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38B-280 (2)
32 WINTHROP ST BP-2021-0145 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-280 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: window replaced BUILDING PERMIT Permit# BP-2021-0145 Proiect# JS-2021-000238 Est.Cost: $8129.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RENEWAL BY ANDERSEN 090125 Lot Size(sq. ft.): 5488.56 Owner. RONALD D ACKERMAN Zoning: URB000)/ Applicant. RENEWAL BY ANDERSEN AT. 32 WINTHROP ST Applicant Address: Phone: Insurance: 30 FORBES RD (508) 919-0900 WC NORTH BOROMA01532 ISSUED ON.81612020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 4 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 Signature: FeeTvpe: Date Paid: Amount: Building 8/6/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner m a 3 � t Q The Commonwealth of Massachusetts cn Board of Building Regulations and Standards FOR y o Massachusetts State Building Code,780 CMR MUNICIPALITY o Q USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Fantily Dwelling This Section For Official Use Only Permit Number: Date Applied: p C-0 i xJ 4s Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: i 1.2 Asselsors Map&Parcel Numbers 32 Winthrop St _ j3 a 6 - GT 38B-280-001 LIa Is this an accepted street?yes no Map Number Parcel Number 1.3 7oning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(tt) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Pravided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ j SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Ron Ackerman Northampton, MA 01060 Name(Print) City,State,ZIP 32 Winthrop St 413.584.4497 rdackerm@live.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'-(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other A Specify: Rpplarpmp Br;ef Description of Proposed Work': replacement of 4 Windows SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1.Building $8,129.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) I $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:S Check No. Check Amount: �Cash Amount: i 6.Total Project Cost $8,129.00 ❑Paid in Full ❑Out alance Due: City of Northampton }' Massachusetts .;[ DEPARTMENT OF BUILDING INSPECTIONS � a 212 Main Street • Municipal Building ��• �. Northampton, MA 01060 PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR NEW 1 &2 FAMILY DWELLING,ADDITIONS, POOLS, DECKS,ACCESSORY STRUCTURES, FENCES, GROUND MOUNTED SOLAR, ETC. I. Building Permit Application signed by legal owner and filled out by owner or authorized agent. 2. One set of plans and specifications of proposed work. (Digital and hard copy) 3. Site plan with location of proposed structure(s)and set backs. 4. Construction Debris Affidavit filled out and signed by applicant. 5.Worker's Compensation,Insurance Affidavit filled out and signed by applicant. 6. Contractors must supply a copy of CS License, HIC Registration and proof of Liability Insurance. 7. Energy Conservation Compliance Certificate(new I replacement windows). 8. Home Owner's License Exemption Form filled out and signed by Homeowner (if applicable). 9. Note any Conservation and/or special permit requirements (if applicable). 10. Driveway Permit (if applicable). 11. Proof of Water and Sewer entry fees paid (if applicable). 12. Trench Permit-public land by DPW/private land by Building Dept. 13. Stretch Energy Code -all new construction will require a HERS Rater Affidavit to be submitted with permit application before issuance of permit. i • I • I . J I . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Jaime Morin CS-090125 _ 10/06/2020 License Number Expiration Date Name of CSL Holder 86 Gardiner St List CSL Type(see below) �I No.and Street Type Description Lynn MA 01906 U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1cC2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 508.351.2277 rbabostonpermittingPg andersen.com I Insulation Telephone Emai'.address D Demolition 5.2 Registered Home Improvement Contractor(AIC) Renewal by Andersen 170810 12/22/2021 HIC Registration Numbcr Expiration Date HIC CompanName or HTC Registrant Name 30 Forbes�d rbabostonpermitting(a)andersen.com No.and Street Email address Northborough, MA 01532 508.351.2277 Cayfrown,State,ZIP Telephone SECTION 6: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..........)KI No... SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWN'ER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Jaime Morin to act on my behalf,in all matters relative to work authorized by this building permit application. Ron Ackerman 8/4/2020 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereb t under the pains and penalties of perjury that all of the in.`ormation contained in this application isa and a urate to the best of my knowledge and understanding. Jaime Morin 8/4/2020 Print Owner's or Authorized is. e(Electronic Signature) Date NOTES: --- 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142.A.Other important information on the RIC Program can be found at www.mass.govloca Information on the Construction Supervisor License can be found at uww.mass.aovLps 2. When substantial work is planned,provide the information below: Total floor area(sq.fr.) (including garage,finished basement/attics,decks o:porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Dumber of bedrooms ?Number of bathrooms_ number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open j 3. "Total Project Square Footage"may be substituted for"Total Project Cost" I CITY OF NORTHAMPTON SETBACK PLAN MAP:_ _ LOT:_ _ LOT SIZE: REAR LOT DIMENSION REAR YARD SIDE YARD SIDE YARD) ' I � FRONT:SETBACK FRONTAGE I i I The City of Northampton r Building Department 212 Main Street ,.� Ate• ��- Northampton, Massachusetts 01060 Phone(413) 529-1402 Fax (413) 529-1433 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVA11ON PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: 4 Techology Dr Westborough MA 01581 Location of Facility___ ____ The debris will be transported by: Name of Hauler_ Renewal by Andersen _ _ _ _ _ _ _ _ _ _ _ _ _ _ ;i---- Signature,of Applican :__ _Date:_ $/4/2020 I The Commonwealth of Massachusetts Department oflndustrialAccidents I Conti ess Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PEPI MFMG AUTHORITY. Applicant Information Please Print Legibly. Name(Busincss/OrganizationMdividaa,): Renewal by Andersen Address: 30 Forbes Rd City/State/Zip:Northborough, MA 01532 phone#: 508.351 .2277 Are you an employer?Cheri:the appropriate box: Type of project(required): LCK I am a em 'o er with 0cm t `es(fu aad�orp a`-°n")•' 7. E]New construction 2.❑I am a sale proprietor or parmership and have no employees working for cue inO any capacity.[No workers'comp.insurance reqs.) 8. Remodeling 3.[:]l am a homeowner doing all work myself.[No workets'comp.insurance required.]t 9• ❑Demolition a.❑1 am a homeowner and will he hiring contractors to cond•.ra ail work as m/property, I will 10❑Building addition ensure that all contractors either have workers'compensation msur ace or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13❑ROO f rep airs These sub-contractors have employees and have workers'comp.insu ance.t . 6. We are ac oration and its 14.K]Other replacement ❑ mP right of exemption per MGL e. 152,§1(4),and we bave 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submita new affidavit indicating such. :Contractors that check this box must attached an additicnal sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mus:provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infornradom Insurance Company Name:_ Old Republic Insurance Co. Policy#or self-ins.Lic.M MWC 3145819 Expiration Date: 10/01/2020 Job Site Address: 32 Winthrop St City/State/Zip: Northampton, MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration bate). 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 tris statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veri ication. Ido hereby certify under d pains nd penalties of perjury that the information provided above is true and correct Sienature: Date: 8/4/2020 _ phonc#: 508.351 .2;07. ' Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/License 0 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 R: City of Northampton Massachusetts � <c DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ��'•�� Northampton, MA 01060 rsj, �10 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDA VIT I, _(insert MI legal name), born _ (insert month, day, year),hereby depose and state the folIowing: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.85.1.3.1, in connection u4th a project or work on a parcel of land to which I hold legal title. 2. 1 am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.83. 3. 1 qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR II O.R5.1.2: Person(s) who owns a parcel of Iand 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 shaIl not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualifij for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor far said project or work. Signed under the pains and penalties of perjury on this day of 20_ (Signature) Page 1 of 1 ACOR 1V CERTIFICATE OF LIABILITY INSURANCE °09/18ATE '/2019 09/18/Z019 — lk,� r 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. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may requlre an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NONE: Millis Towers Matson Kid—t, Inc. - c/o 26 Century Blvd ,iuCN u, .er 1-077-945-7374 jF • . 1-0{0.Oi7-217! E-MAIL P.O. Box 305191 ADDRESS: C41ttilicatesewillia.cm Naahville, TN 312 30 519 1 USA MALI g AFFORI)MMICpyELOM NAIC4_ �A: Old Re>pablia 20BUSTA O O MPIMY 24147 INSURED Renewal by Andersen LLC -- - 30 C POrbes Road MTSURERC: Northborough, KA 01532 USA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:x12663065 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, TYPE OF INSURANCE- L ) POLICY N'D WVD 11MBER —POL�Y E Pyr t --- LNMTi _ --- X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE = 1,000,000 [SATO RENTED W CMS-MADE X OCCUR PREMISES(Ea occumenc 4 500,000 A MEO EXP(My ma person : 10,000 NWZY 314161 19 10/01/2019 10/01/2020 PERSONAL A ADV INJURY 5 1,000,000 I((�G��E�NL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 6 4.000,000 POLICY -,Eo- I LOC PRODUCT$-OOMP/OPA3G S 4,000,000 OTHER 6 AUTOMOBR-EU^BtLrrY COMBINED SINGLE—LIMIT 4 5,000,000 (Ea sood-_!I X ANY AUTO BODILY INJURY(Pe,person) 4 A OWNED SCHEDULED RUlR AUTOS ONLY AUTOS 314159 19 10/01/2019 10/01/2020 BODILY INJURY(Per aweM)d 4 ._ . _ HIRED NON-OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY jParaooQ_an 4 f UNDPAL"LIAR IOCCUR EACH OCCURRENCE 5 _ Olt04EM LIAR CLAIM&&V= AGGREOATE 4 DED RETENTION I 4WORKERS — AND O I,V,gRON x STATUTE R A ANYPROPRIETORIPARTNER/EXECVTIVE Y/N E.L.EACH ACCIDENT 4 1,000,000 OFFICER/MEMBEREXCLUDED7 a MIA L 314150 If 10/01/2019 10/01/7020 - -— IMamdatoryIn NH) E.L.DISEASE•EA EMPLO f 1,000,000 h a, IPTfOe OF O 1,000.0 00 DESCRIPTION OF OPERATIONS oebw E.L.DISEASE-POLICY OMIT s DESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe alteched N mors space Is rewired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance 9• '1 Kr ®1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD $1 xo, 18532909 BATCH, 1372547 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washington Street Boston, MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/k lectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmuzation/lndividual): Renewal by Andersen Address: 30 Forbes Road City/State/Zip; Northborou h MA 01532 Phone M 5Q8 3512277 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 30 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or pact-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors haus g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] 1 c. 152, §1(4),and we have no employees. [No workers' 13.© Other replacement comp. insurance required.] •Any applicant that checks box M1 must also fill out the section below showing they workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside eontructors must submit a new affidavit indicating such tCont actors that chock this box must attached an additional sheet showing the name of the subtonttaciors and state whether or not those entities have employees. if the sub-ontractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Old Republic Insurance Company Policy#or Self-ins. Lic.#: Kt W 31415819 _ Expiration Date: 10/01/2020 Job Site Address: i w -- City/State/Zip: North Andover, MA 01845 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 and penalties of perjury that the information prodded above is true and correct Signature: Date: 12/23/2019 — Phone#: 508 351 2277 Official use only. Do not»rite in this area,to be completed by city or town official. City or Town: PermitMetrise# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: D o u b 1 e H u n g ,� byA.nderser..: -. � W'KDOW• REPi.ACEMEHT nnMde[.mCntnMny WoodMny!Composite IF � M Dual Argon Low R SmartSun Double Hu K .. - ` 100-00473518-010 THERGY PERFORf"-IV'E MTITPGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient cn ZO a 1t+ AORITIO:dAI.PERFORiiAi13!CE RAIMPS Visible Transmittance 0 4 21- NFnQ pr.auc[rw ..r na wvam[M..e.D31y d.oy p�oa.cf to. ry.cfb u... Conor.ttirlr.tunn h.ruun 2oth.r product p.[Axm.nt»infannNion. ...�LL N/ww.nfft:Afy 4It;l � Tlrc proerrct nwwfir..n .J;}�f'�!' Y •,f �' atfiniroY.tr.r+Y.r.[.tr4 �... - � t 1••,_( •P •�'ttr.tl.lrl.bC Y.► �.�, � ��m.t4i.(PwtapinA.nA �j.:p'. � •.,Y. DESIGN PRESSURE(PSF) N. k,�d„5 RDA DB Sloped Sill'DH IN Tritl YNN`LG2trA,WAM�ptl�/Lgtt�y,.A{gd( s. .c ootir+MlYlo.b nl.. M1roDI.. As. 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