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29-525 (3) 'ACOR . CERTIFICATE OF LIABILITY INSURANCE TDATE 8/29/2006 MIDD006 8/2 PRODUCER (413) 789-3070 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rejean J. Remillard Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 23 Southwick Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Feeding Hills MA 01030- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Ll0 ds Of London Leger, Albert DBA AL LEGER HOME IMPROVEMENT INSURER B:National Grange Mutual 165 Saw Mill Road INSURER C:Granite State Ins. Co. INSURER D: ,Springfield MA 01118— INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rA ADD'L POLICY EFFECTIVE POLICY EXPIRATION NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MMIDDIYY) LIMITS X GENERAL LIABILITY LGLO59434 12/06/2005 12/06/2006 EACHOCCURRENCE $ 300,000 X COMMERCIAL GENERAL LIABILITY PREM SES Ea oeeur ence S _ 50,000 CLAIMS MADE FRJ OCCUR / / / / MED EXP(Any one person) $ 50,000 PERSONAL&ADV INJURY $ 300,000 GENERAL AGGREGATE $ 300,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 300,000 POLICY PRO- JECT LOC B AUTOMOBILE LIABILITY 21MO4337 10/26/2005 10/26/2006 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILYINJURY $ 100,000 SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY $ 30Q,000 (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ 100,u0O (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR EI CLAIMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION $ S C WORKERS COMPENSATION AND WC 4395821 08/26/2006 08/26/2007 X TORY IMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE S 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (860) 668-0195 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT BURKE CONSTRUCTION CO. , INC. FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1122 Hill St. INSURER,IT NTS OR REPRESENTATIVES. AUTHOR D Suffield CT 06078- ACORD 25(2001/08) ©ACORD CORPORATION 1988 qT, INS025(0108).05 ELECTRONIC LASER FORMS,INC.-(800) -0545 Pagel of 2 r R}c �4 (-( TN Of '��LTrflJ�dtttiJiolt - � R � E ��:�aRrflasrlle' w DEP/1ATMEI,fT OF BUIL.Dr,C INSPEC-11011s 212 Main Strcct ' 'hfunicip.al Building Norlhamplon, A1ass. 01060 i i -v-vC)R T--n,S ColvcpENSATIO.N >;ISURAhCE A=AVIT principal place of business residence at: I. (phone=') (stmt/ci rJ lsza>.c�a p) jdo hereby cerif--, under lhc.p ins and penalties of perjury, hai ( ) I am an employer providing the followln-, -vorklcr's colnocasaoon cove--Sc for III', elnptov •'s «,Orkin on l job: �c Conr�o) (PoliC_.Nt r) F—Expi,atior.i);,,�-) am a sole proprietor, general contractor or homeowner (cicie One) and have hired the cooua tors Iis below w);o have the follo:vine worker s cvLoert2don pe!icies: (i IaMCC Of Co2't^ctcr) (Ilutlraric;: Compi-1)-(roue-,- Numscr) i — (N rile of Cont aor) (Ins-sran= Comoan-viPo6n, Numb----r) (L�irtion Date} (Name of Cott=Cl47) (Insuran=Company/Polio- Numtu) (Et_epira6an Da1C) l , i (N—C of Contracor) (Lasu = Comca¢y/Policy Numbs) ( tpirtioo Datc). (e.C�L'�r_d..roal icC.iraccc._^p w arcu�iarorau�on pcZa.ic:as w.il wc-..cv�) i ( ) I"am_a sole proprietor and r=ave no one world_ng for me. ( } I am,a home owner perfon=' g all the work myself NOTE_p(csc be.-Arc w-bo=,ploy cr rc,.aa w-arir-M r d..cil_Z of i ont t`.arr_Litr is U-b3a the botar aw•'n=raic=oc o0 tb,e P-4 z77art—the—�_-ax C—�rlly or=d—ni w be eirplor-- qCZ(GU152-=1(5)).:-,? SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder, �"C '! �P �? /, License Number n Address— Expiration Date Signature Telephone Not Applicable .❑ 9''Re4stereo°>�ome�impro�rement�Contractor : � „ .� _ � .. �k�g..��,u�„� <.� > Company Registration Number Address Expiration Date Telephone i - - �} 7 SECTION 1'0-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.-1-52,§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...... 0 1 � ; 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 ❑ Replacemenndows Alteration(s) ❑ Roofing ❑ Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks IM Siding ] Other[❑] Brief Description of Proposed work: (-' ���' j�2 �i i d � �,.t ll ICJ /Ar Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet -s,' ,5.�„ �. �a,,-rt,{;,x" '�:w.�^ r w^s �g;.s...•.r sa� lew oase a�ld.of a` itro>r #c .`-xis#inL' .iousln orn to ,PIN wln 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 AGENTOR CONTRAC•TOR•APPLIES-FORSBUILDING 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, erl as Owner/Authorized Agent hereby declare that the ements 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. 1/-T7'— Pnnt Name Signatu e-ol 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 Rear Building Height Bldg. Square Footage 7 Open Space Footage % (Lot area minus bldg&paved #of Parking Spaces (volume&Location) A. Has a Special Perm it/Vohonce/Findi ng mnar been issued for/on the site? �� �� NO ^���� DONT VV ��/KNOW YES t�/ IF YES, dote issued:: IF YES: Was the permit recorded ot the Registry ofDeeds? ' �� NO �� DO07KNOVV 0 YES IF YES: enter Book Page, and/or Document#| � ' B. Does the site contain a brook, body of water o,wetlands? NO 0 DON7KNOV 0 YES 0 IF YES, has permit been or need to be obtained from the Conservation Commission? Needs to be obtained �� Obtained �� �� |��d' �~� �~� ' . C. Do any signs exist on the pnopert �� ��y? 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 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,gradingexcavation,or filling)over 1 acre nris it part nfa common plan that will disturb over 1acre? YES ���) NO [��] IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r x De xera aSeRr City of Northamptons ---�'"(-` Building Department h� Y� 212 Main Street —�! ! Room 100r � " orthampton, MA 01060 a �° Auk 3 on 3'587-1240 Fax413-587-1272 _ �q0 T, � ATtt �ICONST UCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE.INFORMATION" 1.1 Property Address: ThWsectron;tci t► ice e compiefed try off h 1 K !R llnit r®r y k - �p,' - C: �.�+Ai�?� 1'>'119 Zonevexlayxstrrct �EIrn�3t.D�stcict .. CBEDistrct SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: Name(P' Current Mailing Address: Signature Telephone SECTION-3 ESTIMATED NSTRUCTIONt COSTS Item Estimated Cost(Dollars)to be Official Use Only ,- completed by ermit applicant 1. Building -(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 71 This Section For'Official Use Only -Date _ Building Permit Number. Issued: Signature: Building Commissioner/Inspectorof Buildings Date 10�16-140ww ' BP-2007-0231 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2007-0231 Project# JS-2007-000350 Est. Cost: $19100.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: AL LEGER HOME IMPROVEMENT 147701 Lot Size(sq. ft.): 5837.04 Owner: BATTEY JEREMIAH A&SHEILA D Zoning: URA Applicant: AL LEGER HOME IMPROVEMENT AT. 19 GREGORY LANE Applicant Address: Phone: Insurance: 165 SAWMILL RD (413) 519-0619 WC SPRINGFIELDMA01 118-1724 ISSUED ON:813012006 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL SIDING & REPLACEMENT WINDOWS 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 8/30/2006 0:00:00 $50.001123 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo PROPOSAL MA. Reg. # 147701 �;., f� x,, . MA. License # 031151 Al L ,,, (.�.J CT. Reg. # 606697 ome Improvement- 105 Saw MITI Road Springfield,MA 01118 413-519-0619 877-255-3435 Proposal Submitted To: Work To Be Performed At: Date 6 -a G Telephone Lr Name Te-r e r, c> a.6e:�.c, ,ga2&�4 Street Street /'3 r,/7 ��4 L P City State city r'o?.vC-e:' State The following work includes all labor and materials to complete your job in a professional workmanlike manner. LtIZ�r t7 ell 9 TOTAL SALE PRICE t` DOWN PAYMENT �y FTR UPON START T �- A-)� �� UPON COMPLETION I ° Lev ,. ACCMANCE OF PROPOSAL The Above prices, specifications and conditions are satisfactory nd re reby accepted.You are authorized to do the work as specified. Payment will be as outlined above. It Is further agreed,that in the event the Final Payment is not paid upon completion by the Ownerjto the Contractor.there shall be in added to the amount due and owing interest at the rate of one and one haft percent(1-12%)per month or part thereof from the completion date until the date paid. It is further agreed,between the two parties that in the event the Owner fails to pay any bill when due,and the Contractor thereafter is required to turn over such bills to any attomey or agency for collection,then the Contractor shall b$entitled to receive the full amount of the outstanding bill plus any and all applicable service charges in connection with such bill,including,but not limited to filing fees,Sheriff fees,and reasonable attorney's fees and/or collection agency fees. WARRANTY:The Contractor warrants all worts performed under this agreement to be free from defects in workmanship for a period of ("' years from the date of completion.All products will be covered by the warranties of the manufacturers.The Total Warranty Period will begin on the completion date of installation. This agreement may be modified only if the Owner and the Contractor sign a later agreement which sets forth the changes agreed to. In witness whereof,we have this day of JZ> 11.4 f .20 L'Zmade and sign this agreemerit.. To be known as Contractor: To be known as Owner by tw Representative for AL Leger Hom provements 413-519-0619 877-255-3435 Est. start date: Est. completion date: Phone: Home Work NOTICE OF CANCELLATION :You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller which maybe his main office or branch thereof,provided you notify the sellerIin writing at his main office or branch by ordinary mail posted,by telegram sent or delivered,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right.