25C-006 (2) r`$'$T �
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al. Cnt
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OPTIONS & ACCESSORIES INVESTMENT
PORCH $4490 HATTERAS
$5068
GRANDMANOR
$6508 INSPIRE
S C S P 10
TERMS: 33% DEPOSIT DUE UPON ACCEPTANCE TOTAL `?
33% DUE UPON HALF COMPLETION 33% Deposit
BALANCE DUE AT SUBSTANTIAL COMPLETION Balance Due
YOU, THE OWNER MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT
OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE
NOTICE OF CANCELLATION CLAUSE BELOW FOR AN EXPLANATION OF THIS RIGHT.
ACCEPTED AND AGREED: The prices, specifications and conditions contained herein this Agreement are satisfactory and hereby
accepted. You are authorized to perform the work as specified.
(MUST BE SIGNED BY ALL OWNERS)
OWNER: ° %%J + L'i OWNER:
DATE:
AGREEMENT IS NOT FULLY EXECUTED UNTIL SIGNED BY A LICENSED SALES PERSON THAT IS CURRENTLY EMPLOYED
BY JANCEWICZ& SON. -
Pl�
r Vv
Jeff Wbar Jancewicz&Son
DATE: /2-9 10 7
We at Jancewicz&Son would like to thank you in advance for this opportunity to review and prepare this proposal for your home. We
are totally committed to providing "100% Customer Satisfaction" before, during and after your roofing project. We have taken pains
to make sure this proposal is suited to meet your needs for now and in the future. Please call me at your convenience if you have any
questions at all. We look forward to working with you.
Yours truly, i�coV I
7 a-C&A)
'r �7` - C' UJO—t
Dunbar 4
Jancewicz&Son -
//
upa.� ,
2 y e �1:sa�crlJntrcia-
p DEP/1RTMENJT OP DUILDr)tC INSPPCTION'S
212 Alain Strcct ' Municipal Building
Northampton, Mass. OIOGO
__V GRxa R'S CO iti T ENS A'M N GNS URAN CE A I M A.Vj-j-
(li ccnsxJpernv ttcc)
a principal place of businessfresidence at: - -
S V) (phone")
(sn-�t/ci ry/stalrla p)
do hereby certify, under Lbc pains and penalties of pcgu-y, h:i
(� I am an employer providing the following iworker's comocnsadon covemSe for illy
eluployces worong on tills job:
--
(Ir_sun�c Conr`c�) (Pclic: Nu--aarrr) (T:pirrior.Dal:)
( ) I am a sole proprietor, general contractor or homeow-Der (ci c:e one) and have hired
the cono-actors listed below wbo have the following worker's compen_taaon policies:
(�+amc o;Cont^c�or) On uranc-- Cocnoa-y/PoLc Dntc)
(Nzmc of Coaimmor) (lnsaranc:. CompantivPosc-, `Lancer) (xo muon Date)
(Name of Conaaclo,) (Insura.ac Compacy/Po-L-cy N=bci) (Exp maoo Daic)
(Fame of Conaactor) (Iasurancc Compazy/PoUcy Numbci) (Expiration Daft) .
z6didoc-1�x�.ir accQa_-}•w a�cu '�af«-m�oa pertia.iaias w mil«�•-so:z)
( ) I am'a sole-proprietor and have no one worL-ing for me-
( ) I am.a home owner perforTning all the work myself.
NOTE:pl=.=be ea isc twire 6emcOvvcn uFo ccapjQy p_=o=to z= c rc--z it war c an or
not arc.e tin tf-ca�t�in Wbd�the bocncmwe mid..«cc the peones zp�tbea r_-r oa C=.11y ocrd=d to be
eitployes u�c he ,v S rr x x•.,:w Act GL152�1 5
t ( )1 rppiiaaw by a 6otncoava fc c «permit try mdcocc t1:c
1cgsl.+= u of as c=ploy,.c uadcr dw Compom.tioe AV_
uadc.-ztxad tba a copy of lht.cat.®cm olay be f«>.erdnd to tbo Zkpartmmd of lnau ,J AandcsaY Of G-or boon for the
covcz.sc rciretioa nerd t!u L-ilsze t°s¢'src'c°`Krybu undo socs�oa 23 A of htOL 1 S2 nn Irk to the i�sioa of aimia�!pcaaltic
eom-i.iag or a tine or up to S 1_po.00 orup to co-ycr e.od aNil pmal'ua in CS,focm of a Stop Werti Ord¢and a
rim of S 100-Qp y a�ti¢Yt
For�`f—,i u.c only
Pcrmlc Numtc--
Lot l'
f Lic=zc- Pcnniucc e ) �.
05/6712007 14:56 6033576431 CLARk_MORTENSON AGY: PAGE 02/0
IC11entff:50323 JANCEWICZ1 _
CERTIFICATE F LIABILITY INSURANCE 51W/M11�r74YTYY} i
�/�� '���" ► 05ltB7l07
r1 fwoucm -- - THM CER'T RCATE IS ISSUED AS A MATTER OF INFORMATION
Clalrk•Mortenson Agency,ncy,Inc, ONLY AND CONKERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR l
P.O.Box Soo I
ALTER THE Ct'!'W'1=RAF7E APFt7Ri3Eq BY THE POLICIES BELOW.
}Keone,M14 03431
IAISURER3 APFORDING COVERAGE NAIC#
msirr:r� INSURrRk Peerless insurance Company
sanG$wliir.&!ion MSUREP 8; —�
6 Morgan Strimt INSURER C: _
Sellowis Falls,VT 05101 iNbURERr:;
I INSURER E
THE POLICIES OF INSURI NCE LIET'ED BELOW HAVE BEEN!;S511GD TC THE INSURED NAWD AIIIIGVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
Ah'Y NBOUIRENAENT,TER!i1 OIL GQNDiTION OF ANY CONTRACT OR 07HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.,THE INSUNANCE ArFOR ZD DY THS P41JG'ES DESCRIBED HEREIN IS SUEJEGTTO ALL THE TAMS,EXCLUSIONS AND CONDITIONS OP SUCH
POLICIES.AGGREC--ATS 04ITS SHOWN MAY HAVE BEEN REDUCED aY PAID CLAIMS.
LTII �!5a 'IYpp Of'IN?URANCG P*uty NUMBER RUI,ICY kFRpp YF, t 6f Y PIR TIDN _.
ATE iMM;ODt'1�' DAT M LI1glTS
A ITENOUL LIAElLm, �CR1595AW B 05106/07 05106105 EAOH OCCURPENCF. $1.000.000
6A�AB RfiNTfiea
X GC7k{1aEFtCIAL 3FNFRAL LtsRiI,iTY fE
FX n.ssrurrorl
µI CLAIURd'31U„S/�MAD Eil OCCUR { MED E%P , , P116 rgpfyP $5 00
l I'D 18 P7gRgQNA1.wADV INdUF(Y 01,000,000
S �
• QENERALAGGREGATE 3$004 t)0
i
5EN'L a Gr*REGATE LIMIT APPLIES PERT PRODUCT'S�C4MPIOF AGG
'10L Cy RO LOU
AUTOFACIIIILE LIARI_W BA9593618 0510610T 05106/0x3
GOM5INED$iN(i11F LIMIT �81 UOD 000
;lie!aoclrhn!) t :
X ANY AUTP: �
Ai,l.OWNED AL T'DS DOWLY INJURY
SCHEDUi.F'15 AIJt35 P�
I[ (per 06twn)
X }H:Rlsb AUTOS ` + BODILY INJURY III
j X EJON-WNEI�AJT>?? l
(;c ! IPetromldF+nP) t
PROPERTY CAWIGr {fP
I GARAG&UARILITY T-� AUTO ONLY'P.AAG6t0EN? S
ANY ALtru 6A AC 3t g
AUTO ONLY: AGG $
I r
EXCESS/UMBRELLA UARILITY EAC}I CoCUMMENCE S
00WR I_�CLAIME MADE AGGREGATE $
DEDL,"TIULe
RETEN'T*N 1 6
ft W0PK9WgCOMPEN$AnyiANo -- WC9594118 05106147 0510610$ we IMZS.
EMtLCYERS'LIABILITY E.L,EACH A4fjPDFP1i $5040D0
NY R/RXECUi WE
Chr'lGF,Rt"uiEMBERC%CI.UTFf;; I C.L.018BA$E-EAWPLOYEE $500000
C ySe9 �h36G"?yC v�}Ilf;
tiPECil,1_ARf'V4gtpN5 Lela,c �,_, __ E.I..0115" •EUV LIMIT $500,000
OTHER
DESCRIPTION OF 4?ERATltN#S t iGCATPONS!LEi41CLES PP;}'CI,'.,1$!{3N5/1DSSrt?HY CPy6p6i5EMENT?SPECSAL PR4171FiIOP;5 y-- —
J8ncPwI z&-Son
Hume Improvement Co. rrrVT Inc.dba
l
C�RTIFIC:ATF HOLDER — _. ®..�� CANCFLLATION
it3P IJLD ANY OF THE A9OVE DE3CRIBE5 POLICIES BE CANOELI&D 51EFORE tHF EX IRAT,01 ,
JDATE IHEREUF,THE ISZ-VNG INSURER WILL RNDFAVOR TO MAIL Irll/J DAy$'OMITl'EN
NOTICE 70 THE CERTIFPtAIT HCLGER NAME6 TQ 711r LEFT,HUI FAILURE TO DD SD 31ii3OLL
IMPOSE NQ Gel-C,TICK bR UAWITY OF ARV RIND UPOR THC INSURER,ITS AIRM OR
A rf HORIZED RBPRE69WTATVIE
ACORD 35(1001!08'!i uy 2 047529 OTT Co AG+•RD CORrOKATION 19139
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SECTION$-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
'I9ll `ImirC+y�re►e1r>It:Ciot '_ Not Applicable ❑
)t1nCEcc'tC `x�A1 / drIll L iMf�/-'c�`r��tE�t �" G['. Cy- \,'r2mcwrr
Company Name Registration Number
Address Expi—iratioK Date
F s!"+U fir}Ll-S V T Telephone 4i 35 h'
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...... ❑
Y k
4
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 -DESCRIPTION OFPROPOSED WORK{check all aonlicalyfel
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing
Or Doors 1:1 1 Q
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[[3] Other[171]
Brief Description of Proposed
Work: ,Rr- tI 5/D� Vt� LL —9F-0L,1C7= J� SQ TEET �5i4iAJ6-L 5 (�C-- 2-AC
Alteration of existing bedroom Yes_ No Adding new bedroom Yes _No SJDItiC
Attached Narrative Renovating unfinished basement Yes -n-No
Plans Attached Roll -Sheet
{ r;l _ N IA
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 Ia•OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 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
I, ,�1 ySo�' �lf✓b'8�1�2- Ati`C -��'l C SC?/�! as Owner/Authorized
Agent hereby declare that the statemen s 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 periu .
JA D lag.
Print Name
24' c L i
Signatu f Own gent Date
~ ° .
. .
. .
Section 4. ZONING AtI.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
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
of Parking Sp
aces
A. Has ever been issued for/on the site?
�-� ��� »�%
NO «_� DONTKNOVY v�� YES �.�
r-~--- ----~/
IF YES, date issued^ |
l_ ___ _ -
IF YES: Was the permit recorded the Registry of Deeds?
NO n��x�� DONTKNOVV > YES
{ ' — } �---------�
IF YES: enter Book \ Paga and/or Docunment#!
DO��� 0 YES B. O� �����na�� b�����w��� NO 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained m�� Obtained �~� �mtmisyued'^
i------------ 7
' m�� �~� '
C. Do any signs exist on the property? YES ~� NO
|F YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO
----------'----- '---~----- '----~-~----'-`--
IF YES, describe size, type and location: � !
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre uris it part ofo common plan
that will disturb over 1acre? YES NO
|F YES,then n Northampton Storm VVoerK8onogementPermit from the DPW isrequired.
Department use only
City of Northampton Status of Permit:
1 Building Department Curb Cut/Driveway Permit
r r..
212 Main Street Sewer/Septic Availability
__. Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 41;3-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
"�J y -_
AP,P�ICATION TO,) NSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SEC-CTION 1 -SITE INFORMATION
1.1 Property Address: �? This section to be completed by office
I q Wrth �_ `.► Map Lot Unit
Nc�r-tyjavn p�uo, ` /� A Zone Overlay District
cx�cc)
Elm St.(District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
�
'(Y�CC'� )G, 5c�r� C 1�'1C`�C�CtE'1
FcCI N
Name(Print) Current Mailing A ess:
17C2_L.tc,_3- 47
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building r (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) Check Number v
This Section For Official Use Only
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
r
BP-2008-0329
GIs#: COMMONWEALTH OF MASSACHUSETTS
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-2008-0329
Project# JS-2008-000469
Est. Cost: $7829.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Jancewicz & Son 121544
Lot Size(sq. ft.): 33149.16 Owner: COHEN ADAM
Zoning: URB Applicant: Jancewicz & Son
AT. 134 NORTH ST
Applicant Address: Phone: Insurance:
6 Morgan St (802) 463-3585 Workers
Compensation
BELLOWS FALLSVT05101 ISSUED ON.9/25/20070:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE 25 SQ FT OF SHINGLES & CEDAR
SHIGNLE 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 9/25/2007 0:00:00 $25.0040071
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo