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31A-147 (10) BP-2022-1454 16 FORBES AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-147-001 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-2022-1454 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS Contractor: License: HAYDENVILLE WOODWORKING & Est. Cost: 2200 DESIGN INC 116208 Const.Class: Exp.Date: 04/13/2025 Use Group: Owner: GILBERT BORER,JEREMY&EMILY Lot Size (sq.ft.) Zoning: URB Applicant: HAYDENVILLE WOODWORKING & DESIGN INC Applicant Address Phone: Insurance: 35 CONZ ST (413)665-7402 WMZ-800-8007423-2021A NORTHAMPTON, MA 01060 ISSUED ON: 11/08/2022 TO PERFORM THE FOLLOWING WORK: REPLACE 3 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: h .; • * • 3.)0IT Fees Paid: $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner ` ' ' Department use only oQYN M•; City of Northampton = ---Status of Permit: Building Department NOV _ Curtf Cut/Driveway Permit �" 212 Main Street ] 2022 Sevier/Septic Availability Room 100 ; Water/Well Availability Northampton,'MA`0106O",7777 Trr4 Sets of Structural Plans • _r-a phone 413-587-1240 Fax 413-587-12 n' MA0Ecnfleit/Site Plans Other Specify 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 Map �il+ Lot /q 7 Unit 16 Forbes Ave Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Emily Gilbert+Jeremy Borer 16 Forbes Ave Northampton Name(Pr' t) Current Mailing Address: 917-816-0690 Telephone Signature 2.2 Authorized Agent: Haydenville Woodworking&Design, Inc. 35 Conz Street,Northampton,MA 01060 Name(P int) Current Mailing Address: 413-665-7402 Signa re Telephone S N 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 2,200 (a) Building Permit Fee 2. Electrical 0 (b) Estimated Total Cost of Construction from (6) 3. Plumbing 0 Building Permit Fee016 [/ 4. Mechanical (HVAC) tjlp 5. Fire Protection 0 6. Total=(1 +2+3+4+5) 2,200 Check Number L LIP- This Section For Official Use Only )IA../c 7 IDate Building Permit Number: 7 Issued: Signature: /�;7 /1'7'202.2_ Building Commissioner/Inspector of Buildings Date Zinnia HaydenvilleWD.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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: L: R: Rear Building Height Bldg. Square Footage 0/0 Open Space Footage cyo (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 0 DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: C. Do any signs exist on the property? YES O 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 Q NO 0 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 © NO ® 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 n Addition ❑ Replacement Windows Alteration(s) n Roofing n Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding [O] Other[El] Brief Description of Proposed Replace 3-wide double hung window Work: Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x 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 Emily Gilbert+Jeremy Borer , as Owner of the subject property Haydenville Woodworking & Design, Inc. hereby authorize to act oniopbehalf, in all - - - ive to work a : ' ed by this building permit application. f 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 the pains and penalties of perjury. Print Name Signtu of caner/Ag t Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: Zinnia Wu Stetson License Number 35 Conz Street, Northampton, MA 01060 116208 Address Expiration Date 413-665-7402 04/13/2025 Signatur Telephone - 9. eaiste d Ao• e Improvement Contractor: Not Applicable 0 Company Name Registration Number Haydenville Woodworking & Design, Inc. 110732 Address Expiration Date 35 Conz Street, Northampton, MA 01060 Telgp n§165-7402 11/2/2024 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 No 0 City of Northampton ,7#9aY N M >O�_ SAS ..�:.. S1 ,. Massachusetts << * 4 y k . ..I ( � d� ,� DEPARTMENT OF BUILDING INSPECTIONS y v= � 'w ``J 212 Main Street •Municipal Building '~.'_ Northampton, MA 01060 �rlh 3r0°4 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 16 Forbes Ave (Please print house number and street name) Is to be disposed of at: Valley Recycling, Northampton (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) S. at re f P mit pplicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts _ Department of Industrial Accidents ir 'l Office of Investigations •fiv= 600 Washington Street • Boston, MA 02111 �t�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Haydenville Woodworking & Design, Inc. Address: 35 Conz Street, Northampton, MA 01060 City/State/Zip: Phone #: 413-665-7402 Are you an employer? Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and I 6. [' New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7 ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 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. *Contractors 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. A.I.M. Mutual Insurance Insurance Company Name: Policy# or Self-ins. Lic. #: WMZ-800-8007423-2021 A Expiration Date: 12/1/2022 Job Site Address:16 Forbes Ave City/State/Zijorthampton, MA 01060 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 $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 $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 certify under the pa'ns and penalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: 41 -665 4 2 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#: Customer: Haydenville Wood&Design • Project Name: Gilbert Emily 16 Forbs Ave Northampton MA Order Number. 184 Quote Number: 15770077 Line 8 Location: Attributes 20 OPT 2 Lifestyle, Double Hung,Sash Set, Double Hung, 103.75 X 64,Without HGP,White a a 1:Non-Standard Size Double Hung,Equal 111 Q Frame Size: 33 X 64 PK>f General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray •-- 3'+� — Exterior Color/Finish: Standard Enduraclad,White 2119 Interior Color/Finish: Unfinished Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Viewed From Exterior Hardware Options: Cam-Action Lock,Matte Black,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor Screen: Full Screen,White,InViewTM_ Performance Information: SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Egress Meets Typical 5.7 sqft(E)(United States Only) Grille: No Grille, Vertical Mull 1: FactoryMull,Standard Joining Mullion,Mull Design Pressure-20,Overall Thru Direction-Vertical 2:Non-Standard SizeNon-Standard Size Fixed Sash Set Frame Size: 37 3/4 X 64 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16" Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Unfinished Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Performance Information: U-Factor 0.27,SHGC 0.31,VLT 0.58,CPD PEL-N-229-00949-00001,Performance Class LC,PG 30,Calculated Positive DP Rating 30,Calculated Negative DP Rating 30,Year.Rated 08111 Grille: No Grille, Vertical Mull 2: FactoryMull,Standard Joining Mullion,Mull Design Pressure-20,Overall Thru Direction-Vertical 3:Non-Standard Size Double Hung,Equal Frame Size: 33 X 64 General Information: No Package,Without Hinged Glass Panel,Clad,Pine,5",3 11/16",Jambliner Color: Gray Exterior Color/Finish: Standard Enduraclad,White Interior Color/Finish: Unfinished Interior Glass: Insulated Low-E Advanced Low-E Insulating Glass Argon Non High Altitude Hardware Options: Cam-Action Lock,Matte Black,No Limited Opening Hardware,Order Sash Lift,No Integrated Sensor Screen: Full Screen,White,InView."" Performance Information: U-Factor 0.30,SHGC 0.30,VLT 0.56,CPD PEL-N-35-00426-00001,Performance Class LC,PG 35,Calculated Positive DP Rating 35,Calculated Negative DP Rating 35,Year Rated 08111,Egress Meets Typical 5.7 sqft(E)(United States Only) Grille: No Grille, Wrapping Information: Foldout Fins,Factory Applied,No Exterior Trim,3 11/16",5",Factory Applied,Pella Recommended Clearance,Perimeter Length= 336". Rough Opening: 104-1/2"X 64-3/4 Customer Notes: VISIBLE GLASS WILL NOT ALIGN BETWEEN DOUBLE HUNG TO FIXED UNITS For more information regarding the finishing, maintenance, service and warranty of all Pella®products,visit the Pella®website at www.pella.com Printed on 7/25/2022 Contract-Detailed Page 2 of 6