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46 MAPLE RIDGE RD BP-2017-0623 GIS*: COMMONWEALTH OF MASSACHUSETTS k4 pj lock: 36-248 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THEGUARANTY FUND (MGL c 142A) UIL Category: window replaced BUILDING�NPERMIT G Permit BP-2017-0623 Project# JS-2017-001006 Est. Cost: $6369.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: 'flue COWLS BUILDING SUPPLY 098619 Ijpt Sizelsp. ft.Y 31624.56 Owner: PALM JEFFREY A&KELLY A Zoning: Applicant: COWLS BUILDING SUPPLY AT: 46 MAPLE RIDGE RD Applicant Address: Phone: Insurance: P O BOX9676 (413) 549-0001, NORTH AMHERSTMA01059 ISSUED ON:I1/3/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 5 REPLACEMENT WINDOWS ON 2ND FLOOR 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 4 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 11/3/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck- Building Commissioner V 1 U c� /-- 1, re;v • City of Northampton F;`..:} i-, Building Department t> i% - 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOUSH A ONE OR TWO FAMILY DWELLING... ... SECTION 1-SITE INFORMATION gg" I FI'Nal 1.1 Premier Address' � �. ,.. ,'1 La °F b office is More nc Mme- < r, ua � SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner 0 Rpcor4: S � T>o„ v.n H ate ,c1fise RA Name{PdM) ..—. Telephone .gI (o'_C7 signature or �. t t ,. . •\ Ia-x' Su v, ( Ptwn t3(' Name(FMt) Conant Meeing Address: Ht . 36i — SO (r) Signature Telephone SECTION S-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building (a)Bufdirg Permit Fee: 2. CiaAical (b)Estmated'Totel Cost of ConsWctionlromld) 3. Plumbing molding Permit Foe... 4. Mechanical(HVAC) 5.Fire Protection Soli - - 6. Total n(1 +2+3+4+5) ere/ 3oCheckNumher9g4 76- 's4/0 This Section FarOfidi Use Only _. R*Ml g Remtd Nlnnbe I _ !" Issued: o14-1/46' q ,['/ . . Burling Cominitskiwitrinspecoorci eusdbp. Deb SECTIONS-CONSTRUCTION SERVICES _. 3.1 Licensed Construction Sunerviettr: Not Applicable e�yy❑pp `` Nom of License Holder: ��R CZ.-NC 1 cif ,. C-.5 - Oct'A (btq 1 License Number Cr(virrA4 Pt lei A SoQkL. F xd\ey1 o6-a( ci halaretien Dale ylunation YY Telephone 14 1l,•11:"V:. ¢ Aad 1, ,A is e7: °iX.r'P.0 � � �w ' Not Applicable S . . � f� IAIO Company Nome Registration Number a I -7- -Expiration Data �V . w•V-Ncav-5 Telephone 4i3 3(4-903E SECTION 10-WORKERS'COItENSATION:NiSURANGE AFFlDANT otos.o.152,S 25C(8)) 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 budding permit. Signed Affidavit Attached Yes.._... t No._... ❑ The current exemption for"homeowners"was extended to include Owner-oecupled Dwellings of one(I) or two(2)families and to allow such homeowner to engage an individual for hive who does not possess a license,provided that the owner acts gl supervisor.CMR 780. Sixth Edition Section 168.3,5.1 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 noon who 4oa tract$more than one home hi a two-Yser period shag 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 ander the bufidine permit, As acting Co.. . etioo 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 far you under this permit. The uadonsigned"homeowner"certifies and assumes responsibility for compliance with the State Building CM-,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature __ SECTION 5-DESCRIPTION OF PROPOSED WORK(check ell aooliceble) New House ❑ Addition ❑ Or pl�emen t ndows Alteration(s) ❑ Roofing ❑ Accessory Bldg. ❑ Demolition ❑ New SignsSigC]5] Docks [O Siding(C71 Other[f]) Brief Description of Proposed , Ai R✓! c ft /'(d0 �' � Work: 1n) ; n n V 1 B o k_e nn �- l No!1 Sbwe_k:ta) rJ dviodo s Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Atbdwd Roll -Sheet in le, vi�p-w- w.� , i•ti tr;n1"s'ri '. P-i'` r"+`' x ._.. . 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 0. Number of stones? 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 Iloor below finished grade L. Will building conform to the Building and Zoning regulations? ^_Yes No i. Septic Tank_ City Sewer Private well City water Supp '__, SECTION Ta-:OWNER AUTHORIZATIN•TO BE COMPLETED WHEN OWNERS -AGENT :OR CONTRACTOR APPLIES.FOR BUILDING PERMIT 1, JIe- as Owner of the subject MaParn, . II t . hereby authorize C r-,n�\ $ 3: 1 n t ri t no �Jt t Y to act on my._:: Al matters relative to work authorized by this goading appration. Signature of Owner / Data ...—..—. as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application am true and accurate,to the best of my knowledge and belief. Signed under the pains penalties of perjury. hr"f 'r/lam , signature Agent - Date Section 4. ZONING All Inkrrmrtbn Mat M Completed. Permit Can B.gelled Due To Incomplete Wormrtbn _®® Rcquvcd by Zoaog Thie column to be filled in by DOAK Department PIIMM® - 1.1111111.11.111.11111 ,,,; 0.1.1.111.11.01.1. IMIENEIMINI 1.1=1.1....1 Setbacks Fnmt II SSt�e L:0 R:0 L:0 RLI o 0 Rest 0 C I hija o MIN o O opo 0 0 Open Space Footage OM Pm Waco biel&Wiwi © O Yo I = I BEIRMIim ® O 0 A. Has a Special Permit/Variance/Finding ever been Issued for/on the site? NO O DONT KNOW O Y6 0 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 I and/or Document WI B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 Y6 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on Lhe property? YES O NO IF Y6, describe size, type and location; D. Me there any proposed changes to or additions of signs intended for the property? Y6 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(dewing,grachnsoaavaUon.or Ming)over 1 acre or is it part of a common plan that w1il disarb over 1 ape? YES O NO IF YES,then a Northampton Stam Water Management Permit horn the DPW Is required. 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: H (,:, \lf a p to �, (1 ,3 -e R4 The debris will be transported by: Cowl S The debris will be received by: Co\-;-.A 5 Building permit number: II Name of Permit Applicant C-o ck-+\s �v;t 4 ; ,5 5 uppty Date Signature of Permit Applicant A�d CERTIFICATE OF LIABILITY INSURANCE fns/418201$ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFR.ATE HOLDER.TMS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polky(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy.certain Policies may Inquire an endorsement. A statement on this certificate does not confer rights to the certificate holder in Frau of am*endorsemends). PR000C£R _ NAME: Cynthia Henderson, CISR Webber & Grinnell PHONE �, (413)586-0111 ( ."")58.-64918 North King Street Amass,chenderson@Uabberandgrinnell,coal sttIREft E)_AWCRDNa COVERAGE MASS Northampton Nil. 01060 stegymANatherlands/Libor.ty 24171 Mho sauna.9becelslor/Liberty 11045 N D Cowls, Inc, IMURERc Peerless/Liberty PD Bon 9677 muses o A.rat. Nutval _ N5142E2 E: �...... North Amherst NA 01059-0002 mums F: COVERAGES CERTIFICATENUMBERi6ester Asp 11-2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCOES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAX)CLAIMS. AOOL SUM LIRYPO INSURANCE INW WVD POugr MAIM\ gOVAnn (MMA Tyne � TW X CQIMERCIAL GENERA. um R )I oFW f . M OCCURRENCE 1,000,000 r A I CWMBMADE I =)OCCUR FOMENTED 100.000 nAIAWE 0328362731 11/21/2015 11/21/2016 MEDEA'P(My me rayml 5,000 _ FE'M10NN.a,uv INJURY 1,000,000 GEM.AGGREGATE ttUWMIT.APPUESP9l i GENERAL AGGREGATE 2,000,000 X POLICY JCECT LOC PRODUCTS-COMPORAGG .2,000,000 MRCP: AU70MONLEuAaaJry CC IIN&E Uat S - 1,000,000 a _ ANY AUTO 13002.8 Y INJURY(Pet pram) 6Fa ... ED E AUTOS. SR aA8362516 11/21/2015 11/21/1016 BODILY IN URY(hr sYMTO f ALSTOS A Hp EO AUTOS 8 OQ NON-OWNED TY OAZ' — 5 AUTOS RAY 80808,81 pp,A®c 5 8,000 UNtRELLA IVa R rccuR EACH OCCURRENCE 5 10,000,000 C EXCESSwa CtuLIFLka+e ACr.RECATE S 10,000,000 OEO X ROEMIONI 10,000 CDa566542 11/21/2015 11/21/2016 S `AND DG YERT ." Iice IES ANY WNI41ETORIU TNERtXEOUTrrE Y(N EL.EACH ACCIDENT 5 500 000 OFFICER/NEABER EXCLUDED? N NIA �— D (MWmyb Mn M720o200000267016A 1/1/2016 1/1/2011 EL0SA%E_EA EM%.OtE 1 500,000 ayq RON Wx 4 SCRIPIIONOFOFFRAiIOH@Nbi EL OmEA9E-POLICY LIMIT t $00,000 DESOUPTIONo CPNGndta f LOCA110e4S I YENGt@(AC089 insodeacaatRemaits 4MNM,we b .e e4s6pC8Mip.010) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE Evidence of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WRIT THE POLICY RYOWSIONS. Ain4ORXEp b:p,¢.uii'ATNE C Henderson, CISR/CSN .0,- - 01988.2814ACORD CORPORATION. All tights reserved. ACORD 25(2014)01) The ACORD name and logo are registered marks Of ACORD INSG25+xm.am The Commonwealth of Massachusetts Department ofindustrial Accidents Pl =s; ! ; Office of Investigadons =;;r= 3 _.. a_ 1 Congress Street, Suite 100 Boston, MA 02114-2017 y. .w.• www.massgey/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I C. Please Print Legibly Name (Bminea✓Orgeniariodlndirim,d): Cosa,)\ S R c 1(�s yi S u tip 17 .. _ Address: t Sc S t nr�t ' o \ 2\c1 City State/Zip: ' , 1 1�1 • 1 Phone #: `1 I . 3(o )_-(31_C) 3 Are you an employer?Check the appropriate bin: Type of project(required): I.D4 I am a employer with 3 4. 0 1 am a general contractor and I employees(full and/or part-time).* have hired the subcontractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached steel 7. 21 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurances 9. ❑Building addition required.] 5. 0 We are a corporation and us 10.0 Electrical repairs or additions 3.❑ I aro a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12 ❑ Roof repairs insurance required,] t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant nut checks box MI must also fin out the section below showing their woken'compensation policy information. I.Homeowners who submit this affidavit indicathig they are doing all wok and Item him outside connacmas must submit a new affidavit indi Moe such. ICottractos that check This boa must attached anadditiwul sheer allowing the name of the sub-contractors and rate whether or error those eauurs have employees. if the subemnaetas haw eropkryees.they Borst provide their workers'comp.policy number. /an an employer that is providing worker'compensation Insurance for my employees. Below is the policy and Job site information. < fs it 1 J Insurance Company Name]((Se€ Ill 0410U> Policy 4 or Self-ins. Lic.#: Expiration Date: lob Site Address: City/State/Zip: .� Attach a copy of the worker' compensation policy declaration page(thawing the policy number mad expiration date). Failure to secure coverage as required ander Section 25A of MOL 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. /do hereby certify n -r the pains madpenaJlties ofperfary Mai the information provided rw is we and correct Signature: r en ✓ --% Date: JG 31 Phone tJ: Official use only. Do not write in this area,to be completed by city or town official. ' City or Town: Permit/Liceare it 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#: COWLS BUILDING SUPPLY COWLS INSTALLATION AGREEMENT MA. Registration No. 183108 This contract agreement between Cowls Building Supply (setter) BUILDING and Jeff Palm shall serve as a legal and binding document for the sole SUPPLY purpose of supplying material and labor of the following location 46 Made Ridge Rd..MA. ALL SPECIAL ORDERS ARE NOT REIURNANE Integrity (Full Frame) Casement Windows Removal and disposal:existing units will be removed and disposed of.The work area will be cleaned up of any material as it relates to the project. Insulation: We will foam fill the pockets and caulk all locations as it relates to the door/window install. IrdaRallonc all products (see attached) wit be instated per the manufactures specifications. -Five new integrity(full frame)casement windows will be Installed. -New 2 K'primed wood Interior casksg will be Installed. -New 3'IC PVC exfedor casing will be installed. Palnting/staining: No painting costs have been included in this proposal. Other,Standard installation does not Include the removal and/or rehanging of shades, curtains,or other window hedmen,. Instal areas need fo be clear and accessibl tome Instil contractor on scheduled date of Install. Any products, materials, or labor costs that ore beyond the scope of the original contract are not covered. (I.e.: rot, decay, or anything unforeseen). An Extra Work Order will need to be agreed upon before continuing. Guaranteed total instated package price $6.369.06 Payment schedule: 1/3-deposit-$2,123.02 1/3-deposit-$2,123.02 upon delivery 1/3-final payment-$2,123.02 upon completion •ARAMs AND COMMONS 1. The standard tom of weronty moll apply to the materials from the manufacturer. 2. Instal:llon wit carry a warranty of I year.Does not include mated. S, the buyer undamands Ihol the maierld b a colon order and urinal be canceled. 4. Conhact wit not include any wet Or installation of plumbing,electrical,flooring.etc.fix/lb not listed In the contract. Professional Installer. Covets Bullring (seller) // Buyer date —7 a—` }