30A-068 (2) Toll Free (877) 3-STURDY All home improvement contractors and subcontractors
Springfield (413) 543-1651 engaged in home improvement contracting, unless specifi-
' I I U I UWIUI ( ��) 77 call exempt from registration by Provisions of Char 142A
TOTAL t10MC RTNOVATION �J u (UI l ! ( I
www.SturdyHome.com New Haven (203) 848-2118 of the general laws. must be renistered with the
459 Main St.•Indian Orchard, MA 01151 Fax(413) 543-3200 Commonwealth of Massachusetts. Inquiries about registra-
P.O.Box 51033•Indian Orchard, MA 01151 lion and status should be made to the Director, Home
MA REG.#151711 Member Better Business Bureau Improvement Contract Registration,
CT REG.#60152 tt__ � Fully Lic nsed&Insured One Ashburton Place,Room 1301,Boston,MA 02108
Sub i ed�: �- 14 1`�l�' Ly,, (617)727-8598
PHONE Li r 3 r7 (� DATE �f
v woRK 8 �L L t yj j p l Crj
We hereby submit specifications and estimates for work to be performed and materials to be used: IT
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WORK SCHEDULE
t tier will n t begin the work or order the materials before the third day following the signing of this Agreement,unless spot''elf herein.Contractor will begin the work on or about
(date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by date).The Owner hereby acknowledges
and agr s that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not t d to strikes,Acts of God,shortages of materi-
als,accidents,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 contractors,employees or agents,is discovered
after completion of any job,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-,complete in aqcorcianqe f with above specifications,for the sum of:
dollars($ ad'
Payment to be made as follow e
/ v
($__S•:%�on signing contract; STURDY HOME IMPROVEMENT INC.
Name of Contractor/Designated Registrant
40_%($ .2LSD0 1 upon start of work; P.O. Box 51033
Street Address
(.1 � )upon completion of� 2'(Cw Indian Orchard MA 01151 413-543-1681
Z City/State Phone
(s U 1 shall be made forthwith upon
completion of work under this contract. r
Name of alesm
Authori Signature '
Acceptance of Proposal I have read both sides of this document and accept the tce s,specifications and conditions stated.I understand that upon
signing,this proposal becomes a binding contract.You are authorized to do the work p if ied.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 t n an address of the Seller,which may be his maul Of(iCe 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.
Signature � l to ��� , Signature Date
The Commonwealth of Massachusetts
I 1A Department of IndustrialAccidents
Office of Investigations
VV I Congress Street, Suite 100
Boston, MA 021142017
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/1J lectricians/Plumbers
Amlicaut Information Please Print Legibly
Name (Business/Organization/Individual): s 1 L( t"taul ` uyyiL
Address: - n g M cu A �S+M_A-
City/State/Zip: \n&Uafl ()rG41c,cCi� m_.t ck t 5 i_ Phone k
Are y n employer? Check the appropriate box: Type of project(required):
1. I am a employer with 'S 4. 0 I am a general contractor and I 6, 0 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. 0 Remodeling
ship and have no employees These sub-contractors have g, 0 Demolition
working or me in an capacity. employees and have workers'
g Y p tY� 9. F] Building addition
[No workers' comp. insurance comp. insurance.}
required.] S. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 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' 13.0 Other
comp. insurance required.]
*Any applicant that checks box 41 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 tern art employer tliat is provielieta woi-leers'conipeeisatioii iiesnreance for nay employees. Below is the policy and job Site
information.
Insurance Company Name: ::n C". Y-e�5 `fl jJ "ou 0 GV_
Policy#or Self-ins. Lic. #: ^n 0 o l - -q Z -4450— Expiration Date: _�/Z V l S_
Job Site Address: 29�,5 F 10K.I n c u (I C4 4 City/State/Zip: ('(OyCt1 'C.e th✓4 0(C)k02Z
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 peJuiy that the information provided above is hwe and correct
Signature: GaC Q-l/ 'AFB Date:
Phone#:
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 Swervisor:a Not Applicable ❑
Name of License Holder: �+�` -D iccz— !,3 (PO J
License Number
rain& ,r GI y-A Gl t"-)-1 53/ -7 S-
A ddre Expiration Date
S gnat re Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
�5 hA,rGt" 151 rl It
Company NanW Registration Number
tea, roaj n 64. Ino-tai-, yrCu/(V M,4 6tl ,,5i O/Z(,O/'IW
A dress Expiration Date
Telephone 'f=Y4,3[(f3)
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 buildine 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 Windows Alteration(s) ❑ Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [0] Other[0]
Brief Description of Proposed
Work: If AQ D t A--,V f (UA0 5y\e t,+ QCA, Off.L2r 3 t pct�� �A�C � �3) ern�, f r►5t.((C'�iR
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 4,
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
C)'_T, 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.
'-D(W1 C D C,2_
Print N
t
Sig a of weer/A 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 3 m
[ _ 1
Side L. R: L: R:I, a
Rear i
Building Height , j
Bldg. Square Footage IX �` -
-° .__ 1__ E ni .......
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 0._ YES
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 ® , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
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: F
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
Lt Ity of Northampton Status of Permit:
Auilding Department Curb Cut/Drlveway Permit
�j 212 Main Street Sewer/SepticAvailabitity
�;� Room 100 Water/Weil Availability J N rthampton, MA 01060 Two Sets of Structural Plans
l� -587-1240 Fax 413-587-1272 Plot/ ite Plants
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
-29 5 F(ors na Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
�-ii 3 n&-'4 ,55D 2
Telephone
Signature
2.2 Authorized Agent:
-D-A t -D iG�2 -�45q We o n? .irwi OrC-ha,reP iYi,-4 OKI
Nam / Current Mailing Address:
Signature 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) CZ% Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2015-1334
APPLICANT/CONTACT PERSON STURDY HOME IMPROVEMENT
ADDRESS/PHONE P O BOX 51033 INDIAN ORCHARD01151 (413)543-5906
PROPERTY LOCATION 295 FLORENCE RD
MAP 30A PARCEL 068 001 ZONE URA(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 4
Fee Paid T r J
Typeof Construction: SHEETROCK CEILINGS WALLS&INSULATE 3 ROOMS)
New Construction
Non Structural interior renovations
Addition to Existing
Acc Structure
Building Plans Included:
Owner/Statement or License 093603 Su
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR ATION PRESENTED:
proved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition ay
400
Sign of d' 1 Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
295 FLORENCE RD BP-2015-1334
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A-068 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2015-1334
Project# JS-2015-002436
Est. Cost: $6300.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sy. ft.): 14897.52 Owner: WHEELER RICHARD H&CATHLEEN M
zonin : URA 100,/WSP lOOZ Applicant: STURDY HOME IMPROVEMENT
AT: 295 FLORENCE RD
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON.•612212015 0:00:00
TO PERFORM THE FOLLOWING WORK:SHEETROCK CEILINGS, WALLS & INSULATE (3
ROOMS) WALLS & CEILING MUST BE AIR SEALED & INSPECTED BEFORE INSULATION
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:
FeeTyue: Date Paid: Amount:
Building 6/22/2015 0:00:00 $55.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner