvice provider delertrines that it cannot perforin its obligations doe to 3 structural problem with the home,crivironinental hazards such as mold,asbestos or lead Paint,other safety concerns,pricing errors or because work required to complete the job was not includei2 in the Ccritract. Payment Summary. The Payment Summary 9-1 Ci included as put of this Contract. sets riarili the total Contract amount and xa Jzr anis required for tate deposits and find payments by Product{as applicable}. NOTICE TO CUSTOMER You are entitled to a completelF filled-in copy or the Contract at the tinic you sign. too not sign a Completion Certificate(note! there Is one Completion Certificate for each listed Product a.;defined by individual Spec Sheets)belbre work on that Product is complete. In the event of termiriation of this Contract Customer agrees to pay The Home Depot the casts of materials,labor,expenses and ser-Aces provided by`ilio Horne Depot or Authorized Service Provider through the(Lite of termination,plus any other amounts set forth in this AggreeroLut orallowed under applicable la%A-. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE "ONIF DEPOT FROM TuE DEPOSIT PAYMENT Olt OTHER PAVNIENTS MADE, NNrt-ROUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OS=SUCH N.NIOUNTS. Acceptance and Authorization: Cusloricr agrees and undct-�-,lands that this Agreement is Iriz entire Lgl-ceinztnt:tetivecn Cuslunter and the Horne Depot wish regard lo the Products and c Irstallatiurl services and -seder all Pl'j'clr discussions and aerceirw mi,either V Oral or%%ritlen,relating to said products and Installatior.,This 4L L t ca t b ISS1811"d oranien(i d L---,czpt by a w6ting sign2(i by Customer ond The home Depot.Customer acknowledges sG,td agrees tha C mor yr has read.uadcrs'and&voluntarily accepts tic rentis OF and has received a copy of this Ageernent. Acccpfto by: Submit X ( X Cusll;"I�ncr's Signature Dntc-- Sale on aut'sSignature date X I Titte,ptore j o.- Customer's Signature DaLe Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS 4.s nlipficib1c) AGRE&AIENT WITHOUT PENALTY OR OBLIGATION BY DELIVERINGWRITTEN NOTICE 1*0 THE ROME DEPOT BY M1DKH;HT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT . .ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFIC-ALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE, 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: Apie, 4L) 7— P-D The debris will be transported by: W)9> 4 )-)i-TX- The debris will be received by: �CL7s ' Building permit number: Name o �2t �f Permit Applicant Date Signature of Permit Applicant