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30B-063 (3) 294 RIVERSIDE DR BP-2021-1014 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:30B-063 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRA('l ING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit# BP-2021-1014 Project# JS-2021-001734 Est.Cost: $6544.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: PATRICK KUBALA 100114 Lot Size(sq. ft.): 5880.60 Owner: DEANGELIS ABBY Zoning: URB(100)/ Applicant: PATRICK KUBALA AT: 294 RIVERSIDE DR Applicant Address: Phone: Insurance: 5 PELL ST (413) 589-1010 WC LUDLOWMA01056 ISSUED ON:3/17/2021 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 Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NOR HA PTON PON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. (� �• , • Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/17/2021 0:00:00 $40.00 212 Main'Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner gG� The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR 1. Gel Massachusetts State Building Code, 780 CMR MUNICIPALITY USE ___ Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 One- or Two-Family Dwelling i E r--. Thi Section For Official Use Only l ti i 0 0 -- Building Permit Number: 6P- ai 1 U I_I Date Applied: DC /� p z rn Building Official(Print Name) Signature Date zn IN-) //112 D r"o SECTION 1: SITE INFORMATION 1.1 Pro er Address: :17'26l1 o=� o? 9 YE CS;et'� 7, 1.2�A�s�ssprs Map &Parcel Number, �� o f, (� m 1.la is this an accepted street?yes yC no Map Number Parcel Number ______._.-.— -4.3-•-Zening Information: 1.4 Property Dimensions: ••— Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: Outside Flood Zone? _ Municipal 0 On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP1 2.1 Owners of Record: /WV O. (uI zE k 4�e/; 3 7c l EI /1-1a 0 '0 6, z. Nan*(Print) City,State,ZIP d'4L Zv4/2.s i•de. J 4• /7-3o6 •/,04 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other [ Specify: Brief Description of Proposed Work2: g€04 ACE s> 7p u QC E ki.„,, C `JT/,As Ow SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List:_ S.Mechanical (Fire $ Suppression) Total All Fees: ).. Check Nott(�3h Check Amount: a Cash Amount: 6.Total Project Cost: $ 1p. ) j 0 a 0 Paid in Full 0 Outstanding Balance Due: 5: CONSTRUCTION gERVrTC 5.1 Construction Supervfsor LiceSnEs(e:(nCsr) - S r.-- .... .. ...> Name of CSL.1-loki.-1- - - Lice-Ise Numb-- Expirari.r, Daze. • - •--5- /ii. ,5.7"• List CSL Tyr..,e(see tieiow.; 2,7 No.anti Stree: 7\:'Pe 2.).ts- .:7:::,.j0r: : ZkOioaki, 7-/4 e/6.s/ :, , u-,:-....,,,,,i,,,BIZia'ES City:Town,State,ZIP . R _ • _ i M i Masonry RC ! R.00fing Covera WS ! Window and.S.'ding • da r:s a7,..:.-sinsc.ltion : Teieohone Erleil aooress • D ' Demolition -- - ; 5.2 Registered Home Improvement Contractor(MC) i ,, --—-- 4red7/ f .3.4 , 47-42.-ci- ,e-ae ALA _14n.-ez -Vy, geei‘14,7745e----7- HICRegistradolNumb. 1-11C C.- -1.?any Name or HIC Res,E=trt.N,Int.' .= =:c7.'772Z:C 7 : 1 sr- : N;_and Street 41(..2).2.0 a./, imi,C1 0/ac(or ...;z-i-dr"7-%Li Zi . Errai add:ess • City/Town, State,ZIP Telephone : • SECTION 6: WORKERS COMPENSATION INSURANCE AFFIDAVIT(NI.G.L. C. 152.§ 250:4):, Workers Compensation Insurance affidavit must be corozieted and submitted with this atTlication. Fai:z.i.-e : this affidavit will result in the denial of the issuance of the building 7.,,ertn;:. _. _ Signed A ffi davit Attached? Yes X. No rs .. SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ---- I.as Owner of the s-,loyect property,hereby a”rhor-:7e 4 7.4”-- Z6 j.f..7,f 4.4 ..... /04. .....//72. c.; %..-f:•-i---!0-----' to act on my behalf;in all matters relative to work authorized by this bui1ding pe=i-..application. ...-> %....//Z X7ACAtea Prinz Owner's Name(Electronic Signature) SECTION 7b:OWNER:OR AUTHORIZED AGENT DECLA-RATION • _ . • By entering my name below. I hereby attest under the pains and penalties of T.s.erjuLry the:L..;o:;.,.... --__.--- i contained in this application is'.7-,?e and accurate to -1- t of ray'2:tpcwiedae and phderstancling Print Olknes or Authorized Agent .-ne. 's -a E...'lectronic Signature) L'a.:e • NOTES: I. An Owner who obtains a building nermit to do hisiher own work,or an owner who In.res an tnareg,szereo (rim registered in the Home imorovement Contractor CHIC)Program),viin not have'•;"-^ s to the ttttratt2n program cr guaranty fund under M.G.L. c. I 42_A..Other imporlantl-lormation on the H1C Program can be.to,..ini a: www.rnass.covio•ca kformation on the Construction Supervisor License can be found at‘.%-s•••.,:,•.:72SS.2s 0-0.S 2. When substantial wc.i.rk is panned.:provide the information below: Total floor area (sq.ft) r:incluclinc .s.araist.,5...r.i5:2eC:batmen:.al::ci., des or Gross living area(sq. ft.) Habitable room co...lri: - • Number of fireplaces Number of bedrooms — ---- : Number of bathrooms Number of haifbaths _ _ Type of beating system Number of decks:porches _ ,-. Type of cooling system - 17._•nciosed -r'-'- - _ 3. -Total Project Square Footage" Ina-,„ be substituted for-Total Project Cost" _ ___ . --• •—- _. . __ _ -- •---• -- Kubala Home improvements The Window & Door Experts 5 Pell Street Ludlow, MA 01056 855-458-2252 Customer authorization for building permits. I, bc as Owner of the property located at c2q iftt ii 2ise -ac c M4, 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. a" '"49 L-'`L-- - 271Z \ Signature of Owner Date The Common_weafti�of ifassachusetts tDepar-rment oftri7Elus:r1[I -3A:Cdexe te,. .--,,,,tri 1 Congress Street,Suite 100 Boston, :if 02114-2017 If wry. v/ inassaodiia 1--orkers'Compensation Insurance ff'idaEic Bt:iidersiCont_actors ze ieiatt -l'=timbers. TO BE FLED WITH I THE PER.ITTY G AUTHORITY. ;puticant Information Please Print L-nibi .s t ame(B sines'Orga.izatio lindividua:):" ' r-!4 ,4 AL:a ddress: .5 /&iG t S 7- City/State/Zip: la �o� f Doi Phone,=: -� " 1-iG�� � ___ _. :ore you an employer'Check the ro / apg_ priste box: Type ie of project(required): tY :e.u':a C....v:ovr with di rancloyees tf.:andirrpart 7. TT New il --- con 2.�:n_a sore p:or:a or=zrmers:.io and have no et:pso}:cs'xorkin.3 or.-_ 1 i + _8. v any capacity.[No workers'comp.irs..tranc2 r ruin•; .: g- :2i Demolition aT,a crecN^er.o ne all work myself.No workers'comp.insurance reqired.i' i - i i air.a lidelec:wner aaa will be hiring oon a i!work C'0 a property. :w:ii ctom to conduct ' r -my i; 10 B C:rg aco c _.a•sae that all contractors either:ave workers',ocr. r 'oR in_u - ! 1 ? tr --a.:li-' _ :e =i: 2^ce or�:sole - - E;ec c rCpa-S proprietors with co employees. y I I2.0 Flue bin.g re"Zt•-s or.E.thclitions i, 5.L t am a g-_rerai cor.Lzctos and I tuve o eo the uj tractors listed on the a-.::.fled i.eee'. F _ Thes2 st—ct)lt- .,:r:s rage enpioyees a:d Rave• r` - _... .rs_" !( :�.t....1 Room repairs .•C.Se:o�ter.. C{C.' 14 5.7 Wr.ere a corcra3 c ao i*s officers aaYe exec isx;_..tight =ee:otion per'v_e:L (Y .=!Other E52,:I(4),w.d we have no emploc o.(Nc workers'comp.ins:ce re:a rep.j *Any applicant that checks box ri mr a'.o Ea out the sector beie't,showine-sir workers'compensation porey W a:im. •P:ome`w nee n-no submit this affidavit indicating they art dor=>art work and then-,re os-s'cc cocac tors:.3s;submit a new azraav::.- ;ca::g s...... 'Contractors tbar.Cl2oak gtis box mint aic^,t1 c ei iicr i shy as stowing:I=nal=oi•etc cub-c0=Luc:oz5 s.d state w e :s' ampioyses- € t e sub-eon/:ao="have e tct• .. -provide their •.loners':.;rt:o.poi_;•-..-rcher. -+s— t am an employer that isproviding workers'compensation insurance for my employes Below x the policy andjob site information. 3. nsur�ice Company Name:�i� T.�L/tr a L ,��-��1'ivu� �rc 7�4 Z Z-4, G ._-- Policy=or Self-ins.Lic.-:le/e,"2/� y> / Expiration Daze: f�-�/—ue / _ job Site Address: a9? eR�v E�,S %de... R- • sty/Statei2ip: 4 ./I/C.,s rig 0/0lo Z_. Attach a copy of the workers'compensa Lion policy declaration page(showing the policy number and c x-pitation dare). Peilure fo secure coverage as rec4uired under MGT-... 152,§25A is a criminal violarion p iis'.a'ole by a tine hip to S .`3Q:00 a:,cifor one-year imnrsoar±ent.as well as civil penalties.in the form of a STOP WORK ORDER and a five of up.to.5_.,.._O a day against the violator.A copy of this statement.may be foot.warded to the Office of Investigations of the DIA for ins:.a..ice. Coverage verification. I do hereby cerzif;'under the pains and pens"ties of per":ry that rI: •O?Inatsion provided,above is due and correct. Sic-7 a:;.re- Date: C54-/Z o Z/ Ph.cne=. 4(4..R- 5�-y - /ni gOfficial rise only. Da not w7ite in.his area, to be completed ay city or town official. s i Ciry or Town: PernuE'Lleersse- II ii Issuing Authority(circle one): 1 i. Board of Health 2. R, g Fildin Deparraienc 3.City:Town.Clerk 4. lectrical Inspector .Plumbing Inspector it { 6. Other it Contact Person: Phone . ACORD CERTIFICATE OF Lt ABILITY INSURANCE DATE(MMIDDrYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THII 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), AUTHORIZE: REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 or this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER IEAC7 ;istine E Davenport Rchard R Green Insurance Agency,Inc. 32 Somers Rd PHONE (413) ---- F --- rA c.No.Eli): 267-3495 FAx (A/C.No). (413)267-3496 Hampden;MA 01036 ADDRESS: cdavenport@richardgreeninsurance.com _ INSURER(S)AFFORDING COVERAGE --•-•--'- ---' NAIC rt INSURER A: MAIN STRI�TAA�iICAASSURANCE CO - -- 29939 INSURED Kubala Fbrie trproverrents tNsuRERa, NATIONAL GRANGE MUTUAL INS CO 14788 Patrick Kubala dba —.. ._ ----..._ . . 5PcflSt _INSURERC: _—.+_..-'----- -. ...... . . Ludlow,MA 0105E INSURERD: 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 WHIC- 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- .ADDLSUBR. - POLICY EFF POLICY EXP ----- - LTR' TYPE OF INSURANCE .INSD WVD, POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) LIMITS A COMMERCIAL GENERAL LIABLITY NFQ1698U 06/01/2020 06/01/2021 _EACH OCCURRENCE $ I.000.00C !� DANfAGE-T RIhfiED--------- - SOQDDC -- - • CLAIMS-MADE I V' OCCUR PREMISES(Ba nrr,irrence1 $ --..---- mac EXP(My or*person) $ 10,000 PERSONAL&ADV INJURY _ $ __ 1.000,00C 2,DDO,OOC GENL AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ —.PRO — 2,000,dOC POLICY JECT LOC PRODUCTS- AMP/OP AGO $ _._ _._.._._.. OTFER: $ B AUTOMOBILE LIABILITY M1 PI698U 06/01/2020 06/01/2021 rE of INNED SINGLE LIMIT .$ ___ 1.000.00; --ANY AUTO BODILY INJURY(Per person) $• OWNED ��`'�.I SCHEDULD BODILY INJURY(Peraccdent) $ -.-_ . L--..- AUTOS ONLY ,_AUTOS ' .. PROPERTY DAMAGE--- ._... .'. . ._. I .:AUTO , NON-OWN LY IPer axidernl a '�_AU7CS ONLY _AUTOS ONLY S B UMBRELLALJAB ; �/; OCCUR CUP1698U 06/01/2020 06/01/2021 EACHoccuRRENce ---_- $---- -.- - 1-�O.DC; EXCESS LIAR AGGREGATE $ '.600.00 CLAIMS-MADE DEC RETENTION$ 10, • 000 $ B .WORKERS COMPENSATION • • WCP1698U 10/27/2020 :06/01/2021 . f STATUTE ERA_`.-- ._. ._ . . •AND EMPLOYERS'LIABILITY Y/N , .DDO.DG ANY PROPRIETOR/PARTNER/EXECUTIVE Y : N/A EL EACH ACCIDENT $ -- 1 OFFICER/MEM1BER EXCLUDED? , -.-1 ANY .000.00 (Mandatory in NH) EL DISEASE-EA EMPLOYEE.S —. •_ . If yes.describe under EL DISEASE-POLICY LIMIT $ 1,ODD.00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHCL ES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Sole Roprietor is exempt from coverage under the Workers Corrpensation Policy. The certificate holder is an additional insured with respects to the General Liability a Autorrobie Liability policies when required by written contract. 1 CERTIFICATE HOLDER I CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFC RE ""`For hfomrational Purposes Only"'" THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUT!CORIZPD REPRESENTATIVE /-1.• 1 ©1988-2015 ACORD CORPORATION. All rights reserve( ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l. lJ . / /r •/;e t()()rol//OI1W/r'-(te(/A ( ( .> � A. 14'Vir i: ,: .. i4) • (.)ffice of Consumer Affairs and Business Regulation I '1000 Washington Street - Suite 710 i Boston, Massachusotts 02'11 h Home Improvement.Contractor Registration I `' 1 ypo: Individuali I logistraation: 1501 18 1 I'ATfi1CK i<Ut3A1_/1 • -• Expiration: 03/06/2.022. i I:)/13/A PA'TRICK KUIIAI A I-1OMi=i IMPROVEMENTS r, 5 I'ELL.STREET L.UDL_OW,MA 01056 i :`i'"•, M • Dorton,Addros%and Iloturn Cord. i scA 1 1.5 2em.etit / Offlco of Connwnur Aft as nunlnonn Itogulatlon 1 HOME IMPiiOVt Mr::N'r CONTRACTOR tloUlntratIon valid for individual use only TYPE:hulivhltla l boffin)the expiration t o. If found roturn to: I:iQnitltVcltlmn Explrutlun Ofllco of Consumer ,Ira caul Bushmen;Ilncrulatlon 1!i01 II1 OQ/Ot/2022 1000 Washington'' of -Suite 710 f'ATIIICK KUBAI_A Boston,MA 021 I.)p9/A I'ATTBICK KIlitAI.A I-IOMI=.!Mil tovi':MI:iNI's PATRICK J.KIJIJAI.A .....,/4,4,,,,..w �, I.ul)l_OW,MA 010tir ___.___-....__.... Not valid without signature Undorsncrot ary ... ..... n1 -..r..•....:sa......:._.:.._..-.._.. .:.., v-w .; ^ ,1 f k ,e,," . stun, . _, u �r 1.. W e..F � \ c,.u�n.oasw_:.:.:.., .......u. .....:...; \l�r h 1 Kr g e�2��,�7yl r r'7 . , !,,'r� �F`y 1�13��4't `I} A�{.... il.'�' •�JF ..0.:21id�� ^�i .� b..,�.34.n...#aaS4 �s .'4.,..:�4,. Division Of Professional l.icenstara, d9, I STATE OF CONNECT/COT V1FCTlC1I'1' I. DE PA i OF COP1SUMLR P{iCDT1('lYC)l l 1 CAI "P$IIr'W iIIl IINV11AL-I.kr4 k. Ile it know,that 1C /t ' Hoard of Building Regulations and Standards LakiYbB4l:.: p11..0 d ( i ' PA'I'RICK KUIIALA i Conskt!tai't1c)iIlj'ij�rvisor f ii r, 5PELLST I? f:.' Installation CS-10011t1ii .. -;',i ' ,/ spires: 09l09/2U1.1 / LUDLOW,MA 01056-2762 F i i ( 1� c)• M ATRICK J K(if RAI q - 6 I�CLL Sl'ti T t;t 4 ,. 5�I., r� fi.,..nn...k a N a• a•, , t_UDLUIIY MA.4 pf1B ,� ' has satisfied the qualifications requited by law and is hereby crr/atcrell a,a l"'F ?, - a• r :'I''i,1 '• / •`; HOME IMPROVEMENT CONTRACTOR l tItr 11 914 l:at'Yillecti 5)1nm* �J�1n U " .gym 1�`\ Registration#HIC.0619712 1 WtI#M1M,f%aM1r1eM FIK*rsa 6/1/3051 14 14k,.8 Nell Moat• Prw,stn�puuaeraM My RAW. i I PATRIC(KURAIA HOME IMPROVEMENTS Iy. 1.u1WrNMOmmiSSioner /Awn.ts.ilr� �. .. < Effective: 12I01/2020 J2�. /� , '. Expiration: 11/30/2021 /'2 7`r` 1•r; 'a,. AS. 'J.,:e Tj,k bii: ,y#H� va,.4>d 9 r. T4sk7—?t&�i 11/10/2020 WLXkc9VdmimWeNzZGA1Soca6ivtdEmtAJYYYY0pw2u0ESFOMCtiJYZcCnS3hCQg3uFzj1xYF8ZVtZ15RUAl-tBkTMOuJ49Wac2zhcrF... • ys lITS4RTMT.N :)I I bilk f v'5;1 N,Rirs 4 I FALI•SAki RENOV. T10'ti C'O NTRi(."1"/ 1 1(1 hL1HAl•v I.11,IMP Rc)y'+E.atle.: NT ,ultt5 1dCENNEs:I.R(H)20 f of^ll:i.S Sunday;May I I,241:+ 4.N: CCCI i),,#?:CT Vito 34:f.G.1,C t 3 b ',S 1 CAM W,fi#i1 LtC'e si,,1s i si,ED By 7'FiS:1)43.PA;:T 1..\I "):LAI.t:,fl.si A\(AK_S1;".iIi11: ',1\"t[2";C:I'f)RAla)VE..?'("SPnlifi'i'UftF't)s,I(�4f=. F\G;I.:r;I'..I..k::.d' 4='i:II!,Sit\A-('i4)ti. Ti.ri €TCF. SF3 I5 'AL:D 14)1{A.I''1:1N:)(.4'11\1 ,;,r':E-1I?5. THIS LICENSE MUS J?d J IAINVEDl'tZ'I11.1:.ClG1S1tAi roil \,iC:OP.•\'C:F:WITti\1.Ci:if-C.)1; 4'R ll 11N,tii!"+ 4 C'MR.72.04,0'FirC!Fi\C's.FC.:rL :\LEAr.s SFL Rk.P.i1 I'T:.:S\.y;111C �I I' T13•S ( t F:4UI.(5iG WORE..I L u)S 5i•£4E.Ne Tic:' CON1 P,,,i 07iSMAY NOT 1'FF{f tSit'wi V.1UN_FG47'Fi:R1' 1)ECRA DING?'S'U42K W ESS1.1,15.5 I'\1P1.07 Ss.PPkv SOW 4C1I0 HAS I'aIAL+ I. .l:Ecmi`ur3..ELNIN NG AS Iuh{i'1C%iI2F.'I's BY 454 i1vtit:2..1,To ovr:RSRF.:11E NVORK: 'LI H:1:1 H.'r.. (AA,1. DIRECTOR Please detach fins a-railing tab end heap your ttcense certificate in an necess!"v;e location.A cony of this license must be maintained at each worksite, 5.'ELL SEItL 7 1.1.51)1.0L 4':175.`. https://gml.ggpht.com/WLXkc9VdmimWeNzZGAI Soca6ivtdEmtAJYYYY0pw2u0ESFOMCtiJYZcCnS3hCQg3uFzj1xYF8ZV1Z15RUAl-tBkTMOuJ49Wa... 1,1 DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly-licensed solid waste-disposal faeility as defined by MGL o 111., S -150A. The debris will be disposed of in: /6i( // ./sceefe-- LOCATION OF FACILITY g' y-�Lo a/ Sign e of Applicant Date A.P teLDA VIT As a result of the provisions of MGL c 40, S 54, I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposaLfacility, as defined by MGL c 111, S 150A. ertify_thatJ .ilI_notify.the Building Official iby two months maximum)of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of,and I shall submit the appropriate form for attachment to the Building Permit. 7 Date Signature ermit Applicant (PRINT OR TYPE THE FOLLOWING INFORMATION) /:a7 rCA- faieliq Lff Name of Permit Applicant ,41-rei.e.,e %e4,64 c ..L7 pleb re ex"t- off Firm Name, if any 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 C' Omega-Tuff 822 OA 2 2 48 H=-R N2210A .25 .28 .52 Essential P21 OOA .30 .49 .60 Passive P22 t 0A .25 .48 .5 `'c. _ Y PATRICK KUBALA HOME IMPROVEMENTS MI home improvement contractors and subcontractors engaged in home improvement ))." contracting,unless specifically exempt from registration by Provisions of Chapter I 42A MA HIC#150118 of the general laws, must be registered with the Commonwealth of Massachusetts. 41—. 5 Pell Street Ludlow, MA 01056 inquiries about registration and status should be made to the Director, Home oD • improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 413-589-1010 02108(617)727-8598 Yr ,/� Submitted /` To: m C A ViIC l i)()Ins • Job Name: � SRt )'CIVt - or e. ( 0 (0 47,- Job loco SOlt.- fhone 6`..?clog Aay Date +) „&", -gt Estimator: -kfti, , We hereby submit specifications and estimates for work to be performed and materials t e used: + r4 ,C. 7-rei-*.s 1 v Pit-i 54 t r S nit,t4- - 4 04r Incer.,4 ) a _, g f zt Le rr s Ito'lei *ilyetirt 5 48 gig" Ki.i4 es-4A-% th -#2, /.4,1J-fl t a ox " 1 In., t c.. #.4. ..s��ci/ /A r Pt ,c04 i Clad e ttc 1i 1u CO* ( I Cal o I b ost cs 1 (7 . -a. ‘ , /AtifelPr At-f,S - t- a ,r ..-• . )Rt. (. I A ,- v - ,e .sgri_Ae, 4 4 -,t. FA,. - 4i r •� a.SS orb ca c V ✓ 1 gut _ WORK SCIIEDIJI.E Contractoj wi II rip hiF work or order the materials before the third day following the signing of this agreement,unless specified herein. Contractor will begin the work on or about! I%` { afire). Baring delay caused by circumstances beyond the contractor's control. The work will be completed by /OI ,! (date). The owner hereby acknowledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor Including hut 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. WARRANTY The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of ,,tail uwing 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,emplose s or agents,is discovered after completion of any job,including clean up,the Contractor shall at its own cxpasse,forthwith remedy,repair,correct,replace or cause to be remedied. repaired or replaced,such damage or such defect in materials and warkmanship„ The foregoing warranties shall survive any inspection performed in connectites rvith the agreed- upon work. We ropotôS'/v/ crcby to furnishant trial a ii labor -�ctamplete . record ee with above specifications, for the sum of: ,/+ £ /2fr � 01 0✓ s' dollars(S_ et , efl/.,...,._r(24 _ 1a ent'to(b(„7(p�eas � +Q mulxn signing contract; 242;1PATRICK KUBALA HaME IMRPOVEMENTS „�y4;..00." )upon completion of �.."*""*".6` 5 P E LL STREET 0,0 ....+elevt- `� ,1 upon completion of �"�" LUDLOW,M. 1 ► Ei 413-S89-1 r 10 It7/ %(...„ ,,' )shall he made forthwith upon MA F OC 1St completion of work under this contract �/ at 4 Notice:No a,reantent tier home improvement cnntra:lin wars-shall wire a down th spec &.A R p h tm:y minas! (advance deposit)of more than one-third the total contract price or the mall*mount of all depoaitr or payments which the contractor must make,in advance,to comer turd°cmi otherwise Authorized Signature: obtain delivery or special order materials and equipment,which over amount is greater Acceptance of Proposal: I have rend both sides of this document and accept the prices,specifications ns and cooditr,ist, .. = ) I understand that upon signings this proposal becomes a binding contract. You are authorized to do the aye as specified. Pat merit wilt be made as outlined above. You the buyer, may cancel this transaction at any time prior to midnight or the third hosiners dal after the date or this transaction. Sec notice of cancellation form for an e‘planatinn of this right, Please refer to the Notice of(:ant,cliation that accompanies this contract,contents of which are referred to ahuae and incorporated herein by reference. Do NOT SIGN THIS CONTRACT IP THERE ARE:ANY B NK SPACES ekl � '�'"'� pate 21 2 i Si attar kL,VA...,_ ..�.._... .,., ..... Date4 _. Signature - — ..,