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32C-186 398 PLEASANT ST BP-2017-0375 GIs if: COMMONWEALTH OF MASSACHUSETTS Map:Block:320- 186 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MMGLLc.1144/2�A) Category: ROOFING/SIDING BUILDING PERMIT Permit# BP-2017-0375 Project# JS-2017-000619 Est.Cost:$24960.00 Fee:$140.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group_ ENERGY SAVERS OF AMERICA 84919 Lot Size(sn.ft.): 2395.80 Owner: GRYGORCEWICZ JOSEPH P& RENE E GRYGORCEWICZ 7onino:OB(100,E Applicant: ENERGY SAVERS OF AMERICA AT: 398 PLEASANT ST Applicant Address: Phone: Insurance: 3339 BOSTON RD (413)283-6695 Workers Compensation WILBRAHAMMA01095 ISSUED ON:9/20/2014 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP SIDING & INSTALL NEW, STRIP ROOF & INSTALL NEW, INSTALL WINDOW 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: Smolt*: 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 9/20/2016 0:00:00 $140.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck Building Commissioner File#BP-2017-0375 APPLICANT/CONTACT PERSON ENERGY SAVERS OF AMERICA ADDRESS/PHONE 3339 BOSTON RD WILBRAHAM (413)283-6695 PROPERTY LOCATION 398 PLEASANT ST MAP 32C PARCEL 186 001 ZONE GB(1001/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT �/ No Fee Paid r Y I']5Yr UQ /-f f� Building Permit Filled out ��/ P Fee Paid Tvneof Construction: STRIP SIDING&INSTALL NEW,STRIP ROOF&INSTALL NEW, INSTALL WINDOW New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 84919 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance' Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management � Sig re • :ail "'Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. Department use only City of Northampton Status of Permit: �` Building Department Curb Cuuoriveway Permit c� \Q C"'� 212 Main Street Sewer/Septic Availability rjV C j3 Room 100 Water/Well Availability s° "�� Northampton, MA 01060 Two Sets of Structural Plans o� e°e"' ophone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Ili Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELUNG SECTION 1-SITE INFORMATION 1.1 Property Address: This section to be completed by office 1no $ i \eo-SO Dl0Cop Map Lot Unit t Zone Overlay District Elm St.District. CB District • SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT $.1 Owner of Record: -ThSejah GryclorcQ_L.)i(-z 398 PRc3uv'+ �I- flor-1kcnvph N e(Print) v' Curter y aII'u�p Atldr c %SUL - e. . C'. +) relit ( 0— 9415 Teiepitmla S" tore 2.2 Authorised Agent: £n-er� Coyt.rs cy� IA, re.r'iC%� Ic 33.-3 `i � recl 1�ll� l)ic — Name '- TOY �} ew,e,tMaangAd&ess: fY�G. DiD`x c(� l 1401 q13--2 3-6 to 9-3 _ re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Hem 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(8) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.fire Protection _� tii 2V-0 - Total=(1 +2+3+4+5) 021419(0C) — Check Number ,a7.6-44‘ y+2Vp This Section For Official Use Only Date Budding Permit Number Issued: Signature: Building Commhsionerfinspector of Budding, Dale 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 L: R: L R: . Rear Building Height Bldg,Square Footage Open Space Footage (La area minus bldg&paved Parking) #of Parking Spaces Fill: (volume&Lnrationl - A. Has a Speciat Permit/Variance/Findin ever been issued for/on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the a istry of Deeds? NO O DONT KNOW YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO It0 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 , Datte Issued: 0 C. Do any signs exist on the property? YES O NO 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 IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading, cavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION S.DESCRIPTION OF PROPOSED WORK(check all applicable) ,,rte New House ❑ Addition ❑ Replacementt4YYY"""���"' Indows Alteratlon(s) 0 Roofing pd Or Doors t fi Accessory Bldg. 0 Demolition ❑ New Signs [Ct Decks [D Siding Siding frii Other(C] Brief Description of Proposed Work: ,5h^ , c5idir5+ inskul NIA)/ Sbtp roo-+ Os�li Nifttl /c0i, Alteration of existing bedroom_Yes ✓No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ga. If New house and or addition to existing housing, complete the following: a. Use of budding: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 It 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. \7DQ.fh Cr'j 9 orc -etuiLT ,as Owner of the subject property hereby t hereby authorize U' V-Q,V'9 -j Sb-V--ArDChic— -P 'ne.r I CG„. d yl C to act on my behalf,in all matterWrelative to work auth ed by this building permit application. C 2Se ta4 {SY\ t'a[ IIIIMIIIIIMIIIIMIIIIIIMIIMill Signature of Owner (/�°�� �, (' Dante ( ,` i, n�� `-^tit 'Ds, {-,}'1� .(� t/� r `X�-�-{ tc.AD ,as Owner/Authorized Agent hereby declare that the statements and inf on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains d penalties of perjury. Print Na 0,0/A . egvv, ) 9-to -/ t re of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction SUPervlsor: ftp,, Not t Applicablee C game of License Holder: ti.J Us.Qph Ek 1 I (,(,y ;/ ht CS— c S —7 9 t 9 . T _`�C) License Number l3-bpii PD OS 12.-C\ `lt— --1 '7 A.,ressR /r, Expiration Date III, r. kw itch yv\l�t ` A, 4/3/-2-3CS.ce 3 urs s Telephone $.Registered Home Improvement Contractor Not Applicable C L21 8,93 Company Name Registration Number 1 n-er9 (,i :1 )c c P nre�r;cc,1 MC i -. 9 11 Address ,/�Jp �,,� /� 614 o 1 pry,+,'.^ Expiration Date 333? cv1 U 9 gd1 u( (h a Telephone ' ,,.e r SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result In the denial of the issuance of the buil ' g permit. Signed Affidavit Attached Yes No 0 11. - Rome Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts As supervisor,CMR 780, Sixth Edition Section 10$,34.1., Deiinitioa 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 hi 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 Coostraction 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,Stare and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature 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: 31 ? {'CSS Ca r\-(- <� The debris will be transported by: P 1 I eAnR Cm :,"(\LA rz_b I D l i The debris will be received by: Pc-11-ANS c uflAf,1niA_v-ek Building permit number: C Name of Permit Applicant EA\-f'v'q v1 Jnr-u) Dk- A(Nocie.Y QL__, Cir (1 ' (4) i ( 0, Date Signature of Permit Applicant The Commonwealth of Massachusetts i a Department of Industrial Accidents itl f 0„.t=. Office of Investigations i. = Ci imS 1 Congress Street,Suite 100 G !`s Boston,MA 02214-2017 r www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Vv-€r9 �j {),l) zr -- -40,1-cy t(,� .�jc, Address: D?Zs 9 1?70�5-�-(',n 37-e3 J City/State/Zip: Lit VIA(G 4 v 1 (1- U I D) S--Phone m L} 13 2-g ) (C(5 3 Arean employer?Check the appropriate box: 4. Type or project(required): I. am a employer with ❑ F am a general contractor and F 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. 0 Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor me in anycapacity. employees and have workers' 9. ❑Building addition [No workers' comp, insurance comp.insurance.: required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1L[]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12 ❑Roof repairs insurance required.]t c. 152,§51(4),and we have no employees. [No workers' 13.0 Other comp, insurance required.] *Any applicant that checks box tri must also fill out the section below showing their workers'compensation policy information. a Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrectms that check dais box mut attached=additional sheet showing the name of the sub-contractors and state whether or not theseeatities have employees. lithe 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: 3S Qt.-, l6 t1-'€ }r C, A Z'l� l�0't,.' Policy#or Self-ins.Lie.##�+.:: {{ . S” -e6 1 9 L' 1 ___ Expiration Date:' ( L551 T1 Job Site Address: 3 4 Y I't'CA.CCcnn-�-- `+� City/State/Zip:10e 1t)".O1vy#\-0-h ArYiff O I C6% 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifinarion I do hereby ce 1�under the pains and penalties ofperjury that me information providedt above is true and correct. 1 Signature: an" g + .Pg.-.( , , - -9 ( !i- v-, Phone#: LA 2)2.$P, (o(053 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): e I.Board or Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6.Other Contact Person: Phone#: This agreement made the �� �y� day Of ; ,... �+c .�io/L 20 (C, between V / eownenJe• i. i •usneas• (Addess A✓ ST ,[ a 4.1 get( 10Ce © at yoyyiv7 est 0-1w$ j e 0 Jr) J LP Lode areinaftercaw th owner and ENER Y SAVERS OF AMERICA INC.of the Town of Wilbraham,Massachusetts here: Matter called the contractor,witnessed: The said Contractor hereby agrees that'twill for the consideration hereinafter mentioned,furnished all labor and mate- rial necessary to install the following described work at premises IpGa�ted at p Job Mutase Total Quantity No.of Additional Work Total Total a o Windows Purchased Panes Cash Price Oil 9, Regular Double Hung .2 Sliding Daus Down Payment c5, d 40 Picture Windows ))(( Siding yes Upon Start diS acfr icz, 3 the Sliding Windows i )(7. Roofing Yes Upon Completion y214yFD 2 Lite Sliding Windows I Bay Window yCasement Windows Bow Window OTHER-DESCRIBE gliirt,1 „s7t* 0_4C .,» I4w. w. rq „14 d1 -4,-s f 2Z4A-t.J - 7X„4"._ 4( 1 sa4)i-t /.1 p4 t.�A C-10/Alt LJIt:k-be 7 '' .7, 41nLC /l2ehi . b(f5(e Li' . r t -M., Co _st 1 _ Cdn < J 1,4- y^( RIS D_C ('-'0.,,,p., L c c /7 e..t,A1l 4,,C1.J y' ywof , .. "„\,. .-- Ox �-.. 94L L ' e c 41- W A v't 6 -n-Ree 2 Gy y ryAt n,o \.k ,L_ay1 ece—d3 .cce.h.-}- r 4-1A, / a.1a.L L ll ot.) 4or*,i..> �d4,n- 'll2,tmt't\}, / i' �i.; ✓L Van-C Igo c , /o t F z(a$Rvsl (Lstc c'G.'en- N.” ? . Estimated Start Date 4.24,91./. ( _201 k Estimated Finish Date /"Q yr cQQf ?a 14. Contractor does not perforin or assume any responsibility for any Painting,Staining or Wood or Wall Finishing on interior or exte- rior. Md the Contractor does further agree with the Owner that(a)he will begin work within a reasonable time after the execution hereof, and will prosecute it diligently and with due care,and in a good and workmanlike manner;(b)in doing the work.he will comply with all statutes,rules,regulations and ordinances applicable thereto: Contractor to procure all permits required by boat taw-Contractor shall provide public liability&worker's comp insurances. Due to the custom manufacturing of the product and its restricted use unless installed in its intended opening,if the Owner refuses to permit the Contractor to proceed with the work herein,or in the event of any breach of the Owner of this agreement,for any reason whatsoever shall cause the Owner to pay to the Contractor a sum of money equal to fifty percent of the price agreed to be paid,as fixed, liquidated and ascertained damages,and not as a penally,without further proof of loss or damage. SELLER shall be excused for the period of any delay in the performance ofanyobligations hereunder when prevented from doing so by cause or causes beyond SELLER'S control,which shall include.witno,n limitation,war,fire,or ether casualty,governmental regulations or controls,inability to obtain any of the materials involved hereunder,or through acts of God.This agreement shall be binding upon and inure to the benefit of the executors,administrations,heirs,successors and assigns of the parties hereto. 'Owner'warrants that he Is the owner of the property on which the work is to be performed onnehe is otherwise authorized on behalf of the awrers to enter into this agreement. Owner authorizes the Contractor to enter upon'..ne said premises and Owner agrees to obtain,it necessary consent to enter upon all adjoining neighbor's premises In otter to er ^a to Contractor to do and complete the aforementionedwork. This contract represents that entre agreement between the Owner and the Contractor and no representation or warranty shall be binding upon either party,unless mottled hereto or on reverse side. This agreement Is subject to review by Energy Savers of America Inc. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office branch thereof,provided you notify the seller In writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day /7 7.1.- i , o(dte following the signing of this agreement. //,.�/,Y� IN WITNESS WHEREOF,the parties have hereunto signed their names this fT day of Stet 20 /C. t're ha ,,view • the SO%Fu iii-Wogs /1.r Pled :red . - Signed )(s- j, Signed ,,:.a Signed f,/ - ' ff ern Savers of Amen ,Inc. Owner este $2"firnatuuea/ aaadta4ella ). Office of Consumer Affairs and Business'Regulation '1 10 Park Pima• Suite 5170 Boston,Massachusetts 02116 • Rome Improvement Contractor Registration Reptilian: 127883 ' Enphatlon: 712a12011T 202011 ENERGY SAVERS OF AMERICA INC -c;. JOSEPH GULLINI 3330 BOSTON RD. WILBRAHAM, MA 01095 Update Addxa and Morn and Mart ro uroolor chop. 11 o 10.1.0201 ❑ Addrw 0 6aonal [�] 6mphgoant 0 Loot Card 11b41111111 Moaatit Bi dl •nes ut��ons and Mita. tfo=_51wTM.aira•�i�,r .. 3339__ yi sap 1 expiration 11" n.101 aouattaner 0411M017 IvequnsINANCE 11:21:18 Am. 03-03-2019 I/I ,r"'ti • ENERG-1 OP 10:DG • 14 (JRO' CERTIFICATE OF LIABILITY INSURANCE " 002016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE GOES NOT AFRRMAIVELY OR NEGATIVELY AMINO, WEND OR ALTER THE=MG!WORDED BY THE POLICIES- BELOW. MS CERTIFICATE OP INSURANCE DOES NOT CONSIGNS A CONTRACT e@TYYEEN THE ISSUING INSURGR)S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT H the ceUmoats holder le of ADIHTIONAL INSURED,the popey(les)mutt be endorsed. If SUBROGATION IS WAIVED,subject to to tnns and oerdltam of the policy,certain sondes may require en endorsement A sbmmentn this annoy don not confer rights to the drDRAb holder In lieu of such indoreemenda). Meld truism Agency,Ina �RAn 1BTEMt$t .fear LPNC.Mk Lud/ovrAM n1)re CMA pwlho anaoonion POmnScoVaRme MACS Savers Of America Inc . atomn* ' 'Acaooaad Employers)ns Co , mums Energynone;Atlantic Casualty Insurance Co 3129 aRdWRhnMm,MAo1088 • enento,ATENa Protection In CoC41310 ppI IIII 013101W r. mpeR” COVERAGES CERTEICATE NUMBER: REVISION NUMBER; THOM To TO THE INSURED NEWER ABOVE FOR THE PONCE PERIOD INOICATEDCNun o na(AMMO ANY RED IUIREMENT,TEAM OR CONOR ON OP ANY CTHAT THE POWER OF INSURANCE MED SEU3W NAVE BEEN ONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE PODGIER DESCRIBED HEREIN B SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COMMONSOF SUCH EDUCES MRS SHOWN MAY RAVEBEEN REDUCEDBYPAID CIAIMS. x. TIPS MIRMOCI I ,a ... 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ACORD 25 OSUMI) The ACORO name and logo are legaared marks of ACORO