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16D-022 (8) 141 NORTH MAIN ST BP-2017-0592 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: I6D-022 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2017-0592 Project# JS-2017-000958 Est.Cost: $60570.00 Fee:$424.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BAYSTATE RESTORATION GROUP 056785 Lot Size(sq.ft.): 24611.40 Owner: KIRKPATRICK REALTY LLC Zoning: URB(292)/ Applicant: BAYSTATE RESTORATION GROUP AT: 141 NORTH MAIN ST Applicant Address: Phone: Insurance: 69 GAGNE ST (413) 532-3473 WC CH ICOPEEMA01013 ISSUED ON:11/8/2016 0:00:00 TO PERFORM THE FOLLOWING WORK NEW ROOF, SIDING, DECKS & STAIRWAY 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 11/8/20160:00:00 $424.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0592 C.(('���/� O APPLICANT/CONTACT PERSON BAYSTATE RESTORATION GROUP U ADDRESS/PHONE 69 GAGNE ST CHICOPEE (413)532-3473 PROPERTY LOCATION 141 NORTH MAIN ST MAP 16D PARCEL 022 001 ZONE URB(292)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 1M I ,, j Building Permit Filled out UV Fee Paid \ Typeof Construction: NEW ROOF,SIDN6,DECkS&STAIRWAY New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 056785 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: (/Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance' Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management -molition Delay f/41t. - 7/; S _-. eofB•ilding / Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Versionl.7 Commercial Building Permit May 15.2000 -) - Department use only _ --1 City of Northampton Status of Permit: F_ I Building Department Curb Cut/Driveway Permit cur 2 7 itis 212 Main Street SewedSeptic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 141 I r '1/r' 1"/`/(Ji� Main rbMap Lot Unit fIu e,f � . Zone Overlay District _ ...._.__._... . __ Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: -TOM hick pa-k- Name(Print) Current Mailing Address: 374 - LHOb Signature Telephone 2.2 Authorized Agent: Name(Print) Current Mailing Address: 1Nt S. Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS (� Item Estimated Cost(Dollars)to be Oficial Use Only `1c� completed by permit applicant 1. Building /„0 570= 63 (a)Building Permit Fee lLG/�ll.J� 1, 2. Electrical (b)Estimated Total Cost of Construction from (6) 3. Plumbing - Building Permit Fee 4. Mechanical(HVAC) --- - 5. Fire Protection / �W 6. Total=(1 +2+3+4+5) l00( A))70 , tet/ Check Number )3 C1/43 V This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/inspector of Buildings Date Version 1.7 Commercial Building Permit May 15.2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ RoofingoChange of Use 0 Other❑ Brief Description Enter a brief description here. (J�,J IO p—t �rSJ...0,9d r c1i.O_C_$ Q,'cl & Of Proposed Work: t-& — AT L'! I SECTION 5-USE GROUP AND CONSTRUCTION TYPE U51‘” I e cti nc) 1/1,5j5 USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 0 1A j ❑ A-4 ❑ A-5 0 1B 0 ! B Business 0 2A 0 E Educational 0 2B 1 0 F Factory 0 F-1 ❑ F-2 0 2C 0 H High Hazard 0 3A 0 I Institutional 0 I-1 0 1-2 0 1-3 ❑ 38 0 M Mercantile ❑ 4 0 R Residential ❑ R-1 0 R-2 0 R-3 ❑ 5A ❑ S Storage 0 5-1 0 S-2 0 5B 0 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): ,. . ..... Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1s 1st ..__.. 2m _..._ 2ne 3rd _.. 3m _.. 4th _._ 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) ._._ __ . .__.... - Total Height ft 7.Water S ply(M.G.L.c.4Q§54) 7.1 Flood Zone Information: 7.3 Sewage plsposal System: Public Private 0 Zone Outside Flood Zone Municipal al, On site disposal system Version1.7 Commercial Building Permit May 15,2900 8. NORTHAMPTON ZONING 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 ,n Open Space Footage (Lot area minus bldg&paved parkme) #of Parkins Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding e r been issued for/on the site? NO 0 DON'T KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO er DON'T KNOW O 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 1.1 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 e' IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excav on, 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. Versionl.7 Commercial Budding Permit May IS,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPUESPFOR BUILDING PERMIT I. 1 `-' 111 t11IIU Vj . �.7 ¢. � y� l y7� ' I�1. , as Owner of the subject property hereby authorize .6a93-1-0:4e._. 1" )e 3)U i7.H r-1. 4 &j c/WFJ to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date P)� -C 3-l�2Th "^ rJ , as Owner/Authorized Agent herebydeclare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed nde the pair and penalties of perjury °Lin D0Vl CLI t Pnnt Name • ll)-3 -1In Signre• • er/Mient Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction� �Suupervisyo�r: M ail, Not Applicable� O Name of License Holder: It IG 1cf .1 J-O'l V)L/ l, (,,,mss) —'.i/lc-285 License Number bat Criaore_ Ch tcnaaa 5-10%.. b io13 Q G 17 Address ' --' Expiration Date Slgnat• e Telephone SECTION 13-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 buildi permit. Signed Affidavit Attached Yes Ly No 0 Versioni.7 Commercial Building Permit May 15.2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: .._... Not Applicable 0 Name(Registrant): _. ..._..._........ Registration Number Address. ___.... Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date _ .. _. Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 GeneralContractorfctoorbaL (f {� v!a4 6e5�6 I t t `± t 2 - Not Applicable ❑ Companyitame. Yv1al h.DDQA LA,. Responsible In Charge of Construction Leg iQ11e. Gt D I OI 3. Address 53a 64-23 Signature Telephone 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 cc 111 , S 150A. Address of the work: 1-1-I CC/ 2 ma/ n ) The debris will be transported by: V { I � � IVk�1�/K0 vi (1_0_›6 The debris will be received by: P h° _ t 1 £2L Building permit number: �_ Name of Permit Applicant ./ it I Alak t,h ■' i _ i Date Signature of Permit Applicant The Commonwealth of Massachusetts Print Form y= Department of Industrial Accidents F==1i�Cl Office of Investigations "t-- 600 Washington Street s Boston, MA 02111 "•�"`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name '1a- A . Sicfrth(f)(D /w Address: t9//I Gar <+— City/State/Zip:Q ,U Q Wick d bI ne#: 9 3473 Are you an employer?Cherie`theap propriate box: Type of project(required): I. 1 am a employer with g-J 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 5 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance p required.] 5. ❑ We area corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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 MI 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 =Moves. If the sub-conuncrors 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 Insurance C ,,, 1 4I 0 Insurance Company Name:uT' )fi� `t /U�F�ty Q` �/� Policy#or Self-ins. Lic.#: wavN I t dJ I Expiration Date: I tk NCintf) ct' kin.4� Job Site Address; City/5tate,'Zip: 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 anther 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 un �/a pains td penalties of perjury that the information provided'above 1/isstttrue and correct Signature - jri7dt%���zz-'� Dale: IV -4 ! /�Q Phone#: �3 -53pa 341)3 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 4C uo? CERTIFICATE OF LIABILITY INSURANCE °°o °01y"" THIS CERTIFICATE IS ISSUED AS A MAT TER 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 CERT1RCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. tf SUBROGATION IS WAIVED, subject to the terms and conditions at 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 endorsemenl(s). PROoucER 00501 -0c1 HoACT V%label/Lavigne&Deady Insurance Agency,Inc. L�c°% Erq: (413)532-3291 ite Na., (dl3)53a-8982 PO Box 59 BAAL s` Chicopee,MA 01021 - 1SURE.LSAFEORPING COVERAGE NAlcp imapERA' Atlantic Charter Insurance Company VDAC 29211 INSURED m91PEP B Baystate Restoration Group,LLC INSURER C 59 Gagne Street _WSUREP D: Chicopee, MA 01013 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO (1/HICF THIS CERTIFICATE MALSE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POqL�IpCIES.LIMITS SHOWN MAY HAVE SEEN REDUCLELIJD BY ty @ PAID CLAIMS ILq. TYPE OF BSORANCE '�N;P sryyp POLICY NUMBER keeDo/YYYYI maroleIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERALI1A01L1TY DAMAGE TO RENTED ..BEEISEI(Ea.Pn:Nnencel CLAIMS-MADE OCCUR MED EXP(Any one Person' PERSONAL 3ADV INJURY 5 '.. GENERAL AGGREGATE IS GEST AGGREGATE CMR APPLIES PORE PRODUCT-COMP!OP AGG '..$ POLICY JF'T LOC AUTOMOBILE UABILrTY COMBINED SINGLE LIMIT EaacaLenll ANY AUTO. BODILY INJURY(Par person/ If ALL OWNED SCHEDULE© BODILY INJURY(Earacdtlit) _AUTOS ALTOS FIRED AUTOS S AUTNON-OWNED PROPERT!DAMAGE AUTOS IPwaPoIXCEl s UMBRELLA LWB '- OCCUR EACH OCCURRENCE EXCESS CAR '.. I CLAIMS MADE AGGREGATE . ..qm�D(EEEppO pq1I ERRNryETEEqNNT11TIOONN S yw�C;S5TT��TTUU TI{ WgqIyyD@gqApCPppLqq���VEEIAIpPsqtpSBqppBTTLLNNIEFTp4p//EE V/N X TOPYLIMITS .OED A OW!CEWMEMBEP/EXCL11DE0�ECJRVE I N A,I WCVD1200001 1/14/2015 1/14/201 EL EACH ACCIDENT LS Sao,000.00 Manaamry in NH1 EL DISEASE-EA EMPLOYEE S 500000.00 Os roN oYZPERATIONS ben. Policy Coverage State: MA =_L DISEASE-POLICY LIMIT s 500.000.00 No Member is covered by the workers compensation policy- DESCRIPIJON OF OPFRAIIONS/LOCATIONS/VEHICLES 1Attadi ACORD 101,Aumtiona Remarks Schedule,if mare space Is r:afr CERTIFICATE HOLDER • CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POUCIES RE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR. TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUMORILED REPRESENTATIVE / /1 i1 v 1988-2014 AACOROA�,R/D(•CORP,`O'fR�-AA,/TIIO✓N.AAll rights reserved. ACORD R5(2014/01) The ACORD name and logo are registered marks at ACORD CERTIFICATE HOLDER COPY ACO CERTIFICATE OF LIABILITY INSURANCE DATE'MMDD `/ 10/17/2016 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 pollcy(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 Marion Lentes NAME Berkshire Insurance Group, Inc. C"No FMI. (413) 935-1200 FAX Nal: 15)567-5300 138 Longmeadow St. .mlentes@berkshireinsurancegroup.com INSURERIS)AFFORDING COVERAGE • NAIC% Longmeadow HA 01106 ''. INSURERA Philadelphia Insurance INSURED INSURER a Tokio Marine Specialty Ins. Haystate Restoration Group, LLC INSURER C: _ 69 Gagne St INSURER0. I INSURER E: Chicopee HA 01013 :. INSURER F'• COVERAGES CERTIFICATE NUMBER CL16101346076 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 MATH 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 POLICES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I IADOL SUBRI POUCY EFF POLICY EXP TYPE OF INSURANCE IIN o WVO I POuCY NUMBER IMMIDDIPryY) IMMNDIVWYI'- LIMITS I COMMERCIAL GENERAL LIABILITY 1 1Ica OCCURRENCE I S 1,000,000 DAMAGE TO RENTED A 'ice' CLAIMS-MADE X I OCCUR I EREMISES(Es occurrence) $ 100,000 PBPX1562847 10/7/2016 10/7/2017 i MED EXP(Any oneoerson) IS 5,000 PERSONAL 3ADV INJURY IS 1,000,000 GEN'L AGGREGATE LMIT APPLIES PER I I GENERAL AGGREGATE IS 2,000,000 R POLIC1,', -7 I LOC PRODUCTS-CDMPIOP AGO 5 _ 2,000,000 OTHER' I IS AUTOMOBILE LIABILITY I I COMBINED SINGLE LIMIT is !Ea acceent) ANY AUTO i 1 BODILY INJURY(Per person) S --P• LL OWNED � SCHEDULED I BODILY INJURY(Peracodenl)1 $ AUTOS AUTOS ! H• IRED AUTOSON-OWNEDI I• PROPERTYDAMAGE S AUTOS %Per n I S R UMBRELLA LIPS _ • OCCUR I EACH OCCURRENCE 3 1,000.000 B ,i EXCESS LIAR I CLAIMS-MADE''. I AGGREGATE S DED ' I RETENTIONS i 208559655 10/7/2016 j 10/7/20171 'S WORKERS COMPENSATION 'RI C"- AND EMPLOYERS'UABNTY I I _ STATUTE ER ANY PROPL RIETORIPARTNE,WEXECUTIVE Y EEACH ACCIDENT $ OFFICER/MEMBER EXCLUDED' N NIA IMandalnryin HmE_L.DISEASE-EA EMPLOYEE S Eyes Uesaiie under I IDESCRIPTION OF OPERATIONS below I I EL DISEASE-POLICY LIMIT: S B Pollution/ & sro£esssenal 1 eeea(1562864 10/7/2016 10/7/2017 Lino) 1,000,000 DeUu le per cam 5,000 DESCRIPTION OF OPERATONs I LOCATIONS%VEHI(LES (ACORD 101,Additional Remarks Scchedule,may be attached d more space IS required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Marion Lentes/MLENTE \----72k./['c 2[O'LL_L�CZY ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025Imllann :1/4/ *t 9a((ri i( un/rme(1& Offca of Cooeamer ABairR&nusinnexv Regulariou OME IMPROVEMENT CONTRACTOR eg stration: 180476 Type: Expiiatom 1161912016' LLC BAYSTATE RESTORAI ION GROUP,t.LC. MARK [AVIAN O4 GAGNE ST CHICOPEE MA 01013 Undeaeerebry 1®t Massachusetts Department of Public Safely Board of Building Regulations and Standards License. CS-058785 Construction Supervisor MARK R R 75614RERT RD RD SOUTHAMPTON MA Omit h 1C �4n V� Expiration Commissioner 09/091201717i] Baystate Restoration Group 69 Gagne ST Chicopee, MA 01013 (413) 532-3473 F1D#47-1852658 Hic#180478 CONTRACT & PAYMENT AUTHORIZATION Agreement made this Tuesday, October 18, 2016, by and between Baystate Restoration Group 69 Gagne ST Chicopee,MA 01013 and Tom Kirkpatrick 141 North Main St. Florence, Ma (hereinafter referred to as"You") Article 1: Nature of Work and Contract Price. Baystate Restoration Group agrees to commence work on Your property and coordinate matters with You and Your insurance company in order to effect repairs quickly and professionally. Baystate Restoration Group shall supply itemized specifications to You and Your insurance company showing the work specified and its cost, and accept payment in the amount agreed to by Baystate Restoration Group. All proposed work is subject to approval by appropriate building officials and You. The total amount agreed to be paid for the work specified and the time schedule of payments is set forth in the attached payment schedule. The specifications. payment schedule, any addenda and any change orders shall become a part of and incorporated into this Contract. Article 2: Permission to Start Work. You agree to allow Baystate Restoration Group to commence work on the above described property. to pay Baystate Restoration Group the amount agreed to by Baystate Restoration Group and Your insurance company for work performed by Baystate Restoration Group, and to direct Your insurance company to include the name of Baystate Restoration Group on any settlement drafts or checks. Article 3: Additional Changes to Work. You may, from time to time, in writing, make changes in or additions to the work to be performed by Baystate Restoration Group and Baystate Restoration Group shall make such changes or additions at Your sole cost and expense, at such prices as You and Baystate Restoration Group may agree to in writing ("Change Orders"). Baystate Restoration Group will obtain Your written permission before doing any work not covered by Your insurance carrier. 1 Article 4: Insurance and Delays in Work Performance. Baystate Restoration Group may not be liable to begin work or continue the work due to weather conditions, strikes, accidents, unavailability of material, or delays beyond Baystate Restoration Group's control. You must carry fire, general liability, tornado, and other necessary insurance. Baystate Restoration Group and its subcontractors shall provide all insurance required to fully protect their employees and subcontractors. If payments are not made by You within three(3) days after the date as applicable on the payment schedule, Baystate Restoration Group may elect to terminate performance and cancel this contract. If Baystate Restoration Group elects to terminate performance and cancel this contract, Baystate Restoration Group shall do so by notifying You in writing. Performance by Baystate Restoration Group is conditioned upon payment by You. If Baystate Restoration Group is delayed at any time in the progress of the work by an act or neglect of Yours or by any employee or agent of You, or by any separate contractor employed by You or by changes ordered in the work, or by labor disputes, conditions not reasonably anticipated, unavoidable casualties, or any causes beyond Baystate Restoration Group's control, or by delay authorized by You, then the contract time shall be extended by change order for such reasonable items as You and Baystate Restoration Group may determine. Article 5: Workmanship. Baystate Restoration Group shall cause the work to be done in a good and workmanlike manner according to the standard practices of the trade. Baystate Restoration Group will provide a one (1) year warranty as required by Massachusetts State Law. Article 6: Default. In the event of default in payment or in any other manner by You, You agree to pay all costs of collection including reasonable attorney's fees, in addition to other damages incurred by Baystate Restoration Group. You further agree to pay the maximum interest permissible by the laws of the State of Massachusetts on any sum in default. Article 7: Concealed Conditions. Should Baystate Restoration Group discover concealed conditions or unknown conditions in an existing structure different from normal conditions customarily found or unknown conditions below the ground. then the contract amount may be increased by a change order upon the request of Baystate Restoration Group or You within five(5)days after the condition is first observed. Baystate Restoration Group and You and/or Your insurance representative shall agree on the work to be performed and its cost prior to the work being completed. Both parties agree that any work to be performed shall be stated in writing and signed by both parties, which shall become a pan of this Contract. Article 8: Binding Obligations. The obligations of this Agreement are binding upon Baystate Restoration Group and its successors and assigns and upon You and Your heirs, successors, executors, administrators, and assigns. Article 9: Starting and Completion Dates. Work to commence on or before 11/07/16 and be substantially completed in accordance with the terms of this contract on or before 02/07/17, which may be extended for delays beyond the control of Baystate Restoration Group. Any change orders signed after this Agreement date may affect completion dates. Article 10: Permits It is the responsibility of Baystate Restoration Group to obtain all necessary and applicable permits before beginning the Work. In the event You secure Your own permit, You will be excluded from the Residential Contractor's Guaranty Fund. 2 All contractors and subcontractors must be registered by the State. Any inquiries relating to registration should be directed to the following: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 • Phone: (617) 973-8700 YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME YOU SIGN IT. NO WORK SHALL BEGIN PRIOR TO THE SIGNING OF THIS CONTRACT. You, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD (3RD) BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 4) -/5-/6 Baystate Restoration Group Date By: 'nor K of v;Ci.r Print Owner(s): - xx �✓o�� f / C/9 /A By: Date Duly Authorized -r -I0 Bv. Date Duly Authorized 3 Arbitration Baystate Restoration Group and You hereby mutually agree in advance that in the event that Baystate Restoration Group has a dispute concerning this contract, Baystate Restoration Group may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c.142A. Baystate Restoration Group: Owner: XX /7„,v, (j0�� Owner: il/,qyi of NOTICE. The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by Baystate Restoration Group. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. 4 Work Description -Labor and materials to Strip roof, Install new GAF architectural shingles. Clean up all debris remove from site. Install new boots, flashing and ice and water barrier as needed. We will provide upon completion a certificate from GAF for a 50 year non-pro rated warranty directly from GAF for 100% replacement of the roof(details will be included in paperwork from GAF). *any plywood that is damaged or rotted will be an upcharge of $50 per sheet. -Install new Mastic vinyl siding. Cover all window and door trim with aluminum(decorative front door trim excluded). Cover all soffits and facia with metal and vinyl soffiting. Removal of debris included. -Install new piers and pressure treated decks per plan provided. Install new stair system per plan provided. Removal of debris included. 5 IoM kkh PGhLk ii-H A /fail =L (1 gitisiik 9v hN1 6p / I I I &:-ItO ItIA \ . --\ i(1 4 .},ovse) It' ?,1 i iJ M4 ch — /awi4 9