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Nearest Street — 1 Nearest Street ft. ,34 ft. ft. fiitage 1 , SIDEWALK V .+-..-‘ '' -.----.. /f 'Qier /ci �� Street/Avenue: Road / Mark North Point Signature ` PLANNING AND ZONING INFORMATION Type of occupancy Front Yard Setback from Property Line ! STURDY HOME IMPROVEMENT, INC. 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BOX 51033 - SPRINGFIELD, MA 01151 MA. REG# 151711 CT. REG# 601525 877- 3STURDY FAX 413 -543 -3200 W WW. STURDYHOME.COM OWNER PERMIT AUTHORIZATION Name: rJ14-6 Le Ui Address: /5 ,s -oe.:— City /State /Zip: � - ,2 ,," 6 I /9 ram (owner), of the property located at: /y 7' -i_6, v�� r , ° /gi Iforize 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 for this project. I understand and accept responsibility to comply with all regulations and required inspections. e /4 __A c ,2#7 Signature of Owner 'II ate Signature of Owner Date d �. STURDY HOME IMPROVEMENT, INC. ACCEPTANCE PAGE MA REG. #151711 CT REG. #601525 ANY WORK NOT STATED ON PREVIOUS PAGES IS EXCLUDED The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work scheduled to begin the week of____ /___J____. Expected completion date /____ /_ _Weather permitting. The cash price for labor and material as described above is: 1st payment 2nd payment 3rd payment 4th payment Contract Total (upon signing) I v trt CO: 14i aim/( - Roof $ Co deeu. Z "/ 4.1 'Yi'1 c (5 A —TAE, . Ventilation $ Other work $ V cc.V--, L.41 $ i y S� o , L.41 $ 1 Q SO $ L{200. $ 4 ,` $ fibs - Siding Qt a $ 4 S $ L tSb . V $ ( 000 $ 1 A J u' .: $ 4 51)." Windows $ $ $ $ $ Special orders $ $ $ $ $ Other $ $ $ $ $ Totals $ I S , 00 0, La $ tS60. $ $ $ Terms: Cash Finance 4. ?Af'L Cie y172- 7_ Credit Card: #— — __ — - — - 407A. C o d e Payment schedule: Any balance not paid in full within thirty days, will be charged 1.8% interest per month. In order to meet the completion schedule, the following materiaVequipment must be SPECIAL ORDERED before the contracted work begins. (Law requires that any deposit or down - payment required by the contractor before work begins, may not exceed the greater of (a.) one -third of the total contract price or (b.) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule) $ to be paid for CD $ 0 to be paid for Any additional work orders are to be paid for once accepted and approved by purchaser. 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 sta d on reverse side and are part of this contract. In witness whereof Purchaser(s) has /have hereunto signed their names this / day of 20 /2, and acknowledge receipt of a true copy of this contract. UNLESS OTHERWISE SPECIFIED, IT IS NDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTED ABOVE WILL BE HONORED ONLY UNTIL (Date). 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 cancella- tion form for an explanation of this right. Signature affixed below also acts as receipt that Purchaser(s) received separate cancellation 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 c 142A. Representative: �/ t� 4(' G� Owner: 9)L.4) 't 7 Owner: NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner nay 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 Submitted Gl Accepted )y: C rT v by: fr V,,,,,} - Representative Purchaser D accepted Accepted )y: by: Representative Purchaser Date Addendum (A) OTHER WORK sZV IA\ DA 1 414 6',01-zi4y G 4 kt'e.- Kx r -t_. (T. ppi -- i 3 3z )t S a /(li A;<._ L, 7 S'i c cG &ham, c Refriou. — Cbtc SAIL- 4773 a sec.- g *244A1,4re 5 X N % 32 " `R;S c 11 c__ 6 "',,pJ,1 c f'1 xrpe v-twL Cyt,e u, 7. V U S < 13t 3 1\1 r Dea 64 t - /tAJ0 keueA @tia 5' /o C ma c) 7 /% /o rig -eSS TeW►A4 c . r opioos - /re I) It, H OYYVC- g() cid C 4 t, M l 4:1\--3C..— i /{)edeci. CM L4eit, ?o�(I R fd Initials / • Initials W Initials 459 Main Street Toll Free (877) 378 - 8739 Springfield, MA 01151 Worcester (508) 797 - 6600 E -mail: HR©SturdyHome.com Springfield (413) 543 -5906 www,Stufdyk10m8.GOm New Haven (203) 848 -2118 IMPROVEMENT, INC. Fax (413) 543 -3200 HOME WINDOWS • SIDING • ROOFING • ADDITIONS MA REG. #151711 CT REG. #601525 Name \ I �ex) Va.e G Home (3 fJ u q - Business Phone Address I (4b ti Si Cell Phone / Other Town /City r � -- � / Repress t'v a Date 1'� 1 —O "Lc ►iLC_ 4 • ` M u d ue �l �� g 2,0 i - z I /we the owner s) of the premises described hereinafter, referred to as Owner, offer to contract with Sturdy I ( P h S urdy Home Improvement, Inc. hereinafter referred to as Contractor, to furnish, deliver and arrange for installation of all materials to improve the premises as described below. Yes No SIDING SCOPE OF WORK: f1❑ 1. Contractor to obtain required building permit (see attached permit authorization form) 1 ie"'''''2 D 3 d Family home. Li 2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates). L❑ 3. Keep job site in a clean and orderly manner in a broom swept condition. ff❑ 4. Provide job site dumpster, set on planks, to remove job related debris only. Please Note: dumpster for contractor's use only. (see dumpster clause). 5. Provide OSHA approved staging to safely perform work. ❑ 6. Customer to remove all ornamental and personal items away from house, yard and walls outside, etc. ❑ lErr. Strip ' layers of siding off existing house. Wood clapboards Vinyl Cedar Shakes Stucco Aluminum �� Other Li l�&J`�"�• Gutter helmets to be removed and reinstalled by others. ❑ ld' Remove and dispose of gutters attached with spike ferrule. ❑ l � ., � 10. Remove and reinstall existing gutters strapped to roof. Install straps under shingle over shingles . Li r � i�i Remove and reinstall existing gutters with hidden hangers. Linear feet . ❑ IFJ Furnish and install new gutters linear feet, and downspouts (10' lengths). Color . ❑ j(15.-Remove Satellite Dish up to 24" in diameter. Alignment and installation by others. ❑ 14. Remove and reinstall the following items: ❑ Shutters. (see number 16) Li Doorbell ❑ Storm door Li Street numbers ❑ Power meter (power lines to remain, wrap around anchors) Li Lights (see number 15) ❑ Telephone Li Water meter ❑ Cable TV lines CI Dryer vents Ii2(13 14. Install insulation under siding. 3/8 fan fold 0 Tyvek Polar Board 0 High density poly styrene/ Green Board ,0 Total Squares . Li l]'f5. Install customer provided light fixture on house. Please note additional wiring is not included. Quantity . ❑ fie• Install shutters on house. Quantity Color Louvered Panel . ❑ dil:Extensions of water f on the exterior of home are not included. Please note if needed, this will be an additional $150.00 each. I ❑ 18. Furnish and install Uuka, Lvv siding. Color 'I I"` I k ' 1 �' Total number of squares . f Li 19. Install Corners. Color S%Cw / t• - -1 t, -y Style Linear feet . I ❑ 20. Install `i t - %. Light blocks Dryer vents Water blocks. Color . ❑ c '1' Porch ceiling to be covered with soffit siding. Total squares . 21° Li 22. Install J channels around windows and doors. Color Style O . a" 23. Install vinyl soffit on overhangs. Vent soffit boards prior to installing vented soffit materials, Color Linear feet . c ii 24. Install aluminum coil stock on fascias on front, rear and sides of house. Color £.— 44 r—. Linear feet . F Li 25. Install aluminum wraps around <U T? window and L- t4-1'N door(s). ❑ . Cover Gables End vents with siding to prevent air -flow. (if the roof is vented with soffit and ridge vents, then gable end vents must be closed in order to qualify for warranty coverage). ❑ largi. Owner agrees to cut back or remove any landscaping 18" from house in order for contractor to gain access around perimeter of foundation. Zr ❑ 28. Addendum (A) = OTHER WORK. 12r 29. Acceptance Page. Li L:130. Work not included: 1. Final cleaning of windows 2. Any rotted wood (other: � �yf ). Initiale�:77P �' Initiate J/ i P... Fnit,,. The Commonwealth of Massachusetts l Print Form ,,,�,, Department of Industrial Accidents 1 Office of Investigations *WNW d _ = 1 Congress Street, Suite 100 '. Boston, MA 02114 -2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information � ,,/ q ' / Please Print Legibly Name ( Business /Organization/Individual): 5 /7L i }�� u 17 o Imp ro V. e t/� Address: l i5'7 Ma//) 51 City /State /Zip: Ina Orchard Phone #: ('1/3 6 -- M e1 Are you an employer? Check the appropriate box: Type of project (required): 1. [V' 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. I] 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 working for me in capacity. employees and have workers' g any 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 11.0 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.ErOther DPr / 6 - i bi 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 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: re laSufanie, Policy # or Self -ins. Lic. #: (Al C 001 Expiration Date: / // Job Site Address: 6 t Aral d St. City /State /Zip: rlOr'en-Ce t m 4 C /D6q 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 the information provided above is true and correct. Signature:I AAA- Z1 r. Date ® �� Phone #: (11i3) 543 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: Not Applicable 0 Name of License Holder : Da v/ " Di a i / 10 0 3 License Number '/5q main f • I n liat Orchard rim d //5/ g Address Expiration Date (103 ) g - `7 9 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ S&upyi forXe irn_proi/ein.ord 151711 Company Name Registration Number L/ ffl z4 S� . / rLa 5 0rckz / rriA o//c (,/,20/ Address Expiration Date / 'i Telephone t 3 I 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 building permit. Signed Affidavit Attached Yes lid 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 j:. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) Roofing n ,�( Or Doors El Accessory Bldg. 1 � I Demolition ❑ New Signs [D] Decks [Q Siding [ad Other [D] Si v 6 6 7 5 q Uz(1e.- leemo ✓e. creme, Brief De cription of Proposed „ Work: eparr R.,�ht corner of 6-aragre , meta( n.144) etc - fry deor'. eta -;rs, (iu� dt�c / ern Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes No h.QYYt - Attached Narrative Renovating unfinished basement Yes ✓ No Plans Attached Roll - Sheet 6a. If New house 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 , 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 D a ✓i ..d D Q 2 as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. David Diaz Print Name / 81 3-11 d- 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 Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES Q IF YES: enter Book . Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW (i y YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained Q , Date Issued: C. Do any signs exist on the property? YES 0 NO 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 it 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 Q NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only i - -• -.City of Northampton Status of Permit: Ct - `..,� B 'ilding Department Curb Cut/DridewayPermit 212 Main Street Sewer /Septic Availability AUG -8 Room 100 Water/1Nell Availability, L No hampton, MA 01060 Two Sets of Structural Plans' D t h b ' pht2i�,e,; 13 87 -1240 Fax 413- 587 -1272 Plot/Site Plans Specify vRTHA✓ t01060 "- ---� Other 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 1 4 . f/�ro/d 5 - Map Lot Unit 0/ OrerLce MA 010662- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: l ct.-fh�(een_ Pa rent 1 Harald St No r� rice, n� A o 06 Name (Print) Current Mailin A L es < 13� 5 e - L ici_ _3— Telephone Signature 2.2 Authorized Agent: D ✓� d 2)r ^ Da a -- 4J lnc�aj ®rcni - ara MA o1/51 Name (PrirA. Current Mailing Address: Signature / Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4/5) 00 0 , ° a (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) 4/5,000 610 Check Number c� � 1 O This Section For Off Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2013 -0225 `r 6k APPLICANT /CONTACT PERSON STURDY HOME IMPROVEMENT C1/ N I ADDRESS/PHONE P 0 BOX 51033 INDIAN ORCHARD (413) 543 -5906 PROPERTY LOCATION 15 HAROLD ST MAP 12C PARCEL 065 001 ZONE RI(100)/URA(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid �o My's' Typeof Construction: CONSTRUCT DECK,REPAIR GARAGE & NEW ENTRY DOOR 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 THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demolition Delay Signature of Building Official 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 Planning & Development for more information. __ F 15 HAROLD ST BP- 2013 -0225 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12C - 065 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Deck BUILDING PERMIT Permit # BP- 2013 -0225 Project # JS- 2013 - 000368 Est. Cost: $15000.00 Fee: $85.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sq. ft.): 9844.56 Owner: PARENT KATHLEEN E Zoning: RI(100)/URA(100)/WSP(100)/ Applicant: STURDY HOME IMPROVEMENT AT: 15 HAROLD ST Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543 - 5906 WC INDIAN ORCHARDMA01151 ISSUED ON:8/31/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT DECK,REPAIR GARAGE & NEW ENTRY DOOR 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 8/31/2012 0:00:00 $85.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner