Loading...
36-208 (6) 9 BIRCH LN BP-2020-1122 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-208 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: REPLACEMENT WINDOWS/DOORS BUILDING PERMIT Permit# BP-2020-1122 Proiect# JS-2020-000900 Est.Cost:$7416.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WINDOW WORLD/ROBERT E BUSHEY JR 57011 Lot Size(sq. ft.): 65775.60 Owner: CHRISTIAN GRANT Zoning:- Applicant. WINDOW WORLD/ROBERT E BUSHEY JR AT. 9 BIRCH LN Applicant Address: Phone: Insurance: 1029 NORTH RD (413) 485-7335 O WC WESTFIELDMA01085 ISSUED ON.5/13/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-PATIO DOOR, 2 REPLACEMENT WINDOWS, SIDING POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector I-n d e rg ro a nd: 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 SiLinature: FeeType: Date Paid: Amount: Building 5/13/2020 0:00:00 $100.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampton 1 . �\�^�� tatus of Permit: Building Department' /.�, Curb Cut/Driveway Permit ( - 212 Main Street ; Sewer/Septic Availability Room 1010 4, J `,• t ,� Water/ ell Availability Northampton, MA 01bbo Two ets of Structural Plans \ phone 413-587-1240 Fax 413`-587-1272 Plot/site Pians Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be comp�ete-7 y offi (� f' Map Lot n Zone Overlay District O �CJ � _�- Y Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A10 \ ( )�Y %tint ICA (1 TJc,��.� r� Name(Print) L Current Mailing Address: SQC C ontra o Signature Telephone 2.2 Authorized Agent,• Name,fPn ) J � t�rl ( idd 'MA W0165, Current Mailing Address. ignature (�J E., TS .X335 Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be permit applicant Official Use Only 1. Building com leted b LI (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of 3. Plumbing Construction from 6 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection I 6. Total=(1 +2+3 +4+5) 1 -7 L . Check Number This Section For Official Use Onl Building Permit Number:A!! "— G7" Date Issued: Signature: 5- l3-zoz Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House F-1AdditionReplacem indows Alteration(s) . Roofing Or Door g Accessory Bldg. ❑ Demolition ❑ New Signs g [Cl] Decks [Q SidipW] Other[(�] Brief Description of roposed &- Work: t� �� ; tllvll - �e1j.ikrra Alteration of existing bedroom Yes No Adding new bedroom Yes Attached Narrative Renovating unfinished basement No Yes Plans Attached Roll -Sheet No 6a. if New house and or addition to existiin housin coin fete the followin : 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. 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? 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.— el"( r�t l�V (11 Y 11 property y –'� as Owner of the subject hereby authorize _ �y� t-' ( � L/ to act on my behalf, in all matters relative to work authorized by thistbuilding permit application. Gori Signature of Owner Date 7 r o)qert as Agent hereby declare that the statement 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. me � Print J Signature f Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Ro ixr"t License Number a2s Ln o-11 1011 t� 7 � Expiration Date Si9 .I Sn ure Telephone tL► 1 �� I 1 9. Registered Home Imprtivement Contractor• Not Applicable ❑ c� -,r-t l,1C VN.P, b�b 4 I Company Name Registration Number Word of, W 5t-ffn Ma55 inc, 31 t4 j21r Address Expiration Date 12g �10r'�1�1 �.[� W lSil t'� a �nA O1CDSsf-lephone 413" 5'l'�35 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...... ❑ 11. Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780 Sixth Edition Section 108 3 5 1 Definition of 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. 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 buildina 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. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealth of Massachusetts W Department of IndustrialAccidents d I Congress Street,Suite 100 4 Boston,MA 02114-2017 www mass.gov/dia NVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. Applicant Information TO BE FILED WITH THE PERMITTING AUTHORITY. Please Prtnt Legibly Name (Business/Organization/Individual):Window World of Western MA Address:1029 North Road City/State/Zip:Westfield, MA 01085 Phone M 413-485-7335 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 20 employees(full and/or part-time).* 2.❑I am a sole proprietor or partnership and have no employees working for me in 7. ❑New construction any capacity.[No workers'comp.insurance required.] 8. E]Remodeling 3.❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on m propI will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 1 I.[]Electrical repairs or additions 5.[3 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.E]Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.t 13.[:]Roof repairs 6•❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[D Other Replacement Window 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 and job site information. Insurance Company Name:Liberty Mutual Insurance Policy#or Self-ins.Lic.#:WC2-31 S-377947-020 05/07/20 Expiration Date: Job Site Address:e ' �pensa�tionpol�icydecl�arafion City/State/Zip:_ �/Ll(r 0 ci �v IAttach a copy of theworkers'copage(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. Ido hereby certify under the painsfendpallies ofperjury that the information provided above is true and correct Si nature: Date: 5 L L) _Q, Phone#:413-485-7335 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#: AFFIDAVIT In accordance with the provisions of MGL C 40, §54, 1 acknowledge, as a condition of the Building permit, all debris resulting from construction activity governed by this Building Permit shall be disposed of at (NAME OF FACILITY) a properly licensed solid waste facility as defined by MGL C 111, §150A. ' Date Signature of PermitAppiicant PRINT OR TYPE THE FOLLOWING INFORMATION: Fyit,.4j k I i f2- (NAME OF PERMIT APPLICANT) (TYPE OF MATERIAL TO BE DISPOSED OF) (PROPERTY ADDRES ) ,QC R WINDWOR-01 CHRY T L CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NaMEncr Chrystal L Greenleaf Phillips Insurance Agency,Inc. 97 Center Street PHONE (ANC,No,Ext);(413)594-5984 Chicopee,MA 01013 E-MAIL la/c,No):(413)592-8499 ADDREss:Chrystal@phillipsinsurance.Com ----- INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURERA:State Automobile Mutual Ins CO INSURER B:State Auto Property&Casualty Window World of Western Massachusetts,Inc. INSURERC:A. I. M. Mutual Ins.Co. 1029 North Rd 33758 Westfield,MA 01085 INSURER D; INSURER E: COVERAGESINSURER F: --- CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP A POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY —J CLAIMS-MADE u OCCUR EACH OCCURRENCE $ 1,000,000 PBP2891125 4/9/2020 4/9/2021 DAMAGE TO RENTED 500,000 MED EXP(Any one arson 10,000 1,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PERSONAL S ADV INJURY X POLICY C JECT [—] 2,000,000 LOC GENERAL AGGREGATE __ PRODUCTS-COMP/OP AGG 1,000,000 OTHER: _ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 ANY AUTO (Ea accident) g OWNED p T-3248094 4/9/2020 4/9/2021 A�URTEO�S ONLY X AUC�TNNOSULED BODILY INJURY(Per person) $ X AUTOS ONLY X gUTOpf[g BODILY INJURY(Per accident) $ �20PERTY AMAGE er acadentr $ A X UMBRELLA UAB X OCCUR $ EXCESS LIAB CLAIMS-MADE PBP2891125 EACH OCCURRENCE 1,000,000 4/9/2020 4/9/2021 1,000 000 DED X RETENTION$ 0 AGGREGATE r C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER X OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE YIN MZ-800-8007695-2020A 5/7/2020 5/7/2021 1,000,000 OFFICERmtEMgW)EXCLUDED? N NIA E.L.EACH ACCIDENT $ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA.This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn:Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD .650 West Market&t M., o s And 600t--IPA.17030 rVP�� 650 Vvest Market St Goer-- r Grath PA 17030 s th , 5%2R2fVINYUQrl0 Via' D 16�(P rt ,_ T+ er 1 en a Bort 7, FI NY eve ri?an.;r e A :�,& d} 6tte=2: - �2rtef 9i :Ltte V8 Gt - td� _te,r ,sEafe /7 r«'�ori; 51 #� 'iiE f2: ;C{s4;nt FefB riet f q�+Artrteated},lite-2: ion for dinar;?t - E gol'37112 X 37 yrs and doors l Ms^t��fB.fll2d2 r,=err"rau tis LO �'-jco` zerte ion in performance T�prods 6j 4a3.appp _ A• '•��t�-yet ttiTE � - - _ --_..__"_ .�_-�_ _ ° F��a [ es RAI ❑� �Y b su ct to Variation i FEMPO _4 NCE RAT�eIL`+� � �e•��CJ ., performance �.'^--� Y P''�tZ�'Om ., p F`olar '-pAt�€glt4 cae€ftcient Sot � �. . . ar Heat Gain are Beneratty ` [roduct cer- t ' Coefficient -- -- r - ' 0.29 A0011TIONAL PERFORMANGE RATINGS Visible WrattS "►�f'EF�f=CR�AtsfCE RATING oots. fir'€�=w` '�i [t !lf EiC- €P€= mance S kgs(U.S. Air Leal<a ?ht,bake n 9e(U.S./f-f�) V.� qq .. . , � per;,np;�Y.yp�eateeafEtm.ae rnP r p amaze a _ u @�7'irjjE tw--^7°o s+5p-'2S SRC pPceo.t 6?or aecemiVigiQ xttaU pmautt -'•` -es r ,recap APs are Fere Pe Orrr,t°npPscaeic�iPR i Garro mcr,� � am E 'c*a rr3 ta� t rrn2craP ca main eAo a�paemc proautt tae. - mane ar Ea '.rt,v�E?Aat re�Ye,,.:Eri {' ' 3 arft+rda.,_aria(eAyapecfiC USe.CanSuR M �Y pr"ture 4M@aturet ER2rt°ale sudatlif�pMaielart° 4rra iy,., eF'i.u�it brie.use GSE+ re a€2 ute for omcr� psRonneme tAramtanar. specze ���pgCrpe?W�tria°1nCcTyimu�ar0asry sFeuFe�tx:s_e �Wo. Esc Car- energyater.gorMrindowa �}li �� �J Certified/Certifcado For ®Ceetifed'C tulI infomution,sea law an product Para informacioQt�a fOrutation,sae fabe(on ertificado i6 t Rrta Enfomta66n coMteta,Cansoher fa etiqueta del producto, mpieta,cansn►rar a eti�r �jrt Perf Grade +DP Pr°duct°. Perf Grade +DP(ASDj -DP(ASDj Water LC.PG35* 35 3p D} -DP(ASL�} LC-PG35 35.09 35.09 r/1 Max Test Size 50.t3 water 6.06 X 72.04 Re Max Teat ize eport# -______JSTC!t?ITC 40.00 A43722'j FloridatD 5.43 72.00X60.00 Fzo9s ot-to9.�7-� _ 29124 atin s 20840 9 are for individual windo -t- ".stacked units,please ws end Boars on Ratings are for individual windows and doors only. For information regarding mulled nit rest size,Te contact yam ►Y- For info or stacked units,please contact your sales representative.Pas and Ne DP lanced o 'S Ei300. sled to AAMA 1,I MNWD�aC es representative,os tr°n regarding muted ail unit test size.Tested to AAMANck Nor. A 101/itionaAnforma ion Zabel maybe dd flora(inforrnnation re din y be c,,, al d bySA igta ng y ad or A ce e, cod by nail concocted by glaang bead or se visk fuer.For additional information regardng g in taffacetioInst rack installation instructions,please vied wivw.mnvd.eam. !6785673.1.1.1 es`7856�� s/ 1 t ructions,Please visit mn d cam. 2013 26772468.1.1.1 Printed on V!! ° j •°'l 7ramis 3:69:03 PM Pnnted on etiy2p168:ia:!2,q;f City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ai 212 Main Street •Municipal Building 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, S 150A. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: --A� I� ��5 - (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: r ( �ompany Name and Address Si nature of ermit 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. */0 Ul ! Window World Of Western Massachusetts 1029 North Road 413-485-7335 westernmass@windowworld.com Grant Christian grantchristian3@yahoo.com Estimate -. Living room Bill Address: Install Address: 9 Birch Ln, 9 Birch Ln, Estimate#E1587254951751 Florence, MA Florence, MA Date of Estimate:4/18/2020 01062 01062 Valid Until:5/18/2020 DESCRIPTION • • 5%Baystate Noble Donation 1 0.00 0.00 Colored Exterior 2 195.00 390.00 Interior Woodgrain Upgrade(Patio Door) 2 192.00 384.00 4000 Series DH Solarzone 2 549.00 1,098.00 Colored Exterior 3 165.00 495.00 Woodgrain int.Natural Oak 2 179.00 358.00 Permit&Administrative Fee 1 200.00 200.00 Setup and landfill disposal fee 1 250.00 250.00 Full Exterior Capping 2 121.00 242.00 9 Ft. Patio Door 1 3,999.00 3,999.00 TOTAL AMOUNT $7,416.00 CUSTOMER PAYMENT DETAIL Credit Card Amount $3,700.00 TOTAL PAID $3,700.00 CUSTOMER DUE $3,716.00 "No extra work if not in writing "Customer Comments: Installer Notes:Bronze exterior.../natural oak......3 panel with far right operating Design Consultant-Tim Drost HIC:165641 FEID#27-1993659 Customer ID Details Id Type' Driver's license Id#` S346 Id Issue StateMass Id Expiration Date 45 Sales Rep Recommended: for withdrawal. Arbitration;Window World of Western Massachusetts and the PURCHASERS)hereby mutually agree in advance that in the event Window World of Western Massachusetts has a dispute concerning the contract,Window World of Western Massachusetts may submit such dispute to a private arbitration service which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulations and the consumer shall be required to submit to such arbitration in M.G.L.c 142A. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature Sales Rep Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor.The owner may initiate dispute resolution even"where this section is not signed separately by the parties." This Window World®Franchisees independently owned-and operated by Window World of Western Massachusetts, Inc.under license from Window World,Inc.