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29-186 (6) BP-2023-0801 126 DEERFIELD DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 29-186-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0801 PERMISSION'S HEREBY GRANTED TO: Project# windows 2023 Contractor: License: Est. Cost: 10402 BRIAN RUDD 111478 Const.Class: Exp.Date: 01/21/20 5 Use Group: Owner: F TOR EY WAYNE P&HELEN Lot Size (sq.ft.) Zoning: WSP Applicant: SAMB ICO/VISTA HOME IMPROVEMENT Applicant Address Phone: Insurance: 175 COYOTE CIRCLE (413)382-0249 FEEDING HILLS, MA 01030 ISSUED ON: 06/21/2023 TO PERFORM THE FOLLOWING WORK: 4 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: 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 NO HAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: )2 . 5119Jarif Fees Paid: S71.50 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissisner v� m Izv °o c.. m F C (} The Commonwealth of Massachusetts oz _, Board of Building Regulations and Standards FOR z G7 ij rn Massachusetts State Building Code, 780 CMR MUNICIPALITY N USE m ?, Ill !ding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 o 0 One-or Two-Family Dwelling z This Section For Official Use Only !Building Permit Number: _OP- ;03- •g(II Date Ap lied: I 1 i '' 'I . I I'.. Building Official(Print Name) i Signature / Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers taco Deerfi tid Or F1oNTneerrft c ota 1.1a Is this an accepted street?yes )0 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) 1 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? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2,1 Owner'of Record: rr-N Y io n-' q'vi o-en ( c r€nC€t 'lees (l CJ- a Name(Print) J City,State,ZIP a() (-)PPrFif A Or. c(-‘13)S ST)(?) No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building1 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: ief Description of Proposed Work': c2.enn.pu-� 14 reDiQ + \'i(jc . ckce i i-n 4 rP ci(tmeal wi c Oc 1 .Ut c Sic)ti 00 r- no str ttxCU c � an t SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ `t3yQ 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire j Suppression) $ Total All Fees: $ ^i St Check No.add It Check Amount! 1 ` Cash Amount: 6. Total Project Cost: $ (0LA 0 ❑Paid in Full 0 Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I I I t ,1Q ' 12 , I ZS e,.,on q u d a License Number Expiration Date Name of CSL Holder 1 A O()1 Pvedcx -e c--1-, , List CSL Type (see below) V1 No.and Street Type Description 'Nf Q�� �/►4 '('�bq U Unres000cu.ft.) W1 ►,rJ �� R RtriCity/Town,Staçxt ,ZIP ) M Masonry RC Roofing Covering WS(vl ► 3) ;,�fp ON i tG.sncrot SF Window and Siding SF Solid Fuel Burning Appliances N 0' 2 31 ► -vc-nprt,/ecrSSA-,CQc I Insulation Telephone Email address D Demolition 5.2 egistered� `Hoome Imrov�,emment Contractor(HIC) % (0r�o 5 Q 2 11 '2 S I 1`.I ' Y�v`cd HIC Registration Numbers Expiration Date HIC aNampp; Re traNam a10 rr-( v `MGH 1 nfoPvi Si tftm-e itn `o�ni� . No.And et ( 4 1 3) 1 Email address C�`(Y1 tx � ►nCfiec11cnc ()lobe' 3►o - (a‘ City/Town,State, Telephone I 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 Issu e of the building permit. Signed Affidavit Attached? Yes No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLLIES FOR BUILDING PERMIT _ AP 1 / I,as Owner of the subject property,hereby authorize t .1C 0 L-`,(j to act on my behalf,in all matters relative to work authorized by this building permit application. See 1bn-AvckCt cob utia 3 Print Owner's Name(Electronic 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 best of my knowledge and understanding. Ni �.N ,� Pyon I',9/ 1uI a3 Print Owner's or Authorized Agent's Name(Electronic Signature) 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.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" City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ''l!-h, 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. Nic\ -kc Y ern c€ CleOree f Ors }Y-f) jU'i 1e anc c i Sccce in c A ' c&ge(ducylc cam( �� Ste �� On The debris will be disposed of in: Location of Facility: .Oq1 P\\1e. kCA . \VeSk 1` c§- e\c) me Ct O`C) The debris will be transported by: Name of Hauler: v 1 Si-CA (:)me _Ly- npccx c n.en+ Signature of Applicant: Date: f /((-4 The Commonwealth of Massachusetts 1 Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 4 ti www ntass.gou/dia 1l urkers'Compensation Imurance Affidavit:BullderslContractors Electricians''Plumbers. TO BE FILED WITH THE PEIiMI'r'1'INf;AI THORIT . Annlicaot Information Please Print Legit* Name iBusitacsa(kgantnttonrtndividual): 9Ci t C 0 PLC Address: 3 Vq 1 P'VL (C C 1€ City/State/Zip: +Sari ng i e►CJ ME) 0 !r hone#: u 3 r 3 C 31 Are yen-eir ptoyer?Cheek the rpPtrpriate bac Type of project(required): 1.0I am a employer with--_____.___employ(full andior part-time/..* 7. D New construct ion 21:3 l am a sole paoprietnr or partnership and have no employe winking for air in B. , any c'aF i-[No workers'crew.iaaan ere required" . p Remodeling 30 l am a homeowner duing all weak myself [No workers'comp-insurance ate_]` 9. ❑Demolition 4.0I am a homeowner and will be hiring inontractins to conduct all work on my property_ I will l0 Q Building addition maitre that all cuturacturs either have*utters'cvmprs cation insurance urance or are role 1 ILO Electrical repairs or additions proprietors with nu employees. 12.0 Plumbing repairs or additions 311 lam a general contractor and I have hired the sub-contractor listed on the attached sheet 130 Roof repairs These sab-cantractors have employees and have workers'comp.insurance.: 6.®We a a collimation and its officers have exercised triter right of exemption per NIGL c. t4. air .ctQceien are 132,$104),and we have rio employees.[No workers'wrap_insurance required.] 't ► to 14 InCk *Any applicau that checks box it l must also fdl out the section below showing their workers'compensation policy i>ormatu e. Hurnwwsrn who submit this affidavit indicating they are doing all work and then hire outside auntracton new submit a new affidavit indicating such. (Contractors that chest this box tarot attahal an additional sheet showing the name of the sub-cormacturs and slate whether or not those entities have employees_ If die sub•cwWactun have employees_they mint provide their workers'wrap.policy number. I am an employer that is providing workers'compensation insurance for try a ipIoyees. Below is the policy and job site Information. Insurance Company Name: Policy#or Self-ins.Lie. ''#rr:ll . Expiration Date: �^� Job Site Address: 1 DeerF(�1�t� O . City+State/Zip: Or€nCett t-/\�-{�o Attach a copy of the workers'compensation 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 tine 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 under the pains and penalties of petjuty that the information prodded above ist true and correct. f/,��/ Date: )I l C4 l ate) Phone#: 3 Official use only. Do not write in this area,to be completed by city or town of)kiiaL 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#: ®� Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Re ulations and Standards Constctk oI TS (visor CS-111478 ee1111111111,,, i ii4pires:01/21/2025 BRIAN RUDE "'C Aft 2097 RIVERDALE:S' 'i . WEST SPRIN4F1 4'013,vd11D • f THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration d # Type LLC C Registration: 162058 SAMBRICO LLC "; Expiration. 01/02/2025 D/B/A VISTA HOME IMPROVEMENT 2097 RIVERDALE ST _ WEST SPRINGFIELD, MA 01089 Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 162058 01/02/2025 Boston, MA 02118 \MBRICO LLC 'B/A VISTA HOME IMPROVEMENT / �IAN RUDD 197 RIVERDALE ST �� sY - ll,�l �� IC 1 V EST SPRINGFIELD,MA 01089 l lnriarcanratary hint valid without cinnaturp A[�nR/?6 [DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T 7IFICATE 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 have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT NAME: SOUTHWICK INS AGENCY INC PHONE 'FAX P O BOX 100 (NC,No,Ext): (NC,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2097 RIVERDALE STREET INSURER E: WEST SPRINGFIELD,MA 01089 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 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. INSR ADDL3UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM\DDIYYYY) (MM1DD1YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ .- CLAIMS MADE E OCCUR. DAMAGE TO RENTED $ - PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY '$ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL I - $ . AGGREGATnPROJECT nLOC E POLICY PRODUCTS-COMP/OP AGG '$ '$ AUTOMOBILE LIABILITY COMBINED SINGLE $ - ANY AUTO LIMIT(Ea accident) ■ OWNED SCHEDULE AUTOS BODILY INJURY $ AUTOS ONLY (Per person) — BODILY INJURY 1$ I HIRED NON-OWNEDAUTOS ONLY (Per accident) AUTOS ONLY PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB I I OCCUR EACH OCCURRENCE $ . EXCESS LIAB emu( CLAIMS-MADE AGGREGATE I$ - DED LIRETENTION $ 1,s WORKER'S COMPENSATION AND PER OTHER EMPLOYER'S LIABILITY STATUTE UB-2E072183-23 03/12/2023 03/12/2024 ANY PROPERITOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) a N/A E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SAMBRICO LLC DBA VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 2097 RIVERDALE STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WEST SPRINGFIELD,MA 01089 ACORD 25(2016/03)(Rev.09-18) The ACORD name and logo are registered marks of ACORD 1988- 15 ACORD ORPORATION. rights reserved. 'J, AcoRI) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/01/2022 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). PRODUCER CONTACT WM MIS NAME: WILLIAM MISS INSURANCE AGENT PHONE (41 )568-6111 FAX (4'3'-'2-`' '1Ao.Ex : _lAC._o: 156 ELM STREET ADDRESS: BILL BILLMISINSURANCE.COM WESTFIELD, MAO^085 INSURER(S)AFFORDING COVERAGE NAICN __ INSURER A: NAUTILASINS 66915 INSURED INSURER B: SAMBRICONISTA HOME IMPROVEMENT INSURER C: INSURER D: 2097 RIVERDALE RD INSURER E WEST SPRINGFIELD,MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: -HIS 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. INSR ADDL SUM� TYPE OF INSURANCE POLICY EFF POLICY EXP LTR'� INSR WVD POLICY NUMBER (MMIDD/YYYV) {MM/pD/YYYV) LIMITS I GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE X I OCCUR MED EXP(Any one person) $ 5,000 I i X G3679203 08/02/2022 08/02/2023 PERSONAL s ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: °RODUCTS-COMP/OP AGG $ 2,000,000 POLICY C X LOC $ .1F �FCr AUTOMOBILE LIABILITY 1 COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accdenl $ 1AUTOS AUTOS 1 HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS 1 Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'UABIUTY YIN j - -_..-.TORY UMITS i ER ANY PROPRIETOR/PARTNER/EXECUTIVE ( EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 1 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,desenbe under _ DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY OMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE 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 /)'^J A........ "62_....."--, ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights resenra.d. The ACORD name and logo are registered marks of ACORD A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ DP'Y Y) 022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 4O 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 have ADDITIONAL INSURED provisions or 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). PRODUCER CCOONNTACT David R Jarry Neill&Neill Insurance Agency Inc PHONE 413-732-4137 FAX 413-731-6629 662 Riverdale Street INC.No.Ext): (NC,No): West Springfield, MA 01089 ADDRESS, dj@ne Ilandneill.com INSURER(S)AFFORDING COVERAGE NAIL N INSURER A: Western World Insurance Co. 13196 INSURED New England Home Improvement INSURER B: Chubb Insurance Co CHU 43 Booth Road INSURERC: Enfield,CT 06082 INSURER D: 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EF POLICY EXP W LIMITS LTR INSD VD POLICY NUMBER (MMIDD/YYYY) (MM/DDIYYYY) A V COMMERCIAL GENERAL LIABILITY NPP8875448 05/26/2022 05/26/2023 EACH OCCURRENCE $ 300,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 600,000 VI POLICY PRO 300,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S62UB-9F68699-6 05/06/2022 05/06/2023 V PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 1-7 E.L.I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Emailed to:cassied@vhimail.com CERTIFICATE HOLDER CANCELLATION VISTA HOME IMPROVEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2097 RIVERDALE STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST SPRINGFIELD, MA 01089 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 12 2097 Riverdale Street MA Lic# 162058 West Springfield, MA 01089 CT Lic#0621848 <1' Vista = PLATINtIM 'RACT C vistahomeim rovement.com - f'2hFlRRFI (1NlI)R Phone: 888.597.2323 HOME IMPROVEMENT P Fax: 413.382.0241 Nor'Easter Window Contract Customer Information Wayne Torrey (413)586-5778 Date: 06/08/2023 Helen Torrey telehelen@aol.com Rep: Mark Quiterio 126 Deerfield Dr Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: 617.973.8700 The following windows will be installed by Vista Home Improvement Total number of windows in the home 4 Total number of windows being installed 4 Total number of patio doors being installed 0 Nor'Easter Windows Nor'Easter Basement Windows - Double Pane Location Basement Window Number 101 jIMMIII7Size 30 x 13 Interior White Exterior White Screen Full Screen Color of Wrap aspen white Nor'Easter Picture Window - Double Pane Location Living Room Size 46 x 52 Interior White Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Double Pane Location Living Room Size 22 x 52 Hardware White Locks Interior White Exterior White Screen Half Screen Color of Wrap aspen white Nor'Easter Double Hung - Double Pane Location Living Room Size 22 x 52 Hardware White Locks Interior White J Exterior White Screen Half Screen Color of Wrap aspen white Page 5 of 12 2097 Riverdale Street MA License # 162058 West Springfield, MA 01089 CT License# 0621848 Phone: 888.597.2323 VistaP LAT! NUM Fax: 413.382.0241 HOME IMPROVEMENT liP N:..e IRrFFRRED CONTRACTOR vistahomeimprovement.com ENTRY DOOR CONTRACT Customer Information Wayne Torrey (413)586-5778 Date: 06/08/2023 Helen Torrey telehelen@aol.com Rep: Mark Quiterio 126 Deerfield Dr Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: 617.973.8700 ProVia Entry Door �«. Superview 899 Self-Storing -36"x 80"Standard Size Quantity -Café Cream -Standard Z-Bar -Pre-Hung -Color Matched Leaf Hinge -Hinge on Left(Viewed from Outside) -1"Color Matched Bottom Expander -Black Pull Handle with Closer(DH182) 10173377 -Black Closer Included with Handle -Clear Glass } -Bottom Screen with BetterVue Screen Mesh � 1 Inside View Outside View Door Location Front door Door Fees Lead Fee 1 Additional Details Do Not Do (We do not do any painting or staining) Page 6 of 12 LEAD-SAFE PRE-RENOVATION FORM Occupant Confirmation Pamphlet Receipt Q I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before the work began. t/PY/Liti_. -rilea4-A7- Owner-occupant: Wayne Torrey 06/08/2023 Date Renovator's Self Certification Option (for tenant-occupied dwellings only) Instructions to Renovator: If the lead hazard information pamphlet was delivered but a tenant signature was not obtainable, you may check the appropriate box below. ❑ Declined - I certify that I have made a good faith effort to deliver the lead hazard information pamphlet ❑ Unavailable for signature -I certify that I have made a good faith effort to deliver the lead hazard information pamphlet to the rental dwelling unit listed below and that the occupant was unavailable to sign the confirmation of receipt. I further certify that I have left a copy of the pamphlet at the unit by sliding it under the door or by(fill in how pamphlet was left). Person Certifying Delivery Mark Quiterio 06/08/2023 Date Unit Address 126 Deerfield Dr Florence MA 01062 Note Regarding Mailing Option — As an alternative to delivery in person, you may mail the lead hazard information pamphlet to the owner and/or tenant. Pamphlet must be mailed at least seven days before renovation. Mailing must be documented by a certificate of mailing from the post office. , I, Wayne Torrey,Helen Torrey have read the terms stated herein, they have been explained to (me/us), and (I/We)find them to be satisfactory and hereby accept them. Page 8 of 12 Homeowner's Association NO 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 07/23/2023 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 08/10/2023 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below 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 own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired or replaced, such damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With -- Kevin Date Measure Is set for 06/12/2023 2 hour window Measure is set for Between 10 - 12 Total Contract Amount (All Discounts Applied) $10,402.00 Payment Amount Due Upon Signing Contract(1/3 Maximum) $3,467.00 Amount Due At Start $3,467.00 Amount Due Upon Completion $3,468.00 Form of Payment Upon Signing Credit Card Credit card XXXX-XXXX-XXXX-9541 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 if 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 below contents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. NOTICE OF CANCELLATION This space intentionally left bl.nk Page 9 of 12 YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY YOU MAY CANCEL THIS TRANSACTION, WITHOUT ANY PENALTY OR OBLIGATION;WITHIN THREE BUSINESS DAYS FROM THE OR OBLIGATION; WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. ABOVE DATE. IF YOU CANCEL, ANY PROPERTY TRADED IN,ANY PAYMENTS IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE NEGOTIABLE INSTRUMENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY BY THE SELLER OF YOUR CANCELLATION NOTICE,AND ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE CANCELLED. BE CANCELLED. TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO:VISTA OTHER WRITTEN NOTICE, OR SEND A TELEGRAM TO: VISTA HOME IMPROVEMENT, 2097 RIVERDALE STREET WEST HOME IMPROVEMENT, 2097 RIVERDALE STREET WEST SPRINGFIELD, MA 01089 NOT LATER THAN MIDNIGHT OF THE SPRINGFIELD, MA 01089 NOT LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM 06/08/2023 THIRD BUSINESS DAY FROM 06/08/2023 Vista Home Improvement Vista Home Improvement 2097 Riverdale Street 2097 Riverdale Street West Springfield, MA 01089 West Springfield, MA 01089 NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM NO LATER THAN MIDNIGHT OF THE THIRD BUSINESS DAY FROM THE DATE OF THIS CONTRACT. THE DATE OF THIS CONTRACT. I HEREBY CANCEL THIS CONTRACT. I HEREBY CANCEL THIS CONTRACT. BUYER'S SIGNATURE DATE: BUYER'S SIGNATURE DATE: Buyer(s) Acknowledge Receipt of the Cancellation Notice 1/1/G1Apt4a • 7---Vr- /11-i-e"1"" Wayne Torrey Helen Torrey 06/08/2023 06/08/20.3 Date Date This space intentionally left bi. k Page 12 of 12 Contractor, under provisions of Chapter 142A of the Massachusetts General Laws, is required to apply for and obtain all construction related permits. Contractor shall not be deemed responsible for delays in the work described in this agreement caused by regulator, permit granting or inspectional agencies, authorities or individuals. NOTICE: If Owner obtains his/her own construction related-permits for the work described under this Agreement, Owner is hereby advised that in the event of a dispute,judgment and non payment of Contractor, Owner will not be entitled to make claim to or collection from the guaranty fund established in M.G.L. c. 142A. Modification: This Agreement, except as to concealed conditions or delays occasioned thereby or by restarts, cannot be changed except by a written statement signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation. Owner hereby grants Contractor a limited Power of Attorney to complete incomplete documents on Owners behalf. Completeness of Contract for Execution: Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. CA7P-Or‘e_/63 • -----rfril-,- - Aler"/d4"A44,-- Wayne Torrey ®® Helen Torrey 06/08/2023 06/08/2023 Date Date • / / - Mark Quiterio Authorized Representative 06/08/2023 Date This space intentionally left blank