38B-132 (3) 24 EAST ST BP-2020-0477
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38B- 132 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-2020-0477
Project# JS-2020-000813
Est.Cost: $18000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sa.ft.): 3005.64 Owner: HEISLER HUGH D&MIRIAM S SADINSKY
Zoning: URB(100) Applicant: NRB EXTERIORS INC
AT. 24 EAST ST
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413)563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON.10/11/2019 0:00:00
TO PERFORM THE F LLOWING 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:
FeeType: Date Paid: Amount:
Building 10/1 1,'2019 0:00:00 $40.00
12 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
Department use only
-- City of Northaffipto►►}} / tatus of Permit:
Building Dertm?fit 0 ` ,Cut/Driveway Permit
212 Mao Str t Cj J Septic Availability
Room- 9 jWa /WellAvailability
Northampton, M `�9 Sets�f Structural Plans
phone 413-587-1240 Fax 4 ' t/Sit Plans
er pecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVA s O�DE OLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION �0 —c77
1.1 Property Address: 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:
✓l ` Ai
l � , 1 � J �� L NSA "` l�✓��lA�t��h (� l 1
Name(Print) Current Mailing Ac dress*
Telephone
:SAL
��3 3 f�
Telephone
Signature
2.2 Authorized sent:
IN
Name(P' Current Mailing Address:
yrs �c� ,-� 7q
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8695 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee q
4. Mechanical (HVAC) ( "(
5. Fire Protection
6. Total=(1 +2+3+4+5) 8695 1 Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing `
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[0]
Brief Description of Proposed
Work: !ti f w., d t y-K t-, A-_ v4-A� i
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 c/ 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 APPLIES FOR BUILDING PERMIT
1a I, `` M 5 as Owner of the subject
property
hereby authorize /u
to act on my beh all mas r ve rk a orized by this building permit application.
Signature of Owner Date
fx6 �`,uti"S ` -I( 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.
i-)�L_ /^���/
Print Name
Sign Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor,: Not Applicable (❑
l
Name of License Holder: i (, "`O,4 ` /V� I ✓ G1 / �� �
cLicense Number
Address Expiration Date
Ce C 3
S na ure Telephone
9_Re catered Home Improvement Contractor: Not Applicable ❑
Company Name I Registration Number
(�
Address Expiration D to
Sy ' Telephone
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8))
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 buildigg permit.
Signed Affidavit Attached Yes....... " No...... ❑
City of Northampton
� f
Massachusetts - 'll
DSPAR2I4NT OF BUILDING INSPSCTIONS
212 Main Straat •Municipal Building
Northampton, Ml► 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:
P-( -( c 6.�- s ,-1—
(Please print house number and street name)
Is to be disposed of at:
61 �
(Please print name and location f facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signature of Permit Applicant or Owner 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
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): u
Address:_s_10 �� tAJ L—A,� (tst,-� tJ -
City/State/Zip: Phone#: C��3
Are ytrna
mployer?Check th-appropriate boa: Type of project(required):
1. mp►oyer with CJ employees(full and/or part-time).' 7. E]New construction
2.Q I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.n I am a homeowner doing all work myself fNo workers'comp.insurance required.)t
10 Q Building addition
4.[:]l am a homeowner and will be hiring contractors w conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.Q Plumbing repairs or additions
5 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance.t 13. Roof repairs
6.E]We am a corporation and its officers have exercised their right of exemption per MGL c. 14.[:]Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant that checks box#1 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,
tContractors 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 thepolicy and job site
information.
Insurance Company Name: W C `
Policy#or Self-ins.Lic.#: �` Z-L _ r 5 '7 -1 Expiration Date:
Job Site Address: 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 MGL c. 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.
I do hereby certify untie a pains and pe es of perjury that the information provided above is true and correct
Signature Date:
c'
Phone#: S� j" 6.7
Oficial 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#:
tnA negrf w-curia iia 1_ South Hadley,MA 01075
MA Lie#: 147961
MA CSL#: 99565 Cell:413-563-6354
415-707-ROOF (7663) Office:413-707-ROOF(7663)4134 -9748
Fax:413-467-9748
SHINGLE RUBBER
SELECT GUTTERS NICHOLAS BERNIER
Shingleldaster
(Owner)
RoofProsMaom
RoofPros@comcast.net
Pro sal submitted to: Phone# h: ��-7- I D S3 c:
Fi o S t( Special requirements
Stregt
7i
City,state,zip code �j R/U '\J? C>D� Ce
fl,(hi.ae,g12Jdn linJ
Proposal to furnish d inst9ll the following
0
❑,/Re-roof Tear-off [I Gutters
L We shall acquire necessary permits for all work
Complete Roof Prepara ion
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 to existing decking,including flashing,etc.
[K Site to be cleaned on a daily basis with Poll magnet,debris to be removed at project completion by dumpster
❑deteriorated existing dec�ing to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
Install Winterguard ice&water barrier alirt bottom r3 ft. of all roofs,❑ 6 ft.
Vlnstall Winterguard ice&water barrier around penetrations,in valleys and all critical areas
nstall CertainTeed Synthetic underlayment to entire decking
nstall 8"perimeter meta flashing to all edges of all roofs, white ❑brown
C9/ nstall CertainTeed shingles Shingle to bottom and rake edges of all roofs
files to n'Ya ufac urers specifications;❑&nails-i;ai}s— - -
install CertainTeed PVC ridge vent to all peaks in heated areas
[Install Shadow Ridge to;11 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
VZ�Zrranty options
elguarantee our labor/workmanship for 20 years
Y Unerade CertainTeed 4-5 tar Sure StPlus,50-year nonprorated coverage
❑/CertainTeed Landmark-c lor: QObNle I C ❑ 3-tab
❑ CertainTeed LandmarkPro-color
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due $
9S-a1 0a
ACCEPTANCE OF PROPOSAL:The above prices,specifica%ps and conditions are - 1/3 Down Payment $
satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due —7
Payment will be 1/3 down at start of job,and balance due upon completion. upon completion $ yd
Date: — O- Signatur�:
Date: C)—to-12 Estimator:(Print Name) (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 roofing debris or dust in through cracks of the wood.NRB Exteriors Inc.will not be responsible for
debriis or dust in the attic or storage areas. '
A Finance Charge of 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 paym nt of these charges.In the event of default of payment,I agree to pay reasonable Attorney's fees and
court costs.This agreement does not constitut-a-releast of liability.By my signature below,acknowledges an agreement of the above is
hereby made.
Signature:
A &O"et the C�>m
Fully Licer)sed,and Insured hcrztio�rl! 7 Philip Cir Granby, MA 01033
MA Reg.#: 20,:2015718 Phone: 413-563-6354
MA Lie#: 147961 Specializing in Roofing Fax#: 467-9748
MA CSL#: 99565
NICHOLAS BERNIER
(Owner)
EXTERIOR NOME IMPROVEMENTS, Inc. www•nrbexteriors.com
C6rtffied ROOFING F3 SEAMLESS GUTTERS
weAmer Stopper Rooting Contractor Windows - Siding - Decks
Residential - Commercial
Proposal submitted to: Phone# h: 1 DQ " `'> >14 c:
Special requirements
Street
City,state,zipcode J
Proposal to furnish and install the following
_ '✓i krl� � l� ?��/ � h ,.�I�LI�. ✓ Lr.• L- ✓'a' t (( Jt ''. A,I
i
All r��p
Acceptance of Proposal:
The above prices, specifications, and conditions are satisfactory_and hereby accepted. Payment will be 1/2 down upon
signing and balance due upon completion.
Total sale price & do . n pay 600 . upon completion U-O C), C�t�
Customer signature: phone #:
l
Authorized signature: I date: —�-=
s
DAN 00BOD+r M
A609H CERTIFICATE OF LIABILITY INSURANCE
06/1212019
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(les)must have ADDITIONAL INSURED provisions or 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 andorsement(s).
PRODUCER NA"B: Tierney Team
Memory Group (413)562-7007 (888)271-2228
16 North Elm Street
PO Box 750 INSURBRISI AFFORDING COV5 RAGE NAIL a
Watlleld MA 01086 INSURER A: Russell Bond 6 Company/Colony Inburanoe Co
INSURED INSURER a: Sa"Insurance Company 12808
N R B Exteriors Inc INatstER C; VVCRIB/Trevelers
7 Philip Circle INSURER D:
INSURER 5:
Granby MA 01033 r;;;;;,
F
COVERAGES CERTIFICATE NUMBER: CLI961200410 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. NOTWTHSTANDING ANY REQUIREMENT,TERRA 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.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
MR Aum*Ulm POLICY EFF
LTR TYPE OF INSURANCE I POLICY NUMBER M LIMITS
COMMM4 "GENERAL LIABILITY EACH NCE $ 500,000
CwM94AAM ®OCCUR PREMISCIAL29201112ds 100'
000
Subject to $1.000.00 Deductible MED EXP $ 5,000
A 101 GLOO8936301 12/231201 B 12/23/2019 PERSONAL&ADV ftA Y b 500,000
GEN1 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 1.000,000
PR
POLICY ❑JECT F7LOC PRODUCTS,COMPOOP AGO S 1.000.000
OTHER: b
AUTOMOBILE LIABILITY COMBINED SINW UNIT S 1,000,000
ANY AUTO BODILY INJURY(PN perswl) S
B OWNED SCHEOLkED 6244143 03/15/2019 03/1512020 BODILY INJURY Mw aecdW S
AUTOS ONLY AUTOS
AUTOS ONLY MAUTOS ONLY PROPERTY f
Medical payments s 10,000
UMBRELLA I" OCCUR EACH OCCURRENCE S
EXCESS LIAR CLAM-MADE AGOREOATE S
RETENTION S a
YF0111(�IRi OOMPHNBATIONH.
AND MVLOVW LY UTY YIN A
C ANY X " ❑ N/A BZZUB•9F59768.6-19 02113/2019 02/13/2020 E.LEACH ACCIDENT 6 To Follow
fii" MW E.L.DISEASE•EA EMPLOYEE S any From
n waorw
~0FOPERATIO4 billow E.L.DISEASE-POLICY LIMIT The Company
DESCRIPTION OF OPERATIONS/LOCATIONS r VEMCLES(ACORD 101.AOOaJOntl Runarb 2096de,may be attaeArd If mon spit Is ngldnd)
Siding,Window Installation,Carpentry and Rooting and Gutter Installation
RE:Buildings 1.2,and 4
Colonial Village Apartments.181 Vest Street,Ware,MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE VALL BE DELIVERED IN
VAnton Corp ACCORDANCE WITH THE POLICY PROVISIONS.
131 Ashley Avenue Suite Al
AUTNORIZED REPRESENTATIVE
V%st Springfield MA 01089 •
o iftsm s ACORD C ghts reserved.
ACORD 25(2016/(13) The ACORD name and logo are registered marks of ACORD
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