36-076 Reg.#128482 WILLIAMSBURG HOME IMPROVEMENT Lic.#034841
P.O.Box 535 + Williamsburg, MA 01096
(413)268-3553
This Agreement is entered into on the`-_day ot.1� '`� ' 20',-
between
("Owner") and Williamsburg Home Impry(ovement ("Contractor"), and concerns property located at
The Owner and the Contractor agree as follows:
All material is guaranteed to be as specified. All work is to be completed in a workmanlike manner according to standard
practices. All agreements are contingent upon strikes,accidents,or delays beyond our control. Owner will carry necessary insurance.
ARTICLE 1—THE WORK l °� ��,11C P %f`F r ' i I'l 1J:.; 'o �ti ;'' I "l
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Owner may order changes in the work(additions, deletions, or modihi lttions) wit he contract sum and the contract time being adjusted
accordingly. All changes shall be authorized by written Change Order, describing with specificity the nature of the Work to be
undertaken,and shall be signed by Owner.
ARTICLE 2 —COMMENCEMENT AND ESTIMATED DATE OF COMPLETION The work shall be commenced after delivery
of a fully executed copy of this Contract to Owner, and after payment by Owner of the First Payment. It is estimated that substantial
completion will be achieved on or about" Ve,e:,n ! 5uubject to change orders, weather, and availability and delivery of materials.
ARTICLE 3 — CONTRACT PRICE and PROGRESS PAYMENTS The Owner shall pay to Contractor, subject to additions or
deductions by written Change Orders, the Contract Sum of S ���J,, L�t No work shall begin prior to execution of the contract.
The Owner agrees to and shall make progress payments to the Contractor on ac o�ulnttr�of }ei Contract Sum as follows:
UPON SIGNING OF THE CONTRACT S „l /, y �oV U
$
Final payment, constituting the entire unpaid balance of the'Con�tract Price plus any Change Orders and costs of materials shall be paid
to Contractor upon substantial completion of work. If payments are not made in accordance with above schedule,Contractor may
stop work until payments are made.
ARTICLE 4 — PERMITS, ETC. Owner shall pay for all necessary approvals, building permits, governmental fees, licenses and
inspections, assessments and charges required for the construction,use, or occupancy, and Contractor agrees to obtain such permits, etc.,
as Owner's agent. Owners who secure their own construction-related permits or who deal with unregistered contractors will be
excluded from the guaranty fund provisions of M.G.L. c. 142A.
ARTICLE 5—TERMINATION OF CONTRACT If Owner fails to pay within twenty days of the date set in this contract, Contractor
may terminate the Contract, and Owner shall pay for all Work done and for all materials, including reasonable profit and damages. If
Contractor persistently fails to perform any material provision of the Contract, Owner may cancel the Contract after five days' written
notice to Contractor. However, Owner shall provide Contractor with reasonable time in which to conunence the corrective work.
ARTICLE 6—MISCELLANEOUS
6.1 Owner has the right to cancel this contract within three days after signing under M.G.L. c.93§48; M.G.L. c.140D§10; or M.G.L.
e,255D§14, as may be applicable.
6.2 All warranties and owner's rights are set forth in provisions of 780 CMR R6 and M.G.L. c.142A.
6.3 There is no lien or security interest on the residence as a consequence of this Contract.
6.4 The Contract shall be governed by the law of the Commonwealth of Massachusetts.
ARTICLE 7 — DISPUTE RESOLUTION THE CONTRACTOR AND OWNER HEREBY MUTUALLY AGREE THAT IN THE
EVENT THAT THE CONTACTOR HAS A DISPUTE CONCERNING THIS CONTRACT, THE CONTRACTOR MAY SUBMIT
SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE
EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSI''ESS REGULATIONS AND THE OWNER SHALL BE REQUIRED
TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN MASSACHUSETTS GENERAL LAWS.
CONTRACTOR.' OWNER
NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the
Contractor. The owner may initiate alternative dispute resolution even where this section is not signed by both parties. All home
improvement contractors and subcontractors shall be registered, and any inquiries about a contractor or subcontractor relating to
registration should be directed to: Director, Home Inzprovernent Contractor Registration; Onc,4l hburton Place, Roorn 1301; Boston,
MA 02108; (617) 727-8598.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
i
OWNER DATE CONTRACTOR" DATE)
GiQj of 3xTart1jam loll
g 6 fi�asaxcflnsrtte
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060 A `
womR 'T,R'S COMPENSATION INSURANCE NFTMAVIT
(liccnsccJpermittcc)
,v th a principal place of businesslresidence
i4--
(p honcif) l' f5 (7-7
do hereby certify, under the pait)s and penalties of perjui}�, th<a:
O I a�11 an employer providing the folio"-v m v"orb:cl-'s compensation coverage for n1y
enlployecs worming on t1m;job..
(Insurance Company) (Po1ic Nu_nbcr) (Expiration Date)
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the follo•wi119 worker's compensation policies:
(Name of Contractor) (Insurance Compan�,/Pohc), Number) (> xpiration Datc)
(Name of Contractor) Onsuiancc Compaay/Policv Number) (Expiration Date)
r$
(Name of Contractor) (Insuranc c Comp<trry/Poilc7) Number) (Expiration Datc)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(artadr additioml shed ifner-�to include inf rc oa pertain to rill coc ors)
XI am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware thst while homcowmm who employ Pc-zow w do—t-10- come ioa or repair work ou a dwelling of
not morn than thmo units in which the homeowner r=dca or oo tho grounds appurtenant Lhacto arc oot ecnm ly ooandcrtd to be
employrzs under the wo�oanp=s4ca Act(GL152,ss 1(5)�application by a homcowmr for a loose cc permd may wide the
legal ctahrs of an employer under the Wori:cet Compomai Act
I undcataad this.a oopy of this rt ucmcnt may be forwarded to the Dc�of lndzut d Aocid-1 Oflioo of lrnuraooe for the
ooverxgc Valficatioo and that failure to&came covc7t g undo soctioa 25A of MGL 152 can lead to the imposition of criminal pcaal -
oo sistiug of a fine of up to S1,500.00=W-im{uisonmrni of up to ow year end civil pcn ltia in the form of a stop Work Order and a
fine of 5100.00 a day against me
For dgputm=]�BI uvc only
Permit Number —
NfaP4 —_.Lot#
Signature of Liccnscc/Pcrnii.ttcc Laue --
Version].7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11 -"OWNER''AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
Signature of Owner Date
I, A�""`7� �� /V �P rr�' .2>1 1 as Owner/Authorized Agent
hereby declare that the state ents and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : o _,01 A /V _
License Num er
Address Expiration Date
Signature Telephone
G
. - - 2- (_ 'a
SECTION 13 -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....... ❑ No...... ❑
Version 1.7 Commercial Building Permit May 15,2000
`SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor t
,e c 9.f 7 Not Applicable ❑
Company Name:
.&0( ./ter A �v --7— A
Responsible In Charge of Construction
7 1',C L 0
/Iq
Address
Signature —� Telephone
Version 1.7 Commercial Building Permit May 15,2000
7. Water Supply (M.G.L. c.40, § 54) 17.1 Flood Zone Information: 17.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES _
No
IF YES, describe size, type and location:
Version 1.7 Commercial Building Pennit May 15,2000
SECTION 4- SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
,rte — -
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1 ❑
A-4 ❑ A-5 ❑ 1 B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional ❑ 1-1 ❑ 1.2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential l8-' R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION'6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf) 15t
2nd
1st__
3rd
2nd
3rd 4th
c3
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft -- - --------
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Version 1.7 Commercial Building Permit May 15, 2000
r-
Department.use only 1
City of Northampton Statusof Permit:
Building Department 6ueb' Gut/DrlvewayPermit
21.2 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two,Sets of Structural,Plans
phone 413-587-1240 Fax 413-5871272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE 0 U E 0 NY BUILDING
OTHER THAN A ONE OR TWO FAMILY, T Lij
JUN 1 9 4003
SECTION 1 - SITE INFORMATION
1.1 Property Address: This , by o ice
NORTHAMPTON.MA OIP60
Map L01 U111L-
LA/ea-r
AA Zone Overlay District
Elm St.District CB District
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
pv"
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3,+ 4 + 5) Check Number �.
This Section For Official Use Only
Building''Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
, �. BP-2003-1186
GIs# COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-1186
Project# JS-2003-1848
Est.Cost: $7650.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NORMAN ZALESKY 128482
Lot Size(sq. ft.): 609840.00 Owner: HAWTHORNE DAVID L
zoning: SR Applicant: NORMAN ZALESKY
AT.- 339 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P O BOX 53 (413) 268-3553
WILLIAMSBURGMA01096-0535 ISSUED ON.6/20/03 0.00.00
TO PERFORM THE FOLLOWING WORK:INSTALL VINYL SIDING
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 NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 6/20/03 0:00:00 881 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo