23D-194 (4) BP-2003-0525
GIS#: COMMONWEALTH OF MASSACHUSETTS
194 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003.0525
Project# JS-2003-0874
Est. Cost: $2282.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: John Corbett 104000
Lot Size(sq. ft.): 156816.00 Owner: 665-667 MAIN ST HOLYOKE LLC
Zoning:URB Applicant: John Corbett
AT: 70 RIVERSIDE DR
Applicant Address: Phone: Insurance:
56 Dimock St (413) 586-8712
LEEDSMA01053 ISSUED ON:11/21/02 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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 11/21/02 0:00:00 1476 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
r •
tepar tment use only
Q ; f Northampton rs of Permit
Nang Department Curb Cut/Driveway Permit-__
NOV 2 ] 2002 p Main Street Sewer/Soptic nvr,ilabiliky,
1Room 100 Water/"Jell �vaifability _
I N9rtha`npton, MA 01060 Two S is of :structural Plans f.
DEPTOFB!!lLDI. ��.4; -587-1240 Fax 413-587-1272 Plot/Sete Plans
Oti ., � �cifv
a.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
.70 /-1 v z~r-.s/ _ D/� Map Lot
Zone Overlay District F"
Elm St.District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: Pq'v
34 ROA r-u A.Jy ,j rz e1C r% C PKJLvny tk
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
S-74 271
Si ture Telephone
SECTION 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 fromffi)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 45:1-p-��, Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Section 4.
ALL INFORMATION MUST BE.COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
SECTION 5- DESCRIPTION OF PROPOSED WORK(check all'applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) 0 Roofing 0
Or Doors
Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: w5 i 1-1-L— r-+_ i pie-Z w/ <1-*
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6VI"f -"eN 3ho'use'and-or:additionto 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. Mascheck 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
, as Owne Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the es
knowledge and belief.
Signed under the pains and penalties of perjury.
Print me
// /7A)
7 'ignature of Own Agent Date
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable D
Name of License Holder :_
License Number
Address Expiration Date
Signature Telephone
0.Rn g seled m ractorx: .cK Mfg,' � „ Not Applicable ❑
Company Name Registration Number
5. All N(D C-1c S1 7// 6/a ct
Address Expiration ate
� f ,01A O/D S 3 Telephone, 7- 'd"-"
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 ❑
11 Home Owner Exe p u n
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
--ci AMPT
�4
� {
�x� of Nirt1 ant fait j _* �9 , :8
~ (`
assacllnartta = _
�'- DEPARTMENT OP BUILDING INSPECTIONS _5=_�1=
212 Main Street Municipal Building —`=_
'
Northampton, Mass. 01060 ' o/''��
WORKER'SCOMPENSAITON INSURANCE A F] 1BA.VTT
I, GuGc/ CQl fr-S ____11
(li censeeipermi ttee)
with a principal place of business/residence at:
s_S- AOlocit if J-c--49 L Il74 • Oio S 3 . (phone#) s $ 7 / f_-
(h tc Gct/ci ty/state/a p)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Compary/Policy Number) (Expiration Date)
.r.
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/policy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additicaal i if ot,,,,i.ry to include information pertaining to all cou'sadon)
` a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself
NOTE:please be aware that while homeowners who employ persons to do tealntenerv, oxutr dioo or repair work on a dwelling of
not mace than throe unit,in which the homeowner resides or on the grounds appurtenant thereto are not generally coasidacd to be
employers under the worker's compensation Act(GL152,5;s 1(5)),application by a hotneowoa for a license or permit may evidence the
legal stahra of an employer under the Worker's Compoematioa Act
•
I understand that a copy of this etatcmmt may ho forwarded to the Department of Industrial Aecidm*?Off oo of l nurerico for the
Coverage verification and that failure to sure coverage under vc'tion 25A of MOL 152 can lead to the inrpooition of criminal penalties
oomisting of a fine'of up to S1,500.00 and/or imprisonment of up to one year and civil pe-rnitia in the form of a Stop Work Orden and a
ftna of 5100.00 a day against tne.
Foe degatmcnbll tsoo Only
Permit Number
f/ !fVC) Map*# Lot#
i of tccnseelPetmittee Date •
ri x x-o ii r I WINDOW WORLD i,. .0 > IC#1(>400Cl
t
ry
! 1 K ..“> ai I 4, ir..V-, ." Dimock t ,3 t l k ri d E"nr
..'. -. - Leeds, MA 01053 /t,.t. vt ;~ : �: .
()C'`;"' ji Telephone 586-8712
( ,, ,c 61)N. f' ''' r
�... ,...._+i7' CONTRACT
....,....
w"...._ Date.... _ ___0 tl)o�"Z
This agreement, between .... .:1 t 17 f .. ..) ,L . ,L.
`� pry �,�+��y � .�...«...... ft r) _.m�...__.._^_._.._,....._.........._......_..�....__._.. .._..._......_._
of _ _._... «.m.id z ....__...._.i2.i?_x'1.1.1224. r' _ ..0 ^ ,A1:j.0. V ....�. ....................�.,. , and
_.(Address) ,r
WINDOW WORLD OF L..EEDS, ASSACHUSE�rTS.
Phone _.�....74 '` . . . 7' y `..._..
SPECIFICATIONS -
T. . ... _... _...� .._ .
._..._...._.^......... __, �`Jet_
u ....«.. ...._ .«..mx .. .,.,.a...,,..... ,.4..�.._.
�.r„,wrwwnx
.. .. ,.......,.......... .« ...wwa�FY: v... ..w ... . ..........»r.« J G / »
'me'µw. ...H .'-.- ... '-
4444171
_# & .r �. nv..�{�' ^4 . 4r L,.'
on the premises located at t 7 L}..._R..:t..v..S s_ (-._._. _._ a total cost r,t ? r
t r
With this order owner pays down the sum of$ ...... .. . � :* It Lif." -� ..i" )_
Owner agrees on completion of said work by the Contractor to pay the stun of$ .�1131.. ,"t Dint ______ 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 it made subject to labor strikes,tires, 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. MI 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 hom herefore there is ncr uaritttee that this condition will not occur.
In witness whereof,1 have her unto signed myt name this._...�T day of C.� '-�'4=' [•'. .....m __. 2t)....C'4--
. _._............__.__..__. ._._. _ Kl ..e ,,,...m....."......,«...�.....
4,_7.„4„..
aaor ofAura) f(�wrteri