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39A-018 TRAVELERS J� WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: ( 6KUB-9828L1 8-1-08 ) RENEWAL OF (6KUB-81 9X339-5-07 ) INSURER: THE TRAVELERS INDEMNITY COMPANY 1 NCCI CO CODE: 11 347 INSURED: PRODUCER: PRECISION REMODELING INC CHAFFEE HELLIWELL INS P.O. BOX 10432 17 COLLEGE STREET HOLYOKE MA 01041 SOUTH HADLEY MA 01075 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 12 -1 - 08 to 12 - 16 - 09 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA 0 B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: 0 Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: 0 — COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A o -- D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating uy.-- Plans. All required information is subject to verification and change by audit to be made ANNUALLY . DATE OF ISSUE: 01 -06 -09 LP ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: CHAFFEE HELLIWELL INS 28XTC 000120 Precision Remodeling, Inc. Page 3 of 3 Caroline Raisler HIC Registration # 152922 9 Wright Ave., 2nd Floor 413 - 575 -1097 Northampton, MA $150.00 Hang one bedroom door; price does not include the cost of the door itself; price includes adjusting the size of the door to fit the exiting opening. $180.00 Remove existing attic shelves, two sets. $847.00 Installation of laminate countertops and sectional backsplashes, provided by others $400.00 Installation of crown molding (provided by owner) around the tops of all wall cabinets. Materials: Price includes all necessary underpinnings normally required to accomplish the above work. Appliances and major components are included only where specifically listed above. 14. Terms & conditions of work. The owner agrees to grant the contractor reasonable access, which might not necessarily be limited to a typical work day length, to the premises for the purpose of fulfilling his obligations under the contract in a timely and expedient manner. The owner agrees to permit the contractor to make free use of electrical power and water supply as needed to complete the work under this contract. The owner agrees to keep the work area(s) free of superfluous possessions, pets, or persons during each work day and, as needed, between work days. The contractor agrees to accommodate the owner as much as possible, and to bring the work included in this contract to an expeditious and efficient close. 15. Any changes of work from this contract will be by a written "Change of Work Order" which will then become a part of this contract and governed by all above stipulations. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Owner , -.K -, f �::.- . Y D `il 2 ) -L t Owner Date Contractor Date 7/z ?/0 4 (( T i d-e''/ ' . All material is guaranteed to be as specified. All work is to be completed in a professional manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate_ All agreements contingent upon strikes, accidents or delays beyond our control. Terms: Net due upon presentation of bills; past due balances accrue interest at the rate of 1 ' /2% per month; customer will be liable for all attorney and legal fees associated with collection of monies owed to contractor. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. J ember s r° 1 ,,,r. _ EIR REMODELERS Precision Remodeling, Inc. Page 2 of 3 Caroline Raisler • HIC Registration # 152922 9 Wright Ave., 2nd Floor 413 - 575 -1097 Northampton, MA 8. There is no lien or security interest against the owner's property created by this contract. 9. Permits: The permits which are required by this work are plumbing and electrical. It is the obligation of Precision Remodeling, Inc. to obtain the required permit(s) as the owner's agent. Owners who secure their own construction related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. 10. Escrow account: if the contractor deems himself to be insecure he may require as a prerequisite to continuing work that the balance of funds due under the contract be placed in a joint escrow account requiring the signatures of the home improvement contractor and the owner for withdrawal. 11. No work shall begin prior to the signing of the contract and the transmittal to the owner of a copy of the contract. 12. Arbitration: The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 142A. Any such arbitration shall be conducted under the auspices of the Better Business Bureau. Owner Date Contractor Date NOTICE: the signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. 13. Detailed description of work & materials. $4070.00 Cabinet installation (approximately 24 cabinets): Includes dismantling existing cabinets and storage in the cellar, if possible; installation of new cabinets; building out of chimney wall behind to stove; installation of door and drawer pulls. This price does not include the cabinets, drawer pulls, sink, faucet or installation of crown molding. $2318.00 Bathtub installation: Includes the removal of the existing shower stall and wall system; provision and installation of new fiberglass bathtub; reframing of faucet wall to accommodate the new tub; existing shower faucet to remain; resurfacing the shower walls with Swanstone Veritek panels (provided by contractor); installation of plastic window trim in a water tight fashion; connection of the tub drain to the existing piping. (Optional: For installation of a deep lapprox 18 "1 bathtub, add $287.00 to the initial payment). $584.00 Provision and installation of an 18" deep vanity with cultured marble top /sink; the vanity will be 30" wide if space permits; re -use of the existing faucet and drain; installation of sink drain; removal of existing sink and wall shelving. All material is guaranteed to be as specified. All work is to be completed in a professional manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Terms: Net due upon presentation of bills; past due balances accrue interest at the rate of I 1/2% per month; customer will be liable for all attorney and legal fees associated with collection of monies owed to contractor. Owner to carry fire, tomado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. [ r . NAH BBB ressrcY __ _ REMODELERS Precision Remodeling, Inc. Page 1 of 3 Caroline Raisler • HIC Registration # 152922 9 Wright Ave., 2nd Floor 413 - 575 -1097 Northampton, MA Precision Rem oddin Inc. 1. This is a contract executed on 27 September 2009 between: Precision Remodeling, Inc. Home Improvement Contractor 413 -575 -1097 21 Roosevelt Ave. Registration # 152922 413- 315 -6033 fax Holyoke, MA 01040 Federal ID # 04-3317682 and Caroline Raisler 9 Wright Ave., 2 Floor Northampton, MA 01060 2. The work is scheduled to begin on 5 oct 09 and be substantially completed by approximately one week after the delivery of the latest special order material. 3. The work to be done is: Installation of kitchen cabinets (2 floor) and miscellaneous other work. A detailed description is contained in section 13. 4. The total amount to be paid is $8,549.00. Payments shall be made as follows: $3,515.00 upon signing of contract $2,517.00 upon completion of bathroom or kitchen work, whichever occurs first $2,517.00 at substantial completion. 5. Notice: All home improvement contractors and subcontractors shall be registered with the Massachusetts Board of Building Regulations and Standards. Any inquires relating to the registration of contractors or subcontractors should be directed to BBRS, Registration Division, Program Coordinator, One Ashburton Place, Room 1301, Boston, MA 02108; 617 - 727 -3200 ext. 25239. 6. Three day cancellation rights: The owner may cancel this contract within three days of signing it and receive a full and prompt refund of any and all deposits. (MGL c93s48; MGL c140Ds10; MGL c255Ds14) 7. All workmanship will be performed within standard trade practices and is warranted from 1 year from date of completion. All material is guaranteed to be as specified. All work is to be completed in a professional manner according to standard practices. Any alteration or deviation from the above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Terms: Net due upon presentation of bills; past due balances accrue interest at the rate of 1 1/2% per month; customer will be liable for all attorney and legal fees associated with collection of monies owed to contractor. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Worker's Compensation Insurance. ,emu\ ember BR �� NM '') / BBB 4 / REMODE LERS HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations The inspection.processit_quires that the building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits -in conj.unction.to_thehuildi L permit.issued,_ and _that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. - Date Address of work location The Commonwealth of Massachusetts — � - �_ Department of Industrial Accidents • T Office of Investigations • 600 Washington Street Boston, MA 02111 �� www.mass gov /dia • - Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumb.ers. Applicant Information Please Print LegibIv Name ( Business tOrganization /Individmd): c i ? i vn Aevu od , e 1 rL i t Address: Z ( 1 - City /State /Zip: 14-1/y d ) °N11° Phone -m: 4P3 3 - S / o 4 5 Are you an employer? Check the appropriate box: Type of protect (required): 1. I am a employer with Z-- 4.. Q I am a general contractor and I have hired the sub- contractors 6. Q New construction employees (full and/or part- time). * 2. 0 I am a sole proprietor or partner- listed on the attached sheet. 7. c3'Remodeling ship' and have no P-loy ees These sub - contractors have. g_ Q Demolition for me in any capacity. employees and have workers' working Y P ty. $ 9 Q 1311111i f: addition [No workers' comp. insurance comp. Insurance. required.] 5. Q We are a corporation and its 10.0 Electrical repairs or additions 3. Q I- am- a- homeowner- doing - all -worlc — ofric= have xeercasc_dhheir _— 1.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof 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 trout 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. ZContractors that check this box must arf rhed 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. Ian: an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Te 2v e ( . erc Policy # or Self -ins. Lic. #: CP f( Lit? - F23 L / 8 ' t OgExpiration Date: 1 2// 6 f'c P Job Site Address 9 dt/r.:s (( f City /State /Zip: i vvrv-'1t �'ur�p��,� 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 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. e advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverane verification. I do_hereby certify under the . ains and penoftips of perjury that the information provided above_is_true_atid correct _.__ _ Si • . ature: Rea .L _ . Date: lv (S 0 Phone #: iO3 ' `S �`S - /0, Official use only. Do not write in this area, - 10 be completed by city of town offdaL City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectrical Ins.ector 5. Plumbing Ins.ector 6. Other Contact Person: Phone #: 4 0# SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ►/ J Not Applicable El Name of License Holder : �P� > � �T " CS 8,e 74 License Number 21 R.,oseve /f v �� 90 i (A,/ <p Address Expiration te ‘t13 /0 Signature Telephone 9. Registered Rome improvement Co traeta�;� d a . r Not Applicable ❑ r - ; . Vr. vd e it c. 51? Company Name , / Registration Number 1 - i+2a os e ve. � / /7"`*�- /o/ / y / Address / Expiration Date ,6 O ,e # 604 0 (0 1710 Telephon 3 S ?j - /01 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 rk No ❑ n.i:-.4moni6oittietziwittotion The..current_exemption for "homeowners" extended to include Owner occupied Dwellings 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 NoithampfonTrdinai eS; Staate and° ooai`2 - c ring= taws - and -" state of- Massaehusetts- General- Laws - Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ 1 Addition n Replacement Windows Alteration(s) © Roofing ❑ Or Doors 0 • Accessory Bldg. ❑ I Demolition ❑ I New Signs [01 Decks [J Siding [O) Other [0] Brief Description of Proposed Work: T.►s4a// new 1<i4 attii Ergo -)r ' ,ea i,xl -lc 4 Alteration of existing bedroom Yes /C No Adding new bedroom Yes C No Attached Narrative Renovating unfinished basement Yes IBC' No Plans Attached Roll - Sheet BaA Ne kOitttase4iti t a ditia to :xistii ti triAttiti;tto iiiite tiie otfaaKir q: 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, /( nb ptr + (.,t vl T Pr , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name / 6et 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 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 () YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES 0 IF YES: enter Book Page and/or Document if B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW (3 YES (3 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed Ch to or addi signsinteriB6d for the property ? YES NO (31 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 0 NO 6") IF YES, then a Northampton Storm Water Management Permit from the DPW is required , r -4.',4-Vg:04,e4f;'''''':Et4atttr.iiii,Wt*OtitYtttgle4atAgtil • • City of Northampton Sfatusa'ei6ce F Building Department C l?r 1. 40 ; � 212 Main Street s e ye / h i n , 1 � { "� �� : Room 100 Waferelt �uoatar F -, Northampton, MA 01060 Trn Se E;S S .. ctitia�Fart� � °,� ' L. A 4 , r 4,4,-, r'. .. . A A 7 co-7 4 n„ s t „ , r � � .', 'el �." �y 1'' pi one `tfJ- VD / - -1LYV f Q.141J-�1VI-1 � �I t �taFI.7^ �` »�rm �t,, �� APPLICATION TO CONSTRUCT. ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION J 1.1 Property Address: This section to be completed by office 9 We 1`3ht JJ `"e- Map Lot Unit Ric, "41 au( To h, aft l Zo Overlay District Elm:St. District CB District I SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT • 2.1 Owner of Record: - ar - ISkT - o1 , -4 =, ' P`i -- — --( at0 0 Au'R.i No! NuAl t►111 / "✓l / 444 Name (Print) Current Mailing Add ss: y/3 — 3 2 0 - 7-4 lo / Telephone Signature 2.2 Authorized Agent: ieQbPo f 4( N ✓ ?o ?x /o'/32 ii, ( A o/ °`f NamePri Current Mailing Address: '{r3 --5 ;Z$ - 109 7 Signature Telephone SECTION 3 - .ESTIMATED CONSTRUCTION COSTS '' Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 4( .f7 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of m /000 Construction from (6) 3. Plumbing Building Permit Fee 30 J a 4. Mechanical (HVAC) 5. Fire Protection _ 6. Total = (1 + 2 + 3 + 4 + 5) 0 Check Number s � ∎∎ ■ ` This Section For Official Use Only Date Building. Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date File # BP- 2010 -0411 APPLICANT /CONTACT PERSON ROBERT HUNTER ADDRESS /PHONE P O BOX 10432 HOLYOKE (413) 575 -1097 PROPERTY LOCATION 9 WRIGHT AVE MAP 39A PARCEL 018 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ��/ Fee Paid 3P/ COU � Typeof Construction:_INSTALL KITCHEN CABINETS & NEW TUB New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 88742 3 sets of Plans / Plot Plan TH F ,LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pp roved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay ---- ----: // /m. Jo t' Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information.