23A-156 (3) BP-202 1-2203
82 PINE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23A-156-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2203 PERMISSIONIS HEREBY GRANTED TO:
Project# INSULATION Contractor: License:
Est.Cost: 7000 077279
Const.Class: Exp.Date:06/21/2022
SMITH SERENA A & MADELINE WEAVER
Use Group: Owner: BLANCHETTE
Lot Size (sq.ft.)
Zoning: URB Applicant: VALLEY HOME IMPROVEMENT INC
Applicant Address Phone: Insurance:
P O BOX 60627 (413)584-7522 0055030215
FLORENCE, MA 01062
ISSUED ON:11/29/2021
TO PERFORM THE FOLLOWING WORK:
INSULATION/WEATH ERI Z ATI ON
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: 14 � ' (� . �)
� s ,
Fees Paid: $65.00
•
212 Main Street,Phone(413).587-1240,Fax:(413)587-1272
Office of the Building Commissioner
RECEIVEt
The C:ornznonwealth of Massachuse • NOV 1 7 021
rt,
Cli OR
AI
of Building Regulations and Stan rds
Massachusetts State Building Code, 780 �"BFpT of BUILDING it p MUNI �ITY
n� �s Ma 2011
Building Permit Application To Construct,Repau;Renova ra r�tp
--One-or Two-Family Dwelling.
This Section For Official Use Only
Bnildin Permit Number: 5 a.I-i?a1P 3 ' Date Applied:
ig
't)l►- // _-__7 • li-2320Z.
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORM ATION
1,1 Pr n rP. Address .. 1.2 Ase� ears Map&Parcel NT s-zinc, CC-A— _ �314 I
1.1 a is this an accepted street'?yes_ mu - Map law .ber Parcel Naarnber
•1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yard 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 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP` •
Owned of Rec4
- Name(fit) i City,State,ZIP
S2. Pt r - tt( 3--5isk-t-'sv34
No. and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKS (check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s).❑ Alteration(s) Cl Addition 0
Demolition CI Accr sor<yBldg. 0 Numberot'Units Other 6 Speciiy:
- Brief Description of Proposed Work2: 64.0401 t r.% fH ' • ti ' ; t'.% (1' l t .
• SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: • Official Use Only
_._ (Labor and.Materials): - .- --.. ..-.
l Building $ 7` 060 I-. Building Permit Fee: $ Indicate how fee is determined:
fl Standard City/Town Application Fee •
2.Electrical $ ❑Total Project Cost)(Item 6)x multiplier _ x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ --, List: 'S •
.Mechanical (Fire $ _ _
Suppression) All Fees:$� (�
Cheek No 400)2 Check Amount: Cash Amount:
. 6.Total Project Cost: . $ -]1 000 . .p paid in FullC Outctsnding Balance Due: -
SECTION 5: CONSTRUCTION SERVICES
5.. Construction StrperVtsorLicense(CSL) 1 011 9 CO{Zt (2oZ2
Set" Ctl`f f r�� License Number Expiration `Date
Name of CSL Holder
P c6c ( '(0Z1 List CSL Typo(see betotiv)
No. and Street t — --TYPr IZscription
R O� c U Unrestricted(Buildings up to 35,000 c� .f:.) -
C��Pr)(>~ 1v v U _ R_ Restricted I&2 Family Dwelling
CitylTown e. 'IP M 1>Qasr�nr,
/` RC Fctir]{ingi tivering
WS Window and Siding
Si? ' Solid Fuel Burning Appliances
u� 'ti~1S2Z- • I insulation
Te1ephane Email address D Demolition
5.2 Reoistered Rome Improvement Contractor(Hit)
t os3 Blza J a)u.,
I l MC Registration Number Expiration Date
C Comp -Name or WC Registr nt Name
n.F7 0/0 L)O(02- 1 •-kl 105-2C�Oak. b Xv Cot_
No.and Street Email address.
4t3-Sat --522.
City/Tomm.,State ZIP Tele hone
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 thebuilding permit.
Signed Affidavit Attached? Yes litf No ❑ •
SECTION 7a: OWNER AUTHORTZATIONTOBE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDIlsTG PERMIT
I,as Owner ofthe subject property,hereby authorize `N 01-L i A-i S 11 ,ram a-\
to act on y behalf,in all matters elative to work authorized by this building permit application.
Print Over's Name(Electronic Signature). f/v
� Date
SECTION 7b:OWNER1 OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of per' that all of the in formation
contained in this application is true and accurate to • ykn ledge derstan ding.
Sy- r,) >> L 1 r.12114,?A) l r 15—,,2o l
Print Owner's or Authorized Agent's Name(Electronic Sipa= 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(BIC)Program),will not have access to the arbitration
program or guaranty tend under M.G.L. c. 142A Other important information on the HIC Program can be found at
w ivi',.mass.oov/oca information on.the Construction Supervisor License-can'be found at www.mass.aov(dos
_ 2. When substantial work is planned,provide the tnforination 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 halfi`bauis
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 northarno tort
/, r
A Massachusetts (c _lilV:! DEPARTI✓ NT OF' SUILD[l�G £ATSPECS_+ONS I1 .4
,'75 212 Main .Street' a Municipal Building J�� Al,-s, 01060 t._A IYr d"Pic�tha-
_ Et"
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, SSA•, a condition of Building Permit
Number
umner is th at all debris
enri resulting fr nn this work
Sr �n� be disposeddisposedof in a
properly licensed waste -disposal facility, as defined by MG_c 111, S ?SBA.
The debris will be disposed of in:
Location of Facility: \J Q % 12 o c cI t kA-e AC) , (4-han\_LAC,4--,
The debris will be transported by:
Name of Hauler: \1 '�YOmo t& 7 tst — .
Signature of Applicant: / i Date: / 0,2 t
= ' The Commonwealth oPfasscc1ucsetes
� c, Department of Industrial Accid
ent
s jl -A = i
1 Congress Street, Suite 100
' =
Y�5_ 1 Boston,MA 02114-2017
a -" ' _ www.mass.gov/dia
11.'n.rbers'Compensablun Insurance Affidavit:I3nilders/L'mime_torsl!^+leatticlans/Plumbers.
TO OO i%F rILFI)i Willi T-W r71ZMTTTTWVG ATITTIORITY.
Applicant Information , 3 Please Print Legibly
Name(rsrsinexsli,rgxniratit In/intii yid iLai]: al tic:::k' /,-f"-C\ —�(1.)Y '9(C' je�(�ero._ [ 1 1 1C
Address: Mtn lv.-e, —Do CSC . ?- O . 0- (o o C-) 2.-1--
City/State/Zip (-`O.r( a ,' b2... Phone#: 14 V=2D— SS"1-11 S2 Z-
Are you an employer?Check the appropriate box: Type of project(required):
I. I am a employer with ( employees(full andUor part-time).` 7. El New construction
2.0 I am a sole proprietor or partnership and Lave no employees working for me in 8. ®Remodeling
any capacity.[No workers'camp.insurance required]
9. ❑Demolition
3.rl I am a homeowner doing all work myself.INo workers'comp.insurance required.i' r� t .
10 lJ Building addition
4.0i am a homeowner end will be hiring contractors to conduct all work on my property. I will
ensure chat all txtrrtfaczors either have wet ect-s'compensation insuranee or are sole 1.1.❑E.1.e:tt ai.tepaia's fir.additioas
proprietors with no employees. 12.❑Plumbing repairs or additions .
5.1=I I am a general contractor and T havc hired the sub-contractors listed on the attached sheet. ]3 ❑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 perMGL c. 14.❑Culler
152,*1(4 j,and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks big,01 must also all out the section.e;L.:low showingtheir worths'compensation policy information.t�ca.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
.TC infractors that check this ixrx most•a ttathnd'an'adthtivnai sheet showing the name of the stet-vontrauturs and statt-whether ur'nut those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy nundier.
I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A r be. --c-trAcUitc1 r(c, Al rt
`
Policy#or Set-ins.Lie.#: 005 SQ 2a(32\c'', Expiration Date: 91 I I D O
Job Site Address: � (1 C1fL. �� City/State/Zip: 0()4J'i P+U'Z k'1 01 ca
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expix 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$25 0.00 a
day aglinst the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify under t1 ���,'• and penaltie f perjury rmation provided above is true and correct •
Date: . _... ..
St�nattire: �+
Phone#: Q k9D- r� -- 2Z-
Official use only. Do not write in this area,to be completed by city or town official
City nr Town' Permitlll,icense#
Issuing Authority(circle one):
- 1.Board of Health 2.Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
I
Contact Person: - Phone#:
Paradigm Window Solutions Customer(Sell)
per' ra I 56 Milliken Street Phone: (877) 994-6369 QUOTATION
Portland, Maine 04013 www.paradigmwindows.com
Window Solutions For Life
Creation Date
10/25/2021
BILL TO: SHIP TO:
Phone: Fax: Phone: Fax:
Thank you for choosing Paradigm Window Solutions!
QUOTE NAME PROJECT NAME CUSTOMER PO# DATE REQUESTED
VALLEY HOME SMITH
•
SALES REPRESENTATIVE TERMS SHIP VIA QUOTE NUMBER
ringerj@rkmiles.com 761219
Lineltem# Description Net Price Quantity Extended Price
1-1 S279.40 1 S279.40
Comment/Room: Product: 8300 Series,Double Hung,Rpl
RO: 18"x 31.25" ,..,
TTT Overall Size: 17.75"x 31"
TTT Unit Size: 17.75"x 31"
tN
Sash Split: Equal
Performance Level: Standard,
Glass Options:Double Glazed,LowE,Argon,Annealed,SS
3/4"IG Thickness,Clear Opening: 12.375"x 10.085",0.867Sq ft 0 '€
Ratings:U-Factor=0.27, SHGC=0.28, VT=0.53
Vinyl Color: White 1`
Locks: Standard,Single
Hardware: White, R�-7 0
Screen: Half Screen,Extruded-Fiberglass,White,
Primed,
Interior Trim:No,
Installation Options: Standard Sill Angle,
Last Update: 11/11/2021 1:17:01 PM Page 1 Of 2 Printed: 11/11/2021 1:17:34 PM
QUOTE NAME PROJECT NAME CUSTOMER PO# DATE REQUESTED
VALLEY HOME SMITH
SALES REPRESENTATIVE TERMS SHIP VIA QUOTE NUMBER
ringerjgrkmiles.com 761219
LineItem# Description Net Price Quantity Extended Price
2-1 S279.45 1 $279.45
Comment/Room: Product: 8300 Series,Double Hung,Rpl -
RO: 18"x31.5" J
TTT Overall Size: 17.75"x 31.25"
TTT Unit Size: 17.75"x 31.25" i17
Sash Split:Equal
Performance Level: Standard,
Glass Options:Double Glazed,LowE,Argon,Annealed,SS Cr)
3/4"IG Thickness,Clear Opening: 12.375"x 10.21",0.877Sq ft
Ratings:U-Factor=0.27, SHGC=0.28, VT=0.53
Vinyl Color: White I`
Locks: Standard, Single • 7
Hardware: White, - 8„
Screen: Half Screen,Extruded-Fiberglass,White,
Primed,
Interior Trim:No,
Installation Options: Standard Sill Angle,
SETUP: $0.00
LABOR: $0.00
CUSTOMER SIGNATURE DATE FREIGHT: $0.00
DEPOSIT: ($0.00)
78
We appreciate the opportunity toprovideyou with this quote! BALANCE: $$34.93
PP PP Y SALES TAX: $34.93
SUB-TOTAL: $558.85
TOTAL: $593.78
•
Last Update: 11/11/2021 1:17:01 PM Page 2 Of 2 Printed: 11/11/2021 1:17:34 PM
PYmTh, City of Northampton
firers?"
Massachusetts A,
Ci Asa--,If DEPARTMENT OF BUILDING INSPECTIONS Z', 'I1
t 'r"° ^" 212 Main Street • Municipal Building J4:i'• ,1^
••`"'" ; Northampton, MA 01060 r' 37�
•
Property Address: N d 91ti+-6, 9• JUor- L rtnre / All1'
Contractor L
Name: �"(et)-L1 c► J i)1NXI 0'1 / UGt 1 1t I0�-^{_ Tii--P ru:.. .4--(41�"
Address: c ,urJst 1i r r-c / " C't c1J't°/16(.
City, State: l OreJI cZ l .A/lA
Phone: CI 1- — 5f 7 S .a
Property Owner
Name: )e-col 5 ,`-
l�Address: ke -i-,
City, State: clOre7/GE'. , MA
I, S-eAlt. I Si l V{A V J (contractor) attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature /4/ li /
Date
I1/2‘,/ 2 I