17A-253 (3) Dec 18 05 05:38p Michael Bedard 1-401-246-2868 p. ii
Sold.Furnished Roe Yns!alled by
stanch Name: Date: � TI IV At•Hucrw Services.l[x.
d b a TM:Hum.,Dcpnt:1t-141me Services
Toll(;rcce,.uPdStr.ct.11'orcc:$ -7361189
Branch lumber. J .lob k: TPII Fr.c lRtMi)651.$1#:. Fax:56)8-?St:2Bto
1 rdeo:Ill v-1-;MM:MI 111 I it,f Q,114 fit Co".Li,:-1.22-
tL\Hwnctn:pr.ntmrntt""otqu-.w Rag.+t:na4r
instaliotloo,?ddrrsc: f �_�'f�.�t ,___ � 1 , _
012—
City Slaw Zip
Purrhaxrrar - Last i 1)i'n rleer'c l.k.•.E F_\ \to p' rL ra,Me: u rgkgdt.•
_
051,
Hoare address —.___.........__
tlfdifPcr0nr'm!nln<ta11a!1anAtldressl 01% Slate Zip
L-mail dddress no tece!C a updates and p-orm,twob i'mm The Hone
Prniecl I�farmatiun: I:1';Y%vu U*Pumhal�r 1.the a mere of the pnipeov located ar the abo\•c installation address,offer to
axnl,tct wnh E6omc f)t rn
USA-W..-'1 + e %-,yV iiumah.deli,er,1nd atrange for tit.Itl:rallution of all maferiof i m
d�tieril+ct rn tl N11 1:IkJ 5 :Shrc1 - r ncorporated h rein bl refat+rmc and made a part hetrnf.
}tome Depot resen•rs fltr right to cancel This contract If,upon moo spection of rho job,liome 0"ot deternslues that it
cannot perform Its obligations due to a structural problem with the home.pricing errors or because work required to
complete the job uas not included is life Spec$beef or Contract.
DEPOSIT PAYMENT OPTIONS
r8tl:ryea r.�fiord,axtaralinn arJarerdhl artutn'a1.1
C),a•L.eojbi#n Check cv 1 S r,nvl Ssni.c Nlmo,Old=
CONTRACTANIOU\T 5 ` rVr-pea kn Tt.•ttamtixpvu
-�" Ernst:C'atd•and of mleer�c+r-r[vptuxr.•[kth t)ae tHlaw•
�
LER DEPOSIT S • _,,�
firs 5,w9am Di>uwcr American ttprew
1C£DUE /1 ./ The Hanle Ll`fin ,.:ne fmph�w...-nt Loov The Ito=fkpnt t rvbl Ccn!
CI>CONIPUTIO\ c .
lr,r.,renllnl k\lfligy,{acpuat tHIL i NDCt:I)al1.l-I
`\Iinhausa 35%of Contract Amont due upon 1,.11ghle Credit:S tHll.&HpCC o�Lt r
eeutlon of tlik contract.
{srr'1�'I/�Lfl�G/C�ri 3L:�Imp
�._. ..._. ._._..�-_r....r - \_y,ca-r+�t,rar.,K.:JTJ.Lt(1>i".-r.lk�'t�7�••.L=.S.C:�^' _
Indicate Pad ment Method Fur -Flc IM our,Iflgqtvrc lrclo,,.l%% tierce to allow Home Drput to
BALANCE DUE ONCO.IIPI.l:FION"; rge.tisef6r�f�ttc�dcredi a ardforthedctxnititidiicaaledd../
-map be suhject to C'redil.iipprocab Fund NIL or FIDCC.•luthorir?tina CbdM __—
Varilicalion an*or Credit Card.authorization T Deposit �_ , ' FInaY Pu+meat
fi #
h-.-er i_ra !hat.orwn:0ra!e1,upon Compl.haa of.-IN•.cork.par :aai*v.;!l_�c:utc a Compl.0on Cc::ificale and{rr:nu:•
6:1.ur..due' Purchil ct airt•:lgrcc,ta.i•c+sr,I?,1:k1„tn:,11}ebh,—x d.,!,I Iillbl.ita.:umitr
Fntlre.% rcemeu, 1 iu,?t teamto tt and r:5 aN.+Cinncrn,,hwlWim-,an; tilcurciag a^reemem.contain!be cnnlpfaa:nr,+rment
anc•cen the pur:tes and::!n mp hr erra.•nt!cd o!n!tdified ur.i-•.in,tnbug in a,eprraic IS,btsh pattKS.
NOTICE TO MRC•HASIER
Do not sisn ibis contract before you read it. 1•eu are vntltled to a tomplelep filled-In Mpg of the contract at[he trtrre
you sign, ikeep It to protect ioor rights. Do not ilga a Camplelion Certificate before/hIS praject is romplety. Lan
prohibits home repair contractors from requesting or acteplln%a Complcdon Certificate signed ht the o..der prior to
the victual completion of(tile wurk to be performed under the contract.
Y611 Irlar cancel[his Transaction an%time prior to midnight of the third business do%'offer the date of thk contract. Set
.NoIICe of Cancellation for tin e\ptslralion of Ibis tight. 'There will he a,truer chart egnai in 1014' of The contract
atuoun[if job is rancriletl he Purchaser-{FTE R the third business day,but REBORE materials are ordered.There will
he a scrvict:charge equal to 23Sa of the contract,mount it job 15 eanceLlcd b! Pnrchnner.\F-T'ER materials arc ardtr"L
H9 \IVOLk SIG\,\- -Ri. RLIMU. i ,Ir ;'•ii2=F l'f.: IK K(',\f) P) TH}TFRIIS OF THIS f'0.\fP-AC1. °u1.
>,KNOWLLDGI-Rt=e F.IPT Or A CnP1'OF THIS C•ONTR,%CT {1D TA%'0 COMPLETED COPIES OF THE NOTICE
L)r c:%NCELLATION
BY MY 01.,R 961ATURE- BEI-011i% I WE UN!7FRSTa\!i FHAT THE.'WiRUNIENT 15 Sl HJLCT TO REVIF11'OF
MY OUR L-KCAN I'IIiSTORY:\ND i%I L Alt,!!W1UZI'HOW DLPOT TO VfFLIFY A\!)RP.GIEW tll OL'R C KWIT
XLLQRV WITH �?Ci1rD41.-\bL\T CRFEAT REp\)RI i\(:.WF\CY.v\0 RtLFaSE THL.M HCI?`I \LL L1A11111TY
IICC'RRLDFltOJt O1?L•R ORS
SUBMTTED RN:
/ r
AC'C•EPTFI) � � Pate: 1 �5
H.c�tw'n�
t.I Date
llamaw.ncr
\OTICf.:ADDlT10NAL TER?'iS:t ND CO1D11 spc5 ARE STATFU ON THE REVERSE SIDE
.4_1D ARE PART OF TFUS COITIUCT
5/S d SHY 4ac _ 00;"St-0-900Z
4�N�►MP�.
0y$ Lritg of Narthalliptan
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�834RCITtiSttt3 � -
DEPARTMENT OF BUILDING INSPECTIONS /_:
INSPECTOR 212 Main Street • Municipal Building �>o
Northampton, MA 01060
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as l-.is/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
�� goy (rzi
� a E �orf11alliptoil� �f � � —MEE
9 � E �Za�aeCSinsctta' -
•O DEPARTME117 OP BUIL00\1C INSPPC iotdS
212 Main Strcct Municipal Building `
Northampton, Mass. 01060
tip`O RTC;R'S C O 1ZI'ENS A'ITIO N G S UR.A_N CE A 17M A`'IT
(]j ccnsxJpa,nI ttcc)
v.9th a principal plat.- of business/res;dencc at:
s � .21 (srr�t/ci ty/sla��a p
U
do hereby ce�', under the gins and penalties of e rJ '; hai
(VI am an employer providing the Following %vork&5 compensaao, cove rz gc Lor Im
etmployces xvortJng on this job:
CrJ1z5_ f
i
) (Pctic: D?s.c)
( ) I am a sole proprietor, general contractor or homeowner (circ;e one) amd hzve hired
the contractors Fisted below wbo have the follo iag worker's cot oen_a6on policies
Clia lc O.' Cc!-.^M 'orl {IARl�Itl: COITIDC 1}jt�GUCi ti�tt]nl_<:) f`r_?:")lidU^ l�alC)
(N..me of Conmaor) (Lnsuranc;, Comoa�lw?OUC-i Nusncrr) (L\DU bon Daze)
i _
(Name of coaaacl ) Omsuranc;.Compamy/PoUcy Numbs) (EN:pirrcioo Datc)
(Namc of Contractor) (LM511 acc Comcaay/Pobcy Numb:.r) (E:, irttioo Datc) .
(an, :Ai io=l rSccc.if nco=s--•to atciud_iarorm,Eoa pertaiaias to av maw-so-n)
{ ) I
an a sole proprietor and have no one woriong for me.
( ) I am_a home owner performing all the work thyself.
NO'It:PI--be aa-src f-'vi le bc=owvm vto C=PIQy pcn'3q=Lo L4o,-_.:._„- c=_zcj0c c rgair-ork on,d.c(1_C or
aae mots tha o =ri iu ubieh ibc bemrmwer rezida or on tb c x,�purLca za th r=a c nx .Iry Oo=d i w be
aploYcs " o siioa Act tGL152so l(5)�apptiazDOO try a bomeoav=fer a lice__a permit zy a
d=o t$c
IcVI n--.,or as exaloyw ucde din Woc e .Co¢�omation Ad
f yodast+aC Ib+a x Dopy of thu¢it®cat naay be Corv.ard.sd�tSo Dcgar�mma of tpdastJicJ nccdcav'Offioo oflru+c�c for�.
wve &c veirc=ioo aad U%--L L-irtzc to serum.-lrovrT�uz&r oc 25A of MOL 152 can Ied to the i=P-600 o(eimiosl PrnilUd
oomisa$of a fmc orup to 51 500.00 andIcr mmWiyoazn� orup to co yu aad ovi)pmahio io t5c form ora S1oq Work Ord=aad a
f>.m 0(5 1 DD.00+(Ly tp=' tnc
For u, only
perojit Numbcs
L_ Y
t y, htips__ Lot 3'
Sigma rc of Lic=Lscc/Pcrmiucc e
SECTION 8 CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
x Not Applicable .❑
iS [edI l on7`e,m rQ @ F1$fitZofiftj °
Comoany Name Registration Nu er
C)1�3f— ... '7�3- y
Address Expiration Date
f -I,(— Telephone
SECTION 10 WORKERS'COMPENSATION-INSURANCE AFFIDAVIT(M.G.L.c.1.52,§-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...... ❑
t, �x
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
SECTION 5-DESCRIPTION'OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [CJ Siding[o] Other[❑]
Brief Description_of Proposed
Work:
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
xr
domtoyexlstind ousm` 1-20 6a f 1 e t . mp ete t al OWai�q:
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 TWHEN
OWNERS AGENT OR CONTRAGTOR.:APPLIES F;OR=B ILDING PERMIT
cc)dc., 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.
i�C)In
Signature of Owner Date
I, 15 I G [D"4—'— 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 u r the pains and penalties of perjury.
r' t Name
� I
Sig u e f Owner/Agent Date
o w
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:w— L:' R:
Rear
Building Heigbt —: '
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved f
parking)
#of Parking Spaces
Fill:
x�
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW ® YES 0
IF YES, date issued::
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#�_
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Date Issued: r
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: ;
D. Are there any proposed changes to or additions of signs intended for the property? YES I NO Q
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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
-
City of Northampton [ " t �
Building Department
212 Main Street
Room 100 '
4
Northampton, MA 01060u,
phone 413-587-1240 Fax 413-587-1272
�a
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 beoomplaeted by;offce
t � t
mot rt m Mff klntt:
I L�
.Zones " a Overta,X'�1;3rst5nct x
SECTIOR2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner Rf Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorize ent: 7
Nam (Print) ` Current Mailing Address:
Signature
Telephone
SECTIO `3-+ESTIMATED CONSTRUCTION.COSTS-
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)-Building=Permit Fee
2. Electrical (b)-Estimated"Total Cost-of`
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=0 +2+3+4+5) Check Number �a
—This Section For'Official Use Only
.Daf
Building Permit Number Isste.
Signature:
Building Commissioner/inspector of Buildings Date
149 OAK ST BP-2007-0662
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map.-Block: 17A-253 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
Pemvt# BP-2007-0662
Project# JS-2007-000996
Est. Cost: $3320.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sq. ft.): 16291.44 Owner: BOYLE ALFRED H&CATHERINE V
Zoning: URB Applicant: HOME DEPOT AT HOME SERVICES
AT. 149 OAK ST
Applicant Address: Phone: Insurance:
345 GREENWOOD ST UNIT 1 (508) 341-9401
Workers Compensation
WORCESTERMA01607 ISSUED ON:1212012006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 5 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 Signature:
FeeType: Date Paid: Amount:
Building 12/20/2006 0:00:00 $25.0016523
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo