36-036 (13) AW,Aff WALr r Page No, of Pages
CNOICE V, �+�
_ PROPOSAL
33 Grattan Street All home improvement contractors and subcontractors
CHICOPEE, MA 01020 engaged In home improvement contracting, unless {
(413)592-2376 specifically exempt from registration by Provisions of I
Chapter 142A of the general laws,must be registered with It
SUll"Itted Edward Boube the Commonwealth of Massachusetts. Inquiries about I
To: - _.._ ___. registration and status should be made to the Director,
Elam bnpprovenlent Contrad Regis�rion,Or*Ashblueon �E
_----- tlf�ar Ter._.__._.._________ __.________ _. _______...____ Puss,Room 1301,Boston,MA 02109 (617)727-8598
Florence,MA 01062 Owners who secure their own construction related kE
permits or deal with unregistered contractors will
be excluded from the Guaranty fund Provision of I
MQL c. 142A.
PHONE DATE REGISMTM wo. - 112653 CT-REG.NO.W51540
413-584-0209 11-10-13 LICENSE NO, -060612
'M t -5197 Cell .nos LOCATION
YMs f� for work be pertiomred and malarlals to be used;
_. ......... ___ __.. _... _....._........ ..._.
2 Vinyl$ide homsse uryng Mastic Cstvodwood D4"-Sago vinyl siding,Lihtm warranty.
3. Irielatl regWar corrrer Qoeta
4. J-Blocks for all light fpcfarr+ea,fiwcets,&dryta vaits
5. bwdl two Sage Able vents. jjV1k) ~-^
6. WritA ail Facia(try)W Safe co1i.
7. wrap all whWom&doors in Sage ahtminum coil,Anderson Bend.
af��a��Se�e ter vent soffit,mien aA overhangs.
1B�Kemc�ve�En-mStmff j SWUM
1 o ww"bfs c
13- MyWW6W.° _...... ___._._._..._._._ __
ltitR[
_ ----
R-K SCHEDULE
Contractor will not begin the work or order the materials babre the thud day following the signing of rift Agreement,unless specified herein writing.Contractor wNi begin the work on or
abort 8 mordho from date of signing.Barring delay caused by circumstances beyond Contractor's Control,the work will be completed within t year from date of signing. The Owner hereby
acfmawiedges and agrees that the schaduhrig dates are approximate and that such delays that are not avoldabte by the contractor shag not be considered as violations of this Agreement.
WARRANTY
work furnished hereunder eras be hee from defects in material and workmanship for a period of one year following completion and shah comply with the
rMq: rbmanld n tarry n p or m
ens year after completion of any job,Including clean up,the contractor shall,at his own expense,forthwith remedy,repair,correct,replace,o cause to be remedied,repaired,or replaced.
such damage or such defect in materials or workmanship.The foregoing warranties shall survive a local Or state Inspection.
We PrOPOSS hereby to furnish material and labor —complete in accordance with above specifications,for the sum of:
Ten fow hundred and ninety-five doll=and 00/100. 10495.00
dollars($ )•
Payment to be made as follows:A finance charge of V/2%per month(18%per annum)will be charged on unpaid balances.
in additional thereto, in the event that this matter is placed in the hands of an attorney or collection agency, the owner herein shall be responsible for
reasonable attorney's fees,collection costs,court costs,and other cost or fees associated with the collection of any outstanding balances here.
33 346301
% ($ )upon.signing Contract; John W.Wtriz/t=kfyl Vinyl Inc _.
-n — 'IdF t AA arriirat of Mtkt0r•ialo Name of 6ontragor/Designated Registrant
G
3($ )upon completion of 33 rtittfzfrt Street
' r are
°10 ($ )upon completion Of l Ctdcopes,MA 01020 _
crr�stat.
% (, 4� shall be made forewith upon (4131582-2376 65-1215510
completion of work under this contract. f ;e" " y Fade ai7Q IJo.
Jotm Notice: No agreement for home improvement contracting worts shag require a amt Walz trr otfty 's"W or Terry L.Messier
o Sa on of parson 1 Name of Saiespergm+
down payment{advance deposit)of more than one-third of the total contract price
or tits total amount of all deposits or payments which the contractor must make,In Authorized sig
advance,to order and/or otherwise obtain delivery of special order materials and
eq Note:This proposal y be raven by us if yccapted wHhln --days.
Acceptance of Proposal I have read both sides of this document and accept the pr) fications and conditions stated. I understand
that 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,the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the
date of this transaction.Cancellation must be done In wrlting.
DO NOT SIGN THIS CONTRACT IF THERE AR ES.
? Slrxrature
Data
IMP INFORMATION ON BACK
M
City of Northampton 212 Main Street, Northampton, MA 01 060
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:
Q �o6�
The debris will be transported by: VO 10. r iv', 's
CO 14-
The debris will be received by: y u r z r-t-
Building permit number:
Name of Permit Applicant _T c) �✓�< z
Date Signature of Permit Applicant
A;N The Commonwealth of Massachusetts
f Department of Industrial Accidents
,1. Office of Investigations
X :!. '-`' i 600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): FINYL VINYL INC.
ATTAN ST.
Address: CHICOPEE MA 01020-1327
City/State/Zip: Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. Z I am a general contractor and I r 6. ❑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. Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. g, ❑Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.E]Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees.[No workers' (
comp,insurance required.] 13.[�Other /Y .� >
•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 a new affidavit indicating such.
lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/Zip:
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 tinder the pains and penalties of perjury that the information provided above is true and correct
Si ature: 2 Date: �ZA_ 11 / (a
Phone#:
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermitUcense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Suttpervisor: Not Applicable ❑
Name of License Holder: `')r')rrd✓ !'�✓c�. 2 (', 6 �>
License Number
ZZ
Address Expiration Date
jk:f 4-'
Telephone
9.Registered Nome Improvement Contractor: Not Applicable ❑
Company Narliie Registration Number
Address t d eat L, Expiration Date
Telephone'-/ 4 3�?t
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....... p/ 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.Akerson 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
Fmployees 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 171
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding[LDT— Other[a
Brief Description of Proposed �^
Work: N% vi
Alteration of existing bedroom Yes ✓No Adding new bedroom Yes y 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 13E 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
1, ,9 h 1 l/�.l ( �`` 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 Name
Signature t 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 Depai-tment
Lot Size
Frontage
Setbacks Lront
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus b)dg&paved
of Parking Spaces
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
�� ����
NO �_/ DDNTKNDW ��/ YES \�/
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
AdMk YES 0 NO 0 DONTKNOV W
IF YES: enter Book Page and/or Document#
ALIN
B. Does the site contain a brook, body of water orwetlands? NO 0 DON7KNOY W YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs tmbeobtained \`�/-� Obtained /—_�� Date� '
C. Do any signs exist nn the property �� ��� Y[6 \�� NO v��
|F YES, describe size, type and Location:
D. Are there any proposed changes to o[additions Oy signs intended for the property? Y[5 0 N
|F YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,o,filling)over 1 acre vriob part nfo common plan
that will disturb over Iacre? YES ( > N(}
��
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
RECE� ti�!;r '—Ao Q Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 WaterlWell Availability
orthampton, MA 01060 Two Sets of Structural Plans
pho e 4 3-587-1240 Fax 413-587-1272 Plot/Site Plans
DEPT Or BUILDING INSPEc noNs Other Specify
NORTHAMPTON MA 01060
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
T 2 v^ Map Lot Unit
/6 d- ,�,G /Y'Ct �� Q Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:,
ti 1 ,3 � - 4 � � Ct
Telephone
Signature
2.2 Authorized Agent:
i,h-1 V.) UJ Q I Zz Ce 3 e_ v� �
Name(Print) Current Mailing Address:
PV 1-113 SCrJ g � � �
Si 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) Check Number . 6 b
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building CommissionerlInspector of Buildings Date
5 WINCHESTER TER BP-2016-0941
GIs#: COMMONWEALTH OF MASSACHUSETTS
MaR:Block: 36-036 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: vinyl siding BUILDING PERMIT
Permit# BP-2016-0941
Project# JS-2016-001594
Est.Cost: $10495.00
Fee: $71.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN WALZ 060612
Lot Size(sq_ft.): 11020.68 Owner: BERUBE CYNTHIA L&EDWARD A
Zoning: Applicant: JOHN WALZ
AT. 5 WINCHESTER TER
Applicant Address: Phone: Insurance:
66 Bray Street (413) 592-2376 Workers Compensation
CHICOPEEMA01020 ISSUED ON.112612016 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL 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 1/26/2016 0:00:00 $71.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner