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4/26/2007 2:23 PM FROM: Charles S. Carillo I Charles Carillo Insurance TO: +1 (860) 6233611 PAGE: 002 OF 003
A CORD DATE(MM)DDNYYY)
TM CERTIFICATE OF LIABILITY INSURANCE 11/07/2006
PRODUCER (860)623-9895 FAX (860)623-9548 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Charles S. Carillo Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
30 Suffield St HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
PO Box 403 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Windsor Locks, CT 06096-0403 INSURERS AFFORDING COVERAGE NAIC#
INSURED Custom Craft Industries Inc. INSURER General Casualty Insurance Co. 024503
64 Main Street INSURER e:
Windsor Locks, CT 06096 INSURER C.
INSURER O.
INSURER E.
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.
INSR 1,DD'L TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE POLICY EXPIRATION
LTR NS DATE(MMIDDIYY1 DATE fMI LIMITS
GENERAL LIABILITY CCSO447243 10/04/2006 10/04/2007 EACH OCCURRENCE IS 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
•nrP $ 100,00
CLAIMS MADE O OCCUR MED EXP(Any one person) $ 5,000
A PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2.000,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000
POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUiO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS
(Perperson) $
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO EA ACC $
OTHER THAN
AUTO ONLY AGG $
EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ❑CLAIMS MADE AGGREGATE $
if
DEDUCTIBLE
$
RETENTION If $
TORY LIMITS FR
WORKERS COMPENSATION AND CWC0447243 10/05/2006 10/05/2007 X WC sTATU- oTl+
EMPLOYERS'LIABILITY
A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACHACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-FA EMPLOYEE $ 100,000
If yes,describe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER ANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Custom Craft Industries Inc. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
64 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
Windsor Locks, CT 06096 AUTHORIZED REPRESENTATIVE
Maria Curto CISR
ACORD 25(2001108) FAX: (860)623-3611 eOACORD CORPORATION 1988
Contract Page No. of Pages
New England&NY �1. (860)623.7800
(800)999-7377 Custom Craft Industries, Inc. FAX(860)623.3611
Corporate Headquarters
CT Reg.#544538 C1 64 Main Street • Windsor Locks,CT 06096 MA Reg.9115081
Proposal jSubmj4edto Homeowner Work To Be Performed At
Name �� Street ,
street City State
City State, " �'- Date of Plans
Date Telephone
S.S.# S.S.#
C ete Descriptto of Work to be Pe ormed: It Date: C mpletion Dade:
r �
r
All material Is guaranteed to be as specified by manufacturer.All labor is guaranteed for 1 year after installation.All work to be completed In a workman like man-
ner according to standard practices.Any alteraflon or deviation from the above specifications must be made in writing oh a Add-On/Modlgcatlon 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,tor.
nado and other necessary Insurance.Homeowner agrees to pay for all work as set forth below.If the homeowner defaults,homeowner agrees to pay_all cost of
collection.Including roasonablt attornwg fees,in addition to other damages incurred by contractor.Homeowner Is responsible for all necessary building permits.
kAll,,,complalnts must ho submitted to Gu tom Craft Industries,Inc.in writing.C Re hereby to�urnis material an Ia6or. omplete I ac'o nee with the above specifications,for the sum of tars I$ " Said amount shall be paid as follows:.
IS IS A CONTRACT, NOT AN ESTI AT .ALL CONTRACTS MUST BE ACCEPTED BY CORPORATE
OFFICER.YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT
OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED
NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT(SATURDAY IS A LEGAL BUSI-
NESS DAY IN CONNECTICUT.)THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLIC-
ITATION SALES ACT AND THE HOME IMPROVEMENT ACT.THIS INSTRUMENT IS NOT NEGOTIABLE,
Work will not be begun u you:-fight to cancel has expired and you have paid a deposit of _
dollars( ),unless this agreeme s of rwis AKE CHECKS PAYABLE TO CUSTOM CRAFT
INDUSTRIES,INC.ONLY.
Signature of Contractor or authorized representa Rep. Reg#
(INVe)have read the terms stated herein,they h'bve 6Wn explained to(metus),and(INVe)find them
to be satisfactory and hereby accept them. By signing this contract,we are also authorizing you to
investigate our credit reference
Signature of Homeowners)
----------------------------------------- --------------------------------------------------------- -- - - -
NOTICE OF CANCELLATION Date of Transaction
YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION WITHIN THREE
BUSINESS DAYS FROM THE ABOVE DATE. IF YOU CANCEL, ANY PROPERTY DED IN ANY
PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE AND ANY NEGOTIABLE MTRU-
MENT EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS FOLLOWING
RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND ANY SECURITY INTEREST
ARISING OUT OF THE TRANSACTION WILL BE CANCELED, IF YOU CANCEL YOU MUST MAKE
AVAILABLE TO THE SELLER AT YOUR RESIDENCE,IN SUBSTANTIALLY AS G60D CONDITION AS
WHEN RECEIVED ANY GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE' OR YOU
MAY, IF O1F THE COMPLY
OODS AT THE THE INSTRUCTIONS
EXPENSE AND RISK.
REGARDING THE'RETURN
IF YOU DO NOT MAKE THE GOODS AVAILABLE TO THE SELLER AND THE SELLER DOES NOT
PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF CANCELLATION,YOU MAY RETURN OR
DISPOSE OF THE GOODS WITHOUT ANY OBLIGATIONS UNDER THIS CONTRACT.
TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED AND DATED COPY OF THIS
CANCELLATION NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND A TELEGRAM TO: CUSTOM
CRAFT INDUSTRIES, INC. at 64 Main Street,W�1 df�or Locks, CT 06096
NOT LATER THAN MIDNIGHT OF 2Z 7
ate
I HEREBY CANCEL THIS TRANSACTION
Date Signature of Buyer
p. 5
Jul 09 01 10: 23a
9 AasaachoccIt
DEPA-RTMENT pP BfjfLt)[NG-INSPECTIONS .. -
212 Main Street . Municipal Du+lding
Northampton. Maas_ 010GO
«'OIUCER'S COi�rf.I'ENSr1TION MSUR"CF AI?MAVIT
_—r
� (licct�scclpermiftcc}
v,riLh a principal place of bu Ts'ne . residence ai
jig&,W S r __L6_qA_ 3
(SIIC.c aci I}/9AM1b p)
do hereby certifj=, uncicr the pains and pen2lties aCnerjw-Y 0111.
( ) 1 am an employer providiUlS the foilowing work=er's cornoenS-ion cove:-�;,c for 1w,
et-oplovecs worlang on Illis job:
(InsurY--(_- CoracZEy) - (pour:N.U--AL)_r (T--%I)I r-,6 Go.Dale)
( ) I am a sole proorictof, Genera.{ coutractor or holneowDer(c cic one) aad Iizve hir!:d
the contractors listed bekow cvbo hive the foUo%VWg worl(ees compensadon policies:
(Name of Concmctoo (Iasuran(x- Compan)"t('GUci Nurr^c:) i yisa:,or 4)atc)
(Name of Coucracioc,)_ -- Onssrancc CompariviPollcy Nu.alc:T) (Expimlion 021c)
(Name of Connacior) amm-anc- Compao)•/polic). N-winbru) (E�aif deo Marc}
(Name of Contractor) (insuran(-_Cofzfr.zay/Policy Nunikrl (ExPLnon Diu-).
(cn1G1�1i;oczl Luc irrc�:.:-::o nc'�ic.�c,�L•�a_tioc ixru:°ucaS W.0 coa5-_.r�o-�)
it sole proprietor and 63vc no oue working for me.
{ ) C am a.home o-m)cr.performing all the work myscil.
1407'k.:Plcse be e+ t tfi_s t:lc bcaxo.tvn'to eyplay pcsom W db �- cc :�e'.rJn c tt�,au w m m. of
UD4 W'cm taro L f'x fro 1.1 K yC5 I.bG bo-nW0 -e ncxda or oa Lb,Owad,a,pNrj,*_.%th.-o.ere ex�<aa=1t y 0.-,a-d=d L,bt
cdvloy�"et'the•m'1r's ac(GLI,57,a1(5)�=vP1kw,;oo by%60mao-za icr-lies or pvmn U=y c ie-xx Uc
i cIPI n.tuc of"axploycr doder d-Worlccl. Aa-
I undcrvun 4 did a°WY of thL-1. _.Y b.fa-i...nl.cd to tpo T)olwr.m,eoi er k t5.w AtQdooi a Off oe of 4ew.oco f-the
oo-1cc-rirc�400 aid th_t ULM to acsauc COWT-kV under socxitw Z SA*r M0I,157 tao 1c d to the ia,,osaim of C-Mma' sl KcAbia
. 000siaia$of a Gx of up to S 1300.OD.rtN.x x.-y of up to ooc yev t.od a tii1 ncn.l'va is tx fora+of.Stiap Wort Oe'a aid a
fim c(S 100.00 a day a¢ian a e
Fl it Nun�bCf
Side Irc of t,ruaz 'ermillcm �Le
Jul 09 01 10: 22a P• 4
! 2 Licensed Construction Supervisor. --�' , / Not Applicable O
Name of License Holder': J`�CI 7 , �--�
icense Number
Add- ss Expiration Date
Sigma Telephone
Not Applicable ❑
ComRany Name - Registration Number
LA
A drdss Expiration Date
Telephone
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuanc oft building permit.
Signed Affidavit Attached Yes_._____ No...... ❑
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 fancily 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 aff such work performed under the buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,durbig 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
Jul 09 01 10: 218 P• 3
s
New House 0 Addition ❑ Replacement Windows Alterations)❑ Rooting, 0
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ j Siding[ ] Other[ ]
Brief Description of Proposed Work: e11 J��
Alteration of existing bedroom Yes� Adding new bedroom Yes IR6
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll 0-Sheet❑
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. _ Mascheck Energy Compliance form attached?
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
i
. a
3
ai2i:
( 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
as OwnertAuth ri d Agent
hereby declare—that the statements and information on the foregoing application are true and accurate,to the b of m
knowledge and belief.
Signed under the pans and penalties of perjury.
P'nt me 6
�✓ u 7-d)7
Si r of Owner/ ent Date
` Jul 09 01 10: 21a p. 2
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
- BLLlld10$DC[.187C111CA2 ,
Lot Size
Frontage
Setbacks Front
Side R:
Rte.
Building Height
Bldg.Square Footage %
Open Space Footage
(lot area minas bldg&paved'
parkin ' _
ff of Parking,Spaces
-
Fin:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
B. Does the site contain 4kb water or wetlands? NO ^ DON'T KNOW
YES
IF YES, has a rmio be obtained from the Conservation Commission?
Needs to be b inObtained , Date Issued:
C. Do any signs a ist on 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_
No .
IF YES, describe size,type and location:
P.
Jul 09 01 10: 20A
y
� - - - H�_ a Vii♦ iti
City of Northampton
Building Department
212 Main Street
Room 100 _
Northampton, MA 01060
phone 413-587.1240 Fax 413- 87-1272
APPLICATION TO CONSTRUCT,ALTER, REPAIR,RENOVATE 0' S IL '.bWELLING
t
SECTION AI SITE:IfYF40RMATtON -a
ti
1.1 ProperAy Property Address / T t ab ffcea
DLO e.
v e
l_41 0Y
:
SECTION.2=-PROPERTY OWNERSHIP/AUTHORIZED AGENT .
2.1 Owner ai RtcOrd:
Name(Pant) � Current M S Add
Telephone
2-2 Authorized A ert :,
me(Pri t) Current Mailing Address:
i
gwllo b z3 7
Si,gnat re Telephone `T
EC ON -ESTIMATEDCONSTRUCT10N 0 T
Item Estimated Cost(Dollars)to be - t3lficral t�l�e-Only
completed by ermit appLSant
1. Build n {a)'8uilit rig PerMit'Fe$
2 Electrical (b)Estimated Totall C of
Construction;frorn 6
3. Plumbing l3uild�ngf'ermit Fee
4. Mechanical(HVAC) '
5 4
5. Fire Protection
6. Total=(1 +2+3+4+5) li
A.
14 rr M `"4.5 T. } iirr �%4.L>f :iir7a� T]I:Fnti'. -- ..•'i :F'S' _'7
-� 3� x 17,ate .ed • " '' r -_ -
nY,Pit
t
a BP-2007-1208
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2007-1208
Project# JS-2007-001930
Est. Cost: $9980.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: CUSTOM CRAFT INDUSTRIES INC 115081
Lot Size(sq. ft.): 10541.52 Owner: GABRY STEVEN
zoning: SR Applicant: CUSTOM CRAFT INDUSTRIES INC
AT: 45 CAHILLANE TERR
Applicant Address: Phone: Insurance:
64 MAIN ST (860) 623-7800 WC
WINDSOR LOCKSCT06096 ISSUED ON:611212007 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP, PLY & 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 6/12/2007 0:00:00 $25.003867
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo