32C-302 (4) PATRIOT HOME IMPROVEMENT
REGISTRATIONS . `
a<. ^S>:rh� ♦:,�» I(�'r.i• '•y rf':'{y, <�.�,, i •rn' .. I !. 1��~' !` r.\Z: \ s ,. . Ell A r 1 J i /IIl
�� . Board of Building Re la ions and Standards
Y g
f One Ashburton Place - Room 1301 '"
y Boston. Massachusetts 02108
_ t Home Improvement Contractor Registration
Reqistration: 115804
Type: Private Corporauon
Expiration: 4/19/2006
FOR-U BUILDRES/•PATRIOT HOME IMPR.
RAY FOUCHER
820 UNION ST �
=� WEST SPRINGFIELD, MA 01089 PY
A.
1 1110 Bill
�.: <
Llsulation ❑Tyvek ❑Shelter Wrap ❑High Density Poly Stirene
j Strip YES❑ NO❑ Gable Vents(Louvers) YES❑ ❑ NO
J Blocks&Dryer Vents YES❑ NO❑ Porch Interiors YES❑ NO❑
Shutters YES❑ NO❑ N of Pairs Color Profile
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Gutters&Down Spouts YES❑ NO❑ ❑ Ute ❑ Heavy(Seamless)
ALUMINUM TRIM Wrap Window&Door Casing(PVC with Anderson Bends) ❑Color Wrap Window&Door Casings(Flat Coil) 0 Color
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SOFFIT FACIA Use Vented Soffit?YES❑NO❑ Color Cover Porch Ceilings? YES❑ NO 0 Wrap Beams&Posts YES 0 NO❑
f Locations?
WINDOWS Type? NOR'EASTER I NOR'EASTER II_ Odds YES 0 NOV.— Configuration?
How Many? D/H�� 2 LS 3LS CAS HOP BOW(4 or 5 Lite) Bay AWN-
Casin Covers ES q t�Iv❑ C 11.11 Coil ❑❑ C w/Anderson Bends Color s
DOORS Steel Core Entry#--Style— Storm X Style
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ROOFS Shingle 0 Strip❑ 0 Color Ice Barrier YES 0 NO 0 Ridge Vent YES 0 NO 0
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WORK SCHEDULE pt
Contractor will not begin the work or order the materials before the third day following the signing of this A r 0 a runless specified here In writing.Contractor will begin the work on or about aye).
Barring delay caused by circumstances beyond Contractor's control,the work will be completed by ,G/ 'I (1 date).The Owner hereby acknowledges and agrees that the scheduling ales ire approz-
Imale and that such delays that are not avoidable by the Contractor shall not be considered as viol of a Agreement. �/ f
WARRANT'I
The contractor warrants that the materials furnished shall be free from defects for a period of INI—Inn completion,and shall ccmply with the requirements of this agreement.In the
� event any defect In workmanship or materiels,or damage caused by the Contractor,his subcontr t s,employees r agents,Is discovered within one year after completion of any job,Including cleanup,file
Contractor shall,at his own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired,or replaced,such damage or such defect in materials.All workmanship Is waaanleed for e
period of one year.The foregoing warranties shall survive any Inspection performed In connection with the agreed-upon work.
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We Pr pose hereby to fL�r ish ma priat and Ip ,omp�Jete 9n accordar}�e'with above specifications for the sum of:
'lL �' .. ' dollars($
Pay Kent o be made a ollows. ~
>u
%($ _) upon signing Contract; Name of Contractor/Designated Registrant
PATRIOT HOME IMPROVEMENT
upon delivery of material; Street Address
820 Union Street, West Springfield, MA 01089
% ($ ) upon 112 job completion; Phone
1-800-458-8082
Registration No,
shall be made forthwith upon completion MA# 115804 CT# 546-192
work under this contract Name of Salesman
Notice:No agreement for home improvement contracting work shall require a down payment -- -- - --
Authorized Signature
(advance deposit)of more than one-third of the total contract price or the total amount of all
deposits or payments which the contractor must make,in advance,to order and/or otherwise
obtain delivery of special order materials and egwpment whsF�ygr_amQynt i5 grQJt.Pr
Acceptance of Proposal I have read both sides of this document and accept the prices,specification and conditions stated. I
understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be mad
as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after t
date of this transaction. Cancellation must be done in writing. See accompanying Cancellation.
qO NOT SIGN THIS CONTTACT IF THERE ARE ANY BLANK SPACES
S"gnatur� �"` /4 fir•/(J. _ -^Oath // Sgnature lixrn
_-----_ -' �;% IMPORTANT INFORMATION ON BAC
w
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
F;Cd tsteced-,Hbrrie.Tm"'ravement.G ntrac or , :e _ Not Applicable ❑
_LffliV�6MICIA) l
Company Name Registration Num a--6 ---"- --
�-/-&o/ (7�L
Address / t Expiration Date
CAV1V N 16-y) Telephon
SECTION 10--WORKERS'COMPENSATION INSURANCE.AFFWWR(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...... ❑
l �om �rer Eri >r
The current exemption for"homeowners"was extended to include Owner-occupied Dy ellir.;of one(1) or mro(7)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-vear 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House [-1 Addition ❑: Replacement.,Vndows Alteration(s) ❑ Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [[3] Decks [[] Siding[p] Other[p]
Brief Descrip;ion o Pr p sq�
Work:_/ /- // /�_ �� CIU �/ f Gu J r/1J C1 iv
Alteration of existing bedroom Yes No Adding new bedroom Yes No .
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
Nevii house~and-or addi fi 4611i
6a- n wilvc:
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
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.
2.
Signature of Owner Date
I, 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
Signature of Owner/Agent Date
.
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Section 4. ZONING All Informati6h 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
Rear
Building Height —.7
Bldg. Square Footage %
Open Space Footage % I——-----
(Lot area minus bldg&paved
#of Parking S paces
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A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
x�\ �~� x�\ �
N0 �~� DON'T KNOW \~� Y�5 �~�
IF YES, date issued:, /
IF YES: Was the permit recorded ut the Registry ofDeeds?
NO DON'T KNOW YES
IF YES: enter Book / PoQo and/or Document#. ,
B. Does the site contain a brook, body of water urwetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tobeobtained _��~� Obtained /�\ Date� \�� ' �
C. Do any signs exist on the pruporty �� ��� YES x�� N0 �~�
IF YES, describe size, type and location: .
D. Are there any proposed changes to or additions of signs intended for the property? YES NO 0
|F YES, describe size, type and location:
E Will the construction activity disturb grading or filling)over acre orisd part ofo common plan
that will disturb over 1 acre? YES K`_^) NO � )
� `~,
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
_ Depai l a nt use only
City of Northampton Statu-tofi Permit
ing Department Cur13Cu'vW7v11,wa�Permtt
12 Main Street SerreerSepttcA�a�ltlft r�
Room 1.00ater/Well Avartab �fy
No a pton; MA 01060 Tin+oSets ofiStructttcal Plans
r
�Z0413-'68`/ 1240 Fax 413-587-1272 ns
t Other Specify
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LICATlO'I��i,� TRUCT ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION''
1.1 PropertvAddress: This.section to be completed by office
11�� �;�( Map' -VALot
Zone Overiay Dfstrfcf
EhmSh District CB District
SECTION"2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:..
JfV/V sl
Name Print) r nt ailing Ad°rg
r -
6N l/v - l.6-Y'/Y) Phi=°-, --
Signature
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED`CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted b permit applicant 1. Building �' (a)Building Permit Fee
6. 06
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building;Commissioner/Inspector of Buildings- Date
17 VALLEY ST BP-2005-0690
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:32C-302 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: BuildinQ DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL C.142A,
Category: BUILDING PERMIT
Permit# BP-2005-0690
Project# JS-2005-0943
Est. Cost: $8600.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group. PATRIOT HOME IMPROVEMENT 115804
Lot Size(sa. ft.): 6490.44 Owner: WILKINS-CARMODY DONNA
ZoninwURC Applicant: PATRIOT HOME IMPROVEMENT
AT. 17 VALLEY ST
Applicant Address: Phone: Insurance:
820 UNION ST (413) 731-8082 WC
WEST SPRINGFIELDMA01089 ISSUED ON:113105 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 Occupangy Occupancy Si nature:
Feel e: Receipt No: Date Paid: Check No: Amount:
Building 1/3/05 0:00:00 8505 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo