36-044 (4) 19 WINCHESTER TER BP-2019.1272
GIs a: COMMONWEALTH OF MASSACHUSETTS
Migi.§ ck:36-044 CITY OF NORTHAMPTON
Lot, PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:window replaced BUILDING PERMIT
Per Au BP-2019-1272
Project it JS-2019-002059
Est.Cost$3300.0
Fee $65.00 PERMISSION IS HEREBY GRANTED TO.
const.Class: Contractor: License:
Use Grow PATRICK MCCLAY 089719
Lot Sim(sa.ft.): 10018.80 Owner: BLAKESLEY CLAIRE
Zoning, Applicant. PATRICK J MCCLAY
AT: 19 WINCHESTER TER
AnaiicantAfts.s2: hone: Insurance:
63 WALDO ST (413) 531-9921
HOLYOKEMA01040 ISSUED OtW5/17/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 11 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 0 Foundation:
DrN way Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough; M Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certfficate of Occuoanev So.-nature:
FeeTvoe: Date Paid: Amount:
Building 5/17/20190:00:00 865.00
212 Main Street,Phone(413)587.1240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
nE T- G-HRa.
li Mote
Department use only
City of No am ton UrbC
Permit
Building D part anh Driveway Permit
2t2 Mai Strt AY 1 p 2019 pticAvailabil y
Roo 100ll AvailabiliNorthampt , , M of Structural Plans
phone 413-587-124 �PBCT' Plans
A 010,0cify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION V op— .9 /� 72'
1.1 Property Address. This 2 /��section to be completed by office
If y{/j�/C�ST�� 1-11F,01! . Mapes Lot GT 7 Unit
Zone Overlay District
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
paki Fi✓E 6 KES y
Name(Print) Current Mailing Morass:
Telephone
Signature
2.2 Authorized Agent:
Name( np Current Mailing Address:
Q��GZYL /�K./_,L/_OXY_ df..
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) Y�
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Num r Date
4 42 Issued' O
Signature: 5- 17- �Il
jikling Commissioner/Inspector of Buildings Data
C
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING NI Information Must Be Completed.permit Can M Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column w be filld in by
Budding Department
Lot Size ....._..
Frontage
Setbacks Front --
—-
.
Side L R: L:'�.. R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage o
(Lot area minus bldg a paved
#ofTarking Spaces
Fill:
volwoe&Laetion
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O 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 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. WII the construction activity disturb(clearing,grading,excavation,of 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 S DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows AlteraUon(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [01 Decks [q Siding[0] Other(OI
Brief Descripfion pf Pro ose
Work 'A/�Yt1LL QEIDLALEK�A/r I�i.vAmWS
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
Q Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
t 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
I, DA�f.GEil/� /3aA.YL"S�rCy .as Owner of the subject
property 4 cA
hereby authorize
to act o behalf, in all matters relative to work authon by this building pe It plication.
Signature of Owner Data
1, AA�2CEg/E Bl.r>`iE2�S��/ 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.
ENE /3i.A�.S�c"
Print Nam
Signature of OwnedAgent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Superevisor: Not
rAppplicable 13Name of License Hold P&/`�eK -T '�/GCL�J ` -5 � CJ7 e
7/1
License Number
43, wf}c Ao O Ir-.aa -,leo.Ao
Address
/uCC Expiration Date
Ps.
Signature Telephone
9.Registered Home Imcrowment Co haclw: Not Applicable ❑
0-1eE-W1F -S f/d.KFCP.t'avc.�cc�y/' /VO V3 g
Company Name Registration Number
7 44T. -roM AVE, 3 el- R0,W
Address Expiration Date
ff e4-1/O/CE A4f Telephonei-i"W/
SECTION 70-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.152,f 26C(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.-...
r
City of Northampton
Massachusetts
L
' Ia:PAR1R1&NT 08 80ZLDZNG INSPBCTIONB
212 Nein street • mnici"l build nq
Nortaupton, Ha 01060 p
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstnrcticn,alteration,renovation,repair,modernization,conversion,
improvement,removal, demolition, or construction of an addition to any preexisfing owneroccupied building containing
at least one but not mare than lour dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors.
Note.If the homeowner has contracted with a corporation or LLC,that entity mast be registered
Type of Work: Est.Cost
Address of Work:
Date of permit Application:
1 hereby certify that
Registration is not required for the following reason(s):
_Work excluded by law(explain):
—Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owneroccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE ROME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIHH.ITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury.
I hereby apply for a building permit as the agent of the owner:
S--//9 wee "eiyiE.e /90 8 39
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, 1 hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton ,
T I
� Massachusetts
DNPBBT!ffiiT OF BUILDING INSFZCTIONS
212 Min street • l nieipsl BuildLy • � �
N rth ton, M 01060 \0
Massachusetts Residential Building Code
Section 110.115.1.2
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 fans structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner.
Section I IO.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR 11ORS, provided that if a homeowner engages a person(s)
for hive to do such work,then such homeowner shall act as supervisor.
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.
r City of Northampton
Massachusetts / t- •rte
F
DB'PARTI6NT OF BDILDING LNBplCTLONa �•� y
212 Min etrMt • nicipal Builtli�y
MorNUQtoMun, M 01060 n
Debris 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.
The debris from construction work being performed at:
(Please print house number and street name)
Is to be disposed of at:
1>. P VY ./Ytj"�Y PeNcl-W111
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
)Uay
Signatureure of Permit AApplicantpplicant or Omer Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth ofMassaehusetts
V11,firkers'Comperagation
Department ofIndustrialAccidents
1 Congress Street,Suite 100Boston, MA 01114-10177whrmanass.gov/dia
Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information /�a'y,p �I Please Print Legibly
Name (Business/Organlaationladividua0C
: 6N1ERS /41//L(E SAJ6& /��E
Address: 7 MT, TAM 40r .
City/State/Zip: Phone#: yI3`s3f' /pf-�1I
Are ya i a empta ma!Chert ere appropriate,ar: (required):
Typee of project(req ):
LE]I am a employer with employea(full antdlor pen-tool' 7. ❑New construction
2�Imawle propriermmpaanshipavdave mempbym working
thrown 8. Remodeling
any cation, (No workers comp.insurance required.)
3.❑1 am a amrownor doing all work mymlf.[No workers comp.insurance required.] 9. ❑Demolition
a.❑I aura homeowner and will be haasg movanos to coMart all work on my Milan, I will 10❑Building addition
ore that an conaacmrs eithaave woken compewlion ivawmmmare wlc 11.❑Electrical repairs or additions
pmpnelms with am emplorees. I2.❑Plumbing repairs or additions
5❑l an a general mnaworml l have hired the suhcomrecmrs listed on the attached sheet 13.�ROofrepairsa-
Thesesohteave
-e—moseloemand d havewodon'comp.mameni U�fN 1>00-5.1>00-56Q
We arc a coryoretion and its otf¢ s a
mve exercised their right ofemniptbper n MGL c. 14.❑Otho!
152,pllgl.and we have oo cmtrbYees.INm workers'comp.imurarce mquard.l
•Myepplicantttat cheeksax#I mustnlao Mind the section below showing thea workers'emaimoseaon policy au lima.
'norarownere who submit this affidavit indicating they are doing all work and Nen him outside cmnuamroa moat submit a new affidavit in iwting such.
:Contravors tat check this We moat atmehed m whimerrml sheet showing the amp of the sub-conbomors and shote whether or not Nose entities have
employees. If the subawnuacm.have employees,they oust provide area wor mos wrap.policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob.site
informotion.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
7 do hereby certify
runder
thepa' s anrdp�entilaesof perjury,that the information provided above ist
true and correct.
Signature: /'gyres/ WiA4k — Daze-
Phone N: y� zi— /rjl 'Alt.)/
Official use only. Do not write in this area,to be completed by city or town offrciat
City or Town: Permit/Licerew#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cityaown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trainee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)annals),address(es)and phone numbers)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,arc not required to tarty workers'compensation insurance. Han LLC or LLP does have
employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be maimed to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Seif-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
�� � 000 ' i X OS
ruusaC Page# of pages
pJ iHCC�f� y CAR PL iv 7— t/
PnnPOSN.BbYr1®T6. JOB NAME JO9e
OARGFJt/E 6�AKc SLE �
"IDDRISS EA oe to anox
l=LuRc�vc c ,ry¢ . oio6 �- pA>ES i—iy onJagBPtuas �
PHONE In //i 3 = .2/0 — 9� 3 3 taw.
e hereby submit specifications and estimates for:
I-/VSr/9LL i1 h'Ej��rlCc-.�rtniT wiNDorv= � 60�°d
19e propose hereby to furnish material and labor—complete in accordance with the above specifications for the sum of.
y Dollars
with payments to be mane as follows: F6'L
Anyaltembonm aewamo nom above succomatione involving aara cods Respectfully,
will bemaroetl omy upon waned drier,and will b�mean extacharye submitted >
rarer"dome ria¢somal¢. NI ageemenrs'armor rat upod sbiion.
adcidenn,or Raw beyaN our,ronbol. Note—this proposal may be withdrawn by oe if not accepted within
Oltteptante of Vropooat
The above prices,specifications and conditions are satistactury and are
hereby accepted. you are authorized to do the werk as specified.
Paymentswillbemade asoWlnedabove. Signei J11
Date of Acceptance �� ��� Sgnabi
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511512019 City of Northampton Mall-Winnows
0li of Kevin Ross <kross@norlhamplonma.gov>
1 Nortillucisysi
Windows
1 message
Kevin Ross<kross@northamptonma.gov> Tue, May 14,2019 at 4:38 PM
To:dcblakesley@gmail.com
"i 1-4
Good afternoon Darlene,
I am reviewing the permit application for replacement windows. I have a few questions regarding them.
-Are any of these windows located in areas requiring safety glazing per Section R308?If so, please provide details on their
locations.
-Will any of the windows require fall protection devices per Section R312? If so, please provide details on their locations and
type of devices proposed.
-Are any of these windows in a room requiring Emergency Escape and Rescue Openings per section R310?Please provide
details.
-Will any of the existing framed openings be modified to accept the new windows? If so please provide details.
Any questions please let me know.
Thank you,
Kevin Ross
Local Building Inspector
212 Main Street 587-1240
Northampton,MA 01060 Fax 587-1272
kross@northamptonma.gov
htlps://mail.google.WWMIUUM?ik=6c393b23db&view=pt&search=all&pe.Mld=thenad.%3NL47003892629145969&simpl=msg-a%3 -846000916... 1/1