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43-133 (3) 21 LONGFELLOW DR BP-2017-1521 GIS#: COMMONWEALTH OF MASSACHUSETTS Mao:Block: 43- 133 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 14 BP-2017-1521 Project# JS-2017-002544 Est. Cost:$14000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: STURDY HOME IMPROVEMENT 151711 Lot Size(sq.ft.): 31537.44 Owner: TWAROG JOSEPH&PATRICIA P HEA zoning: Applicant: STURDY HOME IMPROVEMENT AT: 21 LONGFELLOW DR Applicant Address: Phone: Insurance: P O BOX 51033 (413) 543-5906 INDIAN ORCHARDMA01151 ISSUED ON:6/28/2017 0:00:00 TO PERFORM THE FOLLOWING WORK STRIP ROOF AND INSTALL 30 YEAR SHINGLE 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 6/28/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Depar n ent lice only M • City of Northampton Stayb 4+f PermiL Building Department Cdrb CutlpnvewagP.ennl� 4 40�+ 212 Main Street Seworl�gptig w311a3114y y �� r >`' a $< �! i i' S Room 100 Water)Weh Av3Aa asa� n � `�` '" z 't'= ' Northampton, MA 01060 Two Sets of- ra � s�. �- " w=.-+�r s phone 413-587-1240 Fax 413-587-1272 PIOUSite NIPS --7. .k> ., "` `t. AP'JCATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property// Anddress: lThis section to be completed by office aI 6(1,9 T1�.I11G✓U OrNce Map Lot Unit RO✓Qyt� MA Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: , oSPIQh tu�Nr� 4" �ln1)YiGG� �e 2B-I lo4 Qe-U OW l�rCvc )Tarr k Ka Name(Print) Current Mailim4Addre s: 2Et- 7-) i- '1459 Telephone Signature 2.2 Authorized Agent: S4tL1Cyrvu �twprovervie- T.4C • `l59 cnit SiYa SV.6 t3 Name(Print) Current Mailing Address: Th(A) ( trA CA..il (L63) SIR' " . Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Buildingp u (a)Building Permit Fee 141000, 2. Electrical (h)Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) ii° 5. Fire Protection � 6. Total=(1 +2+3+4+5) \`4 /' 1UOo O� Check Number 7 ,ggp3 This Section For Official Use Only Date Building Permit Number: Issued: / Signature: �� i P <7 /full in, ammissio r/Inspector of dings Date a EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING AR 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 __.. . ..... I Setbacks Front r" I I Side L R,-. ' L•i R:__ [ I Rear _..; Building Height Bldg. Square Footage IJ r % r. _- I f___� t .... Open Space Footage % (Lot area minus bldg&paved E 2 ,_- I I _ -__ parking) N of Parking Spaces _ Fill: _..... _ .. ._. _ __.. I (volume&Location) ---..- --. __ _-.. .. __ .__ A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW er YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES O IF YES: enter Book j - Page', and/or Document M j B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW 0:91.7CES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO 0-7.----- IF 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 0.7 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pad 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 Da Or Doors O Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding[p] Other[0] Brief De$crption of Proposed j2E Nlcct A- y riot trick woad HA^^( tr,.p ark 6'F(-,m(w-fes.`ee c4J 4clsecl cov�{ny(1-) Work:54-rnp eA hn4( I04rciswro. .5,.�.d+3nrhtfd 3o.Sogesrkitukcelanma k S1,trgf� t(-dlor &j✓rt4Sre.,r-�. . Alteration of existing bedroom Yes Adding new bedroom Yes \�o Attached Narrative Renovating unfinished basement Yes y-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 o =.throoms c. Is there a garage attached? d. Proposed Square footage of new constructio Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation .mpliance. Masscheck Energy Compliance form attached? h. Type of constru '.n i. Is constru '.n within 100 fr.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Dept .f basement or cellar floor below finished grade k. I 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 CONTRACTORyAPPLIES FOR BUILDING PERMIT I, vr'Se 11 I I--v 034- T/t Y clk fl Eus<_r_ii, ,as Owner of the subject property hereby authorize S rc tt �4 $vLC. to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner —1� Date 1111.11111 I, UV2 -s{ vc�. cl.� ,as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Tri ;ot ��i� COP P' t Name Signature of Owner/Agentt % Dat SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Nat Applicable ❑ LA Name of License Holder: epaAkek d./17,t2 Os- 093(003 License Number 210 mt k Slra�k ��r(e) ill Olt 04 g h t l Address _ Expiration Date ..... r9 _ 4t3 -r- - 1 Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable 0 U g tQ In f- iyiC I s 1 I I Company Name Registration Number LIS OI L{a,h Sd td-' )-e i3 = 0 . iA4 ct t S I —liar' 1$ Address '(� Expiration ate X11 �( L J Telephon jt3 )shcy tsis. SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit mus e 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 ❑ City of Northampton ;*..... Massachusetts i .2i '� DEPARTMENT OF BUILDING INSPECTIONS v �� 212 Main Street • Municipal Building y'��'✓ Northampton, MA 01060 N-21 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the "reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: I d oY -C ( ,r A Est. Cost: kR( pp .c.a Address of Work: al l_oyx5ce l(�rl yi�,�E 1� (we nC'- Date of Permit Application: (..e{ a-qj R- I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE NOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: -l -.) tl Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton / S�5". SSC ,41/ Massachusetts • AL sr;,n... 'o ; d jc �' DEPARTMENT OF BUILDING INSPECTIONS a_ �* 212 Main Street mp o , MA Building fie. �'- Northampton, 01060 ?‘ Debris 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. The debris from construction work being performed at: al Lonccidlow Dee)-( (Please print h se number and street name) Is to be disposed of at: SSA WrT� e CLEC4,6-C �C,�,�S Sh() kot(s evC1 (Please print name an catio f facility) Or will be disposed of in a dumpster onsite rented or leased from: ShoLtut,t,itt • 3 JdJCC (Company Name an Addre • IAA g_- Signature of Permit Appli t or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. t' ' 1 ' II0hiF_: I NI IICINI 0140 Substitute Mr tgtat ilii WORCESTER SPRINGFIELD tiARI'NQRD 459 MAIN STRBBT-P.M 21OX51033-SPRINGI af.D,MA01151 • MA,REM/151711 Cr.REM 601525 9773311JRDY PAX411..5 33300 Wnia lanThaMa[nM OWNER PERMIT AUTIIORLZATION Name: TOSCilA I.7c:ft R.7C-It'"-, C. /-*c,.--/ Address: a--/ / ,,,, giic../ /b rIi City/State/Zip: �`c7"-ma �/cf , _ oi Q I. Jos ep k d.7.Jk r 10A-l'�a.� f. N` owner),of the property located at:,}14-...7 lL-•., > fl- "'-< , Ml 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. S tore of Owner Date Signature of(Wrier Date i The Commonwealth of Massachusetts �_`-- Departmental lndustrialAccidents Office of Investigations ii 600 Washington Street Boston,Mass. 02111 " - www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(susinesslorganizatioaandividuap: S-Y(A,i DLII i. 1-Vont P. Tn rove YllPn-1- . n( • Address: LIS I J-'lai(1 .81-red sS}e n City/State/zip:_�j[ClnOra/r y/AIMAc11(Si Plione#: C Lis) S43 5164 Are you an employer?Check the appropriate box: Type or project(required): 1.Q I am an employer with La 4. 0 I am a general contractor and I 6.0 New construction - employees(full and/or part time).* have hired the sub-contractors gpRemodeling 2.0 Ian a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8.0 Demolition worldng for me in any capacity. employees and have workers' 9.0 Building addition [No workers'comp.Insurance comp.insurance.f required] 5.0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption pemiMGL insurance required]t c.152,§1(4),and we have no 12.,0 Roof repairs n employees.[no workers' 13.Mlther I ZDOl(��r-4 0(CMc comp.insurance required.] /// r *Any applicant that cheeks box#1 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 hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the name a the sub-contractors-and state whether or not those entitles have employees.If the sub-contractor have e ployees,they must•rovide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance formy employees.Below is the policy and job site information. _ Insurance Company Name: Lie)I rct veru :C Policy#or Sel€ins!.1Lic.#: (` 5 a )(„7.5 -I co Expiration Date: -1 IA(1 Fl sob Site Address: pI L 5fel(O^- Drt Jc City/State/Zip: avtna_ L14- NOV?". 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. Ido herb j`���rtfy under the a'us and penalties ofperjury that the information provided above is true and correct. Signature: �jJ�fjA1-t-44 �JIktT Date. (,e 'a'7( i} �j Print Marne: [( a-✓lC` 0I�Z Phone fl: Cif1 �) SA--; — a) dL1' ' Official use only Do not write in this area to be completed by city or town official City or Town: Permitdicense#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.CityiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: 1 Phone it: g; l% o onsumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 0 Home Improvement=Contractor Registration Registration: 151711 �� � tl z7. 1 Registration: Type. Supplement Card STURDY HOME IMPROVEMENT, INC:411,111,111 .k111,--z±11 .1 Expiration: 6126l2018 DAVID DIAZ --- -- 459 MAIN STREET I 1 i; 1 INDIAN ORCHARD, MA 01151 Update Address and return card.Mark reason for change. SCA ss zae-0n E Address ❑ Renewal ❑ Employment ❑ Lost Card d/ro WOMMOrrraerdlh/704lmsaoGrtietle Office f consumer Affairs&B Suess Regulation License or registration valid for individual use only � JI�ME IMPROVEMENT CONTRACTOR ' before the expiration date. If found return to: �—� Office of Consumer Affairs and Business Regulation A gistr ton 1517tl. Type: to Park Plaza-Suite 5170 Ex i2hon ' P 8727207$ _ Supplement Card Boston,MA 02116 STURDY HOME IMPRQVEME U,,INC DAVID DIAZ 459 MAIN STREET • r/ (� INDIAN ORCHARD MA 01151 Undersecretary Not valid without signat Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CS-093603 Construction Supervisor DAVID DIAZ v SPRINGFIELD TFIEID 0 M11'p 0[7 � - N"'ti'1 Com. Expiration: Commissioner 00107/2091 • a CERTIFICATE OF LIABILITY INSURANCE 8/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELCLY. 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 he endorsed. If SUBROGATION IS WANED,subject to the terms and condittons of the poitcy,certain pollutes may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lien of such endorsement(s). _ PRODUCER CONTACT Orchard-Dowd Insurance Agency LLC HONE Nadine We,et FAX 14 13obala Road lac ,o _'LN.%:413-439-14s0 ' san Holyoke MA 01040 MOM:"PRIMMER €ss: nWCst®dpwd.tory f.LfIYOIA EA Ipp S !MORA AFFORDING _.. .. SU INBURER($I AFFORDINOCWEM{i6 NM1ICIX stINSurdy W6UHERA: t_. Casualty Snanr3Tyce Cq({paRy 42814 P.O. B x eS1 Smprnvement, Inc. INSURERS: P. . Box char3 Indian orchard MA 01151 Inln_sU1:TAC: INSURER n: INSURER E: NSUIERF: COVERAGES CERTIFICATE NUMBER:397345024 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE EOCENE POLICY PERIOD INDICATED.NOT WT THSTAND MG 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. INTYPE OF(NSRANCEPo VNUMBER Far pmM YEW WITS IE;LUAeIUW M150(0199 0/7/2016 0/9/201] EACHOCCURRENCE $1,040,000 .r"I'T.-yiED MNFRCIAL GENERAL LUBLLITY :tdyi _a _. _..a SSB,oeo CLAIMS-MADE I 1OCCUR MEOW 'c mn person g5,ee0 PERSONAL 8AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,005 GMAGGREGATE LIMIT APPLIES PER: PROODCTS-WMPNPAeG $3,000,000 $ AUTOMOBILE LIABILITY COMBIINEDSINGIEDMR $ Ell I ANYAIITO (Ea anNpml) BMW iNVRY(PELPYmll) ALL OWNED AUTOS ■ 6CHEOULEDAUfOS BODILY INJURY(Per anidei) El III PROPERTY DAMAGE HIREDA:TOS IFe' 'q NONOWNEO AUTOS UMBRELLA LIAO OCCUR EACHCCCURRENCE _ ■ EXCESSDAB CLAIMS-MADE EACH EIEWCTflE IIIIIIMIIIIIIII ■ RETENTION 1111111.11111.1 WORKERS COMPENSATION NC ETA (]ff('4 AND EMPLOYERS LIMO"! TORYII h �E ANYPROPRIETORNARTNEMEXECUnVE Y/N EL FAf.H ACCIDENT EL DISEASE-EA EMPLOYE: OFF10E EMBgER EXCLUDED? I NIA (Myaenatl In NX) yppeRtwww DES RIPFIONOFOPP: . N8 babe EL.DISEASE-POLICYLIMIT i ell DESCRIPTION OF OPERAIONSI LOOATONY/VEHICLES(Attury ACORD I01,Additional Remarks Schedure If more a pace Is(Bgalretl) Workers' Compensation Certificate Of Insurance to toiler; separately from the carrier. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICYPROVISIONNS. AUT OPIZEGREPRESENTA1NE ©19002009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks oFACORD is t R CERTIFICATE OF LIABILITY INSURANCE DATE(MMJnnnrrtt v,mSy CElR�FECATEDOEISOISSUED RM TIVE TERYC NEF GATIVLYAMON . ATECONFERSALTER RIGHTSCOVERAGE E AFFORDED THOPOLR.IC THIS B CERTIFICATE GOESFOT INSURANCE DOES O CONSTITUTE EXTEND CONTRATBTREEN THEHECOVERAGEAFFORDED BY THE POLICIES BELOW. RENS REPRESENTATIVE ORINSURANCE AND SHE CERTIFICATE H LDNTRACTBETWEEN'fHE isSU'iNGINSURER{S),AUTHORlZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate fielder is an ADDITIONALINSURED,the po!ky{ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and CondRloua Onto policy,cerfatn policree may require and endorsement, Aotatemont on this certiIICale dos not confer eights to . the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT ORCHARDINSAGCYINC ... . ...... . 4S5 MALN STREET {A(CA _.. E-MAIL INDIAN ORCHARD,MA 01151-1241 • 28YCR • INSURER(S)AFFORDING COVERAGE I NAICM INSURES INSURER A: TRAVELERS MDESROTYCOMPANYOAAMERICA STURDY1O4HMPROVEMENT C INSURERS: INSURER C _ PO110X51033 INSURER IN INSURER E: INDLAN ORCHARD,MA 01151 INSURER F: • COVERAGES CERIUM-1e NUMBER: REVISION NUMBER'. THIS CIAO CERTIWTHATTNUPOL(C:ES OF INSURANCE LISTED BELONNAVE BEEN ISSUBU TOTHEINSURED NAMED ABOVE AORTAE POLICYPERIOO INDICATED. OTWITHSTM'N'ACiANYESSIAS UNT.TERM OR GONOITION GfAWGONTRAOTOROTHERGOC NENTEAM RESPECT TQWHICH THIS CEZTIFKATEMW SLSSUED OR MAY PERTAIN,THE INSURANCEAFFORDEn BY THEPOLICIES OE SCRIBED HEREIN IS SUBJECT TO ALLTHB TERMS,EXCLUSIONS AND CONDITIONS OF SUCH SUCCOR.LWNS SHOWN MAY HAVE BEEN RENEGED BY RAID CLAIMa (,NSR ADD SUB POLICY EFS SATs POLICY EXP DATE LIR TYPES?INSURANCE L R POLICY NUMBER (MMIDOherej (MMIDOIYMO LIMITS GENERAL LIABILITY —, ACH OCCURRENCE $ y1 CM/CASCO/AL GENERAL LIABILITY SAMAGE TO RENTED JJ TIARAS MADE n OCCUR, •REMISES(Ea occurrence) :4ED EX?(Anyone perent) $ •ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POliCY I I PROJECT[TELCO RODUCTS COMP/OP AGG $ AUTOMOBILE LIABILJTY —y CJMBINED SINGLE $ ANYAUIO NNIIIT(EaecAdent) ALL OWNED AUTOS rBODILY INJURY $ SCHEDULE AUTOS JPerMAM HIRED AUTOS BODILY INJURY NON AUTOS (Far accident) PROPERTY DAMAGE $ (Per accident) UMBREIJA.LI#B [i OCCUR NACU OCCURRENCE 1$ r EXCESS DEDUCTIBLE 1 CLAIMS-MAOI AGGRESSED _h RETENTIONS $ A WORKER'S COMPENSATION ANON'c>TATUTORY OTHER EMPLOYER'S LIABILITY Y!N UR—B aS09ge 07/212015 07!2!!2017 - LRSTS ANY PpAERIPEEXCLUDED?LNOECUTNE IY"1N/A E.L.EACH ACCIDENT $ 1,000,000 OFFIUSMFMBFR EXCLUDED? Mandator/in NHf HL.DISEASE-EA EMPLOYEE $ 1,000,000 DSREEba Iakr DESCRIWI E.L.DISEASE-POLICY LIMIT 5 1,000,000 OMOP*r EPATIUNS beau DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES(RESTRICTONS(SPECIAL ITEMS THIS REPLACES ANY PRIOR CYRTIFTCAT31SSUED TO THE CERIUM ANS HOLDER AEkFCTThm WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES co CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 11,1 ACCORDANCE WITH TEE POLICY PROVISIONS. AUTHORIZED REPRESENT E ^1/} ACORD 25(21110108) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORD CORPORATION. All rights reserved. Toll Free (87 378.8739 459 Main Street 508 797.5800 15� � Indian Orchard,MA01161 Worcester ( E-mail:HR@8turdyHome.com yHome.00m NewSpringfieldHaven(473 5435806 www.SturdyHome.00m New Haven(203 848-2118 Fax (413 6435200 HOME IMPROVEMENT, INC . MA REEL#151711 CT REO.#0801526 WINDOWS • WINO • ROOFING • ADDITIONS NameHome Plane Business Phone T'oc, Twarnog 'mic7r9937 Address Cell Phone Other21 1..0 TV? c/law DK Town/Qty Rep resents live Date FLogewcg pin . r3/zot7 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 es described below. Yes No ROOFING SCOPE OF WORK et ❑ 1. Contractor to obtain required building permit(see attached permit authorization form) 1 v 26 3 0 Family home. (4 ❑ 2. Provide certificate of Insurance for workers compensation,general liability.(see attached certificates). or-❑ 3. Provide Job sits dumpster,sat on planks,lo remove Job related debris only. Please Note:dumpster for contractors use only. (see dumpster clause), ®• U 4. Prior to stripping roof,tarp sides of house beneath work area,from roof edge to bottom of wall. (see additional prateotion clause on back). or at 5. Keep Job site In a clean and orderly manner.Rake work areas at end of job.Use magnetic sweep to pick up nails. 13" ❑ 8. Provide OSHA approved staging to safely perform work. a' ❑ 7. Work consecutive days excluding inclement weather.(rain,snow,high winds,high heat,thunder showers,elo). a' ❑ 8. Sts project with qualified mechanics experienced in residential asphalt roofing. 5 Q q u ❑ a Strip existing 1 da.c) SO layers of asphalt roofing(see roof plan,page 2). Number of squares 50 A. A one layer cedar removal. Number of squares O B. Q one layer slate removal. Number of squares a' 0 10.Inspect roof deck prior to re-roofing.Renall I ose boards: A.Replace rotted or cracked boards at$ 3 t81 per linear foot. B. Install new plywood at$ 74'ter sheet. C.Number of sheets of plywood Included Into this estimate:Quantity (see unit cost abovefor add111onal sheets). fes❑11. Furnish and Install it rw.?16i t'd( LA1,4 Al ak A shingles. Color Mesa" Rhos. r ❑12.Furnish and installs"aluminum drip edge around roof perimeter.White F) MB 0 Brown ✓ ❑ Ia 13.Install cedar drip edge at eaves under alumin'-mr)tlnad Li ear y 12r 014.14. Furnish and Install ka/water shield at eaves J `� ser. Three feet in valleys and around all roof penetrations. er ❑15.Furnish and Install underayment to entire roof._Roofer select� DIeroo p sk NOC lar ❑16.Furnish and Install starter course shingles,eaves&rake. • ]' U 17.Furnish and install hip and ridge cap. a❑18.Furnish and Install new neoprene roof boots at soil pipes up to 4"In diameter. Quantity 2-• Size y(boots at electrical mast to be reused). O aria.Reuse stove pipe flashing kits. a' ❑20.Reuse existing step flashing at roof/wail intersections. ❑ aui.Furnish and instail new 0 aluminum 0 copper step flashing at roofiwall Intersections,Linear feet a . If siding work is needed,a cost assessment will be made at that time. a' 1322.Reuse existing wall flashing at rootwall Intersection. ❑ ®23.Furnish and Install new aluminum wall flashing at roof/wall Intersections.Linear feet G .If siding work Is needed,a cost assessment will be made at that time. i4" ❑24.Furnish end install new ✓ aluminum n Ayr-step flashing at base of chimney under exisling lead counter flashing. re ID 25.Replace chimney lead counter gashing. I flueQ 2 Ilues ✓3 fluea other2L. ❑ 1328.Install new roof hood to vent bathroom(s)with Insulated flexible tube.Remove roof deck to gain access into attic.Color black only. ❑ t 7.Gutter Helmets to be removed and reinstalled by others. ❑ a28.Remove and dispose of gutters attached with spike and ferrule. ❑ a29.Remove and reinstall existing gutters strapped to roof.instal straps under shingle <1 over shingles 6 ❑ ego.Remove and reinstall existing gutters with hidden hangers. Linear feet t7 , U 5591.Reuse skylight flashing idts_foReplace skylight gashing Mtn Quantity. (Velux models,stack only). ❑ (8G2.Remove and dispose of the following:Antenna_QSnowAce Wires 0 Snow Quardsfce bells O Solar panels_. ❑ @03.Remove Satellite Dish up to 24'in diameter. Alignment end installation by others. O- ❑34.Page 1Wo=ROOF PLAN. 11 SAV.Page Three=VENTILATION. S &1A- 1c Vt' '17�.o oaf-. vd+ ❑ 6.Page Four=VENTILATION PLAN. ❑ G}$7.Addendum(A)=OTHER WORK. O f138.Addendum(B)=LOW SLOPE ROOFING, 1 - U 39.Acceptance Page Iniels 10# Initials_bridals 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___/___/_ _Weather permitting. The cash price for labor and material as described above is: 1st payment 2nd payment 3rd payment 4th payment ContractContract Total (upon signing) rinr-e.t - , WnTeK. COrip(Tpu Roof $ 69,410..-r 4elteee.-1. T 1iio- aero 6 tui...u.1.—, Ventilation $ Other work $ Roofing total $ ivy tOO $ _ $ $ $ Siding $ $ $ $ $ Windows $ $ $ $ $ Special orders $ $ V ' $ $ $ Other $ $ )j Ce‘ $ $ $ Totals $ /ytWW. $ - ea �� \, $_5'600. " $ 5600.' $l Yco Terms: _Cash Finance Credit Card:#_ _ _ _ _ _ _ _ _ _ _ _ _ _ Exp.date____ /____Code Payment schedule: Any balance not paid in full within thirty days,will be charged 1.8%interest per month. in order to 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.)one-third of the total contract price or Di)the actual cost of any special equipment or custom made material which must be special ordered In advance to meet the completion schedule) $ Q to be paid for 0 $ V to be paid for V - 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 areJs ated on reverse side and are part of this contract. In witness whereof Purchaser(s)has/have hereunto signed their names this (4<if day of V V n/G 20 I? 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 (Date). You the Purchaser(s)may cancel this transaction at any lime prior to midnight of the third business day after the date of this transaction.See notice of cancella- tion form for en 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 mey 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 arbitrationArt-1-1e on ass provided in MGL c 142A. ji/ Representative: �./b < ` ( IC— Owner. �Ar��///(�''ss/^/,/'' 4�^ y'`.��� C Owner J/UAI tr>(6/✓ NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated b a contractor. The owner may Initiate alternative dispute resolution even where this section Is not signed separately by the parties" Do not skin this contract If there are any blank spaces Submitted Acca tetl / / IV �O W tC.� O--' by: p nr A1 . .eedfT 1fi/ t/.7 Representative /t Purchaserrc� Date( Accepted Accept pm_ L��,/ 6/g,��7 Pit by: lot (ata Representative Purchaser Date STURDY HOME IMPROVEMENT, INC. 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