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17D-049 (8) 88 STRAW AVE BP-2020-0103 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17D-049 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:replacement windows/siding BUILDING PERMIT Permit# BP-2020-0103 Project# JS-2020-000177 Est.Cost:$40000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STEPHEN D ROSS 079160 Lot Size(sg. ft.): 8581.32 Owner: BATTLES LAURA Zoning:URB(100) Applicant: STEPHEN D ROSS AT. 88 STRAW AVE Applicant Address: Phone: Insurance: 36 SERVICE CENTER RD (413)584-1224 () WC NORTHAMPTON MAO 1060 ISSUED ON.7/29/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:S I D I NG & 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 7/29/2019 0:00:00 $100.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner C 6( ()/CC C4,e a,�, Department use only �, zttr City of North —�� I �Q rr�t �, Statu of Permit: Building D part w t-' urb ut/Driveway Permit 212 Mall Str et ewer eptic Availability , I y ,4 Room 100 J J X019 ater/ ell Availability _ � • '` Northampton, MA 1060 T o Se of Structural Plans �:..- phone 413-587-1240 ax 13-587- 7-2- iPtol/SitelPlans G cun nrFa1-o Oth�Y�pecify APPLICATION TO CONSTRUCT, ALTER,-R A R, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office RA �cv /� Map_ C:) Lot dUnit Zone Overlay District Elm St. District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: A, AL z Name(Pr' t) C nt M 'ling Addrels: lloz74 Signature a ephone (, 2.2 Authorized Agent: ", er' t) Current Mailing Address: ign ture Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estim ed Cost(Dollars)to be Official Use Only compWed by permit applicant 1. Building tT (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing _ J Building Permit Fee 4. Mechanical (HVAC) 16) 5. Fire Protection L 6. Total = 0 + 2+3 +4 +5) Q !7. Check Number111 4f 6y, This Section For Official Use Only Building Permit Number: Date Issued: Signature: L�ZZ_ 7 ZG -1-7612 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Z41 .4, 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: R: Rear Building Height Bldg. Square Foota % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location A. Has a Spec' t Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 0 YES Q IF YES, date issued: IF YES: Was th,e,permit recorded at the Registry of Deeds? NO & DONT KNOW 0 YES Q IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading,exation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 8-CONSTRUC71ON SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: c_ Ras S /93 M/ D License Number (O Address Q/Q�j a Expiration Date yi3•spy--/�.� Signature Telephone Not Applicable ❑ �S��hu� „Ross G �� C' �rne�orSD Company ame ,P 407 Registration�jumbeeh'^ Address (mac/tCGT� T�fit� 0�0(/l� �'J •dfi�/ Expiration Date Telephonel/3* -1 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...... ❑ 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.C 1IR 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 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 Windows Alteration(s) Roofing ❑ Or Doors M. Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [01-1" Other[p] Brief Description of Propose '� J Work: i < ►^^rte �, t L�, Alteration of existing bedroom Yes No Adding new bedroom Yes �.r No Attached Narrative Renovating unfinished basement Yes 1,, No Plans Attached Roll -Sheet 6a. 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 I, C u-pct cel as Owner of the subject property hereby au horize to act on alf, in all matt s lati rk authorize this building permit applicati -Z << l Signatur f O er Date I, 1 .� _ fE S as Owner/Authorized Agent her by 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. Pri"NaA(eSigner/Agent Date The Commonwealth of Massachusetts x Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia :Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): �1 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.Vlam employer with employees(full and/or part-time).* 7. ❑New construction 2. sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.r_1I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.F-1I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'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. :Contractors 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 MGL c. 152, §25A is a criminal violation punishable by 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.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 t e p ' s and penalties of perjury that the information provided a ve is tr and correct. Signature: Date: -7 Z `� Phone#: Ojficial 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#: City of Northampton Massachusetts -A r I- DEPARTMENT OF BUILDING INSPECTIONS �r { 212 Main Street *Municipal Building v Northampton, MA 01060 k� ! tati Debris 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: (PI ase print nam and location of cility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) 7APcIllf ign re Permit Applicant or O ner Dafe If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. City of Northampton f ' Massachusetts DEPARTMENT OF BUILDING INSPECTIONSv 212 Main Street • Municipal Building Northampton, MA 01060 rsMW ,�11+3� AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity mus be registered a G'' Type of Work: 'r li+� v�-�cnt��' Est. Cos Address of Work: k �'-� ,�o,�,J �y� �,�-H-cn �jft p/D(�-T, Date of Permit Application: Z t' 1 hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: 71-2 y 1 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY) 06/21,2019 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED.subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 AIC No Ext): A/C.No): 8 North King Street E-MAIL bgynkiewicz@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: West American/Liberty 44393 INSURED INSURER B: AIM 33758 Stephen ROSS INSURER C: Attn:Kim Clairemont INSURER 0: 36 Service Center Road INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 3/1/20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR ADDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDlYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 AMA ENT 100,000 CLAIMS-MADE ® OCCUR PREMISES Ea occurrence S MED EXP lAnv one person) S 15,000 A BKW58371793 03/01/2019 03/01/2020 PERSONAL BADV INJURY S 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s 2,000,000 POLICY ® PECROT F7 LOC PRODUCTS-COMP/OPAGG $ 2000000 J OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident ANYAUTO BODILY INJURY(Per person) s OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY Per accitlent S UMBRELLA LAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION S v S WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT S 500,000 B OFFI CERIMEMBER EXCLUDED7 F7yN/A WMZ80080065462019A 07/01/2019 07/01/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS Delow E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,.may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN "For Insurance Info Only" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 7/26/2019 Energy Data for Marvin Windows and Doors I Marvin MARVIN Q ENERGY DATA This tool provides some of the most common options on windows and doors and related NFRC certified values. Energy performance data for select combinations of options is available in table format on each product page. To access those tables, select the individual product of interest and scroll down to the Professional Resources section. This tool is a guide only and does not reflect variations resulting from features and options not included in the tool. For more information about the energy efficiency of specific products and options, please contact your local Marvin sales representative (/?page=find-a- dealer). The National Fenestration Rating Council (NFRC) has developed and operates a uniform national rating system for the energy performance of fenestration products, including windows and doors. NFRC does not recommend product and does not warrant the suitability of product for any specific use. For additional information regarding this rating system, see www.nfrc.org/WindowRatlnqa_(http://www.nfrc.org/WindowRatinga). See Energy Efficient Windows and Doors (https://www.marvin.com/Energy-Efficiency,) for further information on this topic. ------ Product Select ------ Collections and Product Lines: Signature Ultimate Door or Window: Windows • Product: Signature Ultimate Double Hung Insert G2 • ------ Available Options ------ Surface: lClad, Wood Species: Pine or EQ v https://www3.marvin.com/support/energy-data 1/4 7/26/2019 Energy Data for Marvin Windows and Doors Marvin Impact Zone: Fo �_. MARVIN Q Divider: € SDLS < 1 " • Spacer: !Stainless Steel Glass: Insulated Glass Coating: Low E2 • Gas Fill: Argon Blinds / Screens: !No Blinds' Combination: :False Reset Option Filters Energy Factor Value (range) U Factor: 0.30 Solar Heat Gain (SHGC): 0.27 Visual Transmittance (VT): 0.46 Condensation Resistance (CR): 56 Energy Star: NC Energy Star Canada: U Factor Canada: 1 .70 CPD Number(s): MAR-N-73-02740-00001 (http://search.nfrc.org/search/cpii/cpd search detail.aspx? ,pd n u m=MAR-N-73-02740-00001) Marvin experts are experienced in working with architects, builders and homeowners to ensure your vision becomes a reality. https://www3.marvin.com/supporUenergy-data 2/4 7/26/2019 Energy Data for Marvin Windows and Doors I Marvin FIND A DEALER (/FIND-A-DEALER) MARVIN Q V) MAR VIN Our Collections (https://www.marvin.com/products/collections) All Windows (https://www.marvin.com/products/windows) All Doors(https://www.marvin.com/products/doors) All Design Options (https://www.marvin.com/products/design-options) SOLUTIONS Coastal (https://www.marvin.com/coastal) Contemporary(https://www.marvin.com/contemporary) Historic Design (https://www.marvin.com/historic-design) Replacement(https://www.marvin.com/replacement) INSPIRATION Photo Gallery(https://www.marvin.com/photo-gallery) Project Gallery(https://www.marvin.com/project-gallery) Blog (https://blog.marvin.com/) WHY MARVIN Our Story(https://www.marvin.com/our-story) In The News (https://www.marvin.com/news) Energy Efficiency(https://www.marvin.com/energy-efficiency) SUPPORT Care and Maintenance(https://www.marvin.com/products/care-and-maintenance) Contact Us(https://www.marvin.com/contact-us) Glossary of Terms (/support/glossary) Owner's Manuals (/support/owners-manual) Warranty Information (/support/warranty) PROFESSIONALS Drawing and 3D Models (/tools-and-documents?resType=drawing) AIA Courses(/professionals/architect/aia) Energy Data (/support/energy-data) Tours and Training (/our-story/visitor-center) https://www3.marvin.com/support/energy-data 3/4 7/26/2019 Energy Data for Marvin Windows and Doors I Marvin Tools and Documents(/tools-and-documents) MARVIN Q COMPANY (/) Our Story(https://www.marvin.com/our-story) In the News(https://www.marvin.com/news) Careers(/careers) International (/international) TOOLS AND DOCUMENTS (/TOOLS-AND-DOCUMENTS) FIND A DEALER (/FIND-A-DEALER) REQUEST A BROCHURE (/INFORMATION/REQUEST-INFORMATION) EMAIL SIGN UP (HTTP://GO.MARVIN.COM/MARVIN-EMAIL-SIGN-UP) z.c dTbjaa%� inbrand/) Privacy Statement(https://www.marvin.com/legal/privacy) Terms of Use(https://www.marvin.com/legal/terms-of-use) California Users(https://www.marvin.com/legal/california-users) ©2019 Marvin Windows and Doors https://www3.marvin.com/supporUenergy-data 4/4