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32C-232 (5) 15 HANCOCK ST BP-2017-1256 GIS#: COMMONWEALTH OF MASSACHUSETTS Man:Block: 32C-232 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-2017-1256 Project# JS-2017-002099 Est.Cost: $28000.00 Fee: $140.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 093603 Lot size(so.ft.): 7013.16 Owner: METZGER LINDA T Zonine: URC(100)/ Applicant: STURDY HOME IMPROVEMENT AT: 15 HANCOCK ST Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 WC INDIAN ORCHARDMA01151 ISSUED ON:5/3/20170:00:00 TO PERFORM THE FOLLOWING WORK:ROOF, SIDING AND WINDOWS REPLACED 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 5/32017 0:00:00 $140.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner File k BP-2017-1256 APPLICANT/CONTACT PERSON STURDY HOME IMPROVEMENT ADDRESS/PHONE P O BOX 51033 INDIAN ORCHARD (413)543-5906 PROPERTY LOCATION 15 HANCOCK ST MAP 32C PARCEL 232 001 ZONE URC(I00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST /�rvCLOSED REQUIRED DATE ZONING FORM FILLED OUT // �� Fee Paid I Building Permit Filled out Fee Paid Typeof Construction: ROOF,SIDING AND WINDO 5 REP ED New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 093603 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 4--Ala-proved_ 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 deo lition D- .y � ' S /7 Signa ure of Building Official 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. • A\ �nt use pgly City of Northampton Statism#(de4 A Building Department Curb'Gut dveWay� � *'? � . 212 Main Street Sewfd9yptto . P� Room 100 W*t /Wef Ab� j Northampton, MA 01060 n4'8etet Sl DaPJsr6s 1M ¢S^ r \ phone 413-587-1240 Fax 413-587-1272 Ptut/9ilei a r `: ,4- /APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 15 ul.vtn�� ��� Map �� Lot A32 Unit w OY 4-„ /'t nen HA 010 Z( Zone Overlay District !� ' Y f" Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Linda .1-4e,f2ff,r ly kotrrnctsirenf Name(Print) CurrenLMa mgAddr s: CLBI - tCI - KY-to. Telephone Signature 2.2 Authorized Agent: S+2tt`CG ) kat{ praNevyl Tit LIS-9 °air Si—tett )11e i 3 Name Print) Current Mailing Address: I /Iwo e`I (�)3\131i6 � Signature Telep one SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building d 0 1 OUB CD (a)Building Permit Fee 2. Electrical �j V V (b)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection oo VV 6. Total =(1 +2+3+4+5) V'G,0a) Check Number 41/949 /5/n This Section For Official Use Only TT�� Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size _ _ ____ _. Frontage -.______ _... ___— ( ___....___ _— 1 Setbacks Front — """—' Side L - I R: L: __: R _j r • _ i Rear • _ . I Building Height Bldg. SquareFootage - : o - 1 . ___. 6. : oota e Open Space Footage [ (Lot area minus bldg&paved _ '. ; [. , parking) #of Parking Spaces [ ---I [ Fill: (volume&location) - J _._ ___I A. Has a Spe ial Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES O IF YES: enter Book I Page: : and/or Document At B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW © YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Dat ed: • 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 0...----- IF TIF YES, describe size, type and location: i E. Will the construction activity disturb(clearing,grading,exca 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. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House in Addition ❑ ReplacementtWdows Alteration(s) n Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [C] Decks [C Siding MC Other[C] BriefD scriptlon of Pr po etl iLefficer. 'plyoz�(.f Fofkd- u s c kut Work:11e tle& Wnvt,-5-i (st'Sntiu&GC3)atnn l,.nr akiia . Qni;e-ck WIu�rtaichT,ics.1%tf+lnsiz,-U'CF/Iwt 2.1 �-5 14Y 50' McL,St 510..1' sae cendn+q&) mut- u` Alteration of a ting droom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.If New house and or addition to existing housing.complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? 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, LiNincAc. IAIQ ip ,as Owner of subject property I hereby authorize S+u.rot." l* Y(u A-bc . to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date S+k.r t O'LC . ,as Owner/Authorized Agent hereby declare ih he statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Thc-✓iA II LiL P nt - e C . 1 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES —� / 8.1 Licensed Construction Supervisor: � Not Applicable tw l., Name of License Holder: �QM,j "n,161,.,2— 0 s- 6 cokb 3 License Number a10 Ivernt 4 S iamLio / ii , I i -i AddrelExpiration Date c t l1 ltri L-t13 hone -13c, e— Signature I lepone 9.Registered Home Improvement Contractor: Not Applicable ❑ 4,We -kms319? 1CI11I Company Nam / �( Registration Number y 5 CI 1111 Se '3 1p� 18 Address Expiration ate ! IGLA_ O(c�G(zi 1--14-c i CI Telephone(1(31-C /3 /e SECTION 10-WORKERS'COMPENSATION INSURANCE AFF/DAVIT(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 building p it. 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 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 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: 1 The debris will be transported by: USA CvG o1 The debris will be received by: 'act ix.iivvistiv CT Building permit number: Name of Permit Applicant Lh kC,1: ,L4 EA-4 c t Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents P_.._ /, c =the Office of Investigations • Ic =al= 1 Congress Street, Suite 100 =''fI�—if Boston, MA 02114-2017 _ www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): —torch -----mkk U�p�yC i 1 . Address: `15C1 �(,ii 11lib ' e 1- C City/State/Zip:J1 A O1'F,k� Phone#: 3-514, Are you an employer? Check th appropriate box: Type of project(required): L.11 -am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the subcontractors 6. ❑New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insurance3 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I m a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' eom right of exemption per MGL Yp. 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13_�Other� . comp. insurance required.] *Any applicant that checks box 81 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 him 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 employees- If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job.site information. , ��[ � Insurance Company Name: 11 ,,) ( k,e`GL)S a-r.c Policy#or Self-ins. Lic. # N : -SJ3(o -oS- I (ic Expiration Date: "' �( I11g— Job Site Address: 15 R661(Gf City/State/Zip: Nitp I tiC>,-(- 'II .LAA4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby remit& under the pains and penalties of perjury that the information provided above is true and correct. Siunamre: L--IQ.r.v. ..)))A_, Date: L-( 1 D I/ 1- Phone#: Ccc-f"( ) S-II - Sq Q5- 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 Mro' i Massachusetts 42%�5. a • t s >( - ' DEPARTMENT OF BUILDING INSPECTIONS oi "Jr 212 Main Street Municipal Building \_/ CO NaztAamp[on, MA 01060 kit— • 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 Iwo 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 backfill). sonotube holes (before nourl, 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 occupancy until the work can be inspected If the homeowner hires other trades to perform work(electrical, plumbing 8 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 DELAY the project until such time as the proper permits and inspections are made LAhaa �ltt.�C v understand the above. (Home owner/resident's signs re requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date °{I a- Il I } EL Address of work location I S r\[c.C. V Sike-itiL YkG I UY1 LL - dekteddridi 4,.:. ( � fico o onsumer Affairs (nd Business Regulation' ` �t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImprovemO 'ontractor Registration 1 '' Registration: 151711 III[ 1 J/74 Type: Supplement Card I r 7 E. �I{� Expiration: 612612018 STURDY HOME IMPROVEMENT, I C i � DAVID DIAZ , 459 MAIN STREET t �� i � lt �, .` INDIAN ORCHARD, MA 01151 11 j;_r ;1/ � Update Address and return card.Mark reason for change. sent C zornosni - 0 Address Q Renewal Li Employment fl Lost Card do Wommo,,,wereNc l „ r/ r ,ern .Off of Consumer Affairs&B ss Regulation License or registration valid for individual use only - gi3ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i fiftegistratlon Office of Consumer Affairs and Business Regulation 159711 _ Type' 10 Park Plaza-Suite 5170 ExpuaL�R, 6261287& - Supplement Card Boston,MA 02116 STURDY HOME IMP e_VJ✓EOTtiiic DAVID NISZ - 459 MAIN STREET � ,?.nt-ti ib5p"--- ,..___ a,µ�c > INDIAN ORCHARD,MA 01151 Undersecretary Not valid without signaduj Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-093603 Construction Supervisor DAVID DIAZ 11, 210TREMONT STA SPRINGFIELD HffOQ� Expiration: Commissioner 0810712017 ACORD DATEIMMNBrIYWI INSURANCE v!` CERTIFICATE OF LIABILITY8/8/2016 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 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). PRODUCERNTACT NAME: Nadine West Orchard-Dowd Insurance Agency LLC PHONE FAX 14 Gobala Road Inc No Extk411-417-Soso (Am,Noy.41a-417-1ASO Holyoke MA 01040 E-MAILSS: nwest@dowd.cam PRODUCER[Dm STIJRHOM-02 INSURER(SI AFFORDING COVERAGE NAICtl INSURED INSURER A:At lantic Casualty Insurance Company 42814 Sturdy Home Improvement, Inc. P.O. Box 51033 INSURERS: Indian Orchard MA 01151 INSURER C: INSURER n: INSURER E: 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AWL SUER POLICY EFP POLICY EXP NSR_WVD POLICY NUMBER IMMNDIYYWI IMMNDPYYYI LIMITS A GENERAL ABILITY men:100199 S/7/2016 0/7/2017 EACH OCCURRENCE $1,000,000 RENTED COMMERCIAL GENERAL HABImY PPREMMISES((Ea OCCUTErcel $EO,000 CLAIMS-MADE OCCUR MED EXP(My me person) $5,000 PERSONAL BADV INJURY al,on,000 GENERAL AGGREGATE $2.000,000 GEN_AGGREGATE LIMIT APPLIES PER PRODUCTS-COVE/OPAGG $2.000,000 7 POLICY PRP-r- n LOC $ Fn AUTOMOBILE VAEILJtt COMBINED SINGLE UMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per Pram) $ ALL OWNED AUTOS BODILY INJURY(Per arident) $ SCHEDULEDAIRCS • PROPERTY DAMAGE HIRED AUTOS (Pet avdenq NON-OVMEDAUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESSUA9 CtAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTON $ $ WORKERSCOMPENSAPON TORYTS 0TH H- AND EMPLOYERS'LIABILITY ANY PROPRIETBRRARTNERIEXECUTNE YIN EL FS HACCIDENT $ OFFICER/MENDER IXCLUDED? NIA (Mandatory In NH) EL DISEASE-EA EMPLOYEE$ If yes.describe under E.L DIBF> E-PoLICY UMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTON OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remark.Schedule,if more space Is required) WorkersCompensation 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. AUTHORIZEDREPRESENTATNE�^$yam 44 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORO • AlT rrn� 0712711211182n18 Y10 CERTIFICATE OF LIABILITY INSURANCE DATE IMM TW TIFIC IFICATEIS ISSUED AS AFFIRMATIVELY OF INFORMATION EONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFRIRMATIVELY ORNEGATIVELY ITUTE AEND,E%TENDOR TWEEN RTHECOVERAGEAFFORDED 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 he 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 endorsement(s). PRODUCER CONTACT NAME: - CRCRABJ)INS AGCY INC PHONE FAX 465 MAIN STREET (A/C,No,Exy: (No,No): E-MAIL INDIAN ORCHARD,MA 01151-1241 ADDRESS: 2BYCA INSURER(S)AFFORDING COVERAGE RAID INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA STURDYHOMEIMPROVEMENT,INC INSURER B: INSURER C: PO BOX 51033 INSURER D: INSURER E: INDIAN ORCHARD,MA 01151 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS]BTO 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 OFANY CONTRACT OR OTHER DOCUMENT VAIN RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED By THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS,EXCLUSIONS AND CONDITIONS OF SUCH PORGIES.LINTSSHDWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. ]NSR ADD SUB POLICY EFF DATE POLICY IXP DATE LTR TYPE OF INSURANCE L R FOGGY NUMBER (MMIDDIYYYYI (MMNDIDBOD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1COIMMERCIAL CLAIMGENERALLAE1LlTY DAbMAGETORENTED CLAIMS MAGE nOCCUR. PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ n POLICY npROJECT El LOG PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea aocldenl) — ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-0WNEU AUTOS (Pereccitlent) PROPERTY DAMAGE $ (Per accident) 1 UMBRELLA LEAD OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANOWC STATUTORY OTHER EMPLOYERS LIABILITY YIN US-513368505-1B 07/21/2018 D7/2112017 `D. I WAITS ANY PROPERITOWPMTNERIEXECUrIVE D OFFICER/MEMBER EXCLUDED? WA P,LEACH ACCIDENT $ 1,000,000 mandatory In NM E.L DISEASE-EA EMPLOYEE $ 1,000,000 Fyn, scdbe:Baer DESC PTIONOFO E.L.DISEASE-POLICY LIMIT $ 1,000,000 DEBLRIPTIONOFOPERATIONB below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPEVA L ITEMS THIS REPLACES ANY PRIOR CERTIFICATB ISSUED TO THE CERTIFICATE HOLDER AFFECTING 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 E `y} ACORD 25(2010/05) The ACORD name and logo are registered marks of ACO RD 1988-2010ACORD CORPORATION. All rights reserved. 459 Main Sheet TolFrse (877)396$600 . �D� SprHgffeS,MA t01151 ome Worcester (508)797•8600 E-mail:HR®SNrdyHome.cem Springfield (419)549-5906 . www.5turdyHome.com New Haven(203)648-2118 Fax (413)543-3200 HOME IMPROVEMENT,. INC . MA REG. p16171 t CT REG.x0801525 WINDOWS • SIDING • ROOFING • ADDITIONS Name L wJa Mel-LICK "°"e 2-59 /9oe tuskless P"pe Mane - Cau Phone Other IS krati cock Tr TownfOty /' Represents' a Dale' Aid A.-N, n ince r . MN �o l2/2—s zo n Uwe the owner(s)ol the premises described hereinafter, referred to as Owner,offer to contact 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, Yea No SIDING SCOPE OF WORK: I ❑ 1. Contractor to obtain required building peruM(see attached permit authorization form) 1'2_U 3 O Family home. per'❑ 2. Provide certificate of Insurance for workers compensation,general liability.(see attached certificates). 19" ❑ 3. Keep lob site In a clean and orderly manner In a broom swept condition. l ❑ 4. Provide job site dumpsler,set on planks,to remove job related debris only. Please Note:dumpsler for contractor's use only.(see dumpsler clause). Q 5. Provide OSHA approved staging to safely perform work. C1 ❑ 8. Customer to remove all ornamental and personal Items away from house,yard and walls outside,etc. layers ol siding off existing house. Wood clapboards 0 Vinyl 0 Cedar Shakes 0 Stucco (7 Aluminum 0 Other c • ❑ (at Gutter helmets to be removed and reinstalled by others Irrl 9, Remove and dispose of gutters attached wittispN a lemic. @r❑10. Remove and' existing gutters strapped to root. Install straps under shingle Q over shingles_0 ❑ f3111. Remove and reinstall existing gutters with hidden hangers. Linear leel • I ' ❑12.Furnish and install new gutters_ /» / linear feet,and downspouts art. (10 lengths). Color GI N' t. ❑ RM. Remove Satellite Dish up to 24"In diameter. Alignment and Installation by others. . ¢p R 'Q.e I i tF 1001 ❑ Q1"4. Remove and reinstall the following items: ❑Shutters. (see number 18) ❑Doorbell ❑Storm door U Street numbers ❑Power meter(power lines to remain,wrap around anchors) ❑Lights (see number 15) ❑Telephone ❑Water meter ❑Cable TV lines ❑Dryer vents tar ❑14.Install Insulgdnn ugder siding.3/8 fan fold- •Tyvek ._ Polar Board, 0/$ __High density poly styrene/Green Board Total Squares_.. ❑ p15.Install customer provided light fixture on house. Please note additional wiring Is not included. Quantity_. ❑ Imo. Install shutters on house.Quantity Color _ Louvered_ ., ._ Panel • ❑ lat7.Extensions of water faucets on the exterior of home are not Included. Please note If needed,this will be an additional$150.00 each • ❑19.Furnish and Install OA Ism) ST (xwfcnrRcdsidng,Color_ c-U.'L.. Total number of squares 1} ❑19.Install Corners.Color C6For2c ,.,,_,Style, 3 VY Linear teat 4U_ 12r ❑20.Install r- _-Light blocks • Dryer vents Water blocks, Color Cf .-..., . ❑ 0.11.Porch ceiling to be covered with soffit siding. Total squares 13' Q 22.Install J channels around windows and doors. Colorh 1-"r. Style n'/r.__ • Ir' ❑23.Install vinyl soffit on overhangs. Vent soffit boards prior to Installing vented soil materials. Color t" tfc linear feet..4ES. Ur ❑24.Install aluminum coil stook on fascias or 1roni, rear and sides of house. Color 1.,-) 1♦L to -Linear feel_ a I/ lit"- 25. Install aluminum wraps around__ /4 sl=window and .4 door(s). v..+Iq'(K ov,•� c <,o,.s( , ❑ ®20. Cover Gables End vents with siding to prevent ah-flow,(if the root fs vented wilt.soffit and ridge verde,then gable end vents mus be closed In order to quality for warranty coverage). CY❑27.Owner agrees to cut back or remove any landscaping 18"from house In order for contractor to gain access around perimeter foundation, ❑ ❑28.Addendum (A)=OTHER WORK. r❑29.Acceptance Page. gr-0 30, Work not included:1.Final cleaning of windows 2.Any rotted wood(other: L� metzc3ete NW)S00. 00M 459 Main Street Toll Free (8'77)378-6739 s'rt 0VE-mail:HROS,dyl oma Worcester 508 797.6600 E-mal:HR�Smr Home.com Springfield (413)543.5906 www.SturdyHome.com NOW HaVen(203)848.2116 Fax (413)543.3200 HOME IMPROVEMENT, INC. fes' ey-� WINDOWS • SIDING • ROOFING •peADDITIONS MA REG.#151711 CT REG.#601525 Name ,`{c l 26'Cl'., �(�t 2 jr10$ Edginess Phone Address '! Nick Arno k ST" Cell Phpne OtherTownrCiy AJ/ - Representative Date /14 Rterta.. pl n Het/Auce�tc-_. 2 ZI 2017 I/we the owner(s)of the premises described hereinafter,referred to as Owner,offer to contract with Sturdy Home Improvem t, Inc.hereinafter referred to es Contractor,to furnish,deliver and arrange for Installation of all materials to improve the premises as described below. Yes No WINDOW SCOPE OF WORK: Q- ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 d2 C 3 s Family home. 13 ❑ 2. Provide certificate of Insurance for workers compensation,general liability.(see attached certificates). fit' ❑ 3. Keep job site in a clean and orderly manner In a broom swept condition. O' ❑ 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). - f17� ❑ 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. Cr] 6. Provide manufacturers warrantynron all windows. U.--LI 7. Remove and dispose of 'f (quantity)windows. ❑ art. Remove and dispose of (quantity)storms. 18•' ❑ 9. Remove and reinstall stops. Please note:if stops need to be replaced,an additional cost assessment will be made at that time. ❑ ff 70.Remove and reinstall trim. Please note:if 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. ❑ [ . Remove weights in pockets and dispose. 14 ❑12. Insulate weight cavities with fiberglass insulation. 13-#1:113. Provide all silicone sealant. (8'^❑14. Install aluminum,' wraps around windows. Quantity d Color (N tel/C• . censer 2.9 IY❑15.Install new l4e 7treplacement windows. Quantity_) _Manufacturer OK>v4 Y@7 Model 0 g'"L' ❑ lilt Install new construction windows. Quantity 6 Manufacturer G Model S ❑ 1347. Install bay/bow windows.Vinyl O Wood 0 Quantity Manufacturer 0 Model Other 0 12- LJ 18. Install new glazing on each window: Low-E Q Low-E with argon C6iihi 6 whoa/other 6 ❑ Iirri Install grids in each window:5/8" a Colonial style 0 other GBG v Interior Grids_O_____SDL 6 Brasstone 0 Brushed Nickel 0 ��/ Top Sash Bottom Sash a p ❑20. Install new hardware on window. Color I/•• U17C. Cr❑21. Provide screens with windows:half screens full screens O aluminum 0 fiberglass 1S 0 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. U 23. Addendum(A)=OTHER WORK. ice -,r❑24. Acceptance Page U ❑25. Work not included:1. Final cleaning of windows 2.Any rotted wood(other: i � 459 Main Street Toll Free (877)378-8739Indian Orchard,MA 01151 Worcester (508)797-6600 Sy� ly E-mail:HR Sturdrncorn Springfield (413)543-5906 www.SturdyHome.coe.com New Haven(203)848-2118 Fax (413)543-3200 HOME IMPROVEMENT, INC. WINDOWS • SIDING • ROOFING • ADDITIONS MA REG.#151711 CT REG.#0807525 Name I1 W}� �^ T Q 1 z I e Ham Pon Business Phone O1.Lt ' •t i zs� ( gap Address ' f k�� caGL Sr Other Towdcity > Representative Date AL kik esteeta M4 c 2-lul/ft3/7 I/we the owner(s)of the premises described hereinafter,referred to as Owner,otter to contract with Sturdy Home Improve em,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 ROOFING SCOPE OF WORK: a" Q 1. Contractor to obtain required building permit(see attached permit authorization form) 1 2 3_ Family home. Q" Q 2. Provide certificate of Insurance for workers compensation,general liability.(sea attached certificates). C4- Q 3. Provide job site dumpster,set on planks,to remove job related debris only. Please Note:dumpster for contractor's use only. (see dumpster clause). 14 Q 4. Prior to stripping roof,tarp sides of house beneath work area,from roof edge to bottom of wall. (see additional protection clause on back). U- U 5. Keep job site In a clean and orderly manner.Rake work areas at end of job.Use magnetic sweep to pick up nails. p' Q 6. Provide OSHA approved staging to safely perform work. 13' 1J 7. Work consecutive days excluding inclement weather. (rain,snow,high winds,high heat,thunder showers,etc). 2 ❑ 8. Staff project with qualifieOnechanlcs experienced In residential asphalt roofing. le ❑ 9. Strip existing 1_0 2_ 3 O layers of asphalt roofing(see roof plan,page 2). Number of squares A. O one layer cedar removal. Number of squares C B. 3 one layer slate removal. Number of squares 0 a- ❑10.Inspect roof deck prior to re-roofing.Renail loose boards: A. Replace rotted or cracked boards at$ -7 cO per linear foot. B. Install new plywood at$ JO "per sheet. C.Number of sheets of plywood Included into this estimate:Quagtity (see unit cost above for additional sheets). E'❑11. Furnish and install C�Rrarr/"t•2 Lc s-( erne.!. ea-ft-f-MT a- shingles. Color ©-1❑12.Furnish and install 6°aluminum drip edge around roof perimeter.White c-Mill O Brown . CS . ❑ afg.Install cedar drip edge at eaves under aluminum drip edge.Linear ft 0 . Ld" U 14.Furnish and install ice/water shield at eaves (43' 44' 0 other. Three feet in valleys and around all roof penetrations. 1Zk ❑15.Furnish and Install underlayment to entire roof. 0 Roofer select "Diamond Deck W. ❑16.Furnish and install starter course shingles,eaves&rake. ' ❑17.Furnish and install hip and ridge cap. ❑ ar8.Furnish and Install new neoprene roof boots at soil pipes up to 4"in diameter. Quantity Size (boots at electrical mast to be reused). ❑ i1)-19.Reuse stove pipe flashing kits. ❑ WO.Reuse existing step flashing at roof/wall Intersections. ❑ 1221.Furnish and install new aluminum copper step flashing at roof/wall intersections. Linear feet . If siding work Is needed,a cost assessment will be made at that time. ❑ U22. Reuse existing wall flashing at roof/wall Intersection. ❑ 243.Furnish and install new aluminum wall flashing at roof/wall Intersections. Linear feet . If siding work Is needed,a cost assessment will be made at that time. ❑ [y24.Furnish and install new aluminum copper step flashing at base of chimney under existing lead counter flashing. ❑ Ir425.Replace chimney lead counter flashing. 1 flue_2 flues_3 flues_other_. ❑ Za126.Install_new roof hood to vent bathroom(s)with insulated flexible tube.Remove roof deck to gain access into attic.Color black only. ❑ p27.Gutter Helmets to be removed and reinstalled by others. ❑ [3'28.Remove and dispose of gutters attached with spike and ferrule. ❑ C129. Remove and reinstall existing gutters strapped to roof.Install straps under shingle_over shingles_. ❑ 1230.Remove and reinstall existing gutters with hidden hangers. Linear feet ❑ .Reuse skylight flashing kits Replace skylight flashing kits_ Quantity-(Velux models,stock only). ❑ an.Remove and dispose of the following:Antenna_Snow/Ice Wires_Snow Guards/Ice belts_Solar panels_ ❑ ®33.Remove Satellite Dish up to 24'in diameter. Alignment and installation by others. la' ❑34.Page Two=ROOF PLAN. p���� n Ur L135.Page Three=VENTILATION. S Hi..vte ("a+ { n eatti - Mitt. ❑ ❑36,Page Four=VENTILATION PLAN. ❑ 0 37.Addendum(A)=OTHER WORK. STURDY HOME IMPROVEMENT, INC. ACCEPTANCE PAGE MA REG. 4151711 CT REG.410601525 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 IJ___. Expected completion date__) / Weather permitting. • The cash price for labor and material as described above Is: . 1st payment 2nd payment 3rd payment 4th payment Contract Total (u❑on signing) .M nTe 46,12/ / L Roof $ r. (_ t�t oakr• ck(w�...J. �'3(anti � flQ e,F-Pb g Ventilation Other work $ _ • a. Roofing total $ Soto.' $ goo IS' $ 3zc0. $ 77.60. $ 5300. Siding $ t(otxco ' $ t (.-00a $ L `'ao, W $ G 'az $ /660; Windows $ boo $ 1 ) o'. $ 6 o e;4 o` $ .Prbo, $ (S"U.' NED vHeu...i. $ le COC? o •$ 2. —o $ /0�cs, $ root`"' $ 2S"a own/.teeP Cee rcP Other $ $ $ $ $ Totals $ oma, $ $ $ $ Terms: _Cash Finance _ till Sec Credit Card:tt;' v Payment schedule: 255Ge Lk 60'F-/p Pi • Any balance not paid in full within thirty days,will be charged 1.8%interest per month. 4dCPAv[./eL <PP. Q/Jf' in order to meet the completion schedule,the following material/equlpmentmust be SPECIAL ORDERED before the contracted work begins. . (Law requires Chit any deposit or down-payment required by the contractor before work begins,may not exceed the greater of(a.)one-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) $ d to be paid for C $ D to be paid for 6 - 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 todh 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 • at.* day of ' Com..P 20 t*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 ABOVE WILL BE HONORED ONLY UNTIL (Dale). . 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(or 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 142A: '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 aarbitrr'ation a as//provided In MGL c 142A. /, Representative: UO 4._'c y`d'- Owner. L Ad t' ' //✓s_ %/ 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" ,it Do not sIgn this contract if there are any blank spaces . Submitted �� /�, {l.® , .//_ Accepted 6 . Y" AX (/C( Irk b ' ��� - / Representative purchaser , Date Accepted Accepted ��11. 002 e4fas5 2rsnl LF,Gnsm r�- HOME IMPROV EM "No Substitute for Qu WORCESTER SPRINGFIELD HAW 459 MAIN STREET-P.O.BOX 51033-SPRINGFIELI MA.REG#151711 Cr.REG#601525 877-3STURDY FAX 413-543-3200 W W W.STURDYHOME.COM OWNER PERMIT AUTHORIGA'1'ION Name: L//✓Of//:/ItJ 72 4E62 Address: /5- 114-NC S EE J City/State/Zip: /\/,9/ t 7`7l MA / ‘� I ,L/A17' /n/1Y7_GK6C (owner), of the property located at: /S/fflM'/PK C7: z.1 di ill authorize 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 for this project. I understand and accept responsibility to comply with all regulations and required inspections. Signature of Owner Date Signature of Owner Date