35-290 (5) 120 WOODLAND DR BP-2017-0632
G1S 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-290 CITY OF NORTHAMPTON
Lot:-GUI PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:window replaced BUILDING PERMIT
Permit# BP-2017-0632
Project fi JS-2017-001026
Est. Cost: S23 98.00
Fee:$40,00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sq.it); 31973.04 Owner: ROHLICH THOMAS H&WAKAKO S
Zon ng Applicant: RENEWAL BY ANDERSEN
AT: 120 WOODLAND DR
Applicant Address: Phone: Insurance:
30 FORBES RD (505) 919-0900 WC
NORTH BOROMA01532 ISSUED ON:I/5/2017 O:OO:OO
TO PERFORM THE FOLLOWING WORK:REPLACING 11 WINDOWS, NO STRUCTUAL
CHANGE
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 1/5/20170:00:00 $40.00
212 Main Street, Phone(4131587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
•
•
City of Northampton
�On • Building Department
212 Main Street
Room 100
Northampton, MA 01080
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address-
120
swim be be completed Was
120 Woodland Drive, Florence, MA 01062 Map Lot list
Zone Greeley District
Mm at DMMN CS batt
SECTION 2.PROPERTY OWNERSHIP/AUTHORIZED AGENT
g,1 Owner of Record:
Thomas and Wakako Rohlich 120 Woodland Drive, Florence, MA 01062
Name(Mint)
C413-318",9171
Maws Ares;:
(see contract) Telephone 13-387-7171
eMWa a
Signature
12 Authorized Agent
JAIME MORIN 30 FORBES ROAD NORTHBORO,MA 01532
Name(Prfip Curren swing Address:
{see contract} 508-351-2214
Signature Telephone
SECTION d•ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official the Onty
completed bypermit applicant
1. Building $23,398 (a)Building Permit Fee
$40
2. Electrical 0 (b)E. neted Total Cat of
Construction from DS)
3. PlumbingU BuildIng Permf Fee $40
4. Mechanical(HVAC)
5.Fire Protection 0
6. Total=(1 +2+3.4.5) $23,398 CheckNumber 9007937 iege{�y
Thle Section For Official Use Only
Building Penni Number Isste
tasuad:
Signature: 17�,/L" , //— / -/{
eUMrrg Cearmia enertlatim dr of eaeangs Date
Section 4. ZONING AN Mormsbn Mat Be Completed.Permit Can Be Dented Due To kxonnolde Information
Required by Zoning
lair Munn robe film in by
Budding equir Uepenm
ellt
® I1,111.1. 1111
Setbacks Front
Side L:= R:= L= R= = 0
Rear
MEM
OMU =11 I .
Open Space Footage
on
I tot blots epaved I-1
11
CI [0 MEM
MEM
PSIMILIJIMMLS
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES O
IF YES: enter Book Page 1 and/or Document A
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
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. win the consbuction activhy disturb(clearing,grading,excavation,or filling)over I acre or is it part of a common plan
drat will disturb ovef 1 acne? YES O NC)
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(cheek ell eooneaMe)
New House ❑ Addition ❑ Replacement Windows ANerationls) ❑ Roofing ❑
Or Doors
Accessory Elide. ❑ Demotitlon ❑ New Signs [CI Decks ID Siding[O] Other[C]
Brief Description of Proposed
Work: Replacing 11 windows: no structural chanae
Alteration of existing bedroom_Yes ,t No Adding new bedroom`Yes v No
Attached Narrative Renovating unfinished basement Yes Y No
Plans Attached Rog -Sheet
Sa
a. Use of building :One Family T 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 healing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance toren 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 Wow 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
Thomas Rohlich and Wakko Rohlich .as Chimer of the subject
properly
hereby authorize JAIME MORIN
to act on my behalf,in all matters relative to wok authorized by this building permit application.
SEE CONTRACT 10/31/71116
S of Ower Dee
JAIME MORIN 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.
JAIME MORIN
Print Name
(see contract) 10/31/2016
signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor: Not Applicable ❑
NamaotlkameNmar JAIME MORIN 90125
Litems Number
86 GARDINER STREET LYNN, MA 01905 10-06-18
Address Expkahan Date
508-351-2214
Signature Te epha,e
` Not ApDlicabk ❑
RENEWAL BY ANDERSEN 170810
Comoany Nam@ Registration Number
30 FORBES ROAD NORTHI3ORO,MA 01532 12-23-17
Address Expiration Date
Telephone508-351-2214
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G.L c.162, 26C(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 building permit
Signed Affidavit Attached Yes a No 0
IL-2 oats i - Irl
The current exemption for"homeowners"was extended to include Owner-orraoied Dwellings of one(t) 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
p supervisor.CMR 788. Sixth Edition Section 186.3.3.1.
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 veiled shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a forth acceptable to the Building Official,that he/she shall be
femoesibk for all sock work performed ender the bgiMlut penult,
As acting Construction Sepervisof 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 inference 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 fir 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 I+tai Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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Name(ea telakoam+Im.1S RENEWAL BY ANDERSEN
Address: 30 FORBES ROAD
Civista dZip: NORTHAORO.MA 01632 phone 0. 505-351-M14
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4C RO CERTIFICATE OF LIABILITY INSURANCE 70/
THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDERTHIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGANELY 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: Sties AvdOmN haidar bean ADDITIONAL INSURED.Ste paae7tMa)mat M andarnd. H SUBROGATION IS WANED,swat to
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IWICATED. NO1 WTHSTA NDMO ANY REQUIREMENT, TEAM OR CONOSIom OF ANY CONTRACT OR OTHERDO;LME T WITH RESPECT TO Mai TWS
CERTIFICATE MAY BE ISSUED OR MAY PETTML NE INSURANCE AFFORDED at THE pains DESCRIBED HEREIN IS SUBJECT TD Mi.TREMENS.
ONLHSI is AND CONDITIONS OF SUCH POLICIES.OMITS SHOWN MAY HAVE BEEN REDUCED BY PMD CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DEW WDatlas BE CMI/2UED SWORE
THE ElwIRA1 m DATE THEREOF, NaTICI MILL SE DSUVIBED M
ACCORDANCEYTT me POUCtrPS
mamanawed Y ee
Proof M imams 1• '+ -
ACORD 25(201441) The ACORD name and logo an 01000.2014 ACORD CORPORATION. All BEMs nand. {
IphNend marks ofACORD
10 Massachusetts Department of Public Safety
Boats of Building Regulations and Standards
License:.CM-01141% ■ ..
Construction Supervisor
JAMS L MORONS
LV0 MA Ut41 T�CSi3'
LVNIMA 01006
r•••amis– C.CU– Expiration:
sioner 1641900 I
Con*uSon$upMWac
ReNtiatsd to:
Umashdfhd-Buildings M any use group which cattalo
less then 35,000 cubic feet(9111 cubic meters)of
enclosed space.
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RENEWAL BY AN
JAIME MORIN _k
30 FORBES RD .<a_1..t.—
NORTHBOROUGH,MA0153R
Undersecretary
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ENERGY PERFORMANCE RATINGS
U-Factor(U.SJ/i-P Solar Heat Gain Coefficient
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ADUrRONALPERFDiIAAICERATINGS
Visible Transmittance
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Renewal�w1YAgreement Document and Payment Terms
M/'aNeT5Cl1 du:auroral bs.Maines ei aortas mown and WaMM Roma
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Commix-Its) Name: Thomas Rohlkh and Wakako Rohlich Contrast Oats 09/29116
Cottony,hi Street Address: 120 Woodland Dr,Florence, MA 01062
nun,, kkrilium Number: (413)387.7171 S sondarr IU.-phonc Nutlike (413)2214945
Rhrurt Emil:wrohlchOgm&l.com ktandan Email:
Ru eel st hereby,011111y and en mall; agrees to purchase the prsdusrs audio(sets KO Renewal by Andersen 1.1 CJ&Me Renewal b.
Andersen of Rmton('Coneratw'I, in.aordanse w,th the tmm and.ondtuam deo mind to thisAgreement INA unwed and Payment
Terms.Nance of Cancdfanno.Itemised Order Receipt terms and Condition.of Sok. load-Safe Form.thither or Kinkier. Electronic
Ccdneot.and any other document attached to this Agreement Document. the mm.of which ate all agreed to by the patties and
incorporated herein ha reference Icollectiveh.this_Agreement').Ru)rrts)herder agrees its ugn a completion ern thaw after Canna:toe h,
cometed all work under this Agreement.
Total job Amount: $23,39$ By opting rho agreement.you acknnwiedge Char the Rabns Dur. and the Amount
Financed mast Ire math by personal check.hank thiole.tr tin card.or dash-
Ik.Prnit&wind: 67,799
Balance Dox: $15.599 Littman/SOH: Esunuted Completion:
.Amount /hulked: $0 12 weeks 2-3 Days
Method of Parmame. Credit Card We uheduk installations Fused on the dart of the rigncd contract and,o:ond,ily on
the date an which we complete the technical measurements.The.nnallation date that
Notre: The customer is using a we arc prm-iding a this time k stub an estimate.We will communicate an official due
Discover. and um at a later Jaw. Run and mine weather ora the must umomun snots two
delay
Notelet agrees and understands that this Agreement commutes the endo unsictuardings between the panics and that there arc net sobai
undemanding ck,aging or modifying any of she taro.tri rho:Agmment. No akctaoun,fo or deruuuns tom this Agreement will be:s ard
without rhe signed,written(onsen,of both the Ru)-erttl and Conn-wow Rusernt lwrtin'a.'knowledgm that Hoards) 1) has read this
Agt am.understated,the terms of this Agamont-ad has meted a completed..ansa,and dated cops N this Agreement-including
the two attached Notices of Cancellation.on the date 6n. mitten above and!f was orally informed of flan-(,tight to canal this
Agreement.
NOTICE TO OWNER: Pu nut rig:tins Lantra'if blank_You are entitled to a cam:of the contract at die time sou sign.
YOU,THE BUYER.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT
OF 10/0312016 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER.SEETHE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION OF THIS RIGHT.
Las.am ftaewalbt.LL.nw LIC Gmmnt,t
a acatwal kr Andersen of Boma
( c!.,.- ((Jii. Str 4 t4 dtt,4h-S. ��JJ//
Signature of Salm Lkrsun Signanue *name
Roland Pelletier Thomas Rohlich Wakako Rohlich
Print Name of Saks Perum nim Name Prim Nate
Fa 1_ 2 .a
V=al Itemized Order Receipt
Far dim taarrd by Mdenaa of Bane Thomas and Watate eeasrca.1411/4 IHC 1114610 . '
wren 4'9 iitl..8:-J i il:'
4'S.:a22CY J¢ . Prim•[a . :Ea.,. -"C --- ld ' 4'3 71-'76•15-7
101 Fam
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Misc. tau
102 Fam
Screen: ' `.. oorr. Grille Style: „ -.
- iiia:.• h- Grille Pattern: i,,. - -- - I•- •
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103 Dm
'tie; 4r5:,' Hardware:
.. Screen: r: - ,v n Grille Style:
,.pr Gli•s .(Jr 5 Grille Pattern: Sr,:'
Mat: No
104 Din Window: Dcnr :. +. - .s - • - -• -.
^,a^•� ... .:.care,_ Hardware-
Screen: :::.. - Grilit Style'. :-...,..
lilac, E._ Guile Pattern: 4 - -' >e
2. Wit: !4o•
np,2Prrfi eat; r - �3
Renewal Itemized Order Receipt
Nru merserl ale Ramat br Mdanre of Been
Theenav aero Waikato"taei[e
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Mist: No'
106 Lc
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Misc. Ne'
107 01( Window' Parte _
r;. I r:l F 'e :. •R i` itFl se 1- Glass °rsn 4
;h F17vrr;an E_ _ .. 'lo P tic Hardware:
., r Screen: r z Se ie..�. Grille Style: ":;
cewrtz*. Glass '.G2ri Grille Pattern: ;-,; _: . 21.9
• Mise No-
106 Ott Window: Bqubc--. - l_ u . a. e -. ...
,n Pe.lsnnr.rc. '1-a • .. :'ia;;. 'i.� P11.4 Hardware:
• Screen . r .. : s,,,.«„. Grille Style-
1.11,41S
tyle Blass 'L_ Grille Pattern: S .. _ _c .
Misc: Wp^
Renewal Itemized Order Receipt
',Andersen
F dot Rcwwd In Hansa of tette Thomas ana wataba Rums
c�, nAn 1 1r - tlitrd p
SC 1170*10 m."OW
s.:51.:2r V.g E'.y , r a_ ;. . ,q.:(u 4'3.Z21Sx.15
109 BSI
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Misc: Ho-
110 Bed?
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Misc: tt?�
111 Bed2
-pF N"'4 •- Eleas, FIG Fit': Hardware.
3. .• Grille Pattern: )- ; - -- . 4.4
Misc ha-
t4111DO11S:1/ PATO DONK:a SPEOAUY.O 611Sc 0 TOTAL $23396
UPDATED: 09/29(16
Reww4lb4.4nde...0.; ;nmmirred to...a r.a-hewer. raten) hi
.emftuxg arrh:1> ale(curt lrad .t a e.t pare rt ryrciraed Ay :re t 1'1.
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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 150k
Address of the work: zit jI,// /an . , i
The debris will be transported by: fit v&rjfAL „y ANbses&n)
The debris will be received by: R z n as uN - 134 iq toboOts&n)
Building permit number e p 020/? - l/,3d
Name of Permit Applicant 314 c M C µant RI
Date 'Signature of Permit Applicant