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39A-054 (7) BP-2023-1019 74 LYMAN RD COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 39A-054-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1019 PERMISSIO IS HEREBY GRANTED TO: Project# WINDOWS 2023 Contractor: License: Est.Cost: 9153 PATRICK KUBALA 100114 Const.Class: Exp.Date: 09/09/202. Use Group: Owner: WAGL R GOLDENBERG, CAREY&WILLIAM Lot Size (sq.ft.) Zoning: URB Applicant: PATRI I K KUBALA HOME IMPROVEMENT Applicant Address PhD= Insurance: 5 PELL ST (413)589-1010 WCA1038596 LUDLOW, MA 01056 ISSUED ON: 08/01/2023 TO PERFORM THE FOLLOWING WORK: 9 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: r ,2 TIT Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commis& ner The Commonwealth of Massach ,.:tts ��� Board of Building Regulations an. �•. . FOR ta Massachusetts State Building Code, :' o i- `As US ALITY 9p 6 / Building Permit Application To Construct, Repair, Renov• - a0 .t e. '{' ' vised i ar 2011 One- or Two-Family Dwelling �T ti,/tie This Section For Official Use Only �'40frit� Building Permit Number: 6P-)-3' 101 q Date Applied: (Ivs VeViij 72.5.5 e i-ZoZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map &Parcel Numbers 74 Lym4w /LD 1.1a Is this an accepted street?yes X no Map Number Parcel Number 1.3 Zoning 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 0 Private 0 Zone: Outside Flood Zore? — Check if yes❑ i Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2. Owner'of Record: CH rt Gi a o G,D.E N,B EK G /1t0I .7,414yi p-ra N,, ,- o/c 6 0 Name(Print) City,State.ZIP 7# £�m4A/ Rv oto6 -3 93--irVk No.and greet Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: lee p0pe.4 9 Q►jel,,/ O&J 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 Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No.q1O Check Amount: t, Cash Amount: 6.Total Project Cost: $ 9./S 3.0 v 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) w10 Q /2 /7,I.2J"-- "ArrX.2-Ci. kit A qG a Licen$e Number Expiration Date Name of CSL Holder(Or homeowner if owner applying) 3 t/ List CSL Type(see below)/ tc a$i /� 5T No.and Street Type Description �O m� d�D U Unrestricted(Buildings up to 35,000 Cu.ft.) 4-4. w R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masomy RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 'Y/3 A t7 t+e-r 1 y e K N gala 'l.wor €. - Insulation Telephone Email address �o M D Demolition J 5.2 Registered Home Improvement Contractor(HIC) a(D f /,/ /•3//LO 2 S-- 1 :041A , nC .,Z"Oeo '4ciic A' ice— HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 3� /�Gt 04A i .t'T Zei/e(-4 Pk4.44L9 A/o/It e—Dcy—) N nd Street Email address o.4u.ni0 W /Z(A- d) 0 5-6 l 3 -Sip-/0J0 City/Town,Stats,ZIP Telephone SECTION 6: 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 -E ' No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize / 702.rek_ µ 44 LA to act on my behalf,in all matters relative to work authorized by this building permit application. 4,Yee Print Owner's Name Signature Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pe jury that all of the information contained in this application is true and accurate to the bes y knowledge and understanding. _ 7 471 Print Owner's or Authori Agent's Name &Signature 780 CMR R105.3(6.) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of iialf/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" Kubala Home Improvement Your Window & Door Experts 34 Hubbard Street Ludlow, MA 01056 855-458-2252 Customer authorization for building permits. I, i( {' Ur , as Owner of the property located at �IA (-Apt'an A/114h1,Oq1 "1 /IM-, hereby authorize Patrick Kubala Home Improvement to act on mybehalf, ih all matters relative to attainingbuildingpermits, and all m relative to work au rized by such building permits. Signature of caner Date KH1103 l tC l.Vfnrnure► nscin uJ .►Lua,a gi ligi3VLW a Department of Industrial Accidents Office of Investigations Lafayette City Center • 2 Avenue de Lafayette, Boston, MA 02111-1750 wwH.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinessiOrganizatiotvindividual): iezzigAL n ,jniy,1` y,4 t k/<.,7E,V 5' Address: e A A <S7 City/State/Zi.: X(4..4oGcJ 4 / Phone#: 46/3 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with /0 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. 9. ❑ Building addition required.] 5. 0 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.❑ Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. 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 and job site information. Insurance Company Name: 82ee �,t �T`(' sTgRL 1'N,s>t,[/egive &I) Policy#or Self-ins. Lic. #: (/CA �"6 Expiration Date: • .14a I Job Site Address: 711 4i, #v T d City/State/Zip:, rfl, At,oror", /71 o i'b c 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penaltie ofperju at the information provided above is true and correct Signature: Date: Pik' Phone#: 9/3 —S /�p — ajn Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(check one): --11 10Board of Health 20 Building Department 3IILJCity/Town Clerk 4.0 Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: A�OR©" PATRKUB-CL DKENI CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDnm^r THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THI$. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZEC 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 Smith Brothers Insurance,LLC - CONTACT NAME: 300 Main Street PHONE --- Oxford,MA 01540 (vc,No,Eat):(508)987-0333 FAX Na):(860)652-3236 an'eDREss:genera,mailbox@smithbrothersusa.com INSURER(S)AFFORDING COVERAGE NAIC# !WIRED , INSURER A:Merchants Mutual Insurance Company 23329 Patrick Kubala Home Improvements&Kubala Home INSURER s:MAPFRE Insurance 23876 Improvements LLC INSURER c 5 Pell Street INSURER D: Ludlow,MA 01056-2762 INSURER E: COVERAGES INSURER F 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. LNOR TYPE OF INSURANCE iADDLISUBRI POLICY EFF POLICY EXP A 1 INSD 1 WVD POLICY NUMBER X COMMERCIAL I t (MMlDD/YYYYf (MM/DD/YYYYt LIMITS 1,000,OC jE OCCURRENCE CLAIMS-MADE X OCCUR DAAMAnF TO RENTED CH $BOPN09317 6/1/2023 6/1/2024 PREMIS aom ES(Eurrence) $ 100,0C — MED EXP(Any one person) $ S,OC PERSONAL&Am/INJURY $ Include GEN'L AGGREGATE LIMIT APPLIES PER 2 OOO,OC pR�. GENERAL AGGREGATE $ + X POUCY n 2ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,0C OTHER: $ B AUTOMOMLE UABIUTY (E�acaidaB SINGLE LIMIT $ 1,000,0C — ANY AUTO BDMM6�4 6/1/2023 6/1/2024 BODILY INJURY(Per Perscn) $ OWNED SCHEDULED 1 y AUTOS ONLY X SCHED aool PROPERTY ROP i vJURY(Per acc dent] $ t'- AUTOS ONLY X N O ONLY (Pe�ac RidentDAMAGE $ LAB I OCCUR EACH OCCURRENCE $ A X UMBRELLA L 1,000,OC EXCESS UAB CLAIMS-MADE CUP9151661 6/1/2023 6/1/2024 AGGREGATE $ DED X RETENTIONS 10,000 i $ A D EiiPLOYERE'L IABI PER - STATUTE ER ER ANY PROPRIETOR/PARTNER/EXECUTIVE v/NI N/A 'WCA1038596 6/1/2023 6/1/2924 . EL EACH ACCIDENT $ 1,000,0( A PERJM R EXCLUDED? IfMy��rMI^NH),describe � E.L DISEASE-EA EMPLOYEE$ 1'000'OC DESCRIPTION OF OPERATIONS belowE• .L DISEASE-POLICY LIMIT $ 1,000,OI I 1 • DESCRIPTION OF OPERATIONS I LOCATIONS I 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserve, The ACORD name and logo are registered marks of ACORD IIIST,1TE ()I' CONNECTICUT"' W Board of Building R ulltions and Standards of p IN/iir%r or co‘will k /will,( Ho\ -.:." Cans Ill SOT iSilik*Ie i ' 44 __:;,..,_ _. .14' • ROME thiP01011t#0,1TRACTOR S-100114 4? 11'6 t r Kipires:09109/2025 .• BURMA H 4MP0 T LLC PATRICK.2: ,., , • . 34 HLIBBA ST'7 J4'irof i -: i L - 100 I LUDLOW 114gI 311 " '\•i / .,-, ic V / • Ve. ) I 1 °I.L•fdiV) x , ' HIC.0669025 /03X29,_20P.1.--' 03/31/2024 I Commissioner S4edi., --QA,,_insrf,,,----• _•,,,,,, i ..---..-- _ __. THE COMMONWEALTH OF MASSACHUSETTS 47.,,,. Office of Consumer Aff. 1;* . , • Business Regulation 1000 Washing 2Ii7,PAt,. - Suite 710 Bosto 7 „.... . .—..... ._...—.1,... 118 -.... .7.--- -- Home Im•ro :77—•4-1,474.: :"..S.77.1.. ..Ze•istration ji •70.0.07,0•77.,1710.00 V 1011.0017 t == ""- **"1" 1•.... - Type: LLC '', 7.1!....• KUBALA HOME IMPROVEMENT ..• #014.0.1.141k mi.Mt i=;e I t;ation: 207481 ..= E Ilion: 01/31/2025 .......0. 4,4. 34 HUBBARD STREET .MI. . ge....010...- .... .....r.rwroomom LUDLOW,MA 01056 .........701 I. AI = """""""= ::: if•....WM kJ i 14 .......4.... ' .• ."---, ,57 kt...-55N Update Address and Return Card. • • - „.... ...• . ... ._ ,„ .., - - , - ._. -. .... .... . . . . -- .... .,.. ...... ... . - ...... ,.. ..... •• "' ".. ' THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff Business Regulation Registration valid for individual use PIP,before the HOME IMPROV lk, ONTRACTOR I expiration date. If found return to: Office of Consumer Affairs and Business Regulation L4....ltiLL'11.........iuu. 1000 Washington Street -Suite 710 PLC Boston,MA 02110 :PALA HOME IM• • ,"I ':::7 Allifisii ' V . ,..;„...:,4.-. 1 ...zrezcs -! -..„:...,_.:_inii....4.....c... 1TRICK KUBALA 7,-2 : -=.".^r,...•- e ,9 •HUBBARD STREET '-'•""'-','''''±.*--- '',' gae,..of a./4"4.4• IDLOW,MA 01056 4...... " ..i.....• el sawialkne g•cirsnalhora r 1 • . . 4..... ... .. n . ..,. x • ; . .-•- ... -• ..• . 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I i I 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 properlylicensed solid wastedispesal-fseility as defined byMGL o 111, S 54A., The debris will be disposed of in: LOCATION OF FACILITY 7//7!A3 Si of Applicant Date AF.E"WA VTT 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 disposal.facility, as defined by MGL c 111, S 150A. Se.eztify_tha2 I wilLugSify the Building Official (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 fat attachment to the Building Permit. i'/,?7/a 3 Date Signature ermit Applicant (PRINT OR. TYPE THE POLL OWJ G INFORMATION) 7797-e. rCdc" G/f Name of Permit Applicant l RriKSG rc /d,f64 6.7e•tom j�_ 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 CR Omega-Tuff 52210A .24 ! .21 .48 47 Hi-R N2210A .25 .28 .52 47 Essential P2100A .30 .49 .60 55 Passive P2210A .25 .48 .59 46 KUBALA HOME IMPROVEMENT LLC MA HIC#207481 All home improvement contractors and subcontractors engaged in home improvement O contracting,unless specifically exempt from registration by Provisions of Chapter 142A 41 34 HUBBARD STREET of the general laws, must be registered with the Commonwealth of Massachusetts. Eg (/ 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 d Ww 5 a7-7•}4,% q,„61 0 Submitted To: r "a1tr1b co �0 f��t-11L Job Name: &ot"`e.n a b.() ypictfl 47�" , 1 MA OW 6,0 Job location: l f f-Phone D to / j _'; 7 �?[(,r1[7 Estimator: Jñ') la(A40{j We hereby submit specifications and estimates for work to be performed and materials to be used: L ''4 ti r.'_ '; & PO ' u `4 S41 R . II• oI / ti I Is d/U b ! . -em A /a n. !,:1 , . it I g l�rta► iiIA ''/..: q ! . /.///.oI.I,,' tE I r r l',1 t / 1 �i� s .. r1/I 2Z� r r .:/ r. I dI a I .�i. ►. lai r/.. . A //,/ 6 MAIL t A /: �e / • . �' tigelli L ir [�T� ������U s , .11r : �i& G FF�r u �. i • Mrt•'%ti� ♦ l�•�Ilj1��/���L_i _ ► III Isfa�: �� / : ___ _I ! �.•ti /i.M. /A li1..757.a�e r ! _ tArMA i 1�JAAZ 0161``r0`♦ 'a t► .i/ I - r /111./ i t i. - t ak OM WORK SCHEDULE Contractor wt n t 1�0�10.44,Lic or order t e materalsbefore the. ird day following the signing of this agreement,unless specified herein.1Co o w the work on or about i �(�[e)• Baring delay caused by circumstances beyond the contractor's control, The work will be completed by /J.V1g( ate. 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 Agrceruent. O f WARRANTY -�) (+' The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of v 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 P o ose hereby to furnish material and labor-complete in a •ord. e.with ab wee specifications,pQ for the sum of: /� t ` _ ' ite.dollars(S__Ci i 6 ____). paw t to be ma as follows: %( c 'I )upon signing contract; KUBALA HOME IMPROVEMENT LLC %(__ )upon completion of 34 HUBBARD STREET 0;6( )upon completion of LUDLOW, MA 01056 413-589-1010 9_796(—_ D 1 1 shall be made forthwith upon .-Cli-5 MA HIC 207481 completion of work under this contract. /4r Notice:No agreement for home improvement contracting work shall require a down payment Salesperson: c w (advance deposit)of more than one-third the total contract price or the total amount of all ?f deposits or payments which the contractor must make,in advance,to order andior otherwise Authorized Signature: 1 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 co iitions 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 transactio at any time prior to midnight of the third business day after the date of this transaction. See notice of cancellation form an explanation of this right. Please refer to the Notice of Cancellation that accompanies this contract;contents of which are referr o above and incorporated herein by reference. DO SIGN THIS CONT CT IF THERE ARE ANY BLANK SPACES Signature Date ( ICf „Zignature Date t,atot