12C-036 (4) 48 STERLING RD BP-2017-1326
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-036 CITY OF NORTHAMPTON
Lot: -001 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-2017-1326
Project# JS-2017-002195
Est.Cost: $2487.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouo: HOME DEPOT AT HOME SERVICES 092937
Lot Size(sa.ft.): 14331.24 Owner: DAHLQUIST KENDRA
Zoning: RR100)/URA(1001/WSP(100)/ Applicant: HOME DEPOT AT HOME SERVICES
AT: 48 STERLING RD
Applicant Address: Phone: Insurance:
24 SUNRISE DR Workers Compensation
PROV I DENCERI02908 ISSUED ON:5/16/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 2 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:
FeeTnie: Date Paid: Amount:
Building 5/16/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use onty
- - ---, 1 ity of Northampton Status of Perms:
r- - ---! :uilding Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
MAY 1 62017 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
�_— yl50ne-413-$87-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION bp- 77-fD
V This section to be corn eted by office
1.1 Property Address: l (n1 �
`ice Map �d V Lot Unit
-6 4//�- �y - Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
2 A 7 Zi8 5aZ J— RI
Name(Print) (,"�)(�� Current nyn��es n//�
lierr Telephone
Signature -/ )?' 4'9-37Er
2.2 Auth• ' ed • -ent:
-------' ,- Current Mailing Address'
- ; -- . ����e ll1r�-- ori
Signet re Telephone j—), —`—�
SECTION 3-ESTIMATED CONSTRUCTION COSTS / -
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ) 147/, (a)Building Permit Fee
2. Electrical '7�/ (b)Estimated Total Cost of
Construction from(6)
•
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection Alif•
6. Total=(1 +2+3+4+5) 2A197Nv Check Number d.I u.'0�/ ,,TO
This Section For Official Use Only
Building Permit Number: Date
sued:Signature: ���� L`/6 -` -/
G
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 a 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
(dot area minus bldg&paved
parking)
h of Parking Spaces
Fill:
(volume&Lwumu
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES 0
IF YES: enter Book Page and/or Document#
6. 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 O
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 O
IF YES, describe size, type and Location:
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 ' doves Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [M] Decks IQ Siding IC] Other[CO
BriefDescription ) l 4) mP/ .,,�-grit hiA2 / * i /1_ ��
Work: / /./L J / 01'�-� / � ��/� 1��,�/ �J'-rJg�t'1/S_
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 belowfinished 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 FOR BUILDINGUPERMIT
I._ /`�jyv/I9/2 2 9 }7 , as Owner of the subject
property �//�. /� T'/J�
hereby authorize yam) /l )e #7a
to act on my behalf, in all ma ers rel Live to work authorized by this building permit application.
/ 7 &—q—/ 7
Signature of Owner Date
Miligill
nni
I, '-‘071/24: IIOnn/ , 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 und: a paidand pe Sties oLE2th .
aem-
�� b---'-- »
Signature if Owner/Agent Date
•
•
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supeervisorr:., / ]�// gmtt�y�� Not
Appplicabllee7 0
eName of License Holder: `�G�/ V / tel
License Number
911#2 /6J- tett 2A,/, i4-24—)9
Address Expiration Date
Signature Telephone
D/
9.Re•istered Home In.•roveme t Con r:et•r: Not Applicable ❑
lJ>riar //z7
Com an to'' f/— (SRegistr boon Number
rr/�J Z2_
Addres //^f,/r y,.t� /� /� )V�- Expiration Date
/ '1f/ ` O/PA4 Telephone/ �/ 4
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 buildi ermit.
Signed Affidavit Attached Yes `17 No ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or Iwo(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 resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as definedb MGL c 111, S 150k
Address of the work: J�/}y T/ �1� It47
The debris will be transported by: pp�� /717Y"VI/
The debris will be received by: aa nie- '
Building permit number: DD� ,�,�'� —fin
Name of Permit Applicant 1C/i" /�2)
Date Signature of Permit Applicant
•
Home Depot Contractor License Numbers:
MA Home Improvement Contractor Reg.#126893
Salesperson Name and Registration Number:
Timothy Drost : HIS 0553710, R-R-073-15-00005
Home Improvement Agreement
Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or
service the equipment listed below at the price, terms and conditions as outlined on this form.
Customer Information:
Kendra Dahlquist Boston North 10007734
First Name - - - Last Name Branch Name Lead tr
48 Sterling Rd. 'FLORENCE MA 101062
Customer Address ary - _ state Zip
L(413) 341-3415
orne Phone# Work Phdne# Cell Phone#----
keadah lq u ist@g m a il.com
Customer E-mail Address ...
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
908 Boston Turnpike Unit 1 Shrewsbury MA 01545
Address City State Zip
or Email CustomerCancellationNorthEast@homedepot.com
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE.
YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME
CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU.
OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT
HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL.
Acknowledged by: •
X 04/22/2017 • ...
cus lnjts signature
1
Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless
a different payment schedule is specified in the State Supplement.
2487.00 Includes all applicable discounts, rebates, and , taxes.
Contract Price $ Excludes finance charges.*
Minimum _ %deposit$ Due Immediately
Remaining balance $ Due upon completion
Finance Charges
*Any interest payments or other finance charges will be determined by Customer's separate cardholder
or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's
payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or
loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service
Provider may collect Customer's payment(s) made payable to The Home Depot.
Insurance proceeds will will not o' be used to pay some or all of the total amount of sale.
Description of Work to be Performed:
Installation of Windows
A more detailed description of the work to be performed is included in the section entitled Scope of Work
which appears on page 3 of this Agreement.
Anticipated Delivery Date / Installation Schedule
Approximate Start Date: 06/17/2017 Approximate Finish Date: 07/15/2017
All dates are approximate and subject to change based on unforeseen events including inclement
weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if
applicable.
Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you
consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and
written communications related to this agreement. By contacting your Service Provider, you may update
your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents
at no charge. By providing your consent and verifying your email address above, you confirm that you
have access to a computer that can receive and open emails and PDF documents.
By initialing this paragraph, I consent to receive only electronic records related to this transaction.
t::.'1Initial
Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service
Provider to perform Installation and/or(b)order and arrange for the delivery of special order merchandise,
including special order merchandise that may be custom made, as specified in this Agreement. Do not sign
if blank or incomplete. (Service Providers/permitting information may need to be provided to You later.)
By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety,
including the General Terms and Conditions and State Supplement, if any. You further acknowledge
receiving a complete copyof this Agreement. Keep it to protect your legal rights.
X 104/22/2017
Customer'sslgnalute perp
X
Co-signer or applicable) oats_._. --
X1� 104/22/2017
Sales consultant's Signature oat
License number(s) held by or on behalf of the Home Depot:
2
WINDOW SPECIFICATION SHEET - Spec.Sheet F'. 10007734 Sheet: 1 of 1 r
•
Customer Kendra Dahlquisl Job Y: 10007739 Consultant Timothy Drosl Date: 04/22/2017
- New Window
Existing Window Hinge Locations
Measuremenls Grids Produd Option Labor Options From outside,
Left to Right
I
- Bays,Bows
Location Color Rough Opening if of bars 4 of bars Csmnis,l OO
use L.R orS
Glass Misc Items
• Hardware
code
Screens For doors use
r u--— • S fr _ ] Mull -s.=stationary or
Style wraps w 17 _ E u _ g 6 ® '� 'x^=operating
_ , Room Floor Code (YM) Style Code i SeriesCode ' 5 3 i 5 m O 5 _i > I
I uv 1d ON v 0110emu 6100 Ma wd 1ssm sem 91 .OBG WEIWI Tp 2 1 TO 2 r Sm.cmacxr.MannedLSO
2 .N let rix v 0H-o 6+07 win we moo56.07 91 GBO vm,we C
T ] 'TO 2 G�nupm standard LSR
4 men
._. L, _—A_. - _.... �J
•
•
•
•
1 1
SPECIAL CONSIDERATIONS:
Wrap Color t White,2 White MISC1.Cul down window ,MISC2 Build mull
Interior Casing Type
Bay or Bow window.
Sealboard materiel(vinyl only.Birch or Oak)
Bay Project Angle(30 dr45)
Bay Flanker Type(DH,SN,or Cwmp —.
Top of wof WindOW to SON(Inches)
Ir tied to soffit.color of soffit material IIM1eve reviewed andIM1 SII he ob
Construct Root(Yes or No)' Sagree mi specifications alma end Me
_. penal Terms and Condibons on the followma Page
Garden Window:
Sealboard Matenel(vinyl only White Monde.Birch or Oak)
•
Nall Thickness(inches) Customer Signature
Additional Shelf(Yes or No)
'There is no guarantee that new shingles will match exiting color.
r;t111
it;„
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License CS-092937
:onstruction Supervisor
SLAV MOKAN r
43 SABRINA BROOKE LN
WESTFIELD MA 01D86
r'rt
k',r�
% "rre Expiration:
Commissioner 04/29/2019
-ie C/ 11411t,Onzvea7 lit 6/Qv f,a,;:itcwAu:ie/t
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Supplement Card
HOME DEPOT USA INC Registration: 112785
2455 PACES FERRY RD C-11 HSC --- - Expiration: 04/22/2019
ATLANTA,GA 30339
Update Address and return card. Mark reason for change.
❑ Address ❑Renewal ❑ Employment 0 Lost Card
Office of Consumer affairs Si Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
- ' TYPE:Supplement Card before the expiration date. If found return to:
_ Registration Expiration Office of Consumer Affairs and Business Regulation
112785 04/22/2019 10 Park Plaza-Suite 5170
HOME DEPOT USA INC Boston,MA 02116
2455 FERRY RD C-11 HSG -
ATLANTA,NTA,GA
GA 30339 Undersecretary Not valid withou signature
Ac o' CERTIFICATE OF LIABILITY INSURANCE °"TE; ;in"""
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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 INSURERS. AUTHORIZED
REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER.
IMPORTANT If the certificate holder Is an ADDITIONAL INSURED.the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this cediflcate does not confer rights to the
certificate holder In lieu of such endorsementis).
PRODUCER CONTACT
SSEL
MARSH USA,a 4C. a HON Ma
TOW ALLIANCE CENTER MF no F+ry- I[I=a 'G-HCC
3560 LENOX ROAD,SUITE 24W CMUI
ATLANTA,GA 30326 ADDRESS;
INSURIRISI AFFORDING COVERAGE I u NAIC 0
100492-HOReDGAW'4148 MSUReX A:Old Repub5c Insurance Co 24141
INSURED WSURERe:P9N GanarM Insurance Comgaln 42152
HE E PpTU DEPOT,
HOMEDEPOTRAS OINSURER 0: NYRpSFIim T,s Co i
2455 PACES FERRY ROAD INSURER o:
BUILDING CA0
ATLANTA.GA 3033 ,INSURER E:
INSURER a;
COVERAGES CERTIFICATE NUMBER: AT 3T46381,14 REVISION NUMBER:2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMRCH THIS
CERTIFICATE MAY eE 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 SEEN REDUCED BY PAID CLAIMS.
IINj;RTYPE OF INSURANCE AMEII
INaD'IM DED' POUCY NUMBER I(MWYOTYV;I IM1M C�1 I LIMITS '
A X 1 COMMERGAL GENERAL LIABILITY WM2E310022 03R12017 103918018 I EACHaccuRRENCE s 9.80000
I Ca Ms-MADE *....00CUR I PRMLGES{Ea OtihO tialiCal s
I PREMISES KWh()
H .. -._ LIMITS OF PCUCY PS MED ESP(Any aro P rstn) I5 EXCLUDED
DF SIR:SIM PER CCC ! PERSONAL E ADV INJURY 5 9.000.000
i GEHL AGGREGATE L:MTAP0.1GS PER - III lI GENERAL AGGREGATE S 9,000,D0
' X PCUcr °ZUS: LOC I uiCCuCTS-cOPPLOP AGO s 9,000,D00-
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WOCOMMIS/WONO COMMIS/WON WLRC49I 1230OQNi 03E4017 03taial8 X i PEERTUTE I f 0T I
AND EMPLOYERS'LAa,u Y WOO2j,1024Z3 RK
ANY?ROPREETORPARFNERESECu1NE V ( NH.fA1.Yil O'All2^vti O1Cll2E19 EL SAGA ACCIOENr S I.iAT`.OW
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EVIDENCE OF INSURANCE
CERTIFICATE HOLDER CANCELLATION
NONE DEPOT USA INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE
2405 PACES FERRY ROAD THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS,
AUTROR2ED REPRESENTATIVE
= of Marsh USA Inc.
Manasrtl MALAYAN _MnnmNA ,fL.weuwJu
01988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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Tha ACORD name and logo are ragietered marks of ACORD
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