The URL can be used to link to this page

29-511 .ii ucpci Uv11(;e riume Improvement, ll1C. Federal ID # 26- 4277650 1_ / 7 . 1 - I Main Office: aV U 8c. 1 ' 2D, Sv i r' ' Branch Office: ►w �'�4� V� ^^ 60 Manchonis Rd. �v� IU� Wilbraham, MA 01095 ti f 3 �1C,C1 —C1 C_� �3 4 - I c ` 1 ti l ti KA6.%. 2_`; Horne Improvement, Inc. 413 -596 -0103 • 866- 987 -8768 11�/ ' THIS CO TRACT made the � day of _t∎in.).a.�w in the year c. 1-1--- between Independence Home Improvement, Inc. and I‘C k r,r orl. 413 -- c5 Ski — fel 47 (OWNERS (HOME PHONE) (BUSINESS /CELL PHONE) OF l it r...„,..... c : -'mil' - 1v)" 010 6 )- (STREET) (TOWN) (STATE) (ZIP) As used in this contract, the words we, us or our refer to Independence Horne Improvement, Inc. and the words you and your refer to the customer. We agree to furnish all labor and material necessary to install the following described project at: SA M O e-Glarss-ovith 443 -Gas ❑ Argon Cas ❑ Other (See Addendum) Total Units: # of Each Style: Grids: Y/ N Window Color: -______`—" -■_--, • We do not do any painting or staining. ( 3 "°( Double Hung Units: J We are not responsible for conditions or circumstances 0 Picture Units: beyond our control including condensation resulting from or Total due to pre- existing conditions. Our limited warranty is herein q 1 S incorporated by reference. Hopper Units: Price: r 2 - 3 - lite: Sliding Units: 1 -lite: 2 -lite: Deposit Awning Units: With Order: t2 °` 1 Casement 1 -lite: 2 -lite: e: 4 -lite: 5 -lite: Units: Balance Due Garden Windows: Upon Deliver: 3-lite: 4 -I ite: 5-lite: Bay /Bow Units: DH / CS Balance Due Exterior Finish: of Soffit Total • on Knee Brackets: Y/ N Upon Final Install: Entry Doors: Steel Fiber Style: 1 l G 3S -i) 6.-5 - 1 r ,, Alum Woo re Style: ,:it re c z,�r{ Storm Doors: _ t.e; fc: -^ �b ;' Sliding Glass Doors: # Inside Look i (n; C ( ". cur +uP ' to Er;` 'j ie el viCt Capping() N # Capping Color: S" Selo-- a 1 C Additional Notes: (—I, \: `Ar (\Q., re'e) p of c,+jI 5�,f)C j . R. \e,Gt l..,O to 'ioYi, rccr t9 -.4c L ',..g. �.., MSc (ska.r✓+ .- ^„1 i/� VV . - k I • c,„2._ --' ✓ } '",I I (0,- slo , f .r r G � V 1 nOr -evA SlO eL rc , ,ts U 5 A"t \; -r cw- re ‘D'„ 1-4-, ,---- -,4 v-e -k 0,z),,... �`l ' j S�c•c - c�,t L. �o 95 1 t. t . S l r rI �.c.� - � n \ pt- ;NIN • \ n St -A I re. Ce as • n -C1 4 c ( ,o''4 - >`rle i .,) + e f „ .. r , - k • f l r, Ay c 0 Do not do . M r ! Yw � � -:� ` �SG ! G Y� C .' L t- l t1 S . , 4 DEPOSIT WITH ORDER ❑ CASH CHECK # ❑ MC /VISA /DISCOVER L 5 BALANCE DUE `CA ❑ FINANCE You agree to pay cash according to the terms sFiown above or, if your credit is approved, to sign a note provided by us for paynAent of the amount tol e. - ( c l, « , r , , o kk Yv2MC.' -o— �i r r c.(< - n , tJ The installation will begin on or about 1 12 ^k-S and will be substantially completed on or about ( ` . It is understood by you that the following t- - contingencies could materially change the estimated completion date stated above: Customer's inability to obtain or qualify for financing; inclement weather: strikes or other labor disruption; material change listed on a change order; non - availability of materials; acts of God. We represent that we carry Workers' Compensation and Public Liability insurance in the amount of $100.000 - $1,000,000. IN MASSACHUSETTS, ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS MUST BE REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION. INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO: DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION, ONE ASHBURTON PLACE, ROOM 1301, BOSTON, MA 02018 (617)727 -8598 BY SIGNING BELOW, YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY ANT THAT YOU AGREE TO ALL OF THE TERMS OF THIS CONTRACT, INCLUDING THE ADDITIONAL TERMS ON THE REVERSE SIDE OF THIS PAGE. YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION, AND THAT YOU HAVE BEEN ORALLY INFORMED OF YOUR RIGHT TO CANCEL. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. IN WITNESS WHEREOF, the parties have hereunto signed their names this a� 2U day of 1 •-. LV--- r� i in the year of 2 - • Signed j (� Signr;, �� MARKETING REPRESENTATIVE OWNER The Commonwealth of Massachusetts j Print Form. J Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers A ' I licant Information Please Print --.' 'blv Name (Business/Organization /individual): A410 -HALL try 2 \d`P -� n ' hC Address: at 9,0 305- r Rd . 5 /0 City/State/Zip: L i /bal t ni, ThI4 010% Phone #: L f,3 ' S �I 3 - s o Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. Et I am a general contractor and I employees (full and/or pars- time).* have hired the sub - contractors 6. ❑ New construction ?. ❑ I am a sole proprietor or partner- listed on the attached sheet 7. [] Remodeling ship and have no employees These sub - contractors have g. 0 Demolition working forme in any capacity. employees and have workers' 9. 0 Building addition com p [No workers' comp. insurance . insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.❑ Roof repairs insurance required.] r c. I5?, § I (4), and we have no employees. [No workers' 13Other R ani re CI comp. insurance required.] •Any applicant that checks box N 1 must also fill out the section below showrng 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 affdavit indicating such. :C'ont actors 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 subcontractors have employees. they must provide their workers comp. policy number. 1 am an employer that is providing workers' compensation insurance for any employees, Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: �cw City/State/Zip: C'lorene� Cl0 (c, 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 5250.00 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 u the pains asd penalties of perjury that the infonnmion provided above is true and correct s; nature: -�Z late: /a //e /ia Phone #: 113 _ 3 G y- e Oflkial rise only. Do not write in this area. to be completed by Ciry or town o y clot 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 ❑ Name of License Holder : V (.t,al r'r' P / D 3 3 ? L/ License Number giver C v (Ait 5r\ , � till c oc a / s // 3 Address Expiration Date /by ( 3- LI 7 3 ° 16 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Ln eta re vth s,et 14 'limp rover /1,4 !. _ /6 a 7 3 3 Company Name yn�nn�A Registration Number x`10 5 �n Rek• S`e ID WA' ll � 1 /t4r►'1 , (rl f d /eq `l /6 /1 3 Address Expiration Date Telephone La - s --- ti 6 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 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 SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Windows Alteration(s) ❑ Roofing J24 Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [0] Other [0] Brief Description of Proposed I Work: 4•�%.r exi4ired 'f k tv►,4L ih5 -€i ivau Czr`ki►,ktc( rni(ruwh. (sotA1n Sys -fr► Alteration of existing bedroom Yes No Adding new bedroom Yes No 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 I, ka,t I � t o r∎I NC , as Owner of the subject property hereby authorize T f✓( . rl to act on my behalf, in all matters relative to work authorized by this building permit application. 6 ;/ /a /lo %,a Signature of Owner Date I, l ,w`1S N,y0 ' 4T , i- c > , 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. is • C oco ry Print - ; ‘,) 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 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW Q YES Q IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES O NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 0 , 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 ?, City of Northampton Status of Permit: RECE V °L) Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability rice 1 0 a I Room 100 Water/Well Availability N rthampton, MA 01060 Two Sets of Structural Plans DEPT. OF BUILDING IN PIO 41 - 587 -1240 Fax 413- 587 -1272 Plot/Site Plans NORTHAMPTON, M 01060 Other Specify 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 I ✓I may & Irae Map Lot Unit T640162 , MA a ( No &. Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: I4 t + 14';54€ t - c r2 r "1 T Tvek C∎re tt Ffc -e2 , 1 4 (WC a Name (Print) Current Mailing Address: (4ct rx-)-4,( ce.+i.c -t6 Lill- 5 tI - v � y Signature 2.2 Authorized Agent: , p- a_ - i1 � J J V n 0 . itnr�.Y ,�/W�G roLierhily+ i an(- acitt �l>S*',-, RA 54 (c? W ;gre44Ytyr+ m4 �� i � Name (Print) Current Mailing Address: •! _ _ ._ 1 1/3 5 "S4. Sig ure Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building a (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of U Construction from (6) 3. Plumbing U Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection © _ 6. Total = (1 + 2 + 3 + 4 + 5) 7 6 5' ,O) Check Number X59 F3.5 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 9 TARA CIR BP- 2013 -0643 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 511 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2013 -0643 Project # JS- 2013- 001052 Est. Cost: $7635.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: INDEPENDENCE HOME IMPROVEMENT INC 103334 Lot Size(sq. ft.): 5401.44 Owner: KRONER KARL E & KRISTIAN M Zoning: Applicant: INDEPENDENCE HOME IMPROVEMENT INC AT: 9 TARA CIR Applicant Address: Phone: Insurance: 2040 BOSTON RD STE 10 (413) 543 -5600 WC WILBRAHAMMA01095 ISSUED ON:12/11/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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: 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 12/11/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner