30A-055 36 LIBERTY ST BP-2020-1015
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30A-055 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2020-1015
Proiect# JS-2020-001713
Est.Cost: $23875.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: DAVID RUFFNER 057308
Lot Size(sa. ft.): 12196.80 Owner: LEROUX ROBERT
zoning: URB(100)/ Applicant: DAVID RUFFNER
AT: 36 LIBERTY ST
Applicant Address: Phone: Insurance:
120 SUSAN DR (413) 562-6467 SOLE PROPRIETOR
WESTFIELDMA01085 ISSUED ON:3/12/2020 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 10 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 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 Occupancy sil"nature:
FeeTyne: Date Paid: Amount:
Building 3/12/2020 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
�, Gni ti/JOG,JS
Department use only
City of Northampt(j'n Stat of PXmit:
Building Departme V Cjjrb t/Dri*way Permit
212 Main Street er/S tic Availability
}, Room 100 1 Water vallability
l
Northampton, MA 01060
p T Q `e �f ructural Plans
phone 413-587-1240 Fax 413-587-1272 "" Oi'Q ,S,t6 Plans
�CC Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENUVA OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property AddressThis section to be completed by office
: �
f Map O Lot Unit
. VJ f �� Zone Overlay District
V Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Use Only
completed by permit applicant
1. Building2 r (a) Building Permit Fee
2. Electrical �1 , (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = 0 + 2 + 3+4 + 5) Check Number 3
This Section For Official Use Only
Date
Building Permit Number: - Issued:
Signature: Aga
10
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
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 R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage %
(Lotareaminus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location) ---
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 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 Q NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement VVty(dows Alteration(s) Roofing El
Or Doors W 9 1
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Q Siding [p] Other[O]
Brief Description of Proposed &Z�
� (�Q
Work:
Alteration of existing bedroom Yes�_No Adding new bedroom Yes —/No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition tR 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
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. J Masscheck Energy Compliance form attached?
h. Type of construction (aCQMr
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, , 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 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.
Signedthe pains and penal es of perjury.
and
Print Name
Signat Felf weer Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address , Expiration Date
Signatur )Telephone
9.
9.'Registered Home ImproyeVMt Contractor. Not Applicable ❑
Company Name RegistrIation Number
Iii �c � Prm�_
Address / Expiration Date
LL5 rt' —* . Telephone //a`� 1/� 'ts(�
Q0
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 permit.
Signed Affidavit Attached Yes....... ❑ No...... ❑
I
City of Northampton
Massachusetts
4
DEPAR2WNT OF BUILDING INSPECTIONS
s 212 Main Street • Municipal Building
Northampton, 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 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� Est. Cost:
Address of Work: l�
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:
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:
X3--1-.� a Ze,-,)vk
Date Owner Name and Signature
City of Northampton
.C�~�r�-r�`: Stir..•",.sib
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
N
212 Main street • Municipal Building �y
«--- Northampton, MA 01060
Massachusetts Residential Building Code
Section 110.R5.1.2
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 farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner.
Section 110.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 110.R5, provided that if a homeowner engages a person(s)
for hire 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.
City of Northampton
Massachusetts
gg .�
DEPARTMENT OF BUILDING INSPECTIONS y,
212 Main Street •Municipal Building
` Northampton, MA 01060 byeYa�h�
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:
r /
(Please print house numb r pfid street aine)
Is to be disposed of at:
i lnl 0111
ease p nt name a d loc io of f cility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
(-
Signrm t or Owr� r 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 of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
M www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Le ibl
Name(Business/Organization/Individual):
Address: �• L, (
City/State/Zip: O/d1F,!�'Phone
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with employees(full and/or part-time).*
/ 7. ❑Ne construction
2.W
am a sole proprietor or partnership and have no employees working for me in g, emodeling
"'FFF���any capacity.[No workers'comp.insurance required.]
9. Demolition
3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10❑Building addition
4F_1 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.❑Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5171 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insuranceJ
We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Wirier
EJ
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 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 submit a new affidavit indicating such.
tContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information. ,L
Insurance Company Name:��/
Policy#or Self-ins.Lic.#: 4E_1 2('j_b2_EQZ/. J75d Expiration Date:
Job Site Address: �� Ll. , A !iK ,��AP_16A City/State/Zip:
Attach a copy of the workers'compensadon 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 un pains and penalties jperjury 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 official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cite/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Four tiP Ruffner Home Improvement, LLC
RHI, LLC Proposal
120 Susan Drive
_ Westfield, MA 01085 Accou t# DATE ESTIMATE NO.
ga INT ' Office: 413-562-6467 Mobile: 413-374-6335
LR4591-120 1/13/2020 20-024
S � q9
FULLY LICENSED,REGISTERED,AND INSURED IN THE STATE OF MA.
Customer NAME/ADDRESS
WE HEREBY PROPOSE TO FURNISH THE MATERIALS AND SUPPLY THE THE LABOR
Robert Leroux NECCESSARY FOR THE SUBMITTED WORK BELOW AND COMPLETED IN A SUBSTANTIAL
36 Liberty Street WORKMANLIKE MANNER. ALL MATERIALS ARE GUARRANTEED TO BE AS SPECIFIED,AND
Northampton,MA. 01062 WORK BELOW TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND
SPECIFICATIONS SUBMITTED BELOW.ANY ALTERATIONS OR DEVIATIONS FROM THE
ABOVE SPECIFICATIONS INVOLVING ADDITIONAL COST WILL BE EXECUTED ONLY UPON
WRITTEN ORDER,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE
413-588-4591 PROPOSED ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS, OR
DELAYS BEYOND OUR CONTROL.THIS ESTIMATE IS VALID FOR 2 WEEK BEYOND
lerouxs@comcast.net RECEIVED DATE.
Proposed Start Date Proposed End Date I P.O. No. Terms Due Date Rep
20024 Mat.Deposit,1/2 start... 1/13/2020 DER
ITEM DESCRIPTION QTY COST TOTAL
01.2 Building Per... Building Permits 185.00 185.00
SUF-I Project setup fee. 85.00 85.00
One time fee to setup and take down:start of day one,and upon completion of
project
Product Material Cost of Project:PELLA QUOTE ATTACHED IN EMAIL: 1 10.768.47 10,768.47
LIFESTYLE SERIES,FULL FRAME,WHITE,FULL SCREENS,WHITE
HARDWARE,SNAP-IN GRILLES,INCLUDES INTERIOR TRIM.
EXTERIOR TRIM INCLUDED ON INSTALLATION LINES.
FF-5 KITCHEN SINK:2-W CASEMENT 1 975.00 975.00
FF w/EXT.Trim(Tearout)Installation up to 91-100 UI
FF-3 KITCHEN:LARGE AWNING 1 895.00 895.00
FF w/EXT.Trim(Tearout)Installation up to 71-80 UI
FF-4 OFFICE/DEN:SINGLE DH 1 895.00 895.00
FF w/EXT.Trim(Tearout)Installation up to 81-90 UI
Thank you for the opportunity to help you your Home fi;iO7 needs.
TOTAL
NOTE--THIS DE SIT APPLIED:
PROPOSAL MAYBE � � RESPE FULLY SUBMITTED 0L;(,V6&E. R.u�fvt,P,y' Date 1/13/202(
WITHDRAWN BY J
iL
US IF NOT
ACCEPTED l �� �
WITHIN(14)DA f
OMER SIGNATURE Date
Payment Schedule:Deposi o order Materials-
CUSTOMER � - ( 232J
With Balance Due upon Completion. CUSTOMER SIGNATURE"' _ Date
Phone# Mobile Phone# Email P Web Site MA CSL#057308
413-562-6467 413-374-6335 deruffner@comcast.419 1 www.RHII.LLC.biz MA HIC#101035