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30B-097 (8) 139 FEDERAL ST BP-2020-0493 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-097 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2020-0493 Project# JS-2020-000837 Est. Cost: $3908.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PATRICK KUBALA 100114 Lot Size(sg.ft.): 9888.12 Owner. BRUMBERG MARK D& Zoning: URB(100)/ Applicant: PATRICK KUBALA AT. 139 FEDERAL ST Applicant Address: Phone: Insurance: 5 PELL ST (413) 589-1010 WC LUDLOWMA01056 ISSUED ON.10/18/2019 0.00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL 4 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: FeeTvpe: Date Paid: Amount: Building 10/18/2019 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of Northamptoti..�(�C� Status of Permit: " °1 Building Depart ment yAGopriveway Permit 212 Main Street O vu�r/Seocvailability Room 100 CT , Wa rfWe� Availability Northampton, MA-Q,1060 Tv o Set 'of Structural Pians phone 413-587-1240 Flax272 P ok/sit Plans �nN ther pacify J APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION I J C ` 3 1.1 Property Address: This section to be completed by office //��Q� X39 /�EJ�a?A L. 5TV. Map 3y� Lot ! ? Unit Zone Overlay District Elm 3t.District CB District SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: /� /4119,eK orea m BE e 6 /,3 y AL L -S-j- , Name(Print) Current Mailing Address: " - Telephone Signature 2.2 Authorized Agent: ,Q s 3aCA �mr- i fttl 57—. Name(Print) VCurrent Mailing Address: '11e- "9—/V/o Signatu Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit 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) Q08", p d Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: -0717/ 9 Building Commissioner/Inspector of Buildings Date 6 eV e r- (a) t 3 n c,4 4-1oM C-C)It-) EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [[] Siding[0) Other[EI] Brief Description of Proposed Work: "/0'Ls0C,6 Al 6.)XM-how's 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, 3R Lt m 4��2 G as Owner of the subject property hereby authorize �7- 1tC &,06,q.(.4 o nrc, — /yt C A to act on my behalf, in all matters relative to work authorized by this building permit Ypplication. c3;—r QT4CA-,4--D 5W>i _ Signature of Owner Date t-*B,f (.Q 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. SignF6-7-,,r-Xe-t der the pains and penalties of perjury. 9( 4 Print Name /O P, 1.2 Signat a of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Su rvisor: Not Applicable ❑ Name of License Holder: %�1 74 as — ,/06 //5', License Number S- i-2 G L S % Zeeo zo 0/9 /2. / Address Expiration Date Signatu Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 967 e Ba c A ©rte E ,Qe) 01 6'^., Company Name /\� / y� / Registration Number )046z/, V T ,G C[JI LIW I /�-�A— V 1 D S ` Address 'l Expiration Date Telephone 1113- sJ�/Oip 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....... No...... ❑ S Pell Street Ludlow, MA 01056 HOME IMPROVEMENTS 413-589-1010 MA HiC#150118 Fullv Insured www.PatrickKubala.com Customer authorization for building permits. I 1�''eo" 'u 3 as Owner of the property located at herby authorize Patrick Kubala Home Improvements to act on my behalf, in all matters relative to attaining building permits, and all matters relative to work authorized by such building permits. j 4Z Signature of Owner Date The Commonwealth ofMassachusetts Department of IndustrialAccidents 1 Congress Street; Suite I00 Boston,MA 021-14-2017 www.mass.gov/dia AVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plambers, Annil"pt TO BE FILED WITH THE PERA'BTTING AUTHORITY. o Please Print Name (BusineWOrganizaaon/Indzvidual):Patrick Kubala Home Improvements Le�bly Address:5 Pellm City/State/Zip:Ludlow Phone#:413-589-1010 Are you as employer?Check the appropriate box: 1. r lama a em Type of project(required): ❑ employer with employees(full and/or part-time),* Type 2. I am a sole 7. ❑New construction ❑ proprietor or partnership and have no employees working for is aay capacity.[No workers'comp.insurance required.] $• Remodeling 3,❑I am a homeowner doing all work myself[No workers'comp,insurance required.)t 9• ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensuro that aU contractors either have workras'compensation insurance or are sole proprietors witb no employees, I 1•❑Electrical repairs or additions 5.❑1 am a geaeral contractor and I have hired the sub�ntractors listed on the attached sheet 12.❑Plumbing repairs or additions Trtese sub oomtractors have employees and have workers,comp.insutanee.i 13.❑Roof repairs 6.❑We are a corporation and its Officers have exercised their right of exemption per MGL c, 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] t *Arty applicant that checks box#1 mast also Sll 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 rxust 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 MPI oYMS• If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation informadvn, insurance for my employees Below is the policy and job site Insurance Company Name:Associated Employers Insurance Co. Policy#or Self-ins.Lic.#:WCC-500-5016474-201 A Expiration Date: Job Site Address: _ 7y� S i Attach a copy of the workers' compensation policy declaration page(Showing aty/e Policy number and exp ationatee). /O Z Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 fuze of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 190 hereby certify under the pains pen FJury that the information provided above is Prue and eorrec= Si Date: Ph e#• rp/U F only. Do not write in this area,to be completed by city or town official : Permit/License# ority(circle one): LOther f Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector erson: Phone#• AC V CERTIFICATE OF LIABILITY INSURANCE DATE(MIMMUN-Y" OSOM19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the poky, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CWstine E Davenport Richard R.Green Insurance Agency,Inc, S, 32 Somers Rd PNONt= (413)566-0028 (iv,No):(413)588-0090 Hampden,MA 01036 AD M: cdaenport{¢�rich�dgreeNrsurarxe com 8 AFFORDING COVERAGE NAIC H INSURER A: PATRONS MUTUAL INS CO OF CT 14923 INSURED Patrick Kubala Hwe Impraer*t INSURERS: COMMERCE INS CO 34754 Pabick Kubela dba 5 Pell St INsuRER c: Associated Employers Insurance Company Ludlow,MA 010% INsuRER D: �. INSURER E: fN8U RER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THS IS TO CERTIFY THAT THE PCUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INWRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWi-114STANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CCNTRACT OR OTHER DOCUWNT WITH RESPECT TO WHICH THS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE 7ERMS, EXCLUSIONS AND CCNDrnCNS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IILM>BR TYPE OF INSURANCEAODL POLICY EFF—J=13gMim POLICY NUMBER LIMrrs A COM MERCIAL GENERAL UABI ITY BOP2738247 05M2019 P50=0 EACH OStE $ 1,000,000 CLAPLS RADE 1j OCCUR PREUMS Me $ 300,000 AFD DP S 5,000 PERS;o 4AL&AS 1,000,000 GENL A,GGFMGATE LMT APPLIES PER: r RgL AGGS 2,000,000 POLICY .EST ❑L0C PRODUCTS-COMPIOPAGG i 2,0001000 OTHER: s B AUTOMOS"LtAaLLITY BBMJ33 08/01/2019 08MrA'020 $ 1,000,000 AWAUTO O BODLY @ymy(Per Peso^) S / SCHEDU_ED AUTOSONLY AUT I BODILY k1w(Per accident) Is _ WNED AUTOS ONLY � qV OS ONLY S EACH UMIBREIIA LIAR OCCUR EXCESS LIAR CLAINs MAADE OCCURRENCE $ Dim RETWION S C IWORI(IMCOMPENSAMONC_50C)WC -5016474 2018A 1=701810/27/2019 AND ISMPLDYEW LL LLITY Y/N V1 PER —� AW PROPF OFFICEMADAPER E?[Z E a NIA i E.L.EACH ACCCENT $ 500,000 (Marmhaery in� E.L.OISEASE-EA EMPLOYEE $ 600,004 OF QffMATKM below EL.DSEASE-POLICY LUT S 500,000 i I I j I I DESCRWTION OF OPERATIONS!LOCATIONS I VENICIBS(ACORD 101,Addalonst Remarks Schedule,may be attached It more span Is required) Subject to pdicyterrrls and conditions. Sole Proprietor is e)ciuded from omwage under the Workers Compensation policy. The certificate holder is an additional Insured with respects to the Generai Uabilityand Autarwbile LIabiIitypoi icy wt>an requested by mitten cared CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR INFORMATIONAL PURPOSES ONLY" ACCORDANCE WITH THE POLICYPROVOMS. AUTHORM REPRESENTATIVE 0 1988,2015 ACORD CORPORATION. AN rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD t Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1801 Boston, MeIsetts 02108 Home lmprovemtractor Registration Type: Individual M Registretlon: 150118 PATRICK KUBALA N w Expiration: 03/08/2020 D/B/A PATRICK KUBALA HOME IMPROVE 5 PELL STREET r LUDLOW,MA 01056 =� w h Update Address and Return Card. SCA 1 O 20M-OW17 ........... ..........._r—_.._ _ office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Regletratton valid for Indlvldual use only -IndMdu ? before the expiration date. If sound return to: Office ofConsum Ira and 8usinese Regulation 03/06/2020 10 Park Plaza- TO Boston,MA 16 PATRICK KU i ? DIB/A PATRI IMPROVEMENTS 's � c l PATRICK J,KU "; �R CGS 5 PELL STI ��; LUDLOW,S MA oloss 'J Not valid without signature Underescreh Division of Precessional Licensure Board of Building Regulations and Standards CIERTIRED010*40 ConskFP fiZA%*t visor L CL• ' CS-100114pires:09/09/2021 PATRICK J K�BA ` 5 PELL STREET ? _ ' AV461n i Up-ft4w E14rcri4' LUDLOW MA-41056 .- ' ID#70000M Gelid Binee �On6 O1S��io Kubala-,Paft EX tiFes.✓ 112U;'e!2 Commissioner �.,c SPe"sueet — LWIDW.MA HOME IMPROVEMENT CONTRACTOR PATRICX SUBAI A 5 PELL'ST LUDLOW,MA 01056.2762 flE HIC.0619712 12/0112018 11/30/2019 SIGNED City of Northampton •! A `G Massachusetts 4. 1 DEPARTMENT OF BUILDING INSPECTIONS �. ' 212 Main Street •Municipal Building yJb•., C�� Northampton, MA 01060 Debris 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. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: 0! z S ,tf � (Please print name and locatron of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signature f ermit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. Cerocate No: A THE COMMONWEALTH OF MASSACHUSETTS EXEanivE Omm OF LABOR AND WoRKFORcE DEVELOFIv w DEPARTMENT OF LABOR STANDARDS 19 STAmRD Sum,BosToN,MAmAmmm- s 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSE` PATRICK KUBALA HOME IMPROVEMENTS I PELL STREET LUDLOW MA 01056 LICENSE: IM62184 EXP`IIt A: Monday- April 271020 IN ACCORDANCE:WITH M.G.L.C. 111,§ 197B(b)AND 454 CMR 22.04,THIS LICENSE IS ISSUED BY TAE DEPARTMENT OF LABOR STANDARDS-TO-THE CONTRACTOR ABOVE FOR THE PURPOSE OF ENGAGING IN LEAD-SAFE RENOVATION AND/OR MODERATE-RISK DELEADING WORK THIS LICENSE IS`VAL1D FOR PERIOD OF FIVE(5)YEARS. THIS LICENSE MUST BE MAINTALNED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L.C. 111, § 197B(hx2)AND.454 CMR 2.2.04 WHEN ENGAGED IN LEAD-BARE RENOVATION AND/OR MODERATE-RISK DEL.FADING WORK.LEAD SAFE RENOVATION CONTRACTORS MAY NOT PERFORM MODERATE RISK DELEADING WORK UNLESS THEY EMPLOY A SUPERVISOR,WHO HAS TAKEN THE REQUISITE TRAINING AS REQUIRED BY 454 CMR 22.00,TO OVERSEE THE WORK. it J cera Dox ..i Kubala Home Improvements The Window & Door Experts 5 Pell Street Ludlow, MA 01056 855-458-2252 Kubala Custom Windows Energy Star & Performance Data Revised June 2019 OPTION MFG CODE U-Factor SHGC VT CR Omega-Tuff S2210A .24 .21 .48 47 Hi-R N2210A .25 .28 .52 47 Essential P2100A .30 .49 .60 55 Passive P2210A .25 .48 .59 46 4' PATRICK KUBALA HOME IMPROVEMENTS All home improvement contractors and subcontractors engaged in home improvement 4 contracting,unless specifically exempt from registration by Provisions of Chapter 142A MA HIC#150118 of the general laws, must be registered with the Commonwealth of Massachusetts. 5 Pell Street Ludlow, MA 01056 Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 413-589-1010 02108(617)727-8598 Submitted To: a.ry" <1 �� Job Name:StIM 4e!' �t`Xthp�1N`i�l�Yl fro,, Job location: � Q� N z` S goI1 Date la Estimator: �G+� We hereby submits ifications aDLLQstimates for work to be performed and materials tt be used: not :�To-6x, "'& oc>/!� et � I'1 !'y^OV 711 e 1 ask{ �s k rs�1 -�, r •►� 91/1 aim r� A G - ASS WORK SCHEDULE Cont r ill not the work or order the materials before the third day following the signing of this agreement,unless specified herein..Contractor will being the work on or about �- a Baring delay caused by circumstances beyond the contractor's control. The work will be completed by L/ 4y(date). The owner hereby acknowledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor including but not limited to strikes,Acts of God, shortages of materials,accidents,and all other delays beyond the its control,shall not be considered as violations of this Agreement. (ON The contractor warrants that the work fumished 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 subcontractors,employees or agents,is discovered after completion of any job,including clean up,the Contractor shall at its own expense,forthwith remedy,repair,correct,replace or cause to be remedied, repaired or replaced,such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed- upon work. We opose hereb t furnish materand labor-comple e in accordance wit above specifications, for the sum of 0,e I dollars($ 3909 rpY t to be as follows: r-1 j i 1 -?e 'p�Z� 115 C) O O VN upVon✓siggnmgcontr'alct; PATRICK KUBALA HOME IMRPOVEMENTS %( )upon completion ofd 5 PELL STREET � l upon completion of LUDLOW, MA 6 413-58,9-1910 a % shall be made forthwith upon MA HIC 15 18 completion of work under this contract. Notice:No agreement for home improvement contracting work shall require a down payment Salesperson: r L (advance deposit)of more than one-third the total contract price or the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise Authorized Signature: obtain delivery of special order materials and equipment,which ever amount is greater Acceptance of Proposal: I have read both sides of this document and accept the prices, specifications 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. See notice of cancellation form for an explanation of this right. Please refer to the Notice of Cancellation that accompanies this contract;contents of which are referred to above and incorporated herein by reference. ,JINOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date 42 Signature Date