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17A-048 (5) sTUR0,Y HOME IMPROVEMENT WORCESTER SPRINGFIELD HARTFORD 459 MAIN STREET-P.O.BOX 51033-SPRINGFIELD,MA 01151 MA.REG#151711 CT.REG#601525 1-877-3-STURDY 508-797-6600 413-543-5906 FAX 413-543-3200 OWNER PERMIT AUTHORIZATION Name: a , Address: �'- v City/ State /Zip: (o z I 1 (Owner), of the property located at: hob PwAA.-e d2d . Fjoj b pN« authorize Sturdy Home Improvement Inc. to act as my agent for the construction project taking place at the above address. I also authorize Sturdy Home Improvement Inc. to obtain a building permit. I understand and accept responsibility to comply with all regulations and required inspections. Signature of Owner:_ Date: Page 1 of 1 ���®� Toll Free(877)3-STURDY All home improvement contractors and subcontractors Springfield(413)543-1681 engaged in home improvement contracting,unless specifi- Worcester(508)797-6600 rally exempt from registration by Provisions of Chapter 142A 'TOTAL HOME e.com RENOVATION New Haven(203)848-2118 of the general taws, must be registered w'i$i the www.SturdyHome.com 159 Main St.•Indian Orchard,MA 01151 Fax(413)543-3200 Commonwealth of Massachusetts.Inquiries about mg'LSh'a. 0.Box 51033•Indian Orchard,MA 01151 lion and status Should be made to the Director, Home IA REG.#151711 Member Better Business Bureau Improvement Contract Registration, T REG.#601525 Fully Licensed&Insured One Ashburton Place,Room 1301,Boston,MA 02108 w ubmitted to: +�; 7 of '' L rn L� / (617)727-8598 rt !'Ct_� (n��i1 PHONE �G D % 1 WORK Ve hereby submit specifications and estimates for work to be performed and materials to be used: To ! t� 5• � �-��'�' /��C� � ��rL 17 1=3 L� S i G�� �l P�i�-.: �r:t"T�"_*-� ��'C rN ti>,,, i q�( =�-�:`i r�f� scc—i"�L�:; /l �✓ l�C I—L � ��► , A YI-J r l A` k � 1 A `�C��',.; a•-�..� .�j,h�,� /�'��" �'���#-- ��=-a- �l�� �::;- � c I`. lirl,j F? C 6C� �JnLL i' txlrti Slliiu` � �C3fir tom_ 6, 1 `vim f1iv 4Tr'� G� �t C� C" �7 L4i� WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified 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 (data).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoldable by the Contractor including,but not limited 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 subcontractors,employees or agents,is discovered after completion of any job,including cleanup,the Contractor shall,at its awn 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 accordance with above specifications,for the sum of'. (� // ff // / Cs', Laic TYL'✓_ X'A dollars($ I• Paymentto be made as follows: —,Ili—/ n G^ upon sig In con J�' (S STURDY HOME IMPROVEMENT,INC. C; + ct; Name of Contractor/Designated Registrant on a 51n33 _A($ � -2-C C' 1 upon start of work; Street Address ' _*/6(s 3 2�--1.. 1 uponcowWotiat+of �l„�-. Indian Orchard MA 01151 413-543-1681 ' City/State Phone (S T_ + - 1 shall be made forthwith upon / completion of work under this contract. _Z3 G �✓�(� Name of Salesman Authorized Signature Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated.I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You may cancel this agreement it it has been signed by a party thereto at a place other than an address of the Seller,which may be his main office 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 s,�-IL' r /' r L! Date J > Signature Date City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: The debris will be transported by: The debris will be received by: �i Yl Y1 C 3 2 �,-�+c.l�� S1—v-�•2-r-,rtg a-�Czrn , Ita�,o�ao Building permit number: Name of Permit Applicant Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 kvi Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: C�I i5 Phone #: j Aran employer? Check the appropriate box: Type of project(required): 1. m a emp loyer with R 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp, insurance.$ required.] 5. ❑ 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.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §l(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. 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lie. #: 3619 5YCK-- I D Expiration Date: Job Site Address: �,� 1�1(�f ! Ci City/State/Zip: - _ rerra k7r, C 6x) 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 DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: 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 SSu/p�ervisor: Not Applicable ❑ Name of License Holder: ,JWk% I d License Number Lf Add r Expiration ate r 413 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ ear_ '�,� -�� 1 ►��r�s��e �� s ���-7 1 i Companv Name. Registration Number L��r ri S-4 S ►to an ox-c Ka . ►� - � ) 'Z�i i Address ,, ii Expiratio Date Telephone O )3L�/73"� 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....... n 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 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 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Ef Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding[ ] Other[a Brief De ription of Proposed Work: trnG:: i � :r n tr�c� l'om me b a c K zi t&m sc Reps Sid � oe or►-►-, Alteration of exis' g 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 I, C*1(NA S4at/] (Yl ' as Owner of the subject property I' hereby authorize ➢ to act on my behalf, in all matters relative tojmork authorized by this buil ing permit application. Signature of Owner Date I, m-ord Q k'M C_ imp l JV J` Dl(,,(J 1 1. '/ 1J ^(.Ae—" ,as Owner/Authorized Agent hereby declareAhat the statements and inf rmation on the foregoing application are true and accurate,to the best of my knowledge and belief. Signe n the pains and p na It.es ury. / r � / CJ Pri Signature of Owner/Agent 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 _I Side Ll R: _ L: . R:i. . _ 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/Findin ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Re istry of Deeds? NO 0 DON'T KNOW YES 0 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 0 YES 0 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 Q 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 Q NO 0 IF YES, describe size, type and location: 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 C) IF YES,then a Northampton Storm Water Management Permit from the DPW is required. �r7 Department use only U City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit OCT 6 is 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability orthampton, MA 01060 Two Sets of Structural Plans C,Plumbing&Gas In Northampton,,AAI1 01 s ne 3-587-1240 Fax 413-587-1272 Plot/Site Plans 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 ocao Map Lot Unit J" Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: C! i+r)y1Akn[rn�Sleu Name(Print) Current /a" g Addres Telephone ``l Signature 2.2 Authorized Agent: Name p Current Mailing Address: 403--543 Sig 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) CO Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 160 BRIDGE RD BP-2016-0465 GIs#: COMMONWEALTH OF MASSACHUSETTS Man.Block: 17A-048 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-0465 Project# JS-2016-000767 Est. Cost: $8000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sq.ft.): 11107.80 Owner: WALMSLEY CATHERINE A Zoning: RI(100)/uRA(100) Applicant. STURDY HOME IMPROVEMENT AT. 160 BRIDGE RD Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON:10 1612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 8 SQ ROOFING & REPLACE SIDING ON DORMERS 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 10/6/2015 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner