11C-008 (4) I I BERNACHE ST BP-2017-0564
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mack; 11C-008 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MOL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2017-0564
Project# JS-2017-000912
Est. Cost: $9000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VISTA HOME IMPROVEMENT 162058
Lot Size(sq. it): 7971.48 Owner: BERSON DAVID
Zoning: URAOCOY' Applicant: VISTA HOME IMPROVEMENT
AT: 11 BERNACHE ST
Applicant Address: Phone: Insurance:
2003 RIVERDALE ST (413) 382-0249 WC
WEST SPRINGFIELDMA01089 ISSUED ON:I n/2472016 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE OLD ROOF WITH NEW
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector f Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House VI 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 10/24/2016 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
.Department use only ,
f;;) City of Northampton StaiusofPennit
Fb,-.0i =� Building Department Diet GNDdveway PennR
212 Main Street Sewer/SepticAYa9abllity
CGI 20 Room 100 Water/Well Ai/anabllity
orthampton, MA 01060 Two Sets of Structural Plans
prn of , ;pf�An- . t-587-1240 Fax 413-587-1272 Plot/Site Plans
.,,r..a... Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION a.O— 17-b W 7
1.1 Property Address: This section to be completed by office
\ %IZX •Ce k\S c- A. Map Lot Unit
___ ct J c t VI G ` 05b Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
0vy c C-961 SO(
\ y o� gQ c)�(C*y& - Lao +
NameCI � NV A�VcTX7l-- CuV �u'1�d `-1 � (Z� ,� Ct(J53
elep ne
Signature
2.2 Authorized Agent: �7
�QA �h V'jk\n� SUC�j C.,WtrdClU,_-,,,'vv\,QSA- V'1(t c 4
Name Print) �\ \ \) CurrentntMelling Address: /\ I �, 1 �/t CA
Gel
Si natur r. V/�/Nt Vir�_ i 1 9>U)O %3` 1— I l q 1"v Y't 66"
Tel phone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 9 ( "JJ()/'5 (a)Building Permit Fee
2. Electrical ` J` J\ J (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection � /� ,,dd
6. Total =(1 +2+3+4+5) (I f 0015 Check Number 413ab eO 410
This Section For Official Use Only
Building Permit Number: " Date
Issued: /�
Signature: � /0 —2116'
Building Commissioner/Inspector offBBuildings _ �/D-te /
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 J •.. _-. -.
Building Height
Bldg. Square Footage % _ --- --
Open Space Footage
(Lot area minusbldg&paved
parking) __....
K of Parking Spaces ----- - - -
Fill: _. _. _.. •
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW • YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW • YES O
•
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO •
IF YES, describe size, type and Location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO •
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO •
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) ��tt
New House n Addition ❑ Replacement Windows Alteration(s) Roofing Of I
Or Doors D J�
Accessory Bldg. ❑ Demolition ❑ New Signs [Dl Decks [0 Siding[O] Other[O]
Brief De prion of,P,,,roppo,sed
Work: �( u'0 C1 vvc- c \c\G A 0 > cm1\ I 00p-A
Alteration of existing bedroom Yes \iClo Adding new bedroom Yes X-,No
Attached Narrative J� Renovating unfinished basement Yes X. No
Plans Attached Roll -Sheet /�
Sa.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 OCONTRACTORRCCTOOR APPLIESFORBUILDING PERMIT
I, 0 V \C` 1 -Q. ` .S\/./V \ . , as Owner of the subject
property
hereby authorize v\ \ 'I A \t-Y\ p(Y/ttbA �),
to act on my behalf, in all matters re ative/to work authorized by this building permit application.
C C\ 1\-\tom`
Signature of Ownnerr-{� \ r \ �] .(Date ` p
I, `/ x & \ w ` \` \�V \ Y.\1 Q\ N) `0� W �� ,as Owner/Authorized
Agent hereby declare that the stat ents and information o e foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Prit tkramekt
a n �l \ C) J C\Lc
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licens•d •nstruction •ervisor: ._ Not Applicable D
Name of License Holder: , a , 1 (5 j x
_ W--)
/` License Number
•
Address ^' - Expiratlin Dat
1t. _ �JV�� • C ' _ )_ �l
• ature .. -ephone
9.Reglstered Home Improvement Contractor: Not Applicable 0
l sane `• w a itb iblr.. 14 1 . Ts
I.•
omMpany Name p Regis ration Number
Address 0 I 031 Expirati in Date
Telephone I3 3gZ-C?4,.
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
`lbuilding permit.
^
Signed Affidavit Attached Yes 1 \' No 0
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 3Q .. (
C1\*-v-ay 4_
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150k
Address of the work: \ \ )QcfC' '\ _Q-4. C\g LAA- C \053
The debris will be transported by: \\ 0(A \itC, 'Qct LISLoalis
The debris will be received by: A Vntcivc. v\Y\) ty\
Building permit number:
Name of Permit Applicant KQ_.1�}� �
\U\ b\yKQ ;�"L_
Date Signature of Permit Applicant
. \ __....__._..__.... _r .. ..•.__.._
Department of Industrial Accidents
P
°==,`j�{=Cl Office of Investigations
t=AB= -0 1 Congress Street, Suite 100
`�1-.,a Boston,MA 02114-2017
r>. ,
044-
www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information \ Please PrintriLegibly
Name (Business�/Orgga+niizatioMndividual): \/ \ r �k ,� ' J 1 ' JN -
Address: 9CfD3 21\.\ Itch- -c- (' jJ4- 1 v-�}-
City/State/Zip:\ k�Q 5,1-5.961 ivicii\let ILA 'done #(1( -.1 .',3S'7_, —C7J-4 I
Are ou an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).'
have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or listed on the attached sheet. 7. ❑ Remodeling
partner-
shipand have no employees These sub-contractors have g
❑ Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance.t 9. ❑ Building addition
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.1ggoof repairs
insurance required.] r c. 152, §1(4),and we have no
employees. [No workers' I3.0 Other
comp. insurance required.]
'Any applicant that cheeks box NI must also fill out the section below showing their workers compensation policy information.
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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
'nformation. \,� (n (\`c (� (' ppp p
nsurance Company Name: CAA
AA \ ,U\�7C`IQ r� \ \\l,s� NU\r\\ c\ \�` .
'olicy#or Self-ins. Lic.#:] \ 3`(7�CCifl 7( \I dip p- \ \9 Expiration Date:"ON 12 1 f�
fob Site Address: \\ . 9X c\ ),I2 \k.. Sr City/State/Zip:1021,\.S �{t} C'\0.73
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
3ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine 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
tf up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvcstigations of the DIA for insurance coverage verification.
r do hereby cerci under the pains and penalties of perjury that the information provided above is true and correct.
3ianature: �l kpp //}}��77 -1\� Date: U t LCA i ( lP
'hone it: LA \3Th ?-)S-7 —07Lig
Of use e only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
C�?ie Fbni rwnraea t4 d/0/Zae,L ae/r
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162058
Type: LLC
Expiration: 1/122017 Tri 262537
SAMBRICO LLC dba VISTA HOME IMPROV
BRIAN RUDD
2003 RIVERDALE ST - - - - - -- -
WEST SPRINGFIELD, MA 01089 ---- - - - - -- -
Update Address and return card.Mark reason for change.
aper Cr 2014-05/11 -', Address Renewal Employment - Lost Card
/412. o Jor at.,a0/Add./ H,.:v.,Ambr,
Office ofCommer AtRin&Batons Regulation License or registration valid for individul use only
E IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
on: 162058 Type: Office of Consumer Again and fleshless Regulation
ration: 1/12/2017 LLC 10 Parc Plaza-Suite 5170
Boston,MA 02116
SAMBRICO LLC its VISTA HOME IMPROVEMENT
BRIAN RUDD j� / —
2003 RIVERDALE ST
t�
WEST SPRINGFIELD.MA 01059 -- - - -- - _- ' - --
Undersecretary . valid without signature
. . . a_ a / . f a` ♦ ♦ . ar yes ♦ 1a ar
` A STATE OF CONNECTICUTa+ DEPARTMENT OF CONSUMER PROTECTION ' 1
Be it known that
SAMBRICO LLC
2003 RIVERDALE ST
W SPRINGFIELD, MA 010894060
is certified by the Department of Consumer Protection as a registered
` HOME IMPROVEMENT CONTRACTOR )
Registration # HIC.0621848
VISTA HOME IMPROVEMENT
4.
J , Effective: 12/01/2015
Expiration: 11/30/2016 �
J, alum Atiarda,Coma
09/23/2018 2:47PM FAX 4135729191 WILLIAM MIS INSURANCE 20001/0002
CERTIFICATE OF LIABILITY INSURANCE DATE '
08/23/20162016
THIS CERTIFICATE M ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. TIM CERTIFICATE OF INSURANCE DOES NOT COWTIIUTR A CONTRACT 9ETWEEN THE ISSUING INSURER(S), AUTHORISED
REPRESENTATNE OR PRODUCER.AND THE CERTIFICATE HOLDER
IMPORTANT. R the certlecetr holder is se AOOMONAL INSVREO, the policy(lea) MUM be endowed_ If SUBROGATION is WAVED, subject to
IM knits end conshlons of the policy, cantle policies may require an endpnement A statement an this certificate does not confer rigida to the
c<nNlcete holder In lieu of such endommwnl(s).
mane cm TMJ MIS
WILLIAM J MIS INSURANCE WAX ... __..._...
(41
156 ELM ST a.w Lite 3) 568 - 6111 lµi,x.y(A131 572 - 9191
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WESTFIELD, 1M. 01085
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INURED
INSURERS:
SAIBRICO LTG DBA
MY RC:
VISTA NOM RHPPtIVITNIHT ._ _.. . .
"'Flo!?I_
2003 RITiBIEDALD STREET INSURER E;
•
WEST SPRINGFIELD 6A 01089 NEMER F:
COVERAGES CERTIFICATE NUMBER REVISION NUMSG:
THIS IS TO alar' THAT THE POLIES OF INSURANCE. LISTED 88.0W HAVE BEEN ISSUED TO THE INSURE) NAMED ATOM FOR TNN POLICY PERIOD
INDICATED. NOTW ISTKIDR(G ANT REOUREMENT. TNRM OR CONDITION OF ANY CONTRACT OP OTHER DOCUMENT MITA RESPECT TO WHICH THIS
CERTIFICATE MAY BE EBUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI I. THE TERMS.
NNCLUaON5 AND CONOMONS OF SUCH POLICES.IMRS SNOWS MAY HAVE BEEN REDUCED BY PAD GLOME
Tien ANL Iw YWR
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CERTIFICATE HOLDER CANCELLATION
SAMERICO LLC DBA
VISTA NOME 1MYROVh13NT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED spoke
TIE EePIMTON CATE THEREOF, NOTICE WILL BE DEIKERED IN
2003AIVBPUIILE ROAD ACCORDANCE WITH THE ENJOY PROVI0 NS.
WEST SPRINGFIELD MA 01009 wrwla Tw
1
IS -2010 AGA'S CORPORATION. All Apesreserved.
ACORD 25(201010.5) The ACORD name and loge are registered narks ACORO
0-4 3/15/2016 5:36:45 AM PAGE 2/002 Fax Server
CERTIFICATE OF LIABILITY INSURANCE I DATE MhMENTYYY1
nanOtInt
FICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT APFIRMATNELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERtS),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 and endorsement Astatement on this certificate does not confer rights to
the certificate holder in lieu of such endosemenps).
PRODUCER CONTACT
NAME:
SOUTH WICK INS AGENCY INC PHONE FAX
562 COI[FOE HIGHWAY WC.No,Et): (ATC,Neje
E-MAIL
SOUTHWICK,MA 01077 ADDRESS:
28TKC INSORINAS)AFFOROINO COVERAGE NAIL#
INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMM[FCA
SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B:
*GuaER e:
INSURER D:
2003 RIVERDALE ST INSURER E:
WEST SPRINGFIELD,MA 01089 INSURER F;
COVERAGES CERRFICATE NUMBER REVISION NUMBER:
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AUTOMOBILE LIABILITY COMBINED SINGLE S
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A WORKERS COMPESATiON AND X WG STATUTORY I OTHER
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OESCRIFION OF OPERATIONsPLOCATION5NSdCIESIRESTRCOONS/SPECIAL NEMS
This REPLACES ANY PRIOR CERTIFICATE ISSUEOTO THE CERTIFICATEHOLDER AFFECTING WORKERS COMP COVERAGE
CERT1FICAIE HOLDER CANCELLATION
TOWN OF WEST SPRINGFIELD SHOULD ANY Of UHEABOVEOESCRBED POLICIES BE fiacgLLEO
26 C'ENTRAL.ST BEFORE THE EXPIRATION E.II
ATION DATE THEREOF.NOTCH WILL HE DERED
B ACCOROANCR all,.THEPOLICY PROVISIONS.
AUTHORIZED RBPRESEM . { _
WEST SPRINGFIELD,MA 01089 ly; �(fy,*-.
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1S85-2610ACORD CORPORATION. NI rights reserved.
1 he Official Website of the hxe utNe Of ice of Public Safety and SecurAy f EOPSS)
le
Public Safety `i
6Ao fav Hoene Slott Agencies•
1 (S. Mass.
eases Details
emographic Information
Full Name: KEITH W DEVIN
cense Address Information
ity: WEST SUFFIELD
tate: CT
ipcode: 06093
icense Information
License No: CS-110285 License Type: Construction Supervisor
Profession: Building Licenses Date of Last Renewal:
Issue Date: Expiration Date: 1/9/2020
License Status: Active Today's Date: 10/20/2016
Secondary License Type:
Doing Business As:
tus Ch n e R as : License Is inns
on
No Prerequisite Information
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® 2011 Commonwealth of Massachusetts Site Policies Contact Ug
Ke yr,(h v" eols44./ /w10^Ciet i 1071 / lian't
- Roofing jropo at -
.REG.No.0621818 Page No. W' Pages •
AREG.No. 162058 % t Tj L+}r�
HOME IMPROVEMENT
Also fromel
2003 RIVERDALE STREET run N um.
2011-2013 WEST SPRINGFIELD,MA 01089
Toll Free:1.888-597-2323•Local:413-382-0249 -
FAX:413-382-0241 II l
Proposal Submitted To Honeownar Work To Be Performed At
{�
Name l lA 0l41 /30 rSe•-A ! Name Sav 'C •
-
Street 1 I r n O—, L¢ . 14 Street _
City / PP S state PIA210O/OS3 City State Zip ,,
Date 10/1 -0ti Telephone 9/4 799 /213 Dale Telephone_
•
Vista Home Improvement agrees to do the following:
•
didrAryulre all permits n ❑ts for roofing work WMaterial Location„*01-__(..d. I __ _ •
Srhingle Over.2Tear 0Main House 4Gareg-e0 Shed a-supply Dumpster-Location y
Sm e.t"0
Inspect Decking la ar damage S Replace Decking® per sheet
U Install an New Docking-TypeG Per sheet '
Roofing MFrttw (in./Cmor,SlaTI/f STfe 1.-......).4 r41-41.9 -rrllRl Brown drip edge drF-8 ❑F-5
cock Underpaymentea LI f15 Felt Pro Armor U GDeck Defense/
$Weather Lock G SSealing Ice on Water Barrier ❑3 . ecat
6' U Full yy,lash all valleys,penetrations,eaves and chimneys
U Supplyand install ppe loot flashing . Supply and install ridge vent U Generic Wrlidge Cal U
❑Supply and install vent kit ❑Supply and install soffit vents- Ota. O H&H Gutters O Total Job Clean-up
❑Suppland Install 12 in.lead on chimney
WARRANTY
U Standard i/Preferred Protection U Platinum Protection
MMmlon Honrwwtva:mono cover all prwn.l worming.In the ask,garage,Or etorpa areas der to the possibility of reeling
debris or duet coming throught me creeks W the wood.VMS Home Improvement will not be response,.for debrisor dust in 1M eras
mentioned.Also visa a not responsible for gape from siding on home and roof pre due to multi layer srlw.
❑Rolled I Rubber Roofing Type Color Location
Other: I�4"-Ov-ct CdPe k it -:,fo ran ,,-Fre r 4 e ct c' eel_ mi Prox,
/�."P✓ �� (� 4n f rr1�I a - fie,
✓4n-flr .rlr.d-a`e , i � l�. ,,p—I o„_i ...-.4L. . > _ - , r„- 'a
at _ 21-___. - ci, Pc' — / Yl
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d.MI worlem bbmpleteib awohcrnahle m cmN
ang W slvMara'pracfce T,nyatielrztion '
or deviation from the above specifications must be made in writing on an MdnNMWMutio of Contract form and may become an extra charge
over and above the amount sated herein.This agreement Is contingent epee 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 term
below.If the homeowner defaults,homeowner agrees to pay all costs 04 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 moose hereby to Nmiah material q(HO laborp complete in ace. •:nee with the aboyB sptications,for: - m of:
ri • - , 4• - / ffiy0 -6 �
St Voss shallbpld in follows:
NM:TN.papaw Vey be worsen by as E net act WWII t&O days.
YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIM 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 M A
LEGAL BUSINESS DAY IN CONNECTICUT.)THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT ANN
THE HOME NW TIOYEMENT ACT.THIS INSTRUMENT IS NO NEGOTIABLE. v
Sgnalure of Contractor or authorized represenullw:/—(Cf�L— ✓-4
'ioae)hem reed Mx terms Melee thein,they has fou,lipWn.dM(ni✓ml.and(Me)end than to be satisfactory ed Sway swept then.
memento Hoo emmorO): xf 9 x