29-175 (10) BP-2024-1516
175 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-175-001 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-2024-1516 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est.Cost: 11384 PATRICK KUBALA 100114
Const.Class: Exp.Date:09/09/2025
Use Group: Owner: PAUL HOLDEN
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: 11/13/2024
TO PERFORM THE FOLLOWING WORK:
11 REPLACEMENT WINDOWS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
l-nderground: Service: Meter: Footings:
Rough: Rough: House # Foundation:
Final: Final: Final: Rough Frame:
Cas: Fire Department Driveway Final: 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.
Signature: ft7P
Fees Paid: $60.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
& The Commonwealth of Massachusetts •
�`, Board of Building Regulations and Standards FOR
`i i' Massachusetts State Building Code, 780 CMR ���ZCIPALITY
Building Permit Application To Construct. Repair, Renovate Or Demolish a Ret isea S Mar 01 i
i One-or r. Two-Family Dwelling
This Section For Official Use Only i
Building Permit Number: /lj O oZ 75 N/Ce, I Date Applied:
•
Bull Official N •
�S , �t Nine) Si store Date I
SECTION 1:SITE LNFORMATION i
1.1 Prope Address: i....Assessors Map& Parcel Numbers
l.la Is this an accepted street?yes )C no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frema c(f
j 1.5 Building Setbacks(ft)
Front Yard Side Yards •• Rear Yard .
Required I Provided Required I Provided I Required Provided
} i i .
i
1.6 Water Supply:(M.G.L c.40.§54) 1.7 Flood Zone information: ' 1.8 Sewage Disposal System:
Public D Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposa system 0
i Check if yes0
SECTION 2: PROPERTY OWNERSHIP' .
2.1 Owner'of Re-cord:1 ,AU L � ��o 2-J a,/ ,e N c /yl4 of a 6 Z_
iName City_State,ZIP
1/7.c ,‹ooxs,,/, �>,c. 0.r.3 • 3 •
• No.and Street Telephone Email Address ___
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
•
i New Construction 0 1 1 Existing Building 0 t Owner-Occupied 0 Repairs(s) 0 A tera:ion(si 0 Addition 0 .
i Demolition 0 1 Accessory Bldg. 0 1 Number of Units Other a Specify:_ —
Brief Description of Proposed work': "Keel.¢Ce l/ a t✓e%a/ S
I •
• SECTION 4:ESTIMATED CONSTRUCTION COSTS •
1 Estimated Costs: Official Use Only
Item I (Labor and Materials)
1. Building $ 1. Building Permit Fee: S Indicate now fee is determined:
0 Standard City;Town Application Fee
2. Electrical $ 0 Total Project Cost'(item 6)x multiplier x •
3.Plumbing b i 2. Other.Fees: S
4.Mechanical (HVAC) , $ List:
5.Mechanical (Fire i 1 „
Suppression) S i Total A,=
Check NtSt 0 g Check Amoun O C sh Amount: •
6.Total Project Cost: \ Si( ? GZ,�.72 1 0 Paid in Full Cl Outstanding Balance Due:
-- a SECTION 5; CONSTR£CTION SERVICES
3.1 Construction Supervisor License gm.)
/vo i 21- /ylo2.r'
•--�5� der Expiration Dare i Name of CSL Holder(Or homeowner if owner applying)1 C9V /4/ 0 Z ST ' List CSL Type(see below) a
No.and Street Type I Description
"M IQ cu Thq. d J 0s ! Unrestricted(Buildings un to 35.000 cu.ft.)
I City/Town,State,LIP R I Restricted I&.2 Family Dwelling
M ! Masonry
RC Roofing Covering
WS I Window and Siding
SF I Solid Fuel Burning Appliances
9/vi0 r K !�. E. I ! Insulation
j Telephone mail address " D j Demolition
S.2 Registered Home Improvement Contractor(HIC) oZ�,��� /� i,J
r�fiL6�bAO MC 2/17Ae0 yf aleAi — :DC Registion Number 'Expiration Date
HIC Company Name or HIC Registrant Name L/
1 ,2+i� �u6.4AAV J'T h CYe,..4 Pfeu.A4L9.i1p/YK , _.1",-)-
1 No Street Email address
r)Iow /IAA- a, o.S6 11,- •Sa-F—,"iv
!
City/Town,Statf,ZIP Telephone
-,'+ '4 'ICOIVIPENSATION INSURANCE AFFIDAVIT(NI.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 drnial of the Issuance of the building permit.
Signed Affidavit Attached? Yes • ' No n
;,.,. 7 ' 47.r ,+ 7,s:O' ER.ADTHORIZATION.TO BE COMPLETED WHEN
•�__ ___ ,. s. .r t .S AGENT-OR CONTRACTOR APPLIES FFORBUILDLNG PERMIT
1.as Owner of the subject property,hereby authorize 4T .Dt +mod LA :o act on
behalf.in all matters Art'
to work authorized by this building permit application_
jee �'r"r. ;e'.44.
Print Owner's Name Signature Date
-Ai 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 nontained in this
application is true and accurate to the knowledge and.understanding.
Print Owner's or Autho ' Agent's Name &Signature 780 CUR RI05.3(6.) Date
. ,.,� .. NOTES:
2 An Owner who obtains a building permit to do his/her own work or an owner who hires an unregistered contractor(not
registered in the Home Improvement Contractor(HIC)Program),will fiat have access to the arbitration program or guarant
fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at www.mass.gov oca In`ornat
on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is plan►ii provide the information below:
Total floor area(sq.ft.) (including garage, finished basement/attics, decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks;porches
Type of cooling system Enclosed Open
1 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, --1721310 0H_R 4,406Pf , as Owner of the property located at
( 7 c &Do s)p,<C . fi�.o,2 j.ic41 MA ��
(2 , hereby authorize Patrick Kubala 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.
143/v1-1 /9q
-
Signature of Owner Date
KH1103
1(t l.l.gt11N.((rPCUttlt (.f :rtU3.3Uc14M3rtia
Department of Industrial Accidents
Office of Investigations
N=7 } 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'lndividual): 4/402 E ve 0-,e0L.- 7—
Address: eYfl `/k, 4a,p,
City/State/Zi.: L2Io W i4 r/d - Phone#:_ 03 —,S Pf-/e i v
Are you an employer?Check the appropriate box:
1. I am a employer with
7 4. ❑ I am a general contractor and I Type of project(required):
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'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] ' c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.
'Homeowners who submit this affidavit indicating they axe 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 their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance Or my employees. Below is the policy and job site
information. ,4 (�j _
Insurance Company Name: I ,?CMQ/V7�S'' 4 ree4-4 ,_,�A '(L,2a4?,- c Co •
Policy#or Self-ins. Lic. #: 6i4 /0.3�.f ir�'' Expiration Date: 6//a e'.2 J�
Job Site Address: /f'S ,-cS''.o1G. City/State/Zip:/2,tLA/ , 4/19 4/D 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that t rmation provided above is true and correct.
Signature: '/ Date: /''/7/2 >
Phone#: .5/41--L /0/
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(check one):
10 Board of Health 20 Building Department 3.DCity/Town Clerk 4.0 Electrical Inspector 51=1Plumbing
Inspector 6.0Other
Contact Person: Phone#:
---,'"'"'IN PATRKUB-CL LWONG
ACORD' 1 DATE(MMlDONYYY)
�.......- 1 CERTIFICATE OF LIABILITY INSURANCE 024
THIS CERTIFICATE IS ISSUED A$ 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 PRODUCED,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER ►CT Lori Wong
!Smith Brothers Insurance,LLC PRONE 300 Main Street WC,Sp,a :(508) —� _
` y ---
Oxford,MA 01540 Ataatl_wong@smithbrotherausa.com __ _
/NSURERISI AFFORONG COVERAGE HNCM
----------____-_ -- imamA:Merchants Mutual Insurance Company_ 23329
INSURED RTSuRJR MAPFRE Insurance 23876 ---
Patrick Kubala Home Improvements dba Kubala Home IQT —
Improvements --
34 Hubbard Street INaURER D:
Ludlow,MA 01056-2762 INSINIER E r___
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING AN' 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 SL1�H POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
RON IADDL.a11SR y YI EfF 'POLICY EXP
LIR TYPE OF INSURANCE ,NM NOD POLICY NOMA 'p011DIVYYTY1, Lem
A X__ Co1MnCUL eamiem.UMIUTr 1,000.000
! EACH OCCURRENCE
CIA IS.AIADE OCCUR BOPI109317 6/1/2024 6/1/2025 DAWGE TO RENTED 500,000
PREN s E.�s�e1T.__ 5,000
_ MED EXP(Any one swoon) i$
ded
_ PERSONAL a ADV INJURY j{ Intl i
GENT AGGREGATE LT PER: GENERAL AGGREGATE r. 2,000r000LIMITX POLICY JpERC�T ri LOC PRODUCTS•COMPAOPAGG ,$ 2,000,E
OTHER: [ € 'f
B AUTOMOBILE LIABILITY ! i COMtee nIe se NGLE LIMIT rsi $ 1,000,
ANY�AUTO _ ( BDMM64 6/1/2024 /1/2025 BO Vi , Y(P«minion► 11
_ AIJcOi ONLY X_ AUTOS LED
1� AWN?
pB�QpOIpLEY INJURY(Per accident/ $
x AUn{RfONLY x ("t1TOS OIAY' �_SPar R� 1_ --
I t 1,000,000
A X UMBRELLA LIAa X OCCUiI EACH OCCU13BliPlCE $ _..._____.__.......__..._............
EXCESS LAB I cLAILIS MADE CUP9151661 6/1//2024 6/1/2025 AGGREGATE.._._.._ $ 1,000,000
DEO X RETENTION$ 10,000 $
A WORKERS COMPENSATION II?pp�t
AND EMPLOYERS'LUSRJTY `STATUTE
ANY PROPRIETOR/PARTNEREXECUTIVE V N WCA11036596 6/112024 6/1/2025 EL EACH ACCIDENT $ 1.000,000
pfF10ER/M(M5ER EXCLUDED, I I NIA
IrylyaanadeMne M NH)under,desert* E.L DISEASE-EA EMPLOYEE $ 1,600,000
DESCRIPTION OF OPERATIONS below ' r EL DISEASE-POUOY LIMIT I• 1,000,000
I
i
i J
DESCRIPTION OF OPERATIONS I LOCATIONS I VSHCLE3(ACORD 101,Additions'Remarks Schodolo.may,be attached H more spice Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
Kubala Home Improvement,LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
P ACCORDANCE WITH THE POUCY PROVISIONS.
34 Hubbard Street
Ludlow,MA 01056 —
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) y 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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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
sprawly solid waste-dispersal-facility-as defimed byMGL o I I is.s 5OA.
The debris will be disposed of in:
/ rya 4.
LOCATION OF FACILITY
11/74 '
S' of Applicant Date
AFFIDAOITT
As a result of the provisions of ViGL c 40, S 54, I acknowledge that as a condition of
Building Permit Number all debris resulting from the const-uction
activity governed by this Building Permit 0,211 be disposed of i. a properly licensed solid
waste disposel.Pselaty, as defined by MOL e ill,S 150A.
-.-- I certify tharl grill natsitLJA Building Official y (two months -
maximum)of the location of the solid waste disposal facility where the debris resulting from
the said constriction activity shall be disposed of,and I shall submit the appropriate form for
attachment to the Building Permit
774 V--
Date Signature ermit Applicant
(PRINT OR TYPE THE FOLLOWING LN-FORMATION)
/477e...rCF Lff
f Name of Permit Applicant
l�orxe-cCdc . .6./!R c .1ire.Go/GI7l,-
Firs-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 r S2210A .24 .21 .48 47
#� Hi-R N2210A .25 .28 .52 47
Essential P2100A .30 .49 .60 55
Passive P2210A .25 .48 .59 46
/F KUBALA HOME IMPROVEMENT LLC N t�i�o g.6 • 4-Ivic 1 013 1( ail 1 r v
�\i MIA HIC#207481 All home improvement contract and subcontractors engaged in home improvement
�, 34 HUBBARD STREET c ra onttctantr,antes specifically exempt from registration by Pnntsion.of Chapter I 42A
rA, of the general laws, must be registered with the Commonsscaltlt o1 Massachusetts.
LUDLOW, MA 01056 Inquiries about mgistration and status should be made to the Director, Home
Improseanent Contract Registration. One Ashburton Place, Room 1301, Boston. MA
413-589-1010 0210 t617l 727-$598
Submitted (Vf)
To: Le 1 /bL vc.& J�
//1 lob Name: / f 01-
(ROOI1-61�‘ 1e,I,.
/(/�Q 0/04R lob location: ( /1,4
Phone 5 'r!pate 1,
443 ' O 3jtJ5 /C/21 /2q Estimator: ,aif- IA !
• =reby submit specifications and estimates for work to be performed and materials to be used:
.I / >! 111, , :• � . /l 1 •OO O a 1,) 8i o F.) 3'D,.7 .p),
>r _ 1 4' _ .s !.
S 7_ '* J
A
i . . • .—. to . iY . - W_1ri r. . �� = 2 L '
o. - . a t IL . ) . ...' ' L . r
1 .1 . / • a/" L. AtMIIIIMPAr// • 4..� . I r.. 1
• S s j 4 i - /0 do i .! hJ 41 � . • --1,. ' ,PA _
. ' . -d c ; S 1 t..i N . i rt. too AV ,I :
1-1- : ` L. , .1 3o-7: war"- T G,1oAl. //4 t GFVae
LA •11- �3tlr
•Poi ti, rd l,ANce 'Dv & 10 T/t W. tGowtPl.4 'op) ,
WORK SCIICt)L'LE
Contractor will not bennn the work or order the materials before the third day following the signing of this agreement,unless specified herein. Contractor will being the work on or
about ,'g Raring delay caused by cin:umstanct_w beyond the contractors control the work will be completed by I _' (datel. The owner hereby
acknowledges and agrees that scheduling dates are approximate and that such delays that are not asoidable by the Contractor including but not limited to strikes.Acts of God,
shortages of materials,accidents.and all other delays beyond the its control,shall not he considered as I.iolat ions of this Agreement
WARRANTY
the contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 74Z-L+D sllowing 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 after completion of any job.including clean up,the Contractor shall at its own expense, forthwith remedy,repair,correct,replace or cause to he remedied,
repaired or replaced.such damage or such detect in materials and workmanship. The foregoing warranties shall minis any inspection performed in connmtion with the agrcei-
upon work.
We Propose her "to furnish h r material and labor complete in accordance wit ovc specifications, for the sum of:
-(i Ai 4409)-/w _ittg vopgepSit y f6W ,liars(S II 3&L • T_1.
l'acmcnt to he f h n r r
4a( � • 1)up nt signing contract; C ttr, a DISC" KUBALA HOME IMPROVEMENT LLC
t �� _)upon completion of �� 34 HUBBARD STREET
L , __ _d_)upon completion of _. ,.-_� LUDLOW, MA 01056 413-589-1010
%t 7 8 Pt shall be made forthwith upon ek6,4/Ctt/'`. MA HIC 20748
eon-mit:irm of work under this contract. r-
Notice:No agreement for home improvement contracting work shall require a down payment
Salesperson: 1
tads ance 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 advance,to order and or othcnsisc Authorized Signature:
obtain delis cry of special order materials and equipment,which eser amount is greater
Acceptance of Proposal: I have read both sides of this document and accept the prices.specifications and conditions stated. I understand tint
upon signing, this proposal becomes a binding contract. You arc authorised to do the work us 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. See notice of cancellation form for an ex/Ammon, of this right. Please refer to the Notice of Cancellation that aecontpanics
this contract:contents of which are referred to above and incorporated herein by reference.
DO NOT SIGN TIIIS CONTRACT IF THERE ARE ANY BLANK SPACES
•
di,
Sianaturc 0--------- -Date (0 r2N/2 L,r Signature Date
Isnunt