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36-108 (2) Reg.#128482 1 WILLIAMSBURG HOME IMPROVEMENT �� 3,#1841 �r P.O. Box 344+Williamsburg,MA 01096A,) (413)695-1418 A) 0 1 1 O C.r Col ,20 t��between ��I Ig' s – This Agreement is entered into on the_day of �, ("Owner") and�Wj ilr(lia'm''"s'j I burg Home Improvement(("Contractor"),,/and concerns `proper/ty/ located at The Owner and the Contractor agree as follows: 01c) 6 a 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 I –THE WORK T_ ( O a 514) LA/ r---.- /11 n e.%.E f`U ( ti Uci kJ ' n c, y 12q PC)r (_ Owner may order changes in the work(additions, deletions, or modifications) with the 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 b'e achieved on or about A/0 t/ 1 0 5 , subject 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$ No work shall begin prior to execution of the contract. The Owner agrees to and shall make progress payments to the Contractor on account of the Contract Sum as follows: UPON SIGNING OF THE CONTRACT $ S 0 $ l A g L4 $ (I ( Ca 0 Final payment, constituting the entire unpaid balance of the on Price plus any Change Orders and costs of materials shall be paid m 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,a4d 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 : 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, Contract9 may terminate the Contract, and Owner shall pay for all Work done and for all materials, including reasonable profit and damages s " Contractor persistently fails to perform any material provision of the Contract, Owner may cancel the Contract after five days' wrtta notice to Contractor. However, Owner shall provide Contractor with reasonable time in which to commence 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 SERVIC114Q111 GH HA EEN AP ,ROVED BY THE SECRETARY OF TIIE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BT;fSINE REGCJLA IONS A D THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED P`.MASSA HLiSETT GE L LAWS. CONTRACTOR'? —�� OWNER , NOTICE: The signatures of the parties above apply only to the agreement of the parties to alte 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 Improvement Contractor Registration; One .Ashburton Place, Room 1301; Boston, MA 02108; (617) 727-8598. DO,Ai4� GN THIS CANT CT THERE ARE ANY BLANK SPACES. y OWNER DATE CONT;RACTO DATE `-1 O O �1A34ACI�IT4ttt4 DEPARTMENT OF BUILDIJ1,TG INSPECTIONS /? INSPECTOR '212 Main Street • Municipal B uilding 5 •`. Nortluunpton, MA 01060 ,r HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CNM 108.3.4 to act as iris/her construction sups: a o.r. The stare defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be,a orne or two_ami y dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner." Tl ebuil ding department for the City of Northampton wants-any persons)whorl seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and fegulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footines (before backfiIl), sonotube holes (before pour) a rough building inspection(before work is concealed) insulation inspection(if required) and a final building inspection.:The building department requires these inspections before the work is concealed,failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work(electrical, plumbing& gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made L understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me - -- Dade Address of work location r PLO r `E (riff cf R -' E �Zc7anrllasrtla' —' — c� DEPARi1.1ENT- OF BUIL.DI\,G INSPEGiIol.'s 212 Alain Strcct ' Municipal Building NorthampLon, A1ass. 01060 - __ � 'OItI -R IS COW PENSATION G` SURAhCS AI'I'LT)A.Vj-j- p1Jpc:m;citx) %VILh z principal place of business residence at: - -- - C (phone') (02 ,� j�f tylnztr/a p) -� do hereby cerdi :, under dic.pains and penalties of perjury h:t ( ) I am an employer providing die following'Woricer's cocnocnsaoop cove age for ln} etUpiovcLs wor ang on ties job: (l^sur-�c Conr v) (Policy N=ubcr) DzL} ' i ( ) I am a sole propr,etor, general contractor or.homeowner (c cie one) a0d Dave hired the Coco actors !is below vrbo have the `oilo mg workees comoep_ta'on pe>_icies: (1+8rllc Oi Con!^CiOr) (lns-u rail c:. cornt)3 i)'/17Guc }�tL1QLC:) (rxpirJuon ID11c) I (Name of Coua-z 0-0 onsarancc ComnantivPolim; NUM cr) (Ex-Dimtion Dale) I _ i (N.me of Coa=cidr) (Irsvr'ancc Comp.aoyfpo[:c)• Numb,-,) Zxpimaon Dalc) i 02 zmc of Conriactor) (MSUm.n= CompanyRobcy Numb,r) (–Ea-pimldoa Datc). (at:J.4jt:.ds�oca!ttcet,tf aceeu_-y to meiuc�iafoem��on peteiaia6 w.17 - I am a sole pFopnetor and have no one worio.og for me. ( ) I am:a home owner performing all the work myself. NOTE:place be cwxre Eb.-�tcije hemco+xra wto crxplay p=-,=to do a rrpuir-or-i on. of aoe mote the n tlso-_�r�in the bomoownc r-esid=«oa the pmua+ app.;,rt o =tbc.cn c.:we�.:.�ty co=al.-oi m be crploy=unG-the..u-S c•:�?�.. Ca Aa(GL!152.=1(5)).=PpU=-6co by a bommax fer-bcy^v or pa=h ray cvidmoc thc Ic•-,1 n :=of ea c=ploye under dro Woclk. ,C:ompomit loo.Act [undcsz+ad tha a O6PY of thi.-I—u y be for--td to the pop-n of T�.cl,4cdea:M-of Irau+oo.for th. cove v=iGcmioa and the L-iltae to acc=`cover x,-c land--=cGc a 23A of MoL 152 na Id to the i..•rposi -of crim;wl peralti= ooa=zz g of a frnc orup to S I30 .00-dfor is{a isoom orup to ooc y--.end cvi]p=,I-i=is e5c form ora Stop WcrE Ord--and a rt=of s I oo_oo.dsy.pj= For l6 0 Permit Numb- $itailtr Af I-ir LO[ nwlP r SECTIONS-CONSTRUCTION SERVICES 8.1 Licensed Constructio�nt `Supervisopr: Q - [� ( Not Applicable ❑ Name of License Holder: 1V 4 A/t^f\,� ( 2 10 ` � 7� License Number Address Q © (Z' Expiration Date Signature Telephone �.S' Q d 1 �{ !3 Redlg�ereil-°1•{oiTreinpraveiriesrt_EontraEtar Y` ' Not Applicable ❑ Company Name--�- Registration Num er -- — 6 Pax 3% (A Gc/I d eg s— 6 `a Address / / Expiration Date q[„ Telephone t? C N "f r,- Q Gj SECTION 1'0-WORKERS'COMPENSATION INSURANCE AFEIDAV1T(M.G:L c. Z2,•§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...... ❑ sk, x� The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature t SECTION 5-DESCRIPTION OF PROPOSED WORK(check'affayolicable) New House Addition ❑ Replacement Windows Alterations) ❑ Roofing ❑ Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding X Other[0] Brief Description of Prop ed AA \\ Work: �/ �A,/ 562J/y Lr- Alteration of existing bedroom Yes_?41 No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa (f`New��io>ase an'��` �tlr#o�'ta�eXtst�riciai�sncr c`o Q�e���freta�ic: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? `e d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain - Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION"Ta-:OWNERAUTHORIZATION-TO BE COMPLETED WHEN -OWNERS AGENT OR'CONTRACTORAPPLIE$FOR BUILDIN'G.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. Signature of Owner Date I, /" © 0,M^-Al A C V as Owner/Authorized Agent hereby declare that the statements 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 3 0 �- Signature of Owner/Agent Date ' m ^ _ Section 4. ZONING All Informat-j6h Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved of Parking Spaces (volume,&Location) ' A. Has o Special Perm b/Vuranoe/Findi ng ever been issued for/on the site? �~� �~� ' NO x x���� DON7KNOVV �~� YES �~� - IF YES, duteissuedc IF YES: Was the permit reoorded at the Registry of Deeds? NO v���� DON'T KNOW 0 ,ux IF YES: enter Book Page and/or Document# B. Does the site contain ubrook, body of water orwetlands? NO 0 DON'T KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? ' Needs tobeobtoimed �~\ Ohta�oad �~\ Date x�� ' � C. Dn any signs exist un the property? YES x-� NO 0 IF YES, describe size, type and location: D. Are there any proposed changes tour additions ofsignsintandedfurtheprpa ? YE NO 0 IF YES, describe size' type and location: E. Will the construction activity disturb(clearing,gradingexcavation,nr filling)over 1 acre uriod part ofu common plan that will disturb over 1 acre? YE8 � ) NO K l »_^ � "�� IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r u G ity of Nort1 ,ampton tt�so J "� 6 Btl.i ing Department HI,CS -212',Main Street 100 R om , hamp on; MA 01060 40 Fax 413-587-1272 PIo1Stt Plans ` .,, G�^ „AEP ICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1.-ZITE INFORMATION 1.1 Property Address: Thrs section to be completed byoff[ce a4`7 ?Ro o tc 51DF- CIA, ot Unit � Q /t'l Zone g O�e�fa Distri t? ct 1' (n P To w SECTION 2-PROPERTYOWNERSHIP/AUTHORIZED;AGENT 2.1 Owner of Record: i �. VdNb Z �✓ M4tI /v � � 3� o ;si©z c; Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: O /0 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=0 +2+3+4+5) Check Number This'Section'Far Official Use Only Building Permit Number. ,Date Issued: Signature: r G Building:Commissioner/Inspector of Buildings- Date 247 BROOKSIDE CIR BP-2006-0368 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:36- 108 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0368 Proiect# JS-2006-0536 Est.Cost: $9100.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NORMAN ZALESKY 128482 Lot Size(sa. ft): 20647.44 Owner: MICKIEWICZ MATTHEW E&NOREEN Zoning URA Applicant. NORMAN ZALESKY AT. 247 BROOKSIDE CIR Applicant Address: Phone: Insurance: P O BOX 535 (413) 268-3553 WILLIAMSBURGMA01096-0535 ISSUED ON.101512005 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: Date Paid: Amount: Building 10/5/2005 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo