23A-218 20 BEACON ST BP-2017-0460
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23A-218 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: replacement windows/sidino BUILDING PERMIT
Permit# BP-2017-0460
Project JS-2017-000762
Est. Cost: $24485.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME COMFORT INC 001332
Lot Size(sq. ft.): 7884.36 Owner: EWERS JENNIFER CRAIG&WILLIAM.' EWERS
Zoning: URB(100)/ Applicant: VALLEY HOME COMFORT INC
AT: 20 BEACON ST
Applicant Address: Phone: Insurance:
20 WAREHOUSE ST (413) 781-0230
SPRINGFIELDMA01118 ISSUED ON:10/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACEM ENT WINDOWS-ALL BUT 2 -VYNYL
SIDE ENTIRE HOUSE
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 10/11/2016 0:00:00 $100.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit
' \ uilding Department Curb Gut/Orrveway Permrf
5 12 Main Street SeweSphcAVeilal2➢rty °
'\ �\ Room 100 Waier*ed dYeilabilily *^
\ \ /.. /Northampton, MA 01060 Twa Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 PIot/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
�1,.. 0QR ,� S4 , Map Lot Unit
2�/ Zone Overlay District
lmRe tl ee-
Elm St.District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/7/ Etve,e5 20 &aw Sf.
Name R ///(Print) �/� Current Mailing Address
Ai/ �(ie s Telephone Y/3 t S- .3S03
Signature rryyy e'l
2.2 Authorized Agent:
UR//eyihme�auZed 2o 4J9,eeAaaje -* *Via
Name Print Current Mailing Address:
,ea:e— 4//3 7FI/--0,30
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building4 v-1,4g5. — (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 .40
/�7)
6. Total=(1 +2 + 3+4+5) Check Number 7/41(,//�1 /rev
This Section For Official Use Only
Building Permit Number. Date
Lssued:
•
•
Signature'401111.111111°L- Vol — 7
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 filled in by
Building Department
Lot Size I I I . I t _
Frontage L_ ___ I 1 I I .. .I
Setbacks Front L_J I. _I I. I
Side Ll R1.. __ I Er IRI I _ . ___I
Rear I _ I 11-1 I
Building Height
Bldg. Square Footage I If- l % __. I [ I I I
Open Space Footage _ - % -�
(Let minas bldg&laved r _ I 1 -. _I i _ i 1 _ -
parking)
#of Parking Spaces L. _ I_. _I - i
Ftll
_ . . — Ii
Fill:„oh &Location) - - -' —
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DON'T KNOW 0 YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q
IF YES: enter Book f Pagel and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
I
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location: L _..
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q
IF YES, describe size, type and location: L
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 Q NO Q
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 n Addition ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding [0] Other[o]
Brief Desyryptio of Proposed r J
X Work: 4 e!./Ag.(/G 4//.v �/ /�%A r y/Jie/ iy
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 authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature/tuof Owner Date
111111111. 11
I, t4�� 4 ,1q'e CSM f e_ ,as Owner/Authorized
Agent here y declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un.er the pains and penalties of perjury.
,eoyee aaarPel�,
Print Name / 2o /E
Signature of.n ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
-6]-Licensed Construction Supervisor:+� --- --- - _-- _NolApplicable. ❑
Name of License Holder: eo ye,Q U//f C/AIrvc- 0€2/832. V/
f/, License Number
20 Claee�oce 5 2 Si- • SO4 /414 • G -G - /
Address Expiration Date
refi/� �� // yze 3/43 7t/-023o
SignatuTelephone
vile jc I°c�r CGM I • C70,11
.9. Registered Home IImprovement Contraaccor:wt eaMJ , Not Applicable 0
/y//4. A /000
Company
/
Company Nam Registration Number
20 eel/Me/69a se Si • e 6—
Address Expiration Date
Telephone78/-02.3e,
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 he required from time to time,duringand 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 he liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with tie State Building Code,City of
Northampton Ordinances, State 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: 10 ncocS
/
The debris will be transported by: (//;4 )142,r{e �oM{ra c
The debris will be received by: 66,rdet 4441 Aly S
Building permit number: / ®�
Name of Permit Applicant OrPc/A/vt
&2 i. 6/ 20/G 4� �--
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
' 1111 l Office of Investigations
ir1 Congress Street, Suite 100
71 f�Cr- Boston, MA 02114-2017
�y www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information p Please Print Legibly
Name (Business/OrganizatioMnndiviidual): (/A//.j )4 ,gc(%m' ,4Q7 „yJr
Address: 7° 44#€ 1", >a S�-
/ t
City/State/Zip: a/ /OA CMS— Phone it: -923 _7,7 02.550
Areoil an employer Check the appropriate box:
Type of project(required):
1. I am a employer with 3 4. ❑ I am a general contractor and I
employees(full and/or part-time).' have hired the sub-contractors 6. Li New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ 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 10.0 Electrical repairs or additions
officers have exercised their 11.❑ Plumbing repairs or additions
3.ID I am a homeowner doing all work
myself [No workers' comp. right of exemption per MGL 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 that checks box*II 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.
l 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. Tic.#: Expiration Date:
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$25000 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DR for insurance coverage verification.
I do hereby ter ' under the pains and penalties of perjury that the information provided above is true and correct.
Signature: /i}i(� �7 ,//JLQ Date: �(' c 29//
Phone#: /777 /81—x.30
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#:
Oct 07 -15 09: 15a Valley Home Comfort 4132146256 P. 1
PURCHASE AGREEMENT MicThALLEYDare a?�e/..itt2/6
Tel. No. �� a--,3. ']0.,3 20 WAREHOUSE STREET
Purchaser ._ ,�,. -tai SPRINGFIELD, MASS. 01118
Address .....gQ_���GCCcerivo Z P/.y/tfL-1.. EL• TEL: 781.0230
area City
Subject to the conditions hereinafter specified we propose to furnish and install the following on your building in
accordance with the instructions specified below:
Mass. Reg. #
100061 Mass. Lic. #001332 Coann. Lie. #504665
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26100 0 ,077 .//>v. J ,/.�./7X: KreelemA./y 2Q,1% <�-2. /iia%//�J
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yin_ l<ii/ 1.4:, .c/fcJ Sea-,--1 /Th 0 >-, 1/ / . �ao O, {7 cg 970/2
The above products are warranted agoing defective material aid workmanship for one year from
the dote of installation and any defects appearing dueng said period will be conecied free of
charge. /
CASH PRICE -'7` 1 4 I
Title to, and security interest in above products shall remainwith the Seller until the pour
the price 's pDid in lull ccording to the terms and toteabove. In the event of a default_ 7 —ter” it,
payment f any installation due hereunder and said default shall continue for more than five Down Payment r44 ��p •• le' ,,Q'P`
days, the Seller or its servants or agents may of its option enter upon the premises of the Buyer, ,Ft�i
and remove said products without being guilty of any trespass. These hall remain personal NET BALANCE DUE 7127,/Z'
property regardless of the manner in which they may be affixed w attached to any building or
of thisre. The Purchaser agrees that if payment shall not be made in accordance with the terms
of this agreement interest in the amount of I /of of the unpaid balance shall be addeeach month -r s„..-] �67t/
to the amount due, and that all expenses of collection, 'f collection is necessary, including a
reasonable attorney's fee, shall be added la the amount due. Purchaser acknowledges receipt of
an exact copy of this agreement completely filled in prior to the purchaser having executed it.
Valley Home Comfort, Inc., is permitted b proceed with the installation without interruption.
Valley Home Comfort,Inc.conies Workman's Compensation and Public liability Insurance,but does not assume risks of any other character in con-
nection with this order and is not responsible for delay,damage or inability to any on the work of installation caused by or resulting from stokes,lockouts,
fires,accidents,lack of materiel or any other muse beyond its reasonable control either before or after the delivery of the material and equipment of said
premises.
This agreement shall become binding only upon the Seller's acceptance hereof or upon the Seller's commencing performance.Upon acceptance this shall
constitute the entir agreement and be binding upon the parties hereto,there being no covenants,representations,warranties,guarantees,promises or
agreements, I or oral,except as herein set forth. Necessary power For the electrical equipment to be furnished 6r the .
Salesman .17.14../ _ �/4L0 ` Purchaser A- .
"YOU,THYER,MAY CA;'EL THIS TRANSACTION AT
ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY Purchaser
AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACH-
ED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION VALLEY HOME COMFORT, INC. -Seller
OF THIS RIGHT."
Buyer acknowledges receipt of two copies of Notice of Opportunity to rescind. Accepted by
I Seal I
BUYER President Treasurer