23A-218 (2) 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/siding 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 Grouo: VALLEY HOME COMFORT INC 001332
Lot Size(sq.ft.): 7884.36 Owner: EWERS JENNIFER CRAIG&WILLIAM J EWERS
Zon no: URB(IOOV Applicant: VALLEY HOME COMFORT INC
AT: 20 BEACON ST
Applicant Address: Phone: Insurance:
20 WAREHOUSE ST (413) 781-0230
SPRINGFI ELDMA01118 ISSUED ON:10/11/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACEMENT WINDOWS -ALL BUT 2-VYNYL
SIDE ENTRE 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/I 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 10/11/20160:00:00 $100.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Departmentuse only-
City ofNorthampton ..
- uilding Department Curb Cut/Driveway Permit
5�.. - t, 12 Main Street Sewer/SeptieAvaiiability
\ c \ ! Room 100 WatidWelFAvailabiiity L.
---"Northampton, MA 01060 Two Sets of Structural Plans
=phone 413-587-1240 Fax 413-587-1272 PIoUSite.Plans . - "`'
Other,.Speclfy
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
20 4QR co A� S Map Lot Unit
WC/l n � � Zone Overlay District
ok ` /r'6 Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
A,// Sa.a5 2-0 eenci,ptii5/ .
Name(Print)Q // Current Mailing Address'
• 'i/ &JAS Telephone yy3 �09S 3503
Signature :iYVr,
2.2 Authorized Agent: / /
�R//P,LJ Awe-(.B.t/�.2e i G 20 4%ee4u o e S$- 70.
Name(Print)/ Current Mailing Address_ 00
.//3 n/-02x30
Signature / / Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building4 2t-1/ g 5 (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 n "l
6. Total= (1 +2 +3 +4+5) Check Number 7/4/0 07
This Section For Official Use Only
Building Permit Number: Ds
suu
ed:
Signature:ice-�'��S /
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 1 I i I —__I
Frontage I_- ____ 1 I -_. -. I 1 ---__1
Setbacks Front 1 j` J ` j
E... -—I —__-
Side L R:1. L I ! R:, I
Rear I_
Building Height ,_-- - _-' I I-__—'
Bldg. Square Footage I I— J / I _ I I I I I
Open Space Footage
(Lot area minus bldg&paved r l j. �
parking)
#of Parking Spaces l . - — I ��
Fill: 1 ..-
L
(volume&Location) — - 1 — --
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW O YES O
IF YES, date issued:I _ - _1
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book 1 _ JPagei _.. _ and/or Document #i
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O
, Date Issued:
L
C. Do any signs exist on the property? YES O NO 0
IF YES, describe size, type and Location: I
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: I
_--
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 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) ❑ Roofing n
Or Doors 0
Accessory Bldg. ❑ Demolition New Signs [C] Decks [D Siding[CO Other is
Brief Despryption,of Proposed
Work: dPrv'et/Pif/CG�/. t/ Ji;/ye/Fail
S /
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 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.
Signaturetuof Owner / �y,r, 1 -y Date
I, 64/1�q ye N-G�y C.J N� , 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 unser the pains and penalties of perjury. /�
,P yee Carle/A c_
Print Name /
Ler -„,t,t. Sr G 20 /6
Signature of%+ ner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1-Licensed Construction-Superyrr
iso � -- -- _ . Not Applicable_❑_
Name of License Holder: Porto U1.4/1le_lAIVC_ 400/3
License Number
20 (a#PeAoce 5 t S-fr . S� A/A . 6 -6 - /
Address { Expiration Date -
A////-�� >-� 503 711-0230
Signatuq Telephone
„fie : OHeJ (°l t @GM I • c0H
9. Registered Home Improvement Contractor: Not Applicable ❑
/lam//e 144zgiP Cc,q,&Z,` Ji `/moo 6/
Company Namb Registration Number
20 (el/Me/case Sf • e 6-- /cr
Address Expiration Date
Telephot 7//-0230
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 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 he 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 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: 20 .9c1P,i c3.
The debris will be transported by: U �/ %ma c3M x,24 �_
P/
The debris will be received by: ',u fly .5-4,Building permit number: / ���
Name of Permit Applicant act Ortelflr ye—
a/. G/ 2O/G 4 me-.---J
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
1St—Tht tOffice of Investigations
�I I•
ma . ar 1 Congress Street, Suite 100
QN Boston,MA 02114-2017
t, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information pp � y//�/�� Please Print Legibly
Name(Business/Organization/Individual): ( I4 i,04,e,�/ m'7"6a ::4--
Address: 70 4/40 ,& S/-
i
City/State/Zip: is i i, n'14 O///C Phone #: 11,5 —297-672 30
Areyou an employe 1. Check the appropriate box: Type of project(required):
I. I am a employer with 3 4. ❑ l 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. ID Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in any capacity. employees and have workers'
P 9. ❑ Building addition
[No workers' comp.insurance comp. insurance.•
required.] 5. ❑ We are a corporation and its 10.1DElectrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their l 1.❑ 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
employees. [No workers' 13.1D Other
comp. insurance required.]
*Any applicant that checks box#1 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.
tContractors 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'comppolicy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob.site
information.
Insurance Company Name:
Policy#or Self-ins. Lic. #: Expiration Date:
Joh 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 herebycar ' under the pains and penalties of perjury that the information provided above is true and correct.
Signature: /,17/g61:(_1,6 //"/p,! elate Date: & G . 7.12/2.
Phone ��7 i-O23o
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Oct 07 -16 09: 15a Valley Home Comfort 4132146256 p. 1
PURCHASE AGREEMENT ALLEY
OME
OMFOR
Dare a7.er .ae.0/6 INC.
Tel. No. —"lilt
�,.*103 20 WAREHOUSE STREET
Purchaser ...R.1G(�(/..1. SPRINGFIELD, MASS. 01118
Address X70 ,e_lQeernvo,&:._ .Gt1E-/.F/ .i/..Aa TEL: 781-0230
Street Ciy
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 Conn. Lic. #504665
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.J >/ di ...".,tea..e., i el .,i Ammesiore _1.IT . ./. S`_�i%I'�� • A �,
The above products are warranted against defective material r nd workmanship for one year from
the date of installation and any defects appearing during said period will be corrected free of
charge. in
Tele to, and security interest in above products shall remain with the Seller until the p CASH PRICE (/
choseprice ispaid in lull according to the terms and stared above In the event of a default uin 07 �"itij���
the payment of any'installation due hereunder and said default shall continue for mare than five Down Payment M'( - /1-, '�
days, the Seller oriservants or agents may at its option enter upon the premises of the Buyer
and remove said products without being guilty of any trespass_ Thesehall remain personal =
property NET BALANCE DUE
regardless of the manner in which they may be affixed or attached to any building or f. / '
*velure. The Purchaser agrees that if payment shall not be de inaccordance with the terms q
of this agreement interest in the amount of I %z%of the unpaid balance al be added each month Terms/742.46 -t6/l
to the amount due, and that all expenses of collection, if collection s i necessary, including a
reasonable enamels fee, shall be added to the amount due. Purchaseracknowledes receipt of
an exact copy of this agreement completely filled in prior to the purchaser having executed it.
Valley Home Comfort, Inc., is permitted to proceed with the installation without interruption.
Valley Home Comfort,Inc.carries Workman's Compensation and Public Lability 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 corry on the work of installation caused by or resulting from strikes,lockouts,
Fres,accidents,lock of material or any other cause beyond its reasonable control either before or after the delivery of the material and equipment at 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
conslitte the emir agreement and be binding upon the parties hereto,there being no covenants,representations,warranties,guarantees,promises or
agreements,w 9 or oral,except as herein set forth. Necessary power For the electrical equipment to be furnished - the Owner
/� 44 _ a . 1
ti
Salesman , ./S/' �/45h Purchaser , L_ . I _
'YOU,TH 2. YER,MAY CA a 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