31B-077 IMER ST BP-2017-1387
COMMONWEALTH OF MASSACHUSETTS
Tuck:31 B-077 CITY OF NORTHAMPTON
01 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
-ory_ROOF BUILDING PERMIT
_ta BP-2017-1387
ectN JS-2017-002312
Cost:$38443.00
:$268.00 PERMISSION IS HEREBY GRANTED TO:
nst. Class: Contractor: License:
e Group: DICKY MATOS_ 105917
4 Size(s4.ft.): 7797.24 Owner: Gandara Mental Health Center, Inn
?A_ng:URC(100)t Applicant: DICKY MATOS
AT: 18 SUMMER ST
I pPlicant Address: Phone: Insurance:
GLEN ST (413)530-5335 WC
r1O LYOKEMA01040 ISSUED ON:6/1/2017 0:011:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF AND REPAIR
CHIMNEY
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: Oily 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 6/1/2017 0:00:00 $268.00
212 Main Street.Phone(413)5874240,Fax:(413)587.1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-1387
APPLICANT/CONTACT PERSON DICKY MATOS -
ADDRESS/PHONE 3 GLEN ST HOLYOKE (413)530-5335
PROPERTY LOCATION IS SUMMER ST
MAP 318 PARCEL 077 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE O x
PERMIT APPLICATION CHE IST
ENCLS.ED F QUI'ED DATE
ZONING FORM FILLED OUT
Fee Paid It ilN��
Building Permit Filled out �
Fee Paid
Typeof Construction: STRIP& SHINGLE ROOF AND REPAIR - : EY
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 105917
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
_ Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Deo: tir•
At
y 531/7
Sign.�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
Hanning&Development for more information.
•
+ Version I.7 Commercial Buildin• Permit May 15,2000
Department use only.
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit _
1 '—' 212 Main Street Sewer/Septic Availability,_.
1 NAY 3 Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
D _
phqne 413-587-1240 Fax 413-587.1272 Plat/Site Plans.___,,,_„�
Other Specify i
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
"''i
1.1 Property Address: /TTh�is section to be comple�ted by office
''l ! 5 umnfler 5 . .. _ ..._. Map alf Lot Oil Unit
IVo ikh Ciro Pit>' rna-_ Zone Overlay District
_-- — - -- - - -' Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Iyer nJ 01r/ n 541” W rot Spr i nylned
Nate(Snot) Grondotra. Q 11 Y- Current marling Address
Signature .__.._... _... Telephone .... .. __
2.2 Authorized Agent
\1 3 es- s+ 11ro ._rna_ ONO
Name(Prrnt) i){CK7 I�-,~-�S Current MaYtngAddress �
413—_ 530-5335
Signature �� Telephonesir
_
SECTION 3-ESTIMATED CONSTRUCTION COSTS
ttem Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building + i LI J 2 r7 5 s (a)Building Permit Fee
2, Electrical (b)Estimated Total Cost of
Construction from (6)
3, Plumbing Building Permit Fee
4 Mechanical(HVAC) '
5. Fire Protection •
6. Total=(1 +2+3+4+5) i Check Number
This Section For Official Use Only „
Building Permit Number Date
Issued
Signature:
Bul&ng Commissioner/inspector of Buildings Date
� M roo-rl nqc) t c I OL-1-c{ .corn
Version .?Commercial Building Pennd May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition❑ Repairs 0 Additions 0 Accessory Building
Exterior Alteration D Existing Ground Sign 0 New Signs 0 Rooting Change of Use Other 0
Brief Description Enter a brief description here T CGv' cerven+1 r no DP
Of Proposed Work. !? (,A f��,\A�w one a(ti 1 t- 1 r C I YYl Yee.
SECTION S-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE 7
A Assembly A-1 ❑ A-2 0 A-3 0 1A 0
A-4 0 A-5 ❑ 1B 0
B Business 0 2A 0
E Educational 0 28 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard ❑ 3A ❑
I Institutional 0 I-1 0 I-2 0 4a 0 3B 0
M Mercantile 0 1 4 0
R Residential ❑ R-1 0 R-2 0 R-3 0 SA 0
S Storage 0 S-1 0 S-2 0J_ 513 —..L. 0
U Utility ❑ Specify. ___... ..._._ . ..
M Mixed Use ❑ Specify. .. ....
S Special Use 0 Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: _ _ Proposed Use Group .... . _... _. .
Existing Hazard Index 780 CMR 34) Proposed Hazard Index 760 CMR 34): _..
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUON OFFICE USE ONLY
CTI
Odor Area per Floor(sf)
1a
2m
.... _ 40 _ . . __
4 f __
Total Area(sf) lotal Proposed New Construction(st)
Total Height(5)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system
Side .
-==_ L R
Rear
Building Height
1
Bidg. Square Footage �.. ._.
me
Open Space Footage __
(1st area mems bldg&paved -.
• rung) _.
#of Parking Spaces _
r
Fi11
(volume&Lcatovl _._ •
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO e( DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document
B. Does the site contain a brook, body of water or wetlands? NO el DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued: ;. .. .
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location _ ..... . .. .
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO e
IF YES, describe size, type and location
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over I acre or is it part of a common plan
that will disturb over t acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
\\,
1.4
9.2 Registered Professional Engine° S .,.. �_
--� Arae of Responss bit - --
Name
--- —'—... -- Re9lstra+ion Number
Atldress
— Teiephone Expiration—Date
—._— ---'-- —_—'---- --'— Area of ResPansbilfty
Name __. .
------- ' - '—
Address Reglstrahon Number
_. ...
SlgnaNra Telephone Eepmaoon Date
Name _.. Area of Responsibildy
Ad;;;;; -- Registration Number
Sgnature Telephone Expiration Date
Name Area of Responsibility -----
Address Regstration Number
_Signature _ Telephone Fxpvehon pate
9,3 General Contractor
C i :4 t T jQ O .. ....... _ ElCo
Company NameNot Applicable',
3 &I-en 4
Responsible In Charge of Construction
46\L cQ C`"i c o
Atldra55
Ahr +ji}'"SSD' 5'33 ?c
Siynatur- Telephone
r i
Versionl.7 Commercial Building Permit May IS,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage _...
Setbacks Front
Side 4. R ___. L R ...
Rear
Building Height
Bldg. Square Footage % ---Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: _. _.. .
(volume&Location) ._.._ .... _ _.. ..... .
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ei DON'T KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
ND Q DONT KNOW Q YES Q
IF YES: enter Book Page and/or Document rt
B. Does the site contain a brook, body of water or wetlands? NO e DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO e'
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,�exycavation,or filling)over I acre or is it part of a common plan
aJ
that will disturb over l acre? YES Q NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version 7 Commercial Building Permit May 15, 2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
._ .. _.__. _. _. . Not Applicable 0
Name(Registrant):
Registration Number
Address ... _.
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
I.0 14_4 tr1Q.+oS ... . Not Applicable 0
Company Name
Responsible In Charge of Construction
1 cn\tc6K.2 rick c o'Q
Address
—�� +113 53DS33
Signa - Telephone
•
VersionL7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No �/ply
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
,as Owner of the subject property
hereby authorize; _. _. _ .._ to
act on my behalf. In all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ) VC C\) _.`- -0D- L.1 , as Owner/euthorizeq
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
Sbelief. _. _. .
Signed under
der the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Pak-0 C S t NotApplicable ❑
Name of License Holder _.. t !)�1`Y.- o5cfl 1
J II
License Number
3 C— r; st 1 FFV o _010 U : 3 /_s0lao
Address /1 Expiration Date
i X413- 53053s sr
Sign:tu Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the bui ding permit.
Signed Affidavit Attached Yes ef No 0
•
The Commonwealth of Massachusetts
-- Department of Industrial Accidents
Office of Investigations
'--£+—r
Ht71 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information f Please Print Legibly
Name(Business/Orggaa'nnization/Individual)a� 1 (t 1C\j 1'l( `A+t S
Address: LS len S� 2
City/State/Zip: I ID\—tO'lc IY1C. 0340 Phone#: i 3-- 0 -,D3
Are you an employer?Check the appropriate box: Type of project(required):
L lam a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees (full and/or part-time).` have hired the sub-contractors
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees Those 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.❑ 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 oofrepairs
insurance required.] t c. 152, §I(4), and we have no
employees.[No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
[Contractors that check this box must attached an additional sheet showing the nave of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'camp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ACC-
� xI
Insurance Company Name: A - PcC ' y r I CCE-1
Policy#or Self-ins. Tic. #.S A r (p 2, ,7 4 Gr. - Q —17 Expiration Date:
�Uq- I Co- 1
Job Site Address: N' Su rnmev kk S-1— City/State/Zip: I I L:wriof1 rY1C`.
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.
I do hereby certify in the pains and penalties of peduty that the information provided above is true and correct.
Sianature: Date: 5 -3 l - I q
Phone#: l — 530- j•33'S
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#:
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: VS `U m ln'\PY 5-1"
The debris will be transported by: btUt12
The debris will be received by: I'i"Q L5)ice ('om e t spo Set L
Building permit number: J
Name of Permit Applicant 1(lCy Hal OS
Date Signature of Per ,pplicant
9MassOchuseits Department of Public Safety
Board of Building Regulations and Standards
License: CS-108817
3£§iWN83A2;cr
""'� � Expiration:
Co 'Ssioner yOy
C e Wont/no ..tc�ea�L o cluirtela.
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Regiatra8ac tel
Type: Inde
Expiration: 8/72018 Sit 280608
DICKY MAIDS _
DICKY 6AAtOS
3 GLEN ST. — — —
HOLYOKE, MA 01040
Update Addrmad meta rad.Mart rasa Ier
D Address ❑Resent p Eapioy.ru ❑ Loot Card
SCA, b 204.Ain,
rib
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1:flre7PR1C7JR bete aeapirSaidatia irked ranSu
k1. 168207 TYPO: 14I arCsaaaele517G aslRimSaess Regaaraa
a Explradcn: 80'2058 MdMdual 40 Park Pea-Salve SI78
xr Bates.MA 82114
DlOC MATOS
DICKY MATOS
3 GLEN ST. •,i.+ x �....,.— ._. _
HOLYOKE,MA 01040 .t7rdersma'ury. Net vigil widest Aponte
AC Rte® CERTIFICATE OF LIABILITY INSURANCE
� �'Ma e'17
TNS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OILY MID CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Bresnahan Insurance Agency Inc PHONE FM). (413) 536-0536 FAX (413) 53+-4291
100 Whiting Farms Road E LAte.
Holyoke, MA 01040 AD°Ess:
__ INSURERSIAFFOROING COVERAGE NAIC9
insURFRA:Atlantic Casualty Insurance Co
INSURED INSURER B:Citation Insurance ___
Dicky Matos INSURER C;Torus National
3 Glen St. INsunERo:ACE Group I
Holyoke, MA 01040 INSURER E.
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS is TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSLRED NAMED ABOVE FOR THE POLICY PERIOD
INDCATED. NOTWITHSTANDNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO WHICH THIS
CERTFICSTE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TEE POLICIES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS,
EXCLUSONS AND CONDTIONS OF SUCH POLJCIES.LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
1XS0. ALOLISUBRI POO&EFF- PEXP
LIR TYPEOF INSURANCE INSRI ENOJ POLICY NUI ER IMMINIYYYI 1dU1MMmbYWYI LIMITS
A GENERAL LIABILITY i 11.270000622 2/25/171 2/25/181 EACHOCCURRENCE IS
1,000,000
X COMAERCIAL GENERSL LIABILITY
DAMAGE TO RENTED
PREMISES IFRyaumvn 5 100,000
�jc1AIM1SMAOE X OCCUR I DT w wnr ore Poem) S 5,000
I PERSONAL&ADV INJURY 5 1,000,000
f GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APP LIES PER PRODUCTS-COWIOP AGO 5 2,000,000
moor I LOG iNaI %
B !AUTOMOBILE LIABIUTY RZV182 ', 3/13/17 3/13/18 £ LNEEO,BINGLELIMR S 1,000.000
ANY AUTO I BODILY INJURY(Per q,mn) $
ALL OWNED x SCHEDULED I BODILY INJURY(Pet scICenI) $
AUTOS
KNON-OWNED PROPERTY DAMAGE
X HIRED AUS X I MN
AUTOS m
I (Pee etleN) E
I5
CuM%REua LIAR X OCCUR I AN037014 3/23/17i 2/25/1BI EACH OCCURRENCE 1I S 21000,000
X'EXCESS UAB CLAIMS-MADE I i AGGREGATE S 2,000,000
DED RETENTIONS ' a
VARNfpS CIXAPENSATION 4/16/17 4/16/18 'rVVC TATU- mq
D US-9£63246-0-17 ' X .
AVO EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE I EL EACH ACC]DEM s 500,000
WFICERRAEMBER EXCLUDED? N PRI AI .
Ifes o®a in NH)
( { E,�.DISEASE-EA EMPLOYEE-S 500,000
I DESCRIPTION OF OPERA TIONS Paw EL.DISEASE-POLICY LMR ;5 500,000
•
DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES (MTh ACORD 101,AOIOanel Re ntd Schedule,if more erste Is reqd red)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF ME ABOVE DESCRIBED POLICES BE CANCELLED BEFORE-
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED W
DM Roofing ACCORDANCEWITH THE POLCY PROVISIONS.
3 Glen St.
Holyoke, MA 01040 AUTHORIZED REPRESENTA
I
CT 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The AC ORD name and logo are registered marks of ACORD
Phone: Fax: E-Mail:
Gandara Center
CONTRACT NUMBER:
Cost Center: I : : 1 1-1 -a)
VENDOR NUMBER:
CONSTRUCTION CONTRACT
FOR
18 Summer St Roofing/Gutter Work
THIS AGREEMENT, executed this IT rP day of
y and etween:
D1eK / � a }as Roo-iv
hereinafter called "Contractor" and the Gandara Center, party of
the second part hereinafter called "Owner" .
WITNESSETH, that for the consideration hereinafter mentioned,
the Owner and the Contractor shall agree to the terms and
conditions contained in this contract, enumerated as follows :
The Owner-Contractor Agreement, Advertisement, Bidding
Documents, Contract Forms, Insurance Requirements,
Specifications, and all addenda issued prior to and all
Modifications issued after execution of the Contract.
THE OWNER shall pay the Contractor for the performance of this
contract in the sum of;
aq yy3. 15 dollars in
accordance with the terms of this contract .
This contract shall not be altered in any particular without the
consent of all parties to this contract . All alterations to
this contract must be in writing and authorized as such by the
agency executive director.
In the event the Contractor is a corporation a certificate that
the person executing this contract is duly authorized to sign,
must accompany this contract.
Final payment on this contract shall release and discharge the
Owner from any and all claims against the Owner on account of
any work performed hereunder, or any alteration hereto.
This contract shall be deemed to be a Massachusetts contract and
it ' s interpretation and construction shall be governed by the
laws of Massachusetts and the Charter and Ordinances of the
Owner.
The Gandara Center is not bound by this contract until approved
by the Executive Director.
CONTRACTOR: �\ 1 C � c
COMPANY NAME
L it' s
AIITHO IZEI7 SIGNATURE
LAY?C,— DATE � ia / 7.
TITLE
Gandara Center:
BY: / 1
v )1i (tic, CI .7 ;'Li'1
• Name and Tittle
Date
Gandara Center
CONTRACT NUMBER:
Cost Center: ) 0) 960
VENDOR NUMBER:
CONSTRUCTION CONTRACT
FOR
18 Summer St Chimney Reconstruction
THIS AGREEMENT, executed this d day of
h • �Qj'� by and between: � NCKy el-1-6( o0'h, n S
hereinafter called "Contractor" and the Gandara Center, party of
the second part hereinafter called "Owner" .
WITNESSETH, that for the consideration hereinafter mentioned,
the Owner and the Contractor shall agree to the terms and
conditions contained in this contract, enumerated as follows :
The Owner-Contractor Agreement, Advertisement, Bidding
Documents, Contract Forms, Insurance Requirements,
Specifications, and all addenda issued prior to and all
Modifications issued after execution of the Contract.
THE OWNER shall pay the Contractor for the performance of this
contract in the sum of;
91 004 dollars in
accordance with the terms of this contract.
This contract shall not be altered in any particular without the
consent of all parties to this contract . All alterations to
this contract must be in writing and authorized as such by the
agency executive director.
In the event the Contractor is a corporation a certificate that
the person executing this contract is duly authorized to sign,
must accompany this contract.
Final payment on this contract shall release and discharge the
Owner from any and all claims against the Owner on account of
any work performed hereunder, or any alteration hereto.
This contract shall be deemed to be a Massachusetts contract and
it ' s interpretation and construction shall be governed by the
laws of Massachusetts and the Charter and Ordinances of the
Owner.
The Gandara Center is not bound by this contract until approved
by the Executive Director.
bb n
CONTRACTOR.: _ C ( f�l it;
'COMPANY
it's
ADT.ORIZED SIGNATURE
U WY1G2 DATE
TITLE
Gandara Center:
tort,
Name d Title
Date