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23D-131 (8) BP-2008-0180 GIS#: COMMONWEALTH OF MASSACHUSETTS 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 Permit# BP-2008-0180 Project# JS-2008-000280 Est.Cost: $11160.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: HOME DEPOT AT HOME SERVICES 126893 Lot Size(sq.ft.): 15899.40 Owner: HARVEY MICHAEL R&KATHLEEN M Zoning:URB Applicant: HOME DEPOT AT HOME SERVICES AT: 83 HINCKLEY ST Applicant Address: Phone: Insurance: 345 GREENWOOD ST UNIT 1 (508) 341-9401 Workers Compensation WORCESTERMA01607 ISSUED ON:8/22/2007 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 Occupancy Signature: FeeType: Date Paid: Amount: Building 8/22/2007 0:00:00 $25.0019585 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo Qepaitent use ority ���ity of Northampton Status of Perms a 1�3udlding Department Cuthc t/DnvewayrPerrfut K (� 1'+ 212 Main Street SewerfSept�cAvaitabrtrt Noe- 100 Water/Well Avaifabr[ity G 2 2Qc1 Northampton, MA 01060 TwoSetsofStrucfurarPlans PV phone 413-587-140 Fax 413-587-1272 PloffSite Plans ��S �OtherSpecrfy AP(�LICATION TQ7.cONST T,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 Map; Lot Unit U� .1-1' Zone Overlay District Y��� ,,""1 EImSt..Districf CB District ,: SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: r v4.111 �O �S `3aj }In1�(o 1,t col ' �'I�, 4lo� Name(Print) kr, Current Mailing Addr3— 5• 1 Telephone Signature /,,�., 2.2 Authorized fil ' : I Io(4 ©� ',9 -c�^--r �D 1 wfJ' ' Name(Pri gr ,—/iii-- Curr ent Mailing Address: `v �j�' Signatur _ Telephone SECTION 3///-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building �� (a)Building Perm it Fee 2. Electrical (b)rEstimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) � ' �j° Check Number I�� (( This Section For Official'Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 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 - L:- - R:. Rear ' Building Height Bldg.Square Footage % . Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: I (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? -- NO 0 DON'T KNOW 0 YES ® — IF YES, date issued:: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page. and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q 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: ! - C. Do any signs exist on the property? YES 0 NO O 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 O 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement�(Ilpdows Alteration(s) Ei Roofing n Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks =J Siding[O] Other[DI Work: �6j�G, t I( Bnef Description of Pr �J � 02pkLQY4O01--I.Oldra,c2 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes 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. fluodplain 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 .11 I, Cbt5114f( ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit appf atio . /flv-7 Signature of Owner Date ---- -----p _ I, . C1( orie ,as Owner/Authorized Agent hereby declare that the statemen s and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed • •-r the pains nd penalties of perjury. tl \____ . . Signatur of Owner, en Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder: License Number Address Expiration Date Signature Telephone 9.-Registered Home.lin rovement Contractor:'"a. -:. . _.. .._ .•_.. Not Applicable 0 ,- RD11115-7-DeeDi 1p�L - Company Name Registration Number LI 5— 6;reen (inDJ`If c3, ‘3 lit Addrre ry f ' ' Expiration Date Wi!1` 1` N� [I l � Teieph n�(1- 5-.7 G'-J3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the buildi permit. Signed Affidavit Attached Yes No 0 11.:--Home Owner.Exen ption 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 The Commonwealth of Massachusetts Department of Industrial Accidents _ h_:? Office of Investigations '—. 600 Washington Street Boston, MA 02111 ,...„ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADobcant Information Please Print Legibly Name (Business/Organization/Individual): r-1-6 ,b D �� • ir7 Address: .� "�C E.;ffid / City/State/Zip: VOceoLe HA 01 Phone.#: Are you employer? Check the appropriate box: Type of project(required): 1. am a employer with (Q3 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. 0 Demolition workingfor me in anycapacity. employees and have workers' $ 9. ❑Building addition [No workers' comp.insurance comp. insurance. required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their i l.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roo epairs insurance required.]t c. 152, §1(4),and we have no ., � ��c-� employees. [No workers' 13. ther t-i/ J comp.insurance required.] ------"Any applicant that checks box#1 must also nll out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicatine 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: Oe 13 F I a- C(:- Policy#or Self-ins. Lic.#: OCOd 100 Expiration Date: `l /' Q Job Site Address: .6 `i{{ap q� {gy City/State/Zip: ( p HA DIOG� Attach a copy of the workers' compensatio 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 iuiprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investications of the D A for insurance co raee verification. I do hereby certi,, and' a pal s a enal ' s of perjury that the information provided above is tie a d correct. 7 'Z PI 0 Suture: ,-- Date: Phone#: 4)1 3J ('3 ,t li Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �O¢T t1A'f p1. (City ofiartflaniptart r, w � Y �$ _4i 3.1� dh [ 3 I-J . c.t• 1�.;53+r DEPARTMENT OF BUILDING INSPECTIONS i 8��i.= te INSPECTOR 212 Main Street • Municipal Building ' a�4 Northampton, MA 01060 . HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sup:: Hsor. 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 peiiuits 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 . � .. .,.,i«.- r r..rkt+,.,ee,�,.n-aa.:.s..,r,... ... .i•• .. r�yn,�9t3t Branch Name: Dot= THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services � 345A Greenwood Street,Worcester,MA 01607 Branch Number; ch N ; '2„(�d Job#: /; �` 44 Toll Free(800)657-5182; Fax:508-756-2859 Paded1D a 75-2698460 ME Lie H C a2439 Rt Coat.Lied 16427 Cr Lie a SUED; MA Roue Improvement Coehnotor Rea.#126850 Installation Address: fys .0 •• -c .Q,, fY l.F} p (,?0,4 . I Zip ) IA) Purdsser(s): lie.t e Rao Ms/Yri Work Phew: HoraePiwe: KA-ThLEEN VNON Lk?4) 't-31 ( ) .c. -453i ( ) ( ) Rome Address: (If different from Installation Address) City State Tap E-mail Address(to receive updates and promotions from"The Home Depot): Project Information: I/We/You("Purchaser'),the craters of the property located at the above installation address,offer to contract with THD At-Home Services;lnc. H e "►)to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#! ''0`k ) ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it want perform Hs obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not Included In the Spec Sheet or Contract DEPOSIT PAYMENT OPTIONS 1 (Subject to fund verification and/or credit approval.) CONTRACT AMOUNT S 1 ( (0 O t. Check",Cashiers Cheek or US Postal Service Money Order /}�� (Made payable to The home Depot). ?LESS DEPOSIT S 3 7 l•±t 2, Ctdic'Card••and/or other payment options..Circle One Below BALANCE DUE Visa MasterCard Discover America'Express ON COMPLETION S • 1ha HameDepat Homo larperw ti oars. The Hasoe Depot Cleft tMtalmum 25%of Contract Amount due upon II New Account ❑Esi tint Account •f •' exenttsa of this palr'd. Available Credit:t ..5 (HIL&ADCC ONLY) Indicate Payment Method For Ace*: �r Exp-Deter BALANCE DUE ON COMPLETION: �� Name as it appear&oo card: K �,. b s '•By my/our signature below,INde agree to allow Home Depot to (CO3 Jn) �'7 7 7 a j` / charge the above ref creditQ card for the deposit indicated. 'Whca youauthorize provide•cheek as payment.you author as either /(/ �l S"'/7—07 to use informative from your check to make a one-tine elettrouio Carttho ar'a Shgesture a Date ces fund transfer from your account ur to pros the payment as a - check trausetioe.When we use information from your cheek to HIL or}MCC Authorization Codes make en electronic fund transfer,finds may be withdrawn Dom your account es sum u the payment is received,sod you will not Deposit. Final Payment receive your check back. # 117 4.11 # I i'7 Purchaser agrees that,immediately upon completion of the work.Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. lrretire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read It You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual compiWon of the work to be performed under the contract. Yon may cancel this transaction any dine prior to midnight of the third business day after the date of this contract. Sec Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10%of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE'BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATIONS*- SUBMITTED BY: It Date: .>4-7 . G7 las ACCEPTED BY: X. lnlfQQ. Date: 8 —/7 D 7 Purchaser Date: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OR THIS CONTRACT 13-1-07 rev 4-2-07 C-SC White—Branch Fie Yellow—Customs( Perk—Sales Consulted S •d X1713 13C?13Sd1 dH W ALO :9 LOOZ BT 2nd