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38B-213
v.Au f*.I, "o .114 .1,,,,,'.. Boam of UU-Id"JI1 :4u,il.11,011t, 'I'10 (,,miruvivin Stilit"%I'M %pvt,lllll.% LIcense' JOHN A PFKKIF,13' J9 EAST I= �T 6 s,rAFFO]M TROG Q02/2015 ib 4 It It E IMVROVC MLHT CONTRACTof,' 1/.102 1 jCjmW Pr R R IL It j0FIN PERRIER 59 EAST MAIN 51 STAFFORO,CT 06016 LltjdrrlCCIT%ArY A NEMNGL•20 CLEISENRING ti.,.... CERTIFICATE OF LIABILITY INSURANCE °"1271215 rrtr�2vte 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 INSIURANCH 00E3 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRE86NTATIVIS OR PRODUCER,AND THE CORTIFICATE HOLDER. IMPORTANT? If the cortiticate holder Is an ADDITIONAL INSURED,the poucy{loo)must oe endorsed, It 6UBROOA-n5N IS WAIVED,subject to the torso and conditions of the porky,cortaln policies may require on andoreomont. A statement on this certlFlcato does not center rights to the certlficsts lloidar In It6u of such Indorsement a. MR�11.9 N Sharon Johnson AP Insurance Group,LLC FR p--_------ 144 Road Na,t tI.(800)274-4632 Suite 2050 Sudbury,MA 01776 QQA-xsjInfo@apintsgo.com _- INSURE a AFFORDING CQYIRA�E NAIC r IN.URMA:Gaard Insurance Group"' 25844 ._ artUR$R B NEW ENO EEN F LC IytuRtaC� — - 59 E MAI urswtaR o StaHo a' INwatR t _ W6URtRf; COVERAGES C i MBER; REVISION NUMBER; »ue IS TO CERTIFY THA 6 0 ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDINO ENT CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR AIN, AFFORDED BY THE POLICIES DESCRIBED HEREIN{S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF IE& N HAVE BEEN REDUCED BY PAID CLAIMS. xrat _� tYFa 01 aTa{IpANC[ COMMIACIAL 061111RAL LIABILITY R .{_� 0 _J�.EACH uMrT>f _ � EAC OCCURRENCE I CUIMS•MADF 00" �' � � MLO�E f a�u � I PERSONAL i ADV II{,A/RV j y TAGGREGATE w t IN 0$NEAAL AO_Ii_,. 1 PRO M.CTS COVPpP AGO 1 TNCR. _ r. ET`1f`... IM •R ,83 - I AVTG11OatL8 7 '"} 1 I 1 III .n,4,` {ys..T�� ANY AUl '� •. .. 8��e t;*•" 0001"Y INJURY(P.Pawn! i ALL CYMIE Sc EOULBD ..._ AUTOS '' WN @O !.t 00my INJURY(Pr YTfDPER7Y MRED AUfOa P ,N uMYRxU A LAY 00C 1 r r RRtNU I SIiCSib"So CW K t OtD RETENTIONt aiwr:, (X1f r1� t WOPAIRY 00011 "TION ANDaWIlIVFJID't.fAaLUTY �, � A ANY PROPnIETCRKARTNIRJEXECUTNE Ge 08/01/201 1/2016 `... _ OfPIGt:RAAEMaEIt tXCLU6$OT NACCIOIi ! _y__ 100,00 (Mtlw{tory MI aN) y . E.L.' sEA6H. { 104.00 u�'RIV RATIDW bobw I A " E.L.a5 L 600,00 A 1 ! v OadCRWTIOH OF OPERA T"SI LOCAT/ONAIVSWCLSS IwCOaD+o I....1 w......e.s,nw 1a1�`wtp^•,••«�.«q.1«el d.... __� _ r3"1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE PROOF OF COVERAGE The EXPIRATION DATE THEREOF, NOTICE WILL Be DELIVERED IN ACCORDANCE WITH THE POLICY PROV13ION9. wu//ttl/o'ape1eo�ntrne�ENTArrve 01888.2014 ACORD CORPORATION. AN rights roserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD NEWE-GC OP ID: LM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY( 10120/2015 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(ios) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an ondorsomenL A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). O PRODUCER NAAME: Joseph A.Barrett _ Wilcox&Reynolds L.L.C. RHONE 922 Stafford Road,PO Box 521 LAIC,No.Ext).860 429-9387 FAX Nel.860-429-2394 Storrs-Mansfield,CT 06288-0521 E MAIL barrettOwllcox-re nolds.com Joseph A,Barrett _ADDRESS: Y _ INSURER(S)AFFORDING.COVERAGE. NAIC N INSURERA:Ohio Mutual Insurance Group 10202 INSURED New England Green Homes LLC INSURER B: _ 59 East Main Street Stafford Springs,CT 06076 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 AtA THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR .._................ -----...pnOL>SUaR .___ .-.... -._.. POLICY EFF._.POLICY EXP LIMITS LTR TYPE OF INSURANCE f - I POLICY NUMBER MMIDDIYYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE I E 1,000,00 DAMAGE'TO RENTE3 CLAIMS MADE X OCCUR % !BP 0028743 0711412015 0711412016 PREMISES{Ea pccurrence). S 100,00 f.X Business Owners MFD EXP(Any one person .s 5,00 . PERSONAL&ADV INJURY s 1,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 - CTS P PRO RODU -COMPIOPAGG S 2,000,00 X POLICY I ( LOC _..__ - $ AUTOMOBILELIABILITYT f OM IN SIN L LIMIT f S 1,000,000 OTHER' I �a acc�dentj___ _j A ANY AUTO CPP0022611 0711412015 07/14/2016 1 BODILY INJURY(Per person) S AUTOS I I ALL DINNED )( �SCHEDULED i BODILY INJURY(Per accident) AUTOS S -- PROPER iY DAMAIiE NON-OWNED HIRED ALI70S I (Por accdent)_ _. ....�AUTOS '...S X UMBRELLA LIAR X OCCUR I EACH OCCURRE NCF $ 1,000,000 A I r EXCESS LIAB CLAIMS MADE { CX 0002971 07/1412015 I,I 07/1412016 I AGGREGATE 5 .._._..._..,. 1 _. DED RETENTIONS 5 '.WORKERSCOMPENSATION I PER OTH AND EMPLOYERS'LIABILITY YIN PER _ 1 ER ANY PROPRIETORPARTNERIEXECUTIVE E1 EACH ACCIDENT s OFFICER/MEMBER EXCLUDED? F—]NI A (Mandatory in NH) + E L DISEASE-EA EM PLOYC C. s It yes.describe under DESCRIPTION OF OPERATIONS below l E L.UiSLASE-POLICY LIMI f s I j i i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) INSULATION CONTRACTORS CERTIFICATE HOLDER CANCELLATION TO WHOM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. To Whom It May Concern Owners Proof of Coverage AUTHORIZED REPRESENTATIVE Joseph A. Barrett ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) & 1053 1 f 12 117-116 0_0 e-2,, � I.icense Number Expiration Date Name of CSL Holder T I S .-8 ymv--Cq List CS1 Type(see below) No.and Street Type Description Ll Unrestricted(Buildinzsupto35,000 cu,ft. ) Cityfrown,State,ZIP R Restricted l&2 Family Dwelling Mason I RC Roofing Covering ........ 1__WS Window and Siding SP Solid Fuel Burwijig Appl;wwcs P04181er C4 h�.a>" I Insulation Telephone it �_ailaddress_f_ D Demolition 5.2 Registered Home Improvement Contractor(HIC) 1*4 3 6-2-1 P0*;,-1e1eFr, IIIC Registration Number Expiration Date I Company Name of HI Re is rant Nam ie I" i a dress No—.and-Strect 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 pen-nit. Signed Affidavit Attached? Yes ..........% No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE—COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property, hereby authorize NIE%�.. to act on my behalf, 11 matters relative to work authorized by this building permit application- J&4 LK L, , I date Print e pElewronic Signature) SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest tinder the pains and penalties of perjury that all of the information co rained in this applicaii(ln is tru. and accurate to the best of my knowledge and understanding. Ow,U r Is or AuthorizaAgent's Name(Electronic Signature) Wte NOTES: 1. An Owner who obtains a b7il—ding,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 teat have access to the arbitration program or guaranty fund under M.C.L.c, 142A. Other important information on the HIC Program can be found at wwyV,W4ss,P_ov/QcL,t Information on the Construction Supervisor License can be found at wwW.mA5Sgo,v/d s 2. When substantial work is planned,provide the information below: Total floor area(sq. (including garage, finished basement/attics,decks or porch)i. 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—l'otal Project Cost" L The Commonwealth of Massachusetts Writ FQ M Department of'Industrial Accidents Office of Investigations I Congress Street, Suite 100 kv Ifoston, .MA 02114-2017 tvww,rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Alppticant Information Please Print Legibly Nc3trle(Businrss/Orgtrnization!lndiv;dual): New Engldnd Green homes Address,18 BraoUX L�__-ori Ci /State/Zi .stafford,CT 06076 Phone 060-930.7794 Are you ao emptoyvr?Check the appropriate box; 4 4. l am a metal contractor and i Type of project(required): 1.[� I am a employer with __ _ ❑ 8 have(tired the sub-contractors 6. [] New constniction employees(full and/or pan-time).' 2.❑ �. Remodeling 1 am a sole proprietor or partner- listed on the attached sheet, ❑ g ship and have no employees These sub-contractors have S. ❑Demolition working or me in an capacity, empluyees and have workers' g Y 9. �Building addition [No workers' comp, insurance comp. insurance.: required.] .5. ❑ We are a curpur.,t un and its 10,Q I:aeotrieal repairs or additions 3.❑ t am a homeowner doing all work officers have exercised their I i.[] Plumbing repairs or additions i myself. fNo workers' comp. right of cxcrnption per NIGL w 12.❑ Roof repairs insurance required] C. 1 51,§1(4),an � ! eniplugces. [tiu workers' 13.01 Other-' A'JJc Jt�,�XF comp. inyurttncc rcquired.i _ - 'Any applicant that checks box N i must afro fill out the section Wow showing thou wUr{erS'compensarun t>oky inrormaiian t Homeowners who submit this WYidavit utdiwting they art doing all,vrl,atJ then hue dutsidc evntrncrvrs must submit a new affidavit indicating such tContractos that check this box must attached an additional sheet Owviog tic minte otthc suh-contractors and state whether or not those entities have employees. Ifttto subcontractors have anployccs,they most provide their workers'camp poiic•v number I am an employer that!s providing workers'compensation Insurance for my employees. Below is the polky and job site lnformarlon. Insurance Company Name:Intego — Policy N or Self-ins. Lic. 0:NewC424991 b vpiratiori mate: Job Site Address:All Stoats in CityrState/Zip; y1L✓UJ' t/ Attach a copy of(fie workers' compensation policy declaration page(showing the policy number and expt(oratioa date). Failure to secure coverage us required under Section 25A c,f MCL c. 152 can lead to the imposition of criminal penalties of fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forni of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator, Bc advised that a copy of this statement may be forwarded to the Office of InVOstigatiom orthc Die, tier inauicuicc cuvcratrc.cri ri v:+ci�,,. it do hereb_ycerIVY,' under,the aims andpenalfiey_u fperjV n'that the information provided above Is true and correct. Uwe Phone 4: �-_ C)Q Official use only. Do not write In this area,to be completed by city or town official City or Town: Prrmit/t•iccnse lssuing Authority(circie one): 1.Board ofHeat[h 2. Building Department 3. ('i(y1'I'vsv11 C'Ief-k d t•trctrica) Inspector e, Plumbing Inspector b,Otber Contact Person; Phone C NOV 1 2015 T e Commonwealth of Massachusetts and of Building Regulations and Standards FOR ssa lhusetts State Building Code, 780 CMR MUNICIPALITY iu INS FpT.OF 13UILDiNG IN K:..OF 13UILNNG IN USE Non pp ication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-ur Two-F-umily Dwelling ............. This Section For Official Use Only Building Permit Number: Date Applied: Building off lcial(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Propertv Aoclress,: 1.2 Assessors Map& Parcel Numbers Lla Is this an accepted street?yes— DO Map Number Parcel Number—"-.— 1.3 Zoning Information: I.t Property Dimensions: Use Zoning District Proposed Lot Area(,q 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.I.c,40,§54) 1.7 Flood Zone Information: 1. Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal 0 On site disposal system Check, if%eso SECTION 2, PROPERTY OWNERSHIP' 2,1 9waor)of Record; �3.)D 4,,.r Nam (Print) Qiky,Stale.ZIP No,and Str LJ1 3 4CAAAVI�010 &te, Telcpllone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-( cp eraiion(s) 0 �Addi�tiunO Demolition ❑ Accessory Bldg, ❑ Number of Units— Other 0 Specify:_ Brief Description of Proposed Work':___, SECTIUN 4: ESTIMATED CONSTRUCTION COSTS Estimated�Uo—sts.--F- Item (Labor and Materials) Official Use Only I. Building 1. Building Permit Fee:$ how fee is determined: 2.Electrical 0 Standard City[Fown Application Fee 171 Total Project Cost'(Item 6)x multiplier x 3.Plumbing 2, Other Fees: $ 4.Mechanical (HVAC) 5.Mechanical (Fire Suppression) Total All Fees:$ t,. Check No, Cash Amoun & Total Project Cost: ❑Paid in 'ull 0 Outstanding Balance Due:— NEGH 28 Spellman Rd. j, Stafford Springs,CT 06076 File# BP-2016-0628 APPLICANT/CONTACT PERSON JOHN PERRIER ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794 PROPERTY LOCATION 18 FAIRVIEW AVE MAP 38B PARCEL 213 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DA ZONING FORM FILLED OUT Fee Paid � Building Permit Filled out Fee Paid T_ypeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existin Accessoa 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 INFORMATION 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 Demolitio D lay Signature of Building 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.