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18C-020 (5) BP-2023-1147 285 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18C-020-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1147 PERMISSION IS HEREBY GRANTED TO: Project# BATH RENO 2023 Contractor: License: Est. Cost: 18264 BATH BUSTERS INC 072772 Const.Class: Exp.Date: 04/07/2024 Use Group: Owner: CZARNECKI STANLEY J&DAVID J CZARNECKI Lot Size (sq.ft.) Zoning: SR Applicant: BATH BUSTERS INC Applicant Address Phone: Insurance: 30 NORTH MAIN ST UB6N457719 LEOMINSTER, MA 01453 ISSUED ON: 08/25/2023 TO PERFORM THE FOLLOWING WORK: BATH RENO 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: (louse # Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department DriNCN%a) 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: I 0 • • - 9-1 • f Fees Paid: $118.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner EVE The Commonwealth of Massachus s AVG 3 FOR ' II i VI Board of Building Regulations and Sta dar 2 Massachusetts State Building Code, 78 CMR. -of IUS LITY Building Permit Application To Construct, Repair, Renovate PPE ised ar 2011 One-or Two-Family Dwelling r'4A o, soioNs This Section For Official Use Only Building P it Number:� /6,- ?-.3?-.3 - // y 7 Date A lied: ki evr�`loos-) /// 8 Z5 ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Pro a Addre 1.2 Assessors Map& Parcel Numbers 1.1a Is this an accepted street?yes no 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 Yard Rear Yar Required royC$6d Regy.4/ '/,tovided Regt), r vided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information:/ 1.8 Sewa 1 • 1 isposal System: Zone: 44 Outside Flood Zone? Publi MO Private❑ el,Check if yes❑ Munici• site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of 'ft cord: / 7�1 L'' C Z l7/L-'Zi0 71 e a/41.-1 .mac/ / .4 Name Pn ) City,State,ZIP 'kJ - 474 W _ $ -l'e3 2Zir" 7 -1,(Z4�� * i&' -. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: " 2 C C.fS 4J4 .741 - -1X/OA-so-iv �.0 e ti s 7 7t// A'4j _r Cal. 49-7`-. 7 7/1..e.r7 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ a2(p 1,/ I. Building Permit Fee: $ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ Cl Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ S 0 0 '-) 2. Other Fees: $ / 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: � 1 /�� Check No. U Check Amoun . 1` Cash Amount: 6.Total Project Cost: $ ` 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Co 'nstruc 'on Supervisor License L) CC—f ,Z7 7 L.- 2 r / �[s License Number Expiration Date Name of CSL Holder y4 List CSL Type(see below) No and Street T e Description 044111 t i 0l C;Z 4 . Unrestricted(Buildings up to 35,000 cu.ft.) iiv / Restricted 18z2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS _ Window and Siding 9 Z�� y t _ SF Solid Fuel Burning Appliances �y" `��L�� I Insulation Telephone Email address r " D Demolition 5.2 Regis Home Impr ement Contractor(HIC) c HIC Registration Number Expiration Date HIC._,Company Name or C e are /(O 1174/ str t i ji r Q r!-1� _Cta" No. d Street Email address No. c At 0/Vi 3 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NLG.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 .._0 SECTION 7a:0 • ;ORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize. 47 $1"ems C"7-arfi- Zrj,,: ' to act on my behalf;in all matters relative to work authorized by this building permit application. lOwner's Name(Electronic Signature) Date 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 in this applicati urate to the best of my knowledge and understanding. <-'SPrft Owner uthorized Agent's Name(Electronic Signature) Date NOTES: I. 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 half7baths 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" •�A 7` - off Massachusetts 4� i- 'e* c f{ i � + t S - ": {I fi ' _ 1. r a`. 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: 3C , Location of Facility: Cjecr--N,c-74-6 3 0 N d 14:41 K., Les-cip-L,..4./...1---rj--.1 pf..4.„,/. The debris will be transported by: Ce0,--sc,, 0 Name of Hauler: Signature of Applicant: Date: /-�2 " The Commonwealth of Massachusetts Department of Industrial Accidents t' — Office of Investigations 1 Congress Street,Suite 100 IT Boston,MA 02114-2017 1,1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Bath Busters Address:30 N Main St City/State/Zip:Leominster Phone#:978-828-4398 Are you an employer?Check the appropriate box: Type of project(required): I.E I am a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ✓❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' p ty 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. 1Contractors 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: Universal Insurance Agency Inc Policy#or Self-ins.Lic.#:UB6N4457719 Expiration Date::5/8/24 Job Site Address: • 1" '17 CI J City/State/Zip./r 47 "1 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 covera verification. I do hereb certify under the an ti o eat the information provided above is true and correct. Signature: Dater- phone#:978-828-439 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#: A D® CERTIFICATE OF LIABILITY INSURANCE DATE6106/DIYYYY) 0 /06/2023 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)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 Mosarene Scalzer NAME: Universal Insurance,Agency,Inc. PHON o (508)752-9333 (NC,No): (508)752-9303 374 Belmont Street AD I F_SS:Exn:mscalzer©universalinsagency.com INSURERS)AFFORDING COVERAGE NAIC it Worcester MA 01604 INSURER A: Berkshire Hathaway Guard Ins Co. INSURED INSURER B: Travelers Indemnity Co of CT 25682 BATH BUSTERS INC INSURER C: 30 North Main St INSURER D: INSURER E: , Leominster MA 01453 INSURERF: _COVERAGES CERTIFICATE NUMBER: Master 05 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. INSR ADDLJSUBR POLICY EPP POZICYEXP LIMITS LTR TYPE OF INSURANCE INSD VWD POLICY NUMBER (MMIDDIYYYY) (MIVDDIYYYY) X COMMERCIAL GENERALLIABIUTY EACH OCCURRENCE 5 1,000,000 DAMAGE TO CLAIMS-MADE t OCCUR PREMISES(EaENTED occurrence) S 50,000 ') MED EXP(Any one person) S 5.000 A Y BABP367156 11/12/2022 11/12/2023 PERSONAL BADVINJURY S 1,000,000 GEM_AGGREGATE LIMIT APPLIES (PER: GENERALAGGREGATE $ 2.000,000 POLICY !5 !JECT I I LOC PRODUCTS-CAMP/OPAGG $ 2.000,000 OTHER: 5 AUTOMOBILE LIABILITY COMBINED SINGLE UNIT 5 (Ea accident) X ANY AUTO BODILY INJURY(Per person) 5 100,000 A — OWNED —SCHEDULED BABP367156 11/12/2022 11/12/2023, AUTOS ONLY __, AUTOS BODILY INJURY(Per accident) S 300,000 HIRED NON-OWNED PROPERTY DAMAGE 5 100,000 AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTION S 5 WORKERS COMPENSATION X S ATUrE 0R AND EMPLOYERS'LIATY BW Y N , , ANY PROPRIETOR/PARTNER/EXECUTIVE B1 DOO 000 OFFICER/MEMBER EXCLUDED? N N/A UB6N457719 05106/2023 05/06/2024 -EL EACHACCIDENT 5 i,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE S Ir yes,describe under _DESCRIPTION OF OPERATIONS below _ - EL DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Town of Lexington is listed as additional insured on the above General Liability Policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Lexington ACCORDANCE WITH THE POLICY PROVISIONS. 1625 Massachusetts Ave AUTHORIZED REPRESENTATIVE ` I Lexington MA 02420 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts H. vision of Occupational �, cansure s Oa r401 `' , uildin fit? utations and Standards Consre%èevisor A ., 041)gyres: �41 71 ihit fER s '�: AY f NVERS M � 0192 �r ,r f l�� A Te ; � O'"a': "5` THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affa+ =nd Business Regulation 1000 Washing z., - -t- Suite 710 Bostorivtaspg3t .0211 B Home Im•ro istration 070. � , Type: Corporation BATH BUSTERS, INC. egistration: 159805 30 NORTH MAIN ST A _ pj ation: 07/1412024 LEOMINSTER, MA 01453 = riJ -= y • w.. Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVE CONTRACTOR expiration date. If found return to: TYPE: ratio Office of Consumer Affairs and Business Regulation Bligit Expiration 1000 Washington Street -Suite 710 07/14/2024 Boston,MA 02118 TH BUSTERS,INO1 _NER ALMEIDA' ' ^, klORTH MAIN ST, x ,s MINS3"ER,IttiA 01453` 14.1w(4G.��l r fi. Undersecretary Not valid ut signature ill16 Bath Busters, INC 30 N Main St, Leomister, MA 01453 508-925-4300 help@bathbusters.com Purchase Agreement Specification Page I/we, Stanley Czarnecki the owners of the premises described below, hereinafter referred to as the Purchaser offer to Bath Busters, hereinafter referred to as the Contractor, to furnish, deliver, and arrange for installation of all materials necessary to improve the premises located at: Stanley Czarnecki 285 Hatfield St Al Rivera al@bathbusters.com Northampton, MA +15082438029 8608032275 stan.czar@yahoo.com How did you hear about us? HD South Hadley, MA Project 1 (of 1) Bathroom Project Type Shower Shower Project Type Tub to Shower Shower Base Type Regular 3 Wall Base Drain Location Left Hand Base Bathroom Floor level? 1st Floor Soap Dish Wall Width: 58.5" Existing Tub Measurements Soap Dish Wall Height: 97.25" L Sidewall Depth: 31.25" L Sidewall Depth: 31.25" New Shower Measurements Soap Dish Wall Width: 58.5" Soap Dish Wall Height: 97.25" Shower Base Color Solid Shower Base Colors Solid Shower Base Colors White Will ALL 3 walls be the same color as each other? Yes Wall Color Solid Wall Colors Solid Wall Colors White wall color White wall color Wall Patterns Smooth White Trim Type Chrome Shower Head Type Moen Dual Head Left Hand Corner Caddy I Four Shelf I White Shower Door I Sliding Door(Bypass) I Euro Series I Clear Add Shower Guard? Yes, add shower guard Add C10 Microban Spot-Free Coating? No, do not add C10 Back Wall 118" Grab Bar I Customer will Decide on Date of Installation Soap Dish Wall 124" Grab Bar Grabbars: Soap Dish Wall Position Customer will Decide on Date of Installation Add Niche? No Seat No Seat Window Yes, there is a window Window Trim Trim Match Wall Color Height: 44" Window Measurements Width: 36" Wall to Ceiling or no? New Wall Will Go to Ceiling New Wall height is more than 98"? Less Than 98" Ceiling Panel Yes, add ceiling panel Ceiling Panel Colors White Ceiling Panel Measurements Ceiling Panel Measurements Phase 2 services Flooring Install new LVT flooring Install new LVT flooring (customer supplied) Toilet must be done Remove & Replace Same Existing Toilet Remove Existing Vanity & Install New Vanity (Customer Vanity must be done Supplied) Special Instructions for Installers Special Instructions for Installers Page 2 of 14 Home Owner Home Owner Stanley Czarnecki Stanley Czarnecki July 7, 2023 July 7, 2023 Consultant Signature Al Rivera July 7, 2023 Page 3 of 14 Installation and Warranty Details Plumbing of valve, drain, and overflow inside wet area will be included. Any and all wall repair necessary. Any and all floor repair necessary. We clean up at the end of each day and at completion of job. Lifetime warranty on Acrylic products (no abrasive cleaners). 2 year workmanship warranty (from the time of installation). Estimated Start and Completion You will be contacted by our team to set a firm installation date once all the material is ready. Note to Customer Welcome to the Bath Busters family! Thank you for inviting us into your home and trusting us with your business. Your satisfaction is our TOP priority. We hope to EXCEED your expectations and make you Goodwill ambassadors to your friend, family, and neighbors! We really appreciate referrals. If you ever have any questions or concerns, please contact our support email address: help@bathbusters.com Notes from Consultant Welcome to the Bath Busters family! Should you have any questions, please call me, Al Rivera @ 508-243-8029 Page 4 of 14 Promotions Promo-Name Agreement(Description) Signature$ Discounted Veteran's Discount Veteran's Discount $1,000.00 Referral and Marketing Promo Referral and Marketing Promo $950.00 HD Promo Home Depot South Hadley $1,000.00 Referral Bonus and Marketing ($1,000)Referral Bonus and Marketing ($1,000) $50.00 incentive incentive Promotions Total: $3,000.00 Payment Details Sub Total $21,264.0U Promotions Total $3,000.00 Total Contract Amount $18,264.00 Deposit $4,000.00 Deposit Form of Payment Check Balance Due $14,264.00 Balance Form of Payment Financing Deposit Type Amount Check $4,000.00 Page 5 of 14