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11C-048 (6) BP-2022-0512 6 WARNER ROW COMMONWEALTH OF MASS A CHUSETTS Map:Block:Lot: 1 I C-048-001 CITY OF NORTHAMPT I N Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERE o CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A) BUILDING PE 1. IT Permit # BP-2022-0512 PERMISSIONISH' REBYGRANTED TO: Project# ROOF Contractor: License: Est. Cost: 6300 GLOBAL HOME EXTERIO'S INC 106203 Const.Class: Exp.Date:03/I8/2025 DOTY ROBI W & STOODLEY SHERYL & Use Group: Owner: BARTLETT DOTY Lot Size (sq.ft.) Zoning: URA Applicant: GLOBAL HO E EXTERIORS INC Applicant Address Phone: Insurance: 60 DUVAL RD (774)289-0563 7PJUB 1 K76070821 SUTTON, MA 01590 ISSUED ON:05/12/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHA PTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ( ' • r • )2 • 1 • Fees Paid: $65.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner L—JU� fI AC The Commonwealth of Massachusetts • ° i Board of Building Regulations and Standards FOR 6: c:) Massachusetts State Building Code, 780 CMR MUNICIPALITY �.• ' USE Eallding . it Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 ry One-or Two-Family Dwelling r4 This Section For Official Use Only Building Perrk—/ jJ $P A •6'/2. Date Applied: Mules IZ /772 5- IZ.2o2Z Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbecsj Co l/J l f?5'i4--f200 ft C.. Q 417 1.1 a Is this an accepted street?yes no Map Number Parcel Number 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Sheryl Stoodley Leeds Ma 01053 — Name(Print) City,State,ZIP 6 Warner Row 413-588-7439 seriousplaytheartre@gmail.com 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 J Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': _— Remove existing layer,inspect decking replace if needed,insta I proper underlayment and flashing,install new architectural shingles SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 6,300 00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees• Check No.u Check Amount:41(„14 Cash Amount: 6.Total Project Cost: S 6,300.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 106203 03/1812025 Fredy T Arboleda Jaramlllo License Number Expiration Date Name of CSL Holder List CSL Type(see below) RC 60 Duval Rd No. and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Sutton Ma 01590 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 774-289-0563 globalroofingorg@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 193875 01/03/2023 Global Home Exteriors Inc HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 60 Duval Rd globalrootingorg@gmail.com No.and Street Email address Sutton Ma 01590 774-289-0563 City/Town,State,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 Is1suann of the building permit. Signed Affidavit Attached? Yes `H No .❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Fredy T Arboleda Jaramlllo to act on my behalf,in all matters relative to work authorized by this building permit application. Sheryl Stoodley 04/27/22 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 contained in this application is true and accurate to the best of my knowledge and understanding. Fredy T Arboleda Jaramlllo 4/27/22 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 v ww.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 SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD I N/ SIDE YARD Text SIDE YARD FRONT SETBACK FRONTAGE City of Northampton �� 1 '� Massachusetts �4?S ^_ ''<<. A,`T ) , rk DEPARTMENT OF BUILDING INSPECTIONS i f° ` S x o' 212 Main Street • Municipal Building �� Ca Northampton, MA 01060 ssfh 3�VN." 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: Lowell Ma Location of Facility: The debris will be transported by: Name of Hauler: Red Box Signature of Applicant: r;�:..1 Date: 4/27/22 I ACCIRj DATE IMMFDOMYYYI CERTIFICATE OF LIABILITY INSURANCE 12/21/2021 THIS CERTIFICATE IS ISSUED AS A MATTER or 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 pollcyfles)must be ondo ed. 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 Ilou of such endorsement(s). I PRODUCES CONTACT- LEANDRO GUIMARAES POINT INSURANCE INC PHONE 'At.No. (617)783-1160 FAA ADDRESS: iguimaraesapointinsure corn 1103 COMMONWEALTH AVE iNSURERIS AFFOROINO COVERAGE NAIL r BOSTON MA 022 t 51111 iNsu.ER A. TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER a GLOBAL HOME EXTERIORS INC INSURER INSURER 0 60 DUVAL ROAD INSURER E: SUTTON MA 01590 INSURER r: COVERAGES CERTIFICATE NUMBER: 727870 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 REGUIREMEN1, 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 C.AIMS 'LWIN R fYP!Ot INSURANCE ADOL SUB! POLICY ER POLICY EXP 1 MO MD POLICY NUMBER lMM•'DDNYYYL LMM.'DU+YYYYI llMITS COMMERCIAL GENERAL LIABILITY EACHOcCURRENCf S '.PREMISES DAMAGE. E@voct rrs ices CIAO"IAAOE tH:Ci ni >' 1 MEDEXPrA',yanepeleo,•; S N/A PERSONAL 4 ADV INJURY 1 ,I Oil Ar,ldit i,A'i l'4i:AP PI i ILt.P1-q .DERMAL_AOGREC.ATE .$ POLICY ;k i NilCf lOC PRODUCTS COMP/OP AGG 1 rvIl Ii S AUTOMOBILE LIABILI TY COMBINEDS14Gl firbT 1 .it.gc 4M11 ANY AUTO 90D11.Y INJURY'Pet s,..i. ' s ALL OWNED SCHEDULED N/A RODS INJURY ipu ecc,denit S AUTOS k AUTjOWNED PROPERTYOAMAGE S HIRE()AUTOS AUTOS IPir ecr,(WTI •s UMBRELLALIAO OCCUR EACH OCCURRINCI s EXCESS LIAO C LANs MADE' N/A ,AGGREGATE I L'IO in TENTK1Nt PE S WORKERS COMPENSATION • X, PtRiUTt. tR 1 AND EMPLOYERS-LIABILITY .ANY Pii3IRiIE TOMPAR T NEN,LAECUTIVE YIN El EACH ACCIDENT 1 1,000.000 A -or-fictioMEMBERET.CLVOE07 NIA WA WA 7PJUB1K76010B21 12122?2021 112n3)2022• (M.RdMery In NH) E t otsrAst-to EMPLOYE 1 s 1,000 ODD i6 UC iiP i Q)iyvt drwr'.u NOF OPERATIONS C}Irow nao I L DISEASE POLICY lAir t 1000,000 NIA DESCRIPTION OF OPERATIONS?LOCATIONS 1 VEHICLES IACORD 101.Additional Rrmu5A Schsdu'i,may be stlsched 11 more spice le requlsdl Workers'Compensation benefits will be paid to Massachusetts employees only Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires.or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued tunless the expiration date on the above pobcy precedes the Issue date of this certificate of insurance) The status of this coverage can be monitored daily by accessirg the Proof of Coverage-Coverage Verification Search tool at www.mass gov/Mrdlworkers-compensationlinvestigations/ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main St Northampton, MA 01060 AUTHORIZI.DREPRESENTATIVE Daniel M Crowley CPCU.Vice President-Residual Market-WCRIBMA 1.11988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) Thu ACORD name and logo are registered marks of ACORD ACE J CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,YYYY) �..------ 12/21/2021 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 LEANDRO GUIMARAES NAME: POINT INSURANCE INC PHONE (508)552-8066 FAX ( )508 552-8065 (A/C.No,Extl: (A/C,No): 424 BELMONT ST E-MAIL Iguimaraes@pointinsure.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# WORCESTER MA 01604 INSURER A: ATLANTIC CASUALTY INS CO INSURED INSURER B: Commerce Insurance Company GLOBAL HOME EXTERIORS INC INSURER C: 60 DUVAL RD INSURER D INSURER E: SUTTON MA 01590 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Cert 2021 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MIS/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED CLAIMS-MADE n OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 — A L307001561 12/22/2021 12/22/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XI POLICY PRO 2,000,000 JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ 50,000 B OWNED )/ SCHEDULED BDPS64 12/02/2021 12/02/2022 BODILY INJURY(Per accident) $ 100,000 AUTOS ONLY /_2 AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS ONLY _ AUTOS ONLY (Per accident) $ — UMBRELLA LIAB V OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 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 Town of Northampton THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 210 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Northampton, MA 01060 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents z",L — = Office of Investiga1tions ;-«�" 600 Washington Street sof=_ Boston,MA 02111 'rr www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Global Hone Exteriors Inc Name(Business/Organization/Individual): Address: 60 Duval Rd City/State/Zip: Sutton Ma 01590 Phone #: 774-289-0563 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ID Building addition [No workers'comp.insurance comp.insurance.: 10.0 Electrical repairs or additions required.] 5. El We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.2 Other Roof replacement comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contracto's must submit a new affidavit indicating such. :Contractors that check this box must attached 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 for my employees. Below is the policy and.job site information. Travelers Property and Cas CO of AM Insurance Company Name: 7PJUB1 K76070821 12/22/2022 Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 6 Warner Row City/State/Zip: Leeds Ma 01053 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of pedury that the information provided above is true and correct Stbg nature• Date 4/27/22 Phone#: 774-289-0563 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia DREAM HOME Inc. 1-.C.N.T/ 214 Cherry Street Voorhees, NJ 08043 DREAM HOME www.DREAMHOMEROOFERS.com ONE DREAM OUR HOME Customer Information Name: Sheryl Stoodley Phone: 413-588-7439 Date: 4/5/22 Address: 6 Warner Row Email: seriousplaytheatre@gmail.com Leeds, MA 01053 Locations INCLUDED in scope of work to be performed 18 sq Main House We will be replacing your roof. This may include, but is not limited to the following m terial and practices: 1. Remove all existing roofing material down to sheathing(decking). Inspect sheathing for structu I integrity. (3 sheets of plywood are included, any additional plywood needed will not be charged to the homeowner.) 2 Install new flashing and drip edge 3 Install Ice&Water on eves,and valleys 4. Install premium synthetic underlayment 5. Install Architectural Shingle with matching Hip and ridge shingles 6. Thorough cleaning of job sight for debris and n ils Locations EXCLUDED in scope of work to be performed N/A Existing Shingles Asphalt Drip Edge Color White Additional Details Additional Details This contract will be used for obtaining permits Name. n,)4).7 Dale: 4--1l1012.2 Name:_____Ga (-1: Date: 6-/l 6/2.--(— Homeowner's Association No otal Contract Amount $ 6300 Deposit 0 Deposit Form of Payment Finance Balance Due $ 00.00 Balance Form of Payment Finance Financing Details Amount Financed $ 6300 Estimated Monthly Payment $0.00 Balance due: $0.00 FINANCING IS SUBJECT TO CREDIT APPROVAL Additional Details This contract will be used for obtaining permits NOTICE OF CANCELLATION NOTICE TO CONSUMERYOU MAY CANCEL THIS CONTRACT AT ANY TIMEBEFORE MIDNIGHT OF THE THIRD BUSINESSDAY AFTER RECEIVING A COPY OF THIS CONTRACT.IF YOU WISH TO CANCEL THIS CONTRACT,YOUMUST EITHER: 1.SEND A SIGNED AND DATED WRITTEN NOTICE OFCANCELLATION BY REGISTERED ORCERTIFIED MAIL,RETURN RECEIPT REQUESTED;OR 2. PERSONALLY DELIVER A SIGNED AND DATEDWRITTEN NOTICE OF CANCELLATION TO: DREAM HOME Inc. 1101 Laurel Oak Rd Suite 130 Voorhees,NJ 08043 If you cancel this contract within the three-day period,you are entitled to a full refund of your money.Refunds must be made within 30 days of the contractor's receipt of the cancellation notice. Buyer's Signature DATE: Name: Date: CName: _�/l Date: TERMS &CONDITIONS DREAM HOME TERMS AND CONDITIONS OF AGREEMENTI. Definition of Agreement.These Terms and Conditions,the Purchase Order, and Cancellation Notices and Cancellation Form, along with any drawings, charts , and specifications specifically referenced therein, and any subsequent modifications and amendments executed between the parties thereof, shall constitute the entire agreement between the parties with respect to the specific work described in the Purchase Order (the"Agreement"); superseding all prior and contemporary understandings, or all representations, commitments and agreements as to the subject matter herein. 2. Performance of Work. Dream Home, Inc. ("Contractor")shall perform the work as described in this Agreement in a good and workmanlike manner, and in accordance with all necessary and applicable laws and ordinances. Contractor shall have sole control over the means and methods of performing the work.3. Materials. All materials provided under this Agreement shall be new unless otherwise specified. Contractor may, in its sole discretion, change or substitute materials to be used in the works as long as all substituted materials are of reasonably equal or better kind and quality. Any surplus materials, including any materials that are not or do not remain installed are the property of the Contractor. Contractor shall install all materials, equipment, and appliances in accordance with the manufacturer's warranties and guarantees upon full payment of all monies due hereunder; provided that Owner hereby acknowledges that Contractor shall not be responsible for any flaws or characteristics in the materials themselves not directly caused by Contractor.4. Modifications to Work or Materials. Except those matters specifically left to the discretion of the Contractor herein, any changes, additions, or modifications to the labor expended or materials provided under this Agreement shall be proposed to the other party in a timely manner, and must be approved by both parties in writing in order to be valid and enforceable. Both parties agree that the price quoted by Contractor in this Agreement does not include or consider hidden or unknown circumstances or conditions such as but not limited to: concealed pipes, rotted or otherwise unsuitable components of the Owner's property, framing or improvements,foundation conditions at depths in excess of thirty(30) inches, need for relocation of or unknown underground utilities, inability to use existing water pipes, or other conditions that were not know at the time of contracting.Accordingly, any and all necessary work or corrections of these unknown circumstances or added costs therefor shall be the sole responsibility of the Owner.5. Permissions and Access.Owner knowingly and voluntarily agrees to: (a)permit Contractor to make any and all industry standard rip-cuts, openings, close- ups, or alterations, or changes to existing buildings necessary for the completion of the work hereunder. In performing these actions, Contractor agrees to make repairs and/or restorations to the extent deemed necessary or appropriate to restore areas where work is performed to their previous condition; custom manufactured goods, and any other commercially reasonable charges, expense s or commissions incurred in stopping delivery, in the transportation, care and custody of goods after the breach! by the Owner, in connection with return or resale other goods or otherwise resulting from the breach.Additional incidental damages upon an Owner's breach or default may include: sales, marketing, and administrative costs which are estimated at 35% of the total Agreement amount. These; incidental costs are incurred prior to the ordering or delivery of material and/or labor. Contractor m ay,with or without cause, terminate this Agreement at any time prior to starting performance at the Owner's property, in which case any deposit made by Owner shall be returned in full. Upon receipt of notice of cancellation/termination,each party shall be relieved of further performance under the;Agreement,except any payments then earned or agreed damages or costs outstanding Page 11 of 12LeapToDigital.com 1.2.109. To the extent Contractor is liable to Owner for an y damages pursuant to the work performed under this Agreement or breach thereof, in no event shall the total measure of Owner's damages(including compensatory,consequential, punitive, and expectation damages)exceed the total price paid by Owner under this Agreement. Contractor shall not be responsible for any damages of any kind,to Owner or third party, as a result of labor strikes,fires, wars, acts of God, the inability to obtain materials, manufacturer errors or omissions, or any other causes beyond the direct control of the Contractor. 10. In the event any amounts due by Owner is not paid in full to Contractor when due, Contractor may seek to enforce Owner's obligations through the process provided herein.As such, Owner shall be responsible not only for the outstanding amounts owed, but also for all costs expended by Contractor in enforcing the Agreement, including reasonable attorney's fees, which are agreed to be 1/3 of any past due balance or fees actually expended whichever is greater, plus court and collection costs. Customer further agrees and consents to pay prejudgment interest at the rate of eighteen percent(18%) per annum[1.5% per month]on any unpaid balance due under this Agreement. 11. Parties agree that this Agreement shall be governed, construed and enforced under the laws of the State of New Jersey. Contractor and Owner agree that should any dispute arise concerning the enforcement of their rights under this Agreement, each party will first make a good faith attempt to resolve the dispute with the other party prior to filing any action with the court or administrative entity. Both parties knowingly and voluntarily stipulate to the jurisdiction and venue in the courts of Camden County, New Jersey to resolve any dispute arising under this Agreement. 12. Should any part of this Agreement be rendered or declared invalid by a court of competent jurisdiction, such invalidation of such part or portion of this Agreement should not invalidate the remaining portions thereof which shall remain in full force and effect. . (r//////fy.//ii-i///// Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type_ S:ipp ement Card Registrati n 193575 GLOBAL HOME EXTERIORS INC: EriNratren. 1 n03'2022. D 8 A GLOBAL ROOFING 60 DUVAL RD SUTTON MA 3159-D Update Address and Return Card. st:a- 8 2310-05 U"2eo44af+soner Admix L!(ratiraolerea $s HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Su.:-. :avm'Ca^G bt tore the expiration date. N found return 10: Registr�wn Exstiraticn Office of Consumer Affairs and Business Regulation 19.1t5 '213 .:: 1CO0 Washington Street -Suite 710 GLOBAL rit;:' t rE EXTER1ORS I : Boston. ,A D2118 08A GI.OS:AL ROOFING FRE.147t' 1 ARBOLEC)A R-.t.s;_LO �9 11111;arri va d without signature Undersecre.a•} 1' Commonwealth of Massachusetts Division or Professional Lucensure Bowe at Sodding Regulations and Star r is Corxstrrrcttotn:9rrprrvitsor Spacial y CSSL 106203 Expires )1'1812025 FREDY T ARDOLEDA JARAMII I Cl ;q;u 60 DUVAL RD SUTTON MA 01590 Commissioner r Construction Supervisor Specialty Restricted to; CSSL-RF•Roofing FAIllItP to possess a current edition of the Massach its State Building Code is cause for revocation of this I se. For Information about this license Call(811)727-3200 or visit www.rnass.govrdp1