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31A-123 19 FORBES AVE BP-2019-1316 GIs#: COMMONWEALTH OF MASSACHUSETTS MazIllock: 31A- 123 CITY OF NORTHAMPTON Lot: .001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateeorr. window replaced BUILDING PERMIT Permit# BP-2019-1316 Proiect# JS-2019-002124 Est.Cost:$18000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: BRIAN WORGESS 106973 Lot Sizelsm. ft.): 10018.80 Owner: MARY ANN KELLY Zoninw URB(100)/ Applicant. BRIAN WORGESS AT. 19 FORBES AVE Applicant Address: Phone: Insurance: 680 BAY RD (508) 680-6271 SOLE PROPRIETOR AMHERSTMA01002 ISSUED ON:5/23/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.INSTALL 19 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 Ilcoartment 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 5/2320190:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner RECEIVED 60 a(-)bOWS Department use only City of No ham orf,AY 2 U s ws g Perms: Building D parter,l 2019 c Cu Driveway Perk 212 Mai i Street Se verleiiptic Availability Roo 10(r,OF BUILDIW INSPEcI-5 jerAN Il Availabiliy Northampto A OTOBMAUPTON.MAm m Se of Stuciuml Plam phone 413587-1240 Fax 413-587-1272 Plot/Site Plans Omer Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMA;pN 1.1 Proga y Adchess: This segdgg to be ocan M by office Map 3(lq Let 1;;,3 Unit Zone Overlay District Elm to Dbtrkr CB Dhdvkt SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Regard: y (G�L, l 1 ling P1I0 .Lr me(Print) Current rnaiYrg'AZms: r �r 3—Tam-ire /� t- T� Sgneture 2.2 Authorized Agent: ��//�� I /I U1V4v�/ L.TeRb/�,SS (p$'d �a9`>' Q�. WAvt�; Ill Name(P Comes MOM Atldas, (sob) GFa-6Z�1 Sgneture Telephone SEC710N 3-ESTIMATED CONSTRUCTION COSTS INm Estimated Cost(Dollars)to be Oficial Use Only moors letedb permit applicant 1. Building :1 000 (a)Building Perk Fee 2. Electi l O (b)Estimated Total Cost of Constmciion from fi 3. Plumbing 0 Building Permit Fee 4. Mechanical(HVAC) ^ 1 5.Fire Protection L 6. Total=(1 +2+3+4+5) OJ fi OoO Check Number This Section For Official Use On Building Permit Num Dab Issued: Signature: �✓"23'��� Balding Currvriksionerllrnper4or of Brddig, DB! Wo rq Cr,So Lj,)c t.+1 @ ILII . LOK^ EMAIL ADDRESS(RE IRED; EITHER HOMEOWNER OR CONTRACTOR) b-LhliUI)5 -79 E DESCRIPTION OF PROPOSED W K ichmk all applical, New House ❑ Addition ❑ Replacement Wieawa Altanlion(s) Q Roofing ❑ Or Doors 10 Aocesaory BMg. ❑ Dania ❑ New Signs [01 Decks [O Sldingl0l Otherlla Brief Description of Proposed n I �n1 Work'. M1t�lo.ce / _I 1, 3W O tn1S Alteration of existing bedroom_Yes K No Adding new bedroom_Yes X No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet M.M New house and or addition to existing housing.Complete the following a. Use of buikling 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? I, Method of heating? Fireplaces or Woodstowfs Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. Is constmctlon within 1 OO tl.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. Sepbc Tank_ City Sewer_ Private well_ City"ter Supply SECTION Ta-OWNER AUTHORIZAT10N-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property rarely authorize r/ v �'VL� ll//J� 1¢gIX on my be tl,in ell ma rs re five to work autho ed by this building permit application. �/ Sggn/natatureoAm ger —�� /)ttC(/ as Owner,Authommil Agent hereby declare that the statements and information on the foregoing application aro true and accurate,to the best of my knowledge and belief. Signeder the pains and penalties ofp egury. 51p1p, }AoP T (,JDA6tSS Print Name Si neWre of GarIlafti Data - - - i ,, i . . �t. .. •,p r� 4 1 City of Northampton I' •,.P Massachusetts '1 ta'12 Min OF mmZLDZBG l BuillZONS n, \ 212 IYin attest • Wn 010 auildivq aos'thrvptm, Ma 01060 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"reconstruction,alteration, renovation, repair, modernization, conversion, improvement, removal,demolition,or construcUm of an addition to anypre-existing owner-0ccupied building containing at least one but not more than four dwelling units .m to structures which are adjacent to such residence orbuilding"be done by registered contractors. Note:Lfthe homWeownfer has contracted with d a corporation or LLC that entity must be registered. Type of Work: Rep LerM .t/f 01 Alum)$ Est,Cost: A-61000 Address of Work: GS 4'FJ Date of Permit Application: I hereby certify that: Registration is not required fm the following resson(s): Work excluded by law(explain): _]ob under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME 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 RESPONSHRUTES 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/ f�,� g r-, lQrj L'IlgGss g�Zo 7- Date Contractor Name MC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature J [ ':lil'. Rai � 11 E.. . Uicy or norcnalmpcon Q12 2 Na_aaachvartts _ J�c4 1 N YT OF BUILDING ZNSP�lIONS `�=`s 213 Winaetiwt •Nuninigl euildiq vo:tEupt®, w 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c40, 554, I admowledge 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"on!construction work being performed at: I R FrlVV- lgve . (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dpmpster onsite rented or leased from. (Company Name and Address) �Q J LL� Signatur of Permit Appli9fint or Owner Date If,for any reason, the debris will not be disposed of as indicated,the Applicant or Owner stall notify the Building Department as to the location where the debris will be disposed. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ( `) p Not Applicable 0 Name at License Holds Q1C I t9n1 („)o Ii G£SS r 5— 10(A:�3 � Umw Number 0 Q4 3A°( (eo. ►-Lgks-r eA A Oloo2- 3 31 /21 ( a) 630-�Z�l imxason SgnaNm Telephone 9.Realalded Home lm vwmd Conbaefa n Not Applicable 0 131t(94rJ I.) oRGfSS IF Zo 4- Company Nam Registration Number 631) N Rd I I I Z-0 Address I Expiration DaM �— {r'�YV� s'T /�Z Tebphane � SECTION 10•WORKERS'COMPENSATION INSURANCE AFFIDAVIT Ill a.152,§25C(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....... 0 No...... 0 Section 4. ZONING All Informadan Must Be Completed.Permit Can Be Denied Due To Incomplete IMomintbn Existing Proposed Required by Zoning TTis column to bcfilled in by Building Depmenmt Lot Size Fronts e Setbacks Front Side L: R: L R: Rear Building Height Bldg.Square Footage % Open Space Footage % (la atv minus bldg a pared putting) r of Parking Spaous Fill: volume&U ceiimi 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 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 © NO O IF YES,describe size, type and location: E. Wit the construdion adivily disturb(deanng,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb aver lase? YESO NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. � i _ _ _ The Commonweafth ofMassachusens Department oflndustriafAccidents I Congress Street,Suite 100 Boston,AIA 02114-2017 www.mass.gov/dia Wil.ekers'Compensation Insurance Affidavit:Builders/Conhactors/Eleetricians/Plumbers. TO BE FILED WITH THE MRNUTTING AUTHORITY. eAformatio. Please P ' t tegibIv Name(Business/orgareradonandivldual): 0 'S DLJo%t{41uJG Address: (&go &9q RJ y-fpTI,If4�ST City/State/Zip: $T94 Vq OlooZphone k: 0FSb -6Z�/ Arcyoa ee mpbrerrOakthe eDProPrYb boa: of ro (required): Type P 1eet(rs9 k 1.❑iemeemplga wlM emplgm(fWl mdrorpm-time).• 7. []New construction 2�esole pmpritte or pemwisldp eMheve nc emplgas wadtirig formeiv g, ❑Remodeling say capeany.[No workers'compinmrerce n,uired.] 3.❑tare ahomaw�wrdoing alwmk myself'.INo wmkeri comp.imumnce retainer]' 9. El Demolition a.❑l em a homeowmererd will be hying comncmrsm roMuct all work an my pmperry. l will 10[JBuilding addition enswe thmall wnbecrors either have workers'compemetion insuraae+rare sole Il.❑Electrical repairs or additions pro'ea s wire no employees. 12.C]Plumbing repairs or additions 5.❑I am a general conoanor and I lave NnE the ail ovabactors listed an as amchd sheet near susconoaomrs have ambers am have workers'comp.irwaana.t 13.�Roof repairs // 6f]We ere a cnrporationand its oRcera have aseneal then right of exemption per MGL e. 14.ff0th,, . J3,1aJ r'C V 152,§1(4),aM we have no employes.Mo workers'comp insurance required.] 'My apPlicint tar alecks box tl must am fill outd a senior below slowing noir workers'cornpereation poli,iNornuda n. t H...who submit this affidavit irdirating they are doing all work and than hire ouaide conoanors must submit a new affidavit indicating such. :Contractors that check this box must attached in additiorel sheet srswing us,rens of the subcontractors and nae whedar or not uses asitia have employees. Ifthe Utio nuacbrs Mve emplgas,tley mast provide their weakec'comp.poli,number. I am an emptoyer thW is providing workers'rompensadon insurance for my employees Below is the policy a ufjob site information. 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 order MGL a 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 ofthis statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby cardunder the pains and penddes of perjury that the information provided above is true and correct Sirmature' I) Dore, 0,21boll Phone 4, (5 ) 6� GZ�� / �— Official use only. Do mnwMe In this area,to be completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Correct Person: Phone#: J � i Han Ory Item Size(Operation) _ - _Location Link Prim ExL Price 0011 1 P 4'31/4"x 5'01/2"(F) Water Bedroom Picture window $ 784.54 $ 78454 ROSize=4.33/4"Wx5'1"H Unit Size=4'31/4"Wx5'01/2"H 400 Series Unit,Casement Picture, No Flange w/Installation Kt,White/White- Factory Painted, High Performance Low-E4 19 2ofw:Northern Ylaab harlr Exterior U.Factoc 0.26. SHGO:0.34, ENERGY STARS Codified:Yea Subtotal $ 11,751. Total Load Factor Tax(6.250%) $ 734,40 Customer Signature 3.643 Grand Total $ 12,466,31 Dealer Signature "All graphics viewed from the exterior Rough opening dimensions are minimums and may need to be Increased to allow for use of building wraps or flashings or sill panning or brackets or fasteners or other items. ® Ask to see if all of the products you purchase can be upgraded to be ENERGY STARS certified. 19 This image Indicates that the product eNeolad is certified in the US ENERGY STARS climate zone mel you he"selected. Data is current as of December 2018.This dela may change over time due to ongoing product charges or undated test results or reagmrements. Rounds for all sizes are specified by NFRC for testing and coni ation.Ratings may vary depending on Me use of tempered glass or entered grille options or glass for high studies etc. Nexia is a registered trademark of Ingersoll Rand Inc. Project Comments: Quote 4: 470 Print Date: 04/10/2019 Page 501 5 iQ Version: 19.0 Item Gty Item Size(Operation) Location Unit Price Ext.Price 0003 1 TWI 2'9 1/8"x 5'4 5/8"-8 Deg(AA) Green Room If 656.48 $ 656.48 Existing Opening Size:2'9 1/2"W x 6'4 7/8"H Unit Size:2'9 1/8"W x 5'4 5/8"H -. 400 Series Unit,Th-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash) Full Insect Screen,White wxwM tram aamwr Zone:Northern U-Factor:0.30. SHGC:0.32, ENERGYSTARSCemlied:No 0002 1 TWI 2'91/8"x S'4 3/4"-8 Deg(AA) Green Room $ 656AS $ 856.48 Existing Opening Size:TO M"W x 5'5"H Unit Sim:2'9 1/8"W x 5'4 314"H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,White w.wre from Emrlor Zone:Northern U-Factor:0.30, SHGC:0.32, ENERGY STARS Certified:No 0004 1 TWI 3'3 1/8"x 5'4 3/4"-8 Deg(AA) Green Room $ 65BAS E 656.46 Existing Opening Size:T3 M"W x 5'6"H Unit Size:T3 1/V'W x 5'4 3W'H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,While Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,White Yl w from Ea , Zone:Northern U-Factor:0.30, SHGC:0.32, ENERGY STARR Certified:No Quote#: 470 Print Date: 04/10/2019 Page 4Of 5 IQ Version: 19.0 Item _ _O Item Size(Operation) Location Unit Price Ext.Price 0009 1 TWI TO 5/8"x TO 3/4"-8 Deg(AA) Master Bedroom S 585.70 8 585.70 Exiseng Opening Size:2'10"W x 5'1"H Unit Size:2'9 5/8"W x 5'0 3/4"H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,White Aa tram Eaerlor Zone:Northern U-Fector:0.30, SHGC:0.32, ENERGY STAROCertitied:No 0007 1 TWA 2'71/8"x 5'4 3/4"-8 Deg(AA) Bathroom let Floor $ 585.70 S 585.70 Existing Opening Size:2'71/2"W x5'5"H Unit Size:2'7 118"W x 5'43/4"H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,While Y een rraln Extmlor Zana:Northern U-Factor:0.30, SHGC:0.32, ENERGY STAR®Certified:No 0005 1 TM 2'7 7/8"x 5'l 1/4"-8 Deg(AA) Kitchen 8 585.70 E 585.70 Existing Opening Size:2'8 1/4"W x 5'l 1/2"H Unit Size:2'7 71V'W x T1 1/4"H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash) Full Insect Screen,White wowed from E~. Zone:Northern U-Factor:0.30, SHGC:0.32, ENERGY STARD Certified:No Quote#: 470 Prim Date: 04/10/2019 Page 301 5 10 Version: 19.0 Item City Rem Size(Operation) Location Unit Price Ext.Price 0001 3 TWI r 911'x S'4 3/4"-8 Deg(AA) Front Room $ 556.48 S 1969.44 Existing Opening Sim:7 912"W x 5'5"H Unit Size:2'9 1/W'W x S'4 3/4"H - 400 Series Unit,TIR-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,White YNwa 1mm Eawlw Zone:Northern U-Fador:0.30, SHGC:0.32, ENERGY STARS,Certified:No 0006 4 TWA 2'71/8"x S'4 3A4'-8 Dag(AA) Kitchen $ 555.70 $ 2342.80 Existing Opening Size:2'712"W x 5'5"H Unit Size:2'711"W x 5'4 3/4"H 400 Series Unit, Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner, AA Handing, High Performance Low E4(Each Sash) Full Insect Screen,White vlea.4naa F-mrbr Zona:Northern U-Faclor:0.30, SHGC:0.32, ENERGY STARS Certified:No 0012 1 TWI 2'S 1/5"x5'03/4"-8 Deg(AA) Master Bath $ 585.705 595.70 Existing Opening Size:2'5 1/2"W x 15'11"H Unit Size:2'5 1/8"W x 5'0 3/4"H 400 Series Unit,Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing,High Performance Low-E4(Each Sash) Full Insect Screen,White Y1ewe4 Yom Exactor Zone:Northern U-Fador:0.30, SHGC:0.32, ENERGY STARACerlified:No Quote#: 470 Print Date: 04/10/2019 Page 2Of 5 iQ Version: 19.0 09 Andersen Windows -Abbreviated Quote Report Artdasuyt. Project Name: Mary Ann Kelly Quote t. azo Print Dare: O4/1012019 Quote Date: 11418/2019 iO version: 19.0 Dealer: Customer: Robert Walker/Construct Assoc. Inc. Billing Address: Phone: Fax: Solea Rep: Christopher J Skiathitis Contact: Created By: Trade ID: 011783 Promotion Code: Item Qj Item Size(Opemtlon) Lopilon Unit Price Ext.Price 0013 2 TWI 2'91/8"x4'51/8"-8 Dog(AA) Aft OHbe $ 585.70 $ 1171.40 Existing Opening Size:2'9 1/2"W x 4'5 3/8"H Unit Size:2'9 11W'W x 4'51/8"H 400 Series Unit, Tilt-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low E4(Each Sash) _. _. Halt Insect Screen,White VIw,Wfmm Eraarlar Zone:Northern U-Factor:0.30, SHGC:0.32, ENERGY STARS Certified:No 0008 2 TWI 2'7 1/8"x 5'0 3/4"-8 Deg(AA) Master Bedroom $ 585.70 t 1171.40 Existing Opening Size:2'7 1Z'W x 5'1"H Unit Size:2'7 1/8"W x 5'0 3/4"H 400 Series Unit,TIB-Wash Insert Equal Sash Unit,White/Pre-finished White,White Liner,AA Handing, High Performance Low-E4(Each Sash) Full Insect Screen,White Zone:Northern U-Factor:0.30, SHGC:0.32, ENERGY STARD Certified:No Quote#: 470 Print Date: 04/10/2019 Page lot 5 iQ Version: 19.0