23D-031 (5) d
0111101111 BP-2008-0591
GIS#: COMMONWEALTH OF MASSACHUSETTS
4111.1111111111, CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0591
Project# JS-2008-000919
Est. Cost: $6325.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: John Corbett 104000
Lot Size(sq. ft.): 10759.32 Owner: SIMEONE MARIO A&FLORICE B
Zoning: URB Applicant: John Corbett
AT: 43 MILTON ST
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:12/27/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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:
FeeType: Date Paid: Amount:
Building 12/27/2007 0:00:00 $25.002740
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
•
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
Department use only
Status of Permit:
Curb Cut/Driveway Permit
Sewer/Septic Availability
Water/Well Availability
Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 P(ot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER;REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION 2 7 alSEC This section to be completed by office
1.1 Property Address:
Map Lot Unit
/ , Zone Overlay District
dim L'�ry y�
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
/274-1-10 S; m e c: / /Vov PL.) i t' S/ l` /114
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
/},esioc j140 oiart
Name(Print) Current Mailing Address:
S-`d7 '7J 1---
S• re Telephone
ECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (_6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
0. Thiel-(1 1 2 3 4 5) �j �S (:hark Niimhpr 6790 2/5
This Section For Official Use Only
Building Permit Number: ss I e
ssued:
Signature:
Building Commissionedlhspector ofBuddings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R. ,.~V.__ L:. R: _. „ _
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
_._ _ ..._ .. ....E
Parking)
#of Parking Spaces
Fill:
(volume&Location) _. .. . ..,r..._ .._�__._.. ..._... .. ...__
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW Q YES Q w_ .
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO . Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
,
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ ReplacementVlfndows Alteration(s) n Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [Q Siding [II] Other[0]
Brief Description of Proposed.--
Work: _-L.t SiA-L-L (�Lit/Yt— C t S CJ (/A Lue___
Le-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
•
, 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.
Signature of Owner Date
C�s,el-- , as Owner/A thorize
•�..j-- t hereby declare that the statements and information on the foregoing application are true and accurate,to the best of m owledge
•-lief.
Signed under the pains and penalties of perjury.
5
Print Name
IP
�l✓.�___ 114
Sign- . of Owne Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable 0
9`0e)
Company Name Registration Number
WINDOW WORLD '?/DfD
Address 56 Dimoc'K Street Expir Lion Date
Leeds,MA 01053
586 8712 Telephone
SECTION 10-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 0
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor.CMR 780. Sixth Edition Section 108.3.5.1.
Definition of Homeowner:Person(s)who own 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 homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated..
Homeowner Signature
s
���'',„ The Commonwealth of-Massachusetts
Department of Industrial Accidents
, Office of Investig anions
( '-T ,'_— }C 600 Washington Street
,—n � Boston,MA 02111
�: � www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeaibIv
NAme(BesinessJOrgani?arion/Indivi n2o:
WINDOW WORLD
Address: 56 Dimcx'k Street
. Ls,MA 01053
City/State/Zip: 'S F,- e
Are you an employer?Check the appropriate box: Type of project(required):
1.Q I am a employer withpart-time).* 4. I am a general contractor and I
6. ❑New construction
Ioyees(full and/or part-time).* nave hired the sub-contractors
listed on the attached sheer 7_ Q Re-model-Hs
am a sole proprietor or partner-
11 I I shin and have no P-^�leyees These sub-contactors have g. Q;emofiuon
I employees anti have workers'
[No w r for me in any capacity. 9. Q Builriino addiiion
rnr workers'co rp ins,u�ce comp.haszrance.*
required.] 5. Q We are a corporation and its I O.Q Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself ['v o workers' comp.
inc right of exemption per MGL 1 Q Roof repairs
regnired]t c. 152, §I(4),and we have no
employees. [No workers'
comp.insurance required-] 13.0 Other
----- A3iv applicant that cnertr oox Ffd must also till out the secnon oe.ow wowing their workers'coropensanon policy information.
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 mustarnrhed an additional sheet showing the name of the sub-contractors and state whether or not those entities have
ernployeea_ If the sub-cone-actors.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 job site
information.
insurance Company Name:
•
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip: '
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$1500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DLA for insurance coverage verification.
I do hereby ceraiy under the pains and penalties of perjury that the information provided above is true and correct.
Stsnafurt 1--�`�e — Date: 11 . �D T _
Phone=: 2"(' 7 `7/ 1--
Officiai use only. Do not wrzte m this area, tv be completed by city town official
City or Town:
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--:
t •
?. ,yi.w �uta-sac7usc._s
, -'
.r^ -'` cam_ ,,
y DEP:=-RTMENT OF BUILDING I_NSPECTIO_NS ti
T
212 Main Street • Municipal Building
INSPL-CTCR � ,
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachuse is allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sups:: .- sor. The state defines "Homeowner" as, Person(s)
who owns a parcel on which he/she resides or intends 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."
The building=department for the City of Northampton wants any person(s)who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before bacl ll).
sonotube holes (before pour). a rough building inspection(before work is
concealed). insulation inspection (if required) and_a1inal builriina inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until-the-work can-be inspected.
If the homeowner hires other trades to perform work(electrical, plumbing&gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
•
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date _
Address of work
location
WINDOW WORLD HIC#104000
56 Dimock St.
Leeds, MA 01053
Telephone 586-8712
CONTRACT
Date //00e () 20 0 `1
This agreement, between /'A I` 1 o r .
(Owner)
of %J-, Al ► R( I f'L.Qr ent:e /11 A , and
(Address)
WINDOW WORLD OF LEEDS, MASSACHUSETTS.
Phone - - ' 7 7
SPECIFICATIONS
_t )Cl /.I V 1 r;yI..... /1/20 !_e;1rPl Pn (.>,✓ 2e^, pis' },;
2-L fVtniJ'(rN/� LtI;Lf ngo t.r/ 3r/1//i, f,;I - Iel�7
A 4-✓ram r.,�, A,yam, a_z✓rrP i e rt r'.>,1,;d2e, U .
on the premises located at %Y)/ t-.!`r". . `'//?a'*'/ a total cost of t ' `c' - ,i C)
With this order owner pays down the sum of$ 0 —
Owner agrees on completion of said work by the Contractor to pay the sum of$ r< ..? f i7r> dollars
�$ ).
Owner agrees that in the event of any breach of this agreement by him after acceptance he will pay 70%of the total contract
price because vinyl replacement windows are custom measured and made for owners home and will fit nowhere else.
Performance of this agreement is made subject to labor strikes,fires, wars,acts of God,and the Contractor's ability to obtain
material.
This Contract constitutes the entire understanding of the parties, and no other understanding,collateral or otherwise shall be
binding unless in writing signed by both parties.
WINDOW GUARANTEE
Window World's glass is guaranteed for 20 years from date above not to fog up between the panes of glass. All other parts will
be supplied free of charge for life. Service will be free of charge for 1 year from date above. Guarantee does not cover broken or cracked
glass after 90 days from date above or any damage resulting from neglect,abuse,or acts of God. Condensation build up on the glass is
caused from high humidify levels and poor ventilation within the home therefore there is no guarantee that this condition will not occur.
In witness whereof,I hav --reunto sign ,my name this C 1 r h day of A) v pi.ki r•t_ 20
by 4 !� ✓�
ontractor of Authorized Agent) (Owner)
(Joint Owner)