24A-085 (2) 195 NORTH ELM ST BP-2022-0069
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-085 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit# BP-2022-0069
Project# JS-2022-000127
Est.Cost: $4700.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 12501.72 Owner: LUCY ASHTON
Zoning: URA(100)/ Applicant: LUCY ASHTON
AT: 195 NORTH ELM ST
Applicant Address: Phone: Insurance:
ISSUED ON:7/20/2021 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 3 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.
9
Certificate of Occupancy Signature: l
FeeType: Date Paid: Amount:
Building 7/20/2021 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
. .
411.
, The Commonwealth Commonwealth of Massachuse•s
W Board of Building Regulations and S".tidal..:
Massachusetts State Building Code
&(>011,-,.% C1PALITY
Alio E
Building Permit Application To Construct,Repair, ' •n%;•fil : Or Den4th a '•Mvd . 2011
One-or Two-Family Dwelling 4/0,9°);:its4 c.11
'-''. ::''..:7 ' ';•',--i: :::-.-'-.:. - *::•:--'--.- •=:-. ' This Section For Official Use Only 4141,,, 7:::: '--7:-- : -' '
--Ilifiltlgy-..' 1;N.:... ,ee: jfr 1.4 Date Applied: 4• Oros 4, .
igritOfffe141(PrintiVaine) Signature - Date - - --
,..
_. . ,.-- Sc'lION 1:SITE-INFORMATION
1.1 ProDei Addrtss: 1.2 Assessors Map&Parcel NFL) rs
/
1.1a Is this an accepted street?yes no Map Number Parcel umber
1.3 Zoning Information: 1.4 Property Dimensions:
ce----.s/A6r7v7,,,y D. 7.4;7 4 €,--__c
Zoning District Proposed se Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required F-1.......oOlecr Required Prpidd Required Pr"clee
, -
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood0 Zone?
Public.3" Private 0 Municipiii2<th site disposal system 0
Check if yes
-:SECTION 2: PROPERTY OWNERSIIIP1
2.1 Ownerl of Record:
V1/(97/L11>VP/ ./1/
Name(PrOt) City,S te,LIP
No.and Street hone '32._ Jo V Email Address
SECTIONs3iDESCRIpTION-OF PROPOSED WOW,(check all that apply'). -• : ' . '
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) El Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other ;21/S6pecify: Ciz_Lai citizg,-‘,4-0 e-4/
Brief Description of Proposed Work2:
3 a i/4..)/J 0 4) ,e)xi 1/59.4 I/ /—/0 af _-- 7D cr—
Le—Xto4-5. - }ArQ
SECTION 4:ESTIMATED CONSTRUCTION COSTS -
_
Estimated Costs: "
Item Official Use Only
(Labor and Materials)
, , , , _ • . -.
1.Building $424° 1. Building Pertnit Fee:$'. Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Cost (Item 6)x multiplier - k..
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $
5.Mechanical (Fire
Suppression) $ TOfal AllF*;$1 . . , _
Check Not, !. Check Amount: -- - Cash Amount:
6.Total Project Cost: $ 4960 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,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 0 No . ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
As HP/4 VAnJ ►4 tTl 7 a
wilimiumpAuthorizeuRgenemeffe(Elect D e
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. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
,.. _
,
The Commonwealth of Massachusetts
- -- ----:t..,...
it Department of Industrial Accidents
I Congress Street,Suite 100
Boston,AlA 02114-2017
wpvw.mass.govldia
1%orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
It)HE FILE')141TH IRE PERMITTING AITHOR111".
Applicant Information Please Print Legibly
Name ititisiness-Organuationitodoriduali:
Address:
C ity/State/Zip: _ Phone #:
'
s re yos lib eimplikver,Cheek the appropriate hot: Type of project(required):
1.0 lam a cinpkryer with cirniloytes OM antler parktime 1.• 7. 0 New construction
I am a sole pinprick*ar porrnerskrip and have no employees woricireg for nse in S. Ej Remodeling
any capeleit!,[No workers'comp.insurainv retpireal
3' I am a homeowner doing all work myself.[No workers`ems"...insurance motored.1"
so
ilmillz. a c hurrie4vner and will be heristg.contractors enorthet ail w on ork thy priverty. hod!
. 'ore that all ouraractors either have workers'euetaperoation nuns-lime or are.e.le 9. 0 Demolition
I am
100 Building addition
em
I I.(73 Electrical repairs or add 1 i 1+.1 I I:,
proprietor,V.ith no ensployees..
12.0 Plumbing repairs or addition:,
SCi 1 am a genera ra have
l contctor and I hired the isth-eunt rati etrs listed un the attached iheet.
i 3{:1 Roof repairs
Mese inivountraelors have employees anti hive*urkers.,:urnp.saisurance,;
,
6.E3 We air a corporation and its officers have exercised their right of exemption per NKSL e. I 4.0 Other
152,§I(4),and we have tbi.)einiplayees,[No workers'comp.insurance required.'
*An:. 4..7..IrtiL_gni tha chariot box 41 mini ASO tell our the section beltrtli shoVarts their Warta's'ccurspensaitOri policy information_
t itomruutis:IN*ht.iubant thu atlithvit indicating they are dome all work and then hire uctside contracters triles1 step a new atitcb,.it maw:aims.;,Le.:h.
•C,I7itra..-"J,r,I hAt,.:1,2,...k Itu,lox roust art.wthed an althtiunal Nbee r shuo."In.•the name of the,uh-euntraciary and,we 0,tudEicr or riot Lho,c mlati...- k3vc
.:untr.ict-CIN 11.0.:,...::IrIk,:ii:,.l::,..!, 11V-1,1 rt,,,ki,..Li,::- ,,,..rk,::,-;..v1:11,.:,,A,..:y.taturitvr
employer that is providing',others'compensation insurance fur my employees. Below is the polity and lab.111e
information.
Insurance Company Name: _
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/StatelZip:
Attach a copy of the workers'compensation policy decioratiosi page(showing the policy number and expiration date).
Failure to secure cos erage as required under MGL c. 152. §25A is a criminal violation pium...habie by a tine up to$1,500.00
andior one-year imprisonment,as well as civil penalties m the form of a STOP WORK ORDER and a fine of up to S254).00 a
day against the violator.A copy of this statement tnay be forwarded to the Office of Investigations of the DIA for nmurance
coverage verification.
...
.
I do hereby r 'wider the s d pen f perjury hafa
the
•I inrmation prat:lite:dr hove d correct
1t# i I
6K, a.a.s.1 0/ 6--
01 O 1 — c 5 a— / 7 0 (0k, —/0Date:si ) 7 1 o 31
Phone :
Official use only. Do not write in this area.to be contpleted by city or lawn gilic ia I.
City or Town: Perntit/Liccnse#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Eketric.il Inliector 5. Plumbing Inspector
fv.Other
Contact Person: Phone#:
, „
r.7,BRIS DISPOSAL AFFIDAVIT
was issued with the condition that all debris resulting
---71-n this work shall be disposed of in a properly licensed solid waste
osai facility as defined by M.G.L c. 111. s. 150A.
:.fle debris will be disposed of in:
ya,
;ie of Waste Facility
(5 c41-Sritigi/P9PY-1 eie iljEl i,V
!_ideas of waste Facility
Debris: As a condition of issuing a permit for the demolition., renovation,
-.:onouusaon or omer alteration or a Doming or sc ucarre,iviU.i.c.41)S. 34 requires
that the debris resulting therefrom shall be disposed of in a properly licensed solid waste
---1 r_,:t:...__a..s"..a i...1 t n_r tit .. t rn n c:......a......stt......,....:a......t:......t
_..�.""..-....__.......-or•._....................'._..___.......______-__ter._....__
by the Bonding Department and attached to the office copy of the building permit
�..;n..t h..the t2."1.1ttfrt Tlana.t rent Tf the debris will not be disposed of as indicated.
holder of the permit shall notify the building official,in writing,as to the location
debris will be d'i)OSC3.
7Rt{CMR-011111
A
signature of remut Applicant.
0C. t10 ._ 7
vat
City of Northampton
'; .1''1 Massachusetts ' s
.It ,'...0 DEPARTMENT OF BUILDING INSPECTIONS ��
'
_ 212 Main Street • Municipal Building -t� -z.,,
' ' Northampton, MA 01060 ' ,, `
- I / / ' M/�PTION ELIGIBILITY AFFIDAVIT,
I, Lw4' A s 14TOIJ VAN AT1'A (insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. 1 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.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I 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.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify 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 for said project or work.
Signed under the pains and penalties of perjury on this -7O day of J (llLkii , 20 4.
City of Northampton
: 4+ ~� Massachusetts � i�
l
DEPARTMENT OF BUILDING INSPECTIONS
4 '0' 14
,�, 212 Main Street 40Municipal Building 4,, '�
�� Northampton, MA 01060 f r,�h ,+,y"
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 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:
Location of Facility:
The debris will be transported by:
Name of Hauler:
Signature of Applicant: Date:
L
MARVIN® C if✓ MR INSNIA1TURE TETM
COLLECTION
1 Ni r1131 .)I(;11- CAN ilIII'I.1 lip 171lfIIIIIfhllryl F I I.flllll:i
f"
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f_NEf by S rAR �.1 .1 '/
0 Certified
UL DBLHNG ING2
4� , WAIWA
Vertical Slider
NtAC 718" IG low E3 erg
4! 3.1mm 366I 16.0mm arg 13.1mm clr
4,
Nntlanal Fene9trbtlarr .008 SS—D Pine or EQU
Rating CoundIe
MEM MAR-N-441-00321-00001
ENERGY PERFORMANCE RATINGS
ac SOAR HEAAIEfFICIENT
0 .36 0 . 18
(U,
ADDITIONAL PERFORMANCE RATINGS
VISIBLE TRANSMITTANCE
0 .41
-tltlllrtlr
Manufacturer stipulates that these ratings conform to applicable NFPC procedures for determining whole
product performance. NFPC ratings are determined for a fixed set of environmental conditions and a specific
product size. NFU does not recommend any product and does not warrant the suitability of any product for
any specific use, Contlult manufacturers literature for other product performance Information. www.nfrc.org
wir a w e tlo s
MAMJVACTUq[Re AS SCCIATICN Ul ()SLANG ING2
W M A Manufacturer StipMulates HalImai k Certification
Hallmark Certified
weme,com As Indicated Below
UNIT
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Hallmark Product Number 407-P-1149
AMMA+VIDMAICSAI10111,S21A440-11 LC-P0501102223 mm(45,38X81, 9 in)
POSITIVE DESIGN PRESSURE(DP) +50 psi
NEGATIVE DESIGN PRESSURE(OP) .-50 psi
Water P000tratiop Tog Pressure 7.5 psi
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ASC00526 1 IJN256 Al
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