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24A-129 (6) • , ;37 PROSPECT A BP-2006-1212 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A- 129 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-1212 Project# JS-2006-1792 Est. Cost: $2611.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq. ft.): 7143.84 Owner: KINNER DAVID L&JODY E Zoning: URA Applicant: HOME DEPOT AT HOME SERVICES AT: 37 PROSPECT AVE Applicant Address: Phone: Insurance: 345 GREENWOOD ST (401) 935-2633 O Workers Compensation WORCESTERMA01607 ISSUED ON:5/12/2006 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 5/12/2006 0:00:00 $25.0012413 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo .r e • ,, Department use only 'ty of NortOmpton Statusof Permit: ilding Department Curb Cut/Driveway Permit ID �r , 12 Main Street Sewer/Septic Availability �. 20p6 t Room 100 Water/Well Availability ".. N,rthat'ppton; MA 01060 Two Sets of Structural Plans hote.4AS-587- 240 Fax 413-587-1272 Plot/Site Plans n`p,01.\T�N�\0 p1060 Other Specify \ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Lot Unit 31 ,P om-t Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: - i ce. W I nr' 3-1 e--+ 1Adr} -N , 11, Dlex,� Name(Print) Current Mailing Aid`�ess:13 5g4.4 ai Telephone Signature 2.2 Aut orized Agent: N (Pri t) 91 Current Mailing Address: I.til�ia /� 2P �Si n ure Telephone S TION 3-ESTIMATED CONSTRUCTION COSTS _ Item - Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee — G2—a11 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection _ 6. Total=(1 +2+3+4+5) aL11— Check Number AZ (14 �-7/3 Jr 5,` This Section For Official Use Only Date Building Permit Number. Issued: . Signature: 1 Building Commissioner/Inspector of Buildings Date h J Section 4. ZONING All Informatibtt 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:L___J R:' L: R:L f _ I .L . Rear Building Height r 1 Bldg. Square Footage i % ! Open Space Footage % (Lot area minus bldg&paved 1 I I 1____i parking) #of Parking Spaces Fill: ' ! i ` (volume,&Location) • A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES 0 " IF YES, date issued:, IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Pagel and/or Document# _ B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? ' • Needs to be obtained Q Obtained 0 , Date Issued: I C. Do any signs exist on the property? YES © NO 0 IF YES, describe size, type and location: i D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO iO 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 O ,. NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r.. SECTION 5-DESCRIPTION OF PROPOSED WORK(check•all applicable) New House ri Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors „12gc Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding[0] Other[lam] Brief Descriptiqprop :q jposa Cil � Work: � J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6il€ k a (ror lien E ac[d'r":eli#a a ifiThr io.e sing et btete-f i £oiiQv i a . 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- I, d'OA ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit applic tion L) 170L. Signature of Owner Date 1, )CAY 4 . �t�v-e , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Sign- nder the pain an enalties of perjury. (-0 6 -Q--- Print NO OP /07&/0/.- Signatur- ,f Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES t<_ 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9�..Re'Tsteced Ffome mprbveineni.E'ontrastorE '. 4:�',W370 Not Applicable ❑ Compami Name 369 Registration Nu be 0.1PA(QtY)01--- 06. Address(r i� Expiration Dat D� g�. 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 buildin ermit. Signed Affidavit Attached Yes No 0 1 -;i iEome O n n'ot 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 ¢5 iW-1 pi 1 ,'4.`� �'�E (riff cf ;crrflialnvfo), s= A ►r y�E �l.3...cltnsr(la' DEP/iRTME1JT OP IIUILDI-NG INSPECTIONS 4 a 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMCPENSATIO.N LNSURANCE AFFIDAVIT le. �t l f _ ... --- --. • (I;es/permlricc) with a principal place of business/residence at: - -- fLle(-- k. GIltes7 rtj .H HEs RJ 3 CrxeenlZ 1 (pone:. (str=ki rJ/szatda p) do hereby certify, under the pains and penalties of perjury:, har I am an 'employer providing the followin iworkcr's compensation coverage for g my employees worldng on this job: • (Laurin onzanv) (Policy Ni=ter) (Exp. . on Da z) . ( ) I am a sole proprietor, general cootractor or homeowner(circie one) and have hired the coanactors listed below who have the following worker's camoen_sahon policies: (i;ii.mc Or Co !^c-,or) (Insurance Co1noan i?olk— Ntttrnr=r (Expi auon} ) (]:SIC) (Name of Con Tamar) (lnsarance ComoaayPoi.icy Nuzocrr) (Lapiriion Dale) (Name of Counactor) (t>lsuranc Company/Policy Nambcr) (Expirdoa Dale) • • (Name of Contactor) (Insurance Company/Policy Number) (Expiration Date). (.Cat addir-octal thr. ifnccaL-y to c,clu inforau,ioa pclasias to.1.1 r.+^ . -) ( ) I am a sole proprietor and have no one workdng for me. ( ) I arn.a home owner performing all the work myself. NOTE:pl =se be acrzrt:till.'4 ie be woc.a.co co=p1ay See-cr=to do r- --,, - c -.e.1oo a r=nzr work.on r dwdl_r,of not more th_a t_7v==it:in u-seh the bomoownc rad=or cc the Qoux4 wpurteo_'n tbe-tto r_z out Car-.11y oecd.-oi to be czplc- - u°4=the wO± '�r'" fir---/ion Aa(GUI52-=I(5)),opplin600 by•botnma-oa far c rim_or pc^.a 1 tr_y CVidmCe the 1c- J r.aas<of..o c tioy.r und.r tlw Wocicaet Coazpos.soon A . I,+odczt....od that a copy of thi,sai.®rca oa..y bt,focword.d to tbo Dop.<tm ca of Indssricl Ar oaosta'Ofvoo of lsa.r.00,for Lb. oovea.o--e veils tioa and th t Ciltae to scout tovcro. c t, e- _roc 25 A of MOL 152 can l,4 to the i'-px*tioa of eimias1 pr^.Ifies °' '-z^g o(a floc orup to S I500,00 suclior iatprisoa or up to one ya_r rod d.ii prn.hua io the form of.Stop Wort;Orde and. rion o(S 100.00 r day tpiort tDG Far tko.-..-: u,c only r� Pcrm mbc t Nu - Oi` I.�p=—_ Loi : i Signer of Li Pcrmive-1-_ ce I 1 �St1AMpi, !� . assac nsetts !! �- DEPARTMENT OF BUILDING INSPECTIONS A—/= INSPECTOR '212 Main Street • Municipal Building any Northampton, MA 01060 ' ��el HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup': .. 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 r'.egulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill). sonotube holes (before pour). a rough building inspection (before work is concealed). insulation inspection(if required) and a final building 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 r 4r APR-21-2006 01:30PM FROM-RMA HOME SERVICES 5087569008 T-206 P 002/006 F-781 Li r Sold.Furnished and Installed by: , v Branch Namc:. Gtil Data 1 ' �c� TFID At-Home Services,inc, i- .1_j1 d/b/a The Home Depot At-Home Services 345A Greenwood Street,Worcester,MA 01607 Branch Number, Job#: �3 5 BR Toll Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-269n460 Me Lie r7 C 02439 RI Com.Lice 16427 ] CT Lisp 565522; MA Home Improvement Contractor R .N126893 � Instal lotion Add res3: ) ` PR ZC _ +1Jk-. 1U G(hf 0 61666 City Stare Zip P`rchaserj.l: Last.1 Melts of Driver's Us,a&Esp.htoA',, Work Phone: Home Phone; CZ.t 41-.4, 1 GI C 1 (4(3 lr,stC' ( ) ( ) Dome Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Proiect Information; I/We/You("Purchaser"),the owners of the property located at the above installation address.offer to contract with 1-Tome Depot U.S.A.,Inc.(' o to Depot") o furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet N:}tJ 44 ,incorporated herein by reference and made a part hereof. Hume Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its Obligations due to a structural problem with the home,pricing errors nr because work required to complete the job was not included in tile Spec Sheet Dr Contract. DEPOSIT PAYMENT OPTIONS (( (Subject to fund veri Gent ion and/or credit approval,) CONTRACT AMOUNT S 2— ( t I. Check,Cnohrers Check orUS Portal Service Money Order { (Made payable to The Home Depot). (LESS DEPOSIT S CC--4 1 l 2. Credit Core•and/or other payment opllont-Circle One Below Visa MasterCard Discover American Expreae BALANCE DUE 1 y The Hones Improvement Loan The flame Depot Credit Card 4 _ON COMPLETION $ L �+ ❑ Now Autumn 0 Existing Acwunt (All.&11UCC ONLY) •Minimum_5a/o of Contract Amount due upon execution Available Credit;3 (HIE&IIDCC ONLY) of this contract. Aoo s. Exp.Dale:.• Indicate Payment Method Fnr Name as n appears on car:_ BALANCE DUE ON COMPLETION: •By my/our signature below,I/Wa av ec la allow Ilome Depot to chums the above referenced credit Carl for tho deposit indicated. 1 a s fir,( )•i ei °Ca Cardholder's Signalere Due HEIL or HDCC Authorization Codes Deposit Final Payment Purchaser agrees that.immediately upon satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreemspr:This agreement and its attachments, including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER D. not sign this contract before you read it. You are entitled to a completely lulled-in copy of the contract at the time you sign. Keep it tii protect your rights. Da not sign a Completion Certificate before thle projects crimpkte. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual Completion of the work In he performed under the contract You play cancel Ibis trunsoetion at tiny time prior to midnight of the third business day alter the date of this contract. See Notice of Cancellation fur an explanation of this right. There will be a service charge equal to 25%of the contract SmOunt if the job is cancelled by Purchuner AFTER the third business day: BY MY/OUR SIONA'I'URK BELOW.I/WE AGREE O)ire 19OUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RI[CEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF TILE NOTICE OF CANCELI PION. • IlY MY/OUR SIGNATURE I3ELOW, 11WC UNDERSTAND THAT THE AGREEMENT is SUBJECT TO REVIEW OF MY/OUR CREDIT I-Il51ORY AND 1 Wii AU TIIORfZE HOME DEPOT TO VERIFY AND KUVlISW MY/OUR CREDIT RECokD WTI'I-I AN INDEPENDENT CREDIT RIiroieriNti ,'IOIiNCY AND RELEASE THEM FROM ALL LIAI3ILITY INCURRED PROM rN,IDVER'r ENT Ct Sit }t3 RRUle::;;.''���ppp,NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMITTED BY: 1 4, ` v 1WE Date: I 'II 10(.... ACCEPTED BY!iL Date: mAer _ Date. - 11.,mcos n,s NOT AnttTiaNALTRna1N,CONDITIONS AND WARRANITIRS Mkt,:S'rireen N'uI rE REVERSE 51DE AND A1t6 PART Cite TI US CONTRACT Wnns-Branch File Yellow-Llammcr 'ink-Silo Ctmsuhan 9.21.OS C-SC