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38A-009 (6) ��� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162058 Type: LLC Expiration: 1/12/2015 Trk 244493 SAMBRICO LLC dba VISTA HOME IMPROV BRIAN RUDD 2003 RIVERDALE ST WEST SPRINGFIELD, MA 01089 - - - - — Update Address and return card.Mark reason for change. SCA 1 j 20M-05111 T Address .— Renewal l__' Employment !�, Lost Card fillz�x�c6usetG Office of C er Affairs&Busine. Regulation License or registration valid for individul use only SOME I PROVEMENT CONTRAC R before the expiration date. if found return to: Ittegist tion: 162058 Type: Office of Consumer Affairs and Business Regulation 'Expir lion: 1!12/2015 LLC 10 Park Pla�.a-Suite 5170 Boston,MA 02116 SAMBRICO LL db iSTA HO OVEMENT BRIAN RUDD — 2003 RIVERDALE WEST SPRINGFIELD,MA 01089 - — Endersecretary Fti ho ut signature STATE OF CONNECTICUT .O DEPARTMENT OF CONSUMER PROTECTION Be it known that SAMBRICO LLC 2003 PUVIER.D A LE ST W SPRINGILD;:3VYA Q1089-1000 r f is certified by the Depa,On of anst�iner, Ptotection as a registered HOME IMPROVEMENT CONTRACTOR Regis ` �G21848 VISTA HOME IMPROVEMENT Effective: 12/01/2013 Expiration: 11/30/2014 �. William M.Rubenstein,Commissioner °.. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street F., Boston, M9 02111 wifrW mass.gov✓dis Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le °b - Name � �'� \-\,Came city;sttate,7zip; p��ot��, Are you an employer?Check t e appropriate box: _ w Type of project(required): 1.t,I am a employer with _ _ 4• Q I am a general contractor and I i employees(full and/or part-time)'hired the sub-contractors 2. partner- ❑New construction listed on the attached sheet. 7. Q Remodelng Q I am a sole proprietor or ar#ner- d l ship and have no employees I-here sub-contractors have 8. Demolition workin for me in an ca acity. employees and have workers' g y p 9. Q wilding addition [No workers' comp. insurance. comp. insurance.*. required../ 5. Q We are a co oration and its 1 O.Q Electrical repairs or additions 3.Q 1 am a homeowner doing all work officers have exercised their I I.Q Plumbing repairs or additions myself [No workers' camp. right of exemption per MGL I2.Q Roof re airs insurance required.] c. 152, §1(4),and we have no employees. [No workers' 13.g Other _C qoU comp. `insurance required.] I *Any applicant that checks box 41:must also fill out the section below showing their workers'compensation policy information. 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. Insurance Company Name:_ —v P'olicy#or Self-ins.Lic.#: [xpiration Gate: �1 Job Site Address: `�\ Y1C� ���� City/State/Zip: 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 Iv1GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$'250.04 a day against the violator. Be 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 pains andpenalties of perjury that the information provided above is true and correct- Sigrnature: Date: 1_ 2-0 3 Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: rlU'�`�� � `rl Permit/License# Issuing Authority: Building Department Contact Person: W __ Phone#: (41 3)499-9440 Proposal Page No. of Pages CT REG.NO. 0621848 VISTA HOME IMPROVEMENT COLOR WIDTH MA REG.NO, 162058 2003 Riverdale Street West Springfield, MA 01089 INSULATION Tail Free: 1.888-597-2323 • Local: 413-382-0249 FAX: 413-382-0241 Proposal Submitted To Homeowner Work To Be Performed At Name _ Street POW c4L Street_ City State City lip State Date of Plans Date �� Telephone We hereby submit specifications and estimates for: re fit- A t� 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-oNModification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are tufty 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- faction,including reasonable attorneys tees,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: We PPPOOC hereby to furnish mate'al and labor-complete in rdance with the above specifications,for the sum of: 70 Z2 Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within days. YOU,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 TH VISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT.THIS INSTRUMENT IS NOT NE TABLE fr Signature of Contractor or authorized representative: `(VWe)have read the terms stated herein,they have been explained to(melus),and(1/We)find them to be satisfactory and hereby accept them. Signature of Homeowner(s): X ) i �fl- r, X ------------------------------------------------------------------------------------------------------------ NOTICE OF CANCELLATION Date of Transaction_� YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM AE A OVE DATE, IF YOU CANCEL,ANDY PROPERTY TRADED IN,ANDY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTFO RY Y(Ut Wit t as:part rvawn wrmuhl real SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suiverviso r: \ Not Applicable ❑ Name of License Holder: �� \ ,IJ�Y \S Licen Number/ Address Expiral,ion D to LA 3— & _ o Signatur Telephone 11�vw V."If 9.Registered Home ImorvVerrient Contractor: Not Applicable ❑ Company Name Registration Number Address -� F�cpi a ion Date Telephone 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 Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding[0] Other[[3] Brief Description of Proposed j 'nS �� G vo�ll� ­�-\-�YA f EX-5 Work <1\U je \GL`s Y 17t'� 1C u�1 i m Alteration of existing bedroom Yes No Mding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roil -Sheet 6a. If New house and or additloy 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 o_Y A- as Owner of the subject property hereby authorize �(�C3.`C1 �y �t�a�E'ti Y �>� �- `(�1`�`(7�U�Me n4- to act on my behalf, in all matters relative to work authorized by this building permit application: S-Q--p C-u- Y1 log D01! Signature of Owner Date I, '! \C��CrvI `l�U V 1 5 1C� \ �� S w4cou—tyyye Vl* as Owner/Authorized Agent hereby declare that the statements and information on the foregoing atpplication are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. "-�br\ah Print Name M Si tune 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 DONT KNOW O YES IF YES, date Issued: IF YES: Was the permit recorded at the Registry of Deeds? NO P DONT KNOW () YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW () YES O 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 0 NO 7" IF YES, describe size, type and location: 7" 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 9 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only Li C ty of Northampton Status of Permit: B ilding Department Curb Cut/Dhveway Permit DEC 2 6 2013 12 Main Street Sewer/Septic Availability Room 100 Water/Well Availability L= 7 Leiectric� F�lvnc�,!711-777-1,7)4N4ort ampton, MA 01060 Two Sets of Structural Plans 7-1240 Fax 413-587-1272 Plot/Site Plans 1 Other Specify_ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Addre S' C-'0y-+'r0C* Telephone Si nature 2.2 Authorized Agent: M.�f"'rif mevi+- 'wecan�e- w pf-ld VISA —1 V Name(Print) Current Mailing Address: —2� Si ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS I 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) Check Number a? ZO This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 68 PRINCE ST BP-2014-0753 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38A-009 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-2014-0753 Project# JS-2014-001296 Est.Cost: $2072.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grog. VISTA HOME IMPROVEMENT 106156 Lot Size(sq. ft.): 16552.80 Owner: WARNER STUART Zoning:URB(130)/RR(1)/ Applicant. VISTA HOME IMPROVEMENT AT: 68 PRINCE ST Applicant Address: Phone: Insurance: 1346 ELM ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:1212712013 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPAIR BARN 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 12/27/2013 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner