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50-007 (3) Apr.28.2020 08:28 AM Window Works LLC 4135026760 P 2/10 /V O ti Depaw"arlt use City of Northampton StiEhai of F�errnit h ,,- Building Elepartmeat �t�, c,i��s� }` trtx►veweyPeimtlt ,U ,: N. j . 212 Mal n Strep `'� A'"' Av�abiflt4y {�` - Roan, 100--- WatorNall Aveitebiltflr Northampton, MA 01060 Two Seca of Suttcbxal P4ttr>a phone 413-587-1240 Fax 413-587-1272 pliwaite Piens Otrier 5pedfr APPLICATION TO CONAMCT,ALTER,REPAIR,RENOVATE OR DEMOL95H A ONE OR TWO fAMILY DWELLING SECTION 1 .SITE INFORMATION 1.1 Prop•rtx Addrgs*, Thitr section to be completed by office Map 7o Lot 00 P'7 tatn tctr-K Zone Overlay District Elm V.pisMd CS ofWrt SECTION 2-PROPE=RTY OWNHRMNIPJAUTHORIZED AGENT 2.1 Wrier of RoyoN, Nem*( ) c nrent W11%Address' n 2.2 Authoruted Astern: p game A) Curve Mpifrog Addrw 4 aD Q elute T;ApFana cTION s-F.VnMATED CONSTRUCTION Ct}M Item Estimated Coat(Dollars)to be ofhclal Use Onty completed by p"I 8 icant 1. Wilding l� 0 U (a)building Permit Fee 2. Electrical (b)EMmated Total Cost of Construction from 6 3. Plumbing oulkting P"Wt Fee (� 4. Mechanical(HVAC) . 5.l=ire Protection B. Tota;_0 +2+3+4+5) Check Number o Thio Ian Far of Us*Only O Building Permit Number. 6 �o - �� U Date - -- ---- - -- - [56ued' Signature: - -- - -- -- Bidldrto Commisek)rwAro teeW of 9u4dkW robes Gla n c&rye EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER R CONTRACYOR) ' ' Apr-28.2020 08:29 AM Window Works LLC 19135826760 P 3/10 SECTION S•DESCRIPTION OF PB2ERM tAfORK icbW all MNOW New House 13Addition ❑ Replacement Windows Alteration(s) Rooting ❑ or Oaors M Accessory Bldg_ ❑ !demolition ❑ Now Signs (©] ricks Siding[©] Other(ta Brief Description of Proposed wo*.. At'!Gaa n�19 _ ter f '1=kt rzt6 e on.6f sTiilNirV;bsdroom Yea_Z– No fldd; .1 Yes � 4 No Attached Narrative Renovating unfinished basement Yes —44--No Plans Attached Roll -Sheol ,c y. on..if Nor howRle t1ill�tl' 1N8)i tb W*,maut ( l/i� �r'K{r�rID1�R 'L+i 11{�1S1�Qi a. Use of building:One Family T Two Fatuity ,_,,,Other b. Number of rooms in rich fondly unit Number of Bathrooms c. Is there a garage attached? ,- d. Proposed Square footage of new construction. Dimensions e, Number of abries7 f. Method of heating? TtltlC _ Fireplaces or Woudstoves Number of each g. Energy Conservation Compliance. Masschack Energy Compliance form attached? h. Type of construction Q o-e"t4'-. i, Is constructlon within 100 ft.of wetlands? Yes _ - No. Is construotlon within 100 yr. floodplain Yes No I. Depth of basement or color floor below finished grade k, will building conform to the Building and Zoning regulatlons? ,L Yrs 14o. I. Septic Tank City Sewer Private welt City water Supply SECTM 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGE,NT OR CONTRACTOR APPLIES FOR;BUILD]NO PERMIT P ,as Owner of the aubject 390* hereby euth a .i' s to act on shel4FLaetters rein ive to wrk a orfzed by this building tSermiI application. siaAA46 ofowrier Date 1, C. ,as Owne Agent hereby declare that the statements and Information on the foregoing application are true and accurate,to the best of My Fo Fedge and belief. 51 ad under th pptns Intl penailles�equry. 4F�� v'ft0ra Il ^� Print Neme D Z sig 6*0ne Ppr.28.2020 08:29 AM Window Works LLC 14135826760 P 4/10 SECTIONS-CONSTRUCTION SERVICES 8,1 Licensed Construction Supervisor: � Not Applicable 0 Name of License Holder: pa nrl Q (l ��`��. 1 ' 0'T os License Number L0 Hem.enRio z gf PG av d-o Ad s Expiration Date Ign Telephone "B..Resilkeied'Home Imiarovement Contractor: Not Applicable ❑ Rauch !l E I?ol .res /oy k7-— Zompany Name Registration Number 1-11 e m e.t)k wt i Rai , Le un-e t CY Pl 01-00-- ; ►N �i� u Address J Expiration pate Telephone y,3"530 -220 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.d.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...... ❑ Apr-28.2020 08:29 AM Window Works LLC 19135826760 P 5/10 City of Northampton Massachusetts R •� . '�4r G DEPARTMENT OF BUILDING IN•SPSCTION'S fly 212 Main Street •Municipal Building ', ra, Northampton, MA 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, 8 150A• The debris from construction work being performed at: 30 TacK 11► ) R A (Please print house number and street name) Is to be disposed of at: Reojjol tL Services Cb t(jjpee M " Please print name and location of facilitt Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 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. Apr.28.2020 08:30 AM Winclow Works LLC 14135526760 P 6/10 ConstmOlon Supervisor Commonwealth of Massachusetts Unrestricted-Buildings of any use group which eonteln vi I Division of Professional Licensure less than 36,000 cubic feet(991 CubfCmRters)otenclosed Board of Building RegUlation5 And SlandardS sl y Construction Supervisor CS-042573 Expires: 08125/2020 RANDALL E ROBERTS 41 HEMENWAY ROAD LEVERETT MA 0106 FailUre to possess a current edition of the Massachusetts state Building Code Is cause for revocsdOn ofthls license. For infortlution about this neon" A Cat](Sin 727-3200 or vistt www.rnazz gov/dpl Commissioner ���(N„ Of ics of ConsumaAf1wrs a hudnme Regulrttpn HOME IMPROVEMENT CONTRACTOR TYPE.tndMduel R09M'+'atlort vslld for Indivldusl uss only LvirdRp b,f thr sacplratlon data. M found n,turn la: 104673 07114/2020 Offtcs of Corn aw Affrrim snd BuainO"Regulation pow wuhing7ton Bvti ..t. „ka 710 RANDALL E.ROBERTSt�laston,MA 02115 RANDALL E.ROBERTS 41 HE*MENWAY ROAD LEVERETT,MA 01054 Undersecretary _ Not va Without gigneturG Ppr.28.2020 08:31 AM Window Works LLC 14135826760 P 7/10 The Commonwealth of Massaclausetts r Department of IndustrW Acci(knts a X Congress.Vreel,.Sttite 100 Bavton,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbery, TO BE FILED WITH THE PERMITTING AUTHORITY. Ap2Jkjh[glrlill jdj211 Please Print Laeibly Name(Business/Organization/Indivicival):Randall E Roberts DBA Window Works Address:321 Russell ST City/State/Zip: Hadley,MA 01035 Phone 4:413-530-2703 Are you sn employer?Check the appropriate boxi Type of project(required) L�J I an,a employer with 7`„ __employees(full and/or part-time).* 7. Z New construction 2.F-1 I ant it 9010 proprietor or partnership and have no employees working for me in 8. Q Remodeling any capacity.(No workers'comp.insurance required.) 9. Demolition 3,[j 1 am a horgcawner doing all work myself.[No workers'oomp.insurunue required.]1 4.[]l I es homeowner and will be hiring oontraotors to oonduut all work on my prroperty. 100 10 Z Building addition onsuro that all Contractors either have workers'compensation inauranea or ore sole 11.[:]P.lmtrical repairs or additions proprietors with no employees, • 12.E]Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the atiaohod sheet. 11EIRoof repairs These sub-contractors have employee&and have workers'oomp.insurmoe.l 6.[]We are a ootporati on and its otl'iccrs have exercised their right of exemption per MGL o. 14.0 Otber 1527§I(4),and we have no employees.[No workeni'pomp.insurnnoe required] Any applicant that chocks box fel mustt also fill out thtrtction below ehowing thdir.o¢rrkcrs'conrpdneation policy information. 1•I0mcowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. #Conlraoton that check this box must attached an additional sheet showing the name of the sub•eontrautors and state whether or not those entities havo employees. if the sub-contractors have employees,they must provide their workers'comp,policy number. fain an employer that isprovidingworkers'compensation Rebyw is thepolicy andjob site information. Insurance Company Name:Wesco Insurance Company Policy#or Sclf ins.Lic.#:WWC3440283 Expiration Date;10/19/2020 Job Site Address: All Locations 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 MGI,c. 152,§25A is u criminal violation punishable by a kine 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 tip 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 verificatign. I do hereby certify der auis and penalties of perjury that the information provided above is true anrd correct.. e: ate; y D Phone# 4M0-2703 Oficial use only. Do not write in this area,to he completed by city or tmvu offlcltd City or Town: Permtt/License#, Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Apr.28.2020 08:32 AM Window Works LLC 14135826760 P 8/10 34)VP Y' �,H01 Via. Ll -j- UO 16 C, Ver M ., ......y,,y.y.y.p:..wa�+''t� rx.+•n jj lA'�Y". � T iv..; � �r IV Jyy A � .n�'y grl,l`�A + •a �� �f �, y y Iry?j 'p � `{Y". 3 Mya. p "A l t•MI �r'`.,'�,1'' tr• Yri'"yl '{. �h451t�: � ��v.✓,'4, y�.: �r�)� •rr" ..1:;."•:! YNR ,:���. 4" `y< �' is nr��;i:\5. •''�1':.iK..•, A :r;r�i� ';�',�-y, •i�...a,,.,•t:'•r::;to-,..,; p..a 'J .6 •' r. .tin��',.tr��h '*:''� :E:.y. vµ''.. I\\r kffYf.^,Alf .:`,� �0'�(:u\�{•�.'Iy;�.K ,.J �IM'•;�tt^�,•.�;:j t'; '.�ih;�r<:.', d.�'"•. '.1:r s.`�.,...�:..tp... A:Y,,'� Al.` .�,Si.i`;i' '1'R :� �• .. ....G•..�,a" .{:n• .. �•Oi�.iG:;'' 1.�a1,i ��f:.' K' H, r''Y,ir•:l�'.:•f,:' .�'J' i .p..n ... -,'^ n. .�f:•� .A:�.:T.Wet`�ta'+AiF.tiei..,,'19:..^'Ty, 'k `t��) �`1 'I 1 f•�' fir,'• STA k .. d.7� �.ar ,r i f. w Ppr-28-2020 08:32 AM Window Works LLC 19135826760 P 9/10 cy 3-, c� S 0 � Apr.28.2020 08:32 AM Window Works LLC 14135826760 P 10/10 National Vinyl LLC. Customer 7 Coburn Street Phone: 413-420-0548 QUOTATION Chicopee, MA 01013 Fax: 413-420-0560 JDATE ATED www.nvpwindows.com SHIP TO: L4/27/2020 Randy Roberts DBA Window Works QUOTE EXPIRES BILL TO: (1675 321 Russell Strcot Quote Not Randy Roberts DBA Window Works 321 Russell Street Hadley MA 010.35 ShippingZone Phone-. 413-582-0445 Loc-North Hadley MA 01035 Mobije,CALL OFFICE FOR Delivery Date Fax: f1W§SNPK0 Email: robertsgcojuno.com 4/27/2020 Sales Person Q(TOTE# STATUS CUSTOMER PO# ORDER DATE None uotc Not Ur em QUOTED'BY TERMS SHIP VIA PROJECT NAME wu:dowwor s Net 10th of Montl). Delivered on N VPTruck Willard,Chad and Kri sti LiKielt;em# Description 100-1 Qty: 2 Randy Roberts DBA Window Works Windowset 1: Northwind III, Double Hung, Double T Make Size Windowset 36 x 36 - 36"X 636"X 54.5" Windowset 2: Northwind III, Direct set, Right Rough Opening Triangle, Fixed, 36 x 18 36.5"X 55" unit 1: Frame Width = 36, Frame Height = 36, Sash Split � Even _.—..__...._.. Comment/Room: Unit 2: Frame Width = 36, Frame Height = 18 None Assigned Flanker Frame Width = Unit 1: New Construction, Ro Deduction = -1/2" x-1/2", Thermal Sash Unit 2: New Constria.ction, RO Deduction = --1/2" x-1/2", Frame Type = Thermal Frame Color = White Lock Options = Double Lock, Standard, White 36 Half Screen, Fiberglass Unit 1, 2: Glazing Type = Low E. Low E Softcoat, Gas FI11 = Argon Unit 1 Lower Glass( 1 Upper Glass: Glass Strength = single Strength Unit 2 Glass: Glass Strength = Double Strength Unit 1: Unit CPD Number = NVP-K-14-00740-00001, Unit U--Factor = 0.27, Unit SHGC = 0.28, Unit VT m 0.52, Unit CR = 62, Air Infiltration Rating = < 0.3 cfm/ft2, Meets Energy Star = Yes Unit 2: Unit CPD Number = NVP-K-31-00067.00003, Unit U-Factor = 0.25, Unit SHGC T 0.32, Unit VT = 0.58, Unit CR = 64, Air Infiltration Rating = < 0.3 c•fm/•f-t2, .Meets Energy Star = Yes Nail Fin Option = With J-Channel 6 9/16", Primed Finger Jointed, Applied Horizontal, Factory, 1/21" Mull - FH Page 1 Of 1 Apr.28.2020 08:28 AM Window Works LLC 14135826760 P 1/10 FAX COVER SHEET DATE: 4/28/2020 TO: Building Department FROM: Randall Roberts # OF PAGES: 10 (including cover) This is a building permit for 30 Park Hill Rd, Florence. Email to contact us is robertsgc@iuno.com or phone #413-530-2703 Please let us know that you have received this. Please let us know the permit fee and we will mail a check immediately. Please let us know if you require anything else. Thank you very much. May.04.2020 08:08 AM Window Works LLC 14135826760 P 2/ 2 { 3 s r k Ol M'�`s� ''`��(�J1u � .".�+M: �..-^ip.r,.w`• �xnrvee-.rn:�rn....rri.w�ppn,lw,+y'o.^