29-444 (4) 50 ELLINGTON RD BP-2018-1376
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-444 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: ROOF BUILDING PERMIT
Permit# BP-2018-1376
Project ft JS-2018-002436
Est Cosr$25800.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NORTHEAST SPECIALTY CORP 103713
Lot Size(sa. ft.): 13068.00 Owner: GUDITIS ALAN!&DARLENE A
Zoning: Applicant: NORTHEAST SPECIALTY CORP
AT. 50 ELLINGTON RD
Applicant Address: Phone: Insurance:
148 DOTY CIRCLE (413) 739-4333 WC
WEST SPRINGFIELDMA01089 ISSUED ON.612212018 0:00:00
TOPERFORM THE FOLLOWING WOR&INSTALL ICE &WATER SYNTHIC MEMBRANE
STONE COATED METAL ROOF SYSTEM 6" GUTTERS SYSTEM SOLR FAN
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:
FeeTvpe: Date Paid: Amount:
Building 622/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
. 2od r
Department use only
City of Northam,,, Statue of P it:
- Building Departure t c�gutro ' Permit
212 Main Street Sewense A [ability
Room 100 EC7�pNfc van ilny
Northampton, MA 01 60°F'NO�rHgMpTo M1> MArg rat Plans
phone 413-587-1240 Fax 416-58?-1272 regswrwm�
Other
- -
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION CJI_
1.1 Property Address: This section to be completed by office
Map� Lct /77 Unit
50 Ellington Road zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Allan & Darlene Guditis 50 Ellington Road
Name(Print) (� Current Mailing Address: 413-584-4535
I-1 y t- A TI �."�, ,� .�.d� Telephone
Signator—tee —�T
2.2 Authorized A tent:
Name(Print) Current Mailing Address'.
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permitapplicant
1. Building 25800.00 (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) 25800.00 Check Number
This Section For Official Use Only
Date
Building Permit Number Issued:
Signat �
Building Com ionedinspector of Buildings Date
craimondi @ 888nescorl.com
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 wlomn m be filled a by
Building Depamnint
Lot Size
Frontage
Setbacks Front
Side L: R: L R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Int area minus bldg&paved
,kin
#of Parkin Spaces
Fil :
vollume&LocatioN
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O 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 O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO O
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 Q
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 O
IF YES,then a Northampton Storm Water Management 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 D
Accessory Bldg. ❑ Demolition ❑ New Signs [[I) Decks [M Siding[p] Other[[:]
Brief Description of Proposed install ice and water synthic membrane stone coated metal roof system 6"gutters system solr fan
Work:
Alteration of existing bedroom Yes xxx No Adding new bedroom Yes xxx No
Attached Narrative Renovating unfinished basement Yes ** No
Plans Attached Roll -Sheet
ea.If New house and or addition to existing housing, complete the following:
a. Use of building: One Family x 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 stores?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached?
h. Type of construction
L Is construction within 100 fl.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, l+�l 'N �C17G X FQr 4fi as Owner of the subject
prope
North East Specialty Corp
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application(.�
n D A ice: (.K 1 O/20)it �JOw�efQ N" /u�Y
SignatSlgna of yDate y
I, fy-fai (7�spr) ,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.
Print Nam
Sig er/Agent Date
SECTION S-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Matthew Harrison
License Number
148 Doty Circle West Springfield MA 01089 CS081031
Adores Expiration Date
09/06/2019
s r r Telephone
��� 143-739-4333
9.Rea stared Home Improvement Contractor: Not Applicable ❑
II�1r1�� �c�1 Sixtr�lk� CSP
C mpanv ams Registration Number
I �A(� (I tr �l SD�k� Y xL QILfi-C/ 103713
Address —r Expiration Date
TelephoneU I R-7S-Y_gB 7-14-2018
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(0((
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit vdll result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
.i.. SS...`..a<i
�/ ✓ Massachusetts t; >•- <<L
- s
DEPARTMENT OF BUILDING INSPECTIONS ,g
212 Main Streat *Municipal Builtlinq
Northampton, NA 01060
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:
(Please print house lzJmber and street name)
Is to be disposed of at:
��
(Pease print name an cationo facility)
Or will be disposed of in a dumpster onsite rented or leased from:
L1 e
(Company Name and A ress)
S ay 1 of Permit Applicant or er ate
If, four 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 ss IndStreet,
Suite
100 fits
1 Congress Street,Suite 100
Boston, MA 0211 4-2 01 7
www.mass.gov/dia
ulkriters' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aoulicant Information Please Print Lesibly
Name(Business/Orgmimtion/Individuat):North East Specialty Corp d/b/a Nescor
Address: 148 Doty Circle
City/State/Zip:West Springfield MA 01089 Phone #:413-739-4333
Are you an player?Check theapproprlate box:
Type of project(required):
I.
state. with 30 employees(fall and/or pert-time)• 7. E]New construction
2.711 am stoicproprietor,partnership and have no employees working formein S, ❑ Remodeling
any capacity.Mo workers'comp insurance required.]
3.❑I am a homeowner doing all work myself,Mo workers comp.insurance required.]' 9. El Demolition
10 ❑ Building addition
4.❑I nsu ehomeowner end will t e hiring contractors to conduct all work ce or m sole . 1 will
ensure that all contractors either have workers'compensation insurance or ere sole Il.❑Electrical repairs or additions
proprietors with ne employees.
12. Plumbing repairs or additions
5 I ane a general contractor and I have hired the subcontracmrs listed on the anached sheet f repairs Roo
13.�Roo
These sub-connacmrs hue employees and have workess'comp.insurance:
6.❑We are a corporation and in officers have exercised their right of exemption per MGL c
152,§I(4),and we have no employees.Mo workers'comp insurance required.]
"Any applicant that checks box 41 most also fill out the section below showing their workers'compensation policy information.
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
lContractors that check this box most anached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-conaactors have employets,they must provide their workers'comp policy number.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:A.I.M.
Policy#or Self-ins.Liu#:WVC6003962-2017 Expiration Date:0-7/09/2018
Job Site Address: C�\�IVy9\fW\ �CXJa City/State/Zip: 1—\6'g'xz)e
Attach a copy of the workers'cam dation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL a 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
!do hereby cert1 e 'ns andpe perjury that the information provided above is true and correct.
Signature: �� C/�� 1 Date: (0�/�l
Phone#:41 94333
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*
NESCO-1
Aio. o CERTIFICATE OF LIABILITY INSURANCE DATEIMMI120is l
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CENSURER(SL
CATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOD BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IAUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, I
IMPORTANT: If the certl11Cate holder is an ADDITIONAL INSURED,the pollcy(les) must have ADDITIONAL INSURED provisions or De endorsed,
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
INS certificate does not Confer rl he to the certificate holder In lieu of such endorsements . 1
PRODUCER 413 37-5355 c* J Raymond Lussler Ins Agcy Inc
J Raymond Lussler Ins Agcy1m, PHO 413.737. 3 413"732.2027
181 PEno Avenue,Suite 8 LAIC, o,EI11 Ani No):
PO Box 499 n 0 UES or 6UranCe.COm
West Springfiold MA 010900499 1 r
J Raymond Luss{er Ins Agcylnc R
wsuRERA:COLO YIN URANCE CO
INSURED NorthBaSt SpeclaNy Corp INwRBRE:A.I.M, MuIDe Ins. 00,
Nestor14S ,NBURER c,Safety Insurance Company 39454
We Doty
West 6primfl.111gileIQ MA 01089 IN Si
INSURER E'.
INEU0.ERF:
COVE GES CERTIFICATE NUMBER! VISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTNITHSTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR JTHER DOCUMENT WITH RESPECT TO WHICH THB
CERTIf KATE MAV BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID I.Airs
NR
TYPE OFINSURANCE E POLICY NUMBER PD I°YE
°L I POLIVEIP LIMITS
A X COMMERCIAL DENFRAL LIABILITY EACH CCURq NCE 4 'DDD' D
CLAIMS MADE O0cCUR 101 PK00094179.00 03118/2018 07H 812019 nMAG iO RE TED 4 100,000
I 5,000
PERONALBA VINJURY 4 1'000,000
GEN'L AGGR i LIMIT APP. SPEP'. EN 'ILA GFE AT 4 2'000'000
X PoucvjL01 Loc P PI 2,000,000
OTHER. 1'000000
C AUrCAI ICE CIABILIN M OSINGLE LIMI S
0 NED 5 . 2493815 03111120tH 0311112019 vl r
VNOSSDONLY x AUUTOpEyU.rLEED e001LY INJUn Per 8ctl4ml 4
Y` 3%ONLY X AV OS OrvNIQ dVOaERdenl WAGE
UMBR20.A L.As OCCUP EACH OCC AIR OR
EMCESB LAB CLNMSMADE A P 6ATF
Y/ gµDECg RETENTIONS
B Nd FMPLO P TIN )( FER LW
e OTOR'AXR""Tr Cfi0039823017 onearz6n onD'ylzDla 100,00
A.PgpO�PPJE�TgOpPgIPAPTNEflIFNECUTIVE E. . A XACLI°ENT
ImenOetery`Yp"rvnlf%CLUDEDP N NIA EL.p,EEA E. AEMP OYEE 4 100'00
II a:.aauliq plwn As .P v IIT 500,00
'PnNFv ATI Iw
DESCRIPTION OF OPERATONe I LOCATIONS VEHCLEe (ADDED 101,AtlE1110001 R1m111e eatl.dVle,noy Or ittI II Iron Fpeall U ngVlntl
III
CERTIFICATE HOLDER CANCEILLATNON I
F
CUSTOMS I
SHOULD ANY OPTHE ABOVEDEPOLICIES CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,EOF, NNONCE WILL
6E DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AITIORUSO REPRESENTATI, E
ACORD 25(2016103) O 19882015 ACORD CORPORATION, All rights reserve
The ACORD name and logo are registered marks of A�ORO
QT4 1Q� �ez
I Q�z�,o��G,'%G o
Vj Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
' Home Improvement Conjractor Registration
Registration's 103713
1 Type: Private corporation
i
I �i Expiration: 7!14/2018 TO 418291
NORTH EAST SPECIALTY CORP6 ,ATION,
SHARON TARIFF , '
148 DOTY CIRCLE
WEST SPRINGFIELD, MA 01089
Update Address and return card.Mark reason for change,
, ii POM aYII
L] Address Renewal ❑ Employment 0 Lost Card
�- Offt"of Consumer Affairs&Bus(uess Regulation License or registration valid for Individual use only
HOME IMPROYEMENT CONTRACTOR before the expiration date, If found return to:
Registration ' 103713 Type: Ofilceof Consumer Affairs and Business Regulation
Expiration M,1120.18 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
)RTH EAST SPECIALTY CORROKATION
:SCOR
TARIFF
8007
8 DOTY CIRCLE �,e„,.Fes•,.„,_._ .�F46.
EST SPRINGFIELD,MA 01089 ^Undersecremy Not valid without signature
Details Page 1 of 1
Licensee Details
Demo a hic Information
ull Name: MATTHEW S HARRISON
caner Name:
License Address Information
ity: Becket
tate: MA
ipcode: 01223
ount : United States
License Information
icense No: CS-081031 License Type: Construction Supervisor
rofession: Building Licenses Date of Last Renewal: 10/20/2017
Issue Date: Expiration Date: 9/6/2019
icense Status: Active Today's Date: 6/6/2018
econdary License Type:
oinq Business As:
Latus Chane Reason: License Renewal
Prerequisite Information
No Prerequisite Information
http://elicense.chs.state.ma.usNerification/Details.aspx?agency_id=1&license_id=270018& 6/6/2018
NORTHEAST SPECIALTY CORPORATION NNS NESCOR +All home Improvement contractors and subcontractors
MA License#103713 engaged in home Improvement connecting. unless specig-
148 Doty Cimle a WEST SPRINGFIELD,MA 01089 tally exempt from registration by Provisions of Chapter 142A
1.8118-NESCOR-1 1.886$37.2871 of the general law*, must be registered with Me
413.739-4333 CommonwealM of Massachusetts. Inquiries about regicos-
neerornow.00m tion and status should be made M the Director ofConeum tar
Aflerrs and Business Regulation, len Park Plaza,Sora 5170
Submitted Boston,MA 02116-Phone(617)973.8700
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Aeeaptenoe of Proposal: I have read both aid"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 me work as specified,
Payment will be made as outlined above.You may cancel this agreement if it has been signed by a party thereto at a place Omer
than an address of me Seller,which may be his main office or branch thereof,provided you notify the Seller In writing at his main
oboe branch by ordinary mall 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.
00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
san.un� -•Q 9.{ 4! ow [^� yplwW� - - 1 Fri{,va; o.b S S
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