29-395 K
�. CERTIFICATE NUMBER
x *,.t_� .: 3z «•e ATL-000910307-01
PRODUCER THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
MARSH USA INC. NO RIOHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED N THE
ATTN"BRENDA BOOKER POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE
3475 PIEDMONT ROAD,N.E. AFFORDED BY THE POLICES DESCRIBED HEREIN.
(404)995.2594 OFFICE COMPANIES AFFORDING COVERAGE
(40TL4J)�760 5168 FAX
A TA30305 COMPANY
100492-MASTR-RMA- RMA A STEADFAST INSURANCE COMPANY
INSURED COMPANY
THD AT-HOME SERVICES,INC. B N/A
DBA THE HOME DEPOT AT-HOME SERVICES
2455 PACES FERRY ROAD NW CCJMPANY
BUILDING C-8 C AMERICAN HOME ASSURANCE COMPANY
ATLANTA,GA 30339
CCNPMIV
D
THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED
NOTVVTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO VMIC M THE CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN,THE iN9JRANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO A L THE TERMS CONDITIONS AND EXCLUSIONS CF SUCH POLICES AGGREGATE
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAMS
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LM173
LTR DATE(MMIDO/YY) DATE(MM IODIYY)
GENERAL UABLITY GENERAL AGGREGATE $ 4,000,000
A X COMMERCIAL.GENERAL LIABILITY IPR 3757 608-00 02/01/04 02/01105 PRODUCTS-CCMPADP AGG $ 4,000,000
OLAMSMADE �OCCUR 'LIMITS OF POLICY ARE EXCESS PERSONAL aIADVINJURV $ 4,000,000
OMFR'SACONTRACT0WSPROT IOF SIR. $1,000,000 PER OCC' EACH OCCURRENCE $ 4,000,000
FIRE DAMAGE(Any mefm) $ 4,000,000
MEDEXP M RRe sm $ EXCLUDED
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY ALTO
All OWNED AUTOS BCOILYIN.URY $
SCHEDULED AUTOS (Pe,pa—)
HIRED AUTOS BODILYINJURY $
NON-OriMNED AUTOS (PA--)d-)
__. PROPERTY DAMAGE $
GARAGE LIABILITY
AUTO ONLY-EAACCIOEN7 $
ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $
AGGREGATE $
EXCESSl1ABILITY EACH OCCURRENCE $
]UMERELLAFCRM AGGREGATE S
OTHER THAN UMBRELLA FORM $
D EM PLOYERYLMBLITY X I TCRY LIMITS ER
EL EACH ACCI DENT $ 1,000,000
C THE PROPRIETORI INCL RMWC2981M ADS 02/01/04 02/01/05 EL DISEASE-POLICY LIMIT S 1,000,000
PARTNERSEXECUTIVE
D ,
4 OFFICERS ARE. EXCL EL DISEASEZ-AOH EMPLOYEE S 1,000,000
OTHER
C WORKERS COMPENSATION
DESCRIPTION OF OPERATMWLOCA7IONSNERWAELSPECI4L ITEMS
RE.LOCATION NO.RMA.
._-:.,.. <..c....-..x_: .._._.._c-s..s.._c__x.._..:srs..�3a.,.._..s.�..sx.�...c•,•s.•.m <_.._,.-.._:..,c,..._�.,�.:...,.. :_r_.-<.,x`ar...fe__.>.._<a ...:.._ ».o.r._....k <....r.v.«t s.:-.r>s :....Ke..:<3 xa..r..s<...:_.r..K..
9IOU-0 ANY OF THE POLICIES OESCRIBED HEREIN OF CANCELLED BEFORE THE EXPIRATION DATE TWRECF,
THE INSRAER AFFORDING COVERAGE NULL ENDEAVOR TO WJl 30 DAYS WRITTEN NOTICE TO TTE
CERTIFICATE HOLDER NAMED HEREIN OUT FAILURE TO FLAIL SADR NOTICE SILL IWOSE NO OBLIGATION OR
UABILRY OF ANY NIIO UPON THE IN"FR AFFORDING COJERAOF,ITS AGENTS OR REPRESENTATIVE S OR THE
I SSUER OF TH S CERTIFICATE
MARSH USA INC.
9Y. Knnett -�
VALID AS OF:=102/04
063-A-038
40-45 DH
CM
6100 Renovations
Double Hunq - Vinyl
Argon/Low E SC
tuetlonaiFeiaaaato„ SS
�+ocowd
1-800-746-6686
NFRC 2001
ENERGY PERFORMANCE RATINGS
U-Factor(USA-P) Solar Heat Gain Coefficient
0 . 34 0 . 31 .
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0 . 50
Ungachuers fattmia6veanlonubapplic"liiiCPpt wlardsMtaditw"
pxadnctpato - cm 99 1111 1 0 1198111=13d0faftomontal txn1111n, adz
specBcaoduccsite.txnar momiachrrersi, :pnaforolhe 0o uctpariomaaemmatimL
wwMra.arg
E 4~4M sm
Unit qualities for snergy star
Region(s): Northern, North
Central, South Central,
Southern
DP : 30 : R 00iO4W W/11-130
Test size: 44 x 60
Order 1 :3665935020001 40225 ES
�'!� �o>�nroauuea!l�i. g1;llc�aa�.�ao�te
Board of Building Regulations and Standards
- HOME IMPROVEMENT CONTRACTOR
Registration: 126893
y Expiration: 8!312004
Type: Supplement Card
Home Depot At-Home Services
RICHARD FALLONE
3200 COBB GALLERIA PKWY#26
ALTANTA,GA 30339 Administrator
HA1�1P � I
S'OQ„ 'TDy i
Crier of Wort4autpton z =
�ASSAChltB[tt4
t
w DEPARTMENT OF BUILDING INSPECTIONS /= `
INSPECTOR 212 Main Street • Municipal Building o,44
I
Northampton,MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction sup,:,• sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends 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."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backfill),
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing& gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
a
•'
(1,iiy1 of �_Nartljamptnit L .
;R1 K39 Rrllnsrtte '
< III
m DEPIU2I'MENrI' OF BUILDING INSPECT-IONS
212 Main Street ' Municipal Bulk ng
Northampton, Mass. 01060
WORMCEIZ`S COMI TENT SATION INSUIZA.NCE A + I AVI.T
1} ----_ - -
U-116 - - - ------ -- --
v"Ith z principal place of busir..essh,2sidenc-c
CIO hereby Cer-Lif ; UII CIf_1 I)IC p,:,l s isiid pcn if.leS of nCF�m-y, 1li!1.
an empioyei- provlehn- the io11ov,,it?f_ ;oi't:ci's Coil pcilsatioll GOV011",e 0r Iny
employces worI dng an t?Lis job:
(Insiranc:� Company) ('P,Glic-.Num,be r) (F_xT,it t-,) Date)
( j I am a sole proprietor, ge_nerai c:on c cr c,r 11omeov,,mer (curie oct) and 'gave hired
the contractors listed beiov-, tho the `ell :;1 vc OFke,, s compen_,�a on -,".kits:
(�:E1I➢C Of�L�nLT1CiGr) (7115 RC CvInn:'i'r':TG�ICf Nwnbcr)
(Name of Contr czar) _ (7.ISSrnce y Co ra. v/Pclier Nurlrr r, (} atina Date)
(Name of Contractor) (In. ammo: cou;::_n•,•fMic: Nu_n? -_-r) =.x,, rdo 1;atci
- (Name of Cont ICtcr) — (Itisz t�trc� Cetnr -,v!Poiicr Numlt�r) (i:xri-::soc Datei
(r.!ISd:ad^itimal c::xt if:�<<'�-�.-:cn:L-Ll.i1:t:::'r,^.:n:[C;:;-�:_:;i;:r'.:-i;r:c::od<:r•1
i
l 1 mm a proprlC"Ji F:iI'1 1LiVC I?O OI1 c 101 IIle-
( honic o ,,,11L' iCi:CJ`I??Iry ?{i i_'. iii`r l-
N0'11-',:please be Aw2 c Lst'.t1 ilc I'r;�o«1r_,a .;. r, pi:+i�:v n;t i_ nc t.:_n_m cr:a;au c,:.._.._ cllir.
Rot mcce th--a Lhroa L n?i in -.FY t:�;:ti�-rtir.-r`.:_o u oc;
,zip[oyaz uti;ez t}r fr_a �r:((it_I52---z!(ell.-p';!i�:tic:;�y a `:br p=r
legal riatun of=amployor uod r tLc Woriccla o t;oc-,tion .ci
I undcrzti d that.co-y of ells ctutc"_C!m xy bo to:In 1Yticrtaxn:of L dustri cl An'id-�&Oiroo of'•:="''rs.•r-o for LUx
coverage vaifir_.tioa and th_t failure to la u:co%tr_�„ :SA of?,JGL-152 can tcad to the imposition r�i 1 Qasl:u
cbm sling of a Erne of up to S 1-500.00 n:",' i :pri„^� •1 of::?to cn:}: ..:.j c viS xru)tia in y 4 f(--n cf a
frz
a(!;I 00, city tgt.in:.l m
For dq%utr:rstsJ y
Pcrrnit rIumlr r --_-_
si,;natur of i.iccnr JP-rill ittr:. r
A '
SECT ON 8-xCONSTRUCT!ON. SERVICES
8.1 Licensed Construction Su rvisor: Not Applicable
Name of License Holder : Va U t J�b 16 el-11 LAt 7-jX-Kq 6,2
License Numbe
Address Expiration Die
r
Signature Telephone
Reg s ere me maKOUernent Contracto Not Applicable ❑
Ott gq
Company Nam,,e rr Registration Numbe
`�� C� 5
Address Expiration'D to
'W^ \
TelephoneqD
SECTL MPENSATIQN INSURANCE°AFFIDAVIT(M.G.L.,c 552, § 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 oft building permit.
Signed Affidavit Attached Yes....... No...... ❑
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
A
SECTIONS D MR S ?T'QVtG RROPOSED VORK check all ja lacable
New House ❑ Addition ❑ Replacement endows [Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks ( ] Siding[ ] Other [ )
Brief Description of Proposed Work: ( h arc
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative D Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet 0
sa..7=f__.etiy ou :e :nd o a dr`tiWr It"665A i tinge ous'rh0 m - e -h-b-S floIn
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 .
1. Septic Tank City Sewer Private well City water Supply
SECTS(TL7 llrit, AUTHORIZATION' TO BE 0. PUETED VYHEN
OWPCE S GE T 0 1C�ONTRACTOF2 APP Ll E&fO,WtQ ILDING PERiVIIT
l 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
I, 1 e- 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.
Sig under the ins and penalties of perjury.
Prin m
i
Si nature f Owner/Ag t Da
i
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 DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT 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:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO —Y[)WELLING
SECTION 1-SITE INFORMATION F'5 2 rj 104
1.1 Properly Address: Th�.sfisect�on to beon>tpletecT by office
yams . s a �' u
°?kk` 'k:'w
:Z�ile��, a '' t � k OveirTa�rT1lst�ct °
,oy®m,St�DistnCt :� �" GB Distract
n
SECTION 2-PROPERTY(OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
--IU 1'-4 tai' ►moo
Name(Punt) Current Mail' g Address,
Telephone
Signature
2.2 Authorized A t:
Name( nt) Current Mai ring Address:
Signature Telephone
SECTIO 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com I t d by ermit applicant
1. Building Permit,Fee
r
2. Electrical (b)Estimated Total Cost;of
..Construction from 6 -
3. Plumbing Youildling;Permit'Fee,
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2+ 3 +4 + 5) I-°Check Number
This Sectionfor!Official Use Onl
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
i
M
116 SANDY HILL hD BP-2004-0914
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-395 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-2004-0914
Proiect# IS-2004-1364
Est. Cost: $5262.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 12196.80 Owner: LAUREANO LUIS E&PATRICIA A
Zoning.URA Applicant: HOME DEPOT AT HOME SERVICES
AT. 116 SANDY HILL RD
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Com2pensation
WORCESTERMA01607 ISSUED ON.3129104 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 Sisnature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 3/29/04 0:00:00 1667 $25.00
212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo