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29-241 (3) Fully Licensed and Insured &pvec the C 7 Philip Cir Granby,MA 01033 MA Reg#20-2015718 �..� ricion! Phone:413-563-6354 ''MA Lic#: 147961 Fax#:467 9748 MA CSL#•99565 specializing in Ro . NICHOLAS BER NIER (Owner) ""i ° www.nrbexteriors.com W_ ygnl;r R HOME IMPROVEMENTS, Inc. ShingleMaster_ ROOFING&SEAMLESS GUTTERS d•t#,i; U, ca Windows-Siding-Decks Residential-Commercial Proposal submitted to: Phone# h: c: f,. €-) Special requirements Street City,state,zip code Proposal to furnish and install the following ❑ Re-roof 'KI Tear-off ❑ Gutters We shall acquire necessary permits for all work Complete Roof Preparation Home's exterior to be protected by tarps and plywood Shrubs,landscaping,trees to be protected,roofers buggy used Entire existing roofing materials to be removed t exist ecking,including flashing,etc. UJ Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster ® Deteriorated existing decking to be replaced at$50 per sheet of plywood Complete CertainTeed Integrity Roof System • Install Winterguard ice&water barrier along bottom X 3 ft.of all roofs,❑ 6 ft. Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas 91AA-Install 15#•saturated asphalt felt paper to entire decking Install Roofers Select Premium underlayment to entire decking Install DiamondDeck Synthetic underlayment to entire decking ® Install 8"perimeter metal flashing to all edges of all roofs,X white❑ brown [v} Install SwiftStart starter shingle to bottom and rake edges of all roofs Install CertainTeed shingles to manufacturers specifications, ❑ 6 nails IR 4 nails [vj Install Shingle Vent H PVC ridge vent to all peaks in heated areas I Install Shadow Ridge to all hips and ridges,over ridge vent where applicable ® Install new lead counter flashing to chimney ® New flashing installed where necessary Install new pipe flashing to waste vent stacks Warranty options We guarantee our labor/workmanship for 20 years ❑ Upgrade CertainTeed 5-Star Sure Start Plus,50-year nonprorated coverage,including workmanship Upgrade CertainTeed 4-Star Sure Start Plus,50-year onprorated coverage CertainTeed Landmark-color: t o%t kt. 1 U°t G. ❑ 3-tab ❑ CertainTeed Landmark Pro-color J !� ➢ jl'\ We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of:Total Due $ { .;1 ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are - 113 Down Payment$ satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due Pa ment will be W down at start of job, balance due/upon cam letion. y � � Pow .�" upon completion $ r s k) f•IT� Date: .( ; Signature' s Date: r 1 y I Estimator: (Print Name) ��'` 01 q � t'/(Sign Name) Estimates are honored for thirty(30)days from above date ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the possibility of rooflng debris or dust in through cracks of the wood.NRB Exteriors Inc.will not be responsible for debris or dust in the attic or storage areas. A Finance Charge of 1 1/2%monthly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.I agree to pay and/or guarantee payment of these chacgjs.In the event of default of payment,I agree to pay reasonable Attorney's fees and court costs.This agreement dws nbt consd6e a rv>eps of liability.By my signature below,acknowledges an agreement of the above is hereby made ,+ mot'" Signature: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 ,M Sv •. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information q J Please Print Legibly Name (Business/Organization/Individual): 1 y > Address: 7 P�: ` ` � � (�--�.,�; � IAI City/State/Zip: Phone Are you an employer? Check the appropriate box: Type of project(required): 1.[�PI am a employer with 9 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13T] Other comp. insurance required.] *Any applicant that checks box#I 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 contractors 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. Insurance Company Name: " Policy#or Self-ins. Lic. #: '7- Z w Q' C_T I—I 4A Expiration Date: Z fue 71 Job Site Address: -7 �4,1 I ej City/State/Zip:i��+��t tt e J, 4� Attach a copy of the wor ers' 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 certify un the pains and penalties of perjury that the information provided above is true and correct. Siertature Date: ( r U— Phone#: °'-G 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#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �-��C�t, \y�✓�. R✓ V�� ,✓] License Number Address Expiration Date ignature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ C7 GI Company Name Registration Number 12 kt AA dry z Expiration Date Telephone `%r3 5�3 girt 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....... U 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 ❑ Replacement Windows Alteration(s) Roofing Or Doors E] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[EA Brief Descri tion of Proposed Work: —X'3 (( � �� p 1411, f , �+ r Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building: One Family lU Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? Y t-5 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. 1. 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, L.C47 as Owner of the subject property ►� B (� I hereby,authorize f" f` �� s,✓�( �� - I f'y`c�"'45 ?�s^ �P/ to act my-behalf/ in ma_ ve to work authorized by this building permit application. Signature&Owner Date L lv 9 & as Owner/Authorized Agent hereby declare that the statements an information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Sigkatur er/ gent Date 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 L: R: L: R: Rear 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/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES 0 IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO Q 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 0 NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Department use only FMAY -22M4 City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Se tic Availabili ry,J Room 100 Water/Well Availability Electric. Plumbing&Gas I orthampton, MA 01060 Two Sets of Structural Plans n tion VA�,p rye 3-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Prooerty Address: '7 be J e-, ✓ This section to be completed by office Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Lt S C L i 0 P'l l Q Name(�,'rtnt)� Current Mailing Address: Telephone Sign Pe 2.2 Authorized Agent: Name(Print) Current Mailing ddress: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (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=0 +2+3+.4+5) 00 (� Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 7 GOLDEN DR BP-2014-1145 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29-241 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2014-1145 Project# JS-2014-001939 Est. Cost: $6100.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq_ft.): 10497.96 Owner: LIPPIELLO LISA S zonin : Applicant: NRB EXTERIORS INC AT. 7 GOLDEN DR Applicant Address: Phone: Insurance: 7 PHILIP CIRCLE (413) 563-6354 WC GRANBYMA01033 ISSUED ON.51212014 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: FeeTvae• Date Paid: Amount: Building 5/2/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner