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17C-158 AC"R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/09/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If 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 INS AGENCY INC PHONE FAX PO BOX 100 A/C,No,Ext: A/C,No): E-MAIL ADDRESS: SOUTHWICK MA 01077 28TKC INSURERS AFFORDING COVERAGE NAIC# INSURERA:TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED INSURER B: SAMBRICO LLC DBA VISTA HOME INSURER C: IMPROVEMENT 2003 RIVERDALE ST INSURER D. WEST SPRINGFIELD MA 01089 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE D OCCUR MED EXP(Any one erson $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS—COMP/OP AGG POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO SCHEDULED BODILY INJURY Per $ ALL OWNED NON-OWNED BODILY INJURY Per accident $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HC LAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- OTH- A AND EMPLOYERS'LIABILITY (7PJUB-2EO7218-3—14) 03—12-14 03-12-15 X TORY LIMITS ER ANY PROPRIETOR/PARTNEWEXECUTIVE OFFICER/MEMBER EXCLUDED? Y/N E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) Y NIA E.L.DISEASE—EA EMPLOYEE$ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CITY OF NORTHAMPTON, MA AUTHORIZED REPRESENTATIVE 210 MAIN STREET NORTHAMPTON MA 01060 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD PROM.W5!U_-p4,-1 mIS !N9.-RP 41357724191, 1413:14-42 .41 CERTIFICATE OF LIABILITY INSURANCE N-18 MMATS IS MUM #A i7 MrZR OP INVOM"'nox ONLY Amr. awais ko. RjowTa upoN Twe CERTIPICAY9 DWI W1 APPOINATIMY OR WCATIVILY AMEND, EXTIND OR ALUR -,kg 00WR"I WON= try TR POE ogs MI.OW THIS 0£R VICAlt CW INSUAMU OM# NOT 01POIrTV111 A 0ONTRACT ararmaN TKG MWING 1114ultaRts), kv-140RI2 0 RCIPROSUNTATIVS 00 F1060WER,AND TH9 0f!RTI0i0ATF HOLDik F-=MRTANr If the aMRUW 9=1W as an MMMOL 119ORK M p-ajFRW*j must no oat=m&ro1r-=XWMM-1S--WA1VW, subw to th* fliorma SPA ""dhW" a# *to oog", **Amin palkise wAy r*gW)-a tin ondomwngra. A *Mor,*W�.oft M 00" not sonfw fth" 19 tho "Nflaa*wcw In lieu cw tact)*0donm"nual. raata WX& w7taitAx i His INOMMM M114cy wz8TrT%=r IMIA olula-5 wvomar MOM 11 VtST.A f0a tsmovwwT 12003 '.kM*MXtF OT =111 grax"Wilado wh 031099 p Govapt"Wo cl"MPICATi NUMBER: -rime is To =M? ' TM VwFairlw-a or IN W41CATRZ). NO-Vs NSTAWNG AW REOUWMENT TtRM OA CONOM1ON OF ANY COWTWT OR 0*4 oocvmfm-r xd lM Pavfv TO WW-K T-4m CWMIICATFI MINI` 61 4UM OR MAY PERTAIN.. INSUWCS AFFORI*D BY 7HE POCK( M6PWD HV61N IS SU13JECT TO ALL IW TERMS; 6X'.6USWd ANO CONOMONG OF SUCH POLIOE&LNITE!CI+*WN MAY•AW BUN AlEOVAGCO OY PAID CLAW3 Opt df aeatsmeatas 710 JL WAA 010953 -0/14/20103/1i/ 5,000 j P00*44 AW4 NAAW �v 00,000 2,000,000 OWL AQW"*AT*&J*rAPftft MR, W~ 2,000,000 J- --i AMY AWTO waw(pw NOW) is AIL AUX" 4mm i vim WAM ALrf0Z AUT(w Qmopua'�A w" GA4"cow acme IJAV J C T AND Cam ,UfAw" ON i w.4 Accaw , 0 0 VLA MGM-v a M p v' f 0 QWAW POUCY Wie ;I j3 4 CERTIM KIM 93M'M- 77v9-51' -NORTRAW= IV4 ACOAZ 24 12CH Oft 'fho ACORD ftffit jond top am PVDW#d MOM oot AC*t Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162058 Type: LLC Expiration: 1112/2015 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. SCA 1 0 2CM-05;11 Address ._. Renewal L Employment !—. Lost Card '��r 1<'�nv �aniurtl/✓r�'�'�1r..:Srr�lu3c•/!.; - ------.._. =_\ Orliee of Consumer:Affairs&Business Regulation License or registration valid for individul use only j�F $OME IMPROVEMENT CONTRACTOR I before the expiration date. 1f found return to: f2egistration: 16ZQ58 Type: Office of Consumer Affairs and Business Regulation ,expiration: 1/12/2015 LLC 10 Park Plaza-Suite 5170 srr" Boston,VIA 02116 SAMBRICO LLC dba VISTA HOME IMPROVEMENT BRIAN RUDD –� 2003 RIVERDALE ST WEST SPRINGFIELD,MA 01089 ry UndersecrctarY P,alid ut signa ture , STATE OF CONNECTICUT ,+ DEPARTMENT OF CONSUMER PROTECTION Be it known that SAMBRICO LLC 2003 RIVERDALE ST J.W SPRIlG�r ELI); MA 01089-1000 is certified by the Depaxttnet t of�oxisu:Mer P otection as a registered HOME 1A,1 - ENT CONTRACTOR Re stir ` # . 621848 VISTA HOME IMPROVEMENT Effective: 12/01/2013 Expiration: 11/30/2014 William M.Rubenstein,Commissioner .,. ..fir. .,/.�4 .._... ...,. .... .. . .. .. ., - . a ♦ .. ♦ L w A A r w L� �.r; /.\.rh tilt.``/.!. 'i?r;:`'/ - woofing Vropaar - CT. REG.No 0621848 '� T���� Page No. of Pages MA REG.No. 162058 \r/ Ir HOME IMPROVEMENT 2003 RIVERDALE STREET I-wdW"14uhh..l WEST SPRINGFIELD, MA 01089 �Ste�'E�ItB" Toil Free:1-888-597-2323-Local:413-382-0249 FAX:413-382-0241 Proposal Submitted To Homeowner Work To Be PerforJneO At Name 4sJui kM Irl a 4t -Tr..•n,alrti-kFr Name ")E . Street _ ,if Street _ f City State MZip_11'(, City State Zip- � s Date Telephoned` ": y '" Date Telephone Vista Home Improvement agrees to do the following: J �,,„„rrte�"" ly Acguire all permits for rooting word Ll Material Location Ll Shingle Over Tear Off d Main House i.kGarage Ll Shed i 4.48appy Dumpster-Lpcation ~'G-)�.I+nspect Decking for damage _V11 eplace Decking(9 _per sheet ;a Install all New Decking-Type ? e A• 'per sheet " r 1 b Rooting MFG t Color_ /�- . Style ?t.^ p ?'�¢: I*,je/Brown drip edge a7 F-8 F-5 � �r Deck Underlayrnent V#15 Felt Rhino Liner Ll + Ice and water Barrier Ll 3' ld6' Ll Full, lash all valleys,penetrations,eaves and chimneys LA Supply and install pipe boot flashing U'Supply and install ridge vent Ll Generic - Cobra Exhaust ,Supply and install vent kit kJ Supply and install soffit vents- Qty._j t_ I�'R&R Gutters J Total Job Clean-Up Supply and install 12 in.lead on chimney WARAAUTY d le U Standard J System Pius U Golden Pledge Attention Homeowners:Please cover all personal belongings in the attic,garage,or storage areas due to the possibility of rooting 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. Ll Rotted!Rubber Roofing Type — _- Color_ Location .___ _ Other. i �--�;-r.�.�.-L 3 A IJ..ee it )/r$a' .x+� 1 {��._ .-. _,2 f3 ,�•a;.t __,pit_.y/i-.'�?x s !�'8�w .,0{d+ /-°"^'�F 1 :/__ R : U15...--.___—_—__ Y 1 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'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 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 propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: f 44to4 w' -- -- _ Said amount shall be paid as follows: -f Note:This proposal may he withdrawn by us It not accepted within____.lays. 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 NOT NEGOTIABLE. jFdr t Signature of Contractor or authorized representative:._ "(I/We)have read the terms staCed;here'tn the h7a4loesnox Ined to(me/us)-`sPd(IlWe)find them robe setiafactory and here¢q accept them. r ...SI nature of Homeowne s X 'u4� b,.,_ "•.': /' t":" __._,___.---- The Commonwealth qf.t assachusetts Boston, MA W I Workers' Compensation lnsuranec Alridavit. p kafit information 'Please r n'J t .'t t"L .S'*4 e7..Eia+Cs eta 1159£kL::+,S�.z�cnssit .���o;�Eliiii i'i�..tsR,'.i E.,� � ......,._ _�✓, ^,...._,....�., �.. _w..l._��!.�:t�.r:.,L.�w r....1..L�__..—..._.....�.._;.. ire you nn em lover. �.�rec a ra rWe box., 3 � '4 mp n#€crap w* F q 4 �� 1 am a Peneral contractor and t I J. i• 'z ?t., <,..,t a x * hav� St-e d the sub >3ttYAC fiz37S s 3 4+i r i v �r u�Liviy z, Esteed on ihe;marhed sheet. ! 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R SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: [[ Not Applicable ❑ Name of License Holder: aya+ F� 2 i2JUI )l-�.. s rd to is License Number r A (S III& Addres Expireion Dade 4� �Hi .)`38�-c°2`tC1 'signature Telephone 9. Reaistered Home Improvement Contractor: Not Applicable ❑ V,5i--t,,.. lAyyrp r, rrrr sCr.�.�,w l ri r 1�c u t t ., Q L.Q'2 i 4 ss Company Name Registration Number '20 o'-2-, Address Expirati n-Date 1 A:A.I,k 4p(--'IJ rtrr-A Q10S�r Telephone(.`91��`3�Z-o'l�y 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....... d 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 171 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[[3] Other[❑] Brief Description of Proposed Work: UAjyx vi&j •t- rif j c..a a-C t SS"C2z, w t Ltac OU %.4 C&,V%p cnngn f-S Alteration of existing bedroom Yes f No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement Yes iZ" 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, 'IZ cab r rr �t�lL tvrc�R,t �- S-�:c&r, ,A W Q_ h_t'- as Owner of the subject property hereby authorize V.S t-u VV-&'y„---A t VNP rTyt ry k,^} to act on my behalf, in all matters relative to work authorized by this buildi g permit application. Signature of Owner Date -/+5 4 c� nro`° ^�` ,' `-� ,,�-* 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 penalties of perjury. 'T> n a.n d Print Name S Signature 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 Q YES Q 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 a brook, body of water or wetlands? NO 0 DON'T KNOW O YES 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 Q NO Ar IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO 0 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 © NO Rr IF YES,then a Northampton Storm Water Management Permit from the DPW is required. tit Department use only j y of Northampton Status of Permit: JUN 2 7;Ahampton,ilding Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Electric,Plumbing , Room 100 Water/Well Availability Ncrthamptcn, MA 01060 Two Sets of Structural Plans phone 413-587-1240 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 1.1 Property Address: This section to be completed by office CAA NAIA j-1 Map Lot Unit '-7f ACV,-eAC f i1r�f� C31(' "Z Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: j utn Q LA)Q-6 ts.x �I cjOr,JI "". S 1- A 0)oul Name(Print) U Current Mailing Address: / (`-tIS) `5Fs- Telephone Signature 2.2 Authorized Agent: i ,e Na Print) Cu ent Mailing Address: `�13 -�C�- Si re Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ( o t (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=0 +2+3+4+5) 16 U W , Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings Date 84 CHESTNUT ST BP-2014-1406 GIs#: COMMONWEALTH OF MASSACHUSETTS MM:Block: 17C- 158 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-2014-1406 Project# JS-2014-002377 Est. Cost: $10968.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 106156 Lot Size(sq. ft.): 6185.52 Owner: SALMAGGI ROBIN J TRUSTEE&JOANNE K WEBBER TRUSTEE Zoning: URB(100)/ Applicant. VISTA HOME IMPROVEMENT AT: 84 CHESTNUT ST Applicant Address: Phone: Insurance: 1346 ELM ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON.•612712014 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 6/27/2014 0:00:00 $35.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner