35-002 (3) 64 SYLVESTER RD BP-2017-1440
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35-002 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING W FCH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2017-1440
Project JS-2017-002396
Est. Cost: $27620.00
Fee:$140.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: JOHN WALZ 060612
Lot Size(su.ft.): 19602.00 Owner: RUTKOWSKI WILLIAM J III Be PATRICIA M.
Zoning Applicant JOHN WALZ
AT: 64 SYLVESTER RD
Applicant Address: Phone: Insurance:
66 Bray Street (413) 592-2376 Workers Compensation
CHI COPEEMA01020 ISSUED ON:6/9/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:NEW REPLACEMENT WINDOWS, SIDING,
DOORS & ROOF
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: Rouse# 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 6/9/20170:00:00 $140.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck .Building Commissioner
Department use only
City of Northampton Status of Permit:
\ i9 :uilding Department Curb Cut/Driveway Permit
,U\ 212 Main Street Sewer/Septic Availability _
Room 100 Water/Well Availability
c e p,c Northampton, MA 01060 Two Sets of Structural Plans
e/ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION £-j 7 -/'( /0
1.1 Property Address: �1 _/y/hThis section to be coo^�kted by office
(� y gy Ives i-e_ r lx- d Map t/v Lot V //1� Unit
dhawc-c '"`Y OIOG4 Zone Overlay District
Elm St DisWct CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Wil/lam Pel- eraLIJ /- a 'i Sy lues/-er ✓ f Ile enc,
Name(Pont) Current Mailing Address:
413 - a,2.1- / 005`
Telephone
Signature
2.2 Authorized Anent:
doln 't1POail z 66 Rr-r 1 Sr C04ci"+`a
Name(Print) Current Mailing Address:
3 5-4 - a3 > c,
Signature Telephone
$ CTI , 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
Z Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection j
6. Total=(1 +2+3+4+5) -F ••41.71C0 0O Check Number (-7//6740
This Section For Official Use Only
Building Permit Number Date
� ' Issued:
Signature. 6- /q
//,
Building CommissionerAnspector of Buildings Date
SECTION S•DESCRIPTION OF PROPOSED WORK(check all pDDBcaalel
New House D Addition ❑ Replacement Wjpdows Alteration(s) Q Roofing ei
Or Doom IU .✓'
Accessory Burg. ❑ Demolition 0 New Signs [til Decks [fes Suring t�l7 Other[CS
Brief Description of Proposed c„ t
Work: Ike �.S fee faf cln.� eo..) c / SrA,nyJ eel'Si PQ }•- in;
Alteration of existing bedroom Yes'' No Adding new bedroom Yes <----No
Attached Narrative Renovating unfinished basement Yes —"No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing. complete the following: N//-�-
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?
t. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masschedc 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 buikfing conform to the Building and Zoning regulations? Yes No.
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, e tq,,v W t.Uac ! as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application am true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
a 4 W LA) ct4 2_ __
Print Name
4 �{l+p( 4 € t .
Signatu Ownenngs Date
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: G tf S /a es F et fl cc
The debris will be transported by: :A., c /-
The
The debris will be received by: w 10 ,kt, / , c Ser ✓; s
SY rtzfT le CN,:c -t r etc-1
Building permit number:
Name of Permit Applicant F,r y ( Vtv y (
Date Signature of Permit Applicant
SECTION 8-CONSTRUCTION SERVICES
8.1 I.icenaed Construction Supervisor, Not Applicable ❑
Sameof License BokMr: '\14;n. La LVe t'"z- 84,66 / ,.•.
License Number
C . C.> ;ili "vs..4 Sr Gt:, :< _ ,., .e ,4 otcQt. c tfdt3fif
Add?AA'
Expiration Date
Ye .R - y% Lf_.(1a (._S—
SigTelephone
9.Registered Home Improvement contractor: Not AppIienbla ❑
Company Na a Registration Number
3 " 6 x.77 « -t ::>1- c ft,r.,4, 2.t t.14ce //19
Atldrptv c e J,ti C. Expiration Date
Telephone //s S'}) '; 31F nSECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT Mal_C.152,§2.5C(6)) n
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...... ❑
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-accorded Dwd)ines 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 784. Sixth Edition Sect{on 10$.35,1.
Definition of HomeowneG 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 peneo who constructs more than one borne in a two-Year period shall not be considered a homeowner,
Such"homcowmer"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 undo-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 Slate of Masenchusetts General Laws Annotated.
Homeowner Signature
From:Maria Afonso FaxID: Page 2 of 2 Date:12202016 0323 PM Page 2 of 2
ACORNS",
CERTIFICATE OF LIABILITY INSURANCE DATE(MEVDD" I
le....----- 12/202016
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 policypes)must 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).
PRoouCFN DXTACT NAME'. Maria Afonso
FAX
D. FRANCIS MURPHY INSURANCE AGENCY, INC. INC NE Ext (508)7875183 (0JC,Noy
EMAIL mafonsogdfmurphy corn
133 MILFORD ST. INSURERIS)AFFORDING COVERAGE NAICN _
MEDWAY MA 02053 INSLWERA: LM INS CORP 33600
INSURED INSURER B: _
FOURTH GENERATION CONSTRUCTION INC INSURER C:
INSURER 0: ---_ _
328 CHAPIN TER INSURERE'.
SPRINGFIELD MA 01104 INSURER F:
COVERAGES CERTIFICATE NUMBER: 112699 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
INDICATEED. 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 SY 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 TYPE OF INSURANCE AODLS R POIICYEFF POLICY EXP
LTA 1100 4WD MNAW
D POLNUBER IMDYYI RONOEWVWI LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S
OA-�-
CLAIMS-MADE 7 OCCUR PREMISES(EaannwneDnce) S
MED EXP(Any me persml $
N/A PERSONAL a ADV INJURY S
GEMLAGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE S
POLICY JEQ LOC PRODUCTS-COMP/OP AGG S
OTHER.
AUTOMOaILEf1PBILnY [AR81NEOm5 SINGLE LIMIT S
(Ea accid
ent),
ANY AUTO BOOZY INJURY(PM person) $
I nu I__ AUTO En AUTOSCHES NE N/A BODILY INJURY(Per&cadent) S
HIRED AUTOS _AUTOSWNE0 Per aendam0) AGE $
S
UMBRELLA MAO I OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMtMADE N/A AGGREGATE $
DED I RETENTIONS S
WORKERS COMPENSATION V PER 0100
AND EMPLOYERS'LIAWILITY ^ STATUTE ER
A or`FI ERe,IABEEREXCLUOED, urwE xA NM N/A WC531 S372404046 12/13/2016 12113/2017 EL EACH ACCIDENT a 500000
IManda:ow In NMI Et DISEASE�EA EMPLOYEE S 500,000
y aesonba vine, • —.
DESCRIPTION OL OPERATIONS below ELDISEASE-POLICY LIMIT $ 500,000
I
N/A
DESCRIPTION OF OPERA/1AS I LOCATIONS r VEHICLES(ACORD lel.Aearf O aI R..S.w smedwe.MS beached N more'patois required/
Workers Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorizatIon is given to pay
claims for benefits to employees in states other Than Massachusetts d the insured hires,or has hired those employees outside of Massachusetts.
This certificate at insurance shows the policy in farce on the date that this certticate was issued(unless the expiration date on the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verificagon
Search tool at www.mass.gov/Iwd/workers-compensafontnvesggations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE cANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Finyl Vinyl ACCORDANCE WITH THE POLICY PROVISIONS.
33 Grattan St
AUTHORIZED REPRESENTATIVE
Chicopee MA 01020 —IM LJ�
I Daniel M.Crow y,CPCU,Vice President—Residual Market—WCRIBMA
ID 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
# 1 at/N YL Page No. _of Pages
CHOICE 101411111 PROPOSAL
33 Grattan Street All home improvement contractors and subcontractors
CHICOPEE, MA 01020 engaged in home improvement contracting, unless
(413)592-2376 specifically exempt from registration by Provisions of
Submitted Chapter 142A of the general laws,must be registered with
To: Skip Rutkowski the Commonwealth of Massachusetts. Inquiries about
registration and status should be made to the Director,
64 Sylvester Rd. Home Improvement Contract Registration,One Ashburton
Place,Room 1301,Boston,MA 02108 (617)973-8700
Florence,MA 01062 Owners who secure their own construction related
_ permits or deal with unregistered contractors will
be excluded from the Guaranty fund Provision of
MGL c. 142A.
PHOne OATS REGISTRATION No -1I2653 CT-REG.NO.0051540
413-221-1005 4-19-17 LICENSE NO. -060612
JOB?Ahg!rm_
JagLOCATION
We heresu m(t specifications and stl ates for work tp be performed and materials be u.
1. Instal 3/4' insulation as a backer. 2. Vinyl side! to muse using Mastic Ovation 04"-Natural Slate,vinyl siding,Lifetime Wanmrty.
I Install regular corner post 4. J-Blocks for all electrical fixture,faucets and dryer vents.
5. Install two white rectangle gable vents. 6. Wrap all facia(trim)in white aluminum coil.
7. Wrap all windows&doors in white aluminum coil,Andersen Bend.
8. Use white center-vera soffit under all overhangs.
9. Install all new white seamless gutters and downspouts, 10. No shutters.
I I. Strip roof&dispose of waste by truck or dumpster.
I2, Install Certainteed Lifeteime Pewterwood Architectural shingles.
13. Install synthetic paper,ice&water barrier,a ridge vent,new pipe vent boots,and new white drip edge&rake edge. •
14. Install I Simonton Asure double hung vinyl replacement window,Lifetime Warranty: White,low a glass, 1/2 screen,no grids.
15. Install I Sunrise 61t. sliding patio door,vinyl replacement,Lifetime Warranty:White,Low E glass,Screen,No grids.
16. Install 2 Therms Tru Fiberglass#S 104 doors:factory pain white both sides,bore For lock&doadbpits, i col nickel tock&deadboh.
white -
17. Install 1 Therms Tru Fiberglass#5454 door:factory paint mtlolack extcom,bore for Tock&deadbolt,nic el ma.
18. Install One 9x7 insulated solid white garage door with colli opener.
WORK r not begin
abets for nail room dat thf work org order delay laah ule Deyre thcu stthard Gsy wowing C.Nre spring nf this Agis wort W becspeCid d* herein waning. 0f or win - Th the werker y
r
ackno a manure nda tees of t a iedul,g atrecaused o m circumstances cuchhe lay�t was mnvw.ms Dy the be completed mM a cons+mm date agmmg. The Owner ent.
acknowledges end agrees Net the scheduling dales are approximate and that such delays that are not avoidable try the contractor shall not be considered as violations of this Agreement.
WARRANTY
The Contractor warrants that the Work Nrnished hereunder shall be free horn defects in material and workmanship for a period of one year lollewing completion and shall comply With the
requirements of OW Agreement.In the event any defect th workmanaNp or materiels,Or damage caused by tie Contractor,his wb^_or actors.eintactwes or agents,is discovered within
ole year abet completion of any job,including clean up.the Contractor shall,at his own expense.forthwith remedy,repair correct.replace.or cause to De remedied.repaired,Or replaced,
SRO damage or such defect in materials or woMmanship.The foregoing warranties shall survive a IIX031 or state inspection.
We Propose hereby to furnish material and labor -complete in accordance with above specifications,for the sum of;
Twenty-seven thousand six hundred and twenty dollars and 00/100. 27620.00
dollars($- )-
Payment to be made as follows:A finance charge of 11//%per month(18%per annum)will be charged on unpaid balances.
In additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency, the owner herein shall be responsible for
reasonable attorney's lees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here.
33 9114.00 John W.Wats/Roy!Vinyl Mc
% ($__,_)upon signing Contract Name of eomraarenoeaie,atee Registrant
of to no sarin! ,f,watw.;al n Grattan Street
_,_% ($_. )upon completion of _, — seem acoreas
ulr} Chicopee,MA 01020
($_..,�)upon completion of CR//Male
t j
% ,`y snail tie made forewith upon 1413)592-2376 6&1215510
($� comptehon of work under this contract pines rodent to No.
John W.Wal or Timothy J. els or Terry L.Messier
Notice: No ago ement for home improvement contracting work shall require a emwx _ resp„.. - Named smatpera+
down payment(advance depose)of more than me-third of the total contract price V 2. . £4
Of the total amount of alt deposits or payments which the contractor must make,in ,a,„1,:.R-ifr -- -
advance,to order and/or otherwise obtain delivery of special order materials and
NMotet,Skis prproposeproposeY- be ant .�_con w a nWen olaor..�_. ,m dabs.
equipment. (�veranpLini5n2atar.
Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.I understand
that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above.
You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after the
date of this transaction.Cancellation must be done in writing.
DO GN THIS CONTRACT IF THERE - NY BL ^ ' •PACES.
4t �-�_. '-. M ora
atonia ate 17 a�gnaNmed�1.-- .�.
IMPORTANT INFORMATION ON BACK fP-