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10B-037 (3) BP-2023-1226 38 FRONT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 10B-037-001 CITY OF NORTHAMPTON Perm-it: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-1226 PERMISSION IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: WINDOW WORLD OF WESTERN Est. Cost: 6928 MASS INC 115719 Const.Class: Exp.Date: 04/30/2025 Use Group: Owner: CHANDRA HARTMAN Lot Size (sq.ft.) Zoning: URA Applicant: WINDOW WORLD OF WESTERN MASS Applicant Address Phone: Insurance: 641 DANIEL SHAYS HIGHWAY (413)485-7335 C5186654A BELCHERTOWN, MA 01007 ISSUED ON: 09/07/2023 TO PERFORM THE FOLLOWING WORK: 6 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: . ' YYJJ51. • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massach setts, sFP 1 /1 , ty Board of Building Regulations and,:Stan rds NlC ALITY Massachusetts State Building Code 780 r R 6 �yl,,, SPJ Re .! mol Building Permit Application To Construct, Repair, i ``ish a Revis d Mar 2011 One- or Two-Family Dwelling aMAl Nr,',lisp, This Section For Official Use Only p0/°8o/O,ys Building'' Permit Number:�Q-A - 12Lfr Date Applied: elti,,�.as //. 6/1-7,023 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 35 1r o vl 4- -5 1- I e d f 1 lq 0/0 1.la Is this an accepted street?yes 4) no 53 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: / ,o,o,'3 il �-� 0 Q.S'J ('licivldreq HortV'1ci t) ``--'��-.4�.'' Name(Print) City,State,ZIP 3 g F-rot,i 1- 5 f 3o 530'7 Dote 6,l-cl'1ctn d rci.ho I-hwu"1 e(Rim u; I I.awl `No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building' Owner-Occupied '1%1„, Repairs(s) ❑ Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units `, Other 19/Specify: Nei,'V)\($1 C 4_i 1 k ,4 t Brief Description of Proposed Work2: II I kJ i VI O►O W S r p/c ° t7"1 e( 11- New r ,l^fd✓lie_r-I& g._I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 6 q 1. Building Permit Fee: $ Indicate how fee is determined: 1 ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost; (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ k Suppression) Total All Fees:,,$/, g) Check NoH 1 !1 Check Amount: Cash Amount: 6. Total Project Cost: $ C 0 0 Paid in Full 0 Outstanding Balance Due: / SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) A ; C°.5--- `k.�.5 rti1 t ��.C; \V 1Q\o...'- ;�\.-n V\,., License Number Expir tion Date Name of CSL Holder l 0. CN30l ck.0 ��\J e List CSL Type(see below) No.and Street t'3 Type Description ���C� U Unrestricted(Buildings up to 35,000 Cu.ft.) `,,.i1 'c"" �N �-� e . CAS-. 1 R Restricted I&2 Family Dwelling City/Town,S TP M Masonry r _ RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1-kk3)tA%.5.•11Y.jS QszY,m..V to\Al'a t>,_.‘:1n u rkek (, ,11' 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) u=' d HIC Registration Number Expiration Date HIC Company Name or� ` HIC Registrant Na\m\e and Street Va r'm.�--:., C. it.\AAC461.11:t,-,r mil.4: a;.,' Niq. f Email address rr)c_cL e 0.r--S.-oL�:,vv. &. 0\c 1 \t-t‘3)L(`�9 T.Z'cj City/Town,State,ZIP Telephone SECTION 6: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 Gi7 No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize \iA. t,k\ f C\.) & to act on my behalf,in all matters relative to work authorized by this building permit application. Print ter's Name afore(Electronic Si / ate Signature) SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained' this ap ' ati is true and accurate to the best of my knowledge and understanding. c----/- ei/// a ---) Print er' o uthor( A s Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms _ Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts' Department of.industrial Accidents w lr:rw 1 Congress Street,Sze 100 Boston,MA 02114-2017 www.inass.gov/dia Workers'Compensation Insurance Affidavit;Builders/Contracto3rs/Eiectrirtang/.lumbers. TO BE FILED'WITH T.wf,PERM TT.ING 4.1 iti Applicant Information M�+ � 0 c Please Print Legibly a Name(Business/organiration/Individuat): 0111 ) i.� i ,a"i�:;1Y '• O . l • Address: t��a�Gt-1 rt J' �� (1 I City/State/Zip: Phone#: '1/3 17°'8,``) I/ Are you an employer?Check the appropriate box. Type ofproject(required): r W 1.6 am a employer with employees(frill and/orparh-time).* 7. ❑New construction 2.0 ism a sole proprietor or partnership and.have no employees working for me in 5. ❑Remodeling any capacity.No workers'comp.insurance inquired] 3.0 i am a homeowner doing all work myself:[No workers'comp.imams n required.]t 9. Demolition 4.0Iam a homeowner and will he hiring contractors to conduct all work on my properly. Iwill 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[j Electrical repairs or additions proprietors with no employees. 12.[ ,Plumbing repairs or additions 5.0 X am a general contractor and Xhave hired the sub-contractors listed on the attached sheet 13. Roof repairs These sub-contractors have employees and have workers'comp.insuxance.t p 6.0 we are a corporation and its officers have exercised their right of exemption per MGM c. 14. <o 152,§1(4),and we have no employees.[No workers'comp.insurance requircrj] *,Any applicant that checks box#1 must also fill orrt the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they aneTdoing iril wdrk and then hire outside odritractors must salmi*a new affidavit indicating such. tContractots that check this box must attached an additional sheet showing the name of the sub-contractors and spate 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 1Neme: II y i('r i Gall t/1 I e1 -5(4 Y C'/ti) j Policy#or Self ins.Lie.#: (� 7 / 1 t �ij/ � Expiration Date: /U/()! _: �!.': ;e Job Site Address: 38 Pr on 1` /• City/State/Zip:)ed J 1 0/05 3 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 tttia stat€'tnent may be forwarded to the Office of Investigations of the DIA for insurance coverage Yerifi atio* . I do hereby certify under the pains and penalties of perfury that the information provided above is true and correct. JaiSi nature: ' d ttS ,L� '�'��� Date: q Phone#; 413-485-7335 Official use only. Do not write in this area,to be completed by city or town gffcial. City or Town: Permit/License # Issuing Authority(check one): IQBoard of.Health 20 Building.Department 31:City/Town Clerk 4.0 Electrical:Inspector 5,0Plumbing Inspector 61:Other Contact Person: Phone#: City of Northampton (i/7.' �ao��►.,, r dti b� ..d Massachusetts err' !ee, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jos 41 Northampton, MA 01060 th6 • "`t'� CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: ,V� The debris will be transported by: Name of Hauler: V. ,, ‘ 0 \)...\r V�. Signature of Applicant: Date: Ci) IP City of Northampton 0 j . �.' Massachusetts „4/ sui it eft- 4..."' A DEPARTMENT OF BUILDING INSPECTIONS � F i' �� ..'I 212 Main Street • Municipal Building fit:.. � ' Northampton, MA 01060 "--Ov4 al HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT OhI, a d re? 14 a k-i vh a (insert full legal name), born _ (insert month, day, year),hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. 1 am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s)who owns 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 home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this I day of (St'p / 0)16er, 20 a 3 c0�ry o e y‘vzLcAr (St ature) WINDWOR-01 LAURA A CORD CERTIFICATE OF LIABILITY INSURANCE DA4114i2023 TE )_ THIS CERTIFICATE IS ISSUED AS A 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 Laura Misseri NAME: Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street (A/C,No,Ext):(413)594-5984 (AIC,No):(413)592-8499 Chicopee,MA 01013 it1DAFILIEss:laura@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:EMCASCO Insurance Co INSURED INSURER B:EmploYers Mutual Casualty Company Window World Of Western Massachusetts Inc INSURER C 641 Daniel Shays Highway INSURER O: Belchertown,MA 01007 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. - - TYPE OF INSURANCE POLICY NUMBER LIMrrS INSR INSD SUBRL WV /MM(DDY� (JINWD�1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETO RENTED 500,000 _J CLAIMS-MADE X I OCCUR 6Q44324 4/9/2023 4/9/2024 PREMISES(Ea occurrence)___-$ MED EXP(Any one_Rerson) 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X d CT I XJ LOC PRODUCTS COMP/OPAGG $ , 2,000,000 OTHER: $ _ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 _fga accident) ANY AUTO 6Z44324 4/9/2023 4/9/2024 BODILY INJURY_(Perpersonl_ .$ OWNED SCHEDULED _ AUTOS ONLY X_ AUTOS BODILY INJURY(Per sodden!). $ _- X HIRED X NON-OWNED PROPERTY!DAMAGE AUTOS ONLY _._— AUTOS ONLY (Per accident) $ B X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 6J44324 4/9/2023 4/9/2024 AGGREGATE $ 1,000,000 _ DED X RETENTION$ 10,000 $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY Y f N _—_ .STATUSE...__—ER ANYFFICEWMEM ER EXCLUDED?ECUTIVE N fA _E.L.EACH ACCIDENT M H( andatory in N ) E.L.DISEASE-EA EMPLOYEE._$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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, Town of Northampton ACCORDANCE WITH THE POLICY PROVIS ONSCE WILL BE DELIVERED IN Attn:Building Department 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DDIYYYYI A C ,/--y4 02/10/2023 OR �►••.•- CERTIFICATE OF LIABILITY INSURANCE Acct#:2970777 THIS CERTIFICATE IS ISSUED AS A 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), AUTHORIZE D 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 :In this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT LOCKTON COMPANIES,LLC NAME_ FAX 3657 BRIARPARK DR.,SUITE 700 (A/C,o,Ext):888-828-8365 I(A//C No): HOUSTON,TX 77042 E-MAIL ADDRESS: INSPE RITYCERTSMOCKTONAFFINITY.COM INSURER(S)AFFORDING COVERAGE LAIC N INSURER A:Ace American Insurance Co, 22667 INSURED INSURER B: WINDOW WORLD OF WESTERN MASSACHUSETTS INC. — - — --641 DANIEL SHAYS HWY INSURER CI BELCHERTOWN,MA 01007-9529 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 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. INS _.- - --- -- -- ---_-TADDLISUBR -- - POLICY EFF POLICY EXP -LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ _ DAMAGE TO RENTED CLAIMS- OCCUR PREMISES(Ea occurrence) $ --__.._.___-._._ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ .-_-—_ POLICY PRO- LOCIFCT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) __ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _. AUTOS --------- -- HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ _ EXCESS IJAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY NI STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ I r$00r000 (Mandatory EXCLUDED? N/A C5186654A 12/25/2022 10/01/2023 (Mandatory In NH) ..._.-._.___.._--____--._ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-EA EMPLOYEE $ �000,000 __- E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION 2970777 - Town fo Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Building Dept BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 212 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD