25C-037 (3) BP-2024-0153
15 NORTHERN AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
25C-037-001 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-2024-0153 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS 2024 Contractor: License:
Est. Cost: 10628 PATRICK KUBALA 100114
Const.Class: Exp.Date: 09/09/2025
Use Group: Owner: ANNIE ROSE-WEISS MARISSA &
Lot Size (sq.ft.)
Zoning: URB Applicant: PATRICK KUBALA HOME IMPROVEMENT
Applicant Address Phone: Insurance:
5 PELL ST (413)589-1010 WCA1038596
LUDLOW, MA 01056
ISSUED ON: 02/16/2024
TO PERFORM THE FOLLOWING WORK:
6 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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
I }}CU1caly
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Alt' ,4,t-Ace ".-/Yhi¢.7-4 'cr""• " / v : be'de r I y Q . C adRal-fripo-,E . C 0 Pri,
r :EQET
The Commonwealth of Massachusett p �- --f------ ,___.._
Board of Building Regulations and Standard; � ___C E( F: ;FOI2
t "U' ' ! Massachusetts State Building Code, 780 CMRI "I pCIPALITY
4 2024 ►USE
Buil Persitit Application To Construct,Repair,Renovate Or I aliph4a d .Revised Mar 2011
One-or Two-Family Dwelling
E t
DEP)' CC)i 1>U11 DIN.i iTT2,1 T1Ot S e
,A')F i HA" ,' MA(11 ho This Section For Official Use Only ' , r-llt,tn ,lrlso _l -
�j� - .. 'RTHa' ,r 110�iS
Buttding Permit Number:' `1� �'j Date Applied: " ; al A n, .0
4910 ! 55 /1 2-15-2001
Building Official(Print Name) Signature Date '
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/S iote 77-ie t N Ivs
1.1 a Is this an accepted street?yes ,< 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,Q54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone? Municipal CI On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2 A Owner'of Record:
fioizz.ssR �o Se.—`J rs S /ro4,rNRMPToa o1J0 0/v 1. v
Name(Print) City,State,ZIP
/ /Yew«Eeril A 2. 6o1077' •>S1/9
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
1 New Construction 0 Existing Building 0 Owner-Occupied CI Repairs(s) 0 Alteration(s) 0 Addition L7
1 Demolition 0 Accessory Bldg. 0 Number of Units Other .11 Specify:___
Brief Description of Proposed Work': oe;pGQC e_. 6 torivbateis
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Tabor and Materials) _
1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
Cl Standard City/"Town Application Fee
2. Electrical _ - 0 Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2, Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees
/:,j
Check NP/W Check Amount: 't Cash Amount:
6.Total Project Cost: $
1 lQ, 6 off• 0 u 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) rwQ/1 'r /i,a..r-
,�FT,Q,z'ri_.e kJ(A QG f,7 License Number Expiration Date
Name of CSL Holder(Or homeowner if owner applying)
List CSL Type(see below) CotC3 9' ��6c li�B.R op .$T
No.and Street Type Description
// U Unrestricted(Buildings up to 35.000 cu.ft.)
ha IOW �14 D)0-c V R Restricted l&2.Family Dwelling
City/Town,State,flP M Masoruy
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
liances
J :2 9,, p Ze?IC r. }, (a K Ngaza i.tpo'?E• I Insulation
Telephone Email address D Demolition I
5.2 Registered Home Improvement Contractor(HIC) j oZ 0, y�/ �3�/Zo ZS""r
/e44.6s944 Aic'" „_/,2Ae0 y6,n( Ai 1.--- I HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name I
/
2 d StsJGtaaAto ,}'T I�CYtr-4 ,,k cc.4t41A.i/Qi 1 , ��Y�
Email address
N4a low /1'4- D) 03-6 1/;3 -Ser?—/ad0
City/Town,Stats,ZIP Telephone
SECTION fig: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 • 1' No 0
j ' . F SECTION 72:OWNER AUTHORIZATION TO BE COMPLETED WHEN
Q VNEit'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _
1,as Owner of the subject property,hereby authorize l""y7,4xCY 44.44 LA to act on my
behalf,in all matters relative to work authorized by this building permit application.J€ .
Print Owner's Name Signature Date
=' SECTI:ON 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 bes y knowledge and understanding.
/f/d 4i
Print Owner's or Autho ' 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 ww-w.mass.gov:oca Information
on the Construction Supervisor License can be found at www.mass.gov/dns
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"
DocuSign Envelope ID: FF7846C6-F01 E-4F09-B66A-COFD34A1501C
Kubala Home Improvements
The Window & Door Experts
5 Pell Street Ludlow, MA 01056
855-458-2252
Customer authorization for building permits.
Marissa Rose-Weiss
I, , as Owner of the property located at
15 Northern Ave, Northampton MA 01060
, 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.
—DocuSigned by:
AJVr 1/19/2024
'`..--033er71f OA743e
Signature of Owner Date
.rtC C,vmt jU(trvCuttrt of :r1uJJ4CcIc14Je443
— = Department of Indust-rut' l Accidents
Office of Investigations
t '0 Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
Workers' Compensation Insurance Affidavit: Builders/Contra
ADDlicant Information ctors/Electrlcians/Plumbers
PIease Print Legibly
Name (Business Organizatiorv7ndividual)• ,I�QAL/9' WA 1'
Address: S7
City/State/Zip: .0 t4. Zo J Q 1 0 6 Phone#: 174/?
Are you an employer?Check the appropriate box:
1.® I am a employer with /0 4. 0 I am a general contractor and I Type of project(required):
employees(full and/or part-time).* have hired the sub-contractors 6. E New construction
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. E Remodeling
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp. insurance.: 9. ❑Building addition
required.] 5. E We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 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 I2.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.E Other
comp. insurance required.]
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. •
I.Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affiidav it 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Meg Chi/7J ".47-.r'i4L Z pv'Ji 2RDvt E �`7
Policy#or Self-ins. Lic.#: ljl/C,4 /6, 31376 Expiration Date: /'�9Dva I
Job Site Address: /S fro a.T!- '2ry etKi.. City,State/Zip:4' L7/ ei rr1 P 70 /7 1*
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). d/G a
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 penalti s of erju at the information provided above is true and correct.
Signature: ` Date: `4/43
Phone#: y13 -SY, ^ l 10
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):
1DBoard of Health 20 Building Department 3tJCityrrown Clerk 4.0 Electrical Inspector 5Ellumbing
Inspector 6.DOther
Phone#:
Contact Person:
4...... - CERTIFICATE OF LIABILITY INSURANCE j DA E( fYYYY}
5/22/2023
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(SI,AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: I the certificate holder is en ADDITIONAL INSURED,the pollcy(iss)must have ADDITIONAL INSURED provisions orbs sndorsad.
If. BUBROOATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this ceNflGpe does not confer rights to the certificate holder in lieu of such endorsemant(s).
PRODUCER i Fares
Smith Brothers Insurance,LLC I Plow -- ------.---- FAx
300 Mein Street ; A+c,No,i s(508)987-0333 __ IA/G_mo:(860)652-3236
Oxford,MA 01540 �_genera1mailboxesmithbrothersusa.com
INSURER($1 AFFORDING COVERAGE----- "NMC C
1 INSURER A:Merchants Mutual Insurance Company k23329
IUD 1 IN31 R a:MAPFRE Insurance 123876
Patrick ftupala Home Improvements I i<ubald Home 1 Ins c. �
Improvements LLC —_
$Pell Street i I►rsuaER D:
-
Ludlow,MA 01OSS-7782 'INSURER E:
—.;--
INSURER F:
QOV RAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS tS 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR LIMITS
LTB TYPE OF a 1em= ` tri POUCY NUMBER qO Iy yyn'�1
A X 'COMMERCIAL DEMERJII.LIA91LRY EACH OCCURRENCE 1,000,000
S— _
I CLASAIW ADE E OCCUR BOP1109317 8/1/2023 811/2024 PREMISES rmoDAMAGE TO RENTED 10Q,OOQ
(Es oaccrnl ,rS
5
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'--D EXP(MY one person} Included
PERSONAL A ADV INJURY 14,
_geJ L AGGREGATE LW APPLIES PER GENERAL AGGREGATE $ 2,000,000
X POLICY T LOC ! PRODUCTS-COMPtOP AGGG $ .._ _ 2,000,044
OTHIR. - ' r {COMBINED SINGLE LIMIT $•
1,000,000{
B AUlTOuoMLE LIABILITY
ANY AUTO Qt• 6/1/2023 8/1/2024 I aoato'truui Y(Per person' $ v-___-.-
ONLY X AWL")
!!! �ODILY Iµ,tURY(PGr wockltM};$
MIS
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X AUTOB.ONLY X AdITOS ONLY { P�tOPERTY GE $
{pu gcctdsrd} $
A !X IAiaRELLA GAB OCCUR j EACH OCCURRENCE ;
1,000,000.
acme GAB CLAIMS-MADE I CUP9151881 8/1/2023 811/2024 •I AGGREGATE S
DED ( X i R!_TErNTION 3 I0 I $
' DER OTH-
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A F--LAIEkTAITE ER 1,000,000
Y t N I � 6 3 5I112023. i 6/1/2024 E.L.EACH ACCIDENT ;
riSxAt EctITNE 1 N/A E.L.DISEASE-EA EMPLOYEE; 1,000,0001,000,000
IDESCINFT1ON OPERATIONS WON 1 E.L.OIS€Ay^+E-POL,ICY LIMIT ;
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C� ATE t{_ fR� CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE REOF,WITH THE POUCYROV NOTICE � BE DELIVERED IN
PROVISIONS.
ACCORDANCE
AUTNOitIZED REPRESENTATIVE
01
J1988-2015 ACORD CORPORATION. Ail rights reserved
The ACORD name and logo are registered marks of ACORD
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THE COMMONWEALTH OF MASSACHUSETTS
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HOME IMPRo :-.. -77:1 k 1 • cirok I expiration date. If found return to:
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1000 Washington Street -Sulte 710
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DEBRIS DISPOSAL FORM
Zn accordance with the provisions of MGL c 40, S 54, a condit<on of Building Permit
Number is that the debris resulting from this work shall be disposed of in
a properlyitan:sett solid Este-dispersal-facility.as defined by MGL c 11 1,S -I54A,
The debris will be disposed of in:
/ •`pp, -AC
LOCATION OF FACILITY
4/
Si of Applicant Date
AFFIDAV?T
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 n a properly licensed solid
waste d]Sposal.facility, as defined by MGL c i_l_, S 150A.
scerti£y_tb,ai_l_ Lr,.4t�fy_the$wilding Official y (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,
Date Signa=e ermit Applicant
(PRINT OR TYPE THE FOLLOWING INFORMATION)
/ 77e.- CF AlceieF Lf{
Name of Permit Applicant
ortrrete. 7466,>64 c C 06#74"le'c�-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 I VT CR
Omega-Tuff 52210A .24 .21 .48 47
Hi-R N2210A .25 i .28 .52 47
Essential P2100A .30 ' .49 .60 55
Passive P2210A 1 .25 .48 .59 46
DocuSign Envelope ID:FF7846C6-F01E-4F09-B66A-COFD34A1501C
MA HIC#207481 All home improvement contractors and subcontractors engaged in home improvement
contracting,unless specifically exempt from registration by Provisions of Chapter 142A
34 HUBBARD STREET of the general laws, must be registered with the Commonwealth of Massachusetts.� 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 Marissa Rose-Weiss
To: Rose-weiss windows
15 Northern Avenue Job Name:
Northampton MA 01060 15 Northern Avenue Northampton MA 01060
Job location:
Phone 607-272-1419 Date 01/15/2023 PK
Estimator:
We hereby submit specifications and estimates for work to be performed and materials to be used:
Remove and dispose of 6 windows on the 2nd floor. Inspect openings for water/insect damage and repair
as needed. Custom build and install 6 new double hung windows. 1-Pantry, 3-Dining Room, 2- Living
Room. All windows are Kubala Custom Hi-R+ series windows. 100% virgin vinyl , 12- pt fusion welded
corners, insulated frames, full screens, HiR+ glass. All windows are white on the exterior, pantry
window is white on interior, all other windows will have interior woodgrain laminate. Color TBD at
final measure. white window will have white hardware, woodgrain windows will have Pontiac Gold
hardware. Insulate weight pockets, install , insulate and seal . Clad exterior trim with white PVC
coated trim coil . Clean jobsite and dispose of all debris. Price includes all labor, materials, taxes
and permits. Double Life of Home warranty, Free Service Warranty.
Total price net all discounts $10,628.00
***Production / Manufacturing Note*** Match Glass Spacer to KHI-#1674 SRw/MIw #178094
WORK SCHEDULE
Contractor will not begin the work or order the materials before the third day following the signing of this agreement,unless specified herein. Contractor will being the work on or
about 6-10 WK�ate). Baring delay caused by circumstances beyond the contractor's control. The work will be completed by 1 DAY (date). The owner hereby
acknowledges and agrees that scheduling dates are approximate and that such delays that are not avoidable by the Contractor including but not limited to strikes,Acts of God,
shortages of materials,accidents,and all other delays beyond the its control,shall not be considered as violations of this Agreement.
WARRANTY
The contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of DBL LOH following completion and shall
comply with the requirements of this Agreement. In the event any defect in workmanship or materials,or damage caused by the Contractor,its subcontractors,employees or
agents,is discovered after completion of arty job,including clean up,the Contractor shall at its own expense,forthwith remedy,repair,correct,replace or cause to be remedied,
repaired or replaced,such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-
upon work.
We Propose hereby to furnish material and labor-complete in accordance with above specifications, for the sum of:
Ten thousand six hundred twenty eight dollars dollars($ $10,628.00
).
Payment to be made as follows:
0 %(0.00 )upon signing contract; KUBALA HOME IMRPOVEMENT LLC
33 0%0($3,500.00 )upon completion of Final Measure 34 HU BBARD STREET
0 %(0.00 )upon completion of x LUDLOW, MA 01056 413-589-1010
67 %($7,128.00 )shall be made forthwith upon MA HIC 207481
completion of work under this contract. Patrick Kubala
Notice:No agreement for home improvement contracting work shall require a down payment Salesperson: —Docusiened by:
(advance deposit)of more than one-third the total contract price or the total amount of all D
deposits or payments which the contractor must make,in advance,to order and/or otherwise Authorized Signature: f
L--Ioa8trerf t3v 2w5n...
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.
oocusigned bP0 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
LA—� �� 1/19/2024
Signature Date Signature Date
ouanni FpoA7450„
KH1101