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25C-252 (15) Department use only _..... City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit } 212 Main Street Sewer/Septic Availability t Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans eel phone 413-587-1240 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: -:z This section to be completed by office APR 2 2 �ap Lot OY'..�1 Unit 20 37 FAIR STREETorN of I Zont Overlay District —O�gU/L 0 1Nr EI St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: STEVE & CAROL KARNEY 37 FAIR STREET Name(Print) Current Mailing Address: 860-550-4744 Telephone Signature 2.2 Authorized Agent: j� 01685" Name(Print) Current Mailing Address: _ '50- - 6 -3'74�� Signatur Telephone SECTION 3 -ES ATED CONSTRUCTIO OSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by permit applicant 1. Building 18,650 (a)Building Permit Fee i 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) 18,650 Check Number This Section For Official Use Only Building Permit Number:_bo' 40-hq 171 Date Issued: Signature: Building Commissioner/Inspector of Buildings Date DERUFFNER @ OUTLOOK.COM EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Wind s Alteration(s) ElRoofing ❑ Or Doors 0" Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other[0] Brief Description of Proposed REPLACING EXISTING VINYL POCKET WINDOW WITH NEW PELLA POCKET REPLACEMENT WINDOWS. Work: 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,— �—�Pe * C-amL /6/2,)ev as Owner of the subject property RUFFNER HOME IMPROVEMENT hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, !J 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 s and penalties of perjury. Print Name y/Q � 1A Signature of Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: DAVID RUFFNER License Number 057308 Address Expiration Date 120 SUSAN DRIVE, WESTFIELD, MA 01085 11-6-2021 Signature Telephone 413-562-6467 9. R ere o Im vement Contractor: Not Applicable ❑ Company Name Registration Number 101035 Address 06RExpiration Date Telephone 6-25-2020 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 permit. Signed Affidavit Attached Yes....... Nell,, No...... ❑ City of Northampton Massachusetts WK 8 W*z WK # r DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jy4,K b Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered Type of Work: f Est. Cost: , Address of Work: L�/ Fail AH/LgPzaiw , A,, olou Date of Permit Application: �-��-o�L I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building pe • as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS o ��v 212 Main Street •Municipal Building Northampton, MA 01060 psi=3y . _311 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: c3 7 Fqir S4ot - (Please print house number and street name) Is to be disposed of at: Va aw tele-cVC11110 (1) 7*j. (P ease print med I cation of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) �� or Owner D to 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. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information Please Print Leeibly Name (Business/Organization/Individual):RHI,LLC. (DAVID RUFFNER) Address:120 SUSAN DRIVE City/State/Zip:WESTFIELD, MA 01085 Phone#:413-562-6467 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).' 7. ❑New construction I am a sole proprietor or partnership and have no employees working for me in 8. ✓❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.R I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.[:]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:] p Roof repairs These sub-contractors have employees and have workers'comp.insurance) 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.] *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. tContractors 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 and job site information. Insurance Company Name:NEIL & NEIL INSURANCE AGENCY Policy#or Self-ins.Lic.#:7PJUB-2E02812-3-20 Expiration Date:3-27-21 Job Site Address:37 FAIR STREET City/State/Zip:NORTHAMPTON, MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 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 fine 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. I do hereby certify under a pain d penaltie of perjury that the information provided above is true and correct. Si ature: " Date: r �r Phone#:413-562- 467 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#: RHI LLC. lr David E. Ruffner 120 Susan Drive Westfield, Ma 01085 Office: 413-5626467 Mobile: 413-374-6335 For All linar Curpa•naty Va•rdx Since 1979 414107 Hello, The check enclosed is for Carol& Steve Karney building permit at 37 Fair st. I applied for the pemit a week or 2 ago and forgot the permit fee check for forty dollar for replacement windows. I would like to start the job on the 22nd. Of April,when delivery of product is scheduled to the Karney residence. You can contact me for any reason at the phone numbers below,or at my business Email: deruffner@outlook.com Sorry for the delay in payment, Sincerely, Dave Ruffner RHI, LLC: (Ruffner Home Improvement, LLC.) 120 Susan Drive Westfield, Ma 01085 413-562-6467 413-374-6335 MA CSL #057308 HIC REG #101035 http://www.rhillc.biz/ -- LIM 'ITI0 FEWER THAN 596 F ETI MEEN OF CONTRACTORS l� NATIONWIDE. !//Ir Trrlll�N(i N��rll�fll��^l7lliJl7!'Ilf�J('�1 office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE: Individual Registration Expiration 101035 06/24/2020 DAV,Q E.RUFF'--,` DAVID E.RUFFNER Ctk 120 SUSAN DR. WESTFIELD,MA 01085 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards C onstruction'Sopervisor CS-057308 Expires: 11/06/2021 DAVID E RUFFNER 120 SUSAN DR WESTFIELD MA 01085 Commissioner A4—,� � r AC Ro E) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/27/2020 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 policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,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 CONTACT David R Jany Neill&Neill Insurance Agency Inc PHONE 662 Riverdale Street 413-732-4137 ac No )- West : F'°X 413-731-6629 West Springfield,MA 01089 ADss: dj@neillandneill.com BJSURER S AFFORDING COVERAGE NAIL# INSURER A: VERMONT MUTUAL INS CO 26018 INSURED RHI,LLC 120 Susan Dr INSURER 8: Commerce Insurance Company 34754 Westfield, MA 01085 INSURER C: Travelers Insurance Company TRA INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP MMlDDM'YVI (MMIDDrYYYYI LIMBS A COMMERCIAL GENERAL LIABILITY BP11038736 02/11/2020 2/11/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE V OCCUR DAMA E O RENTED PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BCPL99 05/17/2019 05/17/2020 COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO Ea accident OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LUIB OCCUR � EACH OCCURRENCE I EXCESS LIAB AGGREGATE CLAIMS-MADE DED RETENTION$ $ C WORKERS COMPENSATION 0280967 03/27/2020 03/27/2021 PER oTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY OFFICERMIEMBEREXCLUD DE?(ECUTIVE NfA E.L.EACH ACCIDENT S 1,000,000 (Mandatory In NH) I YJ If yes,describe ander E.L.DISEASE-EA EMPLOYEE S 1,000,000 under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pella Products,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 835 Broadway St ACCORDANCE WITH THE P LICY PROVISIONS. Pella,IA 50219 AUTHORIZED REPRESENTATIVE 4 ©1.988-2015 ACORD CORPORJVION. All r is eserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ruffner Home Improvement, LLC RHI, LLC Proposal � JJ x 120 Susan Drive Westfield, MA 01085 Account# DATE ESTIMATE NO. x01VIIELMPI[2ov13viF1vT Office: 413-562-6467 Mobile:413-374-63335 KCS4744-184W 3/13/2020 20-134 FULLY LICENSED,REGISTERED,AND INSURED IN THE STATE OF MA. Customer NAME/ADDRESS -- WE HEREBY PROPOSE TO FURNISH THE MATERIALS AND SUPPLY THE THE LABOR Steve& Carol Karney NECCESSARY FOR THE SUBMITTED WORK BELOW AND COMPLETED IN A SUBSTANTIAL 37 Fair Street WORKMANLIKE MANNER.ALL MATERIALS ARE GUARRANTEED TO BE AS SPECIFIED,AND Northampton, MA. 01060 WORK BELOW TO BE PERFORMED IN ACCORDANCE WITH'THE DRAWINGS AND SPECIFICATIONS SUBMITTED BELOW.ANY ALTERATIONS OR DEVIATIONS FROM THE ABOVE SPECIFICATIONS INVOLVING ADDITIONAL COST WILL BE EXECUTED ONLY UPON WRITTEN ORDER,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE 860-550-4744 PROPOSED ESTIMATE. ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS,OR DELAYS BEYOND OUR CONTROL.THIS ESTIMATE IS VALID FOR 2 WEEK BEYOND 401-265-3916 RECEIVED DATE. Proposed Start Date Proposed End Date P.O. No. Terms Due Date Rep 20134 Mat.Deposit,1/2 start... 3/17/2020 DFR ITEM DESCRIPTION QTY COST TOTAL 01.2 Building Per... Building Permits 1 185.00 185.00 Product Material Cost of Project:Pella Impervia Pfit Replacement Series Quote 1 12,177 35 12,177.35 Attached in Email. 02.20 Pocket Repl... Modified Pocket Replacement Window Installations:Leaving exterior aluminum 9 365.00 3.285-00 trim in place,remove existing vinyl pocket window from interior. Install new window unit per opening above exterior bottom stop to accommodate for new match sill nose installation,and insulate with expanding foam insulation. Re-using existing Interior Stops.Does not include any Painting or Drywall/Plaster repair work. 02.2C Pocket Rep]... Modified Pocket Replacement Window Installations:Leaving exterior aluminum 4 450.00 1,800.00 trim in place,remove existing vinyl pocket window from interior.Install new window unit per opening above exterior bottom stop to accommodate for new match sill nose installation,and insulate with expanding foam insulation.Install new interior trim according to approved layout.Does not include any Painting or Drywall/Plaster repair work. Thank you for the opportunity to ou with yo ome Improvement needs. TOTAL .NO TE--THIS, DEPOSIT APPLIED: � PROPOSAL MA �� YBE �?� RESOECTFULLY SUBMITTED wf fY1eY Date 3/13/2020 WITHDRAWIV BY US IF NOT ACCEPTS C WITHIN(14) DS ° �` C STOMER SIGNATURE Date Payment Schedule:Deposit With Balance Due upon Completion. CUSTOMER SIGNATURE ( �/�` �� Date 7 _ ^G2� Phone# Mobile Phone# Email Web Site DAA CSL#057308 413-562-6467 413-374-6335 deruffner@comcast.rpef9 1 www.RHILLC.biz MA HIC#101035