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45-041 (2) 336 OLD SPRINGFIELD RD BP-2020-0678 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:45 -041 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2020-0678 Pro'ect# JS-2020-00115 Est.Cost: $11895.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JOHN WALZ 060612 Lot Size(sg.ft.): 87120.00 Owner. CHARLAND NELSON F Zoning: Applicant: JOHN WALZ AT. 336 OLD SPRINGFIELD RD Applicant Address: Phone Insurance: 66 Bray Street 413 592-2376 Workers Compensation CHICOPEEMA01020 ISSUED ON.1112512019 0:00:00 TO PERFORM THE Ft OLL0WING WORK:SI DI NG POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing InspectDr of Wiring D.P.W. Building Inspector Underground: Service Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire D artment 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 si nature: Feer e: Date Paid: Amount: Building 11/25Q019 0:00:00 $60.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner S a3//V - Department use only R� �IL' City of Northampton Status of Permit: D i►ding Department Curb Cut/Driveway Permit 12 Main Street Sewer/Septic Availability Nov Room 100 WaterMell Availability 5 �Q�Q N rthampton, MA 01060 Two Sets of Structural Plans Fpr o� p�ho�e 41 -587-1240 Fax 413-587-1272 Plot/Site Plans N�RTyq�1n Other Specify 4 . APPL TCO STRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office n � 3� U C vl Map S Lot Unit .,�r. ielnl� Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: s© -,1,3 `V1 � � � (� Name(Print) Current Mailing Addre s' Telephone Signature 2.2 Authorized Agent: Nam PHI) ) Current Mailing Address: O/0a5 a r'- q /z - Signat 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) � 5. Fire Protection 6. Total=(1 +2+3+4+5) S . D 0 Check Number This Section For Official Use Only �,�� �� /'/7 Date Building Permit Number: (.I -L Issued: Signature: 9 Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Win ws I Alteration(s) Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [M Siding["I--Other[O] Brief Description/of Proposed/ Work: r N e_ (/ ✓l J c\ i4 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 r c. Is there a garage attached? f d. Proposed Square footage of new constructi Di4men e. Number of stories? f. Method of heating? Fireplaces or Number of each i g. Energy ConservationCompliance. M�scheck Energy Compliance orm attached? h. Type of construction / i. Is construction within 100 ft. of wetl nds? 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 1' ' ' ` Q C ` P r'� as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 1, --�:0 V A VJ LA) Ca-r— 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. -:1Jk 'L P' Name l Signatu of Owner/Age# Date I 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 Setbacks Front Side L: R: L: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved / arkin #of Parking Spaces —V Fill: volume&Location 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 DONTK OW O Y O 1O IF YES: enter Book Page and/o, ocument# / B. Does the site contain a brook, body of water or wetland . NO 0 ; DONT K OW O YES O IF YES, has a permit been or need to be obtained f m the Cons��a ation Com ission? 1 Needs to be obtained Obtained Ote C. Do any signs exist on th>d prop rty? YES NO O IF YES, describe sizA, type a d l ation: D. Are there any proposed changes to or add' ions of signs intended for the prope y? YES O NO O IF YES, describe size, type and locati E. Will the construction activity disturb(clearing,grading,excavation,or fillings 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 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ ® (e O CQ 1 Name of License Holder:ST L) �1 / n License Number Address 6 ` Expiration Date Signat a 1-7 Telephone 9.4legistered Home Improvement Contractor: Not Applicable ❑ VL C- Company N me Registration Number 3 ,'-' & 0 C;L- �` �z �` (r� c��f e -a- V-kt-Q d!o L/ �/ ? ) ,-, j Address Expiration Date Telephone7-21 Z 71 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 mit. Signed Affidavit Attached Yes....... No...... ❑ - The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED Xv1TH THE PERMITTING AUTHORITY. Annlicant Information Please Print Lei=ibly Name(Business/Organization/Individual): FINYL VINYL INC. 33 GRAITAN ST. Address: CHICOPEE MA 01020 1327 City/State/Zip: Phone#: IJ' 7 j, a 3�*? C Are you an employer?Check the appropriate box: Type of project(required): I.O I am a employer with 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 $. Remodeling any capacity.[No wrorkers'comp,insurance required_] ❑ 3. I am a homeowner doing all work myself. 9. El Demolition ❑ [No workers'comp.insurance required.)' 4. I am a homeowner and will be hiring contractors to conduct all work on 10❑Building addition ❑ g my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.fA I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.-' 13.QRoof repairs /^ 6.❑ officers We are a corporation and its ocers have exercised their right of exemption per MGL c. 14.® e Other J ck i'h G 152,§1(4),and we have no employees.[No workers'comp.insurance required.) See 4.7ft-e.c.ti.c-c( •Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit tris affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ =Contractors that check this boa must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I airs an employer that is providing workers'compensation insurance for niy employees. Below is the policy and job site information. ^C r Insurance Company Name: t`a d e� (-e—P S fr ae r 6 C/7 J' cl a C / ✓Yl Policy#or Self-ins.Lic.#: 7-p ZT [,/ 8 5l$d?L d 3�!/R- Expiration Date-_/A /1 ,3 //r7 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. I do hereby certify under epains and penalties ofperjury that the information provided above is true and correct. Signature: Date: it Phone#.- Official :Official use only. Do not write 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 Contact Person: Phone#: yam_ The Coninzonfvealth o,f'Massachusetts � .l r Depar-ftrzerzt®f 1r2darstyiczlAceidents 1= - 1 Congress S'tree4 Suite 100 Boston,MIA 02114-2017 ` WWtv.11Zass gov/dia Workers'Compensation Insurance Affidavit:General Businesses. 10 BE FILED wrrp;THE PERMTPI'INGAUTI-1011171Y. un icant Information P)lease Pmt IJed€1)y Business/Organization Name:Christopher Cusson Address:64 Yeoman Ave City/State/Zip:Westfield,MA 1085 Phone##:1-143-977-8871 Are you an employer?Check the ppropriate box. Business Type(required): 1. I am a employer with 1 employees(full and/ 5. ®Retail or atime . 6. nRestaurant/Bar/Eating Establishme7etc.) 2. I am a sole proprietor or partnership and have no 7 Office and/or Sales(incl,real estate employees working for me in any capacity. [No workers' comp.insurance required] 3_ (❑Non-profit 3.® We are a corporation and its officers have exercised 9. ®Entertainment their right of exemption per c. 152, §1(4),and we have l p❑Manufacturing no employees. [No worlcers'comp.insurance required]" 11.®Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 12-� Other Any applicant that checks box R1 must also fill out the section below showing their n,orkers'compensation policy information. ~'Tf the corporate officers have exempted themselves,but the corporation has otheremployees,a workers'compensation policy is required and such an or�-_aoization should check box irl. B ar11 an eniployei-tlzat is pi-ovidirz,,iuoz keis'eoiirpeiisafioiz iriszirance for izt}r employees. Below is the potic3i itzfoi-nzatioiz. hisurance Company Name-A.I.M. Mutual Ins. Co Insurer's Address- City/State/Zip: Policy#or Self-ins.Lic.#VWC1006014349 Expiration Date:04107120-2 Attach a copy of the workers'compensation poficy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Tine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification- 7 do hereby certij ,undenthepains andpenalties q fpeijuiy that the information provided above is trite and correct. Sianature: / - Date: Phone=: Qfjrcial use only. Do not write in this area,to be completed by city or town official. City or Town: Pea mittLicense# Issuing Authority(circle one): I.Board of Health Z.Building Department 3.City/Town Cleric 4.Licensing Board 5.Selectmen's Office 6.Other Contact P efl son: Phone#: wx%mcmass.eov/dia City of Northampton Massachusetts �q�'Ss y, sclC t ` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building J a Northampton, MA 01060 bfSY ,^4p 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 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 must be registered Type of Work: J i I V vL.y ( ; �z p Est. Cost: Address of Work: 3 3 uL o, Date of Permit Application: I 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 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 RESPONSIBILITES 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: fo- .1, " ( �. -It . ( -V, 4- s �s Date Contractor Name HIC 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 City of Northampton `lti►rt�iYr� , Massachusetts M � pq DEPARTMENT OF BUILDING INSPECTIONS Ts + 212 Main Street •Municipal Building Northampton, MA 01060 r~' •• 3 ,^�� 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 st eet nam4) Is to be disposed of at: L) S A W + '� r ec�.� c I ,vty or CT (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from.- (Company rom:(Company Name and Address) Signa, e of Perm it'Applicant or Owner Date If, for any reason, the debrisill not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to th;location where the debris will be disposed. Page No. of Pages CHOICE �,i,�v yL k PRO POSH L 33 Grattan Street CHICOPEE, MA 01020 7Chapter142A rovement contractors and subcontractors ome improvement contracting, unless (413) 592-2376 empt from registration by Provisions of Submitted f the general laws,must be registered withTo:NelsonCharland ealth of Massachusetts. Inquiries about registration and status should be made to the Director, __.36_01d 3 S eld Rd. Home Improvement Contract Registration,One Ashburton � - Place,Room 1301,Boston,MA 02108 (617)973-8700 ton,MA 01060 Owners who secure their own construction related Northamppermits or deal with unregistered contractors will be excluded from the Guaranty fund Provision of MGL c. 142A. PHONE DATE REGISTRATION NO. 413-586-9653 - 112653 CT- REG. NO. 0051540 6-24-19 LICENSE NO. -060612 JOB NAME/NO. JOB LOCATION We hereby submit specifications and estimates for work to be performed and materials to be used: L Install 3/8"insulation as a backer. 2. Vinyl side house&front dormer using Mastic Carvedwood D4"Russet Red vinyl siding,Lifetime Warranty. 3. Install White 6"Traditional comer posts. 4. J-Blocks for all light fixtures,faucets,&dryer vents. S. No gable vents. — -- 6. Wrap all facia(trim)in white al �8 -- _----------��-__ ——--_---_-- umin coil,incl front facing river. 7. Wrap all windows&doors in white all coil,Anderson Bend. 8. Use white center-vent soffit under all overhangs including front facing river. 9. Remove&re-install all gutters&downspouts. 10. No shutters. _---- – --–- ---- _ -- --- – - 11. Strip vinyl siding ONLY&dispose of waste by truck or dumpster- (NOTE: No siding on bottom of house,Keep existing T-111 on front(river facing)of house.) WORK SCHEDULE -- ----- Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein writing.Contractor will begin the work on or about 8 months from date of signing.Barring delay caused by.circumstances beyond Contractor's control,the work will be completed within 1 year from date of signing. The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this Agreement. WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of one year following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is discovered within one year after completion of any job,including clean up,the Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired,or replaced, such damage or such defect in materials or workmanship_.The foregoing warranties shall survive a local or state inspection. We Propose hereby to furnish material and labor –complete in accordance with above specifications, for the sum of: Eleven thousand eight hundrd and ninety-five dollars and 00/100. Payment to be made as follows:A finance charge of 11/2%per month(18%per annum)will be charged on unpaid baladoelars($ 11895.00 s. In additional thereto, in the event that this mallfler is placed in the hands of an attorney or collection agency, the owner herein shall be responsible for reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here. 3__% ($ upon upon signing Contract; John W.Walz/Finyl Vinyl Inc Name of Contractor/Designated Registrant 33--% ($39725-.0T_) upon completion of 33 Grattan Street arIFIVa O materia S. Street Address —% ($ ) upon completion of Chicopee,MA 01020 0 state % ($41n ) shall be made forewith upon city/3) 510 1� 4�b4�00-- completion of work under this contract. Phone 592 2376 65-11 ID No. Phone Federal ID No. Notice: No agreement for home improvement contracting work shall require a John W.W or Timothy J.Walz or Terry L. Messier down payment(advance deposit)of more than one-third of the total contract price Name o esperson ame of a erson Name of Salesperson or the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and Authorize ignature equipment,whichever amount is greater. Note:This proposa may withdrawn by us if not a cepted within days. Acceptance of Proposal I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Cancellation must be done in writing. ADO N� GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature I\ �• ate Signature Date IMPORTANT INFORMATION ON BACK 00--