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29-296 (6) BP-2024-0844 112 BROOKSIDE CIR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-296-001 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-2024-0844 PERMISSION IS HEREBY GRANTED TO: Project# BASEMENTS HOPPERS 2024 Contractor: License: Est. Cost: 4922 PATRICK KUBALA 100114 Const.Class: Exp.Date: 09/09/2025 Use Group: Owner: M HELDT RAYNA Lot Size (sq.ft.) Zoning: WSP Applicant: PATRICK KUBALA HOME IMPROVEMENT Applicant Address Phone: Insurance: 5 PELL ST (413)589-1010 WCA1038596 LUDLOW, MA 01056 ISSUED ON: 07/05/2024 TO PERFORM THE FOLLOWING WORK: REPLACE 4 BASEMENT HOPPERS 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: g/2. Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner ,1414. e #'' , ,39; r -7 0,• ,,i'z✓#ie(,y iu4AcA/fO°7E -Ca The Commonwealth of Massachuset • -_ t Board of Building Regulations and St ard-s . FOR M C`\ / MUNICIPALITY \i�; Massachusetts State Building Code, 78 C /..•. USE Building Permit Application To Construct. Repair, nov e Or Demo is et-•sec : r 2011 One-or Two-Family Zhvellin ili :YT; This Section For Official Vse e y ` 2 ,0 + Building Permit Number: ? c f 'c fy, Date Applied_ r)''")-nr i-Vit��145 /.7/7 T_N Mqo CT'ON 7-3-2024 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers /Ia 3fri,00..c.1 Je Crae 1.1a Is this an accepted street?yes >C no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq it) Frontage(t) j 1.5 Building Setbacks(ft) I Front Yard Side Yards Rear Yard j Required 1 Provided Required Provided Required i Provided II i 1 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private D Zone: _ Outside Flood Zone? i Municipal ❑ On site disposal system 0 Check if vest? • • • SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ,A)/NA At L.D) 1`OWe.ovCe.) /YVV1 of o 4A Name(Print) City.State,ZIP //.7 e. 00Ks;•..lt, n1oo 91* •(06 • S-�3a No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction Cl Existing Building 0 1 Owner-Occupied 0 Repairs(s) 0 I Alteration(s) 0 + Addition 0 Demolition 0 Accessory Bldg. 0 I Number of Units I Other C Specify.____ Brief Description of Proposed Work2: 00 ACG 4/ Z?aytC£/rt�'N 7- 4 eee ie s • • SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) l. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ 0 Standard CityiTown Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire -�( Suppression) $ Total All Fees:$, �•f i Check No.q c J Check Amount: �- Cash Amount: 6.Total Project Cost: S 11703 �19'/ 0 Paid in Full 0 Outstanding Balance Due: I �f • SECTION 5: CONSTRLCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 /vO/7 T- t, kx A RL • License Number Expiration Date Name of CSL Holder(Or homeowner if owner applying) / / List CSL Type(see below) / Vi cg 4/ 4ic&BJ o,c� `Sr Type Description No.and Street tJ IO /�'l� d)Q L' Unrestricted(Buildings up to 35.000 Cu.ft.) W �j R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1(/3 y,. jv l� K(h81i11.1 'l.(no7Ed I Insulation Telephonemail address n7 . D Demolition 5.2 Registered Home Improvement Contractor(HIC) a ,4/4,-1 / /3Y/20 S eeu 6.944 list(P C 2 4doeo YS/!iC A' '— ' HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name .24 X4.4 4144 4 _PT bevc r iy 4.04L4Auparle Gv<Y No.,,aannd Street Email address a nIO W * d, 0 S(, Se??—le City/Town,StatE,ZIP Telephone -gam j' N.4 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 k' No ❑ _ ... iCTION:Ta:OWNER-AUTHORIZATION TO BE COMPLETED WHEN ',1:.]::.'4313.1rigklieS AGENT OR CONTRACTOR APPLIES FOR BULLDLNG PERMIT I,as Owner of the subject property,hereby authorize 4TQ,ztY.k 4.44 LA to act on behalf,in all matters relative to work authorized by this building permit application. kfd-Tf/�L Print Owner's Name Signature Date R SECHOTI;7bt OWNERL OR AUTHORIZED AGE?'T 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 be y knowledge and understanding. Print Owner's or Autho ' Agent's Name &Signature 780 CMR R105.33(6.) Date r,;h} 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(I-TIC)Program),will gat 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 Informati 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. It) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decksi 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, ?AY OR Ira LvT , as Owner of the property located at /tR p i pL Cie. r� N liiik D/aq.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. (2411/"11-6 W14/011 Signature of Owner Date KHI103 all,.w\, 1 ItC t.1/IIi(III/ItWGU[ttlt f/f 1UUJJtUC/tttaCtl, Department of Industrial Accidents =.- 1— Office of Investigations =�_- Lafayette City Center ‘,.. ,i 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 v'_ Name (Business,'Organization,Tndiridual): QdlZ r9 tie, Me Z70.4vvz' eA.2--- Address: $y f .05,0,gg72 ,..,,7— City/State/Zip: 4,D1ow '4 11'S‘ Phone#: 4 3-J�R/O 1 Are you an employer? Check the appropriate box: Type of project (required): 1.1g 1 am a employer with 0 4. ❑ I am a general contractor and I employees(full and/or part-tine). * have hired the sub-contractors 6. 0 New construction 2.❑ 1 am a sole proprietor or p er- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g•9. ❑❑ Demolition working for me in any capac ty. employees and have workers' [No workers' comp. insuran4 comp. insurance.: addition required.] 1 1 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all ork officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' right of exemption per MGL Y' comp. 12.0 Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' 13.1=1 Other comp. insurance required.] *Any applicant that checks box#1 must also 511 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 a da%it 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. airo I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site Information. //yy�� Insurance Company Name: ///!e e,b/we7"S 07t A I �.S U,pw/1/+!E CiU — Policy#or Self-ins. Lic. #: al/if Al, ' ,P Expiration Date: +6�//o2G�:�� Job Site Address: /12 tFR ooXa 1. de_ C�i A . City/State/Zip:/' Lice niC(� /9"I O/O 62 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$1,500.00 and/or one-yea;imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. aimif_ -- ._ - 1 — --I do hereby certify under the pains and penalties of erj at the information provided above is true and correct Signature: Date: 4/t1 rld Phone#: 47`'1-s7 A910 Official use only. Do not write in ithis area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3I:City/Town Clerk 4.D Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: ��.eito, PATRKUB-CL LyypNG A`__ CERTIFICATE OF LIABILITY INSURANCE ' DATE("""° "'"`I 5/2212024 _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OFj INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, sect to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer ri his to the certificate holder in lieu of such endorsement(s). PRODUCER ACT Lori Wong ,Smith Brothers Insurance,LLC ;PHONE --- ., FAX ._.._ 300 Main Street [luc,&w ever(508)499-5064 i ,NO Oxford,MA 01540 :IWvng©smithbrothersu$s.com I- —_ "(WRENS)AFFORDND COVERAGE HNC IS ------.-INSURER A:Merchants Mutual Insurance Company_-- 23329 INSURED imetatERi:MAPFRE Insurance _ 23576 Patrick Kubala Home improvements dba Kubala Home INsuRER c Improvements -- J 34 Hubbard Street ,INSURER D: Ludlow,MA 01056-2762 INSURER e: INSURER F: COVERAGES 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 I 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDRIONS OF SLH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MR *MAMA POUCY EFT LIR TYPE OF M/URANCE J POUCY NUMOEA l MINED WA �yl, LIMITS A X COMMERCIAL GESYMM..uASIurY 1.000,000 EACH OCCURRENCE S CL1WS#MDE X !!OCCUR r -DAMAGE TO RENTED 500.000 I BOPI109317 6/1/2024 6H12025 p PRefa_gs ra oa__:,�Ts I himExP(Ant one Person) 'II$ _5.000 i PERSONAL&ADV INJURY I$ Included OEFrL AGGREGATE LIMIT APPt S PER i GENERAL AGGREGATE ;$ 2'�'000 X POUCY .SECT r J LOC PRODUCTS-COMPOOPAGG $ 2'�'� $ B AUTOMOBILE assure ,kt i �COMBI SINGLE LIMIT $ 1,000,000 ANY AUTO g(� t BDMM64 6/1/2024 6N/2025 IimisY INJVRv(Pr evsonl 's - I.IUITOc ONLY C SWIM t .BODILY INJURY(P�r )J X ra ONLY {X I r�� j-�— +s A X UMSRELLA Luce► ( X I occuR _EAr oNCE $ex 1,000,000 cess LAB CLAWS-NAM iCUP9151661 6/112024 611/2025 AGGREGATE s -1AMON OW 1 X `RETENTIONS 10400 l s A AMMD STAI_ ISSLAM STATtuEE�1_Ei3 ANY PROPRIETowPARTNEfLExEcxrrrvE YIN WCA1030596 6/112024 6/1/2025 �_I,EACH ACCIDENT f 1,000,000 ANY CCE F�CCLUDEDr U NIA1,000,000 (Myyieeeaa�dery� • _E.L rytcs-sE-EA EMPLOYEE f IOS5CRIPTION OF OPERATIONS'�dow E.L. 000 DISEASE-POLICY LAST ;$ 1'�' i i DESCRIPTION Of OPERATIONS I LOCATIONS f (ACORD 101.AddW Remarks onai Schedub•ma y ay be-leache It d n,o epee' Q CLES pe Is r. ulredl CERTIFICATE HOLDER _-- ( - CANCELLATION.- ___CANCELLATION, .---- - II SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Kubota Home Improvement. LLC ACCORDANCE WITH THE POLICY PROVISIONS. 34 Hubbard Street Ludlow,MA 01054 AVINOINZED REPRESENTATIVE ACORD 25(2016/03) *198a-2015 ACORD CORPORATION. AU rights reserved The ACORD name and logo are registered marks of ACORD / A-d,a+..�., e .,t•+.,tom.'--..-..•a'—_►ij-1- .aA,I 4fli tLta flflt�Af.VCIC.."w•lT7�Wt Y/+ I •'J,` I/`/ yl s'f, ' .:.='",4•n' �,_ ,fiwJ;;r�: ks+ ' t ',r0 41 ,, ,`t''' Ypt g-t. + �1' 1. g '4',4.,..1- lit / 1 j r h:. 4'. lJ ^4..4" rl, rl'�,� CO"p CnffR{I'":2%r ter i to T ;j) ittla.""; 5 7..',P ,AriCY , 1,-P4orN,. Vos ..-Ittc:'•'s - 1 '' • glieA *),.. .4k, ;:',,pl'Ilc'`'.. 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Li t.. 1 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 prop'erlyliceirsed solid waste-disposal-faeiiity as defined by MGL c Ill, 5 150A. The debris will be disposed of in: /�`y Q,e,c ,‘,c K� LOCATION OF FACILITY � Id7 )aLi Si of Applicant Date AFFIDAVIT 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. _ _Lcartify-tikes. l_ug y. the_$uild.mg Official y (two months maximum)of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of,and I shall submit the appropriate form for attachment to the Building Permit. G/a7(`'?‘7` Date Signature ermit Applicant (PRINT OR TYPE THE POLL OVv-INGINFORMATION) /"yT,(�-c, Z J 9 Lf1# Q Name of Permit Applicant /,�vrAcC1c 4 6,sl a a -1rr Aizo It 07.1 ti if Firm Name, if any Kubala Home Improvements The Window & Door Experts 5 Pell Street Ludlow, MA 01056 855-458-2252 Kubala Custom Windows Energy Star & Performance Data Revised June 2019 OPTION MFG CODE U-Factor SHGC VT CR Omega-Tuff 52210A .24 .21 .48 47 _ HiR N2210A .25 .28 .52 47 Essebtiai P2100A .30 .49 .60 55 Passive P2210A .25 .48 .59 46 KUBALA HOME IMPROVEMENT LLC MFAin fe ` i fiUg-. G C)0(a4 e l 1 i A4 Ail hams inn orient t Ira asrmomt � MAHtC N207481 p on aotnlraMtor. and wt`:.xtracnxv smkal;cd in!t�ntc pt)'‘) 34 HUBBARD STREET contrasting.unless specifically exempt from rcgistratitin tit, i reAlsiom or(%g art I42A of the general lass, mug be registered with the.Cs,mmonwcahh of Massachusetts LUDLOW, MA 01056 Inquiries about registration and status shautd be ' (),rector, )tome Improvement Contract Registration. One Ashburn Place, Room I ten• "A 413-589-1010 02 ulx 4e17)727-X54x Submitted a O To: tilfil,..,j37- /D‘_ cle . Job Name: F / AMQ to6,R Job location:_ Phonn Date 175'4°4 ' g�$,2 S/! ( +/71i Estimator:___�- 1 T-1-1i We hereby submit specifications and estimates for work to be performed and materials to be used: .-'* IA/ C.v¢ �t D,�t>.-ttof-• ,Q rr'� N__a �': to VIA 1li FvflpA) cpiR5 6,u-1 Ni.sisircv 1r15 r ii,I, ma 11144 • `. I ', - . P , .0tr6 N V.0 . O, ' �0S G 7 . Ic. _ art How' ✓R - • .1- 'Mow eft 41. 4 G is v 6t2 ce po l.W u �. /i-l.L- 411-3 Mitj i 14t-s, le "`R ,6r, rim, t' )i5touV, rs. cis ii 'errs art 41.�te.-.'�‘ iiJ r4i-` corv+Pi-e Tt o#J . WORK SC tItiDULI Contra or will not tiv•in the work or order the materials before the third day following the signing of this agtecment.unless specifics)herein. C'ontrt our Will being the work on tr about ' 40&l Raring delay caused by. eirewnstancrs beyond the contractor's control. Thy work will be completed by 1 P (date) the owner hereby acknowledges and agrees that scheduling dates arc approximate and that such delays that arc not avoidable by the('antraslor including but not limited to strikes.Acts of trod. shortages of materials.accidents,and all other Mass beyond the its control.shall not be considered as violations of this Agreement. WAR RAN TY � the contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship fora period of�',"'y—j 4k+wtng 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 diw:oscrcd after completion of any Joh.including clean up.the Contractor stall at its own expense.forthwith remedy.repair,correct,mplace or cause to he remedied, repaired or replaced.such damage or such defect in materials and workmanship The foregoing warranties shall sunrise any inspection performed in connection with the agreed- upon work Props hereby to furnish atcrial_and abor- complete in cordance with above s ifications, for the sum of: is rVa LrtooffiND J+1 oPPRCP 'rvia ' 4 aa,• i P -1_•_ .,__________). am I to he t:a.'Iinl o`'� �Lt__ _ t`+(�_/_ upon%%ming sow:Kt, C„�,. 9150 KUBALA HOME IMPROVEMENT LLC • si( )upon completion of "~ _._ 34 HUBBARD STREET ✓ s'.( upon ctirnpktionof +" LUDLOW, MA 01056 413-589-1010 _%(_ I'�i shau he made forthwith upon e,45 GG MA HIC 207481 compktinn of work under this contract- Acf- Notice:Noag agreement for home amortisement contracting work shall require a down payment Salesperson x lads aster deposit)ofinore than one-third the total contract price or the total amount°fall deposits or payments which the contractor must make,in adsance,to order and or otherwise Authorized Signature: v. obtain delis cry of special order materials and equipment,which eser amount is greater Acceptance of Proposal: i have read both sides of this document and accept the prices.speciiications and conditions stated. i understand that upon signing, this proposal becomes a binding contract. You arc authorized to do the work as specifics. Payment will be made as maimed chose, You the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See notice of cancellation form fur an explanation of this right. Please refer to the Notice or Cancellation that aceonih,rnies this contract:contents of sshich are referred us above and incorporated herein by reference. r1 DO NOT SIGN •TIItS CONTRACT IF THERE;ARE ANY BLANK SPACES S4.Ildture_.._1+F _ _, _ l):,tc_6p/(lfi2q Signature -- — _ ____I)att