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35-137 (4) 34 WESTWOOD TER BP-2018-1033 GIS 4: COMMONWEALTH OF MASSACHUSETTS MamBlock: 35- 137 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: ROOF BUILDING PERMIT Permit# BP-2018-1033 Project JS-2018-001874 Est Cost:$31710.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: NORTHEAST SPECIALTY CORP 103713 Lot Sizetsp. h.k 10323.72 Owner: SANTANGELO SHANNON zoning: Applicant. NORTH EAST SPECIALTY CORP AT. 34 WESTWOOD TER ApplicantAddress: Phone: Insurance: 148 DOTY CIRCLE (413) 739-4333 WC WEST SPRINGFIELDMA01089 ISSUED ON:4/13/2018 0.00:00 TO PERFORM THE FOLLOWING WORK STONE COATED METAL 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 BV THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 4/13/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner �Z00� Department use only City of Northampton Status of Permit: s Building Department Curb CutfDdvewsy Penna '.. 212 Main Street sewerlSepgcavailabilay Room 100 Weer/Well Avalabft_ • - Northampton, MA 01060 Two Sets of Structured Plans phone 413-587-1240 Fax 413-587-1272 Plat/S'de Plans Other Specify ='a APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION bo- ! 8- 1033 1.1 Property Address: This section to be completed by olgcs Map 35 Lot 169 Unit b \orer�ce 'y-w-, 0\CC-2 Zone Overlay District Elm St.District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 5ll(�Y11'�CFI ���itil14C�Cl t lR � 1��-C�`�`C1C�_�l�'CCElC"p Name(Print) Current Mailinrp`A1tl-]dresa, `p ( JS l tl- Cl Telephone Signature 2.2 Authorized Anent: Name(fig) Current Mailing Atltlre s: Sig�iat�r¢� Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building ` (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee p 4. Mechanical(HVAC) 40 5. Fire Protection 6. Total= (1 +2+3+4+5) Check Number ] This Section For Official Use Only Building Permit Number Date Issued: Signet ure' JtCj Building C missionehinspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) 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 arkin #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW ku YES O IF YES, date issued: IF YES: Was the permit recorded at the�Registry of Deeds? NO O DON'TV.)` $ KNOW W YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(Gearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO }P IF YES,then a Northampton Storm Water Managem/nA t Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ElDemolition E] New Signs [0] Decks [q Siding (0] Other[o] Brief Descri tion of Proposed Work: �\UrP COO�Q c�nY ,Q\E �(YJF \[�94E11 Alteration of existing bedroom_Yes _No Adding new bedroom Yes —/K No Attached Narrative Renovating unfinished basement Yes No Plans Attached Rall -Sheet Ga.It New house and or addition to existing housing. complete the following: a. Use of building : One Family 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 APPL`IErS.FOR BUILDING PERMIT as Owner of the subject property hereby authorizeSC6� to act on my behalf, in all matters relative to work authorized by this building permit application. Signature �of^Owner Date 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. O r Print Na Sig w er gent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed ConstructionF�Suoeundsor: II 11 Not Applicable ❑ Su� Name of License Noltler T 1. l"1 GIT.50(7l �� IO3 License Number nick olpgl:� Address/ Expiration Da e Sig r Telephone 9.Rapistered Nome Improvement Contractor. Not Applicable ❑ Yl)br�-� 1 13 Company Name Registration Number I�QL(]rt �� 1 W I� Address rM Expi ratiod Datel -�U! Yl lei O1Q)a Telephone Ljl3-�c�i" 3�+ SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(S)) 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...... ❑ City of Northampton T 5...-....� / Massachusetts L_ ' � DEPARTMENT OF BUILDING INSPECTIONS 212 Hain Street Municipal Building �' e Norther ton, N 01060 "-yl tier Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: ,�iy �n 1P��-l�.�CkXL (Please print ouse number and street name) Is to be disposed of at: /� \ n ) �Yli—�P�.d l T (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) L� /! ature of Permit Applicant or caner Date�� If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. �\ The Commonwealth of Massachusetts Department of Industrial Accidents 7 Congress Street,Suite 100 Boston, MA 02114-20777 www.mass.gov/dia Workers' Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. ADalicant Information Please Print Legibly Business/Organization Name: North East Specialty Corporation Address: 148 Doty Circle City/State/Zip: West Springfield MA 01089 Phone #:413-739-4333 Are you an employer?Cheek the appropriate box: Business Type(required): 1.0 I am a employer with 50 employees(full and/ S. ❑Retail or part-time).` 6. ❑Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7, Q Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp, insurance required] 8. ❑Nan-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑ Manufacturing no employees. [No workers' camp.insurance required]' 11 ❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp. insurance req.] 12.❑Other *Any applicant that cheeks box#I must also fill out the section below showing their workerscompensation policy information '9f the corpora¢officers have exempted themselves,but the corporation has other employees,a workers'compensation policy Is required and such m mo nortwo should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name:A1.M1 Insurer's Address: 148 Doty Circle City/State/Zip: West Springfield MA 01089 Policy d or Self-ins. Lia N VW50003962-2017 Expiration Date:07/09/2019 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 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. /do hereby c�er/try/yam/" er the pains and penal ieA,ofnp�erju�ry that the information provided above is true and correct. S'enature' // �1 [fvl�� �� Date: Z-22 Phone 4113- Z-2 -732J Official use only. Do not write in this area,to he completed by city or town official. City or Town: PermitfLicense# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: eww.mass gw/dia NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR All home improvement contractors and subcontractors MA License #103713 engaged in home improvement contracting, unless specifi- 148 Doty Circle • WEST SPRINGFIELD, MA 01089 cally exempt from registration by Provisions of Chapter 142A 1-888-NESCOR-1 1-888.637-2671 of the general laws, must be registered with the 413-739-4333 Commonwealth of Massachusetts, Inquiries about registra- nescornow.com tion and status should be made to the Director of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170 SubmittedBoston, MA 02116-Phone(617)973-8700 TO: Sl° liar S'rn7`,tfk `I rF/r <19( � �� /� { II✓�� L .. JOBNAME _�/,Yl Y C JOB LOCATION L'a'te «l(/ nCA— EST di We hereby submit specllrations and estimates for work to bg performed and matenals to be use /y% LtLG .n 7-,- - , f kn-Yc' ti' ' L rt ki ini't' T — oonotdo: I1� — -- - -- �- construction rel ted per ts- WORKSr O LE C r iy er begin the work or order the materials before the third day following the signing of this Agreement unless sp omractm will begin the work on or about (date).gaiting delay caused by circumstances beyond Connector c world,the work will be completed by (date).The Owner hereby ackrowl a her o s that Me scheduling dates are approximate and that such delays that are rot avoidable by the contractor nose ng,but not I, ted to strikes.Acta of God shortage.of.,an. al monarch.am all other delays beymd Its control,shall riot be considered as violations of this Agreement. WARRANTYTJ�f� _ The Contractor warrants Mat the work furnished hereunder shall be free pressdefacls in matenals and workmanship for a period cl L1 rlollowlnp Z potion and shall comply with the requirements of this Alinement In the event any defect in workmansNp or matelots,or damage caused by the Contractor,its subcontractors,employees or agents,is discovered either completion of any job,including cleanup,Me Contractor shall,at its own expense,monsig remedy,repair,con::cl,replace,or cause t0 ba remedied,rePolred or replaced swh dam- age or such defect In materials and workmansti o The form no youresses shall surnse any inspection performed Ill connection with the We Propose hereby to furnish material and labor- plate in acc ancP with bov ecifications,for the sum of: / /may )'fit; f'j �U �'L-kS.—1.`fi'L%� (:- —� lKo� ��(� /t`- dollars(S Payment to be hifishe as follows: ,( i(s )upon signing convect, NORTHEAST SPECIALTY CORPORATION d/b/a NESCOR Name of Contractor/Dasignaletl Registrantethant %R )upon completion of 1_46—DOTY�CIRCLE__ Street Address qts l open comptegoo of WEST SPRINGFIELD. MA 01089 _ 413-739-4333 -4 —71 T Opstam Phone i,(8 )shall be made fonhwlth upon 103713 _ _ a cgnpfe!i�n of under this contract Registration No. _ i`✓1t"C.�.� r-r. goods: No agreement fo home imp/ovament contracting work shall require a down Name of Salesman _ payment(advance deposit)of more than one-third of the tical contract price or the NMI amount of all deposits or payments which the contractor must make,in advance, Authorized Signature to order andor otherwise obtain delivery of special order materials and equipment whlcbe arl amou Is chatis Acceptance of Proposal: I have read both sides of this document and accept the prices, specifications and conditions stated. I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You may cancel this agreement if it has been signed by a parry thereto at a place other than an address of the Seller,which may be his main office or branch thereof, provided you notify the Seller in writing at his main office branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Please refer to the Notice of Cancellation. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. S ! Signetur����...OL( l �i,.i/d�Aate 7.- C� Signature Dete C��re po��o�ieoocr�� o�,�i� rr,U�y Office of Consumer Affairs and Business Regulation ' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 103713 I' \ Type: Private Corporation Expiration', 7/14/2018 Tr# 419291 NORTH EAST SPECIALTY CORPORATION SHARON TARIFF 148 DOTY CIRCLE WEST SPRINGFIELD, MA 01089 %Update Address and return card.Mark reason for change. :, zoM ovn L] Address ,f] Renewal D Employment Lost Card �� Offlee of Consumer Aff i s S,Business Regnlanon License or registration valid for Individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 103713 Type: Office of Consumer Affairs and Business Regulation j Expiration 71141201.8 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 )PITH EAST SPECIALTY CORPORATION :SCOR ON TARIFF 8D B OTY CIRCLE EST SPRINGFIELD, MA 01009 ^Undersecretary Notvalid without signature 3/27/2018 Details The OfOridl W`ehuite of the Exectrtiac ONiec of Public Safety and Security(EOPSS) Maas Gov Homo Slate/Ager,des 1�4ensee Details emographic Information Full Name: MATTHEW S HARRISON Owner Name: icense " ddress information City: Becket State: MA Zipcode: 01223 ountry: United States License norma ion License No: CS-081031 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 10/20/2017 Issue Date: Expiration Date: 9/6/2019 License Status: Active Today's Date: 3/27/2018 Secondary License Type: Doing Business As: ;latus Chance R asn: License R ewal rerequisi a norma ion No Prere uisite Information Close_Window ©2011 Commonwealth of Massachusetts � - � -- Site Policies I Contact Us hnn Nalicanee chs tnte melieNerification/Detailsetax?eaencv id=1&license id=270018& i/1 /1 NESCO-1 OP 10 M 4�orro CERTIFICATE OF LIABILITY INSURANCE oa/zolzols 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 I3ETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certl0cate holder Is an ADDITIONAL INSURED,the pollcy)les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1$WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certlRcate does not confer Tl hts to the certificate holder In lieu of such endorsements. PRODUCER 413.737.5359 CT J Raymond Lussier Ins Agcy Inc J Reymond Lusslerins Agoylnc veoNE 813.737.5359 PAX 413-732-2027 101 Park Avenue,Suite 8 (AIC,Na,Evt: '(AIC,NS l: PO BOX 499 n 0 u&s er OSufaOC(Ncom West Sind ng0 old MA 01090.0499 J Raymond Lussler Ins Agcy Inc m RE AFF o No co E NAG p INBURERA:COLONY INSURANCE CO INSURED Northeast Specialty Corp INSURER a I A.LM. Mutual Ins.Co. Nescor .Safety Insurance Company 39454 1480°ty Circle INSURER c. P y West Springfield,MA 01089 INSURER°. _ kINSURER E: INBURE0.F, COVERAGES CERTI FICATE NUM BE R: 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, EXC W SIGNS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBflTYPE OF INSURANCE APL SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENE RAL LABILITY EACH OCCURRENCE 4 1,000,000 CLANSADEOCCUR 101 PKG0094179.00 03M 812018 03/182019 DAMAIRS.GE TORRP.ENreO B 100,000 ,RED EAP Ao one azo 5,000 PERSONAL A ACV INJURY f 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE f 2'000'000 X POUCY�j� 0 Loc PRODUCTS. NNOR AGG $ 2,000,000 OTHER. D AVrOMOSILE LIABILITY LOMBINEC SINGLE LIMIT S 1,000,000 ANY AUTO 2433825 03/1112018 03/1112019 BODILY INJURY Per ere00 OWNED X saeDULED ANTOS ONLY AUTOS BODILY INJURY Per o¢mem s X :LIYO°soNLY X XRO' ` IFPd�4a�gd�r APACE f 1 UMBRELLA LAS OCCUR EACU OCCURRENCE 3 EXCESS LIAB CLAIMS.MADE AGGREGATE f LED RETENTIONY — IT OTIT E EOBAOEPIYEBT10tt AND ANI PROPRIMTORNARTNERIENECUPVE YIN MC6003962.2017 07109/2017 071092018 700,000 CFRCE'll El BER EXCLUDED9 N❑ NIA EL EACH ACCIDENT $ 100,000 QUI^^ a.o,v.NL11 II es.OesalOeuntler EL.GSEAEE.EA EMPLOYEE 8 RIPT N FOPERATION a low EL.DISEASE_P LI Y LMIT 5001000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLE9 (ACOR010i,AtlEltlontl R.mrtX[8aM1[Gul[,may b.AlhaM1.011 mon[p.<.b nqul,[tl CUSTOME SHOULD ANY of TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AIRHORIZEO REPRESENTATIVE ACORD 25(2016103) O 1988-2015 AC ORD CORPORATION. All rights reserved. The ACORD name and logo are reg letered marks of ACORD