29-167 (4) BP-2024-1095
106 BRIERWOOD DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-167-001 CITY OF NORTHAMPTON
Permit: Exterior Res
POISONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-1095 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est.Cost: 3259 PATRICK KUBALA 100114
Const.Class: Exp.Date: 09/09/2025
Use Group: Owner: SCHEELE,NATHAN A. & HARMONY
Lot Size(sq.ft.)
Zoning: WSP Applicant: PATRICK KUBALA HOME IMPROVEMENT
Applicant Address Phone: Insurance:
5 PELL ST (413)589-1010 WCA1038596
LUDLOW, MA 01056
ISSUED ON: 08/27/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE 3 BASEMENT HOPPERS
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: /7
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
f,n rG Pegwn,z�T -to: Ile✓`",.(1 4,0AL.,411OA•)e- • - 0,71
The Commonwealth of Massachusetts /9�
0 Board of Building Regulations and Stand. ds C FOR
' i Massachusetts State Building Code, 780 'MR �/ NICIPALITY ;
Building Permit Application To Construct, Repair, R. oval- Or D�Yt4bfish a I 'Ui
One-or Two-Family D?:veelin \46'A1 9
,... This Section For Official Use On-Nty 09 7ce,, <94
Building Pen*Number: 15P'�y'- /(Y S� Date •Applied: "n`I;ri
c 474 o'°07 I
'13uildmg Official(Print Name)
i ignature Date / i
SECTION 1: SITE LNFORMATION
1.1 PropejAddress: 11.2 Assessors Map& Parcel Numbers
/b 6 .i2��i2 !e oe 0 .h a✓
1 1.1a Is this an accepted street?yes / no Map Number Parcel Number
1.3 Zoning Information: i 1.4 Property Dimensions:
! Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
j 1.5 Building Setbacks(ft)
t
I Front Yard Side Yards Rear Yard
Required Provided I Required i Provided j Required I Provided
i
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone information: i 1.8 Sewage Disposal System:
Zone: — Outsideo Zone? Ntunici ai ❑ On site disposaD
Public D Private D � Check iiFl yeod❑ p system
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
424 w ,v cit. /•/R/to/0`t,y SC/4 ee-/.e_ /Iod4 ryC£ o?/9 die 6 o?
1 Name(Print) City,State,ZIP
/d,4L3R.FER /�)oov Og 4/7•oll • C/06
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 I Owner-Occupied 0 I Repairs(s) 0 Alteration(s) ❑ Addition ❑
1
Demolition ❑ 1 Accessory Bldg. 0 I Number of Units I Other 50 Specify._ _
Brief Description of Proposed Work:: ' r _�. << - _=•. --
f
1
•
SECTION 4:ESTIMATED CONSTRUCTION COSTS
•
Estimated Costs:
Item 1 (Labor and Materials) Official Use Only
1.Building I $ I. Building Permit Fee: S Indicate how fee is determined: j
2. Electrical $ 0 Standard City:Town Application Fee
•
0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ , 2. Other Fees: S .
! 4.Mechanical (HVAC) $ List:
i
5.Mechanical (Fire $
Total All Fee •
Suppression)
Check No.qI� Check Amoun`:,V Cash.rnount: •
} 6.Total Project Cost: ; S r`J" �� 1a ( ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) '
/vO i; fr/ylo2.r"
"ArTi(021".4' `!1(*4 A4 l✓ License Number Expiration Date
Name of CSL Holder(Or homeowner if owner applying) r
List CSL Type(see below) vt
&4/ Nitarao06 Jr
No.and Street Type i Description
/ U Unrestricted(Buildings un to 35.000 Cu.ft.)
�M 10 ��} �l OSV R ; Restricted lea.Family Dwelling
City/Town.State.ilP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
//43 '.5a 9/v,p ZYe_ .f y lA K“ea.z a 1.1v9'7E; 1 Insulation
Telephone Email address `c M D Demolition
Si Registered Home Improvement Contractor(HIC) oZ e',,�,/ / / // .2;/C 6444 dome 27nAgo Yeal<Ai ' HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
34 /44 as R 29 ..PT C,� Y,r a k ac.4011,u.i pule . G'P�'
�J v
No. Street ! .Email address
nlow 464- 0iaS6 ••,,, -Sip-0,1
City/Town,Statb,ZIP Telephone
Fl lik* RVE4DIVFPEPiSATIO? INSURANCE AFFID 4VIT(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 Issnanr. of the building permit.
Signed Affidavit Attached? Yes k No 0
"' t Q31T'7 OWI ADTffOItI/ATION-TO BE COMPLETED WHEN
r�.,._-. 'S AGENT-OR CONTRACTOR APPLIES FOR BULLDLNG PERMIT
I,as Owner of the subject property,hereby authorize 4T, rC.ét 4.0.4,4.44 :o act or
behalf,in all matters relative to work authorized by this building permit application.
JCL A -,..L.9
Print Owner'siame Signature Date
v .,;':; ¢ M.. .y GTUT}1 71 ; riVNERPOR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby arrest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the bes knowledge and understanding.
Print Owner's or Autho ' Agent's Name &Signature 780 CMR R105.3(6.) Date
rF... ��.,.,• z - r _•r.;: NOTES:
1. An Owner who obtains a building permit to do his/her own work,or art owner who hires an unregistered contractor(not
registered in the Home Improvement Contractor(MC)Program),will riot have access to the arbitration program or guarar
fund under M.G.L.c. 142A. Other important information or.the HIC Program car.be found at www.mass.gov oca Inform
on the Construction Supervisor License can be found at www.rnass.eovidps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basemenvattics, decks or porch)
Gross living area(sq.ft) Habitable room count
Number of fireplaces Number of bedrooms
1 Number of bathrooms Number ofhalf'baths
Type of heating system `umber of decks;porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost'
Kubala Home Improvement
Your Window & Door Experts
34 Hubbard Street Ludlow, MA 01056
855-458-2252
Customer authorization for building permits.
I, kJ r THJ4 ) lJ' C.{fLet , as Owner of the property located at
We, g(Z► wvops 'p2, r,,oec4.x'1 d,>t °f°�' hereby authorize Patrick Kubaia Home
Improvement to act on my behalf, in all matters relative to attaining building permits, and
all matters relative to work authorized by such building permits.
Signature of Owner Date
KH1103
av ua � Vf 11114JJKL/LLLJCtia
Department of Industrial Accidents
Office of Investigations
Lafayette City Center
,/ 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /�' Please Print Legibly
Name (Business.'Organization,Tndividual): /�..!/j9Az/q / of E �,pl�, n/,.,preir,r-
Address: 'y ,a.4,6l3,4ie2 7'—
City/State/Zip: t hu) /1_ r/PSC Phone #: 41/,3-L3 F /O �U
Are you an employer? Check the appropriate box: Type of project(required):
1. Pi I am a employer with 9 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' q Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 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 12.1=1 Roof repairs
insurance required.] * c. 152, §1(4),and we have no
employees. [No workers' 13.❑ 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.
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:heir 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. //yy��
Insurance Company Name: ///4,Q G#4/1/7-5 /27k - c4 -SUip4Are e CC}
Policy#or Self-ins. Lic.#: /d3,1,5!, Expiration Date: 6h/o?G4s"---
Job Site Address: /0 I3"CreE * as a ) A City/State/Zip: �lcve eikec # ?v4 01,6 (9-
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 eemfy under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone#: 'j4-i-���7 /0,0
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(check one):
1❑Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector SC/Plumbing
Inspector 6.0Other
Contact Person: Phone#:
PATRKUB-CL LWONG
ACORO' I was t,•uoaYYYY,
`,,..-- . CERTIFICATE OF LIABILITY INSURANCE you
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 PROOUCEF,AND THE CERTIFICATE HOLDER.
IMPORTANT; If the certificate hdtder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, s to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer ri to the certificate holder in lieu of such endorsement(s).
PRODUCERCT Lori Wong
Smith Brothers Insurance,LLC PHONE _.-.._.... Fut
300 Main Street (A/c,Ns,RA):(508)499-5064 WC.No}: --
Oxford,MA 01540 i Ism",Iwong@stnithbrothersusa.com
INSURERTs)womenI:OAlERAaa macs
INSURER A__Merchants Mutual Insurance Company 23329
INSURED nNsva6s;,MAPFRE Insurance _ 423876
Patrick Kubala Home Improvements dba Kubala Home IMR II c:
Improvements
-- -- — --
34 Hubbard Street IMINIR6R D. _ —_--
Ludlow,MA 01056-2762 L1NsuRER E•
INSURER F:
COVERAGES CERTIFICATE NUMBER_,'-_ REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POOCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN4' 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.p LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
aim ,=01 w D POLICY NtME11 P � Y EMA j LINTS
— —-- —
1� TYPE OF INSURANCE VYYI r
A X COMMERCIAL GENERAL LWILRY1,000.000
] _ : EACH OCCURRENCE ;$ —
CIAIMS•A AOE X OCCUR BQPI109317 6/112024 6/1/2025 DMMGE TO RENTED
-� �PREMSES(Fa oodmlloa) #>i 500,000
_— MED EXP(MY one pawn) $ 5,000
_ t PERSONAL 6 MN INJURY $
Included
GENT-AGGREGATE LIMIT APPLES PER l ) GENERAL AGGREGATE I$ 2,000,000
X pECT PoucY I I.I L_i LOC j PRODUCTS-COMPIOPAGG $ 2,000,000
OTHER. ( (( $
B AUTOrOdLE UAS1UTY : f COMBINED SINGLE uMIT 1,000,000
s
ANY AUTO BDMM64 6/1/2024 N1/2025 Y IN'1---ter ovw,) $
"--_ AUTOSA� p ONLY X .AUUTTOTOSSUryLEDp BODILY INJURY Mr Uodds )3
_ N Tf l ONLY X NAl1T'O'OH[Y I _t �E s
I is
A ,
X unsRELLA LNAs IX' occuR t 1,000,000
—
eXCestiu a ClAI1113�M110E ICUP91S1661 6M/2024 6/1/2025 EACHOCG�I�3ENCE $ 1.000,000
DED RET£Nr10N$ 10,000 $ _
A woRKERB COMPENSAT�E1p • ( • R I pTIT
AND EMPLOYERS'LIABILm 11111T 1AIUIE_L__._�ER
ANY PROPRIETOR/EAXRTNF�CUTIVE INN M!A At036'J96 61112t124 (i/112025 EL EACH ACCIDENT $ 1,000.000
1 •
EL ES DISEASE-EA EMPU Y _ ,000'000
�yes,daaulba under
pE$CRIPTIQN OF OPERATIONS WowEL DISEASE-POILGY UNIT $ 1,000,000
1
l
.
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES WACORO 101.Additional Remarks echsdtls,very be attached M more spuos Is rsqukadl
CERTIFICATE HOLDER __•__ CANc€LIATION_
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE TIO DATEKubala Home Improvement,LLC ACCORDANCE WITH THE POLICY
RP OO ISIOMS. WILL BE DELIVERED IN
34 Hubbard Street
Ludlow,MA 01056
AU1110RIZED REPRESENTATIVE
X00 /
I
ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
{{lr n Aj i•A.• •: r ,,�+ ajw; 1st P It
0i4.41:4411,z
' •'9:.!4y.a A" .'1'r.'''''rei. .7,x
- ta u:aYf`•, •r ',�' [n V^;;� i ''1 `,15 ,.'it> •' IV.'
I' •- J
:,-,,..., •4 :V;,.If 4.4-fi't,,,iri.14.11 . ' i, PX.NL,._4.4.,!,$(14;,4i)! •,));:i.; fr'.00.‘ •tiJ.0,,,,,:4_44,,,/: .).•.71.',;,,"If': .'...N.:1
:::' ..,II* •-•'4'aik.. .1,. ' tfr,,IVii:./'-•,',..'i,* ...,.1‘•'.."1,:i..9. .•71,... ..; 4.., .6,**. 4(4.I.1"lict4t 'Cl.a.M. ' . ' I '' ::
N -'4V4.1.4)‘f:054V d' • 4 Ni'.. '?':;•' .''''''•
J a. o p i I'`+i�+y, '�tA? rG+ r1;`�.2br 4+ j�( •x:t ;b
=re V C 1� f6. I..j • f •, j i, .VtJ'• ,; •• y� ��r Ci`,;`j,'' �I�.
• QU N -or l .... cb.�+,t .9 { ��r,y,1'ytl�'v ;r.x� 1 f r },t�.ai£It t 1 ,
C r+.4::lu�KS tit .a ai. oi,,ri •411.,•8b A 446.4,),,tow,V k •:•' g t ry' N 1
Q w Y 1;,fY • f• o Irt r . •y t�iy fr, J 0.!A� k,41* A✓ , +'•. • •I`
m t,)•'' I �; i t . e.� r }FF�y{{i • t j� ••i ` Y \�1, . N f• .,
IL ,tl, - �i • :`•i F. °fr rk •rtfrl �r,3�x rt ��,• 3'•N' { • }; �;1;ld
Qill '',11� (., I; r' .l 14 •Ti I. .4itr,� '��Y�.t !)�L10.1.". , i re,` `1r,11,e �hY`f klt..')
X j' ai 2I I '1 •\ , ;,D , t.,y y .R11. . ••t•,K�,au' i 1 • j• ! +•t4, ' rc3P � ` y tj
•
J ,W 2 'Al.
:� ,? , ,J �.-fti+1 Cam., iw „R�sr !' `.; {,�:' �,,.�4 fps/
a' .( t yt...,:- 'i' i 4• { e 1�,.1i'1i�!"�k Ill , 1
z co 1L 1 s"(�c,}r; I ` .ta` 4-,' S�/ v` •, } `P.S. ', A•" i �• •r AV,,�yvy;;!1 ‘• O N 1F'!SY' Jy �'t :� .,yu .�• �4 �,1•..04�4*--• f41,• l t.•1,H•/ t4 ,.y� 0....„1y t
o W Q fu co
NW , t'4...,;.+ "`,•ti °Y .1 •-1'.',I tipvif!!/�s-!!�it yy •:7 yi�p�,1','�r,,,of
,„..i
t O (. O t1J .5 h O �' 4 t -•-• 4 •
,••.:, .r `l 3.. . •�' •fr:A,At q ,lN3/n [I(' {
5 W o, O0 al
0 Q ! f• r .`t;d rfl"if 1 I+rYa3•ti: ( �c,k t .1 nt�• 1 �':. ;•�y V It
Z E .I: Y Qj 1 ;y }""!fR!`11dt f I."r.,)dw`.• •N'f'•`i t N �r• 6 • i .;
p Q O (`/ �� C, „` �e ft c`!{yy[k ,aria bpi .Or � r4' 1 1L{`. 4...j �t. .
Q O \ • I. .i' q e",t '• ' v t�1!.'..4 ri, ..t k• `.,' ."" )•• )rk , 7 + %t A.:
:J :l•c• •y '•�t`�'' 13:, ' �1�l><i %t •wir l3 K I. `j
. Y` ..,r
2,. ! .•� ' �l►y y'. • Iik r•i),,., ., . ..:..:
(�: r 1� �t!R!{• : Il..,(,. ,.,;.A< 0u �` tivkt,aiy t!l3t>• :as 10/ i#M'.4.:,t,i..71 �,aF'3 ;��+ �� `•'F•�pA! 5``k I � 'I
• pi a �r 'tt /CA.">�► 1 ''• c'kr " 0Ya, Y�'• rEfa \�' >r
av, f! ••••:•.e,•••• `.. 1 ( ,y' 1. ,14:' I.'a " .tk 'kap ..sh*..t.',.131,,.. • ". . Ptirk. 6 :, ji: ,4,,.''''kW As.:' ' I. ....i..
•
j, f M.� K rk• '1, '• , r% .i�a k'r1 I s ��1�yf t�.Y��.�t, 1
C n O r.k..Nwaorcaaw...xr�..,.. �. *. . y..47.4.e. 4 ,',t':Vit ^ • 4 • ''' Trti,i ` .;;i igi '�M , „ ,
A to 1RIU�r :\ . .1 % r`. '�,4v : L•.;i§ rYry,r'r•, N!; `;'1e....4.ret�'1�itt{�, ', 4 �
y +tj W q,�l, J ,� ,t;�;,,�e \ ,f..i` 1' A ! y..+1'?t l'P f I'r �`.�r44...40g
.j'V�. !•...``''SS fY! ,
�,t �:...a..• + • ,` • hr l -'• + '/ 1: c111Y�Flliiiiii ../
a - ...I uaie`t:..'ra,C •Z`k �lYt€i',�k ,> �1/ ,ct'ta� f :;•T�*i:��y'�f \
Ire-3
f`` \*4t•y : t � �� �r3 � � 1�rA�•;i' '•' rl ,c,•�:a � *y..,'.ult1 �.
gi
�!d"t + ,, .,0:�:.`?r'j.te 11R'� � p' ,t 4;. f,'fxr ' '' 'il •`� gel
716'1
'�1 t�. �•�rff- O tt' .(•W� r''i„ 4 7,r, L�+4 ,y. ,,, •,�� 1'Ip ;{' F.rt�:1' a ;..l•: t1,,..4h
?� it A.'� ; „N Kr' ,�,�+ f x'4 J"',Y ..{4 l.4.:'•,i,•.;�+ . ,:F'.',•,.,. ., .1.
4`'‘ ";. i,,,rtfi'ilv .'4.„-,'iri„.'•''',:s!•'"•`''•.I i:.47th'': •
E . . 4 ':• ,,,I...- '' -��,,.� .,k50 •�• t a c •! pl'itr, f': : ,`Ci '•K�
bi ..4! gg ._ , .
O ;i M C'I L•i � ��,�l t ,. •x ti,�� (",,J. •.'•r S.r .v f-•�.r f t i -',. � ,
.-. ! - ' 1"►4 'tTt '.. 'r'f• Rf ,Ye •r.4$ !i' •'A•1ii�••i li';/r ,.;,i4'fl.:e.: s
g �' SS.�F v''r'7 J , i f, �..
i` '!',6••.• •
•.' S m,iti ram'.•' o ., w. ..15.,r• {:PIre• i,... • .:.
nria•aevirnir.l.+,w"•• •.rra.n: .,r.,rw,.r +rrl��rren••.•'`. 1
•. - \ .,:1
•
s
,
I
, •4 1.v .
. . , .. .-
,..i.
or"
. 1 ..
•
. ' .
. . .
. . ...-
;
. .
. • ' 0
- • . 1 i U. . ... .
I
•
• M •
•
,
:I ‘• 1:114 4.
i!, ' 'it t..1 . .Nti z45.).. •%:''
1 ite
i k.Z.i Ill
k.-.1
i tit,to
•I. .
. p .;•.f.?) i-1:tili iii
•
•Vi
1 .
.#0.,4.-P,,•;01 fii II -• 11
t'', It
( ; •••,•
V> 9/
I 7K,1. 1
..0. .4111 ii.rri 1....-,, Iii r (.,
i 14. ,i,i ., • :,..1 1
19;;;I-!til 't .
' . o ir t.',1 e).
. ,
IA
0 fi b p.i;1 EP •' r:, vil •
.., K, l'i 6, vi) !;.:, •
. • ,•••:,
• ( 9:`,:'
• . 12 . ,
r A,
.11: 114.)?.,1 ;:a1,1 :.'''..), •
..1,
, t'...1i1).0 .1 f),.) .: r•.' 0
1
ri t
.0,
(... t h •
tit itoN' ' to(.1 0 1.1 ifoi I., I).(5)''' it.:1) ti ii Ici;;,•1:,..i. I
11)
4•Z i.
6
1-0.1.1.'
li •
il
i, (),.....),N
..... e.,..
.to-I i,,, ,:c• I
i,„
i
$^. 0 I:
,
1,i ., ...,.: .),•••,, lo ..;.., ••) I
'if.'.k• ••,) ',1, It.'ie.1 I/ e
..,, II
6) '\
I'd tr• r fA.
.1 ,1 0 ., .A (,) (• .,
1
• ::.1'ii. 1(.1 1 IL.t j ' I
)t..)
111 :::.':: sz 1,,o pti 0.4 iK
4.)
C',)
10 0 til 'Y',)r II
. 1.... • --.. , 0, 0..7 4 1.;.', c„ ,...: •,.,•:. 1..,*1
th • •3
0\ VI j•kl •' 1.•.•
feL ,1:1
It
t31 •ist A()VI IA C(1 W rt f 1) '!..:1 9;41 VI
(.4,1 li ci IA 0 — .;1 e ,, ta, si,'
IC)
1
IX.1,11 I iii V .. : -',1 itr.:41 C.) (.1 A.' 1,.1
sti() s, (0.1 I.'.;9 r? il!' 11.; 0 (,°:')
6' el 4•;•ri f).1,,•1 t .„
• . 0 ..,‘,.j.. -,!., oil
•I. o 11.1.4 ‘I, ;to t•I i..)
I',
..i. ;....4 t...i
(J., Co?, .. .,.. .. t
I
`'`; k i'' • 0 111'1 it• 1::A
— (. (''' 'it ',..;el.11)1,1:11"..,;...'.;
... i IA• hi
CO • ••• Ijj
•••I
..,
• t I Iii iil
IA la ty•t,i il k
ol)I'l''''01'.... i l', A lc
'•••‘
C.,3 I-• 4 .1 :11 ,..)
1 •
1'',1 0 0 't•ii ••L' 0 •.
, •• I., 41
h,
0
.• ,
il 171,31 1:e. • i il 14. (41) 0 1:.r, i;i I../...:
1:,1 ..4
\ 1
0;4'i• ..1 .1. 41, ..• f••••
tiP.,
it t1
‹.1)1 toi tAtt
g ilti 11' . \ q 1.1' (:,',;l?.'• 1(1
I.". ,...
e.:. t•s•I
••
••,•, ..,
•
,„.kii 0,
ti.
• 0',0(,i;4
Id ki,
i•I\\ 4
;1,10.,. ,,.,.. • (. V
trd In
(k; (
11I ;10 i lil•,......: GI
() .1
61 J
I r.• I(f I.
I CI.
I•.I •;,I -e..,(.,)( ,
,•••X ...:Al
.)()ij ()
W -1 • it%
( t,
0 ••
I i 11,
i 7) ?o.;I:
P • .0
I:I
1 e I 1,A) It
DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in
a ylot crly Homed solid waste-dispesal-faeilityyas defined by MGL c 111, S -150A.
The debris will be disposed of in:
LOCATION OF FACILITY
i� S/`'
Si . I. of Applicant Date
AFFIDAVIT
As a result of the provisions of MGL c 40, S 54, I acknowledge that as a condition of
Building Permit Number all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly licensed solid
waste disposal:fecility, as defined by MGL c 111, S 150A.
. _--- Cer rhatl 1I ngfX,_e Building Official y (two months -
maximum)of the location of the solid waste disposal facility where the debris resulting from
the said construction activity shall be disposed of,and I shall submit the appropriate form for
attachment to the Building Permit.
/,/�
Date Signature ermit Applicant
(PRINT OR TYPE THE FOLLOWING INFORMATION)
47 FCF ✓Lk lit Lf{
Name of Permit Applicant
l ortird,rc i`s,.Ga �ati+sl eo,1i.#i if
Firm Name, if any
Kubala Home Improvements
The Window & Door Experts
5 Pell Street Ludlow, MA 01056
855-458-2252
Kubala Custom Windows
Energy Star & Performance Data
Revised June 2019
OPTION MFG CODE U-Factor SHGC VT CR
Omega-Tuff , S2210A .24 .21 .48 47
Hi-R I N2210A �25 � 28 .52 47
Essential P2100A .30 .49 .60 55
Passive P2210A .25 .48 .59 46
y KUBALA HOME IMPROVEMENT = 1 �
L OVEM NT LLCilkil �� 7/Qq/214
,Y MA HIC#207481 All home improvement crnvmctors and subcontractor% engaged in home ::nprii%einent
34 HUBBARD STREET contracting,unless srecilically exempt front registration by Pr."r`tons of Chapter Id2•�
of the general laws, must be registered with the Common
of Massachusetts.
in uinc< about registration and status should he made to the Director. Ilontc
LUDLOW, MA 01056 q h I, Roston, NIA
Improvement Contract Registration, One Ashburton Place
413-589- 010 0210801717274598
Submitted To: 4)41014.1 - ,A `'
L/_ ZQ1�(0)019p Job Name: 6`-�t-S� � r
of2E4. iiiii4 Q l o ,? Job location: ,M
Phone Date
N- St 1 4_, •G bG 7 r pe Estimator: "g if6A)
it *03 . 2?gy
reby submit specifications and estimates for work to be performed and materials to be used:
r`� j
1�J►�oyr ,��D ?t�pt DF ��/}� -}�D�Pt W. (1.J 'b:G; . _ / ' N W • 7.1'
woo To .� r....,I a.
r 4- 0ppr gs• k ,u26t pJ V10y4. r-010,0
Ftt�.i. i- i •- v f' F
v ,
Nr7 U4J)Por IRLM Eir uN Pogal • . 1-C40 wIrJDow o t1 61►v ItY Dt)1
t►D �' .1t a t►fir iw.i•
r t Goo Ai .
es 1 fi , .�4>NC • Pt t 5164.. a wteteT tO&
WORK SCllf:l)UI_F.
Contractor will not begin the work or order the materials before the third day following the signing of this agreement,unless specified herein. nnrractor will being the work on or
about oodeOHaring delay caused by circumstances beyond the contractor's control. The work will he completed by l (datc). the owner hereby
acknowledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor including hut not limited to strikes.Acts of God,
shortages of materials.accidents,and all other delays beyond the its control,shall not be considered as violations of this Agreement.
WAR RAN7-Y
The contractor warrants that the work furnished hereunder shall he free from defects in materials and workmanship for a period of following completion and shall
comply with the requirements of this Agreement. in the event any defect in workmanship or materials,or damage caused by the Contractor its subcontractors,employees or
agents.is discovered atler completion of any job.including clean up,the Contractor shall at its own expense,forthwith remedy,repair,correct.replace or cause to be remedied,
repaired or replaced,such damage or such defect in materials and workmanship. The foregoing warranties shall surise any inspection pc-rfbrmed in connection with the agreed-
upon work.
VVe Propose h• eby to furnish material a d labor-complete in accordance with above s reifications, for the sum of: y
��-#Q ' �HD� j) �WD _v v��� rOlga. $snars(S_ , Sq 8
p; nt to he woe as four sss`
'h( /r-.0g0I•,Tupon signing contract 4.t1 .' /t KUBALA HOME IMPROVEMENT LLC
"_.%(_ __ ___l upon completion a - 34 HUBBARD STREET
W.
�"s.o( 1uponcompletionof�._~- LUDLOW, MA 01056 413-589-1010
411/1
�7'.;(4-Q, _)shall be made forthwith upon C,F$ 6 Nit ' MA HIC 2074
T completion of work under this contract n
Notice:No agreement for borne impro%emcnl contracting work shall require a down payment Salesperson: �l�-)1�
(advance deposit)of more than one-third the total contract price or the total amount of all
deposits or payments which the contractor must make,in ads arm:,to order and/or otherwise Authorized Signature:_
obtain Misery of special order materials and equipment,which es er amount is greater
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. I'a ntent will he made:as outlined
whose, You the buyer, 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. Please refer to the Notice of Cancellation that accompanies
this contract;contents of which are referred to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BBLAN SPACES
Signatu . Date?" a Signature /V — — Date �'
kitti.ii