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36-020 (7)
11 FOREST GLEN DR COMMONWEALTH OF MASSACHUSETTS BP-2021-1855 Map:Block:Lot:36-020-001 Penn it: Exterior Res CITY OF NORTHAMPTON PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Penn it# BP-2021-1855 PERMISSIONIS HEREBY GRANTED TO: Project# DOORS Contractor: License: Est.Cost: 9263 115719 Const.Class: Exp.Date:04/30/2025 Use Group: Owner: KRUEGER KARL G Lot Size (sq.ft.) Zoning: WSP Applicant: WINDOW WORLD OF WESTERN MASS INC Applicant Address Phone: Insurance: 641 DANIEL SHAYS HIGHWAY (413)485-7335 WMZ-800-8007695-2021A BELCHERTOWN, MA 01007 ISSUED ON:09/13/2021 TO PERFORM THE FOLLOWING WORK: 2 REPLACEMENT DOORS 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. Signature: ( , ff . 1)1 II� i � Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts lii y Office of Public Safety and Inspections Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number:6( a I-1'9S Date Applied: Building Official: SECTION 1:LOCATION i-t Dfvhvv Ss- ()IOLA) No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building 0 Repair' Alteration ❑ Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 15' Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work: ?-t,cav k' c\-.- v P Q`cxc.e, (4-11\nA- U\r-Nd (e 4 ov\a.- c\nkr Oe.s/J ec -1/4ne\ �J V-41ru r. AcerA iuX S`dnv�q a\nol Irv. "�V \¢Nr, c� aL PUNY' c cs- o SECTION 3:COMPLETE THIS SECTION. IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4❑ A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2 0 I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 (} S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA El VB SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public Check if outside Flood Zone 0 Indicate municipallg A trench will not be Licensed Disposal Site required or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable p Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner AD,ro. tll.'cov )' .dvJarr&Sc\rads oX.1 8 I 31\anlThe't) V A O Ci-V` Name(Print) No.and Street City/Town Zip Property Owner Contact Information: - - 26-(, - o811 Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: ?)avwr 'r'S � Sto3'1,_ C tQ O Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here'. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yesg No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ �J 21 03 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate mu ' pal fac )=$ 3.Plumbing 31 4.Mechanical (HVAC) $ Note:Minimum fe =$ tact municipality) 5.Mechanical (Other) $ Enclose check payable to hh 6.Total Cost $ Z, O-27(C, (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 wledge and understanding. Please print and sign name Title Telephone No. Date O\� _t\)\A., t NV n O\0 b0 rho oloavvoy\a ; bs. - Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: /2 / /6'204 Name Date SIGNATURES By signing below,you agree to items A, B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree, in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional, state-approved arbitration service(cost, if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. MINgtvgttittg this agreementkyou,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc.to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations, statements and agreements,expressed or implied, between the parties,their agents or representatives. You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third / l ,, business day after the date of this transaction. Z`4it ?/! See the attached notice of cancellation form Buyer Date for an explanation e of thisrhight. �/ " ( / Seller retains an equal right to cancel. Barron&Jacobs Representative Date ********************************************************************************************* Contact Information Office Manager: Sandy Scavotto Office:413-586-8998. x100 CI Chris Jacobs. President CT HIS#0554397 Cell phone:413-250-6677 Home phone: 413-665-91 13 Office phone ext: 103 ❑ lesha Gomillion, Senior Designer Cell phone:413-923-7003 Office phone ext: 106 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Contractor 518617 Purchase Agreement Page 16 of 16 ,4co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02/23/2021 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 CONTACT Adina Edgett NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL aedgett@webberandgrinnell.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC C Northampton MA 01060 INSURER A: Main Street America/MSA 29939 INSURED INSURER B: NGM/MSA Barron&Jacobs Assoc Inc INSURER c: A.LM Mutual/A.I M 33758 70 Old South Street INSURER D: INSURER E: Northampton MA 01060-3833 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 03/22 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 ADDLJSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD- POLICY NUMBER (MM/DO/YYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 DAMAGE CLAIMS-MADE X OCCUR PREMISESO(EaENTED occurrence) S 500,000 MED EXP(Any one person) $ 10.000 A MPT8049D 03/09/2021 03/09/2022 PERSONAL BADVINJURY $ 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000.000 POLICY PRO- 3.000,000 JECT LOC PRODUCTS-COMP/OPAGG S OTHER EPLI S 10.000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 1,000.000 g OWNED SCHEDULED M1T8049D 03/09/2021 03/09/2022 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ^ AUTOS ONLY (Per accident) Medical payments S 5.000 UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ B EXCESS LIAB CLAIMS-MADE CUT8049D 03/09/2021 03/09/2022 AGGREGATE S DED X RETENTION $ 10,000 S WORKERS COMPENSATION a PER STATUTE ER OTH AND EMPLOYERS'LIABILITY 91 YIN 500.000 C ANY PROPRIETOR/PARTNER/EXECUTIVE N N I A 80080063652020A 03/01/2021 03/01/, E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED/ (Mandatory in NH) E L DISEASE-EA EMPLOYEE S 500,000 If yes.descnbe under 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ Inland Marine Borrowed or A MPT8049D 03/09/2021 03/09/2022 Rented Equipment $100.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 ''11 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts =:ell_ a Department of Industrial Accidents 1 Congress Street,Suite 100 '""Miley Boston, MA 02114-2017 .� www mass.gov/dia mil- Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY Applicant Information Please Print Legibly Name (Business/Organization/Individual): ?cA((Dr'\ G.`r A 3e,,c_o1�,1 'i ems',-c. , \r Address: 1-C) 0 \d S 01/4)A-V. St City/State/Zip: 1•\0./AA y.,.M,QAUvN MI} 01060 Phone #: -j 3 ' tiKt- 1(1X Are you an employer?Check the appropriate box: Type of project(required): I ®I am a employer with \O employees(full and/or part-time).* 7. 12 New construction ❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. Demolition 10 El 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther 152,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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. *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 joh site information. Insurance Company Name: k\ A /.kukuoA Policy#or Self-ins. Lic.#: ti.)(A�"15.DO („,`bG5 20 20 Ps Expiration Date: I y j2.0 y2 Job Site Address: L 1 CT(OrN aV s St - City/State/Zip: NOrkha MM O\t 6C Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi tion 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 ins and penalties of perjury that the information provided a ave is rue and correct. Signature: 0.7'1 [date: el l c .0 Phone#: '113) `S.c4:, - `'S`'AU1`'f 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#: DEBRIS DISPOSAL AFFIDAVIT In accordance with the provisions of M.G.L. c. 40, s. 54, Building Permit was issued with the condition that all debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L c. 111, s. 150A. The debris will be disposed of in: (X\\ Name of Waste-acility Address of Waste Facility 111.5 Debris: As a condition of issuing a permit for the demolition, renovation, rehabilitation or other alteration of a building or structure, M.G.L. c.40 s. 54 requires that the debris resulting therefrom shall be disposed of in a properly licensed solid waste disposal facility as defined by M.G.L.c. 111 s. 150 A.Signature of the permit applicant, date and number of the building permit to be issued shall be indicated on a form provided by the Building Department and attached to the office copy of the building permit retained by the Building Department. If the debris will not be disposed of as indicated, the holder of the permit shall notify the building official,in writing,as to the location where the debris will be disposed. 780 CMR—6th Edition Signature of Permit Applicant 11\ Date .._74 6/2-my40,4epeadi 0/ 0:4 4, 01ef,4,ea), Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration A. Type: Corporation �, Registration: 100809 BARRON &JACOBS ASSOCIATES, INC ,ram Expiration: 06/22/2022 70 OLD SOUTH STREET = s NORTHAMPTON,MA 01060 ' 4t Update Address and Return Card. SCA 1 0 20M-05/17 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 100809 06/22/2022 1000 Washington Street -Suite 710 BARRON&JACOBS ASSOCIATES,INC. Boston,MA 02113 CECIL R.JACOBS 70 OLD SOUTH STREET CL/, " NORTHAMPTON,MA 01060 Undersecretary Not Valid without signature Commonwealth of Massachusetts it Division of Professional Licensure Board of Building Regulations and Standards Const<luCt niSupervisor CS-060475 _ Eic.,pires: 11/10/2022 CHRISTOPHER R 70 OLD SOUTH ST NORTHAMPTOfI MA r Commissioner . ct K. Q c .147.. .,,...1.4--.;•,.,F.,4....4,7i,:,,',li,:.,,:e„, -4•T'L4,,.1.1,..h...... i 1'',/•;:cro../' . . '; '------'417..;1..141.4, . ' • - • .,),..,'.t, .i.:. rt--7-4,-,,4-, --,..7A,. ..' ,f• Pei"...:,: I A 4°.,. 4 . ;•:.',4••:-:";•".--•• .. • • .-:.• . -- ----' ,,....' '':i.•' ,2.. '4144, ,,,,, ..•• •,-.,.:4-.,!:.,-.,,r...--r, i 1.,.:* tl,',.Wf/.44, 1 '',1•--' , ,,.....-t--,••••..t...t .-..., , . . ,/ 1? • .4."..,•,, • ',.., . .1.\--I . . .. ,.i..• t• _ . 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II ..• 11111It - ..0011igia I.4111111allif aZa....-:. -.•-=-.- ' . • :ii. 4.`4 • ,\, -.-: .li rik-. '. , L ei, 7". 4.."11,-;•'.: , . V let•,,..' ,, i 1 ' ... . \' \ . k \ 11. \ .41 4i." Iilit \ ,, '''''•-: \ ' 1 ' '' \:,:t ‘ \ '. ' , , '; k \ k . \ • : ' ' ,-- . . . ,. '1',...,\1 ,\ ' k \ ‘t ' L \ ' 1 ' • • ,i, ... ... . „,,,...,\L '.4. ''....'''.. ' '.......M.IM•fa.M...............'' ....-....M6,.,1 ......-....•.-....24-L. ...,..:.. I , , ', .-.' 1111r-i t'' .., ,, • _ •1...1.W.,1,',''.',',,," " • ' • ' - - I' •,: ,_____ . • V" " •-‘r.--..... . • I, , r Ji‘v ,Iiii. . . ' . . ,. . . 4111 1 1111111.''•\ I, \ . ____ , As. 41,1, It " 1 1 • I , •i 1111 I [ lq . * .., : 1.11111 • 1 I. • .4 , • , I , .. \' +.',' ,„1 1,;' '- ..• ,Icl, 1 \\ . .... , c--_,.-- (----, ,.-.., \ t. I 1''•'--— .. . . . li \ .. .‘• •.. .,....., , , , _4 • • c,: .. ., 1 I ,'. . 4 • litI.:.... s.,..,.., --,;:,-..,j `••• .- 't• 4.:. , : '‘ '). • ;44- . . ",•-.....,, 1 's''''f-.. _.. 1-.7 ... " . 4 1 , 1'.,1 . I ' ,ti•4-,...:4, '""*" , . - • ' , , 44 • $t 1- -,..,,N moms .,,, , .• . :.? • :,...:4ff rni , . , ...._...._,. .'..i _____,4 I h •4 h ' I 4 h. Lit 4 .\ ,..„ . - , \ir i ... • Cl e . , .... ., I 41.,EI-j- A . . . • .., V .sg,„ • • At , 4 i Mit. 4 . . ..... . _ . ....i, ,.. _ .. . ..... ........,.,,- ..,.,. ___,... , ,, , ,,,_ Barron &I Jacobs DESIGN . BUILD . REMODEL Dear Code Official, Enclosed please find an application and supporting documentation for a requested building permit. I have enclosed a self-addressed, stamped envelope for your convenience. Please mail the building permit to our office. Thank you. Sincerely, Chris Jacobs A Tradition of Building Satisfaction, Since 1986 70 Old South Street, Northampton, Massachusetts 01060 413.586.8998 barronandjacobs.com