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CT. REG. NO 0621848 VISTA HOME IMPROVEMENT
MA REG. NO. 162058 1346 Elm Street -
- , ; : ,, :
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West Springfield, MA 01089 ; ,,,, ,,,,; INSULATION
Toll Free: 1-888-597-2323 • Local: 413-382-0249
FAX: 413-382-0241
NNW
Proposal Submitted To Homeowner Work To Be Performed At
Name 4 1:" : --,° ,: "i'''''' ''''' - - ' ''''' 1 ° Street ..._
-; -
Street ..., - " ' City State
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City , - ' _ '_ State ' —, Date of Plans
Date Telephone .
We hereby submit specifications and estimates for:
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Date work will start _ Date work will be completed ' -
,...—.............,
All material is guaranteed to be as specified. At work to be completed in a workmanlike mannet accorded to standard practices Any alteration or deviation Imre the
above specifications must be made in vyriting on an Add of Contract form and may becorne an extra charge Over and above the amount stated herein.
This agreement is contingent upon delays oeyond our control Owners to carry fire, tornado and other necessary insurance. Our workers are fully covered by
Workmen's Cornpensation Insurance. Homeowner agrees to pay for at work as set forth below. If the homeowner defaults, horneowner agrees to pay at costs of col-
lection, including reasonable attorneys fees. in addition to other damages incurred by contractor. An 18% per month service charge will be assessed for all payments
not made within 10 days of due date per the schedule below:
IDE propoce hereby to furnisn material and labor - complete in accordance with the above specifitations, for the sum of:
r°. „.
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, ..
Said amount shall be paid as follows:
Note: This proposal may be withdrawn by us if not accepted within days.
YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE
DAY OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. (SATURDAY
IS A LEGAL BUSINESS DAY IN CONNECTICUT.) THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES
ACT AND THE HOME IMPROVEMENT ACT. THIS INSTRUMENT 1$ NOT NEGOTIABLE.
Signature of Contractor or authorized representative:
'
*(IANe) 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, .
, .
, .
Signature of Homeowner(s): X___ ..-..-. , X •
ROM :WM .1 MIS INS FAX NO. :4135729191 May. 07 2012 03:46PM P1
CERTIFICATE OF LIABILITY INSURANCE DATE (ttNO patYYYY)
05/07/2012
THIS CERTIFICATE IS ISSUED AB 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 NY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT DETWE6N THE ISSUING IN1URtxR(3), AUTHQRIIEO
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
AAP • • TANT; I the certt 'Gate 0 • or la an T•T. , • L 'c: 1 • • I a pa • n must rm.. : t: ..T i N , Tr• i, au so to
thG terms and conditions of trio popsy, esrta t pottage* may require an endorsement. A statement on title certlEcets does not confer rtOhts to the
certificate holder In Ilau of such andoraan)aht(a).
WI LLIAM' J M28 INSURANCE AGENCY L Ctarr WILLIAM MIS
156 3 ST NL, Ertl; 413 b6B - e111 1 ,, a13- s�2 - g� _ „
usaRtee: EILLQBII,IMTSINSURANCB . C:f71d
TJE tT9ISLD, MA. 01095 PR000t R auerauea
WWII At Ammo CWT,RAea NA C I
I rUrreo INalmW A ARB18LI,A, PROTECTION
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MINIM iLIE RTY Mtr2OAL
VISTA nom instRovEmenT faeuRrdrer
1346 ELM ST
IMMIX a s
WEST SPRINGFIELD MA 01009 IrIURInef
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER
THIS IS TO r.SRii •CHAT THE liOLICIES OF 1NSURAN6E LISTED SKL0W NAVE SEEN I3sUE0 TO THE mates NAMED Aa0va Pon THE POLICY PuZIOb
INDIGATV). NOTWITHSTANDING, ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT ON OYHEtt DOCUMENT Wrrn RESPSC TO WHICH TH)5
CERTIFICATE MAY BE ISSUE° OR MAY PERTAIN, THE INSURANCE AFFORDS° SY THE POLICIES oescreseo HERSIN 15 SIALACT TO Al I, THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY I•IAVC OEON RCOUCED CY PAID CLAIMS.
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CERTIFICATE HOLDER CANCELLATION
SA BRICO LLC, DEA
V79TA ROW IsIPB ITt NT SHODU3 ANY OF THE AWN 0880818110 P000I88 de CANCELLED woes
Tee wane T10 $ DATE THEREOF, NOTICE V U. 8B DEW&Res IN
1346 ELM ST ACCOROANC5 W TH THE POLICY PROVIS4ON9,
W SPRINGFIELD MA 010$9 - ,.. - ... -.,.
FUT • ,ilfa 11 . _,I
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ACOMD 25 (2009/09) The ACORD name and logo are registered m of ACONO
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :f)Y1 ' ° \\ \ DQ ' 3 L
License Number
er
e` � c A- 11 ` I S_
Address Expirati n Da
Signature r� Telephone
VIM
� 9. / Registered Home Improve nt Contractor: Not Applicable ❑
V 6- ck \'? `( VI) (ft (j`Y\sP \ 430 :7
Company Name Registration Number
Address Expir tion Datb
Telephone 3 -- -1/
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 I No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was 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
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) Roofing
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [0 Siding [❑] Other [❑]
Brief Description of P oposed 5 ` S� ■ \g Z5 \" \ Y19 *S S c -s - e- 5 �Q a- \ y r C \ 1
Work:.► ' _. \ "4- L ` v :,rti ta 0 71?
Alteration of existing bedroom Yes No Adding new bedroom Yes No
loN 5\n ly
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
6a. 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
1, �" \ \(\�'.\(\ £'-C , as Owner of the subject
property (� \
hereby authorize (� > \ (� `CN K J (\ --- C \ �7 { `t \e (� (�l/ nkek 1 *
to act on my behalf, in all matters relative to work authorized by this building permit application.
Cam \ \A-Ae-A -- ( 1
Signature of Owner Date
- \Q61\ �\; U J ' � \ W : —`n(Ny rak 6 I T , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application ar true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of erjury.
ckvA v C�
Print N4 _
Signature of 0 . - /gent � � 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 DON'T KNOW 4,4 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and /or Document #
(7 B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained ,Date Issued:
C. Do any signs exist on the property? YES ® NO i]
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 4
IF YES, describe size, type and location: ,
E. Will the construction activity disturb (clearing, grading, ex avation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
wi t . 013 j Building Department Curb Cut/Driveway Permit
1 � 212 Main Street Sewer /Septic Availability
t N y Room 100 Water/Well Availability
DEPT. OF s oEU • rthampton, MA 01060 Two Sets of Structural Plans
NORTHAMPTON M^
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
3 / � 5 AN\ � Map Lot Unit
c)`C T`' G� Pt\? A-CX -) 01 ' Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
�v 1 V.E2
Name (Print) C rrent M a to essp"
S C.3 v)�rac* Telephone Lph .' t
l `i 9
Signature
2.2 Authorized Agent:
` 3V . A COI v — - ( ? E m 5 -1- w - Sprld
Name (Print) Current Mailing Address:
.�„ A
'. nature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ES 9 q (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) ,5 q f / Check Number .3; q g
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
372 SOUTH ST BP- 2013 -0812
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C - 055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2013 -0812
Project # JS- 2013- 001392
Est. Cost: $5999.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VISTA HOME IMPROVEMENT 106156
Lot Size(sq. ft.): 6011.28 Owner: FERNANDES RUI
Zoning: URB(100)/ Applicant: VISTA HOME IMPROVEMENT
AT: 372 SOUTH ST
Applicant Address: Phone: Insurance:
1346 ELM ST (413) 382 -0249 WC
WEST SPRINGFIELDMA01089 ISSUED ON:
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 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
372 SOUTH ST BP-2013-0812
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C - 055 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2013 -0812
Project # JS- 2013- 001392
Est. Cost: $5999.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VISTA HOME IMPROVEMENT 106156
Lot Size(sq. ft.): 6011.28 Owner: FERNANDES RUI
Zoning: URB(100)/ Applicant: VISTA HOME IMPROVEMENT
AT: 372 SOUTH ST
Applicant Address: Phone: Insurance:
1346 ELM ST (413) 382 -0249 WC
WEST SPRINGFIELDMA01089 ISSUED ON:
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 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner