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25C-143 (7) ��� 'j�f���C�=?� �}lxf-'��'�7 s a�3r�o �t �rr� 3" :'a4 �#�� t" g s Coil%tf-ukltion Suptnisor SpccialtN CSSL-099931 KEITH W DEVIN 3134 MOUNTAIN WEST SUFFIELD CT 01109/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162058 Type: LLC Expiration: 1/12/2017 Tr# 262537 SAMBRICO LLC dba VISTA HOME IMPROV BRIAN RUDD 2003 RIVERDALE ST WEST SPRINGFIELD, MA 01089 Update Address and return card.Mark reason for change. scn i u zoM-osn Address Renewal ' Employment i' j Lost Card arirriet�rruefr�I�r�^��ir,;lCrcltrrrvt!' _ Office of Consumer Affairs&Business Regulation License or registration valid for irtdividul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 162058 Type: Office of Consumer Affairs and Business Regulation xpiration: 1/12/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 SAMBRICO LLC dba VISTA HOME IMPROVEMENT BRIAN RUDD 2003 RIVERDALE ST WEST SPRINGFIELD,MA 01089 ------_-___ Wwithbout�signtr, 1lnder secretary STATE OF CONNECTICUT ♦ DEPARTMENT OF CONSUMER PROTECTION Be it known that SAMBRICO LLC 2003 RIVERDALE ST W SPRINGFIELD, MA 01089-1060 is certified by the Department of Consumer Protection as a registered HOME IMPROVEMENT CONTRACTOR I Registration # HIC-0621848 VISTA HOME IMPROVEMENT Effective: 12/01/2014 Expiration: 11/30/2015 William M.Rubenstein,Commissioner Page No. of, Pages J CT,.REG.NO. 0621848 VISTA HOME IMPROVEMENT COLOR WIDTH MA REG.NO. 162058 2003 Riverdale Street West Springfield, MA 01089 INSULATION Toll Free: 1-888-597-2323 • Local: 413-382-0249 FAX: 413-382-0241 Proposal Submitted To Homeowner Work To Be Performed At Name C Street Street > 4 City !r 1 Mate City r State I!/ � / Date of Plans . Date J� Telephone `°'7 :.,'7 2�_� y We submit specifications and estimates for: q 7 f / Y ., / d. S• y ik p i 7-- v Date work will start. Date work wit be completed All material is guaranteed to be as specified. All work to be completed in a wbrkmanlike mariner 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 arrlbunt stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully coveredby ' 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 col- lection,including reasonable attorneys fees,In addition to other damages Incurred by contractor.An 18%per month service charge will be assessecfor all payments not made within 10 days of due date per the schedule below: �r P 10 OTC hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: L/27 U r f! ✓ CAJ M "' Said amount shall be paid as follows: Note:This proposal may be withdrawn by us if not accepted within days. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY ATE HE DAY OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT.{ AY IS A LEGAL BUSINESS DAY IN CONNECTICUT.)THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITAITrodh ALES ACT AND THE HOME IMPROVEMENT ACT.THIS INST N TNEGOTIABLE. Signature of Contractor or authorized representati / '(UWe)have read the,,terms stated herein,they have been explained to(me/us),and(UWe)find them to be satisfactory and hereby i accept them. f 1. Signature of Homeowner(s): X / $' X i --------------------------------------------------- -------- AUG-7-2014 07:21 FROM:WILLIAM J MIS INSURA 4135729191 TO:14133820241 P.6f9 CERTIFICATE OF LIAB LITY INSURANCE "'""° "Y) OS/OT/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 4NO CONFERS NO RIGHTS UPON TWO CERTIFICATE HOLDER. THIS CER71FICATR DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(% AUTHORIZED REPRESENTATIVQ OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT! the cartiflars eldsr Iii an INSURED, t ICY es mUSt Of endeNed, if S eu the farms and conditions of the policy, certain polities may require an end OntenL A statement On this certlHcats does not comer right* to the cerNllcata holder In lieu of such endonsmsnt(s), PRppuceR WXLLZAM HIS WILLIAM .T MIS INSLVM V AGENCY 413-566-6111 , d l N.,l _ tue,Nab 73'572-9797 156 VZX ST , BYizQBZAI.MZenasuaAx4'3c.Cald _...._..._...___ WESTFIELD, MA 01085 INSUNINJI)AFRO DIN ODOVIRAGa •_ RA:NATALRAAQ INS co SAbMIRICO XJA DBA IN URAN 0; uI UR/R C VISTA NOME IMPROVRHLWT IN uRe"D 2003 RIV'rRDAI,II 9TUZT IN UREREI W1.ST 01 NGFIELD ri* 01089 IN URINF1 COVERAGES CERTIFICATE NVME6R: R9Vt3ION NIJM44R: THIS lS Tp C RTthV TI THE POLICIES f IN8URANCE LISTCO DCLOW HAVI+ BEN 188UED TO HE INSURED NAMED ABOVE FOR THP POLICY PEk10 1NDICATOD NOTWITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF i NY CONTRACT OR OTHER DOCUMENT WITH RCSPCCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES owltISBD HER @IN IS SUBJECT TO ALL THE TERMS. CXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY NAVE OGEN RED1.109.1 1 NY MAID CLAIMS. .... ........._. DL MPr_ LTA TYPtWINiIlMNCII INAR VIVD POLICY NUMBER 1MMRRLYYYYI I (MMIDINYYYY) Ulm DaNm,A).wAmrry EAE:H000URRE1,10 s 2,000,000 . A g_ COMMERCIAL GENERALUADILM 108/01/201 08/01/2015 PR6MIa6plEPOaaurmlla 1. 100,000 CLAW4VADE C I OCCUR I MED Sw(Any ini iirSON x 5,00 0 _ -- PBREIONALAAnYRJURY 1 2,000,000 GENERALAGOREOATE s 2,000,000 0111,11.AOORL•DA F LUAT APPLIES PER. Poomr0-CCMP74P AEG 1 2,000,000 POLICY F7 P� LCC 1 AUTOMOBILE UA9UTY ,A iECNNM) S ANYAUTO ROn11.Y IN,gIRY(Pw pomm) I ALL 06 ED AUTO LCD a00R.YPLNRY racWtlorAl i KREOAUT01 AWTOO I,IjD i i~ UMORMLAUAD OCCUR CACHOCCURFENCD .AOOREtiA ._.......—_._....._-- LIED RETENTION 1 1 WiR,ReRe GOMPBNSATION MIDIMPLOYIRS'UNKUTY TORYUMrra At ANY PAC"IItTOR,PAMffRIEXECUTi1� Y N O.L EACH ACCIDENT 1 CtllPlrl!P,MRAMIER E70CLUDEA7 N r A (MSnIMIO,y in NHI 5.L.010ABC-EA IMPLOYEA i it Yoe,44Krlpo antler . 000RNMON OF OPERATIONS OiISN I E L DISF.W•POLICY UMIT I DSOd1MTP7N GP ePpMriDNe 140DATIGNI f VEHNiLEe(Much ACORD 101,A#MkNW Rnm*o,amtluN,e mom space Is,nqugodl CERTIFICATE HOLDER CANCELLATION TOWN OF WILLYAMSTOM WA NOULD ANY OF THE Altaua DROCRI®ED POLICIaa 0e CANCELLED gEFORt: HD EXPIRATION DATE. THgRCOP, NOTICE WILL 114 51504QR91) IN CCORDANCS MTN TN@ POLICY PROVISIONS. AU HORRED REPRReF,NTA 10 ACORD CORPORATION. All rIQ to reeorvod. ACORD 25(2010106) The ACORD name and logo ere n glatered mar Df ACORD "''� DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THLS 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 R PRO FR. IMPORTANT:N the certificate holder is an ADDITIONAL INSURED,the poiicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain polickes may require and endorsement. A statement on this certificate does not confer rig hts to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: SOUI'HWICK INS AGENCY INC PHONE FAX PO BOX 100 (AIC,No.EX* (A/C,No): E-MAIL SOUTHWICK,MA 01077 ADDRESS: 28TKC INSUREA(S)AFFORDING COVERAGE NAIC S INSURED INSURER A. TRAVMJMS PROPERTY CASUALTY COMPANY OF AMMCA SAMBRICO LLC DBA VISTA HOME IMPROVEMENT INSURER B: INSURER C: INSURER D: 2003 RIVERDALE ST INSURER E: WEST SPRINGFIELD,MA 01089 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: MY THAT T OF INS1111ANCE LISTED BELOW MVE REM ISSUED TO THE NWRED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.N HBTANDNG AN Y REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W"RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEDIEAEIN 18 SUBJECT TO ALL THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L A POLICY NUMBER (MMQDIYYYY) (NIMMYYYY) LIARS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE ❑OCCUR. REMISES(Ea occtnrence) ED EXP(Any one person) S rR ONAL 8 ADV PUURY $ GERL AGGREGATE LIMIT APPLIES PER: ERAL AGGREGATE $ POLICY PROJECT LOC DUCTS-COMPIOP AGG $ AUTOMOBILE UABILFTY BINED SINGLE $ ANY AUTO LIMrr(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS BODILY INJURY $ Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOY ERS LIABILITY YIN us-2£072183-15 0311212015 0311212016 X uMtTS ANY PROPERtTORMARTNEEVFXECUTIVE ©WA E.L.EACH ACCIDENT S 100,000 EM OFFICERIMMER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 ti yes,desalbe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS[LOCATIONSNEMCLESIRESTRICTtONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CE]TIFTCAT6 HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTHAMPTON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 212 MAIN ST,ROOM 100 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE /f NORTHAMPTON,MA 01060 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1668-2D1D ACORD CORPORATION. All rights reserved. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction 1Supervisor: Not Applicable ❑ Name of License Holder: License Number Address ExpiratiodDat Sig a ure Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ Company Name Registration Number Address t 2 Expirati Date LU 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....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of 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. 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 undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ ReplacementiWy�dows Alteration(s) ❑ Roofing ❑ Or Doors JX Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (M Siding Other[0] Brief Description of Proposed ,�{ Work:�1.�'i7 4 `�-- \(15 �� l�kN1� ��f� wwldoui ��� � O�6 Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Sa. If New house and or addition to existing housing, complete the following: a. Use of building : One Family V Two Family 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, \ M( all(% as Owner of the subject property hereby authorize 1 az) 19 lS �', XYn�ro Ue mlt�K?� to act on my beh f, in all matters relative to work authorized by this building permit application. V"40k Sig&gure of Owner Date I � ( CcYI as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 4 J�t C V-) Print Name f � v Sigp6ture of Owner/Agent Date 1- 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 Side U R: L: R: Rear Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved arkin #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW © YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW © YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO (7, DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO 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 (Oj IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: 1 ;,1,��;; Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 WaterlWell Availability Northampton, MA 01060 Two Sets of Structural Plans e 413-587-1240 Fax 413-587-1272 Ptot/Site Plans StecIc.P'�um +nc, ��r oU0 Other Specify t�- APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office �rC>ACkr�A Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Curren Mailing Addr s 6�5�LOL4�1 � 1 I Telephone Signature 2.2 Authorized Agent: C',(e Pf-0- Name(Print) '� Current Mailing Address: q 13— cc- Signatug V Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building q (a)Building Permit Fee 2. Electrical _( (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) C) al. Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 41 ORCHARD ST BP-2015-1254 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25C- 143 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit# BP-2015-1254 Project# JS-2015-002313 Est. Cost: $6902.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: VISTA HOME IMPROVEMENT 099931 Lot Size(sq. ft.): 7666.56 Owner: PIAGGI ANTHONY&JULIANNE S SALZMAN Zoning URB(100)/ Applicant: VISTA HOME IMPROVEMENT AT: 41 ORCHARD ST Applicant Address: Phone: Insurance: 2003 RIVERDALE ST (413) 382-0249 WC WEST SPRINGFIELDMA01089 ISSUED ON.61812015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOW 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 6/8/2015 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner