32A-108 B P-2021-2108
54 MARKET ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32A-108-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2108 PERMISSIONIS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 19000 NRB EXTERIORS INC 099565
Const.Class: Exp.Date:05/28/2022
PERET MARY(L/E) &JOHN S,& ROMAN J PERE
Use Group: Owner: HELGA NIELSEN & MARION &WALTERJR. PERE
Lot Size (sq.ft.)
Zoning: URC Applicant: NRB EXTERIORS INC
Applicant Address Phone: Insurance:
510NEW LUDLOW RD (413)563-6354 6ZZUB-9F59768-6-21
SOUTH HADLEY, MA 01075
ISSUED ON:10/28/2021
TO PERFORM THE FOLLO WING WORK:
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.
Signature: I
yg • cgjAtiT
Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
tiClaCI V CU
OCT 2 7 2021
ga The Commonwealth of Massachusetts, Dr PT.OF BUILDING INSPCT1ONS
Board of Building Regulations and Standards NORTHAMPTON.MA 01060 FOR
Massachusetts State Building Code, 780 CMR �IUNICIPALIT"i'
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Sejlision For Official Use Only
Building ermit Number: 6P c) 1• Flo Date Applied:
LR)IAJ 170,5 /D-ZO-7,0 1
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Propeft Alddress: 1.2 Assessors Map&Parcel Numbers
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 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.L c.40,§54) 1.7 Flood Zone Information: 1,8 Sewage Disposal System:
Public 0 Private D Zone: Outside Flood Zone? Municipal D On site disposal system L]
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1
yPQ Record:
AJ ✓ t--n{2 -, ( 1/tl
Name(Print) City,State,ZIP
r /"1'r, Ci(i
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK:(cheek all that apply)
New Construction O Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 0 Addition ❑
Demolition Cl Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2: 4,44 J.0 S Y;..•y J iS; ( (
S i i Vi .,U ��
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building 1. Building Permit Fee:S_indicate how fee is determined:
2.Electrical 0 Standard City/Town Application Fee
0 Total Project Cost3(Item 6)x multiplier x
3.Plumbing l; 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire S
Suppression) Total All Fees:Si440 Check No?1( lCheck Amount: Cash Amount:
6.Total Project Cost: $ D Co D Paid in Full 0 Outstanding Balance Due:
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SECTION 5: CONSTRUCTION SERVICES i'.71.6... 94
5.1 Const(ruct`ion Supervisor License(CSL) J 19
5-/ y g ) (
I L",c\ S C2AA, `� License Number Expiration Date
Name of CSL Holder �` ✓C
c i v ,_ `ems ��I( f, ` 1) List CSL Type(see below) )
No.and StreetV 1 Type Description
�Q U Unrestricted(Buildings up to 35,000 cu.tt.)
C� `�"�State,� l S Restricted 1&2 Family Dwelling
Masonry
C Roofing Covering
/-/LWS Window and Siding
MD_( -W Solid Fuel Burning Appliances
b ( 1 Insulation
Telephone Email address D _Demolition
5.22 �R s red Home Improvement Contractor(HIC) (t /7 c �3-�)
t t " i/LJS `IA C - HIC Re`gistrati umber Expiration Date
HIC C.inn.:,y,Ntitine or HIC Registrot Name 1
6,--i I,-"\ F .V(3/Lig
5No.andSvelte/till ' I I-G-7-C jc Li1 address
5 tAT,
city/Town,State, P 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 t building permit.
Signed Affidavit Attached? Yes Cl,/ No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject pr..- ,hereby authorize N (6 >l ei i J'.S t A (
to act on my behalf,in all m. - ative to work authorized by this building permit application.
Print Owner's Name(Ele I •,is `gnature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in ' li Lion is true and accurate to the best of my knowledge and understanding.
Print s or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building 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 gat have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
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"Total Project Cost"
City of Northampton
�r:W.,'r •':! S '.?�, S,
{ Massachusetts 44, •�
(i;. t „ DEPARTMENT OF BUILDING INSPECTIONS
\ ,w 212 Main Street • Municipal Building ly
Northampton, MA 01060 Jsy..,.,..,,,,. ^4�
1
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: (G (I C.•- C c i 1-161A(Le, _
The debris will be transported by:
Name of Hauler: . S ► w6- Ste.
Signature of Applican • Date: I1
The Commonwealth of.Nassochusetts
.-- .. Department of Industrial Accidents
"' l Congress Street,Suite 10/)
. r4r
Boston, MA 02114-201
''r S' -; wW►►:mass.go)'/dia
%%utkers'compensation Insurance.ltlidaiit: Builderst('ontracturstl:lectriciansrPlumbers.
fOBt:FILED NIlH 111l, rl:R5tt HIM:AtYNOR(fl.
:luulicant Information �J }( p Please Print Lt ibls
Name iBusiness�'Orga izat �lcdev>sfiml):, ,,! J/ `� .L_0/t `: t '��
Address: � ( jb -
City/State/Zip: c In VAA Phone#: S Ct7" (? c"f
Are yob an employ ell Chest the test
Type of Project(regained):pi 1 am a e&4 to ou emgs with . loyees(full and Of part-tire)• 7. (3 New construction
2 I ant a.arlc proprietor or ptutner.htp and have nu employ cx t working fur me in
Illy hood().(Nu w(um'cutup.uauranci nyurred.] �. D Remodeling
301 am a horn..onw er doing all work m v. a yselt.INu alt.'camp.snsurara-e required"
9. 0 Demolition
add
4.0 1 ant a homewwnet and will he twang un tr''tun.+to conduct a!l work on my property. I will 1 F1 (kiddingItWn
ensure that all contractors ether hose workers`caxtrpt msation uwuranox or are%heft 1 1.1 Electrical repairs or additions
prupnctars watt au employees.
12.0 Plumbing mpaks or additions
50 I am a general contractor and i hate hired the arts,-euntracturs Itsted on die attaehe It ist 13�Roof repairs
These soh-runtra,:cun hate employes:.and hn+ ts
r urhers'carmp.tnauratYtl yy
h.❑w,are a curpatration and sit of'fwera hate ca.:ired thew right of exemption par tntc.c. l d't..!( --- __._._____. .____.
152.t11141.and we hate no cruployees.[No workers'comp.insuratae requiretj
*Any applicant that chocks hest,al must also fill out the.eetrsrn below shoeing their*often'eumgscnsatiun pula-y udirtnatwn
"Homeowners who submit this atfioartrt indicating they are doing all wink and then hue outside contractor.must submit a new affwlat a indicating such.
"I-Contractors that check this box must attached an additional sheet showing the name of the sub-caurateto,and stag:whether or not those entities,hate
employ-yes. tithe suit-re ntractars hate employees.they must pre side then workers'.usurp.pokey member.
I ant an employer that Li providing workers'compensation insurance for my employee+. Below is the polit} and job.site
information.
Insurance Company Name: K 4 Cw� GA lgf(�� ' =
Policy'#or Self ins.Lic.#: (oZLG S 5 7G) \ Expiration Date: 1 - ),)--.
Job Site Address: c 1 ` el"k( -1.k City/StateZlp: 'V t��'\ n�t.t
Attach a copy of the wtr& _ens'compensation policy declaration page(showing the policy camber and .-.
dote).
Failure to secure coverage as requited under MGL c. 152,§2SA is a crimitual violation punishable by a fine up to S1,500.00
andior one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the MA for insurance
co%erage serilication.
ram., .
I do hereby tint e ins and_- ties of perjury that the in/irrmation provided above ii true and correct.
Si•nature. Date: / _ -(D
h
Phone# c(‘-, ) ' C- I V'
Official use only. Do not write in this area.to be completed by eiq or town official
('its or Town: Permiti'L.icense A
Issuing.luthority (circle one):
1.Board of stealth 2.Building Department 3.('ityrTown clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other .______..___
contact Person: Phone#: j
h
A� 7 CERTIFICATE OF LIABILITY INSURANCE D"' 0/YTY)
03/05/2021
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE GOES 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 le an ADDITIONAL INSURED,the policy(lee)must be endorsed. If SUBROGATION IS WANED,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 N i4T Denise 8awicld
AMHERST INSURANCE AGENCY INC �t. �, (413)253-b565 1 wc.sot
916t. :.sG dsavvlcklOnethanagencles.com
PO BOX 48 INauRSR(a I f QMis4 COVERA4£ RAi
AMHERST MA 01004 mums: AMERICAN ZURICH INSURANCE COMPANY 40142
INSURED INSURERS:
N R B EXTERIORS INC INSURER c:
, SURERD:
7 PHILIP CIRCLE INSURERS;
GRANBY MA 01033 INSURER P:
COVERAGES CERTIFICATE NUMBER: 629242 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.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.Lt./IT'S SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS,
MLlit R
TYPE OP INSURANCE VjaO Iyo POLICY NURSER PAES-OZWYPI MIDI
COMMERCIAL GENERAL LGIOIUTY EACH OCCURRENCE S
DAMAGE EIY
Gums.MADE ❑OCcuR PREMISES( .�oce i $
MED ExP(Any on.pew) $
_. N/A PERSONAL a ADV INJURY $
GEM.AGGREGATE UNIT APPLIES PElt GENERAL AGGREGATE $
POLICY a JECT 7 LOC PRODUCTS-COMP/OP AGO S
—
OTHER: $
AUTOMOBILE ABILITY t- ut1IMlT $
ilia=Were)
ANY AtuTO 800ILY INJURY(Pet person) S
AIL OWNED --.SCHEDULEDAUTOS AUTOS BODILY INJURY(Pet aoddant) S
^^ NON•OWNED N/A :WhikTYDAMAO( '$ i
HIRED AUTOS irer accident)
S
_J UMEREU.ALIAR OCCUR EACH OCCURRENCE S
EXCESS LIAO CLAWS-MADE N/A AGGREGATE $
Deo 1 RsrENttQE1 - — _ $
WORKERS COMPENSATION X 1 MUTE I r
MID EMPLOYERS LIAMM
ANYPROPRIETORIPARTNE �RIEXECUTIYE Y/N E.l.EACH ACCIDENT S 100,000
A oFFtCERNENeEREXCLttDEOT I NMI NIA NSA BZZUBSF6976B621 92/13/2021 02/13/2022 —----1
(Merd.Re.y In RR E.L.DISEASE-EA EMPLOYEES$ 100,000
a yes desalt!under
DES IPfIQN OF OPERATIQN$gelow E.L.DISEASE-POLICY LIMIT S 500,000
N/A
;ESCRIPTION OP OPERATIONS r LOCATIONS i vEIDCLEa(ACORD tot,Additional Re nvt.Schedule,may be aslehed it more space is regnbed)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 08 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.
Phis 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
ssue 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.gov/wdlworkers-compensationMvestlgations/.
ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL 8E DELIVERED IN
{oaf Pros ACCORDANCE WITH THE POLICY PROVISIONS.
10 New Ludlow Road AumaaeoREP
w RatesTASIve
L '
Guth Hadley MA 010T6 Daniel M. •,A*•y,CPCU,Vice President—Residual Market—WCRIBMA
01858-2014 ACORD CORPORATION. All rights reserved.
:ORD 25(2014101) The ACORD name and logo are registered marks of ACORD
•*mitt)uRlAwd Still tallogivatIwitypat00
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Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
;14. -•i dui Type: Corporation
NRB EXTERIORS INC '41# W ' ' ,, s-�(3 Registration: 147961
510 NEW LUDLOW RD �F Expiration: 08/22/2023
SOUTH HADLEY, MA 01075 `�`'-"� t ....„,_..7 `.,
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.74 /( Update Address end Return Card.
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Office of Consumet Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Restistration f=xplration Office of Consumer Affairs and Business Regulation
147981 08/22/2023 1000 Washington Street -Suite 710
NRB EXTERIORS INC Boston,MA 02118
NICHOLAS R.BERNIER .,
7 PHILIP CIR 4"`4 /�+,,,4
GRANBY,MA 01033 Not valid without signature
__ Undersecretary g
w
�' Cotnt►wnweaith of Massachusetts
Board o/t n of Professional Licensure
Building Reyufations and Standards
Construction SuperInsor Specialty
CSSL-099565
Pares: 05/28/2020
NICHOLAS R BERNIER 61t)NEW LUDL(�iy RD m
SOUTH HADLEY MA 01076 �'
Commissioner Cj .
4.__
. , Fully Licensed a nsured u ffi Over e 510 New Ludlow Rd.
tiow
MA Reg# -2015718 South Hadley,MA 01075
MA Lic#: 147961
MA CSL#: 99565 MOS Cell:413-563-6354
EIS. ,4 �.4I3"767-ROOF (7663) Office:413-707-ROOF(7663)
r ti. SHINGLE RUBBER Fax:413-467-9748
SE E T GUTTERS
SELECT NICHOLAS BERNIER
ShingleMaster (Owner)
**** RoofPros413.com RoofProOwner) ast.net
v Proposal submitted to: Phone# h: /,?. d(n�- 3$j c:
a�1. tie t Special requirements
Street ,^
511 M6,.4ed F.'r 4+,.t,,c t(t,QfS '(l 4 evo,.i J 0
City,state,zip code
Proposal to furnish and install the following •C.C.`/ 1�`--1-1 t 1!wt 1+1 !
❑ Re-roof Fear-off ❑ Gutters
We shall acquire necessary permits for all work
Complete Roof Preparation
'ome's exterior to be protected by tarps and plywood
hrubs,landscaping,trees to be protected,roofers buggy used
g,,En'ire
fie em tt decking,including flashing,etc.
iteto exi be cleanedstingroo on ng a dailymater basis to wbithr roll magnetoved o exis,debris ing toe
o be removed at project completion by dumpster
Deteriorated existing decking to be replaced at '.A'per sheet of plywood.-�()C I w J&,(
Complete CertainTeed Integrity Roof System
K, Install Winterguard ice&water barrier along bottom 0 3 ft.of all roofs,Er ft.
[� Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas
.� Install CertainTeed Synthetic underlayment to entire decking
gInstall 8"perimeter metal flashing to all edges of all roofs, white 0 brown
[� Install Swit1Start starter shingle to bottom and rake edges of all roofs
Di Install CertainTeed shingles to manufacturers specifications, 6 nails ❑4 nails
Install CertainTeed PVC ridge vent to all peaks in heated areas
Install Shadow Ridge.to all 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
Warranty options
0/We guarantee our labor/work rs
i/Upgrade
CertainTeed 4-St Sure Start Plus,50-ye C nonp verage
CertainTeed Landmark-col • � 3-tab
0 CertainTeed Landmark Pro-color
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due S ,9,' OOwO D
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are - 1/3 Down Payment$ L/ ?CV f3C7
satisfactory and are hereby accepted.You are+ horized to do work as specified. Balance due
Payment w lllbbe /3 down at start of job,and b ,ue upon completion, upon completion $I✓,000s`»
Date: Z/ .f Signature: 'M
Date: I- 3✓4 Estimator:(Print Name) /,. l7( �- (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 I Yx%monthly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.I
agree to pay and/or guarantee payment 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 constitute a release of liability.By my signature below,acknowledges an agreement of the above is
hereby made.