23D-134 (14) BP-2023-1748
57 HINCKLEY ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
23D-134-001 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-2023-1748 PERMISSION IS HEREBY GRANTED TO:
Project# DOOR/WINDOW 2023 Contractor: License:
Est. Cost: 5323 PATRICK KUBALA 100114
Const.Class: Exp.Date: 09/09/2025
Use Group: Owner: H SCHUMANN THOMAS K &PATRICIA
Lot Size (sq.ft.)
Zoning: URB Applicant: H SCHUMANN THOMAS K& PATRICIA
Applicant Address Phone: Insurance:
57 HINCKLEY ST
FLORENCE, MA 01062
ISSUED ON: 12/13/2023
TO PERFORM THE FOLLOWING WORK:
BASEMENT DOOR AND WINDOW
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
. , • i
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Buildinc Commissioner
/ ;a
The Commonwealth of Massachusett 1
Board of Building Regulations and S arde5 OFF► �/ FOR
14; Massachusetts State Building Code. 780 tkl . 1' . AI-ITY
Building Permit Application To Construct, Repair, Renovate' olish acp Revise Mar 11
One- or Two-Family Dwelling \\17,;')'�
This Section For Official Use Only •� SeT
Building PPermit Number. 8P-a ,3-, /7c-fg Date Applied: 06/? / ,
KEv„�gns7 IL/ 1 Z.i3 Zoz
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 PropeM Address: 1.2 Assessors Map &Parcel Numbers
S7 fez ,VC2 l c7 s
1.1a Is this an accepted street? yes X- no Map 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 1 Side Yards Rear Yard
Required Provided Required i Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
! Zone: _ Outside Flood Zone'
Public 0 Private 0 Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP1
24,Owners of Record: •
/"A r,&c s"e A/G. 10,04 A' ,✓ �Rr#/CC ( 41 r4 0/0( gi
Name(Print) City, State.ZIP
t57 litactcci Sr 43.c.g:)., s35-i
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building ClT Owner-Occupied 0 • Repairs(s) ❑ Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 , Number of Units Other 11e-Specify:
Brief Description of Proposed Work': PLR C L' flit rd e.t/T c) o Q lF- rc ru irE
jtl.`iv-Lo £C/
SECTION 4: ESTLLti1ATED CONSTRUCTION COSTS
Estimated Costs: I
Item (Labor and Materials) Official Use Only
1. Building $ 1. Building Permit Fee: S Indicate how fee is determined:
2. Electrical 1 $ 0 Standard CityrTown Application Fee
❑Total Project Cost(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) $ List:
S_Mechanical (Fire
t/1,v
Suppression) $ Total All Fff ...4__./�
Check Nont4 Check Amount. • Cash Amount:
6.Total Project Cost: I $ c.c/ojeg. 0 S ❑Paid in Full 0 Outstanding Balance Due:
SECTION'5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /v0/7 r/9/a f-
",(T,Q2T '2:: je4,8 q,ii License Number Expiration Date
Name of CSL Holder(Or homeowner if owner applying) r ,
List CSL Type(see below) v[
&4/ /S/ka.6:o OP ST
No.and Street Type Description
// U Unrestricted(Buildings up to 35.000 cu.ft.)
Af L. IO C(j /114 0)0.. V R Restricted 1&2 Family Dwelling
City/Town,State,Lill M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
(/ -g 9-o�v Le Y�r/r e K N C3GlZA 1.(OP7C• I Insulation
Telephone mail address i+7 D Demolition
5.2 Registered Home Improvement Contractor(HIC) oZ 07 y// �a//�.2s—
0924 MC .=/I2Wie0)/v. 1T( N i HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
N� nd Stree 4.44AR.> ST Izve rl�l �IeCkgRZA alpine , ���
4a in10 W /164- 0 I 0 Sb lei- -,Sa-p-led() Email address
City/Town,State,ZIP Telephone
SECTION 6:WORKKERS'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 AT No 0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PER 11T
1,as Owner of the subject property,hereby authorize 47-F rc. 4.2..:k LA to act on my
behalf,in all matters relative to work authorized by this building permit application.
t. eeArr-xciE_..0
Print Owner's Name Signature Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the bes y knowledge and understanding.
lot-6P-01-3
Print Owner's or Autho ' Agent's Name &Signature 780 CMR R105.3(6.) Date
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.aov/dps I
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"
Kubala Home Improvement
Your Window & Door Experts
34 Hubbard Street Ludlow, MA 01056
855-458-2252
Customer authorization for building permits.
I, Pit (2 ct* 6434ti,,v/t& as Owner of the property located at
5? i-iroUlay s t.tAt ar I otok, , hereby authorize Patrick Kubala Home
Improvement to act on my behalf, in all matters relative to attaining building permits, and
all matters relative to work authorized by such building permits.
Signature of Owner Date
KMI 103
1 fiC l Ulli//W/iYYCUitti Vf :PiU334tCFIU3C113
Department of Industrial Accidents
Office of Investigations
7.2.4160
►_4. Lafayette City Center
2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual): /�/.COAL 9 ‘40Al#. 19ff,470
Address: �j1 q1q� Sr:
City/State/Zi.: �44.4/0 y / ' ,6 Phone#: rf/3 75 7-,p/(>
Are you an employer? Check the appropriate box:
contractor and I Type of project(required):
1.® 4.lamaemployerwith /0 ❑ I am a general
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
shipand have no employees These sub-contractors have
8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp. insurance.
9. ❑ Building addition
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 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no 13.❑ Other
employees. [No workers'
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
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: fi)e g C L/j.jj'7 f /7w-&'4L eca
Policy#or Self-ins. Lic. #: MICA /6 3 f5! ,6 Expiration Date: /./.. e I
Job Site Address: ,s7 fitz,ycctcy, CityiState/Zip: 120 ic4n/C e /714 c /d 6 a--
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
Signature: r / Date: /04/P4'
Phone#: 9f3 -STY l ^ /a/,
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(check one):
112Board of Health 2❑Building Department 31:City/Town Clerk 4.1=1 Electrical Inspector 5Elumbing
Inspector 6.0Other
Contact Person: Phone#:
..`°."11111111 PATRKUB-CL LWONG
0411E....,,CAIRTY
CERTIFICATE OF LIABILITY INSURANCE DAT1(MMIUDtYYYY}
f 1111312023
I 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(les)must have ADDITIONAL INSURED provisions or be endorsed.
1 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 ri0hts'to the certificate holder in lieu of such endorsement(s).
PRODUCER fatiiACT Lori Wong
Smith Brothers insurance,LLC PHONE F�4z
300 Main Street F...iAS,no,U P:{508}499-5ti84 ?{iuc,Noe:
Oxford,MA 01540 I Miss;Iwongesmitherothersusa.com
INSURER(S)AFFORDS4O COVERAGE ... i NAIC s
___-----_.__..__.._ ___......_.......•....____........._... INSU
RER :Merchants Mutual Insurance Company__ 23329
INSURED .DIRER B;MAPFRE Insurance f 238T6
Patrick Kubala Home Improvements dba Kubala Home INSURER c: __._....____..
Improvements
34 Hubbard Street INSURER D:Ludlow,MA MA 01056-2762 INSURER a,
i.
INSURER F:
COVERAG 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NAM TYPE Of INSURANCEVAL Ma POLICY NUER I NISIMPWCDTYYTEXPYI LIMITS
A X COMMERCIAL GENERAL u*ai trY I EACH OCCURRENCE i$ 1,000,000
CLAIMS-MADE X i OCCUR BOP1109317 611/2023 6/1/2024 °RENTED{ ,. !$ 100,000
�^ MED EXP(Any one Peradn) !$ 5'000
PERSONAL&ADVIAIIURY $_ Included
GEN1 AGGREGATE UNIT APPUES PEFt GENERAL AGGREGATE $ 2,000,000
X POLICY 7 LOC PRODUCTS-COMProp Ar _ 2,000,000
OTHER: - p. + €COMBINED SINGLE LIMIT .3 1,000,000
AUTOMOBILE UASILITY 1.4Fs.pf-kk..__ ._e,.1?_ .- ,.
ANY AUTO gg���� EIDMMO4 9i/1 611/2024 DoWL(INJURY iPer person) `$ .
__._ 2I OS ONLY X AUTOS LE° � 1 BODILY IN,R}RY(Per accidentt
���EcJp�s yYE ' IPROPER GE I
X AUT08 way X I . ONIp I I�P_i!_�M _Y S --i
A X UMBRELLA LAB OCCUR EACH OCCURRENCE 1$
Excess LIARr-•W CLANIMPAADE CUP9131681 6/1/2023 0/1/2024 AGGRGATE 1,000,000
DED I X I RETENTIONS 10A/00 .. PER OTH
A V �EYp S STATUT,E.._= ER
YI
ANYPROPRIETOIaPARTNE p� 'WCA1038596 3✓1/2023 611/2t024 EL EACH ACCIDENT r; 1,000,000
CrorMi EXCLUDE T :IVE NIA 1'000,000
1n P►N) I EL DISEASE•EA EMPLOYEE$
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS WOW i El DISEASE•POLICY MST {
•
DESCRIPTION OF OPERATIONS I LOCATE 1 VEHICLES (ACORD'101.Additional Remoras Schedule,may he attached II more specs Is requiredi
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
i ..# GL
ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
(.. . Board of Building R Mlons and sinn(iar(Is
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THE COMMONWEALTH OF MASSACHUSETTS
Office of Cotistarn<:r Aff,�I,,,,,,,�� . , Uusinoss Regulation
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I ()UI.OW, MA 01056 "M . ":"^......
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Ilpdatn Address and Rou,rn Card.
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THE COMMgNWEAITN OF MA88/►.CI1Ut3ETTA
IlOMC IMpRo _ Regulation ftedletratlon valid for individual use only before the
I�ONT RACIOR I oxplratton date. if found return to:
,.u;.''..::"'`"...,,:.., Office of Consumer Affairs and Business Reputation
�1 _ , 1000 Washington Street -Suite 710
e� ! I Heaton,MA 07110
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DEBRIS DISPOSAL FORM
In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be disposed of in
a properly I ,cased solid waste-disposal-faeility••as deed byNIGL e 11 I, S 50A,
The debris will be disposed of in:
/4 17Q .‘ 2ic-
LOCATION OF FACILITY
/.)- �- 3
Si of Applicant Date
AF.eIL)A VIT
As a result of the provisions of MGL c 40, S 54, I acknowledge that as a condition of
Building Permit Number 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.
_--- I ceevfy_thasa_wi Luoti the Building Official ja (two months
maximum)of the location.of the solid waste disposal facility where the debris resulting from
the said construction activity shall be disposed of,and I shall submit the appropriate form for
attachment to the Building Permit.
20- --4? ,,3
Date Signature erm.it Applicant
(PRINT OR TYPE THE POLL OWMTG INFORMATION)
/`�T7CsC A- iL.k46:4'Lrrf
Name of Permit Applicant
Aoredere—e 4454'64 c —.4itt0aie4 ram/"Ar't- /
Firm Name, if any
Kubala Home Improvements
The Window & Door Experts
5 Pell Street Ludlow, MA 01056
855-458-2252
Kubala Custom Windows
Energy Star & Performance Data
Revised June 2019
OPTION MFG CODE U-Factor SHGC i VT CR
Omega-Tuff 52210A .24 ; .21 j .48 47
_( ' Hi-R N2210A .25 .28 i .52 47
-� Essential P2100A .30 .49 .60 55
Passive P2210A .25 ! .48 .59 46
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Y \QKUBALA HOME IMPROVEMENT LLC ►" `�' ' E�U rt„rtncs� cn,ctrap lot home eo rtsvcnttcni iYmtrautur+and sutuontrscturs rngng4J in h , t hk{1 43A
MA HIG tt2t174$1\C‘ P
sntrnrung,unlesssfrecifiecttty ettmop[trsxrt.rckt+'nrot"�'n b`�prz'�"'nn��tW,+.,�ltuK "
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34 HUBBARD STREET M the rtcritl laws, must he rc rst.rorf ,tith the C<mtm+3nt•catdt "i llonttt
Inquiries about registration and status should he made to the uinwtor• ,t;\
LUDLOW, MA 01056 leaf. Itt+lin'
Improvement Contract ttc^ttixtratiw,, One ilstthur#tm Pfuce. Room
413-589-101 f? azltlt lb1717z7-85MR
Submitted
To: l4-i ii (( --4-MCIeln14►h1 j
.. Job Name: � ueIgr�r"
5 7- Ht uc.w 67—
y
LD(� c—e- O 0( '1 Job location: iA
Rho l 13' Sate '',7 3.17 i pate I( ftt76ld 3 Estimator: r )Q
We hereby submit specifications and estimates for work to be performed and materials to be used:
i
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'i ft-ta 400 ')r gc 13'. 'citmJW L r ig. MO 64,446 t% 04'5 • �'7
WORK SCNEDIILE,
Contractor will not bi.•in the weal`or coke the materials before the thins day following the signing of this agreement,unless specified herein. Contractor will being the,cork on or
about /•iL W flaring delay eauued by circumstance beyond the contractor's control, The work grill be coo eted
W- Pi ley' _� ldatea. The owner hereby
acknouledgcs and agrees that scheduling dates are approximate and that such delays that arc not moldable by the Contractor including hut not limited to strikes.Acts of Clad,
shortages of materials.got idents.and all other delays beyond the its control.shall not be considered as violations of this Agsectncrtt.
WARRANTY The contractor warrants that the work furnished hereunder shall he free from defects in materials and workmanship for a period of T..!}�t!40 fjrollowing completion anti shall
comply with the requirements of this Agreement. to the est::n.4 any defect us workmanship or materials,or damage caused by the Contractor.its subcontractors.employees or
agents,is discotcred after completion of any job.including clean up,the Contractor shall at its own expense,forthwith remedy.repair,correct,replace or cause to be remedied,
repaired or replaced,welt damage or such delbet in materials and workmanship, The foregoing watranties shall sun ise any inspection performed in connection pith the aged.
upon Work.
We Prop hereby to forms material d labor-coo 1 etc us accmace with above s cifications.for the sum of:
_till .!N'D_u.. ! I ii�uiJ5 - j ty 1-�=.•-D. oa... dollars{S_4 43_-« • °C
Pnyme'nt to be made as to dries.
g,i t_.._ _..._t upon signing contract; 1CU f3ALA HOME IMPROVEMENT Lt.0
-""°n 1. ..___...___ __...._l upon completion of____ _.. 34 HUBBARD STREET
i; upon completion of. LUDLOW,MA 01056 413-589-1010
folk_%4 J3gia7'a',,,sball tic made forthwith upon 60,10 4,0 IIB 140ielViA HIC 2074
compktrnn of nark under this contract. 6 Salesperson: I`Cna r-r
Notice:No agreement for ltomc impnorement contracting pork shall require a down pat met
(advance deposit)of more than one-third the total contract price or the total amount of all
deposits or puyritents ninth the contractor must make;in ad ance,in order and'irtotherwise Authorized Signature: e
obtain detivery of special order materials and e,,}uiptncnt,which csev amount is greater
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 authorised to do the work as specified. Payment will be m:ttle 8S tluttined
shot c. You the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of ibis
iamaton
s
than contract.: See contents of which are referred to ;hose and incorporated pf herteinight. Pleaseby ref"nm a refer to the Notice or Cancell;ltion that at:cirml,.tnics
00 NOT SIGN THIS CONTRACT IF THERE ARE ANY IlLANK SPACES
.S.
Signature _ . _ � aie1 tPaaaturt ....Rate
ma to,
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