28-001 (3) BP-2021-2310
422 SYLVESTER RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
28-001-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2310 PERMISSION IS HEREBY GRANTED TO:
Project# WINDOWS Contractor: License:
Est. Cost: 11900 W MAREK INC 055201
Const.Class: Exp.Date:06/23/2022
Use Group: Owner: LAVALLEY KATHLEEN E
Lot Size (sq.ft.)
Zoning: RR/WP/WSP Applicant: W MAREK INC
Applicant Address Phone: Insurance:
73 SOUTHAMPTON RD (413)977-9539 WCC-500-5014290
WESTHAMPTON, MA 01027
ISSUED ON:12/16/2021
TO PERFORM THE FOLLOWING WORK:
INSTALL 15 REPLACEMENT WINDOWS
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.
Signature: V ),2. `
ICA.
' I
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
1 ,_>
�t
oEc .., l
The Commonwealth of Massachusetts rr 1 4 49a2L FO /
tw Board of Building Regulations and Standards P�1Z1iVICI ALI
Massachusetts State Building Code, 780 QMR 4' 'ter m. U E
Building Permit Application To Construct,Repair,Renovate Or 81.71
Ain
l '.,rn . , T d Mar 2'011
One-or Two-Family Dwelling -' �. ,�y 07o,',0Ais
This Section For Official Use Only
Buil /...
d' Permit Number: 12'�i• A ?4 U Date Applied:
5�vi� Jug;; /?-/5-07i
Building Official(Print Name) Signature - Date
ECTION 1: SITE INFORMATION
1. rty Aresiv / 1.2-.)—Asse53ors Map& Parcel Numters
Map Is this an accepted street?yes no M P Number Parcel Number
1.3 Zoning Information:. 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft) .
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 ne '�e rralkm (�1 a6
N me Print Ci ,State
jive.*:„/A
sZlti
LA 5 61
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration,(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other cq Specify: �
Brief Description of Proposed Work2: Q4,Jt �, ` '"�.,n / n (� c f n Jçr<
Litt N (Jktjt 0i4 `�,)(�/I��`� Wl(�)( /
ou TIN-,
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I I q00 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ 1 ❑ Standard City/Town Application Fee
- ❑Total Project Costa (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Feehe) ✓ v
Check No.O Check Amount: . ✓
6.Total Project Cost: $ 1 I q 00 ❑paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction ervisorMrKii
(�C LicenseCSL) OCS�1 6/2.4.61___
CjAdOr lLiiceense Number Expiration Date
Name of C older t
73 ��1 Pi
No.an Stye v List CSL Type(see below)Type Description-17" fil*
U Unrestricted(Buildings up to 35,000 Cu.ft.)
IL.
�J�J� IW` R Restricted 1&2 Family Dwelling
City/Townat7IP, M Masonry
RC Roofing Covering
WS Window and Siding
fi`1 J Vu •
1 1 W � �^m SF Solid Fuel Burning Appliances
`� I Insulation
Telephone Email address D Demolition
5.2 Registered H
ome Improvement Contractor(HIC) m Gi a y
1___
co,1 w L� HIC Registration N ber Exp. Date
415_Co an e or�1HI�C Rant Name (AV tt � CID rot
ydv
No.an tr qt ty v o L'IR
., q t✓J I ail address
City/Town,State,ZIP Telephone
SECTION 6: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 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Ahtiikr/I,as Owner of the subject property,hereby authorize /fla /(
to act on my behalf,in all matter relative to work authorized by this building permit application.
1 - It
Print Owner's Name(Electronic Si ture) D e
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I here attest under the pains and penalties of perjury that all of the information
contains ap d accurate to the best of my knowledge and under I din .
Print Owner's or Authorized Agent's Name(Electronic Signature) to
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
l.unuuw,wedun ui massdcnuseus
Commonwealth of Massachusetts
Division of Professional Licensure
Hci '. er
HE-156708 S Expires: 06/23/2023
WALTER L MAREK,III 7
73 SOUTHAMPTON RD
WESTHAMPTON MA 01 rr
yob 4 ,..
Commissioner `t K. tJni -
Commonwealth of Massachusetts
,V`, Division of Professional Licensure
Board of Building Regulationsand Standards
COnstrkittli n it{ipprVjsor
CS-055201
WALTER L MAREK,Ill
06/23/2022
73 SOUTHAMPTON ROAD -
WESTHAMPTON MA 01027
Commissioner �u�4 f Bt.,_,
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
TYPE:Corooration
Reaistratiori Expiration
159488 04/29/2022
W.MAREK INC.
WALTER MAREK III
73 SOUTHAMPTON RD.
WESTHAMPTON,MA 01027
Undersecretary
FF The Commonwealth of Massachusetts
( r`�_= Depa_rt'ment of Industrial Accidents
E 1 Congress Street,Suite 100
a ( Boston,MA 02114-2017
lvlvsi:rnass.gov/ilia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
'TO BE PILED WITH THE PERMUTING AUTHORITY.
Applicant Information W''tt', r l Please Print Legibly
Name(Business/Organization/Individual): t(V' '\( (_ s`,,C...
Address: c ^ to R
` p c; r' �1
City/State/Zip: - C \r1 r \t r ,JI Phone#: 'II 3 G '7 l J
Are you an employer?Check the appropriate hoar: Type of project(required):
I I am a employer with_�` —employees(full and/or part-time).* 7. New construction
2.[ I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.0 tam a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Q Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. i will
ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.0 tam a general contractor and I have hired the sub-contractors listed on the attached sheet.
"These sub-contractors have employees and have workers'comp.insuuance.l 13.0 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other — -
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box MI 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.
1Contractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'camp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. �1 � v
Insurance Company Name:_ _ -
Policy#or Self-ins.Lic.#:UsG- c U - c)I Y +~�G(' c Expiration Date: a 1® ^
1
Job Site Addres' t Li nsh1'V€SW (2\ City/State/Zip , , _�r ;,,lir�! �,r.,V �-..
Attach a copy of the workers'competion policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify in: er the pains tel penal(' f perjury that the information provided�bbo is true and correct.
Signature: L '� /"-' /__� G Date: ..? '
Phone#: Lj13 ri j x�9
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 Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
G.Other
Contact Person: Phone#:
C CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
02/09/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
RODUCER CONTACT
S.K.INSURANCE AGENCY,INC. PHONE FAX
Ext)•(413)527-7859 I C.Nol:(413)527-8314
03 Northampton St. �pD IDS; travissias@ksk-insurance.com
I.O.Box 597 INSURER(S)AFFORDING COVERAGE NAIC#
asthampton MA 01027 INSURER A: REPUBLIC FRANKLIN INSURANCE CO
1SURED INSURER a;ASSOCIATED EMPLOYERS INSURANCE CO
W.Marek Incorporated INSURER C
73 Southampton Rd INSURER D: _
Westhampton MA 01027 INSURER E: _
INSURER F
:OVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ISR TYPE OF INSURANCE AWL SUBR POLICY EFF POLICY EXP LIMITS
TR INSn,WVA POLICY NUMBER IMMIDD/YYYY),(MM/D0LYYYYI_
:OMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000
DACLAIMS-MADE L J OCCUR PRFM RFSEO(Fa oRErcuED enca) $50,000
MED EXP(Any one person) $5,000
PERSONAL 8 ADV INJURY $1,000,000
GE_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
POLICY PE0 { LOG PRODUCTS-COMP/OPAGG $1,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
t (Ea accident)
BODILY INJURY(Per person) $
ANY AUTO 4
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
— AUTOS —AUTOS
NON-OWNED ) ; PROPERTY DAMAGE $
HIRED AUTOS _ AUTOS i _(PEL a:eat)
UMBRELLA UAB OCCUR1 EACH OCCURRENCE $
EXCESS UAB
CLAIMS-MADE 'AGGREGATE
DED RETENTION$ $
WORKERS COMPENSATION X
AND EMPLOYERS'LIABILITY STATUTE ERH
3 ANY OFFICER/MEMRE EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE IYYN N/A WCC-500-5014290-2021A 02/10/2021 02/10/2022 E.L.EACH ACCIDENT $100,000
(Mandatory In NH) E L.DISEASE=EA EMPLOYEE $100,000_
Ii yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000
)ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
3ENERAL CONTRACTOR
7.ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE v" ,. <DA>
yy Y
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
City of Northampton
o¢K�a' 'ra
4„,5 ,�' s/c,
Massachusetts ',f.
/fix r.•
*.,
4 DEPARTMENT OF BUILDING INSPECTIONS �. x
00W
'; 212 Main Street • Municipal Building 3�• Ca
li Northampton, MA 01060 �1'4•• 0\
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of
in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
fj6d
Location of Facility:
le PCC1CArs
The debris will be transported by:
Name of Hauler: (A}r 6,(OV rrIC
i � q
Signature of Applicant: Date: I )-1I
l
QUOTE NAME PROJECT NAME CUSTOMER PO# DATE REQUESTED
MAREK LAVALLEY
SALES REPRESENTATIVE TERMS SHIP VIA QUOTE NUMBER
blaisr@rkmiles.com 756581
Lineltem# Description Net Price Quantity Extended Price
8-1 S477.9 I I S477.91
Comment/Room: Product: 8300 Series,Double Hung,NC
Casing:29.8125"x 51" i
BATHROOM RO:26"x 48"
TTT Overall Size:25.5"x 47.5"
TTT Unit Size:25.5"x 47.5"
Sash Split:Equal
Performance Level: Standard,
Glass Options:Double Glazed,LowE,Argon, pered,DS
3/4"IG Thickness,Clear Opening:20.125"x 18.335",2.562Sq ft
Ratings:U-Factor=0.28, SHGC=0.28, VT=0.52
Vinyl Color: White
Locks: Standard,Single
Hardware: White,
Screen: Full Screen,Extruded-Fiberglass,
Surround(ExtTrim): Offset Flat Casing w/Sill Nose,
Lineltem# Description Net Price Quantity Extended Price
9-1 S376.10 I $376.10
Comment/Room• Product: 8300 Series,Double Hung,NC
• Casing:33.8125"x 44"
BATHROOM RO:30"x 41"
TTT Overall Size:29.5"x 40.5"TTT Unit Size:29.5"x 40.5"
Sash Split:Equal 'd '*
Performance Level:Standard, Ott i a
Glass Options:Double Glazed,LowE,Argon,Annealed,SS
3/4"IG Thickness,Clear Opening:24.125"x 14.835",2.485Sq ft
Ratings:U-Factor=0.27, SHGC=0.28, VT=0.53
Vinyl Color: White g
Locks: Standard,Single Ri = 0'
Hardware: White,
Screen: Full Screen,Extruded-Fiberglass,
Surround(ExtTrim): Offset Flat Casing w/Sill Nose,
Last Update: 9/22/2021 7:26:17 PM Page 5 Of 7 Printed: 9/22/2021 7:26:47 PM