18-003 (4) 426 HATFIELD ST BP-2017-0962
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18-003 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: windows replaced BUILDING PERMIT
Permit# BP-2017-0962
Project# JS-2017-001653
Est.Cost: $19861.00
Fee: 5140.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot Size(sq.ft.): Owner: SKIBISKI MARY A
Zoning: Applicant: RENEWAL BY ANDERSEN
AT: 426 HATFIELD ST
Applicant Address: Phone: Insurance:
30 FORBES RD (508) 919-0900 WC
NORTH BOROMA01532 ISSUED ON:2/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:12 REPLACEMENT WINDOWS
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 2/22/2017 0:00:00 $140.00
212 Main Street. Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
---- - 212 Main Street Sewer/Septic---- - eptic Availability
"` -- - Room 100 Watermell Availability
Northampton, MA 01060 Two Sets of Structural Plans
Z e 413-587-1240 Fax 413-587-1272 PIOVSlte Plans
L. - Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING •
SECTION 1 -SITE INFORMATION Ba, 7^ 9G2
1.1 Property Address' This section to be completed by office
426 Hatfield St. Map Lot Unit
Northampton, MA 01060 Zone overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
John Skibiski 426 Hatfield Street, Northampton MA 01060
Name(Print) Current Mailing Address:
,,e€ £wacato ceswac-r TelephoneRfi-1R77
Signature
2.2 Authorized Mont:
JAIME MORIN 30 FORBES ROAD NORTHBOROUGH,MA 01532
Name(Print) Current Mailing Address:
j 508-351-2244
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building $19,861.00 (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 �(/
6. Total=(1 +2+3+4+5) $19,861.00 Check Number 4'O goo? 4//10
This Section For Official Use Only
Building Permit Nu1,000,
I , Date
Issued:
Signature: 9' -AP/1-1�
g C mmissi ner/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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage
(Lot arca minus bldg&payed
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 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:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,ex vation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
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 in Addition ❑ ReplacementWindowsAlteration(s) I nl Roofing El
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding[0] Other[Q]
Brief Description of Proposed
Work: Replacement of 12 windows
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.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 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 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
John Skibiski ,as Owner of the subject
property
hereby authorize JAIME MORIN
to act on my behalf, in all matters relative to work authorized by this building permit application.
SEE CONTRACT 2/03/17
Signature of Owner Date
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
2/03/17
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Helder: JAIME MORIN 90125
License Number
30 Forbes Road, Northborough, MA 01532 10-06-18
Address Expiration Date
508-351-2214
Telephone
' F __ _ "pu$'F"ftyt;. Not Applicable ❑
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 Forbes Road, Northborough, MA 01532 12-23-17
Address Expiration Date
Telephone508-351-2214
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 61 No C
The current exemption for"homeowners'was extended to include Owner-occupied Dwellings of one(I) 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 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, 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 resuming from the construction
activity governed by this Building Permit shall be disposed of In a property
licensed solid waste deposal facility, as defined by MGL c 111, S 150A.
Address of the work_ 426 Hatfield Street,Northampton, MA 01060
The debris will be transported by: Renewal by Andersen
The debris will be received by: Renewal by Andersen
Building permit number.
Name of Permit Applicant Jaime Morin
2/0117 7. .T
Date '•nature of Permit Applicant
Renewal Agreement Document and Payment Terms
bA_dersen. dba Renewal by Andersen of Boston John Skibiski
������pN111I,,,�' Legal Name:Renewal by Andersen LLC 426 Hatfield Street
HIC 5170810 Northampton,MA 01060
WINNOW CtWn 30 Forbes Road 1 Northborough,MA 01532 H'.(413)586-1827
Phone'.508-351-22001 Fax 1508)986-7072 I RbABostonOperationsoAndersencorpcom C'.(413)32D-7572
Customer(s)Name: John Skibiski Contract Date: 02/02/17
Customer(s) Street Address: 426 Hatfield Street, Northampton, MA 01060
Primary Telephone Number: (413)586-1827 Secondary Telephone Number: (413)320-7572
Primary Email: john@skibiski.com Secondary Email:
Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by
Andersen of Boston("Conaactor"),in accordance with the terms and conditions described in this Agreement Document and Payment
Terms,Notice of Cancellation,Itemized Order Receipt,Warranty,MA Addendum,Terms and Conditions of Sale,Lead-Safe Foran,Owner
or Builder,Electronic Consent,MA Contractor Arbitration,Image,Image,and any other document attached to this Agreement
Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement').
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Total Job Amount: 519,861 By signing this agreement,you acknowledge that the Balance Due,and theAmount
Financed must be made by personal check,bank check,credit card,or cash.
Deposit Received: $0
Balance Due: $19,861 Estimated Start: Estimated Completion:
Amount Financed: 519,862 8-10 weeks 2-3 days
Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on
Notes: GS plan A2531 the date in which we complete the technical measurements.The installation date that
we are providing at this time is only an estimate.We will communicate an official date
1/3 deposit and time at a later dare.Rain and extreme weather are die most common causes for
1/3 due O install delay.
1/3 due O completion
Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal
understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid
without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this
Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including
the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this
Agreement.
NOTICE TO OWNER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign.
YOU,THE BUYER MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT
OF 02/06/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
RIGHT. c,etone*)
ba:Renews by An
#19V-Ca ' -411
Signature of Sales Person Signature Signature
George Holt John Skibiski
Print Name of Sales Person Print Name Print Name
02/02/17 Page 2 / 21
Renewal Itemized Order Receipt
bir/+fldersen. dbn Renewal by Andersen of Bonen John Sklblskl
�61r1 Legal Name:Renewal by Andersen LLC 426 Hatfield Street
�e
HIC 4170810 Northampton,MA 01060
*meow ueensss 30 Forbes Road I Northborough,MA 01532 H (413)586-1827
Phone:508-351-22001 Fax:(508)986-70721 RbABostonOperations@AndersenCorp.com C:(413)320-7572
IDP: ROOM: DETAILS:
101 Entry Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All:
High Performance SmarlSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only(INTW), Grille Pattern: Sash I. Colonial 3w x 2h,
Sash 2: Colonial 3w x 2h, Misc: Non
102 Living Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All:
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1 Colonial 3w x 2h,
Sash 2: Colonial 3w x 2h, Misc: Non
103 Living Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All.
High Performance Sma rtSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: In tenor
Wood Only (INTW), Grille Pattern: Sash 1. Colonial 3w x 2h,
Sash 2. Colonial 3w x 2h, Misc: Non
104 Dining Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All'.
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1 Colonial 4w x 2h,
Sash 2 Colonial 4w x 2h, Misc: Non
02/02/17 Page 4 1 21
RenewalA_JItemized Order Receipt
b'An ern' dbw Renewal by Andersen of Balton /obn Skibiski
sat ] Legal Name:Renewal by Andersen LLC 426 Hatfield Street
M� HIC#170810 Northampton,MA 01060
nem n unvn 30 Forbes Road I Northborough,MA 01532 H'.(413)586-1827
Phone:508-351-22001 Fax (508)986-70721 RbABostonOperationsoAndersenCorpmm C(413)320-7572
IDN: ROOM: DETAILS:
201 Janet Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All.
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1 Colonial 3w x 2h,
Sash 2: Colonial 4w x 2h, Misc: Non
202 Janet Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All.
High Performance Sma rtSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, full Screen, Grille Style: Interior
Wood Only(INTW), Grille Pattern: Sash 1'. Colonial 3w x 2h,
Sash 2 Colonial 4w x 2h, Misc Non
203 Bath Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (I NTW), Grille Pattern: Sash 1 Colonial 3w x 2h,
Sash 2'. Colonial 4w x 2h, Misc: Non
204 Hall Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrall, EXTERIOR White, INTERIOR White, Glass: Sash All
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1'. Colonial 3w x 2h,
Sash 2. Colonial 4w x 2h, Misc: Non
0 2/02/1 7 Page 5 / 21
Rene al Itemized Order Receipt
n. dber Renewal by Amiens=of eonon John Skibiski
Legal Name:Renewal by Andersen LLC 426 Hatfield Street
I
1111lo _ HIC 0770610 Northampton,MA prow
WINDOW ai en 30 Forbes Road I Northborough,MA 01532 H:(413)586-1827
Phone:508,351,2200 I Fax(508)986-7072 I RbABostonOperations0AndersenCorp.com C.(413)320-7572
IDI: ROOM: DETAILS
205 John Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All:
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h,
Sash 2: Colonial 4w x 2h, Misc: Non
206 John Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All:
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1 Colonial 3w x 2h,
Sash 2: Colonial 4w x 2h, Misc: Non
207 Mary Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All.
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h,
Sash 2. Colonial 4w x 2h, Misc: Non
208 Mary Window: Double-Hung, Equal, Slope Sill Insert, Traditional
Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All.
High Performance SmartSun Glass, No Pattern, Hardware:
Stone, Screen: Fiberglass, Full Screen, Grille Style: Interior
Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h,
Sash 21 Colonial 4w x 2h, Misc: Non
WINDOWS: 12 PATIO DOORS:0 SPECIALTY:0 MISC 0 TOTAL $19,861
UPDATED: 02/02/17
/—\ Renewal by Andersen is committed to our customers'safety by
2- complying with the rules and lead-safe work practices specified by the EPA.
02/02/17 Page 6 / 21
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01M63014ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD MRN and logo ate registered mile td ACORD
Massachusetts Departmentof F
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License: GS-0901
Construction Supervisor
JAIME L MORIN
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ExpiratiOnt {:' 23/201.7 Supplement Card
RENEWAL BY ANDERSdN i, G.
JAIME MORIN '= t -
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HORTHBOROUGH, MA 01532 Undersecretary
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