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38B-219 (4) 17 FAIRVIEW AVE BP-2020-1134 GIS#: COMMONWEALTH OF MASSACHUSETTS Mg.-Block:38B-219 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO, NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: KITCHEN RENO BUILDING PERMIT Permit# BP-2020-1134 Proiect# JS-2020-001900 Est.Cost: $30000.00 Fee: $195.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: MATTHEW KOZUCH 106644 Lot Size(N.ft.): 4399.56 Owner: MAZZEI CRISTIANO Zoning: URB(100Applicant: MATTHEW KOZUCH AT. 17 FAIRVIEW AVE Applicant Address: Phone: Insurance: 6 HIGH ST (413) 570-3279 Q FLORENCEMA01062 ISSUED ON.5/21/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-KITCHEN RENO 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 signature: FeeType: Date Paid: Amount: Building 5/21/2020 0:00:00 $195.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northampt �' Status of Permit: .,yam Building Department ti :' ; Curb Cut/Driveway Permit �A, 212 Main Stref Sewer/Septic Availability Room 100 'Qy 19 Water/Well Availability Northampt*,W 01060 Two Sets of Structural Plans -� phone 413-587-124Q``, �,#- -3-587-1272 Plot/Site Plans 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 completed by office Map— Lot 1/ _Unit �D1 rvL A 70 Zone Overlay District 1 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: M Z e- Pa A4 Name(Print) Current Mailing Address: (/ Telephone 2.2 Authorize gent: i /^ I ( /� ' A ` \o 2 c,L','\ l�� I i Q V\ ��. 1' 10(gyp✓�CQ dAA Name(Print) Current Mailing Address: -W q1 ? -3 N I-� Signature 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 J (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) T Check Number This Section For Official Use Only Building Permit Number l Date Issued: Signature: 5 - 2-1-2020 Building Commissioner/Inspector of Buildings Date/ Fti1 i l :/ ' f- z 5--- EMAIL --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 % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'TKNOW-j YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? VO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C. Do any signs exist on the property? YES CN3_0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO 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 r-WO-71 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 Windows Alteration(s) Roofing Or Doors Accessory Bldg. Demolition New Signs [ ] Decks [ ] Siding[ ] Other[ ] Brief Description of Proposed 11 �/, I I Work: h 1ChP (� rC'_N�FJ�F� _ 0 s�( ✓ct✓W C S 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 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 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, as Owner of the subject property `` 11 hereby authokbehn�all�mattQrs Opt t d`Z.� to act on my atArelative to work authorized by this building permit application. v1 Signa Date I, d ,0 _Z_L/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. M T fl,(g 7 Ur "\ Print Name n� Vv` /,t4 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ u Name of License Holder: �D.�'� �B z�� CS ` License Number 3 Ls- Address,�n Expiration Date Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 14 q 2c)-7 Company Name Registration Number SC, I /q /zI Address Expiration Date ly � � c"� S Telephone 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...... ❑ City of Northampton Massachusetts 'A DEPARTMENT OF BUILDING INSPECTIONS x 212 Main Street • Municipal Building Northampton, MA 01060 sSYh 3���J 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 buildinJ"be done by registered contractors. Note:If the homeowner has contracted with a cd l corporation or LLC,that entity must be registered. Type of Work: l SCh f�2 {�Ul.[9(7 C Est. Cost: 3 � Address of Work: I ]: �o;, T V e Ld &f /V'n m Date of Permit Application: /I ho 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: L Nko'M 1792-04 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 Massachusetts A DSPARTMSNT OF BUILDING INSPECTIONS y ` 212 Main Street •Municipal Building J` a Northampton, MA 01060 �SVw ��ac 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: 1 a �d.\CV 1 t?w A f e- (Please print house number and street name) Is to be disposed of at: VC-A\ A (Plea print name nd locatio of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature of Permit Applicant or Owner Daie 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 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information // Please Print Legibly Name (Business/Organization/Individual): M u.-� lha 2✓CG i'\ Address:_6 k-V k Q� City/State/Zip: o`2�� Y VV ©� 6 Phone k 41S 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. ❑New construction 2.51 am a sole proprietor or partnership and have no employees working for me in $. ErRemodeling any capacity.INo workers'comp.insurance required.] 9. El Demolition 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]r 10 E]Building addition 4.❑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 1 1.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑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.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also 511 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. Contractors 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: Policy#or Self-ins.Lic.#: Expiration Date: 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 the pains andpenalties of perjury that the information provided above is true and correct. Signature: /`� � * Date: S /I ZD Phone#: 1-(I� 7 141 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#: 5/21/2020 Capture.PNG P� PRODUCTS SERVICE&SUPPORT FOR PROS DISCOVER PARADIGM 4 PRODUCT DETAILS IF Siandara?:e duras 16 Type U Factor SMGC VLT _ Grid No Grid Grid No Grid Grid No Grid CR R4alue Additional Option' Clear/Clear 0.45 0.45 0.53 0.59 0.55 0.62 45 2.22 LowE 270/Clear 0.31 0.31 0.25 0.28 0.47 053 57 3.23 (p� Available Cola-, C*AYLOWL 270 0.31 0,31 031 0.35 0.47 0.53 57 3.23 Clear/LowE 270 Argon Fill 0.28 0.28 0.31 0.35 0.47 0.53 61 3.57 'fi Performance LPWE 27089 Argon Fill 0.24 0.24 0.25 0.27 0.46 0.51 50 4.17 LowE 270/Clear/LowE 270 Argon Fill 0.26 0.25 0.22 0.24 0.37 0.41 67 3.85 wwE 270/Gear/LowE 270 Blend Fill 0.23 0.22 0.21 0.24 0.37 0.41 69 4.35 SpecsfiCaiior LowE 270/Clear/LowE 270 Krypton Fill NA 0.2 NA 0.24 NA 0.41 70 5 Warranty »_ �+:r�wr rsu��.cno,�e a-m.• �u,m,rrz https:Hmail.goog le.com/mai Vu/0/#inbox/FMfcgxwHNVxDlwxLgSkrcxdDrchzZlbZ?projector-1&messagePartld=0.1 1/1 QJ) - �5 oa G��