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36-165 MAR-22-2004 15.41 P.01 PATRIOT TJONZE IMPROVEMENT +� A Division of For U Builders Inc. 820 Union St. 210 South Main St. All home improvement contractors and subcontractors W.Springrwil.MA 01089 A4iddiatawn,CT 06457 engaged in home improvement contracting,unless 1-877-DO-VML specifically exempt from registration by Provisions of j Fax 1413-7 739-3332 [ 1 Chapter 142A of the general laws,must be registered with st�nme� `a<L,;, 1,�»>, l A rf t•✓R the Commonwealth of Massachusetts,inquiries about registration and status should be made to the diw(or, 7 Home Improvement Contract Registration,One Ashburton Place,Roan 13011,Boston,MA 62108 (817)727-8598 PlK7r✓E _ O �nAfT/f/j� /9 WtleKR } We away AWu.AA zpati6usa5 wk 4eM+u�w.6.:oeF t¢ba Ca[tx--N c�E miHnek!�N�icaS t 1 � . ;'cam SLR A 41, r / .� / t, ../•. .4' i :::7- O Lor r GrntzebaAs��sa� •Csdww4a6amdv L F�¢l/ANAryv�x�br•qugse Tgw�i.aae ,f i�IL 11 aue. _ coo. rvteW P eal�..• �naunhan �Tyva C;Snatta NYro ` tMnsb Pab sxr�ns ,/ 4!V^ YES 0 No:5I Gab*v...Ibr..+n! v I J Ak �{ i J Bbdu d On-V«ea YES aV/,NO Ppta Mrerpm YGS V.0❑ .�r ar+unara YE9.' ':t7 r a w.e Coro.-L.2Y-�>:/rn�..�o�rr ( -_.•� ta..nus ADern amurA YES CI C7 tile ( SB&nksel IVN1W ii.Nx AOR�1Ya�A/N j7t�/ 1 re a V d-t neon C�0 M�Min An—BoMSI wtYr wnim.A m«r�rips lcm Call t]t:oror___./_' Up Venue 9.00 YES 1146 L Cobr 41� �.r raver I -C iwnpei IFS VN0 0 wree"—I 6 4as1x vus l`1 NG it 1 u�A101pplWe , �lypN NDR£ASTERI NOtTEASTEen fslda Y6S'l IKS�:f � \..(��-�•r-_ ywyt—� `• �tNL -2 t3 3i9�_ GAS-110?— BON•f4 or 5 LiUl— Sty_ Awu .1 yl Cho ftws oYes 0 NO A "C7 nw Ga. 0 nC w/AMerewr Hands C. I A �v'A 43nhis f Cl St1e&/Op« .we eras- YES 3, c lydpo VVM Yea C NO aroAK aa¢amc orb'.�@ 44rwts� lreu+Wmpsnr��s+n•.ssWd,�wAwb.emi�wM.�.,,,,;�.-..knq.ln.a.,..ti.�ss�.,.n.ayw.�e.pr.�.err e�e.=x.see,!»..p�s+py{. ' awe nQ Ta1� ae seea•AetlarAiW Mie QOrts!ereM!x�t1l na!ddcroa nvh>Sirn el lne ye",xmr_ wAAAANn - : ?alair!aaarY iMIMAaIeW A.1H.aa Sr4abaMaan a14SN 19raFW94q MrOwM iamalaaA.a1A M!aAewAdfMNa Na►amradTAgAMerA.MM- ..re.,r+a.an��rw�p r:�a:>+..o.s...esrwsoe.arrerr,w..eneranea.erswrw v auras.raw.....s..rw an.,..�r w..i.w,a�ykA.timaq e►..4.e. CmMader Maa.d ,Ieara,naWrn�ir.aamet.a,rs.wcrsly MiwrrNSe.'aoJ'ed.>rap7tl.wAe.iemvi.AtlM�vtMri,rrYa Mro�M�rb4rpnnMMbs • aeaV d Fr Saar.Tr_NSeebie aaraMaa auaiweHaa ary Aaoeelar We'eW M upvrtlrn vim a.a ayaaluor•rM. We Pr heresy 10 furnish material and tabor-compete in accordance vvM above specmcations for the sum oY. r dollars($ I v c f?ayr»r1t Ae7l as foaowA~_. - X( G'"�) upon sronrng GOnlrsch; mme«cmmnemrwgww aayaram PATRIOT HOME IMPROVFMFNT 'Upon delivery CA manthei; —1°0'° ego union Street.went Springfield.MA 01 089 + %($� .._.) upon t/2 po eompkibn: i-81)0.458-8082 't.11 t.made I.M.At,upon mmomion AS I IS 04 CTi 546192 work undsr mil contrsu IIx:P4S?YUn nr+f r9'+mne vnE,9.rmsnl—z-V aurb man!eW�ea�n+:.raP^•m /!� J• �d! f f•r'r. QrA/YgB4e{IOAa)N than ana•a4ni 0 eta nW wnuau«-«aw l w un—t f A O MIR« ahiGfi e»e«wxwr meal mN.e.it edrmrca.b aft A.+wr dna/.iae �7(_a—r••.yyNaRr E i oN«masri+x sa ea�.Nr�ma�c wtishs�.aogwels�r .' ...Av sp"of Proposal 1 have read both swiss of this document and accept the prifss,Specification and conditions stated.i understand that� s*kQ'this woposai becomes a binding contract.You are authorized to do the work as specified.Payment will be made 9i outlined abay e. You,the Gw,rer,may cancel this transaction at any time prior to midnight of the third business day after the data of this transaction.Cancellation must be done in writing.Sea accompanying capeeellation. DO NOT HIS CONTRACT IF THERE AREt ANY BLANK SPACES IMPORTANT INFORMATION ON BACK TOTAL P.01 PATRIOT HOME IMPROVEMENT 820 UNION STREET WEST SPFLD, MA 01089 800 458 8082 April 12,2002 To Whom It May Concern, 1,Ray Foucher,President of Patriot Home Improvement,give permission to Ewald Kucbciak to sign for any and all building permit applications in Massachusetts and Connecticut on behalf of Patriot Home Improvement(Ma. Uc.#115804,Ct. lUc.#546-192 Any questions,please feel free to contact me at the number above. ay Foucher President Of Patriot gco�D CERTIFICATE OF LIABILITY INSURANCE, CSR LC °A09/0D0 0 • --� TH001 09/06/02 IODUCEa H TIFICATE IS ISSUED AS A MATTER OF INFORMATION EYES, MATTSON 6 AGAN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE NSURANCL AGENCY, INC. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 284 Elm Street, Ste 4 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. est Springfield IAA 01089-1848 INSURERS AFFORDING COVERAGE 'hone: 413-739-5803 Fax:413-731-0671 WACO IKSURCRA Nautilus Insurance Company_ INSURER E OnaBeacon Insurance - For-U Home Builders, Inc. Ll INSURER C. 1 Insurance Co. ba Patriot Home Builders 820 Union Street INSURER West Springfield MA 01089 tN3tlRER E' OVERAGES T HE POLICIGS OF INSURANCE L1STE0 BELOW HAVE BEGIN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATEO.NOTWtTNSTANOING ANY REOVIREMENT,TERM 0R CONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WIIICH TH16 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDEO EY THE POLICIES OESCRIBED wEREIN IS SUBJECT TO ALL TNG TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS S140WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ TYPE OF INSURANCE I POLICY NUMOEM OA m"wo DATE MMDO'Y N --v LIMITS GENERAL LIAEILITY I EACH OCCURRENCE S 1,000,000 X X COMMERCIAL GGNGRAL LIABILITY KC180418 05/02/03 05/02/04 FIRE DAMAGE(Any*no f►e) s 50f000 CLAIMS MADE I.K OCCUR PAEO EXP(Any one Parson) S 1,0_00 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 3--210-0-0-10-0-0 GCN'L AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG s 2,000,O00 POKY PERO. LOC _ — AUTOMOGILE LIAGILITY COMBINED SINGLE LIMIT ANY AUTO (6a acmdl) s an ALL OWNED AUTOS BODILY INJURY s 250 000 1 SCHEDULED AUTOS (Per paran) HIRED AUTOS BODILY INJURY f 500,000 NON•OWNEO AUTOS (Per a[cidem) PROPERTY DAMAGE (Per oWomni) 6 100,000 _ _... GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY AGG S uCE33 LIAHIUTY EACH OCCURRENCE s OCCUR F7 CLAIMS MADC AGGREGATE s s _ s DEDUCTIBLE RETENTION S S WORKERS COMPENSATION AND X TORY U►+uri A EMPLOTFIIS'LIABILITY 6R23UB776X675602 08/08/03 08/08/04 E.L.EACH ACCIDENT 5100,000 E.LOISEASE•EAEMPLOYEE • 100 000 E L DISEASE•POLICY UM1T s 500 000 oTIIER , ESCRIPTION OF OPERAT ION3 ILOCATIONSNENK:LES/EXCLUSIONS ADDED BY GNDORSEIIIENT/SPECIAL PROVI610N6 -ERTIFICATE HOLDER IN I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION Ajs.m0 01 SHOULD ANY Of THE AEOVE OESCRIEEO POLICIES Of CANCELLED BEFORE T"E EXPIRATION GAT!TMPtWF,TH!ISSUING INSURER RMLL!NDPAVOR TO MAIL -1Q—EIAYZ VVFd I TEN NOTICE TO TTIE CERTIFICATE"OLDER NAMED TO TUC LS4T,GUY FAILURE TO DO 60 SHALL FOR PROOF OF INSURANCE BSPOSY IRO OKWATON OR LUU MLITY OR ANY KIND UPON THE INSURER,ITS AGENTS OR RSPRESSAll TWIM. "'000piprP, NTATr Pa 8 ookik -/ =RD 26-S(7197) OACORD CORPORATION 1938 'PAT'RIOT" HOME IMPROVEMENT REGIS'TRAT'IONS OTe &wwwwweaa Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 ! . Home Improvement Contractor Registration Registration: 115804 =s Type: Private Corporation Expiration: 4/19/2004 FOR-U BUILDRES/PATRIOT HOME IMPR. RAY FOUCHER ' 820 UNION ST WEST SPRINGFIELD, MA 01089 j Imo___. ..—.--�--�_.— •i. ey. .r �,ti+y �,t " -p't�� `1dt�� i �---T•Tr.-C.•^"�' _'--____� STATE OF CONNECTICU'�' ♦ .DEPARTME`1 T OVF- CONS;I,JlYIE' PROTECTION Bt`it,knowti that ,1, FOB- LDE� -ETC 0 ti, S ! al' 1 1- I has been certified by the �t;d#� `° �r�Psotection as a registered HOME IMP NTRA&OR r Contractor,o tRecor - YMp 1»AUCHER r .t Effective: 12/01/2003 ! Expires: 11/30 2004 Edwin R. RodnguezKCommissioner SECTION 5-PJACEMON OF PROPOSEQW ((dMk aii anoiicabNel New House ❑ Addition ❑ Replacement Alteration(s) 0 Roofing Windows Or Doors Accessory Bldg. ❑ Demolition❑ New Signs Decks [ ] Siding[ j Other[ j Brief Description of Proposed Work: Rc. S(Qf (r i �11/2y W Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached atoll❑-Sheet❑ 15a:: 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. Mascheck 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 . 1. Septic Tank City Sewer Private well City water Supply SECTION Ta-OWNER AUTHORIZATION—TO BF COt-PLE iDQ WHEN OWNERS AGENTOR CONTRACTOR APPUES FOR.•Bd lIL10IN6.PeRMIT I, R 0 6 ERL , US A I L A Fly F O R as Owner of the subject property hereby authorize NT - h?1 0 ( All 0A1 :5 T. W S P R 1 UC r teL n tfA_ to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of owner Date 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. - Print Name £ •d VFW Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 LlcenW ConstrucHm Supe lsor: Not Applicable ❑ Name of License Holder: Ii�A T R QT H(?/TE I,,-fP R OV J/T I 1! $0 4 License Number _QI_t24/ 0 ST WEST, SPRU/60ELDN1A_0(l:2-Yq ��ly � zo6g Address Expiraboh Dater &a L JL tf 3—431—1901Y Signature Telephone ; � ...: Not Applicable ❑ FNS t tsYj(4 CoM"n fftme Registration Number Address Expiration D to Telephone 3`11- 1 -,? SECTION 10-WORKERS'CUt4pEMimoN Imsuil LANCE/#yfbAvrQ".G.l..c.'15Zi 1M.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. 51gned Affidavit Attached Yes....... ❑ No...... ❑ The current exemption for"homeowners"was extended to include Owner-occyied Dwellings- one(l) 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 1083 S 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 aerson who constructs mare 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 rzponsibie for aH such work ggrfortned under the buiWin 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, eLZ I1 iro ei mew ti \v Qty' of Northampton " - �r - Building Department 212 Main Street Room 100 Norihamp` , MA 01060 phone 413 .587-12 Fax 413-587-1272 APPLICATXON TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 I!ERRCM Address 1 , y a ` Y rb SECTION'2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1Qwner 2f Recoml• _t o BERX SuSAA/ L AFL E IA -7�3 5 Frr©ttE�(1C E P Name(Print) Current Mailing Address: ''S�.0 c L�s.. Telephone 'I 1?� 5 eP Signature 2.2 Authorized Agent: ?ATRtaZ 140.E "IMPROVE-14EA1-r 810 U0 0+1 (�T _Litsr5IRU/ r) BLoi" Name(Print) Current Mailing Address: QU0 58-9UU1 Signature Telephone SECTION 3-ESiII►tAM CQNSTRUQTION°CQ. Item Fstlmated Cost(Dollars)to be 0Mclal.Use Only completed by rmit apAicant 1. Building z(a).Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from: 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) S.Fire Protection 6. Total-(1+2+3+4+ 5) Cbeck Number This See icifforOfrjdal:Ilse only Building Permit Number: __—_ Date Lswed: Signature: Builaing Commissionerlinspector of Buildings Date I •d e92: t l fa0 91 jeW 795 FLORENCE RD BP-2004-0901 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36- 165 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2004-0901 Proiect# JS-2004-1344 Est.Cost: $34000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Groin: PATRIOT HOME IMPROVEMENT 115804 Lot Size(sq. ft.): 17424.00 Owner: LAFLEUR ROBERT E Zoning_SR Applicant: PATRIOT HOME IMPROVEMENT AT. 795 FLORENCE RD Applicant Address: Phone: Insurance: 820 UNION ST (413) 731-8082 WC WEST SPRINGFIELDMA01089 ISSUED ON:3124104 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL SIDING, WINDOWS & 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: Receipt No: Date Paid: Check No: Amount: Building 3/24/04 0:00:00 6865 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo