Loading...
23A-021 (3) WORCESTER SPRINGFIELD HARTFORD 459 MAIN STREET-P.O.BOX 51033-SPRINGFIELD,MA 01151 MA.REG#151711 CT.REG#601525 1-877-3-STURDY 508-797-6600 413-543-5906 FAX 413-543-3200 OWNER PERMIT AUTHORIZATION Name: ���� Address: 19 City / State / Zip: ��0�.�nL/� / /g• D�D� Zale&S,�f (Owner), of the property located at: Art QQ. 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. I understand and accept responsibility to comply with all regulations and required inspections. Signature of Owner: Date: Page 1 of 1 STURDY NOME IMP IROVEMENT, INC. ACCEPTANCE PAGE MA REG.#151711 ANY WORK NOT CT REG.#0601525 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 ofh / 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) f�:�(c v //�, �'�, �zt_ Root $ bwt n2�111�� w►`1�C 0�- 6 Ventilation -► ltit�t� �-t• on $ work $ t W e6u,43, UthEr —, f-�' 1 I Roofing total $ $ $ $ r-- $ .- Siditlg $ _° $ $ $ ,, $ I VVincj,\,. $ G3SDi v $ (o©D_ $-2--57S- -.S7S $ 3.57,— $ . SPE-cial orders $ $ g� , $ $ $ dthG_r $ $ $ Totals $ $ $ $ $ Terms: C�Sh _Finance 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 Mee, tie completion schedule, the following material/equipment must be SPECIAL.ORDERED before the contracted work begins. (Law requires ''hat any deposit or down-payment required by the contractor before work begins,may not exceed the greater of(a.)one-third of the tat�1 contr�Ct, toM con r. s 3�nce or(b.)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the �lledule) $ to be paid for $ 6) to be paid for Any additionaLl work orders are to be paid for once accepted and approved by purchaser. Verbal uncdersIaidings and agreements with representatives shall not be binding. All understandings and agreements must be set forth in writing in thi contract. AU this �iio�a�(provisions are stated on reverse side and air part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their nam UNLESS 0:T� 4'1 day of •�"�k�, 20_� and acknowledge receipt of a true copy of this contract. ABOVE WI LL_EAWISE SPECIFIED,IT IS UNDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTE[ Hi HONORED ONLY UNTIL (Date). You the Pu rC tion form fclr �aLr(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 cance kriwlanation of this right. Signature affixed below also acts as receipt that Purchaser(s)received separate cancellation forms. The follo"r `The contra, grand the requirement homeowner Massachusetts ereby mutually agree in advance Improvement the event that the contractor has a dispute concerning this contract, the contra may submf� shall be re dispute to a private arbitration service which has been approved by the office of ConsumerAPPairs and Business Regulation and the consu ref to submit to such arbitration as provided in MGL c 142A. Representg-t 1-,,,<Z Ile— Owner: vYl,% 6_xl ',"" NOTICE.- 7—y,___ Owner: may initlatra -_--;ignatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The own( zFil�mative 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 Je> go .) ��e Ile- Accepted � ,�U a by: Representative Purchaser Date Accepted by:-------- , Accepted _. by: ������ Date 459 Main Street Toll Free (877)378-8739 Springfield, MA 01151 Worcester (508)797-6600 E-mail: HR@SturdyHome.com Springfield (413)543-5906 STURDY www.SturdyHome.com New Haven (203)848-2118 Fax (413) 543-3200 MA REG.#151711 CT REG.#601525 WINDOWS • SIDING • ROOFING * ADDITIONS Home Phone Business Phone Name T nj&V 4 1136yVAIIC_ G/v IrA✓SA/ / ri . r5— Address Cell Phone Other Town/City Aw ��l®6 Re r nt t've 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 WINDOW SCOPE OF WORK: a- ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 0 2 P/3 d Family home. [r'❑ 2. Provide certificate of insurance for workers compensation,general liability. (see attached certificates). [��❑ 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). 'PIcJ<4p '•f' kA Kek"Ojoft•, lam'❑ 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. Ltd-e.�+�^�e. Wk'w►�k' �„-c'`F�}��'o�' f�®❑ 7. Remove and dispose of (quantity)windows. ❑ ❑ 8. Remove and dispose of e`er (quantity) storms. Imo❑ 9. Remove and reinstall stops. Please note: if stops need to be replaced, an additional cost assessment will be made at that time. ��❑ 10.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 paint/stains/wood on windows. Sturdy Home Improvement, Inc. will not be held liable for any painbstain/wood surrounding the opening of any windows. ❑ 11. Remove weights in pockets and dispose. 572• Insulate with fiberglass insulation. Imo❑13. Provide all silicone sealant. ❑ Z f4. Install aluminum wraps around windows. Quantity Color /� a- ❑15. Install new replacement windows. Quantity_Manufacturer bit'•ch yaa rCAAV Mlel V` ❑ W-6. Install new construction windows. Quantity_____!2_Manufacturer Model ❑ ( 7. Install bay/bow windows.Vinyl Wood ® Quantity Manufacturer Model Other U'❑18. Install new glazing on each window: Low-E Low-E with argon �/r�•��M.�ther VC�y ❑ ff9. Install grids in each window:5/8" Colonial style ® other -2j"1"la Ste'if '"`"° GBG d Interior Grids © SDL Brasstone Brushed Nickel a Top Sash 0 Bottom Sash ❑20. Install new hardware on window. Color Gam!-�l�T�• �� ❑21. Provide screens with windows: half screens full screens ® aluminum (:::' _fiberglass ff'❑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. ❑23. Addendum (A)=OTHER WORK. C.111re-LI, XW1'rA V -. ❑i�❑24. Acceptance Page ❑25. Work not included: 1. Final cleaning of windows 2.Any rotted wood (other: I i I ), i /� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 kip Boston, MA 021142017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Iilectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 4 `flbAA 1 )> _ Address: 51� MW 1'1 ' City/State/Zip: �r&hj2 a M Phone #: IJ 5431&K I Are yo an employer? Check the appropriate box: Type of project(required): 1.LY 1 am a employer with_ _ 4. ❑ I am a general contractor and I 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 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 or me in an capacity. employees and have workers' g Y P tY� 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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. i Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 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 rain coat employer that is providiizg workers'cotnpersatioii inseei•(utce for any employees. Below is the Policy regal job site information. Insurance Company Name: 11aAxa r1CA — Policy#or Self-ins. Lie. #: to 0- OU - °�2 ` 12- Expiration Date: Job Site Address: i9 pit �_ 3 "�_ City/State/Zip: F 1(jn�,nrR IY)-4 0 kAo2 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 imprisomnent, 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 peijmy that the infortnation provided above is trade and correct. Sig nature: V Date: Phone# `i'3 �kw� )(a 9 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: r t�1 Z 9 3Lc d 3 License Number T) I1'1C,�t o ,"S I o rki o"n Lr �ci, 1 /l G i l d 9/2 // 5 Address Expiration Date r Signature Telephone 9.'-Registered Homedmprovement Contractor: Not Applicable ❑ �1� �t'LeA l m rU���'l� i .j 1� ► I Com an a ne Registration Number v Address Expiration Date Telephone 51,3 tG 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 buildin ermit. 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 buildinji 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 Win ws Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[tom] Brief Description of Proposed Work: h fef)l .c 13 Wi�C'ko()-zS GL(V"t -q(UU SQL iP5 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 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, Do-,j 1& —D i c'.`2 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. Pri e / Signature of Owner/Agent 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 i Side L:r R:- 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 DONT KNOW 0 YES IF YES, date issued:'; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW YES IF YES: enter Book Page and/or Document #- B. Does the site contain a brook, body of water or wetlands? NO 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 Obtained , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES NO 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway,Permit JUL 6 2015 212 Main Street Sewer/Septic Availability J Room 100 WaterMell Availability Electric,Plumbing&Gas Inspaclions orthampton, MA 01060 Two Sets of Structural Plans Northampton,MA 04hbnp 13-587-1240 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 y � Map Lot Unit ' Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Stan U4 d ,j f��n,e. GC- e4-Iglu L ci PC.%-'L Flor(f.00-k ;g2-A ()lrpkL Name(Print) Current Mailing Address: .1(13 511 Telephone Signature 2.22 A uthorized Agent: D,"wto Dic Z 'U` j rY1(Un 5 nOtaCtn dreula,tCJ CLlS7 Na (Print) Current Mailing Address: t7 r 'L(1:i ` �ltnf�i Signature 10 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) Cj Check Number �s This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 19 PARK ST BP-2016-0020 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:windows replaced BUILDING PERMIT Permit# BP-2016-0020 Project# JS-2016-000033 Est. Cost: $6350.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 93603 Lot Size(ss . ft.): 7187.40 Owner: GALENSKI STANLEY J JR&BONNIE GALENSKI&KATHY J TRENARY Zoning:URB 10oZ Applicant: STURDY HOME IMPROVEMENT AT. 19 PARK ST Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON:71712015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 13 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 7/7/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner