11-011 (9) BP-2024-0449
106 MORNINGSIDE DR COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
11-011-001 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-2024-0449 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS/DOORS 2024 Contractor: License:
Est. Cost: 48878 PATRICK KUBALA 100114
Const.Class: Exp.Date: 09/09/2025
LEVERETT, MONICA JAKUC &LEVERETT,
Use Group: Owner: ROBERT TERRY
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: PATRICK KUBALA HOME IMPROVEMENT
Applicant Address Phone: Insurance:
5 PELL ST (413)589-1010 WCA1038596
LUDLOW, MA 01056
ISSUED ON: 04/17/2024
TO PERFORM THE FOLLOWING WORK:
REPLACE 17 WINDOWS AND 2 DOORS
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:
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
laL CRs.L E"0r?ZL- f'c"n7.t T -To = be_r',-(y e_/-K L,4No • • CO rrl
rta The Commonwealth of Massachusetts 1.4 i
�� Board of Building Regulations and Standards, C�' FOR
��, /, fC.IPALITY
' i t ` Massachusetts State Building Code, 780 CMR „�}.�. , •._.,
USE
Building Permit Application To Construct, Repair,Renovate Oi &nc,li, i a ' Revifed Afar 2011
One-or Two-Family Dwelling ,i� O 202
This Section For Official Use Only �Y
Buildingermit Number 00-.2.$' y I'1n ", :
� y � Date Applied: '^, !^Asper, l �
iL;liZn // �' `'I-17 ZOZ G
Building Official(Print Name) Signature Date /
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
/D t /1 7 gev-rn/ •, s i ele._ .D Q.
1.1 a 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(t)
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 El Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal.system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Own&of Record: �j�N� �f} d/d G Z-
/7!D/L-i'C.4 ¢?v Ei tER r' � v E4d l [—`o / -
Name(Print) City.State,ZIP
/o 6 GP70 2v,i-Nac5:de. ,D,• 9k3 .6-io •S-S.-Kr-
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 , Repairs(s) 0 Alteration(s) 0 4 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Specify:
Brief Description of Proposed Work': ,le PL1c /7 (,c 2;it/�✓ort.S 7 02 J)O OR. 5
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: _
(Labor and Materials) Official Use Only.
l.. Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees
Check No.� Check Amount: 'l V Cash Amount:
6. Total Project Cost: S y. GO�
7 O p d CI Paid m Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /C) I? r79Jo2�
, (i— t A aG License Number Expiration Date
Name of CSL Holder(Or homeowner if owner applying) r
List CSL Type(see below) vt
c3 19/La
No.and Street Type Description
/ U Unrestricted(Buildings up to 35,000 cu.ft.)
QJ /714 01 OS (' R Restricted 1&2 Family Dwelling
City/Town,State,LZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
9/e y Zer K E I Insulation
Telephone mail address iv; D Demolition
5.2 Registered Home Improvement Contractor(HIC) e7,y,/ //3/i ems--jl
feie6r'9LA MC 2/12 ex y{/Y!( �/ % HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name //
/4 1,4kQAR9 s7- bcver..4 e(c.041AA/o/Ylt vcY�
No. nd Street Email address
urDIOW 464- O) O.s" -S"?—/0d�
City/Town,State,ZIP Telephone
SECTION 6 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(1rI.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 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 /— 74 r ck 4434 4 LA to act on my
behalf,in all matters relative to work authorized by this building permit application.pp
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 perjury that all of the information contained in this
application is true and accurate to the bes y knowledge and understanding_
e8/0
Print Owner's or Autho ' Agent's Name &Signature 780 CMR RI05.3(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 halt'/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' 1
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 1 MFG CODE U-Factor SHGC VT CR
Omega-Tuff S2210A .24 .21 .48 47
Hi-R I N2210A .25 .28 .52 47
Essential P2100A .30 .49 .60 55
Passive ! P2210A .25 .48 .59 46
kUbala Home Improvement
Your Window & fear Experts
34 Hubbard Street Ludlow, MA 01056
855-458-2252
Customer authorization for Wilding permits.
1, M011%te.tiLt :: Ie , as Owner of the property located at
I vC !"t.Awii SOLQ Dr Ftramt O' - OiOc2Tereby authorize Patrick Kubala Home
Improvement to act on my behalf, in all matters relative to attaining building permits, and
all matters relative to work authorized by such building permits.
Lam. . � '7 f f
Signature of Vner Date
KNI103
- .-vrrstiWILYl' jltlt Uf _I!UJJUCrtlt3etla
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 (Business,OrganizationJTndicidual): jeGeQR/q s7j.
Address: oW ST—
City/State/Zig: �e4.i/ow 4 I/' 6 Phone #: zf/..? -,5F7—JO/U
Are you an employer? Check the appropriate box:
1.® I am a employer with /O 4. 12 I am a general contractor and I Type of project(required):
employees (full and/or part-time).* have hired the sub-contractors 6. 0New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g, El 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 doingall work officers have exercised their
11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
c. 152, ( ) 12.0 Roof repairs
insurance required.] t §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.
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: Ries de (./14,ad Tj il,4T4g42 _2-t ' e/eg vd e
Policy#or Self-ins. Lic.#: lj!/Cf4 /p 3 f ".f' Expiration Date: '''/.tea.51
Job Site Address: /O - city/state/zip: ,(2oft.„.eitC.� / /17 d/& 6
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 DLA for insurance coverage verification. _
I do hereby certify under the pains and penalti o pe ' ry that the information provided above is true and correct.
Signature: Date:
y�'��a�
Phone#: • / -s-n - _Jo
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):
10Board of Health 20 Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5.0Plumbing
Inspector 6.00ther
Phone#:
Contact Person:
r•'"""1", PATRMA,41- LWONG
OltS.......agerEI T f1 ATE OF LIABILITY INSURANCE DATE(MM(DOITYYY)
11I13/2023
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. THIi:Ct tFICATE 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,1lw policAlss)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 rightsto the certificate holder in lieu of such endorsements).
PRODUCER ,NEB E'CT Lori Wong
Smith Brothers Insuring*.LLC PHONE 5 Net
300 Main Street jtio4C.No,Ext):(50#1 499.6064 I MICJILIN
Oxford,MA 01640ss=twonrnithbrothersusa,com
. INSURER(S)AFFORDING COVERAGE ` HNC e
_______...._. __......... INSURER A.Merchants Mutual Insurance Company 23329
INSURED INSURER 8:MAPFRE Insurance 1231176
Patrick Kuhals Nome Improvements dee Roads Nome INSURER C:
improvements I
34 Hubbard Street INSURER D: 1
Ludlow,MA 01056,270E 1 INSURER E: .
1 INSURER F
COVERAGES - CERTIFICATE NUMBER: REVISION NUJIIBER:
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 COP4DffION OF ANY CONTRACT OR OTHER DOCUPERIT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE 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.
of tADDL suss I — POLICY E.I F POLICY EXP
LTR TYPE OF INSURANCE INSD VND ROCKYNUMeER gHIMSONYYY4 fIW10WYWY1 LIMITS
A X COMMERCIAL GENERAL LU LITY ` EACH OCCURRENCE '$ 1,000,000
( DAlMMr3E TO F2ENTED 100,000
1 CLAIMS-MADE OCCUR BOP11099I7` 6/1/2023 W1/2024 I PR sTME M,,,el 1 t............
MED EXP(Any am Damn) 'Y 0.000— Included
PERSONAL&ADV INJURY I
TE MIT APPLIES PER: GENERAL AGGREGATE ,$ 2,000+000
AU X PQcY Li i Loc PRODUCTS-COMP/OP Ag_ $ Z 000,000
OTHER: s
f '' COMBINED SINGLE LIMIT 1,000,000
e /WVOKOMLE UAMILITY Alt r_t) .
ANY AUTO ' i RENEMIM 61112023 611120 4 i di701LY IN,ivfre(PIN swan) 's
;,+uTos cMILY X DSULNEOp j BODILY INJURY INK accident.t
OILY I A�ONV M PER MACE $
S.
1,�,000
A X ISINI IL A LDS I OCCUR EACH OCCURRENCE I,
EXCESSLAO r CLAIMS-MADE CIPPHHOel: tl/1 8i11 ACIORE.ATE ei—
1,000,000
DED I X j RETENTION$ 10,000. 3
A wonR s eamSP ss I STATUTE
ANY PRC>FPIETOR/YARTNEFZEJ(ECUTIV6 YI �� IW1 61'I12024 EL EACH ACCIDENT J 1,000,000
.°nd: i,,,,A t j ExcLuoE09 *IA 1,000,000
g„L,DISEASE•EA EtAPL k
II yyss,� deaabe under 1,000,000
DESCRIPTION OF OPERATIONS INN/ ♦ E LQISEASE-POLICY mar`s
I*CMPTION OF OPERATtoop►II MIDIisiMMOWN(AOO 11S1.Addttionat Re narxa SchadW.,may bes attach.d if mose xoaceirwgp(Ud►:
I
CERDIPICATE HOLDER.... .. rcANCELLAT1ON .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTS: X
Xne 4
1 ) 101988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
•
THE COMMONWEALTH OF MASSACHUSETTS
W urvrs(oo or Uccupat(ona!L(censure Office of Consumer Affit3.Board of Building Re ullac� rvisor
tions and Standards a &Business Regulation
Consta J 1 HOME IMPROVE 7 CONTRACTOR
x (tlit t ;lcplres•09/09/2025 q'r �. .
PATRICKJ BA(11 tv. j UBALA HOME IMP i--
LUDLOW MA 1086-ti ry y — �
e. in . yr: ( ts,,� r�
r" •y ,'eV'a0 r ••'may• 4TRICK KUBALA `
YOfy�a7� HUBBARD STREET ' �r f c yG� '/.eG�t k
/ : .)a_ JDLOW, MA 01056 ten. .•';,?`
Commissioner -�_..---• Undersecretary
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DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40, 5 54, a condition of Building Permit
Number is that the debris resulting tom this work shall be disposed of in
skaluouly•iicerrsedsoiid waste-disposal-facility-as defined byMQL. �, _.' S 5 A,
The debris win be disposed of in:
4L.ifr p re'E 1�
LOCATION OF FACILITY
dA;' 1>1
Si of Applicant Date
aaA\ „ _- r
AFFIDAVIT
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 disposai,facllity, as defined by MGL c i:I, S 150A
- em T r stl will notify $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.
4/`o/a
Date Signature ermit Applicant
(PRINT OR TYPE THE FOLLOWING IYFORlYIATION)
Name of Permit Applicant
Firm ame, if any
-----
y�/ KUBALA HOME IMPROVEMENT'LLC'
MA HIC#207481 All home improvement contractors and subcontractors engaged in home improvement
contracting,unless specifically exempt from registration by Provisions of Chapter 142A
�y 34 HUBBARD STREET LUDLOW, MA of thegcnenl taus, must be registered with the C'nmmonyvcalth of Massachusetts.
inquiries about registration and status should be made to the Director, Home
Q�'QS6 Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA
413-589-1010 02108(617)727-8598 ,y 255 ' I:CO
Submitted _ ER i//7
To: esett
2Jç (_ev�-�t�'
D.C___ Job Name:
(g I O(a d Job location: Raul c e
Phone e
3 il Estimator: AAA
We hereby submit specifications and estimates for work to be perfoffne_dAnd materials to be used:
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W•RK SCHEDULE / 5517. /YI d iiio earkl 90 /'`
Contra-or n°/t- tl vork or orde the materials before the third day following the signing of this agreement,unless specified he n. Ctotr 141.1keing the work on or
about j"0 "gate. acing defer caused by circumstances beyond the Contractor's control. The work will be completed by Ur b -(date). The owner hereby
acknowledges and agrees that scheduling dates are approximate and that such delays that arc 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 shell be free from defects in materials and workmanship for a period of following completion and shall
comply with the requirements of this Agreement. In the evarttorty defect in workmanship or materials,or damage caused by the Contractor,its subcontractors,employees or
agents,is discovered after completion of any job,includWng 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 pose hereby to furnish'material and labor—complete itt accordance wit above sp '1'aiQns,for the sum of: . /
, C1 1/� � (>ren 1�''dollars(s__ Li iiiii" L_.•
Pa eat to be made as follo
%( 55� >upot signing contract; CV._ KUBALA HOME IMPROVEMENT LLC
%(, )upon nomplet inn of 34 HUBBARD STREET
%( )upon completion of LUDLOW, MA 01056 413-589-1010
� tt forthwith �v\ MA HiC 207481
c %( y t.� )ghatl be made ,Gt.0� 1\
♦'ompletionof work un4cr4hiscontract. }if1/� 1(
Notice:No agreement for home improvement contracting work shall require a down paymt�'
Salesperson: .� rr//I1 !
(advance deposit)of more than one-third the total contract price or the total amount of all
deposiwa,payments which the contractor must make,in advance.to order and/or otherwise Authorized Signature:
obtain delivery of special order materials and equipment,which ever amount is greater
ii
Acceptance tance of Proposal: I have read both sides of this document and accept the prices,specifications anc.conditions stated. I understand that
upon signing, this proposal becomes a binding contract. You arc 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. Sec notice of cancellation form for an explanation of this right. Please refer to the Notice of Cancellation that accompanies
this contract;contents of which arc referred to above and incorporated herein by reference.
DO NOT SIGN THIS CONTRACT F THERE E ANY BLANK : 'I�• CES
11
SignatuIr
Date ' a? t Signet ' Date 3 7 c2H
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