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17C-113 (3) 44 STILSON AVE BP-2020-0082 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 113 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoly: ROOF BUILDING PERMIT Permit# BP-2020-0082 Project# JS-2020-000132 Est.Cost: $23000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NORTHEAST SPECIALTY CORP 110285 Lot Size(sa.ft.): 11979.00 Owner: BENEDISUK MICHAEL S&JEAN L BENEDISUK Zoning: URB(100)/ Applicant. NORTH EAST SPECIALTY CORP AT. 44 STILSON AVE Applicant Address: Phone: Insurance: 148 DOTY CIRCLE (413) 739-4333 Liability WEST SPRINGFIELDMA01089 ISSUED ON:7/22/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 7/22/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ED Department use only City of N rtha n atus f Permit: Building epa ent `� 2 � C rb Cu/Driveway Permit 212 Mai Str t �u Se er/S tic Availability Room 1004PE 8r/We Availability _ Northampton, A F Ctl�tnjoNrMP°� ° ets of Structural Pians phone 413-587-1240 ax'091 !':ot/Site Plans ytr Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLi�.G SECTION 1 -SITE INFORMATION !� --4 ' 9d 1.1 Property Address: This section to be completed by office Map - Lot U ----Un, Zone_ Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: �-A kr, yo--Q,\ + n �XC�ed ISS(.. LI�1 S�► S� iv . ��©re n c�2, t�-� b 2 VNamye((Print) J�� ^ L Current Mailing Address: 1 Va)- 6Z14_ ` 2�3 * 0J ) L�J�y 160Sk Telephone "' (� Signature 2.2 Authorized Agent: r? bQu Gr . Wpm Vko 'W+ QOVI Na rint) Current Mailing Add ss: '-A05 atu a Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dol!ars)to be Official Use Only com feted by permit applicant 1. Building] CUD (a)Building Permit Fee 2. Electrical �7 (b)Estimated Total Cost of Construction from 6 3. Plumbing I Building Permit Fee 4. Mechanical (HVAC) i 5. Fire Protection 6. Total =0 +2+3+4+5) — Check Number 10 This Section For Official Uss Only Building Permit Number: DateIssued: Signature: _ -zz- 26)7 Building Commissioner/Inspector of Buildings Date 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 This column to be filled in by Building Department Lot Size Frontage Setbacks Front I . Side j L: R: L: R: Rear i 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/Findin ever been issued for/on the site? NO © DON'T KNOW g YES IF YES, date issued: IF YES: Was the permit recorded at theRe istry of Deeds? NO © DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water cr wetlands? NO DON'T KNOW (D YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex ation, orfilling)over 1 acre or is it part of a commo-, that will disturb over 1 acre? YES ® NO 10 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 Or Doors 0 r-� Accessory Bldg. ❑ Demolition New Signs [O] Decks [M Siding [0] Other Brief Deacription of Proposed,,1 ,�,�r Work: (YOv� ft.,u A (Q �_ it �ULT__WL Alteration of existing bedroom Yas No rew bedroom Yes No (CL Attached Narrative Rencvating unfinished basement Yes NorrCQ r. Plans Attached Roll -Sheet 6a. If New house and or godition to existi.ing housing. complete the following: utlt �l a. Use of building : One Family _- Two Family___ Other QI\dC�ZS u b. Number of rooms in each family un.t:_ Nur-,Der 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 as Owner of the subject property — -- hereby authorize VN61+� ])ev n- tip nJL seer__ to act on my behalf,in all matters re.::.,, authoriz -:g pe:-:-,,it applicat!on. -k or) Co rt-ro-c+ !4- '1-� �`�-1-►C1 Signature of Owner �R_y`n as Owner/Authorized Agent hereby declare that the statements and information cn t^e fcregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and c, t es of Print Name ignature o Owner/Agent Date SECTION 8-CONSTRUCTION SERViv-- 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: i IC_1l h DQ y•1r'rl )- Y I �`J License Number NS -DrQ fi_ .TtiI�A fll�gq i l a l aU ay Addr s Expiration Date - �(►3-'�3Lj-u333 Signature e: a 9.Registered Home Improvement Contractor: Not Applicable ❑ N4eSCur - --- �3� i3 Company Name Registration Number Iu8 [ - C1(cle. UU fi S,>flF . , o � -�1 i31 Joao Address 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 affida.:_,-✓ill result in the denial of the issuance of the bui ing permit. Signed Affidavit Attached Yes....... No...... ❑ City of Northampton Y' Massachusetts L A. DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building �= Nortkamp on; MA 01060 �F V jr.) v \. AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation ("OCAB!Z")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 ne registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstructon, 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. CTM Type of Work: 1 ( �. _ _Est. Cost: 0\ Address of Work: qL4 Date of Permit Application: 9 I 94 11-9 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 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 peTJ ury: I hereby apply for a building permit as the agen,,o t're owner: �), IQAq - �J. r103_] 13 Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice. 1 hereby appy fcr a building permit as the owner of the above property: Date Owner Name and SiLmature _ City of Northampton ,+ Massachusetts U DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street % Municipal Building ;. Nortramp-.on, MA 01060 Massachusetts Residential Building Coa_, Section 110.R5.1.2 Homeowner: Person (s) who own a parcel o i .nd on which he/she resides or intends to reside; on which there is, or is intended to be, a ons or two family dwelling, attached or detached structures accessory to such use and/ or Tann structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.1.3.1 Any homeowner performing work for whicn a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.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 irese_,ce on the job site will be required from time to time, during and upon completion of the wo.-k for which this permit is issued. Also be advised that with reference to C_-ap,.er 152 (Wor.:ers' Compensation) and Chapter 153 (Liability of Employers to Employees for inu:-ies not resulting in Death) of the Massachusetts General Laws Annotated, you may be li .bie _' r person(s) you hire to perform work for you under this permit. City of Northampton r •" ?Massachusetts Al !r C :r DEPARTMENT OF BUILDING INSPECTIONS r z. R 212 Main Street •Municipal Building Nort amp_on, MA 010 EC s3'i-,y Debris Disposal Affidavit In accordance of the provisions of IViGL c 46, S-4. i acknowledge that as a condition of the bjilding permit all debris resulting from the construction activity governed by this Building Permit shall be disp_,sed of in a properly licensed solid waste disposa: facility, as defined by MGL c 111, S 150A. The debris from construction work being percrrred at: WA hvio-- - (Please print house number street name) Is to be disposed of at: NU IN 15 M40en 'Rd. FX Nd ' 0,-t 0( 'o� � (Please print nam nd !ocation of faciity) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) ,5>49' v r)I(a10 I-Pr--LZ�14on Si nature of Permit App icant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify ti;e Building Department as to the location where the debris will be disposed. �^ `1 NESCO-1 A�CORn' CERTIFICATEOF LIABILITY INSURANCE DAT61131DIY9 06/13/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESEN`rATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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). RODUCER 413-737-5359 c CT J Raymond Lussier Ins Agcy Inc IN Raymond Lussier Ins Agcy Inc PHONE 413-737-5359 FAX 413-732-2027 61 Park Avenue, Suite 8 (A1C,No,Ext): A1C,No): 0 Box 499 A ADDS:Ino usslerinsurance.com lest Springfield,MA 01090-0499 ADD s Raymond Lussier Ins Agcy Inc INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:CO LO NY INSURANCE CO JSURED INSURERB:A.I.M. Mutual Ins. CO. ortheast Specialty Corp SafetyInsurance Company 39454 escor INSURER C: a p y Dot Circle est Springfield,MA 01089 INSURER 0: INSURER E: INSURER F :OVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ISR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS Y YY (MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 101 PKGO094179-01 03/18/2019 03/18/2020 DAMAGE TO RENTED PREMlSESE8 $ 100,000 MED An one person) 5,000 PERSONAL&ADV INJURY $ 1,000'000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY ❑jpa EILOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: 1 1 $ C AUTOMOBILE LIABILITY Ea.,"NED 0,n SINGLE LIMIT $ 1,000,000 ANY AUTO 2433825 03/11/2019 03/1112020 BODILY INJURY(Per erson OWNED SCHEDULED AUTOS ONLY X AUTOS V� p BODILY INJURY Per accident $ X AUTOS ONLY X AUTOS ONY P�ZOOcr ERd�t AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ B WORKERS COMPENSATION X PER OTH- AND EMPLOYE RS'L[ABILITY VWC6003962-2018 07109/2018 07109/2019 100,000 ANY PROPRIETORIPARTNERIEXECUTIVE YIN N E.L.EACH ACCIDENT $ QFFIC.VM�M EXCLUDED9 N❑ N f A 1 OO,000 ((MMand�ory n E.L.DISEASE-EA EMPLOYEE $ If es,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT )ESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached if more space Is required) -ERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE REPRESENTATIVE ACORD 25(2016/03) 01988-(`2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i . I d/w of Consumer Affairs and Business Regulation office I One Ashburton Place- Suite 1301 � Boston, Massachusetts 02108 Home improvement Contractor Registration i Type: Corporation i Registration: 103713 i Expiration: 07/13/2020 NORTH EAST SPECIALTY CORPORATION I 148 DOTY CIRCLE WEST SPRINGFIELD,MA 01089 Update Address and Return Card. SCA 1 c:. 20M-00511C7� C /ee �'b/)t71CC711lCQ�1!O L'`C(S1CYltA/�r�J office of Consumer Affairs&susiness Regulation Registration valid for individual use only I HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TYPE:Corporation office of Consumer Affairs and Business Regulation Registration Expiration one Ashburton Place-Suite 1301 103713 07/13/2020 Boston,MA 02108 I NORTH EAST SPECIALTY CORPORATION / \ ✓/ I SHARON M.TARIFF 148 DOTY CIRCLE Not valid without Signat e WEST SPRINGFIELD,MA 01089 Undersecretary i Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Phase Print Legibly Name(Business/organizatiordIndividual): Address: nor City/State/Zip: 1 N)C,—OLt;�As Phone#: q O,r�e you employer?Check the appropriate box: Type of p 'ect(required): [J'I am a employer with 4• ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ®N con+jctwn ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑R ling ship and have no employees These sub-contractors have g, ❑D olitio working for me in any capacity. employees and have workers' 9 ❑Bui ding tion [No workers'comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.0 EI trical _rs or additions ❑ I am a homeowner doing all work officers have exercised their I I.[]Plui ribing repairs or additions myself. o workers' right of exemption per MGL � comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.2'Otber_ _ y comp.insurance required.] my applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informatialR iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a uepr affidavit.mdicafin such.. bntraetors that check this box rmest attached an additional sheet showing the name of the sub-contractors and state whether or not these entities have irloyees_ if the sub-contractors have employees,they most provide their workers'comp,policy number. ane an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. tsurance Company Name: �.M olicy#or Self-ins`.Laic.#: Expiration Date1 1C1 S tb Site Address: �'lu ���n �� City/State/Zip: 1"r rf na , P� oQ o(o;Z ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). allure to secure coverage as required under Section 25A of MGL c. 152 can lead to the impositionf criminal penalties of a ne up to 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fire up to 3250.00 a day against the violator. Be advised that a copy of this statement may be forward4d to the Office of ivestigations of the DIA-for insurance coverage verification. do hereby certify underpains etndpme ' erjwy that the information provided above is true and aorrea true: Date: C lone#: ' 7�6�-139— .�3 O,(fieW use only. Do not write in this area,to be completed by city or town of'tciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.rmblng Lapeebor 6.Other Contact Person: Phone#: r'. h NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR CT License #545323 -71 } 148 Doty Circle • WEST SPRINGFIELD, MA 01089 1-888-NESIbOR-1 1-888-637-2671 413-739-4333 ' nescornow.com Submitted To: f lZer, gQ14,ee1'. 5vK 1 gq Avt I 1 la/R.n({ AA C% o o62 JOB NAME Bene ct` PHONE DATE - JOB LOCATION_ -- ---- — - f ' ESTIMATOR_..- __-.-�-c✓ti I �+J We hereby submit specifications and estimates for work to be performed and materials to be used: C:II c r;L�.0✓-(` h' jZ.Ou .-� J. 5 �0>4C -''n :-vo J . /. CA C <-�G, F �1' � rM Fi,n �✓4,�-( I u ?* � ( r)I~ 12(,D4� 1 n I(A I No Ctcr � '- C ^,e r,> .1 re s I-c. k f2�n� Ail %.n v f�► r �vc� p ' i'n j A (�� }�r✓ S 1„ f �� cr. A Sola,.. Ali I.1, �•-r. P,, ,?. F 1 <� � 'c �1,� t )-s Al Jt ct,)10 e C c,/ct P Lv 1 a fit ;'✓7 r V1 `•Z J r : ., w 4+•, ,V4.� s o✓ S rl o n on S r.+ 5� j� � � VK-t w'✓v � l„ c 50 ,<<�c �,� �jYPta ��{ I,iv4efd1,+ L a c, , Do not do: 0 , Construction -Il relate �mits:,_ /f N AN WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement,unless s flied erei9r�Contractor will begin the work on or about (date).Barring delay caused by circumstances beyond Contractor's control,the work will be completed by - � i 7 (date).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor including,but not limited to strikes,Acts of God,shortages of materi- als,accidents,and all other delays beyond its control,shall not be considered as violations of this Agreement. WARRANTY I 1 The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of I � 1 following completion and shall comply with the requirements of this Agreement.In the event any defect in workmanship or materials,or damage caused by the Contractor,its subcontractors,employees or agents,is discovered after completion of any job,including cleanup,the Contractor shall,at its own expense,forthwith remedy,repair,correct,replace,or cause to be remedied,repaired or replaced,such dam- age or such defect in materials and workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. We Propose hereby to furnish material and labor-complete in accordance with above specifications,for the sum of: -Ll-,r 4 4- u V 5-ce?C' --- ____- _ �._—__ dollars($ Z 3 , o U v ). Payment to be made as follows: ($ 2 3 o )upon signing contract; NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR _ Name of Contractor/Designated Registrant %($ Z O O )upon completion of M a a SuJ�_ 148 DQTY CIRCLE_ Street Address upon completion of ! r WEST SPRINGFIELD, MA 01089 413-739-4333 City/State Phone shall be made forthwith upon completion of work under this contract. Registration No. Name of Sal Authorized Signature Acceptance of Proposal: I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. 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 or branch thereof, provided you notify the Seller In writing at his main office 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. Please refer to the Notice of Cancellation. DO NOT SIGN THIS CONTRACT IF THERE ANY BLANK SP Signature Signatur Dala f C r ner(s) Salesmarl4 , Signature a Date v Contra r amz_ i MP$5acP1uS(,tt5 Department of Nuhiic autet;r 13oam of Building Reg ulatiori..and Standards License: CS-110285 { construction Supervisor KEITH W DEVIN 3134 MOUNTAIN ROAD WEST SUFFIELD CT 06093 01109/2020