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80 AUSTIN CIR BP-2022-0136 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-346 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Siding BUILDING PERMIT Permit# BP-2022-0136 Project# JS-2022-000241 Est.Cost: $27875.00 Fee:$182.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SAMBRICO - BRIAN RUDD 111478 Lot Size(sq.ft.): 13895.64 Owner: DUVAL JENNA Zoning: Applicant: SAMBRICO - BRIAN RUDD AT: 80 AUSTIN CIR Applicant Address: Phone: Insurance: 2097 RIVERDALE ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON:8/5/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:SIDING &WINDOWS POST THIS CART) 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 8/5/2021 0:00:00 $182.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 1 'r. CIE/r 1/ The Commonwealth of Massach setts 4() Board of Building Regulations and tan rds AUG F R Y Massachusetts State Building Cod , 78UNI PALITY T �/ SE Building Permit Application To Construct, Repair, olish a Revi d Mar 2011 One-or Two-Family Dwelling AM„Tor�Nsp fJ This S tion For Official Use Only N M�o/o a'�NS Building P rmit Number: i2 07a, / �! ate A lied: Even)ass - g-5"zz Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION ciai1.1 Property Address: C 1.2 As21.2 Ass ors Map&Parcel Nu ers /�_ �1, car. LXQy � (fJ 1.1a Is this an accepted street?yes no Map NN,ulhber Parce Number P 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: r' ifiAna,cleUnn Tovat X`O(QACD t mk. a tocs D. Name(Print) City,State,ZIP Ob NLYko Ctc• L115319-81toe No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other COY Specify:Q.,Q OC MQA ' SvA.n� r Brief Description of Proposed Work': L i ifl Sti4.P C.Ur(cm S.cAlttEs- 4 l(12 C . Mt t) Vii � Q Qi'rp'1QI \U W.nachiJS d- \c-S4� l O A) jVk vn60 toy• t)- Friabe .27 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $-i -c.GO 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3 (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All F ((l� //' Check No. Ail Amoun : I us Cash Amount: 6.Total Project Cost: $a'1 g'1'5 , 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) lk.\H1 1�a `) 1c 35 , \ � � License Number Expiration/Date Name of CSL Holder NIC Or�,� List CSL Type(see below) 4..� o n Streets G` . Type Description COS tt 1 ,^1\s1 l,�,� Ob3D Unrestricted 2 Family up toel 35,000g cu.ft.) m1 IV� R Restricted I&2 Dwelling City/Town, e,ZIP M Masonry RC Roofing Covering WS Window and Siding 2 _ SF Solid Fuel Burning Appliances l)L:y b 1 V35 -hOlVt..e.:%t D'J 51-(V1C/A ( I Insulation Telephone Email address . Cv11 D Demolition 5.2 Registered Home Improvement Contractor(HIC) `koacis k)alas co L`A_• HIC Registration Number Expiration Date HIC Compwy Name or HIC Registrant Name QL r 11A4.1611.41 _ S�• irkb1&-•1r,5?r :tr u� yJtJv w and Street WA. O 45.3 7,- uiLt 0 Email address City/ToWn, SState,ZIP Telephone SECTION 6: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 Issuanccee of the building permit. Signed Affidavit Attached? Yes No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES` FOR BUILDING PERMIT lC4r�►I,as Owner of the subject property,hereby authorize ,(to _L L to act on my behalf,in all matters relative to work authorized by this building permit application. -C_ Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER`OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information cont ' ed in this application is true and accurate to the best of my knowledge and understanding. x) g( a.6 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton r }" Massachusetts h? A DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ti a� Northampton, MA 01060 �s!-h CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: 6 ' \3\\ oi\ 1.J, Q1 d C1, O o a The debris will be transported by: Name of Hauler: 05A L - ``\9- CX.A Signature of Applicant: Date: c3AA_g pp � ., The Commonwealth of.ilassachusetts • , ; ;:14 Department of Industrial Accidents :y �m. 1 Congress Street,Suite 100 Boston, MA 02114-2017 ti w'ww.mass.gov/dia r 114a1 cer.' Compensation Insurance Affidavit: Builders/('ontractors/EketriciansiPlumhers. It)BE FILED%4[ID hlIE PER%t1l"1ING Al i IIORITI. Applicant Information Please Print Legibly Name:Business Organization,individual): N N)11), ',CO \,,LL- Address: 3cpki - %\i 4S Q, - CitylState/Zip:',.SQStd . . 6\() 1 Phone #: U 13-e3 Oi3.-t-A-)k.40 .Are you an employer?(Work the appropriate hos: Type of project(required): 1.01 am a employer with employees:toll and or part-tine I.' 7. O New construction 20 I am a sok proprietor or partner:htrp and have no employees working, for me in 8. Cl Remodeling any capacity.[Nu workers'comp.insurance required] 301 am a homeownerdoing all work myself.[No workers'comp insurance etlwnd l' 9. El Demolition 10 0 Building addition 4.0 I am a homeowner and will be luring evNraeturs to conduct all work on my property. I will ensure that all contractors either base workers'compensation unuramv:or arc sole 11 a Electrical repairs or additions pr 12.�Plumbing repairs or additions tun with n o employees. 5 am a general contractor and I have hued the sob-contractors listed on the attached Beet_ 13 Q R f anus cs These sub-contractors lase employees and base workers'comp.uurance.• 6 are We a a corporation and its otTicers lave exercised thew nght of exemption per ri e. 14. \aL.&&QllN 152,i l(4).and we have no erimloyees.[Nu workers'comp.insurance rcyuued.1 S, $1 \n( tp •Any applicant that checks box sI must also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit the atlidav it indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. •c'untraciors that check this but must attached an additional sheet showing the name of the sub-contractors and state whether or not those entries have ernplovees. It the sub-contractors base employees.they must provide their workers-comp.policy number. I am an employer that is providing workers'compensation insurance for aim employees. Below is the policy and job site information. Insurance Company Mane:_ Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address:. JS)h(1 C.c City/State/Zip:3A6(.12f1 CO, MIA 0,s(p a Attach a copy of the workers'compensation policy declaration page(showing the policy number and espiratlon date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a 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 cis°erage verification. I do hereby ter*,under the pains an allies of perjury that the information provided a ahoy is true and correct. St•nature: O-- •1 )C Date: D\a Phan,»: Lk ~'%O 2`kkluiD Official use only. Du not write in this area, to he completed by city or town official. ( its or Town: Permit/License a lssuittg Authority (circle one): I. Board of Ilealth 2. Building Department 3.City/Town Clerk 4.Ekctrical Inspector 5. Plumbing Inspector • ti.Other Contact Person: Phone#: ACC)Ro CERTIFICATE OF LIABILITY INSURANCE DATE 1MM/0DrIYYY) 11/13/2020 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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). PRODUCER La Casa Del Inmigrante NAM FACT Yanahi Zayas 405 Foxon Blvd PHONE 203-508-2592 FAx 203-205-9696 New Haven CT 06513 rzEstl (Alp Nor EMAIL lacasadelinmi rante mail.com AooREss: 9 @9 INSURERS)AFFORDINGCOVERAGE NACU INSURER A: INSURED L S CONSTRUCTION SERVICES LLC INSURER B 9 EASTON AVE Zurich Waterbury CT 06704 ,NSURER C INSURER D• INSURER E INSURER F COVERAGES 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. INSR ADDL.SUDR POLICY EFF POLICY EXP LIR TYPE OF INSURANCE y12, yn M/POLICY NUMBER (MDOIYriY) IMMIDDlYYYYI LIMITS IA COMMERCL GENERAL LIABILITY uRRENCE uRRENCE S ,ORENTED CLAIMS-MADE n OCCUR REMISES(Ea OOarrerc:, S 1 _, _ MED ',Any aw Pcson S PERSONAL&ADV INJURY S GENL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S POLICY n JE- ❑ LOC _PRODUCTS-cONFIOP AGG S OrF+EF ` _ ._ ....___. S AUTOMOBILE LIABILITY Li ` COMBINED SINGLE LIMIT S tEs accident) ANY AUTO u BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY(Per eaadont) S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per,arc den); UMBRELLA UAB — OCCUR Uu EACH OCC.. S EXCESS LIAR _CLAIMS-MADE.I AGGREGATE S DEO RETENTIONS C WORHERS COMPENSATION I i 6ZZUB-5N20647-2-20 10/27/2020 IOI27t2021 { I SSTATUIE l I AND EMPLOYERS UABfLITY LJ E Y N ANYPROPRIETORPARTNEEXECUTIVE 1 EL EACH ACCIDENT I 5 100,000 R OFFICER/MEMBEREXCLUOED? Y 1 N!A 100.000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE. S 500�00 If ins.desnrb✓under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY OMIT i S r 1 1LJ Li' 1 0� DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonel Remarks Schedule.may be attached If more space Is required( CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Vista Home Improvement LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN 2097 Riverdale Street ACCORDANCE WITH THE POLICY PROVISIONS. West Springfield MA AUTHORIZED REPRESENTATIVE Yanahi Zayas 11/13/2020 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Web software.www.FormsBose.com;?Impressive Publishing 30R-20B-197T A�o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 1/27/2021 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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). PRODUCER CONTACT Ion Insurance Corporation PHONE FAX 1520 Highland Ave. (A/c.No.Ext):203-729-5261 (A/C,No):203-729-4343 Cheshire CT 06410 ADDRESS: info©ioninsurance.cam INSURER(S)AFFORDING COVERAGE NAIL# INSURERA:Utica First Ins Co. 15326 INSURED LSCON-1 INSURER B: L S Construction Services LLC Maria Olga Pomaquiza Saula INSURERC: 9 Easton Ave INSURERD: Waterbury CT 06704 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1154160329 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD,WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y ART5153613-00 1/22/2021 1 1/22/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ MED EXP(My one person) $5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY E T LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: FIRE LEGAL LIMIT $50,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY _per accident) UMBRELLA LIAB OCCUR _EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Vista Home Improvement 2097 Riverdale Street West Springfield MA 01089 AUTHORIZED REPRESENTATIVE i(A - tL ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ® DATE(MMIDDYYYY)AccoRD CERTIFICATE OF LIABILITY INSURANCE 04/09/2021 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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). PRODUCER CONTACT David R Jarry Neill&Neill Insurance Agency Inc PHONE FAX 662 Riverdale Street (ac,No.Est): 413-7324137 (A/C,No):413-7316629 West Springfield,MA 01089 E-MAIL DD ESS: dj@neillandneill.com INSURER(S)AFFORDING COVERAGE NAIC k INSURER A: Western World Insurance Co. 13196 INSURED Vladimir Duducal INSURER B: Chubb Chu V&D Home Improvement 776 North West Street INSURER C: Feeding Hills,MA 01030 INSURER D: _ INSURER E INSURER F: COVERAGES 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF w POLICY EXP LIMITS LTR INSD vn POLICY NUMBER (MMIDDIYYYYI (MM/DD/YYYY) A � COMMERCIAL GENERAL LIABILITY NPP8743994 li 10/10/2020 10/10/2021 - EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE V OCCUR PREMISES(Ea occurrence) $ 1 00,0I10 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 V POLICY [ l PRO _ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JEC7 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 1K95803-A-20 04/11/2021 04/11/2022 H STATUTE v ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? Y N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) allysonc@vistahomeimprovement.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VISTA HOME IMPROVEMENT ACCORDANCE WITH THE POLICY PROVISIONS. 1346 ELM STREET WEST SPRINGFIELD,MA 01089 AUTHORIZED REPRES TA E > • 7 ft,..7„,„,c..1 • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD , . „., COrtursoilwealth 01 Massachusetts Dsion of Professional Licensure Board of Building Regulations and Standards ConstrutPt‘tbrtillupprvisor ,i‘" S0,-- 1114714 .7.% ,,.. ....10 , icipires : 01 /2112023 IBRIAN ROCF; ....... -., 41-16 COYOTE CIRCLE ; ,..... . , :111lie FEIED4%1G HILLS MA 01030 ,....... iit • i 3; N.? 4 . (4)/cSal 11° N- 0 • - 4i,o,,,t,i2a A' sYEkondoteke . -,.,. Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type. LLC Registration: 162058 SAMBRICO LLC D/B/A VISTA HOME IMPROVEMENT Expiration: 01/02/2023 2097 RIVERDALE ST WEST SPRINGFIELD, MA 01089 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 162058 01/02/2023 1000 Washington Street -Suite 710 SAMBRICO LLC Boston,MA 02118 D/B/A VISTA HOME IMPROVEMENT BRIAN RUDD 2097 RIVERDALE ST WEST SPRINGFIELD,MA 01089 Undersecretary Not valid without signature Page 1 of 25 2097 Riverdale Street MA Lic# 162058 West Springfield, MA 01089 90' {. CT Lic#0621848 Vista �� •/ = I' LATINUNt Phone: 888.597.2323 HOME IMPROVEMENT vistahomeimprovement.com ,gpRFFFKRE,ION IRA(TOR Fax: 413.382.0241 WINDOW CONTRACT Customer Information Jenna Duval (413)374-8760 Date: 05/21/2021 Lynn Duval (413)374-8769 Rep: David Lauzon 80 Austin Cir duvaljenna@yahoo.com Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: 617.973.8700 The following windows will be installed by Vista Home Improvement Total number of windows in the home 10 Total number of windows being installed 10 Total number of patio doors being installed 0 Dyna Weld - max 134 u.i siding window only Location Living Room Quantity 2 Size 35 x 46 Color White Exterior Color White Color of Wrap aspen white Nail Flange D na Weld - max 134 u.i siding window only Location Bedroom 1 Quantity 1 Size 35 x 46 Color White Exterior Color White Color of Wrap aspen white Nail Flange D na Weld - max 134 u.i siding window only 1 Location Master Bedroom Quantity 1 Size 32 x 46 f Color White Exterior Color White Color of Wrap aspen white Nail Flange D na Weld - max 134 u.i siding window only Location Master Bedroom Quantity 1 Size 30 x 46 Color White Exterior Color White Color of Wrap aspen white Nail Flange This space intentionally left Piano, Page 2 of 25 D na Weld - max 134 u.i siding window only [-m Location Bedroom 2 Quantity 1 Size 32 x 46 Color White Exterior Color White Color of Wrap aspen white Nail Flange D na Weld - max 134 u.i siding window only Location Bedroom 2 j Quantity 1 Size 33 x 46 ----- Color White Exterior Color White I Color of Wrap aspen white Nail Flange Dyna Weld - max 134 u.i siding window only Location Bathroom 1 Quantity 1 Size 30 x 38 - - Color White Exterior Color White Color of Wrap aspen white Glass Upgrade Tempered Glass Nail Flange Dyna Weld - max 134 u.i siding window only Location Kitchen Quantity 2 Size 28 x 47 - Color White Exterior Color White 1 Color of Wrap aspen white Nail Flange I Window Fees Lead Fee 10 Additional Information Page 5 of 25 2097 Riverdale Street MA Lic# 162058 y. West Springfield, MA 01089 CT Lic#0621848 1 Vista Phone: 888.597.2323 HOME IMPROVEMENT vistahomeimprovement.com , •rj ,.. Fax: 413.382.0241 SIDING CONTRACT Customer Information Jenna Duval (413)374-8760 Date: 05/21/2021 Lynn Duval (413)374-8769 Rep: David Lauzon 80 Austin Cir duvaljenna@yahoo.com Florence MA 01062 All home improvement contractors and subcontractors must be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116Phone: 617.973.8700 Siding Specifications Elm Grove d-4 clapboard Color Of Siding greystone Type Of Corner 5.5" Color of 5.5" Corner aspen white Color Of Fascia aspen white aspen white Color Of Soffit aspen white Fascia swap out fascia boards Back of home Siding Add On's New Girardin shutters 4 r and r lights 2 R and R electrical meter 1 Disclosure All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein.This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Workmen's Compensation Insurance. Homeowner agrees to pay for all work as set forth below.If the homeowner defaults, homeowner agrees to pay all costs of collection,including reasonable attorneys fees,in addition to other damages incurred by contractor.An 18% per month service charge will be assessed for all payments not made within 10 days of due date per the schedule below: Acknowledgements YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DAY OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.(SATURDAY IS A LEGAL BUSINESS DAY IN CONNECTICUT.)THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT.THIS INSTRUMENT IS NOT NEGOTIABLE. I, Jenna Duval,Lynn Duval have read the terms stated herein, they have been explained to (me/us), and (I/We)find them to be satisfactory and hereby accept them. This space intentionally left blank Page 10 of 25 Homeowner's Association NO WORK SCHEDULE Contractor will not begin the work or order the materials before the third day following the signing of this Agreement, unless specified herein. Contractor will begin the work on or about 07/21/2021 Barring delay caused by circumstances beyond Contractors control, the work will be completed by 08/21/2021 WARRANTY The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for the period stated below 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 damage or such defect in materials and workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Warranty Period Lifetime Measure Section Measure Set With -- Kevin Date Measure Is set for 06/03/2021 Time Measure is set for Between 2pm-3pm Total Contract Amount (All Discounts Applied) $27,875.00 Payment Deposit $2,500.00 Amount Financed $25,375.00 Form of Payment For Deposit Check Check# 3083 Check Date 05/21/2021 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 or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation below contents of which are referred to above and incorporated herein by reference. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. This space intentionally left blank Page 14 of 25 Owner is hereby advised not to sign this Agreement unless and until all blank sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and related or referenced documents that are incorporated herein are attached hereto. Attorney's Fees/Costs Owner agrees to pay all costs of collection, including reasonable attorney's fees, cost and expenses. Furthermore, interest shall be charged at the highest lawful rate of interest on any and all overdue payments. Copy of Agreement to be given to Owner: This Agreement is governed by the laws of the Commonwealth of Massachusetts. It must be executed in duplicate, and an original, signed copy hereof given to the Owner at the time of execution. No work under the Agreement shall begin prior to the signing of the Agreement and transmittal to the Owner of a copy therefor. Jenna Duval Lynn Duval 05/21/2021 05/21/2021 Date Date David Lauzon Authorized Representative 05/21/2021 Date This space intentionally left blank