17C-023 (5) 1-3 KrNG AVE BP-2018-1218
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-023 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category:ROOF BUILDING PERMIT
Permit BP-2018-1218
Project# JS-2018-002177
Est Cost:$8075.00
Fee:$40.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: CHRIS GORSALVES 106104
Lot Size(sq.R.): 17119.08 Owner: SHEBEK PETER M 1R MAIL TO: EAGLE CREST
zoning:URB000]/ Applicant. CHRIS GORSALVES
AT: 1-3 KING AVE
ApplicantAddress: Phone: Insurance:
219 NAUBUC AVE (860) 748-3459 WC
EAST HARTFORDMA06118 ISSUED ON:5/18/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.•STRIP & SHINGLE ROOF ON GREY HOUSE
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 5/18/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
_ DepaMrent tree alh
City of Northampton Status of Perri -
.v Building Department Curb Cut/Driveway Permit
lI` 212 Main Street Sewen/Septic Availability
Room 100 Waten'Weu Avallabill
Northampton, MA 01060 Two Sets of Saucwrel Plans
phone 413-587-1240 Fax 413-587-1272 Pldlske Plans
APPLICATION TO CONSTRUCT,ALTER,R PAI I H A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 ,f
Properly Achichn'ull V;-j5;r]Ave. T Is fon to be completed by office
1� IorerCC ( A. a�' `O'-" Lot 6,33 Unit
Zone Overlay DlstriM
Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner o1 Record:
Pea' Sr"b c. 1 k,5s A Vie.,. e MA
Name(Print) Current Mailing Address:
H�}-7SC lY4'a,
Telephone
Signature
2.2 Authorized Agent:
(L.;� s alit, fil ,6�,
Name(Pr Current Mailing Address'.
; 8;c)� �tiu•3Ys9
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building n -I (a) Building Permit Fee
2. Electrical a (b)Estimated Total Cost of
Construction from 8
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection [ "
6. Total=(1 +2+3+4+5) 1 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signat / J
Building ommissionerinspedor of Buildings Dale
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
'Ibis column m be fined in by
Building Department
Lot Size
Frontage _
Setbacks Front
Side L R:, I d.: R:
Rear
Building Height -
Bldg.Square Footage %
Open Space Footage %
(Ina area minus bldg&paved
parking)
#of Parkin,Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Find ever been issued for/on the site?
NO O DON'T KNOW YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Re istry of Deeds?
NO O DON'T KNOW YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 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 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 O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor:/ Not Applicable ❑
Name of License Holder C �-,, g \io-.,t),.c 5 (SSL - I a l o i
License Number
d15 fJ..b Le. L<l 114,1f r3 cT INN OS/oa/ao
Add�rres�s Expiration Date
,r K 86o-]vV-315'\
oiynature Telephone
9.Rmlirtered Home Improvement Contractor: Not Applicable ❑
M IisJr.o C 1l -1a',.,. LL(— ),sls-IN
Company Name Registration Number
)lot N a Ive. C4 ".Z « (%fix S/ .l /\x%
Address 1 Expiration Date
Telephone
SECTION 10-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 building permit.
Signed Affidavit Attached Yes....... K No...... ❑
SECTION 5-DESCRIPTION OF PROPOSED WORK( h k II a ollcabl 1
New House ❑ Addition ❑ Replacement Windows Alteratlon(s) ❑ Roofing 671
0r Doors C ^—
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [q Siding [0] Other[17J
Brief Description of Proposed
Work: See AAI ,L�1 Sorge of wofk
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea. If New house and or addition to exlstina housing complete the followina
a. Use of building :One Fani Two Family X 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, ,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 / Data
I, l � v!r.nLcr as Owner/Authorized
Agent hereby declare t at 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 er/Agent Date
City of Northampton
Massachusetts
d: s
\ DEPMTNBNT OF BDILDINO INSPBCTZONS =. ;
212 Main treet *rthamptvv,, MhG1Building
010fi0
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 mAstered contractors.
Note:If the home(o)wner has contracted with
)I a corporation or LLC,that entity mu1'st be registered.
Type of Work: Rn-.� reD�are.-"rr�Y- '1 Est.Cost:CFQocj
Address of Work: I '3 k� ss A c 1'1er _cz MA.
Date of Permit Application:'S
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-0ccupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME 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:
1 hereby apply for a building permit as the agent of the owner:
S/t( (13 / sA6t,,_ C..J, ,.1', I %19'14
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:
Dale Owner Name and Signature
City of Northampton
Y S
Massachusetts
z
' DSPARTNSNT OF BUILDING INSPBCTIONS o
]1] Nei. Street • N .i.ip.l Buildi.g
Northampton, M 01060 ryK-,i,�pm
Massachusetts Residential Building Code
Section 110.85.1.2
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.
Section I IO.R5.1.3.1
Any homeowner performing work for which a building permit is required shall be exempt from
the licensing provisions of 780 CMR I I O.R5, provided that if a homeowner engages a person(s)
for hire to do such work,then such homeowner shall act as supervisor.
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 Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
Boston,MA 02114-20177
www.massgov/dia
Workers Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legiblv
game (Business/Organization/Individual): mllslfo c IrA..rs LL
Address: paid W.-6,L Lt
City/State/Zip: E)� t-.+Q CT aj)5 Phone#: is'60- -746'3Y$`t
Are you an employer?Chick the appropriate box: Type of project(required):
i,El am a employer with reployees(full and/or part-rime)* 7. ❑ New construction
2.711 am a sole proprietor or partnership and have no employees working forcram 8. Remodeling
any capacity.INo workers'comp.insurance required.)
9. E]Demolition
3 M am a homchavordong all work myself.INa workers comp.insurance required It
4 1 an a homeowner and will be hiring corrosion to condom all work on my properly. 1 will 10 ❑Building addition
orame that all contractors either have warkers'compensation insurance or arc sole II.❑Electrical repairs or additions
pmpriuors with no employees.
12.��-/Plumbing repairs or additions
5.❑1 am a general coutivactorand I have hired the subconrradors listed on the oached sheet 13.Ix(IRoof repairs
'I hese sub-comramors have employees and have worken'comp.insurer r'-�l
6 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other
152.$1(47,and we have no employees.INo workerscomp.insurance required.)
*Any applicant that checks box#I most also fill our the section below showing their workers'compensation policy uncommon.
mmion.
r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lCmuravems that check this hox most punched 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 far my employees. Below is the policy andjob site
information.
Insurance Company Name: L6
,J, y
Policy#or Self-ins.Lie.#: UCS`- 3IS- 6(a1S� � I 1 Expiration Date:..//I D /O c` /a )IK
Job Site Address: - 3 k., J �ue- P f(Z re
City/State/Zip: I'Zllre �m crG6d
Attach a copy of the workers'compensafi In policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do herebycerci- un the pains and penoaies of perjury that the information provided above is
true and correct.
S'g alure' Date' S h S ll p
t
Phone#: 960-14$-3ySC
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
Massachusetts
' s
DEPAN� OF SUILDINO INSPECTIONS s,
]1] Mein Btreet •Maalclpel Building
Northampton, MB 01060 rl�F-»tea
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:
1-3 s 6, T lm , c MIF
(Please print house number and street name)
Is to be disposed of at:
CU PM tips (�,.�,e L.. &d;' c r
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
SignaTure of Permit Applicant 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.
Millstream Construction
s LLC
• x, "� ,' 219 Naubuc Ave.
East Hartford CT 06118
P: 860.748.3459
• Protect Home and landscaping with roof to ground tarps
• Remove existing shingle roof down to roof deck
• Inspect Sheathing for rotted or damaged wood,any rotten wood to be
replaced at cost of$60 per sheet or billed at$6S per hour plus materials
• Install ice and water shield (approximately 6 ft. up from gutter edge, in all
valleys (if any), 3 ft. in from rake edges,and around any penetrations
• Install new edge metal to roof perimeter
• Install new Owens Corning Synthetic Underlayment to roof deck as necessary
• Install new Flashing and vent boots as necessary
• Install new Owens Corning starter plus shingle to roof perimeter
• Install new lifetime Owens Corning Duration Series Architectural Shingles
• Install new Owens Corning Ventsure Ridge vent as necessary
• Install new Owens Corning matching hip and ridge caps
• Roof to be left water tight and site cleaned each day
• Clean up and removal of all job related materials
• Magnet to be used as part of clean up
1
Massachusetts Department of Public Safer
t Board of Building Regulations and Standen
Liconse: CSSL-106106
Construciion Supervisor Specialty
CHRISTOPHER GONSALVES
219 NAUBUC AVENUE
EAST HARTFORD CT 'Q814$'.
gommi� ionera-r-- Expiration:
'Commissioner 08/02/2020
- -� __: fe Cra»z»za>ztae«��� a�C��ccl.:ac�u.�el�.r
r
<' Office of Consumer Affairs and Business Regulation
y 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
j Home Improvement Contractor Registration
— — Type: LLC
MILLSTREAM CONSTRUCTION,LLC - Registration: 181994Expiration: 05/17/2019
i 219 NABUC AVE.
EAST HARTFORD,CT 06118
__--^/fir•
.. Update Address and return card. Mark reason for change.
S'A 1 6 XW Os° I
_O Address El Renewal O Employment ❑ Lost Card
Otdoe of ConsumerAaain 6 Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use orgy
r. TYPE: LLC before the expiratlon date. It found return to:
RaWsMadon Expka m Oma of Corounner Affairs and Business Regglation
161990 05/17/2018 10 Pads Plaza-Suite 5170
MILLSTREAM CONSTRUCTION.LLC Boston,MA 02116
CHRISTOPHER GONSALVES ---
219 NABUC AVE' (� Not valid without signature
EAST HARTFORD.CT Will Undersecretary
C�® CERTIFICATE OF LIABILITY INSURANCE DATE 2(nW2nMMIO017 p
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELYAMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(&),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT. Rthe certl/icate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject tG the terms and conditions of the policy,certain policies may require an endorsement. Astatement on
this certificate does not confer rights to the certificate holder In lieu of such eMorcemends.
PRODUCER CONACT MBIIBSe Quinn
NAME:
Brenner&Sumner,Inc 'AIN N (860)423-]]33 FAX N (860)450 7240
]5]Main Street pDp gg: mq.lnn@sJrNV6C rd.Urr1 cOm
P.0.Ever 167 INSURERISIAFFOROING COVERAGE NAICp
WIIIimarric CT 06220 IN.URENA: Evanston Ins.CO.
INSURED MGM Insurance Company INSURER e: P Y 14788
Millstream Construction,LLC INSURER c: Liberty Mutual
219 Naubuc Avenue INSURER D'.
INSURER E:
East Harford CT 06118 INSURER F:
COVERAGES CERTIFICATE NUMBER: 17/18 REVISION NUMBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INBRTYPE P LIC EFF POLICY P
LTR COMMERCIAL
GENERAL LIABILITY
POLICY NUMBER MMNO RRLIMITS
LONMERLIAL GENERAL LIABILITY 1,DOO.00D
EACHOCCURRENCE $
CLAIMS MADE I OCCUR 'RE E Ee w $ 100.000
MED On I.,ane person $ 5.000
A 3EP1701 12/09/2017 12109/2018 PERSONALBADIOULARY $ 1.000000
G ENL AG GR EGATE C MIT APPLI ES PER: GENERALAGGREGATE 1 2.000.000
POLICY O ECi D LOC PRODUCTS-COMPIOPAGG $ 2.000000
OTHER: $
AUTOMOBILELMBILITY COMBINEOSINGLE LI MIT g 1,0001000
X ANYAUTO BODILY INJURY(Pe:personl S
S OWNED SOHEDUl1iD B2T22960 11/09/201] 111DW2018 SODer INTURY(Peleoorell S
AUTOS ONLY
Avros
x
HIRED NON-OWNED pROPERTYDAMAGE
AUTOS ONLY AUTOSONLY enl $
Uninsured motorist $ 1,000.000
X
UMBRELLA ONE OCCU11 EACH OCCURRENCE g 5,000,000
A EXCESS LIAR LLAIMS�MADE 1]1]843]626 12/09/201] 1 210 9/2 01 8 AGGREGATE
DEO I I RETENTION$
WORKERS COMPENSATION PER OT&
AND EMPLOYERSLIABILITY YIN x T Ui E
C. ANYPROPRIETONIPAATNEWEXECUTIVE EL EACH ACCIDENT 600,000
OFFICERIMEMBER EXCLUOE09 ❑ NIA WC531S-61215]-01] 121OW201] 121OW201B
(MmtlaNryln NH1 EL.DISEASE- 500.000
NYeq reeler.IIntlel EA EMPLOYEE $
DESCRIPTION OF OPERATIONS below I EL.DISEASE-POLICY LIMIT $ 500'000
DESCRIP➢ON OF OPERATIONS/LOCATIONS I VEHMLE$ IACORD 1m,AGtllllonel Reme,ka$<IleOula,may be aIle<Ilatl If maK spew Is nyulrotll
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Proof of Insurence ACCORDANCE WITH THE POLICY PROVISIONS.
AVTHORIVEO REPRESENTATIVE �� ^� � �
� ,Lr�
C 19884015 ACORD CORPORATION. All rights reserved
(CORD 25(2DI6/03) The ACORD name and logo are registered marks of ACORO
Millstream Construction
LLC
East Hartford CT 06118
P: 86U 748.3459
Peter Shebek/Eaglecrest
1 Kings Ave. Florence
MA
$bangle Re-Roof
• Protect Building and landscaping with roof to ground
tarps
• Remove existing shingle roof down to roof deck
• Inspect any additional Sheathing for rotted or damaged
wood, any rotten wood to be replaced at cost of$60
per sheet or billed at $40 per hour plus materials
• Install GAF ice and water shield (approximately 6 ft.
up from gutter edge, 9 ft in all valleys (if any), 3 ft. in
from rake edges, and around any penetrations
• Install new edge metal to roof perimeter
• Install new GAF Deck armor Synthetic Underlayment
to roof deck
• Install new Flashing and vent boots
• Install new GAF starter shingle to roof perimeter
• Install new GAF Timberline HD Shingles
• Install new GAF Cobra vent Ridge vent as necessary
• Install new GAF matching hip and ridge caps
• Roof to be left water tight and site cleaned each day
• Clean up and removal of all job related materials
• Magnet to be used as part of clean up
• Lifetime GAF Golden pledge Manufacturer Warranty
50 years non pro-rated) includes 25 year labor
replacement
• Includes unto 5 Sheets CDX
Includes reattaching
Gutters
Roof Cost: $8075
Payment to be as follows:
Deposit: $4000
Final: $4075
Estimated Start Date: TBD
Estimated Completion date:
Seller aeries to sell and buy agrees to buy.all those materials and labor listed below and
o@erwise necessary to install the products listed in this agreement as set fain In the following
specifications and in accordance with the terms and conditions helow,and on the subsequent pages of this
agreement.
All products listed in this agreement are covered by
Manufacturer's Warranty, a copy of which can be provided
upon request.
Buyer:
By:Christopher Gonsalves
INITI.4LHEBE: A/ DDD
TERMS AND CONDITIONS
g yf. " .. M1t F t=IFar F rver M1a=r nn,aged and fulls.Sundectraged.11bi
=nfihia ageemeyen
µ'tM1 he nn�rct=ndin M1at F� a M1e a antl a✓re.men with recdent]Vi hp_mMnei[end
=blood seat winscdhn rcxa� o M1=pmeemra
1. FuIIAgTgIDaL
Buyer acknowledges that he has red this agreement in full,that it is the complete agreement between
the parties,and that no oral promise or representation of any kind will bu recognized by seller, or
asserted against seller by buyer
Any changes to the terms and conditions to this agreement must IR in writing.In the interest of time
both, seller and buyer agree that country can be made via eleamnie mail if the words" BOTH
PARTIES AGREE TO THE FOLLOWING'precede the message,and the receiving IOety replies m
the email I ACCEPP'
This agreement is for the benefit of,and shall he binding upon,the parties and their respective heirs,
successors and assigns.Where applicable herein,all references to masculine shall include feminine and
singular shall include plat
zee
Refer in Section 10 of these Terms and Conditions and the signature page of his agreement for
additional information refunding cancellation and rescission,Buyer also acknowledges receipt of the
Notice of Cancellation form as pelt of this Agreement Boyer further agrees that seller reserves the
right to cancel the agreement within a 10-0ay proud following the signing date of the agreement.
checks
ThnaMNwg One dt
All checks retained unpaid are subject to a 545.00 p theyer is fee.Balances anted atter installation
is rsubject lea service charge of is G per month.If buyer is in default of payment for 10 days,buyer
esponsible for payment of sellers costs and reazonable avorneys fees.
4.Stan Date,
Buyer agrees to accept delivery of materials and praducts purchased Said desenbud in this agreement
fallowing notice from seller of the data of installation of such product,and mmenals.Buyer
understands that the start date listed is an approximation and performance is subject he delays caused
by,but not limited b,weather,strikes,fires,unavailability of the product at the time of delivery,act,of
God and other cause beyond the control of seller.In addition,if seller advises buyer that the project
is ready to Start prior to the atimeted sart date,seller agrees to cooperate is setting an earlier
installation dare.The entire balance and/or bank Completion certificate is due et completion of
installation.
5.Pscolypps,
This agreement does not cover damages that are caused by preexisting conditions,nolun ing but not
limited to laks emanating from the marine due to the accumulation of leaves or other debris or ice
damming,Seller is not responsible for repairs resulting from pre-existing Conditions.
6 ppbil ip,
Unless specifically prohibited by written agreement,seller may use images of the job for advertising
purposes in promotional or marketing materials
Th is Por F'na
If buyer is requesting third Party financing,buyer furter understands that seller is NOT a finance
summary or lender.Seller only informs its customers of potential borrowing sources and cannot be
liable for any terms and condition,of the lender selected by buyer.
g.A✓re sd ead in Arlmraiinn
As a material aspect of the consideration for this agreement,buyer and seller Sigtre to boding
arbitration for Stay claim,dispute,or controversy('claim'')of any kind(whether in coming, an or
aga rwise)arising am of or relating to this agreement and the purchases and Locusts provided for IT,
it,including but not limned to Schuman on and sales issues,.privacy issues,and tents of use issues.This
arbitration agreement does not apply to disputes over non payment or rights of rescission.
Arbitration shall be conductd putauem to the consumer dispute procedures of the American
Arbitration Association.which are in effect on the dada dispute is submitted to the Amcnoan
Arbitration Association.Information ahem the American Arbitration Association,its rules,and its
for vailable from the American Arbitration Aswuiation,335 Madiwn Ascetic,Floor 10.New
York,New York 100 1 7-0605,or on its website.Buyer and sal ler agree that any arbitration pence ding
will be conducted in Hartford County,Connecticut and will be governed!by Connecticut law_
In no used shall buyer have the right o seek detetminmmn ofany Claim in any other proceeding,
whether a court or administrative proceeding.Buyer agrees not to seek raw,trial.Buyer will not have
the right to engage in pre-trial discovery except as provided in the mbitmtion Thea Buyer will not have
the right no participate am a representative or member ofarry cluss ofclaimants pertaining to any Claim
subject to arbitration.Buyer understands that the arbitrator s decision will be Baal and swung,with
limited rights of appeal.The arbitrator a award will provide that the prevailing party shall he
reimbursed IN,the other partly for any and all costs associated with arbitration of a Claim.
�c
INITIAL IIGRB.
9.Buyer Cancellation Notices
NOTICE TO CONST MER
YOU MAY CANCEL THIS CONTRACT AND THIS TRANSACTION WITHOUT ANY
PENALTY OR OBLIGATION,AT ANY TIME BEFORE.MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER RECEIVING A COPY OF THIS CONTRACT.
IFYOU W ISH t'O CANCEL VOL MUST EITHER:
A. SEND A SIGNED AND DATED W RITTEN NOTICE OF CANCELL41'ION
B. SEND A TELEGRAM CONTAINING NOTICE OF CANCELLATION
C. PERSONALLY DELIVER A SIGNED AND DATED WRITTEN NOTICE OF
CANCELLATION I'O:
Millstream( rou"wh w
219 Naubue Ave.
Fast Hartford,CT 06118
Pi86U]48.3159
NOT LATER THAN MIDNIGHT May 142018 April 12 Estimate date
Floor cancel this romruct within the three-0ry period,you ere eatitld to a full refund anyone
money.Refunds must be made within 30 days of the contere is(referred to as seller elsewhere iB
this agreemeuO recruit of the instillation notice.
In addition,any payments made by you under the agreement will he mourned within I'EN(10)
BUSINESS DAYS following receipt by seller of your cancellation notice,
If buyer cancels,buyer must make available to seller at buyer's residuary,in substantially as goad
condition as when reeeivd,any goods delivered to buyer under this contract or mile,or buyer may,if
buyer wishes with the instructions of seller regarding the returned shipment of the goods at seller's
espeme sad risk.
If buyer does make the Roods available to seller and when does not pick them up within in twenO(30)
days itf the data of buyer's natiee of eaneel[.far..buyer in, I.or chimed athe gow,with..,
any further obligation.If buyer fails to make the goods available to seller,or if buyer agrees to return
the goods to seller and buyer fails m do in,then buyer remains liable for perrormaner of all
obligations under this agreement.
FOR YOUR CONVENIENCE,SELLER HAS PROVIDED A FORM NOTICE OF
CANCELLATION ATTACHED WITH THIS AGREEMENT.
IF BUYER WISHES TO WAIVE THREE-DAY RESCINDING PERIOD INITIAL
HERE:
10 Adshcarem In prorate Retained.
Poor to contacting any had Party cadmium agency or posting or setting in posting either not or
eludronle content relating to this agreement,buyer agrees to take the following steps to resolve any
disputes or issues arising out office agreement which buyer feels seller in not properly handling.
If buyers amount has not been satisfactory resolved by counting seller's platy of Festoons in writing or
by phone,buyer will send a Inner via registered or Summit]mail or by nampte l overnight delivery from
FedEx,UPS.or a similar service to"once of the owner,22-5 Arthur To South Windsor.CT M074 From
the time that the letter is received,seller shall have 20 days to commence is cure of remedy buyer's
craccon
Should buyer fail by comply with the above procedures,such a pasting by buyer or involvement of a
consumer agency will IS considered and defined as a slanderous act and buyer understands that he may be
subjeel In damages,both consequential and direct.
IL Deet."nnnf adrd,
Buyer agrees that seller's LIABILITY FOR DAMAGES FROM ANY CASUE WHATSOEVER SHALL
BE LIMITED TO THE PURCHASE PRICE OF THE SPECIFC PRODUCT PURCHASED BY BUYER.
SOME JURISDICTIONS DO NOT ALLOW t'HE LIMITATION OR EXCLUSION OF LIABILITY FOR
INCIDEN IAL OR CONSEQUENTAL DAMAGES,SO THE ABOVE LIMITATION OR EXCLUSION
MAY NOT APPLY 10 YOU.
INITIAL HERE
12 cele nr.rmamon-
Applicable License Nos'.
C'I'HIC.y,4lQsq.MA HIC 181994,RI HIC 39025
Millstream Construction tames Commercial General Liability,Workmen's Compensation and Public
Liability Insurance applicable to the work to be performed under this agreement The telephone number of
the insurance company issuing the arraigned of commercial General liability insurance is Sumner&
Sumnerl851. rJ�l
FOR INFORMATION ABOUT CONTRACTORS AND THE CONTRACTORS'REGISTRATION ACT,
CONTACT THE CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION
RIGHT OF RESCISSION
(This section applies to the Right of Cancellation)
YOU MAY RESCIND THIS SALE PROVIDED [HAT YOU NOTIFY THE HOME REPAIR
CONTRACTOR(REFERRED TO AS SELLER EI SW HERE IN THIS AGREEMENT)OF YOUR
INTENT TOW SO BY MAIL,W 1STMARKED NOTLATER TITAN MIDNIGHT OF THE TI IIRD
BUSINESS DAY POLI OWING THE SALE,Olt BY HEI EGRAM,OR IN PERSON NO LATER THAN
MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING IHE SAIT FAILURE TO EXERCISE
THIS OPTION,HOWEVER,WILL NOT INTERFERE W ITR ANY OTHER REMEDI FS AGAINST
THE HOME REPAIR CONTRACTOR YOU MAY POSSESS.IF YOU WISH YOU MAY USE THIS
PAGE AS NOTIFICATION BY WRITING"I HEREBY RESCIND"AND ADDING YOUR NAME AND
ADDRESS. I HE I IONIC REPAIR CONTRAC'ICE FOR YOUR RECORDS PROVIDES A DUPLICATE
OF TI IIS RECEIPT
NOTICE TO OWNER
(OWNER IS REFERRED TO AS BUYER ELSEWIIERE IN THIS AGREEMENT)
DO NOT SIGN THIS CON"I RAC F IN BLANK.
YOU ARE ENTITLED TO A COPY OF THE CONTRACT AT THE TIME YOU SIGN_
KEEP IT TO PROTECT YOUR LEGAL RIGHTS
DO NOL SIGN ANY COMPILE IION CERTIFICATE OR AGREEMENT STATING THAI YOU ARE
SATISFIED WITH THE ENTIRE PROJECT BEFORE HISPROJECTISCOMPLIETT HOMEREPAIR
CONTRACTORS ARE PROHIBITTED BYLAW FROM REQUESTING OR ACCEPTING A
CERTIFICATE OF COMPI HTION SIGNED BY THE OWNER PRIOR TO THE ACTUAL
COMPLETION OF THE WORK TO BE PERFORMED UNDER THE HOME REPAIR CONTRACT
YOU,THE BUYER,MAY CANCEL THIS TRANSACTICIN AT ANY I IMF PRIOR TO MIDNIGHT OF
THE THIRD BUSINESS DAY At HER THE DATE OF THIS TRANSACTION.SEE THFPROVIDED
NOTICE OF CANCFI.LATION FORM FOR AN EXPLANATION OF THIS RIGHT
BAYER EXECUTES'IHIS AGREEMENT AND INTENDS TO BE LEGALLY BOUND AS OF]HE
DATE BELOW
Data/9/2018 12'. 07'. 09 PM "QUA (011-Iii (Mi—em, k1_4 eF PUL SLJ tk
Buyer
Rep:Christopher Gonsalves
Milbtream Con traction LLC
By:Christopher GeRsalves For Millstream ConstmUion LLC
I
Millstream Construction
219 Naubuc Ave.
East Hartford, CT 06118
To Whom it May Concern:
Marie E. Sic has my permission to pull a permit
Fromthe Ian,/4
Thanking you in advance.
Sincerely,
Christopher R. Gonsalves
Owner