25C-130 (5) 32 ELIZABETH ST BP-2019-1395
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 130 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Categorv: window replaced BUILDING PERMIT
Permi # BP-2019-1395
Project# JS-2019-002239
Est.Cost:$8924.00
Fee:$40.0o PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Gnmir TOM CARTER 052769
Lot Size(sa. ft.), 3397.68 Owner: FISHER HARRY 1 JR&SEBERN F TRUSTEES
Zoning:URB(100 Applicant: TOM CARTER
AT: 32 ELIZABETH ST
Applicant Address: Phone: Insurance:
19 CAROL LANE (413) 775-0139
GREENFIELDMA01301 ISSUED ON.61612019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 21 REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector or 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 Occuoancv Signature:
FeeTvne: Date Paid: Amount:
Building 6/6/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
City p cR EC E I V Department use only
Ci of North t sot ermit
.,r Building Dep e t Cur C riveway Permit
212 Main S a JUN _ ?�,i S r/Se 'c Availability
Room 1 W rANe Availability
Northampton, M 01 of
f Structural Plana
phone 413587-1240 F 4'HiatPtP ��Ns�. rte ns
NOOTHPII', N.VA""
Br Speedy
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prw
ort r Addrear / This section to be completed by alfiw
-; fAEli z4 Map '2 Lot / d, Und
Zone Overlay District
Elm at.phot CS DW&k
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: /`ate No0"AlfQ�1J I KRE-U7 (ZEAL f574TK
4 N, jWu FSHD 34 aj-ZA tCW S7"
Nema(P ) uoentMelt lo6n
yoA� Aprok))�rpp/M a
SignatureTe"#"
t2/ 1 1 �G�d ( CG7 c 0 /'re-1 d
N Current Melling Address:
` (12� 4t3 _27 ) — 0 / -2 !5Sigma Telephone
SECTION 3-ESTIMATED CONSTRucrwhl 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 p �/
Construction from 6 ( Z`l
3. Plumbing Building Permit Fes
4. Mechanical(HVAC)
5. Fire Protection
6. Total =(1 +2+3+4+5) Check Number 7
This Section For Official Use Only
Building Permit Num r: Date
Issued*
Signature: C- 5-zm
+ Building Commisslenemmpector of Buildings Date
I C /
1 ( . / i 51_ @ �tCrzcy -, _.t, -�
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicablel
New Mouse ❑ Addition ❑ ReplecemeM a dowe Alteralmn(s) Roofing
Or Doors
Accessory Bldg, ❑ Demolition ❑ New Signs 01 Decks ED SIdIng® Other([a
Brief Description M Proposed 1l
Work: n 3 *4 ul \ Z /'G� �4 cC n. rJ.� L✓r�1 � dc(/! ^ 2 ci
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No 1�C
Attached Narrative Renovating unfinished basement Yea No
Plans Attached Roll -Sheet
as. If Now house and or addition to existina housina, Gempl!fho followin
a. Use of building: One Family Two Family Other
b. Number o/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?
U Method of healing? Fireplaces or Woodatoves 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? Vee No.
I. Septic Tank_ City Sevier Private well City water Supply
SECTION 7a-OWNER AIfTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BIALDING PERMIT
/ 0 0
I, ;iV, 711
VfT ..Omer of the sublet[
properly
hereby authorize
to act on my behag, in m ens relative to work authorized by this building permit apqicaUon.
$ 15 19
Slgratureo/ ner Date
I, 1 &r-, pla / 4-t/ ,as Ovmer/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 thepains an aities of perjury.
Print Name
Sigraturo of Ovmar/ M Deb
N,1".kr9.
SECTION 8-CONSTRUCTION SERVICES
9.1 Licensed Construction Supervisor: Not Applicable 13Name of License Homer Tom Caner - CS Jic� -76 J
Windows $ Do0rs License Number
19 Qvol Lane S— L J
m ant
Address �� 1 (— f' � - Elgwretlon Date
sign w. Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
IS4Lo
Company Name .I� �, „t11.5 Registration Number
7" 17- IS
Address - - -' Expiration Date
Telephone
SECTION to-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L a 15Z§25C(8))
Workers Compensation Insurance affidavit t 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..._.. Er No...... ❑
_ ..
- - -
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ENERGY •o Certffied in Highlighted Regions
■crrtlflra
NORTHMND N
DOUBLE HUNG
ENERGY ADVANTAGE
Vinyl frame, Double glazed,
Low E coating(e•0.027, S2(,
" co[ax Argonlalrfilled/Dividem
tr -I"0ee2-00002
ENERGY PERFORMANCE RATINGS
U-Factor(U.SA-P) Solar Heat Gain Coefficient
0.2' 1 0.25
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0.46
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�\ The Commonwealth of Massachusetts
Department of IndushinfAccidents
I Congress Street,Smite 100
Boston,MA 01114-2017
www.mass.gov/dia
Ulkirkers' Compenhation Insurance Affidavit:Buildem/Contractors/Ekct icians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Inforination Please Print Legibly
nm L after
Name(Business/OtganirationflndividualV\/'
19 Lane
Address: Greenfi L' !,'d_r1�' )l
City/State/Zip: Phone#:
Are You sm mrproyroI Check the approprmare box. Type of project(required):
I.❑1 s employer with emplmyces(fua and/or psn ime).r 7. ❑New construction
2 lamazole proprietororpannership and have no employees working formeN S. BRemodeling
any capacity,[No workers'camp.insurance required] —
301 em a hmmeowaerdmng all work m5 elf.[No wmkets'comp,imu m required.!t 9. Demolition
401 ane a homeowner and will b,bring counties to mndun all work on my property. twill ]0�Building addition
.sure m#all contrvx.mther have workers'eempemeatcn mt.m or ere Is 11.❑Electrical repairs or additions
proprietors with no employees 12.[]Plumbing repairs or additions
501.. vocerm contractorarW!have hired the subcontmcWra listed me the aftwhed sheet ]3.�Rtwfre
These sub-manusmos have employees and have wod 'comp.insurance? pairs
6,[:]W.me..pommm and its offmershave exercisedmeir rightofexemption per MGL C. 14.E]Other
152,§I(4),and we hive no employees.IN.workers'comp.n comae required]
*Any spplium met check¢box#1 met also fill out the section below showing their workes'compematim policy mdbrmmi..
t Homeowners who submit this eRdavit indicating they are doing an work and then him outside conbectora must sobmh....nliidavit indicating such.
IComroacm then check Ws box most mtaahed so additional sheet showing the name ofthe sub-comrsttors and state whetherornot those entities have
employees. If me sub-comrscton have employee,they menu provide the, workers comp.policy mm"her.
I am an employer that is providing workers'ermrpensation insurance for my employees. Below is the policy and job site
informatlo2
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Daze:
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 become 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
I do hereby cerafy un e pains �that the information provided above is true and correct.
Si /Irv! Date
Phone#
Official use only. Do rtot mite in this area,to be completed by city or foam 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
G Other
Contact Person: Phone#:
�i
: 21 n.' I ! a.i�.l/y -. Uaojlui, Ia 'ai.1.. •tl: t+ -:,; _L:'�ll.•al 11y ..GV Ir aap:.;: l itV 4" Lf
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Massachusetts
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ISPAa'D@a4 Car BOTCHING MSPBC WS
212 r n atNs t .Municipal Bu 1l n
rthaYQ n, M 01060
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:
311�— r lI , 4 (p .tic, r6
(Please print house number and street name)
Is to be disposed of at: 11 � /� 1
( 7 f CC ) `f���1 r ti G1 1 r CG'N 7'c/' V.,
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signat re of Permit Applicant or Owner 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.
Wig1i
07 2PIli -4
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