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38B-122 . v. m . '.MV.. A & J Home Improvements, Inc. 60 Washington Avenue • South Hadley, MA 01075 . : ., , --"gellailliftl"'-- (413) 323 - 7847 • Fax (413) 323 - 6651 • Cell (413) 575 -1290 ,,, , / � AJHomelmprovement @yahoo.com �;-- i HIC Lic # 135399 • GAF -ELK ID # CE17267 s . t Proposal Submitted To: Phone #'s: i 1 ( i \ Home: Cell: Street: i d L 1 i/ . . t ., ;' fi (: , 4/ �, / . City, State, Zip Code:' , k ( 1 1 ' A x..3 Proposal to furnish and install the following: j F 1 ❑ Re -Roof bear -off ❑ Gutter Complete Roof Pre A/ :� t / ' Com j p Preparation Ul Home exterior to be protected by tarps and plywood 7_ Y. 1 r { 1 i Shrubs, landscaping, trees to be protected t .,A k ; 0 Roofers buggy shall be used where accessible with permission from owner ❑ Entire existing roofing material to be removed to existing decking, including flashing, etc. 14.Site to be cleaned everyday with roll magnet debris removed at project completion (included in price) U' Deteriorated existing decking replaced at 2Q..er sq. ft. -, , ' ( ' ( _ Eil ite/ rown 8 inch metal drip edge installed at eaves and rakes ❑ White /Brown 5 inch for re -roof only Cl1Vew flashing will be installed where necessary / install lead to chimney [Install r1W pipe boot flashing L We shall acquire all appropriate permits etc. for all roofing work Complete Roof System teak Barrier installed at the eaves to protect from ice dams (and meet code in the north) U Barrier installed at all valleys, around penetrations, and chimneys tostotect crit areas Q 15.. - ', • _ o , .: _ .• - • • • z - • _ - ' • • Titanium roof underlayment {h _ Shingles: Ell ELK Prestique® Series "30 Year ❑ Lifetime Color GYGAF ELK ridge cap shingles Warranty ❑'`'We guarantee our workmanship for 10 full years We propose hereby to furnish materials and labor - complete in accordance with above specifications for the sum of: Total Sale Price $ I/, ' C. C Down Payment $ 4- / 4, ( ( Upon Completion $ / ` ` r'a: c ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified. Payment will be 1/3 down upon signing, and balance due upon completion. Unpaid balances shall accrue with interest at 18% per annum. Purchaser(s) will pay for all costs, expenses and reasonable attorney's fees incurred by A & J Home Improvements, Inc. to recover an sums due under this contract. �/ Date: l Signature: j ��`r�.l t Phone #� / " t11 i Date: i': 1 -` /(. Estimator's Signature: ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic, garage or storage areas due to the possibility of roofing debris or dust coming through cracks of the wood. A & J Home Improvements, Inc. will not be responsible for debris or dust in the attic or storage areas. Massachusetts - Dehartninent of Public Saftt, 1 Board,of Building Regulations and Standards. Construction Supervisor Specialty License License: CS SL 101017 Restricted to RF,WS AIIDREW DEREIJ- 396 ROCKRIMMON STREET BELCHERTOWN, MA 01007 %-G- —�--- E xpiration: 11/16/2011 ( onnmk Tr#: 101017 A t/ , 4' " Olfice of Consumer Affairs and 'Ausiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 tome Improvement Contractor Registration Registration: 135399 Type DRA ibb A u r1Jivlt tiviHKUVEMENT ANDREW DEREN 60 WASHINGTON AVE. SO. HADLEY, MA 01075 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card Aug -03 -2010 12:02 PM Remillard Insurance 14135386010 1/1 1E-p!igmtIP CERTIFICATE OF LIABILITY INSURANCE OP ID DM l DATE(MINDDITYYY) I 08/03/10 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 poi[cy(les) 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 NAM 4 1 Remillard Insurance Agcy, Inc PHONE a N Ext): FAX No): 79 Lyman Street A ADDRESS: South Had1 MA 01075 •PItUDUC.r.R _ ey CUSTOMER ID u: AJHOM -1 Phone :413- 538 -7862 Fax:413- 538 -7179 INSURER(S) AFFORDING COVERAGE NAICII INSURED INSURER : Wes tern World Ins . , Co . • A &3 Washi Ho3)tne gton Av Improv e m ents Inc INSURERS: Nation..I anion Jar. in.. co. i 60 So Hadley MA 01075 INSURERC: Safety Insurance Company 39454 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. INS J TYPE OF INSURANCE Autn, yU9P POUCYEFF POLICY EXP LIMITS I INSR WYD POLICY NUMBER (MMIDDA'YYY) (MM,DO,YYYY) GENERAL LUIBILrrY EACH OCCURRENCE I S 1000000 — A X COMMERCIAL GENERAL LIABILITY NPP1260682 04/22/10 04/22/11 p M ISES (Ea occurrence) S 50000 CLAIMS-MADE M OCCUR MED EXP (Any one person) $ 5000 PERSONAL & ADV INJURY $1000000 GENERAL AGGREGATE 32000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG i $ 1000000 POLICY E C n L O C $ I AUTOMOBILE LIAIBUTY COMBINED SINGLE LIMIT S (Ea accident) C ANY AUTO 2432426 11/24/09 11/24/10 BODiLY (Per p S- 25 0 ,000 ALL OWNED AUTOS BODILY INJURY (Per accident) $ 500,000 X SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ 100,000 I $ — NON -OWNED AUTOS $ I _ UMBRELLA UAB I OCCUR EACH OCCURRENCE S EXCESS LIAR r CLAIMS -MADE AGGREGATE $ DEDUCTIBLE I I $ $ RETENTION $ 1 1 f 3 WORKERS COMPENSATION WC003796174 05/11/10 05/11/11 X (TWCSTA4TTU. I E 1 AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERJEXECUTN � YIN E.L. EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? ! ' N I A (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 100000 I If yes, describe under EL DISEASE - POLICY LIMIT 3500000 DESCRIPTION OF OPERATIONS below 1 I ` DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IT more space Is required) 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. 1111!!!!!!!!!; . AUTHORIZED REPRESENTATIVE . 1 8 -2009 ACORD C RPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD „ I"..., :\ The Commonwealth of Massachusetts 'fit _ Department of Industrial Accidents "' — }' Office of Investigations �, - ail w 600 Washington Street "• Boston, MA 02111 - V - ;-:-', —/ ..-1' `' www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 6 0 t.c:) ;\? ..� A. City/State/Zip: r AA 0hi1) Phone #: Lb? 15 Ar an employer? Check the ap box: Type of project (required): 1. U I am a employer with 4. 0 I am a general contractor and I employees (full and/or part- time).* have hired the sub - contractors 6. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub - contractors have 8. 0 Demolition working for me in capacity. employees and have workers' g any p ty 9. 0 Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 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 Pluming repairs or additions myself. [No workers' comp. right of exemption per MGL 12 oof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 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. l Insurance Company Name: A� .1alow) Ohio ✓l Policy # or Self -ins. Lic. #: Lo c. 6037161 I - 7 U Expiration Date: — l I _ I Job Site Address: 1 H (o I U^A :a City/State /Zip: PV ; h HA- C !drt 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 cert under the pains and penalties of perjury that the information provided above is true and correct. Signature: !�� /l / _ `-- Date: ` — 1 _ 1 C) Phone #: C M 1 :.) — (DU 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 Supervisor: Not Applicable ❑ Name of License Holder : Altilisf 0 License Number �( A " 1 p ti 1 Yr'1i"Y!'3A 0 6e) 1f� /t 5 - 11, d ,D i p Address p Expiration Date COO nature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number %j ?-k . .(poz c "-? - I Address �,� _1��, ►►��//, � Expiration Date fW ° ; �"�‹, i > L1 / � � > � : Telephone !'Le /. \ 00 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 47' No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner- occupied Dwellinss 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) J Roofing it Or Doors D Accessory Bldg. ❑ Demolition El New Signs [01 Decks [q Siding [0] Other [0] Brief Description of Proposed _ (� Work: S a iii "; 4, a ly K Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. 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 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, Ai- J r'Jom €_ ,n -OAk , as Owner/ thorized Agent hereby declare that the stdtements and information on the foregoing application are true and accurate, to the best of m , • - and belief. Signed under the pains and penalties of perjury. 14 n 4) OV\ Print Name 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 Side L: R: L: R: 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 /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO 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 © NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability ��� Room 100 Water/Well Availability o Northam>}pton, MA 01060 Two Sets of Structural Plans c g phone 413 -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 i Map Lot Unit L OIt �f'�b f -t- Zone Overlay District Nti .1 '.uw“ POI L1 i L 9 U Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: / 1fR S. 4-e kV\ \ (_0 04 Nfrf— N)hi, Name (Print) Current Mailing Address: Telephone 5 b- (4 qt 7 irti Signature 2.2 Authorized Agent: A LOct ar��� 1 I no)! i t .f 1: Rtw rlf., l .i++rt i G V 1� tip 1� ` 1 r cA Do)? i Name (Pri Current Mailing Address: i,S oh Sig ure Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building I ) (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) t1, t L% Check Number .,,,,23/N 3S This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner /Inspector of Buildings Date 14 COLUMBUS AVE BP- 2011 -0211 GIS #: COMMONWEALTH OF MASSACHUSETTS y ?fau:Block: 38B -122 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP-2011-0211 Project # JS- 2011- 000367 Est. Cost: $11800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: A & J HOME IMPROVEMENT INC 101017 Lot Size(sq. ft.): 3833.28 Owner: STEIN MICHAEL Zoning: URB(l00)/ Applicant: A & J HOME IMPROVEMENT INC AT: 14 COLUMBUS AVE Applicant Address: Phone: Insurance: 60 WASHINGTON AVE (413) 323 -7847 WC SOUTH HADLEYMA01075 ISSUED ON:9/10/2010 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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 9/10/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner