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17C-202 (3) /"' :nargYlitnran—rncan.gc.ca FL- fig•,.,-'-• _ c���. t -81i ,et'lovn 11b_1 z�'m Raal lan!clich• SAVE!or IVIUrC releren- 3u otfef SSi�3 ' b,i un 0p' 'nom ,! f n1U„t 117�:i�lad is;_, -1 Fram :' �=��-�„:.;i,�•:.R •�•�� Rio=iil�— .. - .. A.gaa rill gill° in Alf 5pB-.. j ENERGY iF 0RNIA�?C� FkA S 8,30 1 .710 C 0.18 i itt-Pl I DDIT10 NA! Z,RR M ANC R ;�:`'�� CnuL alnt a;v:tct hll.`.tia r.U•i tSSr•'•7 tr n:aa7 KIfi:Dn-i[v rt Sal laixr:n':7cp +1.Js ¢717;t ril:•t pt�: =t XFLG rain11 trt/.lr ant[ br r L•a[ MI t(tet::�n�t'J t'�Stc.t �.[ LJtt rrdaK CT r+t yrolc:t uC7act rti vt.�tt h7 ullUlt�'ct ti. )n•dec77r1.^t*�t�l: :,... ^-GI1 rC7V ti:t:Rl 7 tL•.Y L•R t.)1 lt:lt jtl[VLI jtfcnn+++xr 7nln t:!•,a1t✓i, 1 N.rtU cr :ou rCt Y,-�' •• t �., xrl 1.�.Z.C, JJf Ldlltnifon F•culra nt Rlt - � OP) P} (�5i�.. _ � Ili:cl's l�'.'1.17:tlYKv:^11:'1:.1^lT • ! J f711 n—.CS-7 1G�'J it Lill till I Dec 1915 07:57a p1 HOME IMPROVEMENT CONTRACT PLEASE READ THUS �� .,^� Sold,Furnished and Installed by: Bradth Name:New England Date: THD At-Home Services,Inc. d1b/a The Home Depot At-Home Services Branch plumber:31 906 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75-2698450;ME Lie ft C 02439:Rl Cont.Lie#1642' (J� Cr I-ic R HIC.0565522;MA Home Improvement Contractor Reg,P 126893 Installation address: 'J � "" C—'+ F1 CyAZUQ(2Q— 114 A nIS.drj?. — City State Zip Purchaser(s): (� { WnrkPhone: Home Phone; Cell Phone: L Home Address; (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): I DO NOT wish to receive any marketing emails from The Home Depot Proieet Inform-ation: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and TND At-Home Services,Inc.("The Home Depot")agrees to furnish.deliver and arrange for the installation(`Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,alon-,with any applicable State Supplement and Payment Summary attached hereto and any Chnnge Orders(collectively_ "Contract"): Job#; om .a tar rc .7 pets: Spec Sheets)0: Project Amount {�n ❑RouOng ClSidingW Windows LJ Insulation i [� u�✓ CGutters/Covers 2IS3 ntry Dcorx ❑ Roofing F3Sidin& El Windows ❑Insulation [)Gutters!covers ❑Entry Doors ❑ Roofing ElSiding D Windows Insulation I ❑Gatters I Covers ❑Entry Doors© _ $ 1) Roofing Siding Windows []lnsuktt on $ [3Gutters/Coves ❑Entry Door ❑ Minimum 25%Deposit of Contract Amumadue upon execution of this conttvct. -total Contract Amount ry Maine Purchasers may not deposit more than one-third of the Contract Amount (o Customer agrees that, immediately upon completion of the work for each Product.Cvstomcr will elcecutc a Completion Certilicate (one for each Product as defined by an individual Spec Sheet) and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Products)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos of lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Pavinent Summary: The Payment Summary# �1:] 4 "included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable) NOTICE TO CUSTOMER You are entitled to a completely filled-in copy or the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Castrimer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE. WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH.kNIOUNTS. Acceptance and Authorization: Customer agrees zinc' understands thw ':his A,r:emcnt is the entire agrct!wem be4WCCn Custotrtcr and The Hcmc Depot with regard to the Products and installation services itnd supersedes nil prior discussions and:+gtticmcnts,either oral or written,relating in,aid Products and Installation.This Agreement cannot be assi n or amended except by a writing signed by Customer and The home Depot.Customer uc nowledgex and agrees that Customer as td.understands,voluntar:iy accepts the terms of and has received L copy of this Agreement, ep d by: — Submitted by: X ---- X i AA Ctrs met' ig azure Date Sales,Consultant' Si g .tore Date X Telephone No. Ct wi tier's Siennture Date Saies Consultant License No, CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DEPOT BY RMID MIDNIGHT WRITTEN ON TNT. THIRD BUSINESS �` l./ �/ (�� ✓(/" DAY AFTER SIGNI.NG THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. -•..�r. c.uc CT iTM nH THE R EVEILSE SIDE AND ARE PART O11 THIS CONTRACT City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I 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: debris will be received by: The Building permit number: Name of Permit Applicant Date Signature of Permit Applicant Lzx The Commat9eafth o,f Massachmsem Depaptmene o,f'IndushW Accidents 01rce oflayesfigadons 600 WasknWon Street Boston,MA 02111 www.massgovldia Workers' Compensation Ins»mee Affidavit: BuddergContractors/Electdeians/Plumbers Ann icant Information Piesse Print Lem*bly Name(Business/Organization/Individual): o)",e- Address: 509 6,0 5-40 city/State/zip: S v V. o/SYS' Phone Are you an employer?Check the appropriate box: Type of project(required): 1.[] I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.i 7. F1 Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. 0 Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all wort: right of exemption per 1AGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑ repairs insurance required.]I employees.[No workers' 13. Other 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. TContractors that check this box must attached an additional sheet showing the name of the sub-oaalr8ctors and their workers'comp.policy infomnation. lain an eesaplayer Herat&pro'v1d&g workers'coiWensadan ha urance for my employes Below Is tine pelky aatd fob site kfernwdom Insurance Company Name: Policy#or Self-ins.Lie.#: 1773 I V ? _3 Expiration Date: 3 Job Site Address:_ ✓ 9i ( 1 / I City/State/Zip: Attach a copy of the workers'compensation pol'ecy 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 here rer�lfy ut>rdee pates and of that tine mfomwim provided above h,true and carreet l_ Si ature: _ Date: Phone#: 5 ' Oflkhd use only. Do not write in this area,to be conpleted by city or town officlat City or Town: PermittLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachus tts V. * F,e DEPARTMENT OF BUILDIN INSPECTIONS 212 Main Street • Muni Building Northampton, MA 01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 1, understand the above. f (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 i I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations x 600 Washington Street Boston,MA 02111 ="l www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informiation Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 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 g, ❑Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑Building addition comp.[No workers' comp. insurance required.] 5. ❑ We area 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 per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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: 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 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: 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 Health 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 Construction Supervisor: Not AApplicabl £ Name of License Holder: �7 f �rs o J L a121 License Number . ��� ✓ Address Expiration Date Signature Telephone > 9 :Regisfered'_Home Im rovem nt Contractor:: ,._.. O___ _• Not Applicable £ Company Namejj Q Registration Numb r ion Date f j /R _� Telephone 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.... No...... £ 'l l - Hone Qyvner Egempt>on 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. CNM 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. i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement W' ws Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[0] Other[p] Brief Description of Proposed)r Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa,if New house.and'bra I, ion:to extsflng f ousmg'corripfete fhe followlnC 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 as Owner of the subject property hereby authorize to act o��If, in all to work authorized by this building permit application Signature of Owner Date I, lil Jog- 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. t Signed under pal and penalties of per' Print Name Signature o ner/Agent Date r s 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:€-! L:F=1 RLLJ Rear ---5 '� Building Height Bldg.Square Footage % 1 �� 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 Q DONT KNOW 0 YES Q IF YES, date issued: �� IF YES: Was the permit recorded at the Registry of Deeds? NO Q DO N7 KNOW Q YES Q IF YES: enter Book j Page and/or Document#� B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained , Date Issued: - C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q IF YES, describe size, type and location: T 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 ex IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i � 1 t • a ""€7e arfinehf use onlyn ki ( i US 's ty of Northampton hampton rtJAN L 7 r Ll ' iI treuq Permtt ilding Department uDr a r- 212 Main Street Sevrer/SepCc q�arfa61lrty oO 4�latrllYfel�Avarlb OPi OF BUILDING INSPET e v 1ir 5 Kiff I aly ' I'NORTHAMPiON MAOt ROOM 100 L-il T�ii A;f S{L.-Y' 1 5 tr ]Lf i iII�IFI� 1 Northampton, MA 01060 TwaySetsos#rlrctr,ral Plaris 5i1 if '•�'=:g.. _;:_�_.,.__:_�:.a_r:.;.--:IEv_�h,!�_-e_r '-!r; �y_.z:�-y. r.�:+��_F:.�;'^r::�_. v'=f_�i,` ' �_*y phone 413-587-1240 Fax 413-587-1272 I TOR. r f Other,S;,.;ec,. F I ��.�_�..-__-:.r-IJ�--—��,.�!�„� .•,er._! �' ri APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION. - T h y_. _ o: le ed b o IS�sectrorr_fo e_c. mp....:__..x_;-, 1.1 Property Address. - - - '•°�- � - --= - tit q LAC, rr Lot , r'” UBIt f 1 :_,..:_v�--f v�:i!-y�.,'7:;:.ev_,.+r2iv:�;v:,:v-m.-=�i._,�,_'�r-r—a_u.-_:ILe!�"',=:I?^'fi�=ova- Zone _ f Overlay Dlsfrlct :_:.- EIm�St:,�Disttict;-_,_::,-_r;=':�r_�.::_�:-_-::-=*'GB_�Distnef�=.�=-a'_. SECTION 2.-PROPERTY OWNERSHIP/AUTHORIZED AGENT: 2.1 Owner of Record:a. Name(Print) /? �--. Current Mailing Address: Telephone Signature 2.2 Aut rized A ent: j�, e. Name(Pr' Current Mailing Address: �/v ure Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use-Only completed by ermit applicant 1. Building 1 ,_ ) (a) Building Permit Fee 2. Electrical / (� (b) Estimated Totat Cost of Construction from(d) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=0 +2+3+4+5) Check Number This Section Far Official Use'Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 3 BRATTON CT BP-2016-0952 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-202 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2016-0952 Project# JS-2016-001612 Est. Cost: $1816.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 67121 Lot Size(sq.ft.): 1960.20 Owner: ROSENSHEIN JULIE B Zoning GB(100)/ Applicant: ROSENSHEIN JULIE B AT. 3 BRATTON CT Applicant Address: Phone: Insurance: 3 BRATTON CT Workers Compensation FLORENCEMA01062 ISSUED ON:112712016 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL 4 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 1/27/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner