29-534 BP-2024-0296
4 GREGORY LN COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-534-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0296 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est. Cost: 4906 WKB CARPENTRY INC 117915
Const.Class: Exp.Date: 09/24/2026
GRANT, HENRY DONALD JR. & SUSAN
Use Group: Owner: TRUSTEES
Lot Size (sy.ft.)
Zoning: WSP Applicant: WKB CARPENTRY INC
Applicant Address Phone: Insurance:
91 PINEVALE ST 413-301-8809 AWC-400-7039454
INDIAN ORCHARD, MA 01151
ISSUED ON: 03/19/2024
TO PERFORM THE FOLLOWING WORK:
3 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:
"d-tke.. itiow
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
p.
I
The Commonwealth of Massachusetts MAR 1 8 20,, ,
I Board of Building Regulations and StandardsCzi FOR
MUNICIPALITY
Massachusetts State Building Code, 780 CIs4R .
. ' USE
Building Permit Application To Construct,Repair, RenoVaf;Zilteiisiiih.*:,ONS--4evised Mar 2011
One-or Two-Family Dwelling
This S%tiyi For Official Use Only
Building Permit Number: 4g19-,q- (377(/ Date Applied:
LC.PAi.5 $356 {°`tc IC d--- -- /1"----4c-7( 3 , e 2.4
Building Official(Print Name) Signature fate
SECTION 1: SITE INFORMATION
1.1 Propecty 3,ddress: 1.2 Assn Map& Parcel Num7rs
-4—°rtrIr7 61 (."'-c e-.3ocy Li ./i/fi
1.1a Is this an accepted street?yes ycS no Map Nuttier Parc I Number
1.3 Zilo,li11. Information: _ 1.4p1rty Dimensions:
-"rill 17/,f
Zoning District Propfosed Use Lot dea(sq ft) Front/age(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:
Zone:
Outside Flood Zone?
Public 0 Private 0 — Municipal 0 On site disposal system 0
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Pot) I- Sue, G-tisen/It 1401,,,,piem
Name(Print) City,State,ZIP
III To..A13,)11 ke;( 3 SBY 772- i
c a0lIctildSL:e-q irctvirgyeillenc•c-"ort
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) VI Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units , Other 0 Specify:
i r ,
Brief Description of Propcwd,Work2: rk_q A c-e.-- 3 , 4./,,s4,ICA,;,75 .., eN1 P,,r 5 f- 4-: 'cr-
c
j) i.---4,c1-04- . 17 S.44,,,, Heif emn , 3..I , e e._ 4 ii. .t .,r rloit_ CE a
. ,
MO S-Tp_ucT-uk,uftt-- iin.ot I F I L Po-T Id 0,c 1...._
< - - .N--.
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
(Labor and Materials)
1. Building $ L/y 06 , 3 I. Building Permit Fee: $ Indicate how fee is determined:
0 Standard City/Town Application Fee
2. Electrical $ 0 0 Total Project Cost' (Item 6)x multiplier x
3. Plumbing $ 0 2. Other Fees: $
4. Mechanical (HVAC) $ 0 List:
5. Mechanical (Fire
$ 0 Total All Fees: $1, .
Suppression)
Check No It
21 UCheck Amount
:4 140 Cash Amount:
6. Total Project Cost: $ 4/7(76 ‘ :? 3 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
(Al;ConstructionC
Supervisor License(CSL) '3 I I 7/S7 v may, 4046
w t t a a !<. i3vT1$( ,T( License Number Expiration Date
Name of CSL Holder
i 7 2- i io04 f V/e I n vl 'C•n d List CSL Type(see below)
No.and Street Type Description
C k: CD Q(. ,� i J� „s1 / O 1 3 U Unrestricted(Buildings up to 35,000 Cu.ft.)
1 C/ l R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�9 d / /� SF Solid Fuel Burning Appliances
t.413
b 3 i3i II ? k �3 Vvl ipeiifryt coo I Insulation
Telephone Email address 1 D Demolition
5.2 /Registered Home Improvement
'entt Contractor(HIC `/j 6-4/4j 6 `/ V` 2 015—
�I L.. C i ry V �;c�f►) ��. vrtil
HICI Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
(3.-I I04✓K t3c,a,� fi w�z� �yo
o.and Street �}/j A �/ 7 j �J(� Email aldress /
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 .J2 No 0
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/./1/13 C.oif Pe- P y .n 6!.
to act on my behalf,in all matters relative to work authorized by this building permit/ application.
clAn1, feoR-k fi 3-- io -- 2, 9
Print OwnerName(Electronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
w• 11:`Cfil lc 11,, cry y_g,__ at(
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
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
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
"Total Project Square Footage"may be substituted for"Total Project Cost"
City of Northampton
,tg.,." Ci
r • �- Massachusetts Q:• �- c�
jj H=
DEPARTMENT OF BUILDING INSPECTIONS Vi
212 Main Street • Municipal Building
�.c
Northampton, MA 01060 rs` ',�Q
1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, 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: 1")(41 F( c� I �• � ��
Location of Facility: 2-- C% � fek_
t-L-). / L
1
The debris will be transported by:
Name of Hauler: lit/ K Ceyfee4
Signature of Applicant: Date: . - /0- 7,y
r•. (, ( 14(3 c“.3
13,-aCcti t3 carp, ry. cnr
The Commonwealth of Massachusetts
Department of Industrial Accidents
In Office of Investigations
sir
AIR1 Lafayette City Center
9 t 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): K 6 a.,,l'p 'hY ttl
Address: !/ f,' - A/ct I e j t
City/State/Zip: 1 C> lA 0 II S 7 Phone#: I//3
Are y u an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 9-. 4. [l 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. [remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
p ty insurances 9. ❑Building addition
[No workers' comp.comp. insurance p' 10.0Electrical repairs or additions
required.] 5. (] We are a corporation and its p
3.❑ I am a homeowner doing all work officers have exercised their 11.1:3 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other�i o�v
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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:4 iML7'
f'�
I in sU f41�Ge `--"�
Policy#or Self-ins. Lic.#: Expiration Dated 2- —037.- 2oZ5
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 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 pains and penalties of perjury that the information provided above is true and correct
Signature: . �� Date: s r/v — Z•C/
Phone#: 41/3 ?°( T(0 5 i; l f 0 kict3 t1 ct l^ie e4✓-r Cc/1
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
10Board of Health 20 Building Department 30CityITown Clerk 4.0 Electrical Inspector 50Plumbing
Inspector 6.0Other
Contact Person: Phone#:
AFRO CERTIFICATE OF LIABILITY INSURANCE DATE
YI/30/20Y4
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTNAME: Jeffrey Jeffrey Brochu
Brochu Insurance Agency Inc IArcC.No.Extl: (413)536-3311 FAX Not• 13)536 0900
725 Grattan Street E-MAIL ADDRESS: )eff brochuinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
Chicopee _ MA 01020 - INSURER : Northland Insurance 00000
INSURED INSURER B: Commerce Insurance Company 34754
WKB Carpentry Inc INSURER C: Aim Mutual Insurance Co 0075
91 Pinevale St INSURER D: CNA Surety
INSURER E: Norfield Insurance Co _
Springfield MA 01151 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS
LTR JNSD wvn POLICY NUMBER _IMM/DDITYYY1 IMMID0/YYYYI
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
CLAIMS-MADE X OCCUR PREMISES(_Ea occurrence) $ 50,000
MED EXP(Any one person) $ 5,000
A Y Y WS512697 04/22/2023 04/22/2024 PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL AGGREGATE $ 2,000,000
X POLICY[ I PE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
AWNED AUTOS ONLY /�x AUTOS SCHEDULED Y Y L10896 06/13/2023 06/13/2024 BODILY INJURY(Per accident) $
XHIRED X NON-OWNED PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY (Per accident)
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1.000,000
E X EXCESS LIAB CLAIMS-MADE EZXS3120903 06/22/2023 04/22/2024 AGGREGATE $ 1,000,000
DED RETENTION
WORKERS COMPENSATION X STATUTE ERH
AND EMPLOYERS'LIABILITY
C OANY FFIR/ MBEREUDD PROPRIETOR/PARTNER/EXECUTIVE YIN N/A Y AWC-400-7039454-2024-A 02/05/2024 02/05/2025 E.L.EACH ACCIDENT $ 500,000
(Mandatory lnNH) E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMfT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Andersen Windows Inc.,its affiliates, agents and employees are included as additional insured on the general liability and auto liability insurance policies
including a sepration of insured clause.All policies will include a waiver of subrogation in favor of Andersen Windows Inc.,its affilaites, agents and
employees and will be primary and non contributory with respect to General Liabilty Insurance. Statutory workers compensation shall provide coverage in
accordance with applicalble state law requirements. (30)days' prior written notice of change or cancellation be given to Andersen Windows Inc.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
•
aX: Email: ®1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
,t' Division of Occupational Licensure
Board of Building Regulations and Standards =.i
Constuttiktri fSdervisor
ti' .J.
CS-117915 _4 `* fjyires: 09/24/2026
WILLIAM K ByT a:. ,;gr - _
•
172 MOUNT VER wa: "
CHICOPEE Mit 010
iwi
Commissioner (A.A. O. Si&n ,
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washingto. trt- Suite 710
Boston,:Massachusetts-0?118
Home Improvement={ infracf:;, r egistration
+ + ter ..A
Type: Corporation
WKB CARPENTRY INC M "".." 'egistration: 165446
WM"= E Oration: 11/04/2025
172 MOUNT VERNON RD . = i F
CHICOPEE, MA 01013Vaii�` -" = '+tl
ete
Y \ w
---- Update Address and Return Card.
•
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation. Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
165446 `w 11/04/2025 Boston,MA 02118
WKB CARPENTRY INC ;"ff
WILLIAM K.BUTLER JR4� '
91 PINEVALE ST. r- - t-/ ii�N;t�t�t �!�v
INDIAN ORCHARD,MA 0t1'5tr .- --
-__fir' Undersecretary Not valid without signature
WKB 172 MOUNT VERNON RD ORDER: 178383
CHICOPEE, MA 01013 ORDER DATE: 2/13/2024
CARPENTRY PH:413 883 9283
EST. DELIVERY DATE: 2/14/2024
ORDER CONTACT:
WINDOW SPECIALIST
ORDER ACKNOWLEDGEMENT
INVOICE INFORMATION SHIPPING INFORMATION
Don&Sue Price includes 3%cash or check discount, Finance&credit
24 Trumbull Road card options are available
Northampton , MA 01060.
PH:413 584 7725 FX:donandsuegrant@yahoo.com 1/3 to order windows ,1/3 when windows get delivered to
contractor, Balance @ completion
SHIP VIA:
COMMENT: new stops match window
ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS
178383 2/13/2024 178383 4 Gregory Ln, wood grain
ITEM DESCRIPTION QTY SIZE PRICE TOTAL
1 6800DH INVISION DOUBLE HUNG 2 31 1/4 W X 61 1/2 H $654.08 $1,308.16
REPLACEMENT $0.00 $0.00
MAKE SIZE $0.00 $0.00
WHITE EXT/DARK OAK INT(273) $235.13 $470.26
BRONZE LOCK $0.00 $0.00
ENERGY STAR 7.0 NORTHERN $0.00 $0.00
TRIPLE FUEL SAVER: E270+E270+CLEAR $219.45 $438.90
+ARGN/ARGN
FULL TRUEVIEW FLEX SCREEN $72.68 $145.36
STANDARD SCREEN CLOTH $0.00 $0.00
UFactor Solar Heat Visible CRF Energy Star Structural CAR
Gain Transmittance 7.0 Zone Rating
0.17 0.21 0.39 76 All Zones LC-PG55 029-428
ITEM SUBTOTAL: $1,181.34 $2,362.68
2 6802CS-2 INVISION TWIN CASEMENT 1 38 1/4 W X 38 1/4 H $2,543.65 $2,543.65
REPLACEMENT $0.00 $0.00
MAKE SIZE $0.00 $0.00
WHITE EXT/DARK OAK INT(273) $0.00 $0.00
UFactor Solar Heat Visible CRF Energy Star Structural CAR
Gain Transmittance 7.0 Zone Rating
0.16 0.21 0.38 78 All Zones NOT NOT
CERTIFIED CERTIFIED
ITEM SUBTOTAL: $2,543.65 $2,543.65
3/14/2024 6:03:45 PM 1 of 4
ORDER I ORDER DATE I PO NUMBER I CUSTOMER REF I TERMS
178383 2/13/2024 178383 4 Gregory Ln, wood grain
ITEM DESCRIPTION QTY SIZE PRICE TOTAL
2.1 6802CS INVISION CASEMENT 1 18 7/8 W X 38 1/4 H
REPLACEMENT
MAKE SIZE
WHITE EXT/DARK OAK INT(273)
ENERGY STAR 7.0 NORTHERN
TRIPLE FUEL SAVER: E270+E270+CLEAR
+ARGN/ARGN
HINGED LEFT FROM OUTSIDE
WHITE LOCK
FULL TRUEVIEW FLEX SCREEN
STANDARD SCREEN CLOTH
UFactor Solar Heat Visible CRF Energy Star ! Structural CAR
Gain Transmittance 7.0 Zone Rating
0.16 0.21 0.38 78 All Zones NOT NOT
CERTIFIED CERTIFIED
2.2 6802CS INVISION CASEMENT 1 18 7/8 W X 38 1/4 H
REPLACEMENT
MAKE SIZE
WHITE EXT/DARK OAK INT(273)
ENERGY STAR 7.0 NORTHERN
TRIPLE FUEL SAVER: E270+E270+CLEAR
+ARGN/ARGN
HINGED RIGHT FROM OUTSIDE
BRONZE LOCK
FULL TRUEVIEW FLEX SCREEN
STANDARD SCREEN CLOTH
UFactor Solar Heat Visible CRF Energy Star I Structural CAR
Gain Transmittance 7.0 Zone Rating
0.16 0.21 0.38 78 All Zones NOT NOT
CERTIFIED CERTIFIED
2.3 6802CSTMULL INSIGHT T-MULLION 1 0 W X 38 1/4 H
WHITE EXT/DARK OAK INT(273)
TOTALS: 3 SUBTOTAL $4,906.33
TOTAL: $4,906.33
3/14/2024 6:03:45 PM 2 of 4
Drawings -Order: 178383
r
6800DH INVISION DOUBLE HUNG
31 1/4 W X 61 1/2 H
QTY:2
3/14/2024 6:03:45 PM 3 of 4
Drawing
co
I1 IE 1?A_ �� •8 ;B 1�+�
38 1/4 W X 38 1/4 H
3/14/2024 6:03:45 PM 4 of 4