38A-061 (20) 101 WEST ST BP-2017-0102
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38A-061 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-2017-0102
Project# JS-2017-000171
Est.Cost:$1400.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RHODES GENERAL CONTRACTING LLC 109300
Lot Size(sq. ft.): Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: URC(I10)IRR(0)/ Applicant: RHODES GENERAL CONTRACTING LLC
AT: 101 WEST ST
Applicant Address: Phone: Insurance:
P 0 BOX 402 (413) 658-8276
SHUTESBURYMA01054 ISSUED ON:7/26/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2 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 7/26/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
Department use only
JUL 2 6 Z jy cf Northampton Status of Permit:
Buildi g C epartment Curb Cut/Driveway Permit
i)EPLOFBUILDINGttJSPE Man Street Sewer/Septic Availability
NORT.AMPrONjIAA 01060 Ronin 100 Water/Well Availability
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
1.1 Property Address: This section to be completed by office
0 l jcbA- 51. I.Soclho mpfort to OIOro 3 Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
The Trustees of the Smith College
l24 We-sV• S4. LIzrtha.mp)bn ,m4. 01063
Name(Print) KA t_ 'Lent Fc5T2— T, Z Current Mailing Address:
ac -0S2 0 ++��+W JT>f CC2LE'Z-•b Telephone
Signature
y 13• S-535• Z`-lo`•i
2.2 Authorized Agent:
lco,rt ;iL 12.6 A- 54. rvla Ot06-j
Name(Print) Current Mailing Address:
tl• S8s•zyo`1
Signature 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
I 41
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) t'4O0 Check Number 7/6
This Section For Official Use Only /
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r
L.. }
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 filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side I,: R: F.: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage rr
!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 O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O
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? YEF 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 ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors ifj
Accessory Bldg. n Demolition ❑ New Signs [J] Decks ® Siding ID] OtherBrief
Work:Diksi6fAig fOira9Vfilg windows with double hung replacement windows ,y3.
Alteration of existing bedroom Yes X No Adding new bedroom Yes X tlo
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 i City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I (nv 16-0 '1-9.C57tt3 O -rrrC S 1 vTK CO IL , as Owner of the subject
property
hereby authorize Lln.d44 Cxx1e,1 (-0"4rcii4x1 LA-4-
to act n my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owne? Date "q ,5 7J 6-
, AC.Am 449a/0 we Q 1..d..) Gc",6,4.l Cs..Jrr0,44I1 LL-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.
Adams -Siahaffian
Print Name
Com--- t2 416/24/
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: Adam m .)e,.W bSon C-S- 109 200
License Number
152. 5 y Qcl Pa f,Scw 902. Leverti)., io etoSL 04/ 11 /2019
Address Expiration Date
13. 230 1330
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable 0
ed& G s-'..t CO 11 r0.c}: V.C. S i t3 7
Company Name Registration Number
'S 2 s1...,lcstour./ 'Po e{c2 L-t.vcre}b , X10 Qtv S`'I 511/Zl/8
Address Expiration Date
Telephone '-t CI. 2. Ser l 330
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 0
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 10835.1.
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 Accidents
=,li�l=_
Office of Investigations
_ igi a 1 Congress Street,Suite 100
• =die[=
' Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Rhodes General Contracting LLC
Name (Business/Organization/Individual):
Address:152 Shutesbury Rd, Leverett, Ma
01054 413-230-1330
City/StateiZip: Phone#:
Are you an employer? Check the appropriate box: Type of project(required):
1.01 am a employer with 4. Cl I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ®New construction
listed on the attached sheet. 7. 0 Remodeling
2.® I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. CI Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 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 13.11 Other VJ;r,dpw Qcnipg1 Insiatl
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#I 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: _
Policy#or Self-ins. Lic. #: Expiration Date:
J
Job Site Address: City/State/Zip:
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 under the pains and penalties of pedury that the information provided above is true and correct.
Signature: �` Date: '7/5J Z4/
Phone#: t/1'S• 2 Sc . 010
O
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 it:
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: col
The debris will be transported by: G -*-1 cam .-•.•.Ls0-4„ c�,c,
The debris will be received by: k./0.."k./ 4.-Lf
Building permit number:
Name of Permit Applicant ALL..,
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Mathews Brothers Proud Supplier of Customer
d% & QUOTATIOI\
BROTHERS `�
Tel: t.: ►
Fax: .i: a;a
Email: 4t--
BILL TO: SHIP TO: • 41 j ;:: 14
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QUOTE# STATUS CUSTOMER PO# DATE QUOTED ! j«i:
335933 None 75/2016 10:17:32 AM 't;ai
QUOTED BY TERMS PROJECT NAME QUOTE NAME,;
Tim Warner SMITH COLLEGE RHODES 4.
ILINE# DESCRIPTION QTY NET PRICE EXTD. PRICE F
100-1 2 $240.90 $481.80
Walcott Replacement Double Hung E
33.25 X 52.75 Unit Size,White,Insul Low-E&Argon,Dual I
Lock,No Balance Covers, Insert Half Screen Applied [—:::
w!Sill Extender t, d'i
a Unit 1: UFactor:0.27, SHG:0.31,VLT:0.56,CR: 62 *-�7
Energy Star Qualified(Northern) _ _33–--_ -;�;
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Opening: 33.5"X 53" I K ;
O.S.M.: 33.25"X 52.75" Tag: None Assigned * it L'
,x. F
All Prices are net. Quote is good for thirty days. Please review all quantities, specifications, SUB-TOTAL: i S481.80 ►'
and information for accuracy. Special orders can not be returned for credit. Signature implies LABOR: S0.00 t• : ti
acceptance of these specifications. Your order will not be processed without authorized :FREIGHT: I' CL00 /I
signature.
SALES TAX: I, ,;$0.00 14,i;
Thank you for all of your efforts! TOTAL: 1 $481•.80 11 of
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CUSTOMER SIGNATURE DATE . "' ,
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