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17C-256 (2) - �.00ting �ro�o�at - CT.REG.No 0621848 &Vista Page No. of Pages MA REG. No. 162058 HOME IMPROVEMENT 2003 RIVERDALE STREET WEST SPRINGFIELD,MA 01089E��Bf Toll Free:1-888-597-2323•Local:413-382-0249 FAX:413-382-0241 Proposal Submitted To Homeowner Work T9 Be-Performed At Name ' r Name r - Street 1!y c � , Street City `wf )" � , State flip ( f� City State_Zip Date ; ;'l r Telephone ; "!'S %r( Date Telephone Vista Home Improvement agrees to do the following: J Acquire all permits for roofing work 1. Materlat Location U ngie Over Tear Off ka Main House ❑Garage ❑Shed W.Su(iply Dumpster-Location__ fir `Inspect Decking for damage .d"eplace Decking Q '__�f -' per sheet ❑ Install all New Decking-Type _@_____per sheet Roofi�g,,MFG,t j 'S Color r 'style�_? �,( /v6tp/Brown drip edge ❑f-6 .!F-5 Deck Underlayment ❑#15 Felt ❑Rhino Liner L1 ❑Ice and water Barrier U'3' .,J 6' ❑Fult, )#:f<sh all valleys,penetrations,eaves and chimneys V"Supply and install pipe boot flashing L ,Supply and install ridge vent ❑Generic Lill-Cobra Exhaust ❑Supply and install vent kit ❑Supply and install soffit vents- Orly.____ ❑R&R Gutters �A ?otal Job Clean-Up Supply and install 12 in.lead on chimney tj WAf RMTY_ ❑Standard ❑System Plus ❑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. ❑Rolled/Rubber Roofing Type _—_ Color __— Location Other: ..-,f�-„-.-.......rte- j�• �_-�J� �1�-� 'S _�--�7.--.=�w�- �. te¢" 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: j x Said amodnt shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within .- days. t 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. , Signature of Contractor or authorized representative: '(INWe)have read the terms stated herein,they have been explained to(me/us),and(I(We)find them to be sa(fsfactory and hereby accept them. Signature ofHomeowner(a) t-_.___�} r �''.�___ % 'f The Commonwealth of Massachusetts r Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):VISTA HOME IMPROVEMENT/BRIAN RUDD Address:2003 RIVERDALE ST. City/State/Zip:WEST SPRINGFIELD, MA 01089 Phone #:413-382-0249 Are you an employer? Check the appropriate box: Type of project(required): I.❑✓ I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working or me in an capacity. employees and have workers' g Y 9. E] Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *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 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:SOUTHWICK INSURANCE Policy# or Self-ins. Lic.#:JUB2EO72183 Expiration Date:03/12/2015 Job Site Address: '—AkO Q. Mc" SA- City/State/Zip:-f canU M4 01Q)U � 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 MGL 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: * Date Phone#:413-382-0249 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: - � Not Applicable ❑ Name of License Holder G�Y� 2 nd.,t- ` 1 W 1 `,1' y� �, rr License]Number -2 C11- a4.J7.-r�a�i �)k ( �Yt'1 0+l - IM G i ar� i k i 1 I l l 1.5 Addres Expira ion Dhte Signat lephon 9. Registered Home Improvement Contractor: Not Applicable ❑ Company Name -] Registration Number Address Expirati n Dattd W c-S _h/1 A 01 CAA Telephone(.417)Ih-z-&L L1 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 build' g 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 apolicablel New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing Q Or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs [r-3] Decks Siding[C3] Other[❑] Brief Description of Proposed Work: Removing existing roof shingles and underlying components,replacing with new materials. Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x 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? In. 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 -a '-t° C t S S as Owner of the subject property 1 hereby authorize ��S�-r. �-t-yr�a 62rU* _rn,'n 4- to act on my behalf, in all matters relative to work authorized by this buildi g permit application. Signature of Owner J Date ^�/ I, V C6 "-an,t � w.ariNC�vtir,-�� t`� a s��l Arl r as Owner/Authorized Agent hereby declare that the state ents and informatiorl on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name y <5 1 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 30 DONT KNOW ® YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO � DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained O , 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 ® NO 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Et ; Department use only j ), ity of Northampton Status of Permit: Q uilding Department Curb Cut/Driveway Permit �� 212 Main Street Sewer/Septic Availability Irspections Room 100 WaterANell Availability 1060 Northampton, 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 lo Q Map Lot Unit r'Y)A 6iL%LP�� Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Paul and Elissa Pashkin 46 North Main St.Florence,MA 01062 Name(Print) Current Mailing Address: 413-585-1599 s.{' coy-*'-rte. - ) Telephone Signature 2.2 Authorized Aaent: �/ t s stn CTlS Ya ey\peuvtr r—,e rl}- 'ZcTt73 (fur r-cl�-c L �� ?�C�p'E1 Ck A, Name(Print) Current Mailing Address: Signature Telephone one SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 8,873 (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) 8,873 Check Number 3 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 46 NORTH MAIN ST BP-2015-0197 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-256 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-2015-0197 Project# JS-2015-000376 Est. Cost: $8873.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 106156 Lot Size(sq. ft.): 22389.84 Owner: PASHKIN ELISSA Zoning: URB000y Applicant: VISTA HOME IMPROVEMENT AT. 46 NORTH MAIN ST Applicant Address: Phone: Insurance: 1346 ELM ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:811912014 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: FeeTyne: Date Paid: Amount: Building 8/19/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner