25C-006 (10) 144 RIVERBANK RD BP-2017-1349
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mk:25C-006 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 DOOR BUILDING PERMIT
Permit# BP-2017-1349
Project# JS-2017-002244
Est. Cost: $10857.00
Fee: $77.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RENEWAL BY ANDERSEN 090125
Lot size(sq.II.): 33149.16 Owner: WHITLEY NANCY B
zoning: URB(100N Applicant: RENEWAL BY ANDERSEN
AT: 144 RIVERBANK RD
Applicant Address: Phone: Insurance:
30 FORBES RD (508) 919-0900 WC
NORTH BOROMA01532 ISSUED ON:5/23/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 3 PATIO DOORS
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:
FeeTvpe: Date Paid: Amount:
Building 5/23/2017 0:00:00 $77.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
I
City of Northamp:•n
Building Departm.nt DE-
212
'212 Main Stree —
Room 100
Northampton, MA 01060
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 IP/ 7/3q9
,This section roti by e4fiu
1.1 Property Address: 144 Riverbank Rd. �ay1
Map 11+" Lot.. Runit ,
Zone OvedayDisMet..:..
Elm St.District CB Dlsirlot
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Nancy Whitley 144 Riverbank Rd.,Northanmpton,MA 01060
Name(Print) Current Mailing Address:
413-530-3064
See Attached Contract Telephone
Signature
2.2 Authorized Anent:
JAIME Mt;IN 30 FORBES ROAD NORTHBORO,MA 01532
Name(Print) Current Mailing Address:
stag 508-351-2277
Signature Telephone
ION 3-E MATED • TR CTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
10857
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) 10857 Check Number 9402/07 7
7
This Section For Official Use Only
Building Permit Number: Date
Issued:
�/
Signature: S- �/ -//l
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
Frontage j
Setbacks Front
Side L:I J R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot arca minus bldg&paved
parking)
#of Parking Spaces
Fill: ---- f
(volume&Location) -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
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#�
B. Does the site contain a brook, body of water or wetlands? NO O 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:
C. Do any signs exist on the property? YES O NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I 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) n Roofing n
Or Doors IM
Accessory Bldg. 0 Demolition ❑ New Signs [O] Decks [q Siding[DI Other[O]
Brief Description of Proposed
Work: Replace 3 Patio Doors
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
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
Nancy Whitley ,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 5/18/17
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 pain d penalties of perjury.
JAIM ORIN
Print Name
5/18/17
Signature of Owner/Agen Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: JAIME MORIN 90125
License Number
30 F. b-s Rd. , Northborough, MA 01532 10-06-18
Address Expiration Date
508-351-2277
Signatur- Telephone
""`°•S°.L s;' a'u X+� 2.'s-^>�.avL-ha Not Applicable 0
RENEWAL BY ANDERSEN 170810
Company Name Registration Number
30 FO ES ROAD NORTHBORO,MA 01532 12-23-17
Address Expiration Date
Telephones 0 8-3 51-2 2 7 7
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 t No 0
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 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 Budding 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 shaff be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 144 Riverbank Rd.
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
5/18/17
Date nature of Permit Applicant
Renewal Agreement Document and Payment Terms
&AJn' dime Renewal by Andersen of Boston Nancy Whitley
Legal Name:Renewal by Andersen LK 144 riverbank Rd
}
HIC
s 30 e70810 Northampton13)53 - .64 01060
neaen senate 30 Forbes Road I NmtM1borough,MA 01532 H:(413)530-3064
Phone:508-351-22001 Fax:(508)986-7072 l rhabostonegmaitmm
Buyer(s)Name: Nancy Whitley Contract Date 05/16/17
Buyer(s)Street Address: 144 riverbank Rd, Northampton, MA 01060
Primary Telephone Number: (413)530-3064 Secondary Telephone Number:
primary Email: nbwhitleyegmail.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("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment
Terms,any documents listed in the Table of Contents,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: 510,857 By signing this Agreement,you acknowledge that the Balance Due,and the Amount
Financed must be made by personal check,bank check,credit card,or cash.
Deposit Received: 53,618
Balance Due: $1,239 Estimated Start: Estimated Completion:
Amount Financed: $0 8 weeks 2 days
Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on
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
and rime at a later date. Rain and MIMIC weather are the most common causes for
delay.
Notes: Visa; 1/3dep53618; 1/3startS3618; 1/3subcomp$3618
Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there arc no verbal
understandings 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) I)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 BUYER 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 05/19/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,
WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN
EXPLANATION
y AOF Tn HIS RIGHT.
dba:Renewal by Andersen of Boston Berv(rl
Signature of Sales Person Signature Signature
Brandon Harvey Nancy Whitley
Print Name of Sales Person Print Name Print Name
UPDATED: 0 5/1 6/1 7 Page 1 / 23
Renewal� Itemized Order Receipt
byAndert dim Renewal by Andenen of Renee Nancy Whitley
��,�,�aa..�,s�a Legal Name:Renewal by Andersen LLC 144 riverbank Rd
-1pl. HIC 0170810 Northampton,MA 01060
nom et even 30 Forbes Road I Northborough,MA 01532 (413)530-3064
Phone'.508-351-22001 Fax (508)98620221 rbabostonOgmail cow
IDA'. ROOM: DETAILS'.
1018 Living Patio Door: Gliding, 400 Series Frenchwood, 2 Panel, Active/
Stationary, Exterior White, Interior Pine, Glass: All Sash.
Tempered High Peri. SmartSun Glass, No Pattern, Hardware:
Tribeca®, White, Screen: Retractable, Grille Style: No Grilles,
Misc: None
101b Living Patio Door: Gliding, 400 Series Frenchwood, 1 Panel,
Stationary, Exterior White, Interior Pine, Glass: All Sash.
Tempered High Pert. SmartSun Glass, No Pattern, Grille Style:
No Grilles, Misc: None
102 Kitchen Patio Door: Gliding, 400 Series Frenchwood, 2 Panel, Active/
Stationary, Exterior White, Interior Pine, Glass: All Sash'.
Tempered High Per/ SmartSun Glass, No Pattern, Hardware:
Tribeca®, White, Screen: Retractable, Grille Style: No Grilles,
Misc: None
WINDOWS:0 PATIO DOORS:3 SPECIALTY 0 MISC:0 TOTAL $10,857
Renewal by Andersen is committed to our customers'safety by
complying with the rules and lead-safe work practices specified by the EPA.
UPDATED: 05/16/17 Page 4/ 23
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