50-007 30 PARK HILL RD SOUTH BP-2020-1108
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 50-007 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categor:ADDITION BUILDING PERMIT
Permit# BP-2020-1108
Project# JS-2020-001857
Est.Cost:$12000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: RANDALL ROBERTS 042573
Lot Size(sq.ft.): 30709.80 Owner: WILLARD CHAD D
Zoning. Applicant. RANDALL ROBERTS
AT: 30 PARK HILL RD SOUTH
Applicant Address: Phone: Insurance:
41 HEMENWAY RD (413) 530-2703 O Workers
Compensation
LEVERETTMA01054 ISSUED ON:5/6/2020 0:00:00
TO PERFORM THE FOLLOWING WORK:adding gable dormer above garage
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 si(;
Apr.28.2020 08:28 AM Window Works LLCr _ " ' p .. _ 9135+826760 v P 2/10
/V/ M� ;0
"partmew un only
City of Northampton Istwho of pe"t: ti
,,r Building ( partrneat- U
;,,r,�c,,�,sr fiii. irt�xn►eny Pelt
4 212 Main Streit ^N�THS' ='--- - &iP&AvWWft
( Room 100 - --- - WatecNell Aver
Northampton, MA 01060 Tiro Sacs of Strt,ctural Ply
�`.,,,�. phone 413-587"-1240 Fax 413-587-1272 Ptorlsae gens .
Other Specify
APPUCATION TO CONSTTWCT,ALTER,REPAIR,RENOVATE OR DEMMIGH A ONE OR TWO FAMILY DIIYELLIMO
SECTION 1.SITE INFORMATION
1.1 Prots+ttsr Addrette; seoUon to be aomp'lRW by'} cilia.
11� kb p V I of 0/ -7 Unn__,_�_�_-_
�d J task 1"t r 11 C A Zone Overlay Qlatriet
Etn,SL tUtCI CR nr.atct_
SECTION 2-PROPERTY OWNI?RBf11PIAUTHORiZED AGENT
2.1 Owner of Rraad,
�I1,Lh 4� rc� --b- hairL 41l ►
Name J C,umml MW1130 Addreae, zu.
2.2 Authorized Anent, p
Name nt) Current Melling Aftwo. 4els Sf f oil/Q
ature T;ApKone orl
ACTION s•ES IMATED CONSTRUCTION CM
Item Estimated Coat(Dollar)to be o fidw Use Onty
completed by pemit a icent
1. Building 0 0 U (a)BuMIng Permit Fen
2. Eledrtcal (b)Esttmated Totdl Cost of
Candruction from 8
3. Plumbing tlutiding Pe"At Fee
4. Mechanical(HVAC) .
5.Fire Protection
8. Total:(1 *2*3*a T 5) Check Number S
This Won For QMOW Use Only
Building Permit Number; ' /I U o_---.- -- -- Deft
issued,
Signature.
Bulking Cairenh"rml>.a *=r of WOW Date
robs r{� � � cin o Gv rn
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER10
R CONTRACYOR�
Apr-28.2020 08:29 AM Window Works LLC 14135826760 P 3/10
BLOOM 5•112I:6TION OF PB2MM=RK(Citerk s1I snnNOW
New house ❑ Addition Q RepliteMment Windows Alterstion(s) Rooting
Or ODOM ❑
Accessory Bldg_ ❑ Demolldan ❑ New signs (Cl] Decks Siding 0=] parer I q
Brief Description of Proposed
Work: &td as i1 _.il119C1�r C {babe *ntcr .
Q
' *%Nlofi 6f'i Wiag,dedroom Yes,,,_,L No id air► ;+ Yes No
Attached Narrative Renovating unfinished basement Yes _f+la
Plans Attached Roll •Sheol
on.M Now hoUlf 01111MANW1100h to
a, use of building:One Family_ Two Family Other
b. Number of rooms in sack family unit: Number of Bathrooms
c. Is there a garage attachad?
d. Proposed Sgwro Vantage of new co6truction. Dimensions
e, Number of stories?
f. Mathod of heaths? Pw� rotrC Fireplaces or Woudstoves Number of each
g. Energy Conservation Compliance. Masschook Energy Compliance form attached?
h. Type of construction
i, is constructlon within IUD ft,of wetlands? Yes -4—No. Is construtAlon within 100 yr. floodplain Yes No
j. Depth of basement or color floor below finished grade
k. Will building conform to the Building and Zoning regulstlone? �Yea No.
1, Septic Tank A, City sewer Private waif City water Supply
SECTION Tri-OWNER AUTNOR"TION-TO BE COMPLETED WHEN
OWNERS AGE OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,an O)rnnee of the subject
hereby aullt a
to act on ehalf,I l matters ret JVe towoe orized by this building Oarmit appAcatioh.
sigAaula of 00W Data
i, ,as Owner'
Agan hereby d are that the statements and Information on the foregoing application are true and a=rote,to the best of my knowledge
and belief.
S[ under thXins rn ponaffles erjtlry.
4^+ awn �p ,IL C--
Print VName
. d
Big ar an 'me
Apr-28-2020 08:29 AM Window Works LLC 14135826760 P 4/10
SECTION 8=CONSTRUCTION SERVICES
8,1 Licensed Construction Supervisor: Not Applicable 0
Namo of Lleense Holder: Po-nr`�o `l � `(�O Oq} 0,1573
License Number
41 H et t o L S/ a�I2c� c�
Ad 6 Expiration Date
ign a T®Iephone
tared Home]m'rovement ContYgctor: Not Applicable ❑
R
J 0 k7 -3 art CA a {t � ote.r 15 .� _-_---------
Corrilpany Name Registration Number
L-I 1 jA e me-l-,�k.At i �' Le ue rej� M/I 4 J Aoau
Address Expiration Date
__--Telephone y 3"5530 " "7p
SECTION i(tr 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 dental 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
Massachusettsr' Mfr
Ii DEPARTIMENT 4F BUILDING INSF9CT101VS 75 }
212 Main Street -Municipal Building ' fib~
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:
.fin T .y l Vi l l R
(Please print house number and street name)
Is to be disposed of at:
R L
Please print name and location of facllit )
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 Window Works LLC 14135526760 P 6/10
Construction Supervlsar
Comrnonweafth of lutassachusells Unrestricted-Quildings of any use group which Contain
i Division of Professional L censure less than 35,000 cubit feM(poi cubic"Wersl of sntlosed
Board of Building Regulations and Standards space.
ConslfiICtion 5upervtsor
CS-042573 Expires: 0812512020
RANDALL E ROBERTS
Al HEMENWAY,ROAD
LEVERETT MA 01064 Failure to possess a ewtent edition of the Massachusetts
State Bulldini;Code Is cause for revocation ofthis license.
For infomtatlon IWO this Ittense
/s Call(617F727-3200 or visit www.(lwz&iovlQpl
Commissioner �,� "--
✓1rr lrvrv.nvrrnr:7/f/n�.✓(,�2:v�J✓%rir.r//„ .......
Offics of ConsumsrAffafxs a dualnsss Regulatlon
HOME IMPROVIEWNT CONTRACTOR
TYPE:Individual Rsgls SIIan wild for individual uss only
alaistraw bakalim befwo the expiration date. if tound mum ta:
104873 07114/2020 Disks of Colrsor w Affairs ootid Ruaimms ReQuW10n
1000 W"hingWn fdlVsst'Sults 710
RANDALL E.R08ffRT3 aoston,MA 02113
RANDALL E.ROBERTS
41 HEMENWAY ROAD
LEVERETT,MA 01054 Undereticretary _ Not vs WIthoUt elgnMUM
Ppr.28.2020 08:31 AM Window Works LLC 14135826760 P 7/10
0 Tine Contttwnwealth of Massacliusetts
UkIDepartment of Industrial Accidents
I Congress.S`treet,Sufte 100
Bacton,MA 02114-2017
ivww mass.gov/dia
AN( vers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plunitbers,
TO BE FILED WITH THE PERMITTING AUTHORITY.
APP& nit MgFM#U20 Please Print Letdbly
Name(Business/Organ ization/Individual):Randall E Robetts DBA Window Works
Address:321 Russell ST
City/State/Zip: Hadley,MA 01035 Phone 4:413-530-2703
Are you an employer?Check the appropriate boat Type of prOiiectt(required):
L�J 1 aro a eisployer with 7"..,_. employees(fill and/or part-time),* 7. Z New construction
2.Fl 1 am e sole proprietor or partnership and lave io employees working for me in $. [Z]Remodeling
any capacity.[No workers'camp.insurance required.]
9, 0 Demolition
,3,[]l ata a homeowner doing all work myself.[No workers'oomp.insurance required.]r
10 0✓ Building addition
4.[]l ern s homeowner and will be hiring oontrswtors to conduct all work on my property, 100 f
ensure that all.contractors either have workers'compensation insuranoe or aro sole 11.[:]P.IvQtrical repairs or additions
proprietors with no employees,
• 12.L]Plumbing repairs or additions
�.�I am a gcncral contractor and I have hired the sub.00ntrsetors listed on the attaohod shot, 13.QRoof repairs
Those sub-contractors have employees and have workers'oomp,insunnoe.t t--1
6,E]We are a corporation aid its otrwom ❑
have excroiscd their right of exemption per MGL o. 14. Other
152,§1(4),and we have no employees.[No workers'uomp.insuntnoe required.]
*Any applicant that clrccka boy fen must also-fill out the Station below showing tbdir.a,>rkcrc'cvmpdneatiorr policy inYorntation.
t 1-l0mootimors who submit this affidavit indicating they arc doing all work and then hire outeidc contractors must submit a new affidavit indicating such.
#Conlraotors that check this box must attached an additional sheet showing the name of the sub-oontruuturs unci state whether or nut thvse entities have
cmp►cycea. If the sub-oontraetors have employees,they must provide their workers'coral).policy number.
I am an employer thud is providing workers'compensation inrcuatioe for my eVhp i'ees- ))eb1►v is the prelacy a)ul job site
information.
Insurance Company Name:Wesco Insurance Cblydpany
Policy#or Self-ins.Lie.M WW03440283 Expiratiou 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 raid expiration date).
Failure to secure coverage as required under MGI,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 DLA for insurance
coverage verificatign.
I do herel5v certify der sins and penalties ofperjury that the information provided above is true and correct.
e ate; a
p mel : 41 0-2703
Oficial use only. Do not write in this area,to'he completed by city or town of)7clat.
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#:
Apr-28.2020 08:32 AM Window Works LLC 14135826760 p 8/10
3a volt � ► I VO-
��ber-c- MA
Ll -jo c,
7?
Ift
z.
4m
NOR
wlw
Rl- WON• ,
Q�
..... ..... ......
Apr-28-2020 08:32 AM Window Works LLC 19135826760 P 9/10
� 1
CM
0 - -
Ppr"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 WATER
www.nvpwindows.cotn
SHIP TO: 4/27/202
handy Roberts DBA Window Works QUOTE EXPIRES
BILL TO; 0675 321 Russell Strcct Quote Not
Randy Roberts DBA Window Works Hadley MA 01035
321.Russell Street. Shipping4ge
Phone; 413-582-0446 Loc-North
Hadley MA 01035 Mob11e:GALLOFI"10E FOR Delivery Date
Fax; AWPSAP o
roberts uno.com 4/27/2020
Email; gam)
Sales Person
Q1;1QTE# STATUS CUSTOMER FO# ORDER DATE
310283 1 None uotc Not Ur ere
QUOTED'BY TERMS SHIP Van, PROJECT NAME
wtndowwor s Net 10th of Montle. Delivered onP Truck Willard,Chad in—d K;st1
Lloehem 9 Desciiption —
100-1
Qty: 2 Randy Roberts DEA Window Works
Windowset 1: Northwind 111, Double Hung, Double T
Make Size Hung, 36 x 36 -
36"X 54.5" Wi.ndowset 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 _.—........._. .
Unit 2: Frame Width = 36, Framc height 18
Cummieat/Roorrit: � . >
None Assigned Flanker Frame Width =
Unit 1: New Construction, RO Deduction = -1/2" �
x-1/2", Thermal Sash
Unit 2: New Construction, RO Deduction = -1/2" jam'
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 Glassy 1 Upper Glass: Glass Strength =
Single Strength
Unit 2. Glass: Glass strength = Double Strength
Unit 1: Unit GPD Number = IVP-K-14-00740-00001, Unit
U-Factor = 0.27, Unit SHGC - 0.2$, Unit VT 0.52,
Unit CR = 62, Air Infiltration bating = < 0.3
cfm/ft2, Meets Energy Star = Yes
Unit 2: Unit CPD Number = NVP-K-31--0006700003, Unit
U-Factor 0.25, Unit SHGC = 0.32, Unita VT = 0.58,
Unit CR 64, Air Infiltration Rating = < 0.3
cfm/ft:2, Meet: Energy Star = Yes
Nail Fin option = With J-Channel
6 9/16", Primed finger Jointed, Applied
Horizontal, Factory, 1/2" Mull - FH
Page 1 Of 1
Ppr.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@juno.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-09-2020 08:08 AM Window Works LLC 14135826760 P 2/ 2
1. 1
4
t
r � i
i
4
+
i