24C-172 City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, 1 acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work:
The debris will be transported by: 4 S f r
g z'VO k7 c 's
The debris will be received by: 7 S- 3ur� �t ALL '� , v✓ v d
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
JOB NAME/NO. JOB LOCATION
1 e lI1SLSh S'/2S�'II sutalion as a oacKe for work to be performed and materials to be used:
2. Vinyl side house ONLY using Mastic Carvedwood D4"-Victorian Gray vinyl siding,Lifetime Warranty.
3. Install 6"White Tradtional corner posts.
4. J-Blocks for all light fixtures,faucets,&dryer vents.
5. No gable vents.
6. Wrap all facia(trim)in white aluminum coil.
7. Wrap all windows&doors in white aluminum coil,Anderson Bend.
8. Use white center-vent soffit under all overhangs.
9. Install all new white seamless gutters&downspouts.
10. Remove&re-install eleven pair of shutters.
11. Strip house&dispose of waste by truck or dumpster.
13. Install Two Simonton 2Lite sliding vinyl replacement windows,White,LowE glass,Full screens,cut hole,frame&inside trim.
14. Strip roofs on HOUSE&GARAGE to deck, dispose of waste&install Certainteed Granite Gray Lifetime Architectural shingles.
15. Install 151b.synthetic paper,ice&water barrier,new white drip edge&rake edge,a ridge vent&pipe vent boots.
r
WORK SCHEDULE
Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein writing.Contractor will begin the work on or I
about 8 months from date of signing.Barring delay caused by circumstances beyond Contractor's control,the work will be completed within 1 year from date of signing. The Owner hereby i
acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this Agreement.
WARRANTY
M The Contractor warrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of one year following completion and shall comply with the
& requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,his subcontractors,employees or agents,is uncovered rrlih!n
b one year after completion of any job.including clean up.the Contracior shall,at his own expense.forthvpith remedy,repair.correct,replace,or cause to be remedied.repaired.or replaced, E
- �f-�� � ., .. �.,_ .�n , 4�� U _ ,a _ u .. - .,�:! � -o:;al or_state!rs!ec�'m. ......��.— �...�.......�.
17e sir orltOS hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
Twenty-two thousand six hundred and thirty-six dollars and 00/100. 22636.00
dollars
Payment to be made as follo%vs:A finance charge of 1 V2 -per month (1H%per annum),,gill be charged on unpaid'balances.
In additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency, the owner herein shall be responsible `or
a
reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here.
33 8078.00
($ } upon signing Contract; John W.�tfaiz/Finyl Vinyi Inc
4Z M arriwll of matPrialc Flame of Con actor/Designated Registrant
711AQ
% (� }
33 Grattan Street
upon completion of
/ Street Address
<_ } upon completion Chicopee, rMA 01020
City,state
ka4 t ° t � �' e.Yshaii be made forewith upon (413) 592-2376 65-121510
completion of work under this contract. Phone � Federal ID No
John'Vu.Vt alz or Timothy 1.Gialz or Te f r M
r L. e s s i e r
Notice: No agreement for home improvement contracting work shall require a ----
Name of s- person Name of gs�gson Nome of Sa esperson
doom payment(advance deposit)of more than one-third of the total contract price t l
or the total amount of all deposits or payments which the contractor must make,in
k Authorized S!gfature
advance,to order and/or otherwise obtain delivery of special order materials and
equipment,whichever amount is greater. Note Th!s props l„!,,a hdrawr by us if t ac_�pte Acceptance o4 Proposal I have read both sides of this document and accept the prices, specifications 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 made as outlined above.
You, the Buyer, may cancel adus trans action at, any Urne pricir to rfni inight ooze third business day after he r
date of this trginsaction. Cancellation must be stone in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SAC P._
tt
Signature —tom `� Aate P f'' I Signatures t• i.. °"'" Date �e
IMPORTANT INFORMATION ON BACK
72- Page No. of Pages
- - -
t
i PROPOSAL
33 Grattan Street All home improvement contractors and subcontractors�
CHICOPEE, IVl{`, 01020 engaged in home improvernent contracting, unless
(41 3) 592-2376 specifically exempt from registration by Provisions of
Chapter 142A of the general laws, must be registered with
Submitted Barbara Arrighi&Marla Allisan the Commonwealth of Massachusetts. Inquiries about
TO registration and status should be made to the Director,
93 Franklin St. Dome Improvement Contract Registration,One Ashburton
Place,Room 1301,Boston,MA 02108 (617)727-8598
Northampton,MA 01060 Owners who secure their own construction related
permits or deal with unregistered contractors will
be excluded from the Guaranty fund Provision of
MGL c. 142A.
PHONE DATE REGISTRATION NO. - 112653 CT-REG. NO. 0051540
413-237-9649 I 9-15-15 LICENSE NO. -060612
JOB NAME/NO. JOB LOCATION
e ere ecif tions and tim tes for work to be performed and materials to be used:
n'su a ton as a baMer.
2. Vinyl side house ONLY using Mastic Carvedwood D4"-Victorian Gray vinyl siding,Lifetime Warranty.
3. Install 6"White Tradtional comer posts.
4. J-Blocks for all light fixtures,faucets,&dryer vents.
5. No gable vents.
6. Wrap all facia(trim)in white aluminum coil.
7. Wrap all windows&doors in white aluminum coil,Anderson Bend.
8. Use white center-vent soffit under all overhangs.
9. Install all new white seamless gutters&downspouts.
10. Remove&re-install eleven pair of shutters.
11. Strip house&dispose of waste by truck or dumpster.
13. Install Two Simonton 2Lite sliding vinyl replacement windows,White,LowE glass,Full screens,cut hole,frame&inside trim.
14. Strip roofs on HOUSE&GARAGE to deck, dispose of waste&install Certainteed Granite Gray Lifetime Architectural shingles.
15. Install 151b.synthetic paper,ice&water barrier,new white drip edge&rake edge,a ridge vent&pipe vent boots.
WORK SCHEDULE
I Contractor will not begin the work or order the materials before the third day following the signing of this Agreement.unless specified herein writing.Contractor will begin the work on or
about 8 months from date of signing.Barring delay caused by circumstances beyond Contractor's control,the work will be completed within 1 year from date of signing. The Owner hereby
acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this Agreement.
WARRANTY
The Contractor v arrants that the work furnished hereunder shall be free from defects in material and workmanship for a period of one year following completion and shall comply with the
requi,,ements of this Agreement.in the event any defect in workmanship or materials,or damage caused by the Contractor. his subcontractors.employees or agents is discovered Within
. - -onnoiz[loll of am•J�h i � r „_:r.t. ^-r :hci ..r.'s v Ord •:i;r ,� {, _ ,. ._ _ .�.i_�' c,� .__�.
� such damage or�u..h defA in materials or T,:Or manta. o. e Tory eorrcj_i.arrarifies sTiatt sure:%e e CaTOf siaTein,sPectrorr --- - '�
f%' ti ge hereby to furnish material and labor — complete in accordance with above specifications, for the sum or-
Twenty-two thousand six hundred and thirty-six dollars and 00/100. 22636.00
I;
_ dollars (S 1.
r'ayrnent to be made as foilovis:A finance charge of 111201.per month (18°iq per annum)swill be charged on unpaid balances.
if
In additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency. the owner herein shall be responsible for '
reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here.
A.
33 0 8078.00
john IM,Wain;Finyl Vinyl lne
$ ) upon signing Contract;
2� 711A4nn arrivalnfmatarialc HameolContrac!crDesignatedRe6strant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of In vestigations
600 Washington Street
J . Boston,Mass 02111
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors!Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business iorganization/Individual): `yt V,- .i L- >
Address: C—rq rf ct vL s 1'
City/State/Zip: t h c- c) ,e .c 1y14 U i Phone#: 4 1 3 L c Ll ` c> .A
Are you an employer?Check the appropriate Pox: Type of project(required):
1. ❑ I am an employer with 4.)§ I am a general contractor and I 6.❑New construction
employees(full and/or part time).* have hired the sub-contractors 7.❑Remodeling
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9.❑Building addition
[No workers'comp.insurance comp.insurance.$
required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself [No workers'comp. right of exemption perm MGL
insurance required]t c. 152,§ 1(4),and we have no 12.❑Roof repairs
employees.[no workers' 13. Pf Other )Ve1,J
comp.insurance required.] LJ - r s e er L
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContactors that check this box must attach an additional sheet showing the name of the subcontractors 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 thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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 Section 25a of MGL 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
$250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verification.
I do herby certify under the ains and penalties ofperjury that the information provided above is true and correct.
Si nature: ''!v Date: 2,z t S
Print Name• `� kt,Vt. v,C U-) 'r ¢ ` Phone
Official use only Do not write in this area to be completed by city or town official
City or Town: Permit/license#•
Issuing Authority(circle one):
1.Board of Beath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Constructioon-Supervisor: 1 Not Applicable ❑
Name of License Holder: �,r1h✓� w L V�2 Z- -, 66 1 °>-
License Number
Address Expiration Date
Signa Telephone
9.Registered Home Improvement Contractor. Not Applicable ❑
6'n . l I/,`'-L !;� l � -t //-�A (1 5- -3
Company NaFfie Registration Number
Address E,'0,A0 Expiration Date
Telephone-/o yi,) .73"t
SECTION 10-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....... O,-"' No...... ❑
11. - Home Owner Exemption
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 buildine 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 Wir1dows Alteration(s) ❑ Roofing I &�i �
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[01-"'Other[a
Brief Description of Proposed
Work: S,- A :---, r, k)"-h d J L-1 J O
IF
Alteration of existing bedroom Yes t-,-'No Adding new bedroom Yes '-�No
Attached Narrative Renovating unfinished basement Yes L.--No
Plans Attached Roll -Sheet
sa. If New house and or addition to existing housing, complete the following:
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
1 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
1 -S (J C." Z- 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 Na?
Signat of Owner/AgeM Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zonin
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 Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds? AJ/
NO 0 DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q ��'� 4
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0
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 Q NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
n City of Northampton Status of Permit:
L,J Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
SEP 2 5 2015 Room 100 Water/Well Availability
rthampton, MA 01060 Two Sets of Structural Plans
Electric,Plumbing&Gag -587-1240 Fax 413-587-1272 PlottSite Plans
Northam ton,MA 1080 Other Specify
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 be completed by office
ct 2 1�� 4�i '1 �•�I <S + Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: ^ w—" L r �q (
y� gr,ha+-h Ai°r, �Ctt tCc! ec{ /'� (l,-,S* it �(° / ryan �( I•'Pt .S t- /Vor—f�lcL -Ief011 fk4
Name(Pri Current Mailing Address: r, �./ D G C'
'I/J .237
Telephone
Signat
2.2 A thorized Agent:
I o(, -t �-j �-J ci, 2 Co �1�E��i y / C.'� "e J l� 4
Name(Print) Current Mailing Address: V
`Z j,- �l t� ' P CI_
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building -n i-1 4 n (a)Building Permit Fee
2. Electrical Q (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
Building Permit Number: IIsssued:
Signature:
Building Commissioner/Inspector of Buildings Date
93 FRANKLIN ST BP-2016-0413
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C- 172 CITY OF NORTHAMPTON
Lot:-00 L PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: replacement windows/siding BUILDING PERMIT
Permit# BP-2016-0413
Project# JS-2016-000646
Est.Cost: $22636.00
Fee: $140.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN WALZ 060612
Lot Size(sq. ft.): 10541.52 Owner: ALLISAN MARLA RUTH&BARBARA A ARRIGHI
Zoning: URB(100)/ Applicant: JOHN WALZ
AT: 93 FRANKLIN ST
Applicant Address: Phone: Insurance:
66 Bray Street (413)592-2376 Workers Compensation
CHICOPEEMA01020 ISSUED ON:912512015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING, STRIP & SHINGLE
ROOF & 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 9/25/2015 0:00:00 $140.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner