17A-243 (3) BP-2023-0317
76 LAKE ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
17A-243-001 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-2023-0317 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2023 Contractor: License:
Est. Cost: 10000
Const.Class: Exp.Date:
PARRISH, MELISSA NOHELANI & BO TORLEIF
Use Group: Owner: PERSSON
Lot Size (sq.ft.)
PARRISH,MELISSA NOHELANI &BO TORLEIF
Zoning: URB Applicant: PERSSON
Applicant Address Phone: Insurance:
76 LAKE ST
FLORENCE, MA 01062
ISSUED ON: 03/13/2023
TO PERFORM THE FOLLOWING WORK:
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:
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: t
• • )9
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts
°, Board of Building Regulations and Standards FOR
MAR 1 3 2023 Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE:
L Building Permit pplication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
ref''T OF cult DINT;INSPECTIONS i One- or Two-Family Dwelling
`�?TI IA11^'ON.MA OSOCO
--— --- - ' This Section For Official Use Only
Building Permit Number: op),;j• .?/ 7 Date A plied:
4,0 /// 3 13 20
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
76 Lake St
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Bo Torleif Persson Florence,MA,01062
Name(Print) City,State,ZIP
76 Lake St 732 6407895 torleif.pc'•gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building Ixl Owner-Occupied El Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: Replacement of existing windows,excluding kitchen and bathroom.No structural work.
5 windows on the first floor.7 windows on the second floor,to include window opening control devices due to floor-to-sill distance.
1 downstairs window and 1 upstairs window,adjacent to stairs,will be tempered.
Marvin Elevate windows:U-factor:0.28 SHGC:0.25 VLT:0.42 Condensation Resistance:59
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 10000 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanicat (Fire
Suppression) $ Total All Fees:$y-0:= I
v.,Check No., gel Check Amount: Tv.--
6. Total Project Cost: $ 10000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street Email address
City/Town,State,ZIP Telephone
SECTION 6: 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 . ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,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.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereb est under pains and penalties of perjury that all of the information
contained in this application is a and c e t e of <now and understanding.
Bo Torleif Persson 3/10/2023
Print Owner's or Auth s N e( ectronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
__ The Commonwealth of Massachusetts
( 4 Department of Industrial Accidents
t { ,E '�
T ; �, I Congress Street, Suite 100
'-- f f�y� �; Boston, r'11A 0�11;1-?01?
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r: z*' ww11 ntass.lgot/dia
11 orkers' ('ompensation Insurance Affidas it: BuildersiContractorsfElectricianslPlumbers.
hO HE EWE 11 fill HIE PERMifl'I'LM;Al411()14rl•l.
Applicant Information Please Print Leeibly
Name 4.Husincss:Ortunization'lndasidual►: Bo Torleif Persson
Address: 76 Lake St
City/State/Zip:Florence,MA,01062 Phone 732 640 7895
.tee you air employer?Check the appropriate trot: I),pe of project(required):
I.❑I ant a.mploycr with employees(full andior peat-tirrret.* 7. 0 New construction
20 1 am a suk proprietor or portnenhip and have nu employers working for me in H. 0 Remodeling
any Capacity.[Nu workers'comp.uuurantt nquirot]
9. ❑ Demolition
3 :j 1 arn a homeowner doing all work myself.[No workus'comp_insurance required.]'
4.0 la a hunxowner and will be hiring to conduct all work on my prupaty_ I will
0 0 Building addition
m
ciLsun that all ountracturs either have workers"cuatipotsatrort insurance or are sole 11.Q Electrical repairs or additions
proprietors with nu employees.
12.0 Plumbing repairs or additions
5 1 am a gareral contractor and 1 have hind the sub-contractors listed un tlx attached shoe.
{� 13.a Roof repairs
These sob-contractors have tinpluyces and have workers'sump.msurance.-
14.❑Othea
&El We an a corporation and its officers have exercised then right of exemplum per Mt L c. —
1522, 1t41.and we have no t•snpluyecs.[No workers'comp.insurance required.]
''Any applicant that chocks box n 1 must also till out the section below show in then workers'compensation policy information.
i liorneuwncn who submit this atlidavit indicaline they are doing all work and then hue outside contractors must subnut a new atTidat it inti-sung such.
+Cuntractors that check this box must attached an additional sheet showing the name of the sulrcontraclurs and state w hether or not those unities have
t-rnpluyees. If the sub-contractors base crnpluytes.they mum pro..i.ktheir workers comp.jvlic•s number.
1 am an employer that is providing workers'currrpernatiun insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie..4: 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 MGL c. 152, ;;25A is a criminal violation punishable by a line 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 S250.00 a
day against the violator. A copy of tr atement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby certify a er the pai to " rf perjury that the information provided abate is trite and correct.
Signature: / Date: 3/10/2023
Phone#: 2 640 7895
Official use only. Do not write in this area, to be cornplcrer/by cite'or town officiaL
('its or Tow n: Permit/License k
Issuing Authority (circle one):
I. Board of health 2. Building Department 3. ('itvl fosse Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton_
pR N M.'_ate.. 5 .. S,`
,, Massachusetts �< r,/``
;.
71 DEPARTMENT OF BUILDING INSPECTIONS z
*de' !` 212 Main Street • Municipal Building JA.. Ob
-,„ i Northampton, MA 01060 sS'Hjy' 1/7\'‘��
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 554, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in: Glendale Road Transfer Station
Location of Facility: Northampton
The debris will be transported by: BoTorleifPersson(homeowner)
Name of Hauler: n/a
Signature of Applicant: '�,,--' Date: 3/10/2023
City of Northampton
Si
f?� ° u Massachusetts w� y x_ °t•
._ DEPARTMENT OF BUILDING INSPECTIONS LtroLSIss
212 Main Street • Municipal Building J� ce.'
\ Northampton, MA 01060 "st-t 3'-\A-
HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, Bo Torleif Persson 10/11/1986
(insert full legal name), born_ (insert
month, day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the
Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or
work on a parcel of land to which I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'
exemption, does not involve the field erection of manufactured buildings constructed in accordance with
780 CMR 110.R3.
3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2:
Person(s) who owns 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 home owner.
4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I
qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of
the project or work on my parcel, I am not engaged in construction supervision in connection with any
project or work involving construction, reconstruction, alteration, repair, removal or demolition
involving any activity regulated by any provision of the Massachusetts State Building Code.
5. If I engage any other person or persons for hire in connection with the aforementioned project or work on
my parcel, I acknowledge that I am required to and will act as the supervisor for said project or work.
Signed under the pa' and penaltie of perjury on this 10 day of March , 20 23 .
gnature)
OM5 Ver.0004.01.01(Current) TORLEIF PERSSON
Product availability and pricing subject to change. REPLACEMENT WINDOWS
Quote Number:HSQVRGS
LINE ITEM QUOTES
The following is a schedule of the windows and doors for this project.For additional unit details,please see Line Item
Quotes. Additional charges,tax or Terms and Conditions may apply. Detail pricing is per unit.
Line#2 Mark Unit:elevate casement Net Price: 1,007.0
Qtv:1 Ext.Net Price: USD , 1,007.0
Stone White Exterior
MARVIN Bare Pine Interior
Elevate Casement Narrow Frame-Right Hand
Inside Opening 765.57 me,.X 1456.93 tom.
0 Degree Frame Bevel
Stone White Exterior
Bare Pine Interior
IG
Low E2 w/Argon
\ Stainless Perimeter and Spacer Bar
2 11/32•Simulated Rail Rectangular
i� Standard 1.0:2.0
SDL-With Spacer Bar-Stainless
Top Cut 1W1H-Bottom Cut 1W1H
2 Rect Lites
Stone White Ext-Bare Int
Oil Rubbed Bronze Folding Handle
Interior Aluminum Screen
./ Bright View Mesh
As Viewed From The Exterior Almond Frost Surround
82.55 mm.lambs
FS 756.05 nun.X 1450.58 tom. Thm lamb Instillation
10 765.57 mm.X 1456.93 mm. 1"Frame Expander
Egress Information •••Frame Expander Ship Loose
Width:533.4 mm. Height:1338.66 mm. •••Note:Divided lite cut alignment may not be accurately represented in the
Net Clear Opening:0.71 m2 OMS drawl Please consult
Performance Information ngyour local representative for exact specifications.
U-Factor:0.26 •••Note: Unit Availability and Price Is Subject to Change
Solar Heat Gain Coefficient:0.25
Visible Light Transmittance:0.42
Condensation Resistance:59
CPD Number:MAR-N-431-00362-00001
ENERGY STAR:NC,SC,S
Line#3 Mark Unit:elevate casement Net Price: 1,007.0
Qty:1 Ext.Net Price: USD _ 1,007.09
MARVIN Stone White Exterior
Bare Pine Interior
Elevate Casement Narrow Frame-Right Hand
• Inside Opening 765.17 ern.X 1447.8 mm.
0 Degree Frame Bevel 1
Stone White Exterior
Bare Pine Interior
IG
Low E2 w/Argon
Stainless Perimeter and Spacer Bar
211/32"Simulated Rail Rectangular
/ Standard h.Spac
SDL-With Spacer Bar-Stainless
Top Cut 1W1H-Bottom Cut 1W1H
2 Res liter
Stone White Ext-Bare Int
Oil Rubbed Bronze Folding Handle
Interior Aluminum Screen
b./ Bright View Mesh
As Viewed From The Exterior Almond Frost Surround
FS 755.65 mm.X 1441.45 tom82.55 mm.lambs
10 765.17 mm.X 1447.8 mm. Thru Jamb Installation
OMS Ver.0004.01.01(Current) Processed on:3/13/2023 9:02:34 AM Page 3 of 9