24A-018 (10) 4011111011.1111 BP-2007-1125
GIS#: COMMONWEALTH OF MASSACHUSETTS
.110110111/ 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-2007-1125
Project# JS-2007-001797
Est. Cost: $16456.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: PELLA PRODUCTS, INC 142279
Lot Size(sq. ft.): 11238.48 Owner: WOOLF JASON&KAREN SULLIVAN
Zoning:URB Applicant: PELLA PRODUCTS, INC
AT: 119 PROSPECT AVE
Applicant Address: Phone: Insurance:
155 MAIN ST (413) 772-0153 WC
GREENFIELDMA01301 ISSUED ON:5/17/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 21 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 5/17/2007 0:00:00 $25.0026359
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
04 gse nnh+ ,
Y Y,W...�i �. P �.11 Mri I
City of Northampton ��dx�K,�tI� III srIjlj,
\`c, Building Department 1:- 11' InIIIIIjIn
212 Main Street
Room 100 al-13'
C7
- r,
C_ Q�Northampton, 1 d 2MA O Ofi �af t�ir�i�1�
MAY � 6 � �� A
phone 413-587-1240 Fax 413-587-1272 10:400� pit, „
�pyy� �l ii�l�u4ghlgi pi
di Yi q, III _iaiq o lir,,iflllll II IVI
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY,DWELLING
SECTION 1 -SITE INFORMATION
1.1 Pro Address: This sottlon to be completed by office
9 (O e c �/��"L) e_. Map Lot Unit
n 3 r G-iY\ nf1 ►� Dt (Q l7
v` �v Cl Zone • Overlay District
Fin St.Cletrlet CB,Dlsttict
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Su5On Woolf t c-TP1(TQQc_-f— 40e, ►'l r-} c,,,A0V-0(1
Namo(Print) Current Melling Addre s:
41 3 - l.Q 3gS(Q
Telephone
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Addrees!
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
1 (p LI-55 . tR
2. Electrical (b)Estimated Total Cost of
., Con$truction from(8)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5_Fire Protection _
6. Total=(1 +2+3+4+5) Check Number 602634-11
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: --.
Building Commissioner/Inspector or Buildings Date
TOO ZLZTLS11Tt• XYd TZ:OT LOOZ/tO/5O
— •
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to bc tilled in by
Building Department
Lot Size —.._,..._ -1 7---------1 EL--------1 1--
L___ - ' 1 1 i
Frontage
Setbacks Front
Side 1.:1,-.--I R: L:1 ,R: I r111 L..__!
=
Rear
. —
Building Height
Bldg.Square Footage 7-'7 1; % r..---I 1 1--1
Open Space Footage %
(Lot arca minus bklg&paved r-1 I- .. J =Li
parkingj •
#of Parking Spaces TT] ET 1
7....________. . . ___________
—
Fill:
1 [
...1% 21c&Location) . 1
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:r 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book ' Pagel i and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? .
Needs to be obtained
0 Obtained
0 , Date Issued: I
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
r -
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES,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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Z0012 ZLZIL8CT17 XVd TZ:OT LOOZ/170/n
SE TION 5•DESCRIPTION OF PRO POSED,WORK(check All a cable)
New House ❑ Addition Replacement,lei Indaws AlteratIon(s) Roofing Ei
Or Doors t�
Accessory Bldg. ❑ Demolition 0 Now Signs [Di becks [Q Siding[p] Other[pj
Brief Description of Proposed
Work: Ce- t(' Ce cE✓5 t o �} p.�u e.' cC� ,1>1r( . 1,1,Q eS.5tary
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _ Yes No
Plans Attached Roll -Sheet
00f INgw{hdu0 and or'addition
-- Dt't'�111 15XI�it�tAt�id,{�QrrCrwin�;
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
1, _ ,as Owner of the subject
propertyc_. q 0
hereby authorize - `" t (j'J '\ 1 1
f inallmatters to work authorized bythis ui dib tin ermit application.
to act on my behalf, relative g p pp
Signature of Owner — Date
\ 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.
Signed under then pains and penalties of perjury.
Print e
Cu L „ 3)5 o
Signature of Owner/Agent Date
tno j 7iL7,TLS5CTf XVd TZ:IT L0l)u%fo/ o
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construct) Supervisor' Not Applicable OC
)uamo of License Holder 1 Kir:
License Number
. )_6\1(A • (fl1 ot6ot 1 /31kg,
Ad s Explretian Date
Signe ura Telephone
9.RAgI_gterad,Hole Improvdm9n Cantrlt Not Applicable W
Company_Name — Registration Number
Address Expiration Date
Telephone_
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.,e.162,§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 Li No 0
1 x. Home ( Winer Eiemi:iion
The current exemption for"homeowners"was extended to include Owner-occupied Dwellints 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.CMVIR 7130, Sixtlt Edition Section 103.3.5, .
Deflttition of Hort owner: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 he,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures A person who constructs mare than one borne i two-vear eriod_shall not be et-inside cd a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shell be
responsible for all such work performed under the buildin£.01AL
As acting Construction Supervisor your presence on the job the 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) end Chapter 153(Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von may_a liable for person(s)
you hire to perform work for you under this permit
'l'he 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
fi0Ofl GLGTLBSCTf XVd TZ:UT LOOZ/f'O/50
The Commonwealth of Massachusetts
=v=1= Department of Industrial Accidents
Office of Inve,ytigations
0 600 Washington Street
' Boston, NM 02111
`''•..� � www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ! Please Print Legibly
Name(BusinessfOrganiration/Individual):.j �Q j/ f ro du C}SJ In C
Address: S f'1 �r �
Citylstate/Zip: d+'T Pr b\ n 1 Phone#: I3��l—] 71 1 5 -
Are you an employer?Cheek the appropriate box; Type of project(required):
I.Y I am a employer with ' 5 4, E] I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New❑ construction
2.❑ I am a sole proprietor or partner-
listed on the attached sheet.$ 7. 0 Remodeling
ship and have no employees These sub-contractors have S. 0 Demolition
workingfor me in anycapacity. workers' comp.insurance.
P h'• 9. ❑Building addition
[No workers'comp,insurance 5. 0 We are a corporation and its 10❑Electrical repairs or additions
required.] officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MOL 11.0 Plumbing repairs or additions
myself [No workers' comp. c. 152, §l(4),and we have no 12.❑ Roof repairs
insurance required.]t employees, [No workers' 13.[]Other
comp.insurance required.) —
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information_
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:ICa TYlS t"W'J Ci
Policy#or Self-ins.Lic.#: WC AD —[�c-{'� T2 a Expiration Date: 4 , ibR
r1 M
Job Site Address: 1 k) City/State/Zip:_no( .G.M,pk-Cln 0 `A
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 MOL e. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ce y under the ins and penalties of perjury that the information provided above is true and correct
Si nature! �f] .a Dat
phone#: t� ���] aj
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#�
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#:
«. H tOsEEsELETbT 9b:TT L017,/To/S0
Se -67
—oectilx
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 142279
Type: Supplement Card
Expiration: 3/24/2008
PELLA PRODUCTS, INC.
DAVID WHITE
155 MAIN STREET
GREENFIELD, MA 01301
Update Address and return card.Mark reason for change.
PS-CA1 50M-05/06-PC8490 Address 0 Renewal El Employment ❑ Lost Card
•
..,posal for Customer Project: Sullivan/Woolf,Karen&Jason Quote No.: 37DP10 Alternate No.: 1 r
Outside View Item Qty. Description
Item#'I Qty: 1 Exterior trim: Wood filler strips .
Picture Lo
Not .e§,( /''
Available (a
Notes: �f
Thank You For Your Interest In Pella Products •
Prices are subject to change anytime after 30 days following date of estimate. This estimate does not guarantee availability of any product listed.
Pella Products assumes no responsibility for accuracy of take offs from drawings or blueprints or that the products listed will be sufficient to complete
customer's intended project. CUSTOMER SHOULD REVIEW ALL QUANTITIES AND SIZES FOR THEIR ACCURACY. YOUR SIGNATURE
CONFIRMS THE ACCURACY OF PRODUCTS CHOSEN.
PELLA PRODUCTS INC. MANAGEMENT HAS FINAL AUTHORITY ON ACCEPTANCE OF ORDER.
NO CANCELLATIONS OR REVISIONS CAN BE ACCEPTED ON ANY DATE AFTER THE MANUFACTURERS LAST REVISION DATE.
All prices quoted based on total package price and subject to change if total package not purchased or contents of package change.
THE SALESPERSON HAS REVIEWED THE IMPORTANCE OF OUR(VERY) SATISFIED POSITION ON THE FUTURE SURVEY
MAILING.
ITEMS REMAINING IN OUR WAREHOUSE FOR MORE THAN 30 DAYS BEYOND THE ESTIMATED AGREED TO DELIVERY TIME
WILL BE SUBJECT TO A STORAGE AND HANDLING FEE. THIS FEE WILL BE 1% OF THE NET ON THE ORDER($25.00 MINIMUM
CHARGE).
0 2� Taxable Subtotal $ 12,376.37
Customer Si�atu Pe la Sales Representative Signature
MA at.5.00% 618.82
None at 0.00% 0.00
None at 0.00% 0.00
7.-5/%
Non-taxable Subtotal3,460.00
30/�� U Total $ 16,455.19
Date Date . Deposit Received $0.00
WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated
into and become a part of this contract. PIease see the warranties for complete details, taking special note of the two important notice sections
regarding installation of Pella products and proper management of moisture within the wall system. Neither Pella Corporation nor branch will be bound
by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable for branch warranties which create
Proposal-Page 5 of 6