Loading...
24A-246 The Commonwealth of Massachusetts b_ < Department of Industrial Aceidena DffIce of Investigations 600 Washington Street Boston, ISM 02111 y www°tmss.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDlicant Informati n Please Print Lelably NametBiasiness/t)rganizatianflndi�iclira3}. �� 1~address; :.- City/State/Zip: Pha,ne Are you an employer?Check the appropriate tax: _ Type of project(required):1. 1 am a employer with _ 4, 0 1 am a general contractor and 1 ¢ employees(full and/or part-these). have hired the sub-contractors f'• New construction ?- i am a sole proprietor or listed on the attached.sheet. 7. � Remodeling partner- ship nd have no employees These sub-contractors have p it. Demolition � working for me in any capacity. employees and have workers' € l [No workers' comp. insurance comp, insurance.' 3 Building addition required_] 5 L7 We are a corporation and its 1 Ol Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their i l T Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGT, I 12.,IZajof repairs insurance required.] c. 152, §1(4),and we have no 1 employees, [No workers' � '•3. Other comp.insurance required.] 1 "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. Contractors that check this box must attached an additiomi 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. 1 am an employer that 1s providing workers'campensadan insurance far my em ployeev. Below is the policy and job site information. Insurance Company Name: _ � �; \ 2 Policy#or Self Expiration Date: --ins.Lic.i•?:._—�.,1.1�_.��_.� Ca�.�_�.C�_3..__...__- .._._. Job Site Address: .Attach a copy of the workers' compensation policy eclaration ll a(showing the policy number and expiration sate). Failure to secure coverage as required under Section 25A of MGT,u, 152 can lead to the imposition of crim.trim. inal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties its the form of a STOP WORK ORDFR and a sine of up to$250.00 a clay against the violator. Be advised that a copy of this statement may be forwarded to the erica°of investigations of the DtA foe-insurance coverage verification. I do hereby eerttfy sender the pules and petrar ties of perlary that the information provided above is trra and correct. Date-, Phone#; gMrial use only. Do not write in this area.to be eonrleted lit'c& ar terwar a}iciart $ City or Town: Permit License Issuing Authority: Building Department Contact Person: Phone#. (413)499-9440 i��swwt ppa�l L3RR:i046C't gpirl: RONALD WMELL 92 HA "REST ROAD Sps'inOcid MA 01118 11 M V201 APR-3-2014 15:56 FROM:WILLIAM J MIS INSURA 4135729191 T0:14133920241 P.5/5 CERTIFICATE OF LIABILITY INSURANCE QATlIMNUQWYYYII 04/03/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CQItTIFICAY9 NMOER. TH18 CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND, IIXTENO OR ALTER Tki COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 89*RIIN THE IBSUiNG INSURER($), AUTHORIZED 11CPA4611NTATiVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTN'Tr- If e Is an ADDITIONAL INSURED, the po cy ee Must afl orsac. , Bubject to the terms Cod oondltbns of the polloy, certain poBc(aa msy require an andorsemant. A statement on this cettiflasb do" not Confer tights to #w carUflaste holder In lieu of such endom m.nt(s). PRODUCMR QQNT �ISYaLI I!Q 8 WI1,I, J HIS zNSURANCE AG>rNCY fHDii 413-569-6 17 413-672-9191 1S6 ELM ST Aga$, 11ILLQDILtI11TNf�UEiANC6.COM WESTFIELD, 14A 01085 rMSUKI s)APPORDINaGOVMAOI NAIGa WOURMRAI$AI.M.T,Y TI CZ INIUMD WI MM a. ..... ...~ SAM>3 OO LLC DSA mauslR t s VISTA H= Df VEb=T arsuReRD, 2003 1kSVZR10AT,N ST INSURER aI WEST BFRSNG7IELI3 IIIA 01064 Ir/tnwtP: _ COVERAOE$ CERTIFICATE NUMBER: REVt810N NUMBER; THI8 I ERTIPY THA E M TGIF F INS NC 06 EO HA GRN 16SU6D TO M AM q INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATF. MAY BE 19SUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DBS RIDED HEREIN IS SU0ACT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH tbLICIC$.UMr r,GHOWN MAY HAVE BEEN Aeovow BY PAID CLAIMS. IYR TYPOOPINIURAMCa INaR wV0 NOUCYNUMR9R NWOUtYYYI IM rYYYY) LIMIT11 Tw 0tuesALLlAanm V4HOCCURRMNCA s 2,000,000 A CoWANCIALO�aRALLIASiLrrY SMAOO10953 03/14/201 08/x.41/2013 PREMII a Aadawralua) I 100,000 �ckAm&MAQR r."UH € MEDG%P(My eM Osman)_^ s 5,000 tl PQRODNA.t ADV INJURY 1 2,000,000 GENCRALAORRB(IATr s 2,000,000 GIN'LA KMOATOLIMITAPR=PON: PRODUCT6•COMP40A00 $ Z� ,000,000 POLICY El PRO. E LOO —••_ I .. AUTOareRU UAYMY •a aEaltlard s � ANY AUTO BODILY INJURY(Par paR00) s ALL OWN30 ecNen4111) pOQM,Y INJURY mor WWII) I AUTO$ AVMR I I HAND A1IYQ8 NCN•0"w AUTOS r aaldanl a UMMK6A UM �.0 lUtGr OUR,tQNCR 1 0=11 M wAa T OLAIM6.MA06 I AGORCOATC s DIED RETENTION s I s ANbCrDYRRe'tJApILITY VON ) HY IY6 ER Pi ANY PROPRICTORIPAMIRVACUVIV4 GL•EACH AACIDSNT I OPPI04FUMPAOR GXCLUDEDT � NIA imandmory In NN) Q,L,DIGNAOC•RA CLMP40YCO $ I�I yye�a,dr►adh.1pIr •�••� OP rFITION OF OPERATIONS below a 1 D93GA6G-POLICY LIMB s cuaRIP'hom 00 oPw7wNe!LOGATIoN11 vawLta(AI4ah AODRD tof,AddMOMI Radarl,s sohadUM,R man aparM R nquNadl f i , F , I k CERTIFICATE HOLDER CANCELLATION TOM OF NORTRAb$TON 1 NORTKA1et8TON 1O► OHOU40 ANY OF THE ABOVE DEWF48FD POLICIES BE CANCGt,"91 BOFORS THE RXPIRATION CAY4 THSRgO1N, II41Y104 WILL IN ofiLP/aReD IN ACCORDANCRNTN THR P.OI.tC PROVISION& AUWMIURRD R A 7 9W.20,111 ACORI CORPORATION. All Fiat"ta9atvad, ACORO 25(2010106) The ACORO name and logo are registered marks of ACO ; I From: 04104/2014 04;27 #421 P-002/002 Rightfax C3-1 4/4/2014 7;2 7:54 AM PAGE 5/006 Fax Server ACCR IB CERTIFICATE OF LIABILITY INSURANCE 04T•04-2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH13 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED,the pokcy(ies)must be endorsed. It SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SOUTHWICK INSURANCE AGENCY PHONE Fax PO BOX 100 mc,E&,+J: __.. A/C.No= SOUTHWICK,MA 01077 E-MAIL c. INSURE R(S)AFPOROING COVE RAGE NAiCe INSURER A:TRAVELERS PROPERTY CASUALTY COMPANY OF -AMERICA INSURED INSURER e. SAMBRICO LLC DBA VISTA HOME INSURER C: IMPROVEMENT 2003 RIVERDALE ST INSURER 0: WEST SPRINGFIELD,MA 01089 INSURER E: INSURER F OVERAGES CER71FICAJE NUMBER: SERt THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL E FF POLICY EXP R/1 TYPE OF INSURANCE POLICY SURANCE POLICY NUMBER I q/ppryyYY y ' LIMITS LIABRlTY Imam EACH OCCURRENCE $ COMMERCIAL GENERAL LIABIUTY DAMAGE TO RENTED $ CLAIMS-MADE OCCUR MEO EXP(A one Person) S r^` PERSONAL 8 ADV iNJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE UMIT APPLIES PER. PRODUCTS-OOMP/OP AGO $ PRO- JEC POLICY '1 LOC $ "UTABILRY MBiNEON SINGLE UMtT $ TALLOWNF11 UTO SOOILY INJURY(Per Person) $ SCHEDULED S AUTOS BODILY INJURY I Per accident) $ AUTOS NON-OWNED ER &PAMAGE $ AUTOS $ UM[IRELLA LIRB OCCUR EACH OCCURRENCE $ EXCESS I" H CLAIMS-MADE AGGREGATE S pgD RETENTION S S WORKERS COMPENSATION X I WCSTATU OTH- AND EMPLOYERS'UASHAY Y ;TORY LIMITS TH ER ANV PROPRIETOR/PARTNER/EXECUTIV NIA E.L.EACH ACCIDENT OFFICERMEMBER EXCLUDED? 7PJUB 03-12-2014 03.12.2015 $100,000 (Menddlory in if yes,describe under 2EO72183 E.L.DISEASE-EA EMPLOYEE $100,000 RI FIATIONS pelpa, DISEASE-POLICY LIMIT 1$500,000 --T t I DESCRIPTtON OF OPERATIONS I LOCATIONS 1 VEMCLES(Meech ACORD 101,Additional Remarks SdwduM,PI more Spero Is required) CITY OF NORTHAMPTON,MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 210 MAIN STREET CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NORTHAMPTON,MA 01080 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATME 4 JOHN J.LUPICA,President ACORD 25(2010/05) The ACORD new and logo are registeaed mars of ACORD rights resew a F a 7-14 C ?= Lp 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 Tr# 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. scn i 2onn-os:i1 _ Address :— Renewal Employment !` Lost Card -_ Office of Coasumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: It = registration: 162058 Type: Office of Consumer Affairs and Business Regulation expiration: 1/1212015 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 SAMBRICO LLC dba VISTA HOME IMPROVEMENT BRIAN RUDD 2003 RIVERDALE ST WEST SPRINGFIELD,MA 01089 'Undersecretary of h—oo t-sig/na ttire a -- STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it known that SAMBRICO LLC 2003 RIVERDALE ST W SPRINGFIELD AiA-x01089-1060 is certified by the Depai*nent of �t3mer-1 tection as a r c gistered HOME IMP ROV MENT- CONTRACTOR : sd h —..- �► Regis ( :6621848 VISTA HOME IMPROVEMENT Effective: 12/01/2013 Expiration: 11/30/2014 William M.Rubenstein,Commissioner - hoofing Vropaai - GT.REG.No.0621848 T T���� Page No. of Pages MA REG.No. 162058 v IV HOME IMPROVEMENT 2003 RIVERDALE STREET WEST SPRINGFIELD,MA 01089 Toll Free:1-888-597-2323•Local:413-382-0249 FAX:413-382-0241 Proposal Submitted To Homeowner Work To Be Performed At Name Name I IF Street ( Street A AAA City� p� State Zip_DJQ�p City §jatp Zip Date TelephoneA,�72--7 I-M-31 Date Telephone Vista Home Improvement agrees to do the following: 14 Acquire all permits for roofing work A-Material Location U Shingle Over Tear Off Amain House U Garage )(Shed A Supply Dumpster-Location Inspect Decking for damage U Replace Decking C_ 1-- ___per sheet U Install all New Decking-Type C_____—per sheet Roofing MFG kf 41 Colorq� .Style.� White/ rown drip edge N F-8 U F-5 ADeck Underlayment U#15 F�7 el�t Rhino Liner �ce and water Barrier U 3' [1 6' U Full Flash all valleys,penetrations,eaves and chimneys A Supply and install pipe boot flashing W—Supply and install ridge vent U Generic ,,,��� Cobra Exhaust U Supply and install vent kit U Supply and install soffit vents- Qty. — q+R&R Gutters U Total Job Clean-Up Ld Supply and install 12 in.lead on chimney WARRANTY U Standard U System Plus U Golden Pledge Attention Homeowners:Please cover all personal belongings in the attic,garage,or storage areas due to the possibility of roofing debris or dust coming throught the cracks of the wood.Vista Home improvement will not be responsible for debris or dust In the areas mentioned.Also Vista is not responsible for gaps from siding on home and roof line due to multi layer strips. U Rolled/Rubber Roofing Type_— Color _ Location Other:----------- ----------------- - $_kiA �k H 77&&_ ) �d_ _Aj!�_W_ f/VHF M xft�> - =4—h UP CA9 - _�U,z-S_-w 12� A �, CuT rev�+1rD - Or A/4 rV2—D�/ �[/E _ /1— lt�I^��� !'K 7 c'�y�X --iZ 'Z- , L/1/J _ G,eR --- M 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.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',Compensation Insurance.Homeowner agrees to pay for all work as set forth below.If the homeowner defaults,homeowner agrees to pay all costs of collection,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: We s h reby to iurnlsh material and I b r- omple a inycorclanA Vhjhe a s ec'ficati s r th f rf A JAI A IA- 1 -------- /—! --- — Said amount shall be paid as follows: 1y L Note:This proposal may be withdrawn by uVif not accepted Rhin.___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 IS T NEGOTIAB Signature of Contractor or authorized represents ve: '(l/We)have read the terms stated here he a�no e d to(m/u.), nd(1/We)Ilntl them to be satisfactory hereby accept them. Signature of Homeowner(.): X_._ _ X_ -)-LSdM!.1 ------ :CTION 8-CONSTRUCTION SERVICES I Licensed Constructio Suervisor. Not Applicable ❑ Mme of License Holder: 1 1 -°l.'� o(! I- nse Number ddress Expiral ion D to >ignature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ G �,� Compan-y Name �^ Registration Number Address h Expiratibti Dat Telephone UT/; 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 buildine 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 [O] Decks [C] Siding[0] Other[E� Brief D scription of Pr posed S� � � l \ ,1� Wb 5 U P Work °� t F `jlfll r�` ��S Alteration of existing bedroom Yes No Adding new bedroom Yes No r r'�t Alteration 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 l �\�c �� __ 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. �e CMA -c c-i-- 3/ 1 Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and pena ies of perjury. n cm . v Print Name Signat of Owner/Agent Date Section 4. ZONING Alt 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 Q DONT KNOW © YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW a YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained e Obtained ® , Date Issued: C. Do any signs exist on the property? YES ® NO Q 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: E. Will the construction activity disturb(clearing, gradin , excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. - Department use only ity of Northampton Status of Permit: ilding Department Curb Cut/Driveway Permit APR _ 7 ?0I4 I' 12 Main Street Sewer/Septic Availability Room 100 Water/Weil Availability ampton, MA 01060 Two Sets of Structural Plans phan 13- 7-1240 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 This section to be completed by office 1.1 Property Address: UQ Q Map Lot Unit Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: COO Name Tint) Current Mailin Address: Telephone Signature 2.2 Authorized Agent: ro y vwerdc le 5-1- e�t- Name(Print) Current Mailing Address: -'Ri 'c"', q 13—--tol"91/—4�)I?(�9 Sig ure Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building G (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) l Check Number This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionerlinspector of Buildings Date 60 BLACKBERRY IN BP-2014-1024 GIS#: COMMONWEALTH OF MASSACHUSETTS Ma :Block: 24A-246 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: ROOF BUILDING PERMIT Permit# BP-2014-1024 Project# JS-2014-001774 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.): 10672.20 Owner: MAURER KYLE P Zoning: URB(100) Applicant. VISTA HOME IMPROVEMENT AT. 60 BLACKBERRY LN Applicant Address: Phone: Insurance: 1346 ELM ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:41812014 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE HOUSE & SHED 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 4/8/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner