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23C-086 (4)������ Toll Free(877)3-STURDY All home improvement contractors and subcontractors Springfield(413)543-1681 engaged in home improvement contracting,unless spedtft ME" � r Worcester(508)797-6600 cally exempt from registration by Provisions of Chapter 1= TOTAL HONrdyRENOVATION New Haven(203)848-2118 of the general laws, must be registered with the 9 Main St.-Indian Orchard,MA 01151 Fax(413)543-3200 Commonwealth of Massachusetts.Inquiries about registra- Box 51033-Indian Orchard,MA 01151 tion and status should be made to the Director, Home REG.#151711 Member Better Business Bureau Improvement Contract Registration, REG.#601525 Fully Licensed&Insured One Ashburton Place,Room 1301,Boston,MA 02108 YV A (617)727-8598 bmitted to: / ' ?�^k+) �(J 1.C( PHONE q 7 y DATE WORK# s hereby sub it specifications and estimates for work to be performed and materials to be used: GO cw CU 6L lv\ WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified herein.Contractor will begin the work on or about (date).Baring delay caused by circumstances beyond Contractor's control,the work will be completed by (date).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes,Acts of God,shortages of materl- als,aecidents,and all other delays beyond its control,shall not be considered as violations 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 following 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 lob,including cleanup,the Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam- age or such defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work We Propose hereby to furnish material and labor- plete in accordance with above specifications,for the sum of: e)L✓-C / UY`yl" lI' G7v , dollars($ Payment to be made as follows: _%(g 1 upon signing contract; STURDY HOME IMPROVEMENT INC. Name of Contractor/Designated Registrant. P.O.Box 51 n33 _o%($ 1 upon start of work; Street Address M' C 413-543-1681 _i(g � r )upon completion of-- Indian Orchard MA 01151 City/State Phone shall be made forthwith upon completion of work under this contract Name of Salesman Authorized Signature Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You may cancel this agreement if it has been signed by a parry thereto at a place other than an address of the Seller,which may be his main office or branch thereof,provided you notify the Seller In writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.Please refer to the Notice of Cancellation that accompanies this contract,,con- tents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Date HOME IMPROVEMONT 014No Substitute for Quality" WORCESTER SPRINGFIELD HARTFORD 459 MAIN STREET-P.O,BOX 51033-SPRINGFIELD,MA_ 01151 MA.REG#151711 CT.REG#601525 877-38TURDY PAX 413 543-3200 V WW.STURDYH0ME.COM OWNER. PERMIT AUTHORIZATION Name: �f � r Address: 211,55 S+ City/State/Zip: ,co c AAA 0 J 0(,'Z. Z Evan ',.h�tot, (owner), of the property located at: '46 t3 i r55 authorize 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. Signature of Owner Date Signature of Owner Date STURDY NOME 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 schedLkd 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) �� ` Ventilation $ f b � b /6 '6 Other work $ joL" t e.I Iv r e�A Roofing total $ -Az*=6.0 $ $ $ $ Siding $ a <OO $ $ $ $ Windows $ 7460 $ $ $ $ Special orders $ $ $ $ $ Other $ $ $ $ $ Totals $ $ ��► $ ��x'�. to $ $ Ay gwo Terms: _Cash '✓Finance � BF �c/y 1 Credit Card: _ _ - _ _ l'ZZ' _ _ _ _ - _ _ _ _ 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) $ to be paid for 0 $__j© to be paid for 0 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 ovisions are staled onj verse side an re part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their names this /v day of 20__Lj and acknowledge receipt of a true copy of this contract. UNLESS OTHERWISE SPECIFIED, IT IS UNDERSTOOD 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 arbitratio as provided in MGL c 142A. Representative: t` Owner:--� 1 ��- Owner:__ �'� 21� 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 may initiate alternative dispute resolution even where this section is not signed separately by the parties' �j,I Do not sign this contract if there are any blank spaces ' Submitted b J�"' Accepted e� / �If[ (q Representative Purchaser Date Acce ted by: by: _ ` Accepted P n Representative �^ Purchaser Date N 0 v :3 �- to cn m m Q C U Q. N 0 -0 (� —� J p 0 � D w T Lo �LO T T r(D : pp�� '. L CC 13 iziV NP M v Z J °j (W .. D 0 o w C/) O C� w LLI I0 rr 70 L .0 70 O 0 O 03 C15 0 CO U U z Z Q 0 Z 3 w 0 7 w 4- o cu a �J 0 2 -0 c� w n O= co 0 J- Q II U) rr z N D U) _ T Addendum (A) OTHER WORK auLL, RoNot A )ek)Y C' Ufa f w Caw -�k,�"",CA-1i low. hPJ PJI c 4v it-c,, n7 T (f- 4 cn--c--�, Lh o's + Initials Initials_Initials f 459 Main Street Toll Free (877)378-8739 Springfield, MA 01151 Worcester (508)797-6600 E-mail: HR@SturdyHome.com Springfield (413)543-5906 S www.SturdyHome.com New Haven (203)848-2118 Fax (413)543-3200 HOME IMPROVEMENT, INC . MA REG.#151711 CT REG.#601525 WINDOWS • SIDING • ROOFING • ADDITIONS Name �/I/)H) AM /Q /4/� Horr�g 09 8,� 73 y Business Phone Address Y/v�V Cell`{P.honee Other Town/City M a tative Date A111ty Z_,0/y I/we the owner(s)of the premises described hereinafter, referred to as Owner,offer to contract with Sturdy 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 WINDOW SCOPE OF WORK: e- A-10"❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 A-101 2 d 30 Family home. Iff'La 2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates). :��Q 3. Keep job site in a clean and orderly manner in a broom swept condition. 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). v«-k V p. �❑ 5. Homeowner to remove all personal contents away from all windows as needed in order to install windows. If additional labor is needed at the time in order to remove personal items, a cost assessment will be made at that time. 6. Provide manufacturers warranty on all windows. Qr'❑ 7. Remove and dispose of _(quantity)windows. 0"71J 8. Remove and dispose of l (quantity)storms. [ ❑ 9. Remove and reinstall stops. Please note: if stops need to be replaced, an additional cost assessment will be made at that time. ❑ Url 0.Remove and reinstall trim. Please note: if trim needs to be replaced,an additional cost assessment will be made at that time. Please note: The normal process of removing stops and trim on old windows will disturb paintstains/wood on windows. Sturdy Home Improvement, Inc. will not be held liable for any paint/stain/wood surrounding the opening of any windows. ❑ Will" l l• Remove weights in pockets and dispose. e❑12. Insulate des with fiberglass insulation. f��❑13. Provide all silicone sealant. I 14. Install alumin m wraps around windows. Quantity — Color ��k15. Install new replacement windows. Quantity Manufacturer [x16. Install new construction windows. Quantity Manufacturers Model 43 CCU / ❑ e17. Install bay/bow windows.Vinyl Q Wood_Quantity '� Manufacturer Model d Other w /� 1 Sulwit� S'H�t,�Fk►+� f�❑18. Install new glazing on each window: Low-E Low-E with argon�I UA&Ather ❑ ❑19. Install grids in each window:5/8" Colonial style other U • yA(.r/t Z4 GBG Interior Grids SID L Brasstone Brushed Nickel Top Sash Bottom Sash- ffo_ ❑20. Install new hardware on window. Color w t'��e ff'❑21. Provide screens with windows:half screens full screens aluminum fiberglass CrI,_0 22. Owner agrees to meet the installer during the hours of 7 AM to 4 PM for final measurements. All final measurements will be made by the installer. Failure to meet with installer will delay the installation of windows. ❑ UJ�6. Addendum (A)=OTHER WORK. �❑24. Acceptance Page (�❑25. Work not included: 1. Final cleaning of windows 2.Any rotted wood(other: Initials w(Initials CV Initials _ t 459 Main Street Toll Free (877)378-8739 Springfield, MA 01151 Worcester (508)797-6600 E-mail: HROSturdyHome.com Springfield (413)543-5906 S www.SturdyHome.com New Haven (203) 848-2118 - - Fax (413)543-3200 HOME IMPROVEMENT, INC. MA REG.#151711 CT REG.#601525 WINDOWS • SIDING • ROOFING * ADDITIONS Name A j C'+ Home-75? Business Phone LQ Address /�` Cell Phone Other ^ S Town/City Representative Date I/we the owner(s)of the premises described hereinafter, referred to as Owner, offer to contract with Sturdy 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: I A-101-le�❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1_ 2 - 3=- Family home. P2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates). P3. Keep job site in a clean and orderly manner in a broom swept condition. 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. ao-- ❑ 7. Strip •-'O� layers of siding off existing house. Wood clapboards A"' Vinyl G�7 Cedar Shakes <�V Stucco gZr;,;� Aluminum Other ❑ 4,00,8. Gutter helmets to be removed and reinstalled by others. ❑ WrI.-Remove and dispose of gutters attached with spike ferrule. ❑ f0. Remove and reinstall existing gutters strapped to roof. Install straps under shingle over shingles f"'❑11. Remove and reinstall existing gutters with hidden hangers. Linear feet ❑ Ugrr2-. Furnish and install new gutters linear feet,and downspouts (10'lengths). Color ❑ Gam. Remove Satellite Dish up to 24"in diameter. Alignment and installation by others. ❑ @11'4. Remove and reinstall the following items: ❑Shutters. (see number 16) doorbell ❑Storm door I]Street numbers W Power meter(power lines to remain,wrap around anchors) UaUghts(see number 15) Welephone UMater meter fable TV lines wryer vents ❑14. Install insulation under siding.3/8 fan fold Tyvek Polar Boarc Or- High density poly styrene/Green Board _ Total Squares- Le-L)15.Install customer provided light fixture on house. Please note additional wiring is not included. Quantity ❑ f6. Install shutters on house.Quantity Color Louvered Panel ❑ rr'r7•Extensions of water faucets on the exterior of home are not included. Pease note if needed,this will be an additional$150.00 each. ❑18. Furnish and install M)O1 J iLe. siding. Color RX Total number of squares. W/❑19. Install Corners. Color C it Style Linear feet 4'--❑20.Install QP S, Lig t blocks Dryer vents Water blocks. Color d ❑ BIZ1.Porch ceiling io be covered with soffit siding. otal squares e ❑ d22. Install J channels around windows and doors. Color 42 Style 9 e j-"❑23.Install vinyl soffit on overhangs. Vent soffit boards prior to installing vented soffit materials. Color i-/VrC Linear feet. ❑24.Install aluminum coil stock on fascias on front, rear and sides of house. Color L.v i kl C_ Linear feet ❑25. Install aluminum wraps around CZ window and -door(s). ❑ i f26. 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). or-I'❑27.Owner agrees to cut back or remove any landscaping 18"from house in order for contractor to gain access around perimeter of foundation. 8. Addendum(A)=OTHER WORK. Zr'Q 29. Acceptance Page. ❑30. Work not included: 1. Final cleaning of windows 2.Any rotted wood (other: Initialer�E I Initials F\/ Initials oCl V The Commonwealth of Massachusetts 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1CUQ- �11 �Vf�Vk9.X1 t Address: -C-1,5� mCk,,,t n 3 , City/State/Zip: a rC V �C Yli t t5-1 Phone #: ( l J 5q3-Y-I o o _ Are an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑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 g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition 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.F] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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: Policy#or Self-ins.Lic.#: ( C U G`l 1� Z L{512 Expiration Date: _)12 11114 Job Site Address:__ (D �� wit. City/State/Zip: 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. Si"ure: C - '"L 1 19`2 1 I Date: Phone#: 013) C-03- f�q J(, 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#: Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes No 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, R,as Owner of the subject property hereby authorize: _ . e jto act on my behalf, in all matters relative to work authorized by this building permit application. t Signature of Owner Date David Diaz 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 Na 105/06/2014 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder.•David D iaz :93603 License Number :459 Main St. Indian Orchard,MA 01151 ;08/07/2015 . ........ Address Expiration Date '(413)218-7392 Signature Telephone SECTION 13-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 4 No 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable El Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility l Address Registration Number Signature Telephone Expiration Date .._ Name Area of Responsibility I f Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number @ l Signature Telephone Expiration Date 9.3 General Contractor Sturdy Home Improvement Not Applicable ❑ Company Name: David Diaz Responsible In Charge of Construction 1459 Main St. Indian Orchard, MA 01151 Address ' E ;(413) 543-1681 Signatur Telephone Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size -...- Frontage Setbacks Front �- Side L: R: L:`-, J R:'.- Rear Building Height Bldg. Square Footage % I Open Space Footage _ % _ (Lot area minus bldg&paved a parking) r � #of Parking Spaces Fill: _ volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO @ DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT 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 0 DON'T KNOW YES 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 NO IF YES, describe size, type and location: s D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q 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 Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑✓ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description !Strip existing layer of siding.Replace and install 10 squares of Main St. siding in Cypress.Replace and install Of Proposed Work: [10 double hung windows. Install I new construction picture window. Supply and install 1 bay window. SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility El Specify: M Mixed Use ❑ Specify: � N S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: _ _ Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): : SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 1 St St .. . ... ... .. nd .. ... ,i 2 nd ._ .. 2 3rd 3rd 4m 4tn _ Total Area(sf) Total Proposed New Construction(so Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public E] Private E] Zone i _ Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 i W pppartment use artly ------- h of Northampton Status of Permit: Bu I ing Department Curb CufilDrlvew40 Pernih 4 - I 2014 2 Main Street Sewer/SepticAveliabtiity MAY Room 100 WateoWe1l Availability mpton, MA 01060 Two Sets of Structural Plans Electric, Plumbing&Gas ins e -Phom 13- �-1240 Fax 413-587-1272 Plot/Site Plans APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office t 376 Bliss Street Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: IEvan Vaine 76 Bliss St. Florence MA 01062 Name(Print) Current Mailing Address: '(978) 855-7345 Signature Telephone 2.2 Authorized Apent: ;David Diaz 459 Main St. Indian Orchard MA 01151 Name(Print) 1 Current Mailing Address: 1(413) 218-7392 �( Signature / Telephone 1` SECTION 3-ESTIMATED CONSTRUCTION COS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee $17,400.00= 2. Electrical (b)Estimated Total Cost of I Construction from 6 w. 3. Plumbing Building Permit Fee i . 4. Mechanical(HVAC) 5. Fire Protection —, 6. Total=(1 +2+3+4+5) Check Number 0 This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 76 BLISS ST BP-2014-1179 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23C-086 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:replacement windows/siding BUILDING PERMIT Permit# BP-2014-1179 Project# JS-2014-001989 Est. Cost: $17400.00 Fee: $70.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sg. ft.): 17859.60 Owner: VAINE EVAN Zoning. URA(100)/WSP(100) Applicant. STURDY HOME IMPROVEMENT AT. 76 BLISS ST Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON:51812014 0:00:00 TO PERFORM THE FOLLOWING WORK.REPLACE PARTIAL SIDING & INSTALL REPLACEMENT WINDOWS 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 5/8/2014 0:00:00 $70.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner