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17C-283 (7) B P-2021-2074 22 LILLY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-283-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2021-2074 PERMISSIONISHEREBYGRANTED TO: Project# WINDOWS Contractor: License: Est. Cost: 20000 Const.Class: Exp.Date: Use Group: Owner: STONE SUSAN C Lot Size (sq.ft.) Zoning: URB Applicant: C STONE SUSAN Applicant Address Phone: Insurance: 22 LILLY ST FLORENCE, MA 01062 ISSUED ON:10/26/2021 TO PERFORM THE FOLLOWING WORK: 11 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. Signature: I 1 ' • • .52 - , Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 111111 2 The Commonwealth of Massachusetts ,, Board of Building Regulations and Standards FOR c `� Massachusetts State BuildingCode, 780 CMR MUNICIPALITY ', y_° `v USE 16 Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 o One-or Two-Family Dwelling This Section For Official Use Only Buildin Permit Num er: f' .�/�-tVZ� Date Applied: EU,tJ ss /12 10.22-7.01I Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1. roper Address: 1.2 Assessors Map&Parcel Numbers 1ba IV S-h-tet / i7e. a?3- 001 1.1 a Is this an accepted street?yes V no Map Number Parcel Number 1.3 Zoning Informatio 1.4 Property Dimensions: uR 6. i esid itch ,as 8a, 5 Zoning District Prop sed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided 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: C Outside Flood Zone? Check if yes_ Municipal On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' /` 2.1 Owner'of Record: L5 O.5A J 0 . 3TOM61 N94c4rT�s l n,uLe,e, M q o ID to Z Name(Print) RFt(V 1CKCity,State,ZIP 7 G "Ii3 -5 6/14 (sue'16eroe..��10bv1�-c1�,cowl No. and et Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building Owner-Occupied)4 Repairs(s)\ix Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of P ose1 Work': (( epae� S - rc .e SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ J© WO 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3 (Item 6)x multiplier x 3.Plumbing $ 2. Other Fee : $ 4. Mechanical (HVAC) $ List: a) 5.Mechanical (Fire $ Q Suppression) Total All FeGs;��4 Check No. heck Amount. Cash Amount: 6.Total Project Cost: $ 61 NO 0 Paid in Full 0 Outstanding Balance Due: City of Northampton r d� R♦ Massachusetts JYYY DEPARTMENT OF BUILDING INSPECTIONS 50 212 Main Street • Municipal Building �y Northampton, MA 01060 skn, ,t .'. 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/ 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. 14. Please provide the appropriate fee in the form of a check made payable to: The City of Northampton. 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.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling �' 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 Ate.FIIAVIT(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 0 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 ent 'n my name below,I hereb attest under the pains and penalties of perjury that all of the information containe n this applicati i d a urate to the best of my knowledge and understanding. Print is or Authorized Agent's Name(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. 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" CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE e I City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building vy_ \. Northampton, MA 01060 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: East- (406(5011� GT The debris will be transported by: Name of Hauler: U SO ,if irxq .� e c(„- J /f - i I z Signature of Applicant: � 4t �'!i� Date: /6/cRO;J The Contntonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-201 7 pmw.mass.govidia ‘Vorkers'Conipensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO RE FILED WITH THE:PERMITTING;AUTHORITY. Aoolicant In fo rniation Please Print Legibly N dune iBusiness,Organization Address: City/State/Zip: Phone#: Arc you au i elliphlyyte Cheek Mt appropriate bpi! Type of project cretjuiredv. 1.C3 lam a erripkr,.er with erripioyves(fail amel'or part-tut ' 7. 0 New construction 2.0 I am a sok proprietor or partnership and have no employees workung for me in 8. 0 Remodeling any cwiti.ity.[Na workers'comp.insurance recpaired_] 9_ El Demolition 31:1 tarn a IsOrrse0V,Tier LainN all work myself.[No workers comp,imurance rexinireell 10 J Building addition 40 lam a hoirteownin.and will hirutg oontractors ethatthet all work on my mortify.. I wt.13 ensure that all contractors either law worken.-compensutton maurance or are sole I 1 a Electrical repairs or additions proprietors with no employees_ i 2.0 Plumbing repairs or additions 50 I am a gramal contractor and I have hired the Alb-oantracion listed on the attached these sub-contractors base employees and Etas e wutters'comp.insuranc 13.0 RtX)f repairse:: i 4.C]Other 60 Vic art a oorporation and its offreers have exercised their right at eterription per MC&c. §1(4),and we have MO extep10:•:•ves.[N*0 comp.insurance requiretti 'An:,applicant that Cheeks bait gi mind also fill out the section below.now mg their workers'compensation puli,:y ueralci I kinicowners who submit du s affidavit utdscatme they are doing all work and then hire outside contractors mica submit a nevi affidavit iidiesting such. tCurdnickirs that check thin box must attached an additional sheet showing the name of the sub-continetisrs aUtiAblii: lic-ther ow not those tannin,haw employ cc, It the sub-contractots ourILPL air workers';Amp. nuailvr I run an employer that is providing fkvrAers'compensation insurance for my employees. Below is the policy and job Nita' ihforniation. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City Attach a copy(lithe workers'compensation polky declaration page(showing the policy nurirlier arid epiratiou date). Failure to secure coverage as required under MOL c. 152, §25A is a criminal violation punishable by a tine up to SI.500.00 imdior risonurnerit.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a thy against th :olator. A copy of this statement may be forwarded to the DefierInvestiga.tions of the DLA for insurance ctw eragc e r: rt on. 1 du hereby certify water the pains and penalties of perjury that the information I:Provided ithore is trite and correct. SI Linaruri:: Official fat'only. Do not write in this area.to be completed by chry or town official City or Town: Permit/License It Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 4: City of Northampton 414 Massachusetts zr Pti { DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 HO OWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I (49 6 I, L (insert full legal name), born (insert month, day, year),hereby depose and state the following: 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.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. e12IJJtk , 2O til I, Signed,u der the pains and penyl#iperjury on thisa� day of 07/ .ate V-6 L--(2 (Signat�{cre) CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DINIENSION. .. • p . ... i'•'-. ,.,- ,,It 4,,,c,t. 4 ' , ,, / I, c 1, . , • PI** '.:: ' ,.- • ,,, . -••• ,„ , I r.;,alft ....... ,, ',,,,,.,',..(.4.:.,., . ,.. . ........ , ,• i . ,,' v., .', , ,..,. . . ,.., _ .. . . _ ,_ 2 11: i..,c,„#„ , . v , . . , .... . - .., .~...7.-... it _- --„,-.., g. . . - . . . . ., .1,.. .5.1 „„. „ .....s......_ . " ' 4,;!1.,'k,. '44,'"'"it'T.1',J,,,.,•o, - , ,--, ' ,,-•., _ , , ,,,..,...,..,,-, •Tit;•,....k'•$:•-s, v .1., .., Get Outlook for i05 iii • , .<,—. ‘r't, i''iti:1,,i6 C't),) It 1 https://trallgoogie,comimailiu/O?ik=67976732138,vlew.pt&searctl=alt&g)ermthd=tt-Tread-f%3A1681353826522152205%7Cmsg-f*Ii33A1681353826522„ 111 D22R04 28-OCT-20 11:21 37 AM V11.00.01 Page 1 Sales Order Energy and Performance Information Summary DAVEHAMILTON Customer Name : R K MILES INC-WEST I iATFIELD Customer Address : 18 SR-10 24 WEST ST Order Number : A13C00244 Order Date : 24-SEP-20 Line Unit-id Qty Mark Unit NFRC Unit Description U-val SHGC VLT Energy Star Certification Product Number Glazing Comment ER Divider Comment 1 Al 2 424 Elevate Double Hung Insert 0.28 0.28 0.47 NC MAR-N-424-00530-00001 3.1mm 272 / 11,5mm arg / 3.1mm clr SDLS < 1" 2 Al 3 424 Elevate Double Hung Insert 0.28 0.28 0.47 NC MAR-N-424-00530-00001 3.1mm 272/ 11.5mm arg/3.1mm clr SDLS < 1" 3 Al 3 424 Elevate Double Hung Insert 0 28 0.28 0.47 NC MAR-N-424-00530-00001 3.1mm 272 / 11.5mm arg i 3.1mm clr SDLS < 1" Line Unit-id Qty CCL WDMA Product Description Test Rating and ASTM Certification Product ID -- Size -- DP Rating -- Certifing Agency --. 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