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29-049 i ''' �, A� DATE IM CERTIFICATE OF (LIABILITY INSURANCE C7Rl7 M,DO,YYYY 08'06!14 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(tes)must be endorsed. It 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 endorsements). J PRODUCER CONTACT _- -�-�- "-- NAME Paradise Financial tx Ins S vs.LLC aG No,bKI) 8d0)r (4��'`0 FAX NOT (860)851-9564 8 East Main Street EMAIIISIr,?nI,--Em . ADDRESS. Stafford Springs,CT 06076 IN91,RER(Sj AFFOHDING GOYERACE NAIC N _ Phone (860)684-5270 Fax (860)851 9564 wSUPERA I NISU 4ANGF CUMF,Ann I�siD INSURED INSURER I) Allstate _. - - 19232 New England Green Homes LLC INSURER c urns Nal nil 25496 I 59 East Main St INSURER.o Stafford Springs,CT 06076 iNSUCLR E INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: TH61S-f0 CERTIFY'1 HA'I THE PUL,CILS OF INSI,ANC. L6'C 7 Hf L( ", IrV is I�SOi_i'F) I Iif N";oRf i SAmi DABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY RFOIJ REMFN' TLAM UH CgNI'' J'. If i,1'^0N:f AI. (r„O I r la i7i)I.IIN'f.-N`N,11 I H RESPECT 10 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,1 tF INSUHANCI.Al(C,h1 F:i Rv 11!.rlo. ,I.,,(r Si,kINl D NcR i.N IS;,Ubit_U l W At i THf-TERMS EXCLUSIONS AND CONDITIONS Of SUCH POUCiLi' I MI f S Sf-IbW n!MA', 1tAVF t0 E nl(2F-DU':Ff)Lid PAO _:I.A.VS I NSPI _ -AO"UBR - POLICE e4F PULJCY ERF _ _... L TYPE OF INSURANCE _ _ POLIC`1 N JMBtR IMMIX)YYYY MM DD y,YYV LIMITS GENERAL LIABILITY WVO T ) LA CH UI G„LiHC_NCL ; 1 UOO,OOG 00 --� '3AMAGF ORLNTEJ 1 COMMERCIAL,6ENeraAL uABlury l'�ILMI�ES LtWa o�c"ggcncei �s 100 000 DU CiAIMS MADE OCCDR MED ExP{A y 1e pe v �S 5 000.00 A Y NN386246 109,1Ri2014 10911812015 j — __ PERSONA( Auv INJLRr s 1 000,000 00 GENERAL.AGGREGATE. I S 2 000 000 00 r FRO P L,•'E R ' PHODUC I S Coml AGG 5 2 000 000 00 AUTOMOBILE AGC RE C'A iE DWI An .• U- ! .._.. _ -. TONIOBILE LIABILITY l 1R Y ^ UI 1.000 000,00 . -.. ANY AUTO F C`ILA N l e .per[•rs e ALL OWNED SCHEOU'-ED 6481994L6 H _1 AUTOS AUTOS ` --1 NON-OWNED �I 'HREDAUTO AU1.OS : _... UMBRELLA LIAR �/�GGr'LJII FAC H Cl RHLNGE S 1,0 QO.000 00 -, 23565D 140AL I -__ _.. }_._ jC r EXCESS LIAR -_. CI AIMS MAC 1 04)23/2014 04/23;2075 AC�<;Rr{n + S 1,000,000,00 DES S_J-RLTENTIUN 5 _. .-. --14C- .. -� __. _... WORKERS COMPENSATION 5'aru ' OTl- AND EMPLOYERS LIABILITY Y�N - S9iiY 1JMIL° ,. I tR. �..__ .._,. .... ANYPROPRIETOR!PARTNERiEk uj,'V, =-:ALH ACCIDE.Nr 5 ...; OFrICERiMEMBER EXCLUCF.D" N A - - - (Mandatory In NH) <AEMG OyE'; S I!ye5 desulDe under )E SCRIPTiON OF OPERA,ONC o— DESCRIPTION Or OPERATIONS:LOCATIONS,VEHICLES ;Attach ACORD 161 Adtlitlon8l Remarks ScM1aau+e.H rnor�'vpn<e Is required) COLUMBIA GAS OF MASSACHUSETTS IS ADDff IONAi. INSURED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE COLUMBIA GAS OF MASSAG HL)SLTTS THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2 TECHNOLOGY DH SUITE 250 WESTBOROUGH,MA 015ai AUTHORIZED REPHE5ENTANVE i eZ,,1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010i05)OF The ACORD name and logo are registered marks of ACORD i i '' ii �I I i I ^1 NEWENGL-20 JROBEDEE A RU CERTIFICATE OF LIABILITY INSURANCE DATE 1 814/2 DrYVYY) 81412014 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 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 NAME: AP Worth Insurance Group,LLC PHONE (g00)274-4532 144 North Road a No xe: arc No Suite 2050 E-MAIL Sudbury,MA 01776 ADORES : INSURER($)AFFORDING COVERAGE NAIL 0 INSURER A:Guard Insurance Group 25844 INSURED INSURER B: NEW ENGLAND GREEN HOMES LLC wsURER C 59 E MAIN ST INSURER 0: Stafford Springs,CT 06076 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY 1= _.POLIC UP LTR TYPE OF INSURANCE POLICY NUMBER MM1DDNYYY MIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E CLAIMS-MADE F OCCUR PREMISES"Ea occurrence 3 MED EXP(Any one person) $ PERSONAL&ADV INJURY f GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 POLICY F]JECT LOC PRODUCTS-COMP/OPAGG $ OTHER, $ AUTOMOBILE LIABILITY COMBIN5D SINGLE l $ Ea accident ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE g HIRED AUTOS AUTOS S UMBRELLA LIAO OCCUR EACH OCCURRENCE $ EXCESS LIAB _ CLAIMS-MADE AGGREGATE 3 DED RETENTION $ !WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETORIPARTNER/EXECUTIVE Y f N NEWC529637 0810112014 08/01/2015 E.L.EACH ACCIDENT S 500,00 OFFICER/MEMBER EXCLUDED9 ❑ NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYE S 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE.POLICY LIMIT I S 500,00 i DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks SChsdule,may be attached If Moro epsos Is roqulrod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ThielsCh Engineering,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 195 Frances Ave, Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD i II i I i I� I, The Commonwealth of Massachusetts "trForm Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 UIP Boston,MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Atm scant Information Please Print Legibly Name(Business/Organization/individual):New England Green homes Address:v9 East Main Street City/State/Zip:Stafford, CT 06076 Phone #:860-930-7794 Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 4 4. ❑ 1 am u gene,-a] contractor and t 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 g, ❑ Demolition working or me in an capacity. employees and have workers' g Y P h 9. ❑ Building addition [No workers'comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 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.❑ Roof repairs insurance required.]r c. 152, §1(4),and we have no , S employees. [No workers' 13.� Other comp, insurance required.] *Any applicant that checks box if 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:Intego Policy#or Self-ins.Lic.#:NewC424991 _ Expiration Date: Job Site Address:All Steets in City/State/Zip: 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 forth 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 nder the sins and enalti s o er'u that the Information provided above is true and correct. i t Date I r Phone#: 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#f: i i i �, SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License (CSL) J-0 ImA Peqff A9 ._3 19 Z j Z j License Number Expiration Date Name of CSL Alder ^—i- -r^ qr List CSL Type(see below) ,y No.and Street Type Description *rrP l~r�z�KP S �� 66C,4544 U Unrestricted(Buildings u 35,000 cu.ft.) - — 4 R Restricted 1&2 Family Dwelling City/Town,State,Z[P M Masonry RC Roofing Covering WS Window and Siding o SF Solid Fuel Burning Appliances �3�" q � �r /a haD CoM I lnsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) [;�3 OZ( HIC Registration Number Expiration Date HIC Company Name o Hlt Reiisirant name a v No.and Street Email a dress 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 issuance 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 I,as Owner of the subject property,hereby authorize NR�Psf_EWX-14!�Sof)G— w lkomt—s to act on my behalf, in all matters relative to work authorized by this building permit application.PC �,-) O'hfl 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. L)�Y1 0 i��a lo-- 1 -1-- Print Owner'sJ Authorized Agent's Name(Electronic Signature) Date NOTES: I. 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. ov/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" _-�..rr.r...... i ..� } � L�a ,. ...� :�.' i � •� i i i I i W j The Commonwealth of Massachusetts _ Board of Building Regulations and Standards FOR �jJ N Massachusetts State Building Code, 780 CMR MUNICIPALITY USE oBuilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Buildi g Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 o rty AAdres : 1.2 Assessors Map& Parcel Numbers 1.1a 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? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2 1 Owner'of Record: �>21 C .�( s aL onIJrncp 4( ss Dame(Print) City,State,ZIP' yZaL �3;-&Fly- 31 q No.and Street J Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other V Specify: Brief Description of Proposed Work 2: Id I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ 5, Mechanical (Fire - --- ---- Su ression) $ Total All Fees: $ Check No.�Check Amount: Cash Amount: 6.Total Project Cost: $ � �J El Paid in Full ❑Outstanding Balance Due:_ I i i i File#BP-2015-0471 APPLICANT/CONTACT PERSON JOHN PERRIER ADDRESS/PHONE 59 EAST MAIN ST STAFFORD SPRINGS (860)930-7794 PROPERTY LOCATION 342 RYAN RD MAP 29 PARCEL 049 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 105319 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Delay Signature of Bui ing Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. 342 RYAN RD BP-2015-0471 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-049 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2015-0471 Project# JS-2015-000900 Est.Cost: $2294.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JOHN PERRIER 105319 Lot Size(sq. ft.): 20908.80 Owner: BOULAKIS JON Zoning: Applicant. JOHN PERRIER AT. 342 RYAN RD Applicant Address: Phone: Insurance: 59 EAST MAIN ST (860) 930-7794 WC STAFFORD SPRINGSCT06076 ISSUED ON.10/28/2014 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL ATTIC INSULATION 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 10/28/2014 0:00:00 $55.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner