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24D-217 (3) 7 PERKINS AVE BP-2017-1337 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D-217 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2017-1337 ProjectJS-2017-002213 Est.Cost: $31975.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: INTERLOCK INDUSTRIES, INC 101283 Lot Size(so.ft.): 4051.08 Owner: TOUSEY JOYCE A Zoning: URC(100)/ Applicant: INTERLOCK INDUSTRIES, INC AT: 7 PERKINS AVE Applicant Address: Phone: Insurance: UNIT 7 25 WALPOLE PARK SOUTH (508) 660-6665 () Workers Compensation WALPOLEMA02081 ISSUED ON:5/18/20I7 0:00:00 TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF - 25 SQ 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 5/18/2017 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner mwN,e - I -1 611 City of Northampton Building Department )ryir 212 Main Street Room 100 ' r _ yr. � Northampton, MA 01060 r Funs ' phone 413-587-1240 Fax 413-587-1272LeS r- 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 �7 n, ' Map 41-r0 Lot Z47 Unit /, Zone Overlay District /Jet /1 FNPltn' ( A-4 OI0(0C) Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Sc -1-r, P 9 ,L.ljis At-CPC. Name(Print) Current Mailing Address: • Telephone Signature 2.2 Authorize. • ...rd: " ' iso Sar_ an/ 7 — as uelle % /,K Co Name(Pn' Cu eng_ tM rMess: MPV OZCjI cttdnieiin7re/�z— �4 //C SOF &(or (o(dnC Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit Fee 4. Mechanical(HVAC) SVd 5. Fire Protection 6 Total=(1 +2+3+4+5) 5/( Check Number This Section For Official Use Only Date Building Permit Number Issued: p Signature: t � /y /���jjj / Building Commissioner/Inspector of Buildings /Date Section 4. ZONING AR Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Required by Zoning This column to be filled in by Building Depzmnenr • Lot Size Setbacks Front Side EMEIM Rear Open Space Footage (int area minus bldg R:paved rkin: #of Parkins S....nes 11111.1111..1.11111111111111.11111.1111.111111 manammmummt A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW 0 YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW © YES 0 IF YES: enter Book Pagei and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW ® YES tJ IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O obtained Q , Date Issued: _,__„ C. Do any signs exist on the property? YES O NO O 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 YES, describe size, type and location: E WH the construction activity disturb(clearing,grading,excavation,or Nang)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO 0 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 ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing AR Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (p Siding[0] Other[0] Brief Description of Proposed 17 Nrj Work: -ST?//� f/t'�/4t•;' .-_en9S�il�f STr[]C . re ✓//`/ Alteration of existing bedroom 'Yes o Adding new bedroom Yes X (V/`�'7 Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet Ba.If Newesfu"sulse itid or ale'"'" Xisf fig hous nq:cotntslete 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 BUI NG PERMIT Sk AJ. A. 111 'y- ,as Owner of the subject property r n hereby authorize ac-- /49tni to act on my behalf, in all matters relative to work authorized by this building permit application. 3/3=/7 Signature of Owner Date 111111111.11111 ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SE- ES 8.1 Licensed Construction Sue or: Not Applicabb�leE me of Licen Holder' AUL / (#4LO'.,,//,e."'" ICI rad eS ❑cense Number Out' c9S- 1(41,44M . Sr U.e,ltle/J9A 020F� /vJ// fid° ... Apere /L rt f /J� �6r� �� Erpiratlon4ate Signature !/n•LT`— Telephone gee L" .....,,_ S.Rea-at8re Home rgvement€otitraptoc` , :.: Not Applicable £ P L r c- 1334646 Company Name Registration Number [autk7 e ' :Fc PK t tito ymtk- 7— Zf 17 Address CO 2,0 F ( Expiration Date Telephone, Wt'SC ear SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.182,§25C(G)) 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 permit. Signed Affidavit Attached Yes £ No £ 11.-41ffixteOwileitientratton The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.EMIR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s3 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 tune to time,during and upon completion of the work for which this permit S 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 The Commonwealth of Massachusetts Department of Industrial Accidents • -moi; 7l!I _, XI?=; Office of Investigations 14._AI!'- 4 600 Washington Street iil9 Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -�FikrJ7j/ ;.,CAJC Address: ("Ai} r/ — -C Goa/pelt ,.E wcJpefe City/State/Zip: we) i0/C f1 Bz of-/ Phone #: Sop 666 60 (� Are you an employer?Check$the appropriate box: Type of project(required): 1. I am a employer with / 4. ❑ I am a general contractor and I /� 6. 111 New construction employees (MI and/or p time).* have hired the sub-contractors 2.In 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I1.❑ 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 p1 must also fill out the section below showing their workers'compensation policy information. tHo meownem 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 employees. If the subcontractors 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: .t tier y �enici J (,T✓c'1ue Policy#or Self-ins.Lic. #: Lv Z —P>1 I —6I ZZ S[ —057 Expiration Date: OZ - o/— /t //.�/�'/ Job Site Address: 7 "-efA' City/State/Zip:tinr/ ",tp- OrJ1A7// 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 a inst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance coverage verification. I do hereby certify r the pains and penalties of perjury that the information provided above is true and correct. Signature: a,-C/I9cale Date: S /5 —/7 Phone#: --O? 660 ear 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 it ^% r,g �, Massachusetts tee?' - el., f• (i DEPARTMENT OP BUILDING INSPECTIONS 'n; 212 Main Street • Municipal Building °G �, Northampton, MA 01060 :Pit-R0° 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/footinqs (before backfill), 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 occupancy 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 DELAY the project until such time as the proper permits and inspections are made 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 Address of work location 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 150A. Address of the work: 9 6Grth ,flare The debris will be transported by: tkn. c. he ti The debris will be received by: u-as�e n4a,,,csr,Gcce ,,- Building permit number: Name of f it Applicant Date Signature of Permit Applicant OERT1,FICATE OF LIABILITY INSURANCE (NMEGDT ' —BES CERTSICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COFFEES NO RIGHT&UPON ME CERTIFICATE HOWSE MS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.yam OR ALTER THE COVERAGE AFFORDED EY THE POLICIES BELOW..i is CSIIIIRCATE OF**RANGE nOLS NOT CONSTITUTE'A CONTRACT BETWEEN THeySS1$NGAUTHORITEO RF}NESENTATIVE OR IROW bu L AND TTff CERIIFIC TM HOLDER S#PIXSEANErSeai SalshrY4t'bbtAbpRONAt.RSLV�B� num be MWdBptl.I S1 ATENIS Wao.atiectEt9a Ems an ea:1Smrc MIN FGI:•Y, catAXF.: ...,..maWwsamentAstakFmmton thkozalificals does not totter • InMdovtlCr NWePNtb[&so: .. .._ .,v ....UCSF: :NTALTN T e BFI.CANADA Mwame Se 1cesIM ONE c FAX [00-1ver.BC W2K3sBaml .Xn6 AY': J350S Var .avw.BC VSE2K3 -MAIL AOONESi FaW2lnuueR®pONlylu,Lpa` NA NIGGYERADE FCs INSDRERA:' WNW,NNW FA y Mivii PBe.Knew Cmtmiry INSURED .- INSIIRERE. Imet-cIndustries Inc - VINSURER C: ' INN]-25 nU 2E0 aEN SeNH INSURER D: - WNW..MA 020OMB1 INSURER e. INWRERFt COVERAGES CERTIFICATE NUMBER:it:WC-21 REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLIOS OF INSURANCE usteb SELOW HAVE BEEN ISSUED TO TME mfUREb NAMED ABOVE FOR THE POUCY PERIOD MEDICATE NOTVMTHSTNlDING ANY REOUIREMENT,TERM CR CONDITION OF MW CONTRACT OR OTI�F DOCUMENT WITH RESPECT TO WHICH MS CERTIFICATE MAY BE ISSUED OR Mt PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THR TgRMS )(CUISNNJS AND CONDITIONS OF SUCH POLICIES.LIMITS WON MAY HAVE BEEN REDUCED BY PAID DINMSWIN . R LTR TYPEOF I3MNME C� O Wucv NM k W RY)YF Paaaaibvn l mm s cestAKLumen _ �/.�,M.URL a COMMERCIAL GEI@ML LIABILITY BNM6TO PENTZB t. . B• t�uR MIEOeccv«ael tautAw I1 .d —ann.ADVOCATE LINT APf1U SIVA. . „ ,T LFIMG� a . i Olt posies( Q P#Y ❑ LGL K1 AVTGM3GRELIMIHtt I:I ❑ 'CGL6e2BlYK.LEUWY(Ea $ Q AN(AUTO o eOpAV auattla«plggnl s ALL AOWNED 6LAUTOS O F aallOLr uuugrlP«+m'tl«LI s AlIYtl4 � AUfOS � f ' ❑ WRBDAViOS ❑ &MOWED pNWERNOAM6EWm ! fL{GgWa} o o E ❑ IINSLITT ❑ bCap 5AM6¢LWENCB E LIAEILI ❑ E%CEMUAB ❑ CLAIMS-MADE A§RP GA1E E. ❑ OED O REMNRONS YtRKEM00 P WICONMD FIKOwas* xwnITY WA NL7S114221145r 320.142017 0403123551 LTJots eR Ara PRCPM'NEW . 11.5000,0EIECLIM1IVE OFFICE/ EMgfiR [AGLUOE ? (MNbIMM NXI N FM'.OYE[ 5'1,00940 it yet cleats Wide DE4CRP'FKIN#tlTFAiANB WYn GLa$FI.SE-PDLCY 6Ntli ttbE.02n D SCRIPUONOF#BMTMNLLOGSElNSNEHICLES(ATTACK ACORD 101 MEXNnsI Rtm.iA BElledSFNmalsp anwINNI ma/of COY«ag. ,i sITIFCATEHOLDER CFS LLABON 0ARt0FTl6 MINE 151135zReED POLCB$BE WC ELLBD MAKE WE pntATIFY Ta Waun B Msy Conon OATETHEIWW',NWSEWUBEECEUERED RI ACCO ANTENCDF TFIE POlICY PROVISION •AWOR MRMFRaaAME y I 1 143/ OB OMaftof 196F2]Oi0 ACORD CDPPOMTgk M�qpn mm«eF,,'' ACORD 7519310/01 t ACAPtlntna ANCInt i•91k002"10,0 NACCRD The Comnwnweal h of Massachusetts l4 ^ � / Department of IndustrialAccidents ili 1= 1 Congress Street,Suite 100 et. Boston,M4 02114-2017 ti www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Interlock Industries, Inc. Address:25 Walpole Park South, Unit 7 City/State/Zip:Walpole, MA 02081 phone #:508-660-6665 Are you an employer?Check the appropriate box: Type of project(required): LD l am a employer with 6 employees(full a d%or part-time).* 7, 0 New construction 20 I am a sole proprietor or partnership and have no employees working for me in $, ❑ Remodeling any capacity.[No workers'comp.Insurance required] TO I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. Demolition 10 Q Building addition 4.pt am a homeowner and will be hiring contractorsto conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance cc are sole I l.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 13.1:1Roo£repairs These sub-contractors have employees and have workers"comp.insurance.: 6.0 We are a corporon and its ofticen have exercised their right ofexemption per MGL c. 74.QOther ai 152,§i(4),and we have no employees[No workers'temp.insurance required.] *Any applicant that checks box d I must also fill out the section below showing their workers'compensation policy information. a Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If:be sub-contractors have employees,they must provide their workers'comp,policy number. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Liberty Mutual Insurance WC2-871-072231-057 02/0112018 Policy#or Self-ins. Lie.#: Expiration Date: Job Site Address:7 Perkins Ave. City/State/Zip:Northampton, MA 0106 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGT c. 152,§25A is a criminal violation punishable by 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 tine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ., Date: Phone#: 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#: MANE 14,1-018 6 T City of Northatnpton -In Person INTERLOCK INDUSTRIES, INC. 212 Main St. - 413-587-1240 7 Unit#7,25 Walpole Park South,Walpole, MA 02081 Mon, Tues, Thurs, Fri 8:30-4:30. Wed 8:30-12 — Customer Contact:T-MOsaa-ROOF(-7663) Visit our website at: NewEnglandsBestkoof.com no-urn • r to I u I!) NAME J e yCW t 6 V se 1' ("purchaser") JOB ADDRESS 7 tt ell t n S A tv e r ("Premises') A CITY/TOWN '0 t' 1 ate(}ems MA ZIP CODE 0/4E0 tame anonRESs !• E-MAIL �J . . 'HOMEPHONE E-MAILjY.I^ sKJ4 / CONTACT NAME WORK i . LL / The Purchaser is the registered owner or the Premises and hereby contracts with Interlock Industries,Inc.(the"Contractor") authorizing the Contractor to furnish alt necessary materials and labor to install,construct and place the improvements according to the following specifications,terms and conditions (the"Specifications") on or at^}the Premises; /` PROFILE:CE'. 'R SHINGLE 0/111.E. SHAKE STANDING S' COLOR Deer CAktec4L . oriorr �( !1 Tj f. , f t e i•mad t Home improvement Contra r Begin#139640 1 _ ✓Uri1 ei • fed 1- a 4, t, t ' Z SYR •_te t, d AIM-- L. ee • 1 f %.. .4. jest„Tartil f4oWja& ..:, w� t i— S qt - •z .4 rf1fare` /Dotes G� R. 4e er.nt.. ADDITIONAL SPECIFICATiONS • _. YE NO ROOFING MATERIAL /` `, YES NO eURCHASER WILL f Low Slope Roofing Color Cafe ] ✓ _ Supply adequate electrical power Flash Skylights# r . V — Work with the Contractor to fix damage uncovered during As installation at a cost agreed to by the parties. _� Flash Vents# Plywood for rot repair min charge$2.50 sq ft t/ ., Ridge Vent.... �S V . Respect Respect the work site.In the interests of everyone's safety Undertayment SZTi. / Purchaser will not use or borrow Contractor's equipment / or tools and will not access or interfere with the project t/ _ Snowguards# do Snow Rai: during installation.Skilled professionals should be hired Snowguards ruin charge of$45 each post Installation, for any work that requires access to or traversing your roof. I41;7 Purchaser's Initials LOCATION FOR DELIVERY ROOF REMOVAL ne-61‘ if_ Strip existing roof(#of layers 2 ) - J -Haul away root debris and pay refuse fees. Start Date`,C- /6 cue g .'• 0- 8 ✓ Supply vr plywood t. Substantial Completion Date' . ' . 0 'tom LOCATION FOR RIN:W.L 1.1)4 y 'Unless circumstances are beyond the Contractor's control, THIS CONTRACT INCLUDES GUARDIAN LIEETIME LIMITED WARRANTY,50 YEAR TRANSFERABLE,NON-PRORATED FOR MATERIALS MANUFACTURED BY INTERLOCK ROOFING LTD. PLUS 10-YEAR LIMITED LABOUR WARRANTY PROVIDED BY INTERLOCK INDUSTRIES,INC. LIFETIME LIMITED MATERIAL WARRANTY FOR IB ROOFING,MANUFACTURED AND PROVIDED EY IB ROOFING SYSTEMS. Contract Price $ .4 - SPECIAL INSTRUCTIONS �,,.. Sales Tax $ _ Total Contract Price $ t FINANCING REQUESTED Yes. No OAC Down Payment (max 1/3)” $ k �r'';; INTEREST RATE 999%to 14.99% Progress Payment $ 1� B' 30 kr Progress Payment $ �'7j 2 (/ PAYMENT NOT TO EXCEED $ _ Total Balance on Completion $ a of l , 1 j -' MAKE ALL CHEQUES PAYABLE TO:INTERLOCK INDUSTRIES,INC. 'we are happy lo accept payment by cc for the down payment only. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office of branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of thisss///right. IN WITNESS WHEREOF,the Purchaser and Contractor have hereunto signed their names at the Premises,this of et t Ay „ 20/7 INTERLOCK INDUSTRIES.INC, I Do not sign this contract if there are any blank spaces. Per. ie / �Purchaser. Purchaser: Signature .AL-A.... . 'L Signature Signature .... Print Name _ .. /$((Print Name OycA.A• dt4sey Print Name_... THANK YOU FOR YOUR BUSINESS FEIN.43479096 This is not a credit transaction.If financing is arranged,the Purchaser agrees to sign and provide all necessary documents required by any Lender,immediately on request, in order to complete the financing.Alt surplus material is the property of the Contractor. - '-wwcract tot additional terms and conditions. I MATE i"I-618 II MAY - 12017 )� By_ 111 L. I\® INTERLOCK INDUSTRIES, INC rl�,l Unit 7,25 W Park South,Walpole,MA MA 02081 Toll-Free: I.866.588.ROOF 176631 Tel: 508.660.6665, Fax: 508.660.6918 LIFETIME ROOFING SYSTEMS www.NewEnalandsBestRoof.com REQUIRED PERMITS Registered Home Improvement Contractor MA#139640 Registered Home Improvement Contractor CT.#566583 Registered Home Improvement Contractor RI #18345 Homeowner Information Name: JOVC2 t �DSZu pA� Address: -7terkins Art. City: Northarn y-Ion I MA Zip: 0(060`�� p Phone: 7f3 S22 -9468 Required Permits: The following building permits are required and will be secured by the contractor as the homeowner's agent and IM/e as Owners of the subject property, hereby authorize Interlock Industries, Inc. to act on my/our behalf, in all matters relative to work authorized by the building permit application: 5/ /2017 Own nature Date Owner's Signature Date Owners who secure their own permits will be excluded from the Guaranty Fund provisions of the MGL Chapter 142A This permit notice forms a part of the Purchase and Installation Contract of the same date.