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23D-004 (4) Page No. of Pages Vropo5at CT.REG.NO. 0621848 VISTA HOME IMPROVEMENT COLOR WIDTH MA REG.NO. 162058 2003 Riverdale Street West Springfield, MA 01089 INSULATION Toll Free: 1-888-597-2323 • Local: 413-382-0249 FAX: 413-382-0241 Proposal Submitted To Homeowner Work To Be Performed At 1 Name G(S 6 - 214 C H (._.- f3p4.1Z.i .-- Street Street I X c). 4j"T'v C '< Ifl City `; !� State ` City F1 'E N C C m Stat+ >f/ (i / 0 h?- Date of Plans Date 9 Z.' / ) Telephone 6/t) 't 1-2..-- r , -, ,7 4 2 7 i f. } We bpreby submit speci cations and estimates for: Rt P 'r ( OP Ar l c ) 144 is o f t 1'4 I r(/ ;�41; ip / !IA/X.1W t) i) ciA t)j/ f v % /9t 0A,6 11 ,a 4/i / 44 C cc J\. _S , ` 1 .4-. ...../ -,3 e* CAAl z ..,_ �� Rif`%/ pi% 7i! l-N/fVe it ,1: /9t.._ A. _'1 'C 1c... , , A► r, / AL, r! 1L._/ ' e tr A. .. /'per 114 -..ITN I Ali ( M -'; ;) 11.A '/rte 1'W/ 7/'a' _ ('y Mmii(/ ' - coq �(�� .q--� 'y rte, ry�� ( , tN J 1 I 2--• I\,147) .z)� z T'") .. L _ 1-04! JAI c 'r, Y cn- mac'A 44 r L -\ 1 " E ft t _� - , i , J7 . — G.Aa_ ., _ :. it ?. E,� T?' 71_ ,C1' r 1—, 14444)441 t1/1` 1 1 Date work will start Date work will be completed - "_ , All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. .,111;1 This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workmen's Compensation Insurance.Homeowner agrees to pay for all work as set forth below.If the homeowner defaults,homeowner agrees to pay all 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: i We propOSC hereby to furnish material and labor-complete in accordance with the above specificati ns,for um of: Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within days.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 i 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 1NST- ENT IS NOT NEG• :BLE. s -,Signature of Contractor or authorized representative: X1,7. �j F '(1/We)have read the terms stated herein,they have•een explained tot(m= us),and(I/We)find them to a4isf eby accept them. i a - Signature of Homeowner(s): X `. A The Commonwealth of Massachusetts ,.Ai----" Department of Industrial Accidents 4� Office of Investigations -`,-4 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name f Business!Organi7etion'individuall: JCt 0. e A ro p me Y\"4_ Addressa00' \�� rmiC'-t�t° . �--'f "\--- "_ City/State/Zip: Phone +;`: 3 ,9—, `fy _ _ _____ Are you an employer?Check t'1 a appropriate box: Type of project(required): 1 1.`T 1 am a employer with ? 4. Li 1 am a general contractor and i employees(full and/or part-time).' have hired the sub-contractors 6. L0 New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have - P p 8. ❑ Demolition i working for me in any capacity, employees and have workers' .9. 1 Building addition • [No workers' comp. insurance comp insurance a required.] 5 C We are a corporation and its I 1 lll.❑ Electrical repairs or additions 3.[] I am a homeowner doing ail work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §1(4),and we have no `� employees. [No workers' 13.�Outer C–��, - �LX 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 r-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. n �, Insurance Company Name: _ �j� _-C�- I i�u r C� / � Policy fi or Self-ins. Lic.T: (Qa 511-0_i] _ Expiration Date: �j/ioZ Job Site Address: - ::ityi5tatei/ip• tor -t hei e__ 016' 1 6' 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. Re advised that a copy of this statement may he forwarded to the Office of investigations of the DIA for insurance coverage verification, I do hereby certify under the pa' •and penalties o perjury that the information provided above is true and correct.. &nature: Ad to 1 ! n �._Dat : (VI /L _._.. .. Phone 4: 0 ( 3— 3LZ9:-- 6aLlY Official use only. Do not write in this area,to be completed by city or town official City or Town: ‘nlsrM� Permit/License# 1 Issuing Authority: Building Department I i I; Contact Person: Phone#' (413)49Q-9440 i m SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: i Not Applicable ❑ Name of License Holder: ea0C( t (\ %(1A. _.-t I `t i�(p License Number deb, 0 e{ IACt a ' ' i Add Expir ion to 0. At J Sign. ure Telephone 9.Recilstered Home Improvement Contractor: Not Applicable ❑ t1/4f 64 eA a se "1-vY? rov-e Alt 11 -I- 1 uo(-2.) --8- Company Name Registration Number (9w3 pkvevdc1f 3* L _ speed 4vq- II a� t5- Address Z Expir tion Date `�'ei1 ,41. Telephone`-t(3-3k9-t 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 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 ES Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [C] Siding[0] Other[0] �OL e O e \S--■ `C D(D-k2 �Q r \cc�e�'CQ.\ '$ Ci 15� C+ Brief Des ription of Proposed J �" Work:* • (-. a • \ • - / O \ a`) VeF �\ce `(J(�7Y 9 VI, •. - �,��' Gam. c' - ' A r .w C �� \n..A 1 Ve Alteration o exiting bedroom Yes No Adding new bedroom Yes No 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 I, -C't-'3 'L -E, , as Owner of the subject property hereby authorize \C1/4N\ \�J�Q ' �J \� � P. - ycz)U inTe)/} to act on my behalf, in all matters relative to work authorized by this buil ing permit application. / I 3 Signature of Owner Date eovl v 6- 0 �e V rOV Y11 e f'1� , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are rue and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name l'A/W-1/4 )1\ )//1 I Signatu •f 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 S eclat Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW 0 YES 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# c$Z. B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES O 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 0 NO (S5 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 9 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 O NO 9 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only rr City of Northampton Status of Permit 1� L - Building Department Curb Cut/Driveway Permit r- j 212 Main Street Sewer/Septic Availability OCT - 3 mil f / Room 100 Water/Well Availability f3 Northampton, MA 01060 Two Sets of Structural Plans tric,Piumbino p on= 413-587-1240 Fax 413-587-1272 Plot/Site Plans Northampton`s Cas tns MA*ray* Other Specify APPLICATION T• ONSTRUCT,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 6.3 fovO cV C 1--+ --\--- Map Lot Unit r\.ure)tNe.-e, aM4 a\o'.- Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Care C-- Q c & e cA v--. 1 c3 Nn o,i10=YvC c `-)-}- V- OY'e rCe Name(Pri _s urr�K —1 A ss— 0_7 s 1 ue Gi,r\ - - Telephone Signature 2.2 Authorized Agent: Zr\c,\() Rod. - v-k< c \ o 'P:lvercl4(e 5+, vo 5p'.f id Name(Print) , Current Mailing Address: tit q\3-3�.-6; ? Si ture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building '"� £ 9 (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 / l� 6. Total= 1 +2+3+4+5 99 X694 Total=(1 +2+3+4+5) co�Q � L9 Check Number aj �cJ._� This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 15 NONOTUCK ST BP-2014-0415 is#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23D-004 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-2014-0415 Project# JS-2014-000708 Est. Cost: $6499.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 106156 Lot Size(sq.ft.): 5270.76 Owner: BAKER GREG&RACHEL Zoning:URB(100)/ Applicant: VISTA HOME IMPROVEMENT AT: 15 NONOTUCK ST Applicant Address: Phone: Insurance: 1346 ELM ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:10/4/2013 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 10/4/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner