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24C-096 (3) K z- l2 YA tioa .Gam, ant Toll Free(877)3-STURDY All home improvement contractors and subcontractors Springfield(413)543-1681 engaged in home improvement contracting,unless specific.Worcester(508)7s7-6600 �r—ri pthornreamtrationbyProtrlSIOnt s,ofCt>a�rr.?A wwwSttud omecom New Haven(2o3)848-2118 of the general taws, must be reg-rstered with the 459 Main SL•Indian Orchard,MA 01151 Fax(413)543-3200 Commorm eafitr of Massachusetts.Inquiries about resist,, P.O.Box 57033•Indian Orchard,MA 01151 tiorr and status should be made to the Director, Home MA REG.:151711 Member Better Business Bureau Improvement COntiact lF , CT REG.#601525 Fully Lnsed&Insured One Ashburton pce,Room 1301, Boston,MA 02108 Submitted to: ,/A tl d K p > (617) 2-%% _ 'Z 3 __ M,4fS A 5-6 r PHONE 3 G gs' G o g h ��' z �r- /1,6x�1,NTbn• fvt� WORKS We hereby submit spedfications and estimates for work to be performed and materials to be Me& o 'R ew,��� 14 Lcj p S14 `i�A s Need�z�l iw�i��w S ray wi 11 S U C , w�k; T`2� Ac. t J Govtti,�> Pp 1 e� IQ WOW SarmtnE Contractor a not begin the work or order the materials before the third day famsg the sighing of this Agreement,unless specified heraa Contractor wig begin to work on m ab.A (date).Baring delay catsod by amumstw=beyond Contractor's crontmL the work inn be comS)Ieted by (date).The Owner haWay adu)owledgos and agrees ttrattho schoduling dates are approximate and that such delays that are not avoidable by the Contractor indudvrg.but not limited to strikes,Acts of God.ahavages of Materi- als,aaidonts,and alt other delays beyond Its conlroL shalt not be considered as violations of this AgreemenL WARRANTY The Conbactor warrants that the work furnished hereunder shag be free from defects in materials and workmanship for a parsed of following=nploiion and shag campy with the requirements of thisAgreemenL 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 job,including cleanup.the Contactor",at its own e:gt m.fonhwith remedy,repa,4 correct,repl ace.or cause to be remedied,repaired or replaced,such dam- age or such dolact in materials and wodananstup.The foregoing warranties shag survive any I specUOn pedarned in connection with the agreed-upon work We P[ODOSe hereby to famish material and labpr-complete in accordance with above specifications,for the sum of. p (.'.J D �+rJ dollars($ D_ Payment to be made as follows: Y 4y u`sigm'hywntract; STURDY HOME IMPROVEMENT,INC. Name of ContractocDesignated Registrant (S ��� c� 1 upon start of work: ddre s Qom, �^ StreetAtidress %(S �l�' 1 upon ooa ion� Indian Orchard,MA 01151 413-543-1681 �/S r Cdy/State I Phone 7 "0 )shall be made forthwith upon C9rnpSetlen of work Under this detU2CL Brame of Salesman r Authorized Signature Acceptance of Proposal 1 have read both sides of this document and accept the prices,specifications and conditions stated.I understand'bat 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 party thereto at a place other than an address of the Seller,which may be his man office or branch thereof,provided you notify the Seller in writing at has main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third btrsiness day following the signing of this agreement Please refer to the Notice of Cancellation that accompanies this contract con- lards of which are rate to above and incorporated herein by reference. D THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 5rgrtahue _. Date `� �� Sgnahtre Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Ulf Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): l `- rn Address. +-"� WCUo S ��A- City/State/Zip: 1AeLia2n o �-C.Inc,� n-LA GllS)Phone #: Are yo an employer? Check the appropriate box: Type of project(required): 1.E9 I am a employer with "3 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors ❑ 2.❑ 1 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' 9 ❑ Building addition [No workers' comp. insurance comp, insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 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.❑ Roof repairs insurance required.] 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 anew affidavit indicating such. lContractors 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: e-.P- Policy#or Self-ins. Lic. #: '�4-2 '4512 Expiration Date: '_? 12- (/-1 15— Job Site Address:—1 ,2, (HC:�,544oi J- S) . City/State/Zip: i �v 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 trace and correct. Signature: '`1 � � /L- L — Date: Phone (pF Official case 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: 7� Not Applicable ❑ Name of License Holder: -bouj i c), - DJ &"Z 633 (V®3 License Number TA (n UO S�. JCCJACkn 6rLha,-0J ff)_4 01t,- 7 I7 S A Expiration Date , <413 z ignature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ SSA 15-1 ") t Company Nartid Registration Number MA I'l Address Expiration Date Telephone�]f 3 54L)(C Lei 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 builclinpwrmit. 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 ❑ Replacement Wi ws Alteration(s) Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[0] Brief De, ription of Proposed Work: y .t-,1 r'1)1 a c R t ry- � foq 'Frh tr Velo -e S -A<- Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet sa: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, , 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, ­]_]wj'C5 i C'��Z 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 painsas nnd penalties of perjury. ' D0001 Q� a )1 r Z Print Name �1-e4 Si ature of Owner g� Date ti 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 _ _ l Frontage Setbacks Front Side L:" R: _ L: R:i p Rear Building Height i Bldg. Square Footage % i 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 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 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 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: l 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 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. ti Department use only, City of Northampton Status of Permit: '' Building Department Curb Cut/DriveWayPermit 212 Main Street Sewer/Septic Avaiiabili#y Room 100 Water MellAvailabilityl Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 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 rV �;1 x,y s7,a�i Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Curr n Mailin Address: (04 5 �o$t Telephone Signature 2.2 Authorized Agent: ,t) -c �i C a `4S) d rx)nk) . l�n(,Licvn ©> .hr�.no rYlA ali ni Na (Pr int) —T_ Current Mailing Address: ls6nature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit 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 6. Total=(1 +2+3+4+5) 2 Z 0_'(1) Check Number of This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date 73 MASSASOIT ST BP-2015-1078 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24C-096 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2015-1078 Project# JS-2015-002034 Est. Cost: $2800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sq. ft.): 14592.60 Owner: KATZ DAVID E&KATHLEEN A Zoning URB(100) Applicant: STURDY HOME IMPROVEMENT AT. 73 MASSASOIT ST Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON:51712015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL SKYLITE 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 5/7/2015 0:00:00 $35.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner