17C-175 (6) 26 FAIRFIELD AVE ! BP-2020-0412
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C.-175 CITY OF NORTilIAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED,CONTRACTORS
Permit: , Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate or : REPLACEMENT WINDOWS/DOORS BUILDING PERMIT
Permit# BP-2020-0412
Project# JS-2020=000698
Est.Cost: $8572.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LAWRENCE VOSS 007048
Lot size(sq.ft.): 5314.32 Owner: BARR DOROTHY
tonin_. URB(100)/ Applicant: LAWRENCE VOSS
AT 26 FAIRFIELD AVE
Applicant Address: Phone: Insurance:
298 E HARTFORD AVE .(508) 523-3599 WC
UXBRIDGEMA01569 ISSUED ON.101112019 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE 2 SLIDING DOORS AND 3 DOUBLE
HUNG WINDOWS
POST THIS CARD SO IT IS I ISIBLE FROM THE STREET
Inspector.of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough:1 House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
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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 GULATIONS:
Certificate of Occupancy signature:
FeeType: Date Paid: Amount:
Building 10/1/2019 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (4 L3)587-1 72
Louis Hasbrouck—Building Commissioner
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_ ,3, arDeps�rtme �iseoFlly xr tb ' � � "
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City of Northampton
. •' Status cf P�hmt: "'i1 f r t e i x e 4'Ne ` i r+ hxl gy
� > BuildingDe artmen ` x
p �uwrnieway Permit n
212 Main Street e b A"71
vpb�hty •- �' , , �-, �' '. "_'�z' r
Room 100 OCT
Water a vad Northampton, MA 0060 T� ets Strua)Plans _ 1 s
phone 413-587-1240 Fax 4x13-5 �7-91272 Pfotite ar►s a 'x ' ` '�; `� , }
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4111
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APPLICATION TO CONSTRUCT,ALTER,-REMVIl,,RENO AMa @S A NE�OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
1.1 Property Address:
,Tl I section to be completed by office
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'Z L t-A l VL(�(� Map�� Lot Urnt
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4
Zone Overlay Dtstnct
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
F �
2.1 Owner of Record:
Name(Print) Current Mailing Address: T
Telephone/ � �7 /
Signature C.�
2.2 Authorized Agent:
Na a(Print) Current Mailing Address:1 1 y� � I D�F A l)� 0 1-9�
C 001, '4 V M�` `v 1
Sign ture Telephone
SECTION 3-=ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Offiaal Use Only
completed b permit applicant
1. Building (a)'.Buddmg Perm�t:fee ,.
2. Electrical (b)Estimated TotalCost of:
Constructiow om 6
3. Plumbing Building Permit Fee t
4. Mechanical(HVAC)
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5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
4 This Section For. cial,:Use Onl
Date
Building Permit Numb' issued.
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Signature
Building Commissioner/Inspector of 13w(dmgs. .`: `.Date
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EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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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
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Frontage
Setbacks Front �� I
Side Li= R:= L:= R:=
Rear 0 0
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Building Height
Bldg.Square Footage010
Open Space Footage
(Lot area minus bldg&paved i
parking)
#of Parking Spaces 0
Fill:
volume&Location)
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A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Pagel and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW I* YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
®
C. Do any signs exist on the property? YES 0 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 0 NO 0
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 0 NO 0 II
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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SECTIOK&DESCRIPTION OF PROPOSSED WORK kheck all applicable)
New House [] Addition ❑ ReplacementWo6dows Alterations) Roofing
Or Doors A
Accessory Bldg. ❑ Demolition ❑ New Signs M Decks [M Siding[0] Other[d]
Brief Description of Propwed 2 SLt l��7 f700�S
Work: CC ily'v e7\/11 0 d LG 'N 0,N] a �I n � N b�6�2l�ry fl1V�mF
Alteration of existing bedroom Yes No Adding new bedroom Yes �No NO
Attached Narrative Renovating unfinished basement I es %1�_No
Plans Attached Roll -Sheet 9
sxlf Newti"ouselnidor;aldsJitottQ irxtstinghotisfrig ciri`p[ete titef+�llowtnq
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
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e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves i Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction a
L Is construction within 100 ft.of wetta ds? Yes No. Is construction within 100 yr. floodplain Yes No
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j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building nd Zoning regulations? Yes No_
I. Septic Tank City Sewer Private well City water Supply
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SECTION 7a OWNER AUTHORIZATIONTO BE COMPLETED WHEN
OWNERS AGENT OR CONIRACTOR:'API bb I=OR BUILDING PERMIT
as Owner of the subject
property
hereby authorize _ r-x/L r �� D S S
to act on my behalf,in all matters relative to work authorized by this building permit application. I
OMi�Li
Signature of Owner Date I
I, V-f VV,V-CF/\(G 7. De,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 erjury.
Pnnt ame
tk-LC
Signatureof Owner/Agent Date
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SECTION 8 CONSTRUCTION SERVICES �
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: UA 1S1r 2 G/ (
License Number
24' -� fi L L>leBPi p<�F �
Address Bipiration Date
`L 8 e-A
Signature Telephone I
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49.=Reg�seied.Home=.ImprovementContractor• „. �, F3 { G .z � NotAppiicable El
Company Name Registration Number
Z52- rf-Gl- I - � /nJ(�//1n� C�l l�� 12-/ C.-I 19
Address T'— Expiration Da e
X oo �( 7��o
Telephone
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SECTION 10 WORKERS'COMPENSATION INSURANCE AFPIDAVIT(M
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...... ❑
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City of Northampton
:;.. Massachusetts
' DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal suilding y�; +
Northampton, MA 01060 ^�
Debris Disposal Af f idavi t
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:
Zb I(L C_j -
(Please print house number an street name)
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Is to be disposed of at:
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P151 Al 14 cT 6'j6 37
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
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(Company Name and Address)
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Signature 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.
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�{ 'C; PEOPLES PRODUCTS,INC.
Year House Built •
� ` www PeoptesProductsReviews.com
NOME OF THE HR40 W]kDOW 252 Hartford Avenue
Newington,Cr06111
USETTS
MASSACHAGREEMENT CT Vic#532341•MA tic#158194
r 1-800-354.7660
Thousands of Satisfied Customers . of
NAME:
PHONdH)G17•uC/0�J DATE. 3
L?QOTv ' �, A Rig. Iwl
The andhrsigned Contractor agrees to furnish all material and/or labor nec sary for the work(specified below)on premises locatedat
No. K �1i12lltt;c-tD� AQ.6 Oty tld+✓c State—
zip —`�cate
Specifications of Work: It/400E + pt Aw.'o X. wr.aro ow s i 57>2
�. ftltrrC S7Y[tS all1Q.Q0 r6 cash Pric �Q S 'Z' T
Deposit
P,.In atfonlospection$
x D,jf*'N6 1J0 61t145 t d+A7 W'4r IL014 Payal le on Completion g 5'71 y
aZ $IaC�rT y�Ry
ASSfie' 6 Bala ce to be Financed s
Totall 5 57
if an amount financed,finance charges
Specifications of Materials:Type,brand,grade) Au— t✓Z.,&9--, u2ti are distiosed in financing documents
6& 1� U&A7 Agor"r& re'rrsAk�;Gc'6Y 4- .atm. Lf-A4A-e-S o0?z *X—ZU"re40
JOt?`Ca 1Xr26riv iNNyG <aZQ. '0.0 a AAA-0U44 c?,G ger— lea ui )` NJ
[AES ❑NO t would likl to receive product updates and specials via email. email addr s. I Cm-%
Reconnecting of alarms painting or staining is buyers responsibility. Start Date: I 1 Z 3
`3 _
Contrac rvice Guarantee ...........IlYear Manufacturer Warranty Coverage!
earls)
It i turther agreed that performance of this Agreement is subject to labor strikes,fires,wars,acts of God,ability to obtain ma ial
fir vor force aro y oto rdreumstances not reasonably within the control of the Contracto �.
itis further agreed that this Agreement contains the entire agreement of the parties,that.all prior negotiations,agreemen and
understandings have been merged in or superseded.by this Agreement and that no representation,warranties or uncle ` ndings
of an '" ail be binding on either party unless incorporated in writing in this Agreement.
NOTICE:ANY HOLDER C F THIS CONSUMER S AND DEFENSES WHiCH
THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED PURSUANT HERETO OR WiTH
THE PROCEEDS HEREOF,tiECOVERY HEREUNDER BYTHE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BYTHE DEBTOR
HEREUNDER. If
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
YOU,THE BUYER,MAY GiNCELTHISTRANSACTION AT ANYTIME PRIORTO MIDNIGHT OFTHETHiRD BUSINESS DAY
AFTERTHEDATEOFT ISTRANSACTION.SEETHEATTACHEDNOTICEOFCANCELWTIONFORMFORANEXPLANATiON
OF THiS RIG
Dated at this �+ day of 20 ,
BY
I? I Authorized I Owner
Salesperson's Name_ �'c
iti, )oiri#.owner
Required Permits
The following buidling permits are required. it is the obligation of Contractor to secure such permits as Owner's agent (Ust`..
required permits}
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NOTE Owners who secure fheir own ermitsordealtvithunregisteredcontractorsareexdudedframtheGuarantyFundprovisions
of MGL c.142A
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Fu WInc ar�v HR40 ���r �� :��rformance
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'hype
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Double Hung 0.18 5.56 0.23 0.41
Slider 0.19 5.26 0.23 0.41
Casement 0.17 5.58 0.29 0.34
Awning
Picture 0115 6.69 0.25 0.45
Window
Casement PW M 0.15 6.67 0.21 0.39
Casement Low
Porfile 0.15 6.67 0.26 0.5
Sliding Patio
Door 0.21 4.76 _ 0.24 _ 0.44
Swing Patio
Door 0.22 4.55 0.23 0.42
Width Height U.1. Style Grid Loc. Salesperson:
_
681/2 501/2 11.9 2LG No Living J. Escudero
2 313/4 601/2 921/4 DH No Living Customer:
3 70 314 50 114 121 2LG No Kitchen
4 353/4 611/2 97.1/4 DH No Kitchen Barr, Dorothy
5 321/4 39112 713/4 DH No Kitchen Address:
6 o 26 Fairfield Avenue
7 10 Florence, MA 01062
8 j 0 ` Phone #s:
9 10 617-461-0559
10 0 I
11 I0
12 o �.fir
P ,' OILC p�ORANY
>i.
13 10 ►at'� rFo
_....._.__.._............_. .. .._.._- .._..._.. ..
14 , 0
15 10 I
16 . fp
IT. io
18 10
19 0
20 10
21 10
22 (0 A
23 0
24 .0
1
25 0
26 0
27 i0
28 0
29 0 0
30 0
31 4
32 0
33 ;0
34 IO
35 0
36 1 10 f
Measured by: Leon Ousmanov Date: 9/9!2019
IMPORTANT INFO TO GET.
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.Main Door: Jamb Width, Hinged L or R from outside
Storm Door: Hinged L or R from outside / Garden Window: Jamb Width
Bay Window: Projection from outside wall of house to very front of window,
Jamb width and if cable supports are needed. (wall construction 2x4 or 2x6)
Casements: opens L to R or R to L from inside
Sliding Glass Door: Which panel operates from INSIDE
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Office of Consumer Affairs and Business Regulation
One Ashburton:Place-Suite 1301
Boston, Massachusetts 02108
Home ImprovemefiContractor Registration
TYPE corporation
PEOPLES PRODUCTS INC. '
Regishatlon: 756194
2521 IARTFORD AVE. � ExpiratiorF 12/18/2019
NEWINGTON.CT 06111 .
SCA l O 20M-W17
Update Address and Return Card.
_./C,. +QJSIipt!!-SCIS R
Office of CommmerAtfarts a 8tuness pegtitatioc
HOME IMPRROOVEE_M NTRACTOR R89Wration valid tot,builviduai use only.
Reaistratiori'>>-.... no beforethe expnationdate. Ittoundretumto:
Oft Office of CanstunetAftasrs and Business Regulation
g4: >` !?!18/2019 10 Park Plaza-suite 517 Ii
PEOPLES PRODUCT IMG: ;; MA 0211
WILLIAM WILSON:- wo-'..-',v34-�
252 HARTFORD AVE. :- [� � rl
NEWINGTON.CT 0511 - Undersftm aly valid 8t Signature
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The Commonwealth of Massachusetts
Department oflndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
0
www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Eleciricians/Plumbers.
TO BE FILED WUH THE PERMUTING AUTHORITY.,
Aanlicant Information i Please Print L&Wbly
Name(Business/Orpr&ation/Individual): Lu FL L-r e, 6200 l r,l S
Address: 2 S Z
City/State/Zip !N ' Phone#:
Are
you an employer?Check the appropriate box: Type of project(required):
1I am a employer with -Z-6 employees(full and/or part-time).* 7. New Construction
2. I am a sole proprietor or partnership and have no employees working for me in
8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.[:]I am a homeowner doing all workmyself.[No workers'comp.insurance required.]t i
10 Q Building addition
4-El I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance.: 13.[:]Roof repairs
14yother c
6. We area WTIA e'l r e a corporation and its officers have exercised their right of exemption per MGL �
152,§1(4),and we have no employees_[No workers'comp.insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must sulimit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I
I am an employer that is providing workers'compensation insurance for my employees. Below is thepokcy andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: (�z '��/�C-/ a� I }� (� Expiration Date:_
Job Site Address��1�'�f 1�)(E City/State/ZipAL02g�JL E, 61h&t.
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.
I do herebyertify under the pains and pena�s ofperjury that the information provided above is true and correct
Signature: Date: —
Phone#:
Official use only. Do not write in this area,to be completed by city or town gfficiaL
City or Town: Permit/Ucense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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City of Northampton
<; Massachusetts
` DEPBRTLMENT OF BUTT DING INSPECTIONS
212 Main Street a Municipal Building
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application j
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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,modemization,conversion,
improvement removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four 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 ma!t be registered
Type of Work: Est.Cost:
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Address of Work:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under SI,000.00
_Owner obtaining own permit(explain): I
Building not owner-occupied j
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.1 SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
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Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
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Date Contractor Name HIC Registration No.
OR:
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Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
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Date Owner Name and Signature
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
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Cons�iqd%A%*rvisor i
i x �jt�pires:09/07!2021
X048 ,
ULWRENCE VOSS
298 E HARTFORD All
CS-00 E
j uXBRIDGE Mg.01564
Co. missioner I
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