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29-486 580 BURTS PIT RD BP-2017-1003 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-486 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2017-1003 Project# JS-2017-001732 Est. Cost: $14500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot Size(sq. ft.): 30187.08 Owner: ADAMETZ WOLFGANG A&GAIL A Zoning: Applicant: STURDY HOME IMPROVEMENT AT: 580 BURTS PIT RD Applicant Address: Phone: Insurance: P 0 BOX 51033 (413) 543-5906 INDIAN ORCHARDMA01151 ISSUED ON:3/7/2017 0:00:00 TO PERFORM THE FOLLOWING WORK SUPPLY & INSTALL 800 SERIES ENERGY STAR WINDOW 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: OI: 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 3/7/2017 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / ,� -N. Department use only o jt City of Northampton status of Permit: /; V i Building Department Curb Cut/Driveway Permit 7 a 212 Main Street Sewer/Septic 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,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION be- 17-/0 1.1 Property /�Atltlress: This section to be completed by office 546 y- PA-Q94 . Map Lot Unit '�' i " L✓-Eytte ( AAA Oto6) Zone Overlay District O Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (Tc t A „€a-z 5-6 Pu,+s PA 2ar~ei . Name(Print) Cune t Maili g Address: (i5 �4- e„ qS Telep ne Signature 2.2 Authorized Agent: 34Jy {--yZ yt �'�. nc 4s5. kco,_ S gA- S Name(Print) (� Current Mailing Address: tc D ; Qt-(ki) Sl-i3 SziC5lo Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 4i - 0s3 (a)Building Permit Fee lye' 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building PermltFee 4. Mechanical(HVAC) 5. Fire Protection 6. Total =(1 +2+3+4+5) ILI 0Oo - Check Number 'f/Co, 9' 4440 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Ade ...,•,0#9,., 3 — d-117 Building Commissioner/Inspector of Buildings Date STURDY HOME IMPROVEMENT WORCESTER SPRINGFIELD HARTFORD 459 MAIN STREET-PO.BOX 51033-SPRINGFIELD.MA01151 MA.REG#151711 CT.REG A 601525 1-877-3-STURDY 508-797-6600 413-543-5906 FAX 413-543-3200 OWNER PERMIT AUTHORIZATION • Name: Address: {jrrizt 662,,r 4/t City/ State /Zip: ?i ee, 07,42- �/� a I Ada, (Owner), of the property located at: . ,-;uthorize Sturdy Home Improvement Inc. to act as my agent for the construction project taking place at the above address. I also authorize Sturdy Home Improvement Inc. to obtain a building permit. I understand and accept responsibility to comply with ail regulations and required inspections. Signature of Owner: Alol/_, Date:A¢d-4-,3��J / Page 1 of 1 Section 4. ZONING AU 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 Deparuncm • Lot Size .... _.. Frontage • _._ Setbacks Front Side L: R:: L: It Rear : . ! - . Building Height Bldg. Square Footage - % Open Space Footage o . _ . ... • (Lot area minus bldg&paved parking) k of Parking Spaces Fill: (volume&Location) A. Has a Spe I Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW er YES IF YES, date issued:' IF YES: Was the permit recorded at the 07 YES of Deeds? NO C �.7 DONT KNOW YES O IF YES: enter Book Page and/or Document 11 B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES 0 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 `ham 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(clearing,grading,excav on,or filling)over I acre or is it pad 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing n Or Doors Cl Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[I Siding[0] Otheq{_� Brief Description of Propose pQ -1� p� (' Si 1 �f/ Work: JU1 I lLii-ti 4Ilck uo bO%eCh2$ T-h ftsi,, Lao,Ay x.aS Alteration of existing bedroom YesdL/No Adding new bedroom Yes ✓No Attached Narrative Renovating unfinished basement Yes t/Ao 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? L Method of heating? Fireplaces or Woodstoves Number of each g. Enemy 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. u I /'.'✓'�u✓It avts ,as Owner of the subject properly hereby authorizeS-I CC) -�..,/117AIL a. j-T ('n to act on my behalf,in all matters rel tive to work authori ed by this building permit application. IIIIIIIII Signature of Owner ��[ IC' �� 1/ _ Date I, �""'(`"I ✓I� c1 ✓"p ikon/ • ,as Owner/Authorized Agent hereby declare th t the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Sid under the pains and penalties of perjury. Pnn t.me i—h\ 1311.4- _ Signature of Owner/Agent Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: [� Not/Ap�p�lic`able N❑ Name of License Holder: D .LJ i0 On— l J OR 3(62, License Number Addie s Expiration Date . .loin �4i3D Di - Signs a Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 Skwtf 7� rivn� 2-Irve e ( 51 11 Company Name Registration Number 4 c P t & c 13 � a. uasi (#13.962 )17. Address Expiration ate tt Telephone)0J Spc Q7 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.GI.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 mit. Signed Affidavit Attached Yes No ❑ 11. — Home Owner Exemption The current exemption for`homeowners"was extended to include Owner-occupied Dwellings of one(I) 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 7804 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 lime 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 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 definedbyMGL c 111, S 150A. Address of the work: 5gb bu✓k5 C l`ictCk The debris will be transported by: n AA- Qu �,6,3ti , /-✓` The debris will be received by: S RA,buwt S"jl, Cei ,dv 4 ivy MA- Building permit number: Name of Permit Applicant Q ( AdP n\t ie , 3 131 tg- Date Signature of Permit Applicant The Commonwealth of Massachusetts P e,== t Department of Industrial Accidents e=`III= Office of Investigations el= I Congress Street, Suite 100 s,ni5 _ g ' ='°�itf- Boston, MA 02114-2017 'w."- x www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): simas LA 4 'r tt . 3,01-irtz , Address: ck.V1 AC\lh - Scct (S (� City/State/Zip: SrrA ` I Gtr- IL , ka-✓J OA, Phone#: 9.I 0_ S1c Ip Are you an employer? Check a appropriate box: Type of project(required): 1. Lam a employer with 4. ❑ I am a general contractor and I employees (full and/or pa -time).* have hired the sub-contractors 6. ❑New constmction listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance3 required.] 5. ❑ We arc a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' right of exemption per MGL Y comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' BR Other k14(04--3 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employee. 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. —rat. �> Insurance Company Name: (( 9* (S C -1 $' . Policy#or Self-ins. Lic. #: (}, 9)' 563tifi os- It). Expiration Date: 1 I al I1}/� Job Site Address: `-4BO "JJl'I-S 0,, ----I �CA.e� City/State/Zip:f'Lev rACo tNo-.01(s(a • 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 S250.00 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. 1 do hereby certify under the eypai 3l c and penalties of perjury that the information provided above is true and correct. Signature: .:00-LI.:00-LIi�� � ]�^� t Date: k R-_Phone#: �t3) Se--4; I� (/ 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#: City of Northampton -P =ss. c, 0,1 \ Massachusetts £ < 7v, s E' DEPARTMENT OF BUILDING INSPECTIONS 1 Se 212 Hain Street • Municipal Building `� t, Y.y Northampton, MA 01060 L.,+ -"'(�6C INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her ' construction supervisor. The state defines"Homeowner"as, " Person(s) who owns a parcel on which he/she resides or intends 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 home owner." The building department for the City of Northampton wants any person(s)who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages,which include foundation/footings (before backfilll. sonotube holes (before pour), a rough building inspection (before work is concealed). insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occ minty until the work can be inspected If the homeowner hires other trades to perform work (electrical, plumbing &gas)the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DEI AY the project until such time as the proper permits and inspections are made I, \ ¢A-t Dl (5-�4 understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date . ' 1-3( a- Address of work location 'd C :� jZo C P 7e ..a R4 (:y p,..e-a- TE A RO� CERTIFICATE OF LIABILITY INSURANCE 8/8 2`o1s° 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)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 CONTNAME Nadine Nadine West Orchard-Dowd Insurance Agency LLC PHONE 14 8obala Road INC.No Ertl:411-4l7-1050 FAX No):411-43-)-14sE-MAILn Holyoke MA 01040 ADDRESS: nest@dewd.com PRODUCER CUSTOMER ID n.STURHOM-02 INSURER(S)AFFORDING COVERAGE NAILp INSURED INSURERA:Atlantic Casualty Insurance Company 42814 Sturdy Home Improvement, Inc. INSURERe: P.O. Box 51033 -- Indian Orchard MA 01151 INSURER C: INSURER 0: INSURERE: _ INSURER F: COVERAGES CERTIFICATE NUMBER:397345024 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 AW 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 INDRL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE bWO. POLICY NUMBER IMMNDNYYY) IMMNDWYYYI LIMITS A GENERAL UASILIIY 5185000199 8/7/2016 8/7/2017 EACH OCCURRENCE 51,000,000 DAMAGE TO RENTED $50.000 COMMERCIpLGENERAL LIABILITY -REMISES E,•• rice CLAIMS-MADE OCCUR MED EXP(Any one pawn) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENL AGGREFGAATTE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 POLICY PRO n LOC AUTOMOBILE UAmUTY COMBINED SINGLE MIT (Ea a[ddent) ANY AUTO BODILY INJURY(PerperSon) $ ALL OWNE°AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY AGE HIRED AUTOS (PH a[tldent)tlenl) NON-OWNED AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS HAS CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S _ $ WORKERS COMPENSATION TORY STAID 0FTq. ER ANY LIABILItt ANY PROPRIETORIPARTNERJEXECUTVE Y/N EL EACH ACCIDENT $ _ OFFICER/ EMBEERCLUDED? N/A (Mandatory ry in NH) EL.DISEASE-EA EMPLOYEE $ f ydescribe OESdescribe under OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S OESLNP➢ON OP OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule.if more space 5requiretl) Workers' Compensation Certificate of Insurance to follow separately from the carrier. 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 • ,`ys $ III V ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD • A!'sI7�' CERTIFICATE OF LIABILITY INSURANCE [DATE IMM 12018 YI 0MIVUD016 TNSFETLIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY MEND,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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: ORCHARD INS AGCY INC PHONE FAX 485 MAINSTREET (A/c,No,WC): WC,No): EMAIL INDIAN ORCHARD,MA. 01151-1241 ADDRESS: 2SYCR INSURER(S)AFFORDING COVERAGE NAIC'A INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA STURDY HOME IMPROVEMENT,INC INSURER B: INSURER C: INSURER D: PO BOX 51033 INSURER E: INDIAN ORCHARD,MA 01151 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TIlAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FORME POLICY PERIOD INDICATED. NOTWITHSTANDING ANYREQUIREMENT,TEiM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.IREINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITSSHOWN MAY HAVE BEEN REDUCED BY FAIR CLAIMS. (NSR ADD SUB POLICY EFF DATE POLICY ESP DATE LTR TYPE OF INSURANCE L R POUCYNUMBER (MMIDDIYYTYI IMMIDDYiYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ I{ CLAIMS MADE ❑OCCUR. PREMISES(Ea occurrence) MED EX?(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 7 POLICY ❑PROJECT n LOG _ PRODUCTS-COMPIOP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) — ALL OWNED AUTOS BODILY INJURY $ — SCHEDULE AUTOS (Per person) — HIRED AUTOS BODILY INJURY $ (Perecddenl) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION$ $ A WORKER'S COMPENSATION ANDMETA-RAMOTHER EMPLOYER'S LIABILITY YIN UB-51336850S-16 07/21/2016 0721/2017 `Y LIMITS kV PROPERITOWPARTNERIEXECUTIVE !—IN/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1.000,000 !ryes,descihe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATEHOLDERAEFECTING WORKERS COMP COVERAGE. 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 REPRESENT VE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1980-2010 ACORD CORPORATION. All rights reserved. & 4 , " ..: C��FtudoCduthhP�i ,. - ,,,- e - t f G ficB of onsumer Affairs �zld Business Regulation' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvem kC?,ontractor Registration s 4 zi Re9lstrafmn: 151711 �, is / Type: Supplement Card Expiration: 6/26/2018 STURDY HOME IMPROVEMENT IN� �h 1,, DAVID DIAZ I i f ,1 j 459 MAIN STREET :i INDIAN ORCHARD, MA 01151 �.7 ' Update Address and return card.Mark reason for change. scar o MI 05/11 5 Address Q Renewal 5 Employment 0 Lost Card &Ae Win/ `'ofniacA„em `�Omce ofConsumer Affairs&Business Regulation License or registration valid for individual use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: y eglstrahan {5j711- Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 kti Expiratlpn /2 /2ajy Supplement Card Boston,MA 02116 STURDY HOME IMPROVEIMENP C DAVID DIAZ ' 459 MAIN STREET �ti...<x �-rsz--- INDIANORCHARO MA 01151 Undersecretary Not valid without signet • Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-093603 Construction Supervisor DAVID DIAZ `r% ,r,- '-'. 270 TREMONT ST '� SPRINGFIELD KA u fri'�" Expiration: Commissioner 08107/2017 459 Main Street Toll Free (877) 378-8739Springfield,MA 01151 Worcester (508)797-6600 E-mail: HR@SturdyHome.com Springfield (413)543-5906 ST�R Y www.SturdyHome.com New Haven (203) 848-2118 Fax (413) 543-3200 HOME IMPROVEMENT, INC. W WINDOWS • SIDING • ROOFING • ADDITIONS MA REG.#151711 CT REG.4601525 Name WO P CAI/ -/- / i Ad' Ant GILL HomesP-hoonn� y7 Qom, Business Phone Address seoD° RUktiritt RA Cell Phone Other Town/City Repress tali• I Date �/7 FLO RekX-2 Wli4 c tit-- r. `<- 27u I/we the owner(s)of the premises described hereinafter, referred to as Owner,offer to contract with Sturdy Home Improvement, Inc. hereinafter referred to as Contractor,to furnish,deliver and arrange for installation of all materials to improve the premises as described below. Yes No WINDOW SCOPE OF WORK: Ir 0 1. Contractor to obtain required building permit(see attached permit authorization form) 1`2 0 30 Family home. l27-1:1 2. Provide certificate of insurance for workers compensation,general liability. (see attached certificates). an] 3. Keep job site in a clean and orderly manner in a broom swept condition. 1❑ 4. Provide job site dumpster, set on planks,to remove job related debris only. Please Note: dumpster for contractor's use only. (see dumpster clause). Wig'w -}Nock Vetna b•L . to ❑ 5. Homeowner to remove all personal contents away from all windows as needed in order to install windows. If additional labor is needed at the time in order to remove personal items,a cost assessment will be made at that time. 0' Q 6. Provide manufacturers warranty on all windows. rr ❑ 7. Remove and dispose of ( ® (quantity)windows. 14 Cgc d ecTdqu... t y Li c 0•0•-•-I. ❑ Erik. Remove and dispose of —"' (quantity)storms. S treX,,ry„ ),U S-LC es. aha ❑ I$-9. Remove and reinstall stops. Please note:if stops need to be replaced, an additional cost assessment will be made at that time. ❑ an 0.Remove and reinstall trim. Please note:it trim needs to be replaced, an additional cost assessment will be made at that time. Please note: The normal process of removing stops and trim on old windows will disturb paint/stains/wood on windows. Sturdy Home Improvement, Inc. will not be held liable for any paint/stain/wood surrounding the opening of any windows. Li a-11. Remove weights in pockets and dispose. r❑12. Insulate weight cavities with fiberglass insulation. - C9' Li 13. Provide all silicone sealant. to lktZ°" G�CTTtw h4 CIFe>ra4„ j 1a., I•-Teww., ❑ a-14. Install aluminum wraps around windows. Quantity nit Color lal''IL//e er ❑15. Install new {ii.y'replacement windows. Quantity /0 Manufacturer E/tUIMa fti" Model €00. ' . ❑ ®'f6. Install new construction windows. Quantity Manufacturer Model . a- ❑17. Install keyTow windows.Vinyl k Wood 0 Quantity / Manufacturer 6 Kn-s, '7r //'re . Model Other A tr ❑18. Install new glazing on each window:Low-E Low-E with argon `4 caw/other V P61 teS+ . LC 7Sul.fi... ®— ❑19. Install grids in each window: 5/8" ✓ Colonial style other Sn/H ' F'c`e"' . GBG V Interior Grids SDL Brasstone Brushed Nickel Top Sash ✓ Bottom Sash♦ r . R-- ❑20. Install new hardware on window. Colorj&/p.K lamas.) 47 r❑21. Provide screens with windows: half screens V full screens d aluminum b fiberglass . l8' U 22. Owner agrees to meet the installer during the hours of 7 AM to 4 PM for final measurements. All final measurements will be made by the installer. Failure to meet with installer will delay the installation of windows. W ❑23. Addendum(A)=OTHER WORK. IS ❑24. Acceptance Page 1 ❑25. Work not included: 1. Final cleaning of windows 2.Any rotted wood(other: Initials Initiate Initials STURDY HOME IMPROVEMENT INC. ACCEPTANCE PAGE MA REG.#151711 - CT REG.#0601525 ANY WORK NOT STATED ON PREVIOUS PAGES IS EXCLUDED The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work scheduled to begin the week of_ _/___J____. Expected completion date__J___(____Weather permitting. The cash price far labor and material as described above is: 1st payment 2nd payment 3rd payment 4thpayment Contract Total (upon signing) MaT / it-rev-1;4, / (1-1 1-ptet.,,_ Roof $ -- (o��tEt. Da Ilvrirx.1 Y7 C m per4j i-totaticor. Ventilation $ Other work $ — Au' 171 S cater Applc`& Roofing total $ — $ $ $ -- $ Siding $ $ l ,Thi $ $ $ Windows $ Ho fhb $ rims :3/ $ c7 TO $ r7.T"O- $ (i- e c. ieo3 Special orders $ $ 3/y1,2-en,* $ — $ - $ — Other $ 1 $ 5 $ —, $ —111—• $ Totals $ ' $ — $ — $ $ Terms: Cash Finance Credit Card:k - - - _ Exp.date____ / ____ Code_ Payment schedule: Any balance not paid in full within thirty days, will be charged 1.8%interest per month. In order 0 meet the completion schedule,the following material/equipment must be SPECIAL ORDERED before the contracted work begins. (Law requires that any deposit or down-payment required by the contractor before work begins,may not exceed the greater of(a-Jane-third of the total contract price or(b.)the actual cost of any special equipment or custom made material which must be special ordered In advance to meet the completion schedule) $ 0 to be paid for 0 $ CJ to be paid for 0 Any additional work orders are to be paid for once accepted and approved by purchaser Verbal understandings and agreements with representatives shall not be binding. All understandings and agreements must be set forth in writing in this contract. Additional provisions are stated on reverse side and are part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their names this is day of r.ce . 20 (7 and acknowledge receipt of a true copy of this contract. UNLESS OTHERWISE SPECIFIED. IT IS UNDERSTOOD THAT THE OWNER IS READY FOR THE WORK TO BEGIN. THE PURCHASE PRICE QUOTED T ABOVE WILL BE HONORED ONLY UNTIL 3 14 Cf. (Date). You the Purchaser(s)may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See notice of cancella- tion form for an explanation of this right. Signature affixed below also acts as receipt that Purchaser(s)received separate cancellation forms. The following is a requirement by Massachusetts General Law,Home Improvement Contractor Law MGL c 142k The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract,the contractor 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 providedinMGL c 142A. �/ /J /4 Representative: Cr;C[ O /7L-/ /41./t-e +r - Owner: l (�(�! �lr Owner: NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties" Do not sign this contract if there are any blank spaces Submitted <// Accepted /j Representative Purchaser Date Accepted Accepted by: by: Representative Purchaser Date Addendum (A) OTHER WORK /0 Peat/1c live-y . ar 4t G,d,e laud cite-rya- rrc,t . I (5 c-7-5 // 7GL CKIXt _ „peace 1.40s+t ltd, l Q cifel'ek.. 61T � Na.. Ccke..., is.a w,o c{{rrr /' L,-rc U15.,c,hitjct. gf x} 0 51,w ct7,rv� c,,,w�H / NGw 21v�Y r�:r �iC, 14-til -c ow cacti I %a Initials A...Initials Initials