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17B-007 (2) ACORJM CERTIFICATE OF LIABILITY INSURANCE 01/09/2003 PRODUCER (413)536-0804 FAX (413)534-7874 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Martin J. Clayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1649 Northampton Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. 0. Box 989 Holyoke, MA 01041-0989 INSURERS AFFORDING COVERAGE INSURED Sul enski Roofing And INSURER A: FIRST FINANCIAL INSURANCE CO Siding Co. Inc. INSURER B: Safety Insurance 103 South Street INSURERC: AMERICAN HOME ASSURANCE Holyoke, MA 01040 INSURER D: 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. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 50,000 CLAIMS MADE X❑OCCUR F0492QS10326 12/01/2002 12/01/2003 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 $ 1,000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS 1610306 01/01/2003 01/01/2004 (Per person) $ B X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ NX X COMPREHENSIVE PROPERTY DAMAGE COLLISION (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR FI CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ ATU_ I WORKERS COMPENSATION AND TORY LIMITS ER C EMPLOYERS'LIABILITY E.L EACH ACCIDENT $ 100,000 C6748562 12/31/2002 12/31/2003 E.L.DISEASE-EA EMPLOYEE $ 100,000 E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS S CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL SERVICE MAGIC, INC. 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1626 COLE BOULEVARD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY I STE 200, BLDG. # 7 OF ANY KIND UPON THE COMP Nt IVSZ6E4TS OR SENTATIVES. GOLDEN, CO 80401 AUTHORIZED REPRESENTATIVE Harold Clayton Jr. ,? ACORD 25-S(7/97) ©ACO CO ORA ON 1988 II. PRICE » Contractor agrees to do all work described in Section I for the total price of$ *79,V, III. PAYMENT Payment will be made as follows: Od , 33 1/3 % $ r�L 7 a, upon signing contract: G� '70 upon start of r� $ • ' ' upon start of $ upon start of and the remaining_ »�'_% ($ ,8 yb• ) upon verification of the work by Owner and Contractor as having been satisfactorily completed, which verification shall take place promptly alter completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contactor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever amount is greater. HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustment in the overall price of the necessary work related to this Agreement. In such case the Contractor shall inform the Owner of such conditions forthwith and where necessary a written amendment of this Agreement will be negotiated and executed by the Contractor and Owner. IV. COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless specified here in writing. Contractor will begin the work on or about (date). Barring delay caused by circumstances beyond Contractor's control,the work will be completed by 0"C'h IN,-, ;f—(date). The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement. V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED The Contractor may not require payments to be made in advance of the times specified in Section III(Payment)above for the reason that he deems himself or the payments to be insecure. If, however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work described herein,that the balance of the payments under this contract that are in the control of the Owner,shall be placed in a joint escrow account that requires the signature of both the Contractor and the Owner for withdrawal. Accounts not paid within 30 days are subject to a finance charge of 1 1/2%per month. This is an annual percentage rate of 18%. VI. INSURANCE Contractor will be responsible to Owner or any third party for any property damage or bodily injury caused by himself,his employees or his subcontractors in the performance of,or as a result of,the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury. VII. SUBCONTRACTING Contractor agrees that,not withstanding any agreements for materials and/or labor between Contractor and third party,Contractor is responsible to Owner for completion of all work described in a timely and workmanlike manner. S.E. Sulenski ROOFING & SIDING CO. INC. 103 South St., Holyoke, MA 01040 413-532-3630 Fax 413-536-8354 MA Reg. # 101718 ----- RESIDENTIAL, CONTRACTING AGREEMENT ----- Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. --------------------------- Notice: All home improvement contractors and subcontractors engaged in home improvement contracting, unless specifically exempt from registration by provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Director, Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108. Company Name: S.E. Sulenski Co., Inc. Designated Registrant's Name: John R. Rigalis, Pres. Registration Number: 101718 Salesperson's Name: 1-�O�ry This agreement is made on 0 ?- a 2, - D 2) between S.E. Sulenski Co., Inc. (DATE) (COMRACTOR) of 103 South Street Holyoke, MA 01040 (413)532-3630 (PHONE NUMBER) hereinafter called "Contractor"and (OWNER) of aril-AL 'l oacl-. Ko6-Th(-wiP(ow 7/56 (ADDRESS) (PHONE NUMBER) hereinafter called "Owner". 1. DETAILED DESCRIPTION OF WORK TO BE PERFORMED AND DETAILED DESCRIPTION OF MATERIALS TO BE USED The Contractor and Owner agree that the following additional documents,plans specifications and change orders are attached hereto and incorporated by reference into this Agreement: O Specification Sheets Pages O Kitchen Design Pages Plans Pages O Materials List Pages of M, Northampton, MIrt5s. CONT.-IT"NSATION IN'SURAINCY-1 AFFIDAVII too K J.itil a 1);!1 Ciplj ;,.t- 5 WJI LJ lt) �Kl n 1�1*% e (i-x Dl:-,:i for,D2[c) I Ll 0'1 C i 1, 7 the ("ulltractor- istcO below Tic L).--J)s"t'CT. of CT alllc of --—----------- ,"Naj,, of Jlly m.ucz. COIIIT Y'Tdcy h 1v t©r ;11Q,. , ic NO Y: Ix.,Wait to"o r.of MI'vc lfua tj-.rw v,,-b :! ",)d by OL or t,,=;.�luyor w"icruA.:;d tl:.tt a ccr')y 0(ti-,U to 11,, Axn,':r."'7',tili"of Llro -f-r,'O MZ��r :5Acfh(Gj,152 ran lead to Che of up U)Orr of m Or\;.: T-) al dSb :60 60 ga qaj SECTION''8 CONS:�t3CTIQ�i_5ERV1C.. 8.1 Licensed Gonst3;_ctian uqe!r)i�or: Not Apphcabie t Na—tr ie_.4f License HoJ�e; — �''t�1'L� l - – U::ense Number Address Expiration Date Si tature q 7elep` ne / Not Applicable G IL Comt�anY game PeRistration Nurr,ber t(, r- C Address Expiration Date v- CL'P t t Te • one S CTICENi1J WORK ;ptS' CQh1PErdSAT. -N IN` JRAN .E AFFIDAVIT(h ,':L. c. 152, �, 25C(C ) Workers Coimp,2nsat ;nzuraricw atfidt. rnus )e co'-)pi,;toc and subr',Mt_� with th'; appilLation. Failure to provide this affidavit will result it t`"e der, ! ::,t the issuc.nce .' :he b, .ding Signed AttidaO Atta:.+-�r�c; Yes...... U11, do. .... O _ The current,_->' `or"hoi.. ;owner:, was'.�xtettded to incluc::'. 0�'vner-occunied_Dwellitt.:s of one(l) or two(2)families and to allow s,;_h hor 'ner tc; _ngag .:n ind` idual for hire wn:)decs not possess a license, orovided that the owner acts 3 as supervisor. EMI=, Six; :, Edtt>,._n Se�.?son lOtt. .5.1. Definition ,f ?omec. ^r Per_)n(s) to ow a parcel of land w;i,ch he/shy resides or ir. cnds to reside, on which there is,or is intcnd; to 1? Ile or ','o far iy dwcutng,attached or G,Ian:Clod structures acccssor,, to such use anxi/or farm structures. :r: rson ••v"L3 cons;__rots n. c tfy�a one home in a ttijoo_jc,,r ,erio I shall not h:_ considered ahorneowner. Such"homco�+ner" s:."Jc:ubm : :o the i ::illdint Ofl cial,on a for;:: ac,,.ptable to the Buildin Otiicial�tha Lit v/she shall he responsib,e f,_ all s -vork rforvr :1 unf r 1:.e l;uildin -mi_ As 4_iing A: tructi -,ur yo: presc:,ce u i is.-c job sits •viL , : tequire.? from title tinge. during at; ; upon com,'etion o -,he wo r::-whip this p. rnit is issued. Also oe ac;isc> that v.,i`.:; eferc . c to C': apter .52(Workers' Cc,•:11per.;:aion) and Chap' ;r I (Liability of Fmployers to Emp oycc, f.� injurie• . ,.resui aj in ' zath): :`the Massachusc.•.r, G.n:;rai Laws Annotated,._ou mtiv he fiat; e for person(s) you -ire tc, z:,;;onn w;>:, or yo.: .tndet `;is per.nit. The unden,ioncd"hor;lcc:•vner" rtific: end as:.unes responsibilit v for compliance with the`Ste Building Code,City of North_.mp,o n C)rdinar;��:,, State read Lot .Zcni:7g La,vs and State•.)f Massachusetts Gencral Laws Annotated. Homc;;wnt�r_?i;natu c -� s S •d d�,* :EO EO 9Z q93 OP €t I*O c Ud 11 IffAl F, .t._�:""I..rsSnF.gk'x £,+k2::�•ue E:F.e I?ki.�il 3, l• w� .: ., • ,` , ,ry+n;,te., +r a New House U Addition 0 Replacement Windows j Alteration(s) 0 Roofing ` 1 Or Doors G' I Accessory Bldg. O DemolitionD New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work:__- Tj �? ,,,rQ - Alteration of existing bedroom _Yes—� No Adding new,bedroom Yes No Attached Narrative 0 Renovating unfinished hasem-ent Yes No Plans Attached Roll -0- Sheet 0 `--- lf N t a�n f at 'itl rt?'{o e isfln> y u"�slrig;�c i leke" th f. I —J& a. Use of builcling : Ore Family _._ `1vc Family Other b. Number of rooms in earth far-iily unit:_-____-_a_-_ Number of Eathrooms c. Is there a garage attached? d. Proposed Square footage of ne,v construction. _ Dimensions _ e. Number of stories? _ f. Method of heating? _ Fireplaces or Woodstoves. Number of each l g. Energy Conservation Compliance. Nlascheck Energy Compliance form attached?_ h. Type of construction _ i. Is construction within 100 ft. of wetlands?_ des ,!—No. is construction within 100 yr. floodplai❑ Yes }. Depth of basement or cellar floor below finisher grade k. Will building conform to the Building and Zoning regulations? _— Yes`_ No , 1. Septic Tank City Sewer Private well City water Supply —_ 5ECT�r0 1A �s b;1+ VE�t�AUI"Ft�3,RIZAT[ON -.70 BE COMPLETED WHEN — O CT OR APPL"'IES,'FE3R BUII.p1NG PERMIT =�'- as Own r of the subject property hereby authorize — _ to act on my behalf, in ail matters relative to work authorized by this building perm _it application �__ J• I_ -�I(.(k P.IL C as Owner. Authonzed 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-�, u-nd�er the pains and penalties of perjury. Print N me � .� �� 3 -03 Sig re of Owner/Ag= enter i` bate f, •d d6{, :60 EO 9;3 clazi Sc i i[l 4. ALL INF)W ATP,):^oi JUST' BE , OM-i"LETED, or PERMIT CAN BE SEN D D'JE TJ L XK ;:jF r, i OP. TION E,, .,ting rapo '-Cl Required try Zoning This column to be filled in by Building Department Lot Size Fronts Setback:, Front j i- Side !� L:` --, R:__ Rear +! 13uifdins, Height Bldg. S.,uare Footage i Open S .ace Footr:ge % - (Lot area:}inus bldg Y.paved arkin � I #of Parkin Vices Fill: volume&Location A. 1-ias a S)ecial -ermi /Vari. nce/F ,ding j, er beEn i,lsuad for. on the site? NO DOt 'T Ki OW_._ � ES IF YES, date ssu(3,d _ IF YES: Was t`.e per,•iit rec3rdec at thc: egist of Des is N0 D01;'T K1 OW `'ES IF YES: ente o o k _ _ ____ age _ ; nd/or Document tr B. Does the cots'.yin a k;-ook, body water )r wetlands? NO _- DON'T KNOW YES IF YES, I- ,s a r✓ :rmit teen c' need co be ( taineo from the Conservatior, Commission? N-:eds to be ob�ained _ 'Dbtair;. d Date Is, ued:— __ C. Dc any sig is exi. ; cn tt e prc,)erty? `S -_-� NO IF YES, d-scrib : size, type : id Doc, ion:-- _--- I. Are tl-ere a I prof;osed .hangi ', 'o or !ditic s C signs in vendee for the property ?YES 0 I:'°YES, size, ,ype Lid 1oc.:1,ion: E dZb :EO EO 9E qej Cane-q 00' Northampton 1 Departrnent Stre''et m 100 29i'th mp t n, MA 010600 phone 413.558.12 4 Fax 41158 17 1 72 F PPLiCAT�m NSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This sctr „Rtexdarz�pl C ff ce�,!i — 1.1 Property Address: �yt �.';� Itx• Lone �r.'� b�eclay D�striC��' 1rUe�tr11�Gf lm ►���dV h'1 r� . D I D.('a EIm.St:`Distric;—TB'Di�triCt� _ SECTION 2 - PROPERTY OWNERS HIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: �} j --------- T°!ep h o n e A 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signa u Telephone SECTION-3'- ESTIMATED CONSTRUCTION C05T5 Item Estimated Cos: (Dollars) to be Official Use Only completed by=it applicant _ T. 1. Building (a) Building Permit Fee 6, 7 9 2. Electrical (b; Estimated Totat'Cost of Construction from (6) 3. Plumbing Building Permit Fee fro. Mechanical (HVAC) 15. Fire Protection 6. Total = (l + 2 + 3 + 4 + 5) Check Number M This Section For Official Use_Omy I3uiiding.Permit Number: Date Is Signature Building Commissioner/Inspector of Buildings Date Z •d Jat, :EO 60 se qaj BP-2004-0154 GIS#: COMMONWEALTH OF MASSACHUSETTS w I CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2004-0154 Project# JS-2004-0232 Est.Cost:$6794.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group: S E Sulenski 101718 Lot Size(sa.ft.): 67953.60 Owner: PALM JEFFREY A&KELLY A zoning:RR Applicant: S E Sulenski AT. 448 BRIDGE RD Applicant Address: Phone: Insurance: 103 South Street (413) 532-3630 Workers Compensation HOLYOKEMA01040 ISSUED ON:8112103 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• Receipt No: Date Paid: Check No: Amount: Building 8/12/03 0:00:00 13164 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo