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17D-042 (4) BP-2023-1645 50 STRAW AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17D-042-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1645 PERMISSION IS HEREBY GRANTED TO: Project# WINDOW 2023 Contractor: License: Est. Cost: 2427 NOVA HOME IMPROVEMENTS 116158 Const.Class: Exp.Date:04/18/2025 Use Group: Owner: SHERRI PUCHALSKY RICHARD J& Lot Size (sq.ft.) Zoning: URB Applicant: NOVA HOME IMPROVEMENTS Applicant Address Phone: Insurance: 35 FLETCHER CIR (413)455-8218 20043719 CHICOPEE,MA 01020 ISSUED ON: 11/21/2023 TO PERFORM THE FOLLOWING WORK: REPLACEMENT WINDOW 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: i, bet Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner - `��ma, I �r►i ;f The Commonwealth of Massachusetts NOV 2 1 2023 Board of Building Regulations and Stand ds FOR , Massachusetts State Building Code, 780 C R , MUNI IPAII ITY DEPT.OF DUII_DINO INSPFCTIO $SE Building Permit Application To Construct,Repair, Reno t�.Qr_ .> Maib Mar 2O11 One-or Two-Family Dwelling This Section or Official Use Only Building Permit Number: e Date Appl. d: N; , . 0 ft I; ;1 3 Building Official(Print Name) Signature I F Da SECTION 1: SITE INFORMATION 1.1 ,71/ ndi Pro rty Address: 1.2 Assessors Map& Parcel Numbers . a tR�4// 1.1a Is this an accepted street?yes v 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 Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP` 2.1. oaeraecord:m / w pa dis0 novh itimpicyr Nif- ofe2602 Name(Print) City, State,ZIP So SaRilk/ ifriltiE 1 7&1 SI�l Apichdzs,&/f 6091.4 No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building lki Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: I c 410(/!/16 'X ISM/6 1 %n do Gf/, iris.#i-jf 6 , flew VIny1 Win dae1 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: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ 11 Suppression) Total All Fees: $ Check No.II (1 Check Amount: Cash Amount: 6. Total Project Cost: $a 6 ��2t 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I oI ? L{ .96 1661CR/0#14 License Number Ex irati n Date Name of CSL Holder 3f F`6f(_ n n List CSL Type(see below) No.and Street �� U n T� Description /�th ogge mg No Q© 40 __Unrestricted(Buildings up to 35,000 Cu.ft.) `Ci/ty//`Town,StaiteC�ZIP I7 �/ �(, R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding 9 Q _M/ q q /��y 2 SF Solid Fuel Burning Appliances y13_�5f421 U- tit7�1��l0111 0to2te,(j`' N- I Insulation Telephone Email address D Demolition J5.2 Registered�/rrf Home Improvement Contractor(HIC) g03`Zf q OP,i5 /Mo2jj /YOU/ 6 I/nPfi0 y`xel - HIC Registration Number Expiration Date HICCompany NameIiIC Registrant Name ��/ ���6o1//• L No.and Street Gigf� Email`address 6 (Alt wee 9t0,20 t{t3 -166--8a 18 City/Town, State,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? de ❑ No ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S 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. 1iCMRS PUCMJ f4 f// 023 Print Owner's Name(Electronic Signature) ate SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. 6 4 h J i dd6a#7- ///a20/023 Print Owner's or Authorized Agent's Name(Electronic Signature) 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 half/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" The Comntonwealth of Massachusetts l� _=Aill 1=!t, Department of Industrial Accidents eB1= - I Congress Street,Suite 100 ,: _:i.i Boston, MA 02114-2017 ',',,, ,„-• www.rnass.gov/dia Wasters'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please hint Leaibh Name( 'vidhtal):/247w koit fflpIoo/Zei1 ,c_ Address:?j.6 FLei-r/ g (j(g �Q� ,�] �t � pn/QQ CitylState/Zip: 1 CAI( ' i t8 oiO0 Phone#: 70-•115, —/ cgd Are y an employe/1 Cbetk the appreprlste bin: Type of project(required): 1.0 1 am a employee with employees(till seder part-time).* 7. 0 New construction 201 am a sole proprietor or partnership and have ro employees working for me in 8. Q Remodeling any rapacity_[No sorters'comp.'rnuranrx rrawait:ill 3 I am a homeowner ell work r 9. Demolition sluice myself.[No workers'tromp.irmaetntnce regtsireeL] 4.01 am a homonym and will be hulas entarertnrs to conduct all work cm my property. I well 10 Q Building addition homonym mann:that all coemactota either have workers'c oamprmatwn io,ursnce crate sole 110 Electrical repairs or additions proprietors with no eotploybes. 12.0 Plumbing repairs or additions SO I am a general cot melee and I have bind the s b.eontracton listed on the attached sheet. l ❑Roof repairs These sub-cuntrackm have employees alai have touters'comp. utsurarmec. 6 We are a°reporstion and its officers have exercised their right of exenmpucm per MGL c.94, 14.0 Other 1 S2 41(I),and we have ns employees.[No workers'comp.insurance rcyuireii] 'Any applicant that chocks but al most alas till out the section below showing their wurt..-:.'.,,rapc:i>:uion]tIl i.y infamatied *Homeowners who submit that affidavit indicating they are doing all Mork and Then hire outside contractors roust submit a new affidavit indicahetstack 'C'unuretun that cheek this but must attached an adaliliunal xheti showtog the nature of the sub-contractors and state n}tether La m,t those erttatirrahave crnpluvecs. if the rub-cuniractur%Isasn nripluycca.thcti meat prus'ide their workers'comp.policy number. I um tin employer that is providing workers'compensation insurance for Jury ensployees. Below is the policy and job site Information. Insurance Company Name:6REZ:f /WOu//i/T'i 4 IKu144W cerrt pin Policy#or Self-ins.Lic.#: OQ00I& 7f Expiration Date: P9 ,7/02002y Job Site Addreas:,c0.54M'Gv 14GESIE A CityiStatelZip:�f 14enp i 14404 ©'og Attach a copy of the workers'compensation policy declaration page(showing the policy number atadeipiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fee up to$1,500.00 andlor 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 covcrate 1,erification. 1 do hereby certify under� the pedlar and potables of perjury that the lafo►mla n provided above Is true and correct. Signature10 c6Rf4u/ Otieib"a/oh N7M . Q Date: 11"—c:,U/ :;..3. Phone#: 46""i) z_G*r nole. 4I J -'(W-k r.A. Off vial use Only. Do not weir in thi.% tired,.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.Cityfl'owa Clerk 4. Electrical Inspector 5. Plumbing Inspector f`Other Contact Person: Phone#: THE COMMONWEALTH OF MASSACHUSETTS 4. Office of Consumer Aft I; a;+ Business Regulation 1000 Washing :',. ,, ,4.- Suite 710 Bosto - - x . , -.' 118 Home im r• - •.� ..""zr::..7,_ • • • •- 1 istration ' .A. a 4 AAA — w. � _t Ai r r„ {ff jqf� *IM+nlews � t pr ,.: :0 Type: Corporation ' Mon: 203142 NOVA HOME IMPROVEMENTS INC . , _ . 09/15/2025 ar 35 FLETCHER CIR , .,..r. i`. n .... mow, w CHICOPEE. MA 01020 .. y -Trs `fit.., , z .- -.- Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Aff . Business Regulation Registration valid for individual use only before the HOME IMPROV - 1.. ONTRACTOR expiration date. If found return to: Office of Consumer Affairs and Business Regulation E :, � 1000 Washington Street - Suite 710 rk 4'- • Boston, MA 02118 )VA HOME IMPROxf NTS! ,4 r e,,,,, 44 _EB LEIDERMANt FLETCHER CIR Iciir,--i-. .,--'t ..� i4,►,r,.,�4(�4dr01ICOPEE, MA 01020 e Undersecretary Not valid without signature Commonwealth of Massaa s i Divisionof Professional LACensure Board of Bung Regulations and Standards Coist S rvisor CS-116158 eras: 04/18/2025 GLEB LEIDEMAN + , ` .-: 35 FLETCHEI CIR CHICOPEE M 01I , w r r n _ t by w v � �'�,�4�" �' Yc bow Commissioner i to Ke. FlEYYMIAta,,, . A Rti CERTIFICATE OF LIABILITY INSURANCE DATE 7/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AM)CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I NSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the polcy(ies)must have ADDITIONAL DIN NU:D previsions er be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A MalemeM on this certificate does not confer rights to the certificate holder In lieu of such endorsemerk(s) jPRODUCER 1 CONTACT Amanda Cordewc NAME: Clayton Insurance Agency.Inc PHONE PIti�c Erik (413)S36 0804 mot, (413)534-78 1649 Northampton Street t9 atAIL acixcieumgclaytonsuusaassuial ADDRESS: iNsuRERISIsrrefact COVERAGE Holyoke MA 01040 Ne1NE1tA: GeenMNou ntainlnsu nni C4tsp.n 2 INSURED * N INsuRER$: AIM Mutual Ins.Co Nova Home Improvements Inc tNS1IReRC 35 Fletcher Cif INSURER D INSURER E: Chicopee MA 01020-3834 INSURER r COVERAGES CEIMICATE MOWER: CL2381505IIS REVISION NUMBER: 1 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 TIRE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS p�EEXCLUSIONS AND CONDITIONS OF SUCH POLICES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS AUTILIOUNR-LTR TYPE OP INSURANCE1CLICYEFF -nuzic PDir' MD t1I10 ►O ACY MasmR (MmitorYYYY) .(MtwoIYYYY) . LOUTS cOtatERcuAI GENeRAL LlltarL/TY EACH OCCURRENCE 3 1,000,000 WAGE TO RENTED Ct.Alus•tuADE l�OCCUR r PREMISES de tlnarsncel , 1300,000 —� LIED EISP(Any ens owlan: i 5'" A Y Y 2004371E 1 09107/2023 09/07/2024 PERsoNAL&ADV INJURY $ 1,000.000 GEAGGREGATE LIMIT APPLESPER GENERAL AGGREGATE S 2.000.000 N'L oOIJCY LOG PRODUCTS•COMP/OP AGG $ 2,000,000 OTHE3t S AUTOISOeILE LI/MLITT - r O LISINEi0 SIMILE LIMIT 4$ 1,000,000 — (Ea scndsntt ANY AUTO COOLY INJURY IPw oRraern S 20.000 A .-..- overED AUTOS ONLY AtJT Y Y 20044183 1p1W 2O23 IOWOS BODILY*taw(Peraccaewai S 40.000 HIRED NON-OWNEp AUTOS ONLY X AUTOS ONLY ,tiNtl t0nlAAGE S PIP-Basic S 8.000 UNIIRELLA tJ,AB ---,OCCUR EACH OCCURRENCE S EXCESS LAM CLA A•AOE AGGREGATE $ - D_EO 1 RETENTION S $ aUrIO rei icoavEtrs*uou - A 9LCYBts-LiAaI&ITY YIN STATUTE TE I ER 8 ANY PROPEIABERRPARTTEREXECUTNE (yj NJA Y WCC500502570E 0 107/2023 09/07/2024 EL.EACH ACCir'£NT 'S 500.000 OFfK,EAN,ENeER EJIGLUDEO' ( � f (liasdilepril Reif E:L.DISEASE•EA EtIPLOYEE $ 500,000 `I res.damaa.dpr DESCRIPTION OF OPERATIONS three , El.DISEASE• LIMITPOLICY $ 500'000 I DESORPTION Of OPERATIONS l LOCATIONS(VEHICLES IACO NO 1r I.Additional Rename Schedule.may I.allotted If men apace Is raautedl Andersen Windows,Inc.. its affiliates.agents and employees are included as additional insured on the general liable and automobile Iwbilty insurance polices including s separation of insured clause.policies will include waiver of subrogation in favor of Andersen.its dilates.agents and employees,and will be primary ant non-canbtbutory with rasped to any loss or darn arising out of Contractor's acts or omissions Statutory Workers compensation shall provide coverage in accordance with applicable state taw requirements Thirty(30)days'pno written notice of change or cancellation be given to Andersen Corporatior CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFO THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEUVERED IN ANDERSEN WINDOWS,INC.C10 MY COI ACCORDANCE WITH THE POLICY PROVISIONS. 1075 BROAD RIPPLE AVE SUITE 313 AUTHORIZED REPRESENTATIVE INDIANAPOLIS IN 46220 fr 2. p 4 D 1968-2015 ACORD CORPORATION. AM rights res ACORD 25(2S18f03) The ACORD name and logo are registered marts of ACORD City of Northampton ,orrre ... rram,., ��s Si_ \ Massachusetts ��� '{�Xw� 4� s DEPARTMENT OF BUILDING INSPECTIONSD'. f 212 Main Street • Municipal Building yJy,1 .Ca` Northampton, MA 01060 CS CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. X(44/ b6 ( el atom CzeAn The debris will be disposed of in: Location of Facility: 6-',5 L!/!G3' oor/Ic •sowzh ifev, z( 13 S fr 53 5 The debris will be transported by: Name of Hauler: Signature of Applicant: Date: U—X—b2A3 i Page 1 d 9 35 Fletcher Cir CT MC 0666426 Chicopee, MA 01020 " MA HOC 203142 (413)455-8218 MA CSL 116158 novahome2021@gmail.com Olt WINCIOWnovahomeirnprovementnet HOME IMPROVEMENTS '1NDOWS The way land1k Nova Window Contract All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617)973-8700 Customer Information Richard Puchalsky (413)727-5141 Date: 11/15/2023 Sherri Puchalsky rpuchalsky1@gmail.com Rep: John Lee 50 Straw Avenue North Hampton MA 01062 The following windows will be installed by Nova Home Improvements Total number of windows in the home 18 Total number of windows being installed 1 Wincore Triple Pane Window Location Living Room Quantity Window Number 1 Size 32x50 j Interior Color White Exterior Color White Window Wrap White Tempered Glass None Grid Type None Privacy Glass None Grid Pattern None New Construction None Additional Details Special Instructions Thank you, and welcome to Nova, Rich &Sherri! Do Not Do (We do not do any painting or staining) This space intentionally left blank Page 2 of 9 NOVA PRE-RENOVATION FORM This form may be used by Nova Home Improvements to document compliance with the Federal pre-renovation education and renovation, repair, and painting regulations. 0 Received - I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. Owner-occupant: Richard Puchalsky 11/15/2023 Date Renovator's Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. El Declined - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below at the date and time indicated and that the occupant declined to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit with the occupant. 13 Unavailable for Signature - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by (fill in how pamphlet was left). 4, , 411.C; ) Person Certifying Delivery John Lee 11/15/2023 Date Unit Address 50 Straw Avenue North Hampton MA 01062 Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a certificate of mailing from the post office.