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25C-006 (2) r`$'$T � 4 al. Cnt x" OPTIONS & ACCESSORIES INVESTMENT PORCH $4490 HATTERAS $5068 GRANDMANOR $6508 INSPIRE S C S P 10 TERMS: 33% DEPOSIT DUE UPON ACCEPTANCE TOTAL `? 33% DUE UPON HALF COMPLETION 33% Deposit BALANCE DUE AT SUBSTANTIAL COMPLETION Balance Due YOU, THE OWNER MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE NOTICE OF CANCELLATION CLAUSE BELOW FOR AN EXPLANATION OF THIS RIGHT. ACCEPTED AND AGREED: The prices, specifications and conditions contained herein this Agreement are satisfactory and hereby accepted. You are authorized to perform the work as specified. (MUST BE SIGNED BY ALL OWNERS) OWNER: ° %%J + L'i OWNER: DATE: AGREEMENT IS NOT FULLY EXECUTED UNTIL SIGNED BY A LICENSED SALES PERSON THAT IS CURRENTLY EMPLOYED BY JANCEWICZ& SON. - Pl� r Vv Jeff Wbar Jancewicz&Son DATE: /2-9 10 7 We at Jancewicz&Son would like to thank you in advance for this opportunity to review and prepare this proposal for your home. We are totally committed to providing "100% Customer Satisfaction" before, during and after your roofing project. We have taken pains to make sure this proposal is suited to meet your needs for now and in the future. Please call me at your convenience if you have any questions at all. We look forward to working with you. Yours truly, i�coV I 7 a-C&A) 'r �7` - C' UJO—t Dunbar 4 Jancewicz&Son - // upa.� , 2 y e �1:sa�crlJntrcia- p DEP/1RTMENJT OP DUILDr)tC INSPPCTION'S 212 Alain Strcct ' Municipal Building Northampton, Mass. OIOGO __V GRxa R'S CO iti T ENS A'M N GNS URAN CE A I M A.Vj-j- (li ccnsxJpernv ttcc) a principal place of businessfresidence at: - - S V) (phone") (sn-�t/ci ry/stalrla p) do hereby certify, under Lbc pains and penalties of pcgu-y, h:i (� I am an employer providing the following iworker's comocnsadon covemSe for illy eluployces worong on tills job: -- (Ir_sun�c Conr`c�) (Pclic: Nu--aarrr) (T:pirrior.Dal:) ( ) I am a sole proprietor, general contractor or homeow-Der (ci c:e one) and have hired the cono-actors listed below wbo have the following worker's compen_taaon policies: (�+amc o;Cont^c�or) On uranc-- Cocnoa-y/PoLc Dntc) (Nzmc of Coaimmor) (lnsaranc:. CompantivPosc-, `Lancer) (xo muon Date) (Name of Conaaclo,) (Insura.ac Compacy/Po-L-cy N=bci) (Exp maoo Daic) (Fame of Conaactor) (Iasurancc Compazy/PoUcy Numbci) (Expiration Daft) . z6didoc-1�x�.ir accQa_-}•w a�cu '�af«-m�oa pertia.iaias w mil«�•-so:z) ( ) I am'a sole-proprietor and have no one worL-ing for me- ( ) I am.a home owner perforTning all the work myself. NOTE:pl=.=be ea isc t­wire 6emcOvvcn uFo ccapjQy p_=o=to z= c rc--z it war c an or not arc.e tin tf-ca�t�in Wbd�the bocncmwe mid..«cc the peones zp�tbea r_-r oa C=.11y ocrd=d to be eitployes u�c he ,v S rr x x•.,:w Act GL152�1 5 t ( )1 rppiiaaw by a 6otncoava fc c «permit try mdcocc t1:c 1cgsl.+= u of as c=ploy,.c uadcr dw Compom.tioe AV_ uadc.-ztxad tba a copy of lht.cat.®cm olay be f«>.erdnd to tbo Zkpartmmd of lnau ,J AandcsaY Of G-or boon for the covcz.sc rciretioa nerd t!u L-ilsze t°s¢'src'c°`Krybu undo socs�oa 23 A of htOL 1 S2 nn Irk to the i�sioa of aimia�!pcaaltic eom-i.iag or a tine or up to S 1_po.00 orup to co-ycr e.od aNil pmal'ua in CS,focm of a Stop Werti Ord¢and a rim of S 100-Qp y a�ti¢Yt For�`f—,i u.c only Pcrmlc Numtc-- Lot l' f Lic=zc- Pcnniucc e ) �. 05/6712007 14:56 6033576431 CLARk_MORTENSON AGY: PAGE 02/0 IC11entff:50323 JANCEWICZ1 _ CERTIFICATE F LIABILITY INSURANCE 51W/M11�r74YTYY} i �/�� '���" ► 05ltB7l07 r1 fwoucm -- - THM CER'T RCATE IS ISSUED AS A MATTER OF INFORMATION Clalrk•Mortenson Agency,ncy,Inc, ONLY AND CONKERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR l P.O.Box Soo I ALTER THE Ct'!'W'1=RAF7E APFt7Ri3Eq BY THE POLICIES BELOW. }Keone,M14 03431 IAISURER3 APFORDING COVERAGE NAIC# msirr:r� INSURrRk Peerless insurance Company sanG$wliir.&!ion MSUREP 8; —� 6 Morgan Strimt INSURER C: _ Sellowis Falls,VT 05101 iNbURERr:; I INSURER E THE POLICIES OF INSURI NCE LIET'ED BELOW HAVE BEEN!;S511GD TC THE INSURED NAWD AIIIIGVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING Ah'Y NBOUIRENAENT,TER!i1 OIL GQNDiTION OF ANY CONTRACT OR 07HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.,THE INSUNANCE ArFOR ZD DY THS P41JG'ES DESCRIBED HEREIN IS SUEJEGTTO ALL THE TAMS,EXCLUSIONS AND CONDITIONS OP SUCH POLICIES.AGGREC--ATS 04ITS SHOWN MAY HAVE BEEN REDUCED aY PAID CLAIMS. LTII �!5a 'IYpp Of'IN?URANCG P*uty NUMBER RUI,ICY kFRpp YF, t 6f Y PIR TIDN _. ATE iMM;ODt'1�' DAT M LI1glTS A ITENOUL LIAElLm, �CR1595AW B 05106/07 05106105 EAOH OCCURPENCF. $1.000.000 6A�AB RfiNTfiea X GC7k{1aEFtCIAL 3FNFRAL LtsRiI,iTY fE FX n.ssrurrorl µI CLAIURd'31U„S/�MAD Eil OCCUR { MED E%P , , P116 rgpfyP $5 00 l I'D 18 P7gRgQNA1.wADV INdUF(Y 01,000,000 S � • QENERALAGGREGATE 3$004 t)0 i 5EN'L a Gr*REGATE LIMIT APPLIES PERT PRODUCT'S�C4MPIOF AGG '10L Cy RO LOU AUTOFACIIIILE LIARI_W BA9593618 0510610T 05106/0x3 GOM5INED$iN(i11F LIMIT �81 UOD 000 ;lie!aoclrhn!) t : X ANY AUTP: � Ai,l.OWNED AL T'DS DOWLY INJURY SCHEDUi.F'15 AIJt35 P� I[ (per 06twn) X }H:Rlsb AUTOS ` + BODILY INJURY III j X EJON-WNEI�AJT>?? l (;c ! IPetromldF+nP) t PROPERTY CAWIGr {fP I GARAG&UARILITY T-� AUTO ONLY'P.AAG6t0EN? S ANY ALtru 6A AC 3t g AUTO ONLY: AGG $ I r EXCESS/UMBRELLA UARILITY EAC}I CoCUMMENCE S 00WR I_�CLAIME MADE AGGREGATE $ DEDL,"TIULe RETEN'T*N 1 6 ft W0PK9WgCOMPEN$AnyiANo -- WC9594118 05106147 0510610$ we IMZS. EMtLCYERS'LIABILITY E.L,EACH A4fjPDFP1i $5040D0 NY R/RXECUi WE Chr'lGF,Rt"uiEMBERC%CI.UTFf;; I C.L.018BA$E-EAWPLOYEE $500000 C ySe9 �h36G"?yC v�}Ilf; tiPECil,1_ARf'V4gtpN5 Lela,c �,_, __ E.I..0115" •EUV LIMIT $500,000 OTHER DESCRIPTION OF 4?ERATltN#S t iGCATPONS!LEi41CLES PP;}'CI,'.,1$!{3N5/1DSSrt?HY CPy6p6i5EMENT?SPECSAL PR4171FiIOP;5 y-- — J8ncPwI z&-Son Hume Improvement Co. rrrVT Inc.dba l C�RTIFIC:ATF HOLDER — _. ®..�� CANCFLLATION it3P IJLD ANY OF THE A9OVE DE3CRIBE5 POLICIES BE CANOELI&D 51EFORE tHF EX IRAT,01 , JDATE IHEREUF,THE ISZ-VNG INSURER WILL RNDFAVOR TO MAIL Irll/J DAy$'OMITl'EN NOTICE 70 THE CERTIFPtAIT HCLGER NAME6 TQ 711r LEFT,HUI FAILURE TO DD SD 31ii3OLL IMPOSE NQ Gel-C,TICK bR UAWITY OF ARV RIND UPOR THC INSURER,ITS AIRM OR A rf HORIZED RBPRE69WTATVIE ACORD 35(1001!08'!i uy 2 047529 OTT Co AG+•RD CORrOKATION 19139 0 ;L m D DR iw n O ai D Z \ cn D cn Z = o Wes`` °�5y y cn M O r,'<Z X O mm 3 a `� m ��z ? m � a OXOm o m o o' *D \ z ZOO 0 o m --�Zgo ca ° m ° Z H �Z O O e' < @ -q cn 3 °' a ° m o y bd 3 o a O , U::I Q < CD 0 �5 po CD CD \ O C Lin 1 o f - M c n r "r. 000 aw O0p y CD m . 00 vi' C d. d N C1 ~ a [A O .t °c -, eo a C C 7 N O• �..� p ri p G n �+ b3 ! CO O •e x o o " " o I o y n 00 CL SECTION$-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature Telephone 'I9ll `ImirC+y�re►e1r>It:Ciot '_ Not Applicable ❑ )t1nCEcc'tC `x�A1 / drIll L iMf�/-'c�`r��tE�t �" G['. Cy- \,'r2mcwrr Company Name Registration Number Address Expi—iratioK Date F s!"+U fir}Ll-S V T Telephone 4i 35 h' SECTION 10-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...... ❑ Y k 4 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 building 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 SECTION -DESCRIPTION OFPROPOSED WORK{check all aonlicalyfel New House ❑ Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing Or Doors 1:1 1 Q Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[[3] Other[171] Brief Description of Proposed Work: ,Rr- tI 5/D� Vt� LL —9F-0L,1C7= J� SQ TEET �5i4iAJ6-L 5 (�C-- 2-AC Alteration of existing bedroom Yes_ No Adding new bedroom Yes _No SJDItiC Attached Narrative Renovating unfinished basement Yes -n-No Plans Attached Roll -Sheet { r;l _ N IA 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? 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 Ia•OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 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, ,�1 ySo�' �lf✓b'8�1�2- Ati`C -��'l C SC?/�! as Owner/Authorized Agent hereby declare that the statemen s 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 periu . JA D lag. Print Name 24' c L i Signatu f Own gent Date ~ ° . . . . . Section 4. ZONING AtI.Information 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 Sp aces A. Has ever been issued for/on the site? �-� ��� »�% NO «_� DONTKNOVY v�� YES �.� r-~--- ----~/ IF YES, date issued^ | l_ ___ _ - IF YES: Was the permit recorded the Registry of Deeds? NO n��x�� DONTKNOVV > YES { ' — } �---------� IF YES: enter Book \ Paga and/or Docunment#! DO��� 0 YES B. O� �����na�� b�����w��� NO 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained m�� Obtained �~� �mtmisyued'^ i------------ 7 ' m�� �~� ' C. Do any signs exist on the property? YES ~� NO |F YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO ----------'----- '---~----- '----~-~----'-`-- IF YES, describe size, type and location: � ! E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre uris it part ofo common plan that will disturb over 1acre? YES NO |F YES,then n Northampton Storm VVoerK8onogementPermit from the DPW isrequired. Department use only City of Northampton Status of Permit: 1 Building Department Curb Cut/Driveway Permit r r.. 212 Main Street Sewer/Septic Availability __. Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 41;3-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify "�J y -_ AP,P�ICATION TO,) NSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SEC-CTION 1 -SITE INFORMATION 1.1 Property Address: �? This section to be completed by office I q Wrth �_ `.► Map Lot Unit Nc�r-tyjavn p�uo, ` /� A Zone Overlay District cx�cc) Elm St.(District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: � '(Y�CC'� )G, 5c�r� C 1�'1C`�C�CtE'1 FcCI N Name(Print) Current Mailing A ess: 17C2_L.tc,_3- 47 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building r (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 v This Section For Official Use Only Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date r BP-2008-0329 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category BUILDING PERMIT Permit# BP-2008-0329 Project# JS-2008-000469 Est. Cost: $7829.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Jancewicz & Son 121544 Lot Size(sq. ft.): 33149.16 Owner: COHEN ADAM Zoning: URB Applicant: Jancewicz & Son AT. 134 NORTH ST Applicant Address: Phone: Insurance: 6 Morgan St (802) 463-3585 Workers Compensation BELLOWS FALLSVT05101 ISSUED ON.9/25/20070:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE 25 SQ FT OF SHINGLES & CEDAR SHIGNLE 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 9/25/2007 0:00:00 $25.0040071 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo