17A-008 (2) •
E IMPROVEMENT
`4No Substitute for Qualm
WORCESTER SPRINGFIELD IELD HARTFORD
459 MAIN STREET-P.O.)3 0X 51033-SPRINGFIELD,MA.01151
• MA,REG#1517I1 CT.REG##601525
• 877 3S7:URDU'' FAX 413-543-3200
WWW.STURDYHOME.COM,
. OWNER 1'1.D ER P ERMIT . ,f;J THORIZA TI I N
SEeorlDedtra a- KL[c Z e/1s' t
1
Name: Q 1'l Ce/Z e Yl ki- i t`.
Address: ' 3 9 Lee 0 o'-17 sr,,-66,_
City/State/Zip: F oy-e,nCe iM i 016 6
Z
Join (owner), of the property
located at: 34i l er . Fibre*e 0/1 11 authorize Sturdy Home
Improvement, rue. 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.
11\ i ‘ '
6C , 91,0113
Si,. ., re of/i, nor d Date
1 , tpck
0
Signature of Owner Date
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____/ __/___. 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) INAr"T r13 tca.(, (iii.ifkr< Ct. -110,-4
Roof $ am...* 0 �. ' PlitiPe< 0J-<7.6.6.
Ventilation $
Other work $
Roofing total $ ,,/ $ $ '°� $ $
Siding $ /0'b, $ 1.60, . $" O0 °i° $ 2447 O' $ 5-60'
Windows $ .,�_ $ -- �-�- • S.5-8.1 $ :.- $ $
Special orders $ --- $ $ $ $
Other $ $ '... $ $ $ m
Totals $ $ $ — $ w $
Terms: Cash Finance
Credit Card:#_ _ _ _ _ _ _ _ _ Exp. date____ / ____Code_
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 material/equipment 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)
$ 0 to be paid for 0
$ e) 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. Additio al provisions are stated on reverse side and 4e part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their names
this 1 a A day of 5.00,77 20 and and acknowledge receipt of a true copy of this contract.
UNLESS OTHERWISE SPECIFIED, ITS UNDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTED
ABOVE WILL BE HONORED ONLY UNTIL 'l (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.
li
Representative: 1 `1 14k-) 3 "�.� Owner: 1`!! f`! ove.,,,,,,f44 iL .01
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Owner: q --( 't.-L-aC l-', i/ `z-e- V
NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution(A'itiated by the contractor. The owner
may 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 c:""`� ! Accepted 1 f j`
by: •J C.) i-k"•--3 , 1 �,.je.t ( by: '� c (i/ .,�4.%8'LA.1,4 , f Ii •!
Representative 4 °,urchaser ) /'� 1 Date
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Accepted Accepted -f f f r "` Cir e'(1/1-5
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• Addendum (A) OTHER WORK
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..- eInitits4 • Initials xJ't 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.SturdyHome.com
New Haven (203) 848-2118 , INC.
Fax (413)543-3200 HOME IMPROVEMENT,
WINDOWS • SIDING • ROOFING • ADDITIONS MA REG.#151711 CT REG.#601525
Name •01"' n iv -4-11 Y ' 'V Q�..2.eN S ks' Horr�h c ,u c. Business Phone
Address Cell Phone 7 Other•
Town/City Representative Date
rGUit� -C. M41. 7 ifs, >�Il�.. cli 10 X17
I/we the owner(s) of the premises described hereinafter, referred to as Owner,offer to contract with Sturdy Home lmprovemen, 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: .�
Lt❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 f 2 C 3°Family home.
❑ 2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates).
111•'' Li 3. Keep job site in a clean and orderly manner in a broom swept condition. z-
❑ 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).
11, ❑ 5. Provide OSHA approved staging to safely perform work.
Or❑ 6. Customer to remove all ornamental and personal items away from house,yard and walls outside,etc.
tiV❑ 7. Strip / layers of siding off existing house.
Wood clapboards J Vinyl df, Cedar Shakes Stucco 0 Aluminum
Other 441.0 L cg .
❑ I214 Gutter helmets to be removed and reinstalled by others.
gine' UK Remove and dispose of gutters attached with spike ferrule.
❑ ❑1D. Remove and reinstall existing gutters strapped to roof. Install straps under shingle over shingles .
i am. Remove and reinstall existing gutters with hidden hangers. Linear feet /6 < Re+.+cauc,. VP ere, G..#f_, .4 j V,
❑ le2. Furnish and install new gutters linear feet,and downspouts (10'lengths). Color .
❑ 113. Remove Satellite Dish up to 24" in diameter. Alignment and installation by others.
LI° ❑14. Remove and reinstall the following items:
aSitters. (see number 16) ki.Doorbell
❑Storm door ❑t.8treet numbers
❑Power meter(power lines to remain,wrap around anchors) ❑Lights (see number 15)
❑Telephone Li Water meter
❑Cable TV lines aD'ryer vents
Lr ❑14. Install insulation under siding. 3/8 fan fold ®' Tyvek 4'
Polar Board ® High density poly styrene/Green Board I,/u V S" Total Squares .... .
❑ LI 15.Install customer provided light fixture on house. Please note additional wiring is not included. Quantity .
❑16. Install shutters on house. Quantity Color gewk..1,r.4.u t. ouvered Panel .
a'f7.Extensions of water faucets on the exterior of home are not included. Please note if needed! is will be an additional$150.00 each.
4 .❑18. Furnish and install ilnml,..) Sr_ 1.11.4 (Sj rding. Color (■.I .447'CA Total number of squares .
0*.°'❑19. Install Corners. Color (tea 1-It R`! _ / Style �ri , Linear feet 4 �E.c.,,,
[�°°�❑20.Install �' Light blocks . 1-h L.*w-- I :s".ents / Water blocks. Color ey rtufn ,. ..
❑ 21. Porch ceiling to be covered with soffit siding. Total squares
Dr..-Ll 22. Install J channels around windows and doors. Color t'utle-,Pic- Style 4, .
❑ D23.Install vinyl soffit on overhangs. Vent soffit boards prior to installing vented soffit materials. Color&he/S1s+t,. . Linear feet .
IA- ❑24.Install aluminum coil stock on fascias on front, rear and sides of house. Color Lt✓ I-I it-C Linear feet .
WI- ❑25. Install aluminum wraps around eliia1"... Clit€rvindow andPi oe.T6 oor(s).
de❑26. 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).
ID"..Li 27.Owner agrees to cut back or remove any landscaping 18" from house in order for contractor to gain access around perimeter of
foundation.
28. Addendum (A) =OTHER WORK.
li°❑29. Acceptance Page.
❑ ❑30. Work not included: 1. Final cleaning of windows 2.Any rotted wood (other:
�- ).
The Commonwealth of Massachusetts
Department of Industrial Accidents
�_, `, t Office of Investigations
a
a+��o�
={ 600 Washington Street
" qll
Boston,MA 02111
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'`' r� www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): 01(n 4 J mj f tvoirv.04-ra-
Address: LIS4) (VICO r, �JJ
City/State/Zip: Witat-) ()1 M & Ot. MA 01 tSi Phone#: '(13)Sq-tj`1p(p
Are y u an employer?Check the appropriate box: Type of project(required):
1. I am a employer with '5?' 4. 0 I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers' comp.insurance comp.insurance.I
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 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' 13.0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f 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: l 5(( )-el e I C J irt. wrap C.
Policy#or Self-ins.Lic.#: W 0 (j or)-41 Z,-I-1 S-1 2 Expiration Date:----) /2. I/(Li
Job Site Address: 34 L -(\a `fit City/State/Zip: F Lott,e.c_., tvt.. - CA 0(02
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 perjuly that the information provided above is true and correct.
Signature:O 0Jtke t/t, Date: 9//1!/3
Phone#: @ 13)5.-q3:(o a 1
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 ❑
Name of License Holder: )1 nit 1 j R2_ i 3 G9 U 3
License Number
y5S mat s+• In cekel 0 re,,,t,,, }. OtWW /-7 /0
Addres Expiration Date
04111212 - 3��2
Signa ure Telephone
9.Registered:Home Improvement Contractor: Not Applicable ❑
t tr1ac�i r 1,t,e I n p rokfu&en-� I s-I `-1 I I
Company Nat* Registration Number
S4 MGCIIrk inotfowl are/hare/ 6(1,1 Olt r) lso( -2.-001 144
Address Expiration Date
Telephone e,]3)5`-e—16 v
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 build ing permit.
Signed Affidavit Attached Yes ET/ 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 ❑ Replacement Windows Alteration(s) n Roofing n
Or Doors D /
Accessory Bldg. El Demolition ❑ New Signs [ID] Decks [p Siding[LfJ Other[O]
Brief Description of Proposed
Work: L e%_ tL 'c Ick e 1,;1i.&C,,'es o-f nAcuif s-. nott bl e 4'1 5 Ot ng
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
, 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
1 , as Owner/Authorized
49,0 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.
Print Name
Si a ure of Owner/Agent a 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
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES 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 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 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
• y of Northampton Status of Permit:
ilding Department Curb Cut/Driveway Permit
12 Main Street Sewer/Septic Availability
uSLP i 62013
Room 100 Water/Well Availability
oft' ampton, MA 01060 Two Sets of Structural Plans
Electric,Plumbing& �9t ;7-1240 Fax 413-587-1272 Plot/Site Plans
Northam ton, 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
3y � �� O Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
cXc, Lac2ert Lee no a• ►on n , rt(L/i C)10(497--
Name(Print) rren Mailing Address:
113 5�(o 1
Telephone
Signature
2.2 Authorized Agent:
c-DaA,i(?,I O Oa- LlSca YY'lcc n lC�n OiQhaet�( (VV OIISI
Name •nt) Current Mailing Address:
Si. • ure Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (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 035-
6. Total=(1 +2+3+4+5) 5l (��. G L� Check Number 3.15q
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
39 LEENO TER BP-2014-0321
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-008 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:vinyl siding BUILDING PERMIT
Permit# BP-2014-0321
Project# JS-2014-000554
Est.Cost: $5400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sq. ft.): 13503.60 Owner: KACZENSKI JOHN J&BARBARA A
Zoning: RI(100)/URA(100)/WSP(100)! Applicant: STURDY HOME IMPROVEMENT
AT: 39 LEENO TER
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON:9/17/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE 8 SQ SIDING
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 9/17/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner