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30A-068 (2) Toll Free (877) 3-STURDY All home improvement contractors and subcontractors Springfield (413) 543-1651 engaged in home improvement contracting, unless specifi- ' I I U I UWIUI ( ��) 77 call exempt from registration by Provisions of Char 142A TOTAL t10MC RTNOVATION �J u (UI l ! ( I www.SturdyHome.com New Haven (203) 848-2118 of the general laws. must be renistered with the 459 Main St.•Indian Orchard, MA 01151 Fax(413) 543-3200 Commonwealth of Massachusetts. Inquiries about registra- P.O.Box 51033•Indian Orchard, MA 01151 lion and status should be made to the Director, Home MA REG.#151711 Member Better Business Bureau Improvement Contract Registration, CT REG.#60152 tt__ � Fully Lic nsed&Insured One Ashburton Place,Room 1301,Boston,MA 02108 Sub i ed�: �- 14 1`�l�' Ly,, (617)727-8598 PHONE Li r 3 r7 (� DATE �f v woRK 8 �L L t yj j p l Crj We hereby submit specifications and estimates for work to be performed and materials to be used: IT - iv >g, Y'C.``IJ IS . �h`1Y12 L t"t'n1 _ C'.Z - �, A-t -�- ®.tip-`C C o�ZS iv-, .}- �� 1Z RCO` Alt. 2� ✓V i — S i--� -s� o � el�k c c�`� a-��. zZe�,�,� �=�� S. ,p ye-( °Z )- = 0 �A WORK SCHEDULE t tier will n t begin the work or order the materials before the third day following the signing of this Agreement,unless spot''elf herein.Contractor will begin the work on or about (date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by date).The Owner hereby acknowledges and agr s that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not t d to strikes,Acts of God,shortages of materi- als,accidents,and all other delays beyond 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 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 contractors,employees or agents,is discovered after completion of any job,including cleanup,the Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam- age 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 aqcorcianqe f with above specifications,for the sum of: dollars($ ad' Payment to be made as follow e / v ($__S•:%�on signing contract; STURDY HOME IMPROVEMENT INC. Name of Contractor/Designated Registrant 40_%($ .2LSD0 1 upon start of work; P.O. Box 51033 Street Address (.1 � )upon completion of� 2'(Cw Indian Orchard MA 01151 413-543-1681 Z City/State Phone (s U 1 shall be made forthwith upon completion of work under this contract. r Name of alesm Authori Signature ' Acceptance of Proposal I have read both sides of this document and accept the tce s,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work p if ied.Payment will be made as outlined above. You may cancel this agreement if it has been signed by a party thereto at a place other t n an address of the Seller,which may be his maul Of(iCe Or branch thereof,provided you notify the Seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement.Please refer to the Notice of Cancellation that accompanies this contract;con- tents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature � l to ��� , Signature Date The Commonwealth of Massachusetts I 1A Department of IndustrialAccidents Office of Investigations VV I Congress Street, Suite 100 Boston, MA 021142017 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/1J lectricians/Plumbers Amlicaut Information Please Print Legibly Name (Business/Organization/Individual): s 1 L( t"taul ` uyyiL Address: - n g M cu A �S+M_A- City/State/Zip: \n&Uafl ()rG41c,cCi� m_.t ck t 5 i_ Phone k Are y n employer? Check the appropriate box: Type of project(required): 1. I am a employer with 'S 4. 0 I am a general contractor and I 6, 0 New construction employees (full and/or part-time).' have hired the sub-contractors 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, 0 Demolition working or me in an capacity. employees and have workers' g Y p tY� 9. F] Building addition [No workers' comp. insurance comp. insurance.} required.] S. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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 12.0 Roof repairs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t 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 tern art employer tliat is provielieta woi-leers'conipeeisatioii iiesnreance for nay employees. Below is the policy and job Site information. Insurance Company Name: ::n C". Y-e�5 `fl jJ "ou 0 GV_ Policy#or Self-ins. Lic. #: ^n 0 o l - -q Z -4450— Expiration Date: _�/Z V l S_ Job Site Address: 29�,5 F 10K.I n c u (I C4 4 City/State/Zip: ('(OyCt1 'C.e th✓4 0(C)k02Z 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 imprisomnent, 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 penalties of peJuiy that the information provided above is hwe and correct Signature: GaC Q-l/ 'AFB Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Swervisor:a Not Applicable ❑ Name of License Holder: �+�` -D iccz— !,3 (PO J License Number rain& ,r GI y-A Gl t"-)-1 53/ -7 S- A ddre Expiration Date S gnat re Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ �5 hA,rGt" 151 rl It Company NanW Registration Number tea, roaj n 64. Ino-tai-, yrCu/(V M,4 6tl ,,5i O/Z(,O/'IW A dress Expiration Date Telephone 'f=Y4,3[(f3) 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 buildin ermit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [0] Other[0] Brief Description of Proposed Work: If AQ D t A--,V f (UA0 5y\e t,+ QCA, Off.L2r 3 t pct�� �A�C � �3) ern�, f r►5t.((C'�iR Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing, complete the following: 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 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 4, 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 C)'_T, 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. '-D(W1 C D C,2_ Print N t Sig a of weer/A Date Section 4. ZONING All 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 3 m [ _ 1 Side L. R: L: R:I, a Rear i Building Height , j Bldg. Square Footage IX �` - -° .__ 1__ E ni ....... 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 0 DONT KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0._ YES IF YES: enter Book Page and/or Document #; B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 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: F E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. — Department use only Lt Ity of Northampton Status of Permit: Auilding Department Curb Cut/Drlveway Permit �j 212 Main Street Sewer/SepticAvailabitity �;� Room 100 Water/Weil Availability J N rthampton, MA 01060 Two Sets of Structural Plans l� -587-1240 Fax 413-587-1272 Plot/ ite Plants Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office -29 5 F(ors na Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: �-ii 3 n&-'4 ,55D 2 Telephone Signature 2.2 Authorized Agent: -D-A t -D iG�2 -�45q We o n? .irwi OrC-ha,reP iYi,-4 OKI Nam / 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) CZ% Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-1334 APPLICANT/CONTACT PERSON STURDY HOME IMPROVEMENT ADDRESS/PHONE P O BOX 51033 INDIAN ORCHARD01151 (413)543-5906 PROPERTY LOCATION 295 FLORENCE RD MAP 30A PARCEL 068 001 ZONE URA(100)/WSP(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 4 Fee Paid T r J Typeof Construction: SHEETROCK CEILINGS WALLS&INSULATE 3 ROOMS) New Construction Non Structural interior renovations Addition to Existing Acc Structure Building Plans Included: Owner/Statement or License 093603 Su 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: proved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition ay 400 Sign of d' 1 Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 295 FLORENCE RD BP-2015-1334 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A-068 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-1334 Project# JS-2015-002436 Est. Cost: $6300.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sy. ft.): 14897.52 Owner: WHEELER RICHARD H&CATHLEEN M zonin : URA 100,/WSP lOOZ Applicant: STURDY HOME IMPROVEMENT AT: 295 FLORENCE RD Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON.•612212015 0:00:00 TO PERFORM THE FOLLOWING WORK:SHEETROCK CEILINGS, WALLS & INSULATE (3 ROOMS) WALLS & CEILING MUST BE AIR SEALED & INSPECTED BEFORE INSULATION 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: FeeTyue: Date Paid: Amount: Building 6/22/2015 0:00:00 $55.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner