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22D-109 (4) 33 AVIS CIR BP-2020-1159 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D- 109 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-2020-1159 Proiect# JS-2020-001954 Est.Cost: $8500.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq. ft.): 27834.84 Owner: BARONDES LISA Zoning URA(100)/WSP(100)/ Applicant: NRB EXTERIORS INC AT. 33 AVIS CIR Applicant Address: Phone: Insurance: 510 NEW LUDLOW RD (413) 563-6354 WC SOUTH HADLEYMA01075 ISSUED ON:5/26/2020 0:00:00 TO PERFORM THE FOLLOWING 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: FeeTvpe: Date Paid: Amount: Building 5/26/2020 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of NorthamptoRv, �i�\� Status of Permit: Building Department 1.,• � Curb Cut/Driveway Permit f, 212 Main StreetSeWer/Septic Availability t, -i Room 100 4? ater/Wetl Availability \ Northampton, MA 1060 fin' �To Seth of Structural Pians phone 413-587-1240 Fak, ''f - 7-1272tJSite Plans ., Othef'Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RE ^� A,�DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office i �tr Lc S 1jGl J 0�eJ Map �a Lot CR Unit Zone Overlay District S3� f✓ / C Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner offpRecord: I 7R I I`ut. i/,.r1 Name(Print) Current Mailing Address: �Atv I� 1�\' �� . Telephone Signature 2.2 Authorized Agent: t—'J-4(�j J7 Name(Print Current Mailing Address: (23 -C' y Sigrg676 TTe e�phone 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 4. Mechanical (HVAC) (�— 7u 5. Fire Protection J �' 6. Total = (1 +2+3+4+5) Check Number 20 This Section For Official Use Only +U Building Permit Number: DateIssued: Signature: 5-22-2020 Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[O] Other[Ci] Brief De cription of Proposed /nJ Work: *,,1101,2 BCS t. 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 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 I, Lt- z( �ct✓0t1 L,( as Owner of the subject property / r hereby authorize V �t` t 7 _ Y ' i ^ C- to act on my behalf, in all ma ers relative to work authorized by this building permit application. MA Y'ym (�v Signature of Owner Date I, ( `r ' �� 1 iJ✓ ('��- 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 pains nd penalties of perjury. Print me \ Si ature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: op Not Applicable ❑ Name of License Holder: 6 y� License Number Address Expiration Date S' t re Telephone 1 9. Reuistered Home Improvement Contractor: Not Applicable ❑ Avg(� JAC W-7 C mpany Name �tRegistration 1Number Address Expiration Date Telephone �Z SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152, §25C(6)) Workers Compensation Insurance affidavit m st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building ermit. Signed Affidavit Attached Yes....... 0(-/ No...... ❑ City of Northampton Massachusetts } "r4 i DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building yeti r�. Northampton, MA 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: r (/1 S - I,✓ (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: �t � 0 U..G � Y ,f, ,41-k C,+ (Company Name and Address) s �!J / Sig ure 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): Address: I NJ" IJ U—, f) City/State/Zip:,J Phone#: Are you employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]t 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are 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 511 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Lt Policy#or Self-ins.Lic.#: 2L Lt/�—�� / �G X _ Expiration Date:,, Job Site Address: ?,) -7--- ' C 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 5250.00 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 t pains and pe hies of perjury that the information provided above is true and correct i atur Date: Phone#: �� C 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#: ' Fully Liigented and Insured 510 New Ludlow Rd. MA Reg#20-2015718 South Hadley,MA 01075 MA Lie#: 147961 MA CSL#:99565 Cell:413-563-6354 413-707-ROOF (T66 ) Office:413-707-ROOF(7663) Fax:413467-9748 SHINGLE *RUBBER SELECT NICHOLAS BERNIER ShingleMaster (Owner) C�t�°�'e RoofPros413.com RoofPros@comcast.net Proposal su t iitted to: Phone# h: Rp(} � Y(n c: _Special_requirements .. .... .Street __.._ __. _. Cl ,state,zip code -nn Proposal to furnish and install the following ttA J A ❑ Re-roof Tear-off ❑ Gutters 9 We shall acquire necessary permits for all work Complete Roof Preparation _ J` Home's exterior to be protected by tarps and plywood W Shrubs,landscaping,trees to be protected,roofers buggy used (� Entire existing roofing materials to be removed to existing decking,including flashing,etc. [� Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster [� Deteriorated existing decking to be replaced at$50 per sheet of plywood Complete CertainTeed Integrity Roof System Install Winterguard ice&water barrier along bottom ❑ 3 ft.of all roofs,EKIft. Q�Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas Install CertainTeed Synthetic underlannent to entire decking Install'8" perimeter metal flashing to all edges of all roofs, hite ❑brown [� Install SwiftStart starter shingle to bottom and rake edges of all roofs Q!Install CertainTeed shingles to manufacturers specifications,❑6 nails(ails Q Install CertainTeed PVC ridge vent to all peaks in heated areas [f Install Shadow Ridge to all hips and ridges,over ridge vent where applicable Install new lead counter flashing to chimney Q� New flashing installed where necessary Q/Install new pipe flashing to waste vent stacks Warranty options We guarantee our labor/workmanship for 20 years 9"'Upgrade CertainTeed 4-Star �5�yea n ttprocate coverage ❑AertainTeed Landmark-colo • ❑ 3-tab ❑ CertainTeed Landmark Pro-color '-"--- --'r We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due $• (, ' ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are - 1/3 Down Payment$ ,��'Cki __satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due Payment will be I/3 down at start of job, nd balance due upon completion. ,\\ upon completion $ SPC ' • Date: Z V Signature: I jf Date: �i— l '�"d Estimator:(Print Name)k± �}t ' G/ (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 debris or dust in the attic or storage areas. A Finance Charge of 1 Yz"/o monthly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.1 agree to pay and/or guarantee payment of these charges.In the event of default of payment,l agree to pay reasonable Attomey's fees and court costs.This agreement does not constitute a release of liability.By my signature low,acknowledges an agreement of the above is hereby made. Signature: ` ® .. i;i .onv.ofrncoProfessional.ar.v- ia,aa-oa.nLicensuruacua Divisie Board of Building Regulations and Standards Construction Supervisor Specialty CSS L-099565 Up i res: 05/28/2020 f' NICHOLAS R BERNIER 510 NEW LUDLOW RD '. SOUTH HADLEY MA 01075 N A,\ Commissioner C '"� Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation NRB EXTERIORS INC Registration: 147961 510 NEW LUDLOW RDJAN i ,, Expiration: 08/22/2021 SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 1 d5 20M-05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 147961 08/22/2021 1000 Washington Street -Suite 710 NRB EXTERIORS INC Boston,MA 02118 NICHOLAS R.BERNIER 7 510 NEW LUDLOW RD SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature AC Rte® CERTIFICATE OF DATE(MM1DD/YYYY) �.-- LIABILITY INSURANCE 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(ies) 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 CT N AME: Denise Sawicki AMHERST INSURANCE AGENCY INC (413)253-5555 FAx - A/C No dsawickir�nathanagencles.com PO BOX 48 INSURER($)AFFORDING COVERAGE NAIc NAMHERST 01004 A: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED N R B EXTERIORS INC INSURERS: INSURER C: 7 PHILIP CIRCLE INSURER D: - --- INSURER E, MA 01033 INSURER F: COVERAGES OVVERA ES CERTI TE NUMB R: 115615._._ REVI NUMBER: E BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAV INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDEOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOD BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICYMM/DD/YEFF MM/DDlVYYV LIMITS X COMMERCIAL GENERAL LIABILITY FACH OCCURRENCE y 500,000 CLAIMS-MADE �OCCUR A 100,000 PREMISES Ea occurrence S MED EXP(Any one person) y 5,000 A 101 GL008936302 12/23/2019 12/23/2020 PERSONALBADVINJURY y 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: 1,000,000 POLICY ❑jE a LOC GENERAL AGGREGATE E PRODUCTS-COMP/OPAGG y 1,000,000 OTHER. Employee Benefits $ AUTOMOBILEUABILITY COMBINED SI L LIMIT ANY AUTO IEa acddentl s ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS N/A BODILY INJURY(Per accident) E HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB OCCUR $ EXCESS LIAR EACH OCCURRENCE S _ _ CLAIMS-MADE NIA DEC) RETENTION$ AGGREGATE $ WORKERS COMPENSATION Is AND EMPLOYERS'LIABILITYV/N X STATUTE ETH ANYPROPRI ETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? WA N/A N/A6ZZU69F59768620 02/13/2020 02/13/2021 E.L.EACH ACCIDENT $ 1(X1,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached M more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass-govltwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Roof Pros ACCORDANCE WITH THE POLICY PROVISIONS. 510 New Ludlow Road AUTHORIZED REPRESENTATIVE South Hadley MA 01075 ' 1 0 Daniel M.Cr y,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD