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City of Northampton
Building Department
Plan Review
212 Main Street
Northampton, MA 01060
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pursuant to various applicable lien-laws. Owner also agrees to sign a completion certificate upon
completion of work. Owner agrees to pay all costs of collection,including reasonable attorney's fees,
costs
and expenses.Furthermore,interest shall be charged at the highest lawful rate of interest on any and all
overdue payments. If Owner cancels this contract at any time subsequent to midnight of the third
business day after the date of the contract,Owner will be responsible for all of Contractor's damages,
which will include,but are not limited to,the difference between the contract price and the cost of
material and labor which would constitute lost profits in addition to any and all other damages suffered
and/or sustained by Contractor. Contractor reserves the right to cancel this contract at any time
within thirty days of the date of this contract. If the Contractor cancels, Owner will be promptly
notified in writing by an authorized officer. If Contractor cancels, Contractor will promptly return any
down
payment(s)Owner has made.
PAYMENTS: If the Owner fails at any time to make a payment of the price as finally determined and
agreed,the Contractor shall be entitled to stop work without being in breach of contract.
Owner agrees to pay the contractor the reasonable costs of enforcement or collection, and/or if in the
event it is necessary for the Contractor to retain an attorney and/or to institute legal
proceedings, Owner agrees to pay reasonable attorney's fees and costs incurred,whether or not court
proceedings are initiated,in addition to other sums.
RESTARTS: If the project is stopped by the owner for any period of time,a restart fee of ten percent
(10%)of the contracted price will be required to compensate the Contractor for the necessary
time and re-mobilization of staff and materials. Depending on the duration of the stoppage, an
additional equitable adjustment may be necessary to cover wage increases and general escalation.
SERVICE WARRANTY:In addition to any warranty extended to you on the product(s)used in a
service, should the workmanship(or application)of this service prove faulty within ONE YEAR,
sturdy Home Improvement,Inc.will upon notice from you,cause such faults to be corrected by repair
at no additional cost to you.
Service under this warranty is available by calling(877) 3-STURDY. This warranty gives you specific
legal rights and you may also have other rights which vary from state to state.
START DATES: Unless otherwise stated in contract,the start date shall follow the completion of
previously scheduled projects. Completion of project shall follow in a workmanlike manner
consistent with established construction standards.
SUBCONTRACTING: Contractor has the right to subcontract any part, or all,of the work agreed
herein to be performed.All permits,license requirements,workman's compensation and/or other
job requirements shall be the sole responsibility of the subcontractor. Contractor agrees that,
notwithstanding any agreement for materials and/or labor between Contractor and a third party,
Contractor is
responsible to Owner for completion of all work described in a timely and workmanlike manner.
SUBSTANTIAL COMPLETION: Owner agrees that upon the substantial completion of project that
final balance minus double the value of the product yet to be install will be due upon
contractor's request. Failure to make payment will constitute a restart of project as noted above.Any
failure or delay in payments will void any Sturdy Home Improvement, Inc. warranty for workmanship
unless agreed upon in writing with the management of office only.
SURPLUS MATERIAL: Any remaining surplus materials after completion of this job shall remain the
property of the Contractor.No credit is due on returns.
delivery/removal of trash containers by the contractors sub or employee of Sturdy Home Improvement,
Inc.
HAZARDOUS WASTE/ASBESTOS/CONTAMINANTS/MOLD: Owner represents and warrants
that the project area and house are free from hazardous waste,lead paint, asbestos and/or
other contaminants. Therefore,in consideration of this representation and warranty, it is agreed that by
accepting this contract,owner does hereby release and indemnify and hold harmless the
Contractor from and against all claims,damages,liabilities, losses,expenses,direct and/or indirect
including but not limited to,attorney's fees and defense costs arising out of,or resulting from the
performance of any of the services by Contractor or claims against contractor relating to,involving or
arising out of hazardous waste,lead paint, asbestos and/or other contaminants. Owner is hereby
advised that mold can grow and be present in concealed areas of the home. Contractor has neither made
an analysis nor verification and assumes no liability for the determination of mold existing in or on
owner's residence. Owner hereby agrees that the contractor shall not be responsible for the detection,
containment,or remediation of any existing mold. Owner further waives all claims and agrees to hold
Contractor harmless against any claim based in whole or in part on the release or spread of mold that
does not originate with Contractor's negligence.
INSTALLATION: It is understood that the contractor may not install said material but that by your
signature you authorize the Contractor to arrange for the performance of the installation by a
qualified installer. You also authorize the Contractor: (1)to issue an installation work order with the
specifications shown herein. (2)To pay the installer upon your execution of a completion certificate
establishing that the installation has been satisfactorily completed. You agree to pay to the Contractor
the amount specified herein,which will cover the prices of said materials and the installation charge.
MODIFICATION:This agreement, except as to concealed conditions or delays occasioned thereby or
by restarts,cannot change except by a written statement signed by both Contractor and
Owner. However,cancellation by Owner is not allowed in accordance with the Notice of Cancellation.
Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on
Owners behalf.All change orders or additional work orders must be in writing,regardless of the
amount or additional time.All additional work orders or change orders will be paid for in full once
accepted
so as to not affect payment schedule. Receipt of check and amount within start and finish dates,unless
specified in memo of check,will constitute an agreement to change order or additional work order
work performed.It is the responsibility of homeowner to receive written additional work order or
change order for documentation.
ORAL REPRESENTATIONS:ANY AGREEMENTS OR REPRESENTATIONS STATED ORALLY
OR IN WRITING BY THE CONTRACTOR'S REPRESENTATIVE PRIOR TO THIS AGREEMENT
SHALL BE SUPERSEDED BY THIS CONTRACT. THE CONTENTS OF THIS CONTRACT,IN
PRINT AND WRITING, CONSTITUTES THE ENTIRE AGREEMENTS BETWEEN BOTH
PARTIES. UNLESS
STATED IN THIS CONTRACT,THERE ARE NO GUARANTEES OR WARRANTIES,
EXPRESSED OR IMPLIED,MADE BY THE CONTRACTOR.
PAYMENT/DEFAULT. Owner agrees to pay cash in accordance with the written terms and
conditions;provided,however, if Contractor, at its sole discretion grants Owner credit,then Owner
shall sign Contractor's promissory note for the credit so granted. The terms of the promissory note shall
be incorporated herein by reference and made as part hereof. If Owner fails to make all payments
strictly in accordance with the terms of this contract, and/or otherwise defaults hereunder or on the
promissory note,the entire unpaid balance of the contract and note shall be immediately due and
payable, without further protest,notice or demand,and Contractor shall be free to exercise its
cumulative rights and remedies,which may include,but not be limited to, suit, attachment and rights
AIL
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64 i
work.Contractor shall attempt to protect landscaping, shrubs, driveways and lawn.Access to
perimeter of structure is needed to install products outlined in this agreement. Contractor shall not be
responsible for any damage that may occur to landscaping while accessing work areas.
ADDITIONAL PROTECTIONS: Protection of inside areas of attic and living space is the
responsibility of homeowner. Contractor will provide tarp(s) at owner's request. Contractor is not
responsible for dust and/or debris inside structure as a result of work performed on the property.
ADDITIONAL WARRANTY INFORMATION:All warranties for goods supplied by Contractor under
this Agreement shall be those given by the manufacturer of such goods,which shall be and
are hereby passed through directly to Owner. Under such manufacturers'warranties, Owner may be
required to register or mail in a warranty card or other evidence of ownership and use of such
equipment in order to activate such warranties. Owner's failure to mail in or register such
documentation,which failure voids the manufacturer's warranty, shall not create responsibility for
Contractor to
warranty such goods.The warranty gives Owner specific legal rights and Owner may also have other
rights which may vary from state to state. Under Massachusetts law, sales of goods carry an implied
warranty of merchantability and fitness for a particular purpose.All materials will be specified.All
work to be completed in a workman like manner.Any alterations or deviation from the above
specifications requested by Owner involving extra costs will be executed only upon written orders,and
will become an extra charge over the original estimate.
ARBITRATION: The parties hereby agree that the Massachusetts Arbitration Act shall apply to all
disputes and claims arising out of,or relating to this agreement, including the breach thereof.
The parties agree to follow the expedited procedures of the Commercial Arbitration Rules of the
American Arbitration Association at a hearing only to be held in Springfield,Massachusetts.The
commencement of arbitration proceedings by an aggrieved is a condition precedent to the
commencement of legal action by either party, except,mandatory arbitration procedures required in
this
Agreement shall not be applicable to any claim by Sturdy Home Improvement,Inc.,wherein it seeks a
prejudgment remedy such as a real estate attachment,for cases where Owner has not paid a bill
which is due to Sturdy Home Improvement,Inc.
ATTORNEY'S FEES/COSTS: Owner agrees to pay all costs of collection, including reasonable
attorney's fees,cost and expenses. Furthermore, interest shall be charged at the highest lawful rate
of interest on any and all overdue payments.
DELAYS:There shall be no liability for delays in,or failure to complete delivery or installation of all
or any of the herein mentioned merchandise,if due to any cause beyond Contractor's control,
including but not limited to fire, strike,war,terrorism,government regulations, acts of God or labor or
materials shortages.
DELAYS IN COMPLETION DUE TO CONCEALED CONDITIONS: Owner hereby acknowledges
that in certain remodeling work,the demolition of portions of the pre-existing structure may
reveal additional defects, conditions or the need for additional work which must be repaired,altered or
carried out in the order to complete the work described under the contract.In such case(s),owner
agrees that the duration of the work and the scheduled date of completion may differ from the date
stated on the front, and that such variation shall not be considered to be a violation of this contract.
DUMPSTER(S): Dumpsters delivered to the site will be done by others,unless stated on the contract.
Sturdy Home Improvement,Inc. will not be held responsible for any damage to driveway,
lawns,landscaping,curbing, fencing,etc. The existing driveway must be able to withstand the capacity
of a truck with a fully loaded container. Sturdy Home Improvement,Inc. cannot be held responsible
for previous damage to existing driveways(cracks,dips, scratches or unforeseen conditions). The
Contractor will not be held liable for any damage that may occur from the curb into the property with
the
forms.
The following is a requirement by Massachusetts General Law,Home Improvement Contractor Law
MGL,c 142A:
"The contractor and the homeowner hereby mutually agree in advance that in the event that the
contractor has a dispute concerning this contract,the contractor may submit such dispute to a private
arbitration service which has been approved by the Office of Consumer Affairs and Business
Regulation and the consumer shall be required to submit to such arbitration as provided in MGL e
142A.
Owner:
Contractor:
NOTICE: The iynt es of the parties above apply only to the agreement of the parties to
alternate dispute tion in itiated by the contractor. The owner may initiate alternative dispute
resolution even where this section is not signed separately by the parties."
Do not sign this contract if there are any blank spaces.
Representative of C ntrac
Submitted By Date: i Ic6
Accepted By Date:
Representative or:
Accepted By Date:
Accepted By & Date: G
ACCEPTANCE: This contract and the agreement for credit,if any, shall constitute the entire agreement
between the parties,which the entire agreement and specifications shall not be altered or
modified except by written agreement between the parties hereto.
Owner(s)understands that this document does not constitute a valid and binding Contract for any
purpose until and unless it is signed and accepted by Sturdy Home Improvement,Inc.
IN THE EVENT THIS OFFER TO CONTRACT IS NOT ACCEPTED BY CONTRACTOR,ANY
PAYMENT MADE HEREUNDER SHALL BE REFUNDED TO THE OWNER(S)AND THIS
PROPOSAL
SHALL BE NULL AND VOID AND OF NO EFFECT.THE CONTRACTOR IS NOT
RESPONSIBLE FOR EXISTING STRUCTURAL DEFECTS, DRY ROT OR CODE VIOLATIONS.
NO REPAIRING,
PLASTER-ING,CARPENTRY OR DECORATING IS INCLUDED UNLESS SPECIFICALLY
CHARGED FOR AND SPECIFIED IN WRITING HEREIN.
ACCESSIBILITY: Owner agrees to allow Contractor access to entire perimeter of building to perform
MW
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Payment Schedule
Total Price of Investment $25,805.60 o`Z
Design Deposit -$600.00
Acceptance of contract $4290.00 RCVD
Start of demo $3485.00
Start of Framing $3485.00
Start of Plumbing $3485.00
Start of Tiling $3485.00
Start of Start of Painting $3485.00 woo
Completion $34$5-@ a`1 U
Payment schedule is based on project milestones,not the cost of ant particular phase
Any balance not paid in full within thirty days will be charged 1.5%interest per month.
Additional work orders are to be paid for once accepted and approved by purchaser.
GENERAL CONDITIONS
I. UNFORSEEN SITE CONDITIONS: Site conditions that hinder excavation,foundation, or
concrete work that incur additional expense shall be billed to the customer.
2. UNFORSEEN STRUCTURAL CONDITIONS:Any unforeseen or pre-existing framing and
structural conditions that create a hazard or danger,or that do not meet state building code,
shall be upgraded at the customer's expense.
3.UNFORSEEN MECHANICAL CONDITIONS:Any unforeseen deficiencies in the electrical,
plumbing, or HVAC systems,or pre-existing work that creates a hazard or danger, discovered
during demolition or construction, shall be upgraded to applicable building codes at customer's
expense.Moving of wires, ducts,or plumbing pipes that are discovered during demolition or
construction may incur additional charges.
4. MATCHING EXISTING FINISHES AND MATERIALS: Where Contractor's work involves the
"matching of existing fmishes or materials,"Contractor will use his best efforts to match
existing finishes and materials
5. START DATE/COMPLETION TIME
Tentative start date is week of February 15,2016. Work will progress on consecutive work
days until completion, with the exception of inclement weather,inspections, etc. The estimated
time for completion is _3-4 weeks from the start.
6. CHANGE ORDERS
The contract amount and payment terms as shown in this contract will be changed if needed
only by written change order, agreed to and signed by both parties.
Verbal understandings and agreements with representatives shall not be binding.All
understandings and agreements must be set forth in writing in this Contract.Additional provisions
are stated on reverse side and are part of this contract. In witness whereof Purchaser(s)has/have
hereunto signed their names this— 18 day of January 2016 and acknowledges
receipt
of a true copy of this contract. UNLESS OTHERWISE SPECIFIED,IT IS UNDERSTOOD THAT
THE
OWNER IS READY FOR THIS WORK TO BEGIN. THE PURCHASE PRICE QUOTED ABOVE
WILL
BE HONORED ONLY UNTIL March 15 ,2016 .
You the purchaser(s)may cancel this transaction at any time prior to midnight of the third
business day after the date of this transaction. See notice of cancellation form for an explanation of
this right. Signature affixed below also acts as receipt that Purchaser(s)received separate cancellation
r
A Z��
Section 7 Specialties
7.1 Countertops-None
7.2 Interior Stone Work-None
7.3 Tile Work
Fired Earth Ceramics Renacimento Vision Tub Surround and Kneewall accented with Polished Emperador Dark Border
Marble Tile and Hand Hammered Copper Tile
Floor Tile
Fired Earth Ceramics Renacimento Vision 12x12 Burnt Ochre banded with Mocha Brown(Customer to Supply)
4"Strip Polished Emperador Dark Border Marble Tile on right hand wall of sink.
7.4 Wood,Vinyl,or Laminate Floors-None
7.5 Carpet-None
7.6 Glass and Mirrors
2 Customer Supplied Medicine Cabinets above sinks
7.7 Bath Specialties
Install bath specialties i.e.robe hook,towel bar etc.(Customer to supply)
Section 8 Paint
8.1 Interior Paint
Walls and Ceiling.
8.2 Exterior Paint-None
Section 9 Landscape,Paving,Walkways
9.1 Topsoil, Seeding,Sodding-None
9.2 Plantings-None
9.3 Walkways-None
9.4 Hardscape-None
9.5 Driveways-None
Section 10 Clean and Close
10.1 Punchlist Items
'10.2 Final Clean
Section 5:Mechanical
5.1 Plumbing
Move drain to accommodate Jetted bath in place of tub
Move drain to accommodate new location of the toilet
Rough and finish plumbing for the following fixtures:
Toilet(Customer Supplied)
Dual Sinks and faucets(Customer Supplied)
Jetted Bathtub(Customer Supplied)
5.2 Heating,Cooling,Ventilation
Provide and install exhaust fan ducted to outside(Customer Supplied)
5.3 Electrical
Wiring for Customer Supplied fanlight
GO outlet by sink
Light over vanity(Customer to supply)
Power Supply for Jetted tub motor(Does not include subpanel or electrical upgrade)
5.4 Insulation
Batt insulation in exterior walls
Section 6 Interior
6.1 Plaster or Drywall
Hardie Plank on kneewall and bathtub interior wail
1/2 Moisture resistant drywall
6.1 Interior Doors-None
6.2 Door Trim
3"Pre-Finished Polystyrene Casing
6.3 Window Trim
3"Pre-Finished Polystyrene Casing
6.4 Baseboard and Wainscot
3 1/4"Pre-Finished Polystyrene Baseboard
6.5 Stairways and Handrails-None
6.6 Cabinetry
Install Customer Supplied Vanity with premounted countertop and sink
6.7 Closet Interiors-None
M
Sturdy Home Improvement
WORCESTER SPRINGFIELD HARTFORD
459 MAIN STREET-P.O.BOX 51033-SPRINGFIELD,MA 01151
MA.REG#151711 CT.REG#601525
1-877-3-STURDY 508-797-6600 413-543-5906 FAX 413-543-3200
CONTRACT FOR: Daniel&Naomi Lesley
DATE: January 18, 2016
NAME: Daniel & aomi Lesley
PHONE: 301.501.1779
STREET:28 Gleason Rd
TOWN:Northampton MA 01060
STURDY HOME IMPROVEMENT INC ("contractor")PROPOSES TO: Renovate the main
Bathroom as per plans provided by Sturdy Home Improvement and the following the specifications.
Section 1:Plans and Permits
1.1 Plans and Engineering
Provide design/build plans
1.2 Permits
Provide building permit from Municipality
Section 2:Site and Foundation
2.1 Site Work-None
2.2 Demolition
Demo bathroom down to studs and subfloor
Demo enclosed space behind toilet including studs
2.3 Excavation-None
2.4 Concrete-None
2.5 Masonry-None
Section 3:Framing
3.1 Floor Framing-None
3.2 Wall Framing
Build kneewall to mount jetted bath tub
3.3 Roof Framing,Ceiling Framing-None
Section 4:Exterior
4.1 Roofing-None
4.2 Siding-None
4.3 Gutters-None
4.4 Shutters-None
4.5 Exterior Doors-None
4.6 Windows
Replace window with new Okna 800 Window with Tempered Glass to match other new windows
HOME IMPROVEME
WORCESTER SPRINGFIELD HARTFORD
459 MAIN STREET-P.O.BOX 61033-SPRINGFIELD,MA01151
MA.REG#151711 M REG 9601525
1-877-3-STURDY 508 767.6600 413-543-6906 FAX 413-643-5200
OWNER PERMIT AUTHORIZATION
Name: N[tam c ��
Address: o`�`� okou
City/State/Zip: G1W*ef!L)
1 t � (Owner), of the property located at:
authorize Sturdy Home Improvement
Inc.to act as my agent for the construction project taking place at the above
address.I also authorize Sturdy Home Improvement Inc.to obtain a building
permit. I understand and accept responsibility to comply with all regulations and
required inspections.
akSignature of Owner: Date: Q 1
Page I of 1
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: 27 C-t WO �r Cd 0 cA4,jaaµ�, M R- M o4 d
The debris will be transported by: U,01 Ina 4 dl(A l "Dna.rG-h p\�
vti�uy
The debris will be received by: t- QCLACI inn
T
Building permit number:
Name of Permit Applicant may} C-A
P1
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
' d 1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): ,fay kk
Address: QQA Sly 4C kA
City/State/Zip 0115' hone #: x-� lQ Sl
Are y u 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. E] New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. I&Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working or me in an capacity. employees and have workers'
g Y 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 11.E] Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs
insurance required.] t c. 152, §l(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
I Homeowners 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: O�.V' 2 e1 n t
Policy#or Self-ins. Lic. #: �� x — l� Expiration Date:
Job Site Address: Q CSLYI 2�1 cy City/State/Zip:�c)(4) " 1 ,A 0 (�l�
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 nthe pains and penalties of perjury that the information provided above is true and correct.
Signaturecl y, Jjq 1, �fi Date: 1 1 2616 u
Phone#: _Alyb — I I
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: j� � Not Applicable 0
Name of License Holder: DEC bV 1 �LJ 10 L— _ .�7-' �-/ �
License Number
yq �nS�,r ►3In�n �rchard� cL�l 08 ( o"I ( "1
A s Expirattiio Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Sk k�6� kern 1S 1-1 t I
Company Nam Registration Number
LAS-PL 0 S1 f--A I IkE 1!6 a- I A Jaho �d .�t�«-I t o 12,Le 12(Dl W
Addr/ 1" Expir tion Date
J t Telephone Lk Q p y3-I(P191
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 build' g permit.
Signed Affidavit Attached Yes....... W 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 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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑
Or Doors F-I
Accessory Bldg. ❑ Demolition ❑ New Signs [t]) Decks [Q Siding[01 Other[tom
Brief Description of Proposed
Work:(24!!66J0A%1— PnOA-Iclfuo" .
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a.If Newhouse 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, -V-n 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
I,1) U 1CJ Z � a ICA t=A -t—bn-XD -UT � Y>{N Q,(l/a.1( , as Owner/Authorized
Agent hereby declare that the st tements and info mation on the foregoing lapplication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
—)av la T-�) Z
Z�/ z2,1�2
Signature of Owner/Agent Date
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
( E.. € _
..... I .., ... _
Side L:1 ..__ R:s_- i L: _,. R:I _...
E I.
Rear . .......3
Building Height
Bldg. Square Footage - % i— i i """
Open Space Footage a °/U ;
(Lot area minus bldg&paved j
parking)
#of Parking Spaces
Fill:
volume&Location u......... j
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book Page and/or Document#1
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued
C. Do any signs exist on the property? YES NO 0
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 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 0 NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
1� Ci of Northampton Status of Permit:
Bu Iding Department Curb C NDrivewayPermit
JAN 2 6 24�s 12 Main Street Sewer/Septic Avabbility
Room 100 Water/Well Aitatlabllit
rth mpton, MA 01060 Two Sets of Structur`a ans
p�o OF�'N - -1240 Fax 413-587-1272 Pfotts to 01 ns
Other p eak
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
`eDtsC)n � a � Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�An Ne\ kj�!Sle�A 22 Cl 1 ec,�son V-oc W
ame TP rint) Current Mailing Address:
Telephone
Signature
2.2 Authorized Acient:
Na Current Mailing Address:
I- kS- 21%-*382
ature Telephone
SECTION 3 ESTIMATED CONSTRU TION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (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 Y, 1001 0
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2016-0944
APPLICANT/CONTACT PERSON STURDY HOME IMPROVEMENT
ADDRESS/PHONE P O BOX 51033 INDIAN ORCHARD01151 (413)543-5906
PROPERTY LOCATION 28 GLEASON RD
MAP 18C PARCEL 09') 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid o
Building Permit Filled out
Fee Paid
Typeof Construction: REMODEL BATHROOM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 093603
3 sets of Plans/Plot Plan
TH�FO WING AC TION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFON PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolit n Delay '
Sign of Bui in O icial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Plannino& Development for more information.
28 GLEASON RD BP-2016-0944
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C-093 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2016-0944
Project# JS-2016-001598
Est. Cost: $162.50
Fee: $162.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sq. ft.): 21126.60 Owner: LESLEY DANIEL&NAOMI
Zoning: URB(100)/ Applicant: STURDY HOME IMPROVEMENT
AT: 28 GLEASON RD
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON:112712016 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMODEL BATHROOM
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 $162.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner