23A-021 (4) 10
IF-M MITI
459 MAIN STREET-P.O,BOX 51033-SPRINGFIEtD,MA 01151
MA.REG#151711 CT.REG#601525
877-3STURDY FAX413-543-3200
1 1 t�1m@ M
OWNER PERWY AUTHO .ION
Name:
Address:
City/State/Zip: /7,-0
��r (owner), of the prop city
located at: i ./�,. authorize,Sturdy Homo
Improvement,Inc, to act as my agent for the constru ction proj cot taldng
place at the above address. I also, authorize Sturdy Home TmprovemcntL jho
to obtain a building p otmit for this prof ect. I understand and accept
responsibility to comply with all regulations and required inspections,
c l /'S
,signature of Date
,Signature of Owner Date
STURDY HOME IMPROVEMENT, INC. ACCEPTANCE PAGE MA REG.#151711 .
CT REG.#0601525
t 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 scheduled to begin the week of____/____/____. Expected completion date_____/____! Weather permitting. f«r
The cash price for labor and material as described above is:
1st payment 2nd payment 3rd payment 4th payment
Contract Total (upon signing) dTN-0AIul /� ` �e y
Roof $ ;irfz� C�tU �i it� �-� --�
Ventilation $ LA) =
Other work $ � �..{., �j 1 '�cit.�°► ��1'\'f I��� .
Roofing total $ -�° _ $ $ $ r $
Siding $ _. $ $— $ $
Windows $_^' � $ $ $ $
Special orders $ $c!f-� $ $ $
Other $ $ $ $ a�
Totals $ _ $ $ $ $
Terms: Cash Finance
Credit Card:#_ _ _ _ - — _ _ _ 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
$ to be paid for
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 provisions areated on reverse side and W-part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their names
this day of a/ � 20� 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).
r
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 arbitration as provided in MGL c 142A.
a � r
Representative: (�/41) Owner:
Owner:` _
NOTICE.The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution in' ated by the contractor. The owner
may initiate alternative dispute resolution even where this section is not signed separately by the parties"
Do not sign this contract if there are any blank spaces
bubmi - ��^�'.' j /f_ Accepted
y r —_� r•
Representative r ha Date
Accepted Accep.Wd R _
/
by._ by:
Representative Purchaser D e
459 Main Street
Toll Free (877)378-8739 Springfield, MA 01151
t Worcester (508)797-6600 E-mail: HR@SturdyHome.com
Springfield (413)543-5906 s www.SturdyHome.com
New Haven (203)848-2118 134F
Fax (413)543-3200 HOME IMPROVEMENT,
WINDOWS • SIDING ROOFING • ADDITIONS MA REG.#151711 CT REG.#601525
Name Home Phone Business Phone qt 3
Address I t;e one Other
( "7 vci, �� ell rya' 8 S2-
Town/City X02 Representative 11 Date
I/we the owner(s) of the premises described hereinafter, referred to as Owner, offer to contract with Sturdy Home Improvem nt, 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:
W' ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 1!!5�2 0 3 4) Family home.
WI./ 'j 2. Provide certificate of insurance for workers compensation, general liability. (see attached certificates).
11 1 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).
❑ 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.
00- ❑ 7. Remove and dispose of (quantity)windows.
&0'❑ 8. Remove and dispose of (quantity)storms.
0`*❑ 9. Remove and reinstall stops. Please note: if stops need to be replaced, an additional cost assessment will be made at that time.
❑ X10.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 paintlstains/wood on windows.
Sturdy Home Improvement Inc. will not be held liable for any paint/stain/wood surrounding the opening of any windows.
❑ 11. Remove weights in pockets and dispose.
d''°'❑12. Insulate weighteavities with fiberglass insulation.
Up-AD 13. Provide all silicone sealant.
❑ i rt4. Install alumi um wraps around windows. Quantity ed;1 Color
❑— ❑ 15. Install new treplacement windows. Quantity Manufacturer 'Wet . Model
❑ DI-6. Install new construction windows. Quantity-_4 Manufacturer s Model
❑ L01-7. Install bay/bow windows.Vinyl Wood Quantity Manufacturer
Model Other
d17 J
Imo❑18. Install new glazing on each window: Low-E 0 Low-E with argon( /mA 1.1a. ther 0 44
❑ &19. Install grids in each window: 5/8" Colonial style other Pe1v:4-ej
GBG h Interior Grids SDL Brasstone e-l� Brushed Nickel e0
Top Sash Bottom Sash
f ❑20. Install new hardware on window. Color W
❑''�❑21. Provide screens with windows: half screens tom' full screens 60 aluminum fiberglass
I -❑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.
❑ I23. Addendum (A)=OTHER WORK.
❑24. Acceptance Page y '
❑25. Work not included: 1. Final cleaning of windows 2.Any rotted wood (other: `AA;'
y/fJ )•
Initiate Initial, Al is Initial,.!! i
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: I-I pau7 - �The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant \C Dw,-2
Date Signature of Permit Applicant
Alk The Commonwealth of Massachusetts
Department of Industrital Accidents
Office of Investigations
' I Congress Street, Suite 100
Boston, MA 021142017
www Mass.govIdira
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): �JLU —
Ac1dress:1,)11`�--,91 O(k o
City/State/Zip: 1-5- Phone #: ) 0 6
Are yo n employer? Check to appropriate box: Type of project(required):
1. I am a employer with 4. 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. 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.] S. F] 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.] e. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
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 avid job site
information.
Insurance Company Name: '7:ZaA �t'1DW' 1 2,n ox -7 —
Policy#or Self-ins. Lie. #: (,v C C20 -'��Z L4( 12— Expiration Date: (l 2- 1,-`
Job Site Address: h OCU-t-- City/State/Zip: F1 Octo e-,- n/Vt" U lU((,Z
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 petjmy that the information provided'tabove is true find correct
Signature: Date: 7/, //
Phone 4: �3 �' 61
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 Not Applicable ❑
Name of License Holder:- s 1/l�N pct yJ �2— 93UO3
License Number
ress Expiration Date
Signature Telephone
9.Registered Home improvement Contractor: Not Applicable ❑
Company Name(_) Registration Number
,14ep, ffla,t,n i neb C ln ( 5'G410-1r e-(' t'}1,A G v S'7 (r /2-(0/( to
Address /2 Expiration Date
Telephone �� 513«I
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 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 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 indows Iteration(s) E] Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [tom] Other[C7]
Brief Description of Proposed
Work: Q,iid nn 4 '6 U o 4( a —4 �;C'ar'l y-"Oof 'f0O �n-Se
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 existinq 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, 1(2( -D [ck2 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.
Print
Az
S re o 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: L:i ._. R�
Rear
Building Height i
� _ u
Bldg. Square Footage %
Open Space Footage % ..
(Lot area minus bldg&paved
parking)
#of Parking Spaces -
Fill: i
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW YES
IF YES, date issued:;
i.
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES 0
IF YES: enter Book I 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 ® Obtained ® , Date Issued: i
C. Do any signs exist on the property? YES 0 NO I
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0
IF YES, describe size, type and location:
I
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
ity of Northampton Status of Permit:
uilding Department Curb Cut/Driveway Permit ,
� 212 Main Street Sewer/Septic Availability
Room 100 Water ell Availability
mpton, MA 01060 Two Sets of Structural Plans',
0
-1240 Fax 413-587-1272 Ptottsite Plans
`gctn°'ortha<n� Other Specify
PPLICATION 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
(� PC T-L S� Map Lot Unit
t' Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
& 11 ���'k S1 nbranCk M,-1 G(O&Z
Name(Print) Curr nt Mailing Address:
P3 0i 345,2—
Telephone
Signature
2.2 Authorized Agent:
lD ,s>c% - it C,7 J1 c-) )V1Ct`4 o G+-C1,Va ps m sti
Nam Current Mailing Address: 005-1
Si Ina ure 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 = 0 +2+3+4+5) a(SV Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
19 PARK ST BP-2016-0061
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-2016-0061
Project# JS-2016-000109
Est. Cost: $3900.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: STURDY HOME IMPROVEMENT 093603
Lot Size(sq. ft.): 7187.40 Owner: QUIGLEY KATHY
Zoning: URB(100)/ Applicant: STURDY HOME IMPROVEMENT
AT: 19 PARK ST
Applicant Address: Phone: Insurance:
P O BOX 51033 (413) 543-5906 WC
INDIAN ORCHARDMA01151 ISSUED ON:711512015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 8 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 Deaartment 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 Sienature:
FeeType: Date Paid: Amount:
Building 7/15/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner