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23A-163
BP-2022-0531 106 BEACON ST COMMONWEALTH OF MASS CHUSETTS Map:Block:Lot: 23A-163-001 CITY OF NORTHAMP N Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERE CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY F ND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-0531 PERMISSION IS REBYGRANTED TO: Project# INSULATION Contractor: License: Est. Cost: 822 EXTERIOR ASSOCIATES II C 113456 Const.Class: Exp. Date:07/23/2022 Use Group: Owner: DOWNES JO N FRANCIS Lot Size (sq.ft.) Zoning: URB Applicant: EXTERIOR A'SOCIATES INC Applicant Address Phone: Insurance: 408 SOMERS RD (860)978-591 1 WC9097314 ELLINGTON, CT 06029 ISSUED ON:05/16/2022 TO PERFORM THE FOLLO WING WORK: INSTALL DOOR 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHA PTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I. , ;�, ,2 1, I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413) 87-1272 Office of the Building Commissioner C , .. The Commonwealth of Magaachus itsiti �¢ > Board of Building Regulations and S tutor 4r FOR kl_ ;' Massachusetts State Building Code. 0 C 3 2 MU IL IP,FOR/ nfip QZ2 US Building Permit Application To Construct. Repair, R orsy § olish a R rso, ar'n!! One-W' Two-Family Dwelling �j11:44�INc IN This Section For Official Use Only 41 07( 527 s Building Permit Nuniher (AR—}..• 63/ Date Applied. E U ok) n ,f/& 5-/6'20ZZ. —Building Weird(Pant Name) Signature f?utr SECTION 1: SITE INFORMATION 1.1 Pro ens Address: 1.2 Assessors Map& Parcel Numbers 1 la is this an accepted street?yes X no Map Nitrite Pereel Number 1.3 Zoning Information: 1.4 Property Dimensions: Z„ntna putriet Proposed Use ..._ Lot Area Isq Al Frontage(Al 1.5 Building Setbacks(r) From Yard Side Yards Rear Yard Required 1 Provided Required 1 Provided ' Regwicd Provided 1.6 Water Supply:(14.G_ c.40.§54l 1,7 Hood Zone ' Ill Sewage Disposal System: Zane: Outside Flood Zone' Pu blie El Private O T Cheek if yes° 1 Municipal❑ On silo disposal system D SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 11111111111111111111111111111111111111111111. Name(Prim) City.State.ZIP No.and Street Tctihone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check al that apply) Nev..Construction 0 Existing Building 0 Owner-Occupied Cl Repairs(s) Q Akeration(s) Cli Addition 0 Demolition ❑ Accessory Bldg. 0 Number of Units Other NI Speofy: Door ___ -- Brief Description of Proposed Wo SECTION 41 ESTIMATED CONSTRUCTION COSTS Estimated Costs: —. Item Offklatl Use Only (Labor and Materials) I. Building S! I. Building Permit Fee:$ Indicate how lids determined: Electrical $ 0 Standard Citys`Town Application Fec 2. 0 Total Project Cost`(Item 6)x multiplier x 3. Plumbing S 2. Other Fees. S 4.Mechanical (FEV'AC) $ List: 5, Mechanical (Fire Suppression) $ = Total All Fees $ uu r/ll Check No. l lOkheck Amount:` ' Cash Amount: b.Total Project Cost: SIMI. , 0 Paid in Pull ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES SA Construction Supervisor license(CSL) 113458 7/23)2022 Kyle Nielson License Number Expiration Date Name of CSL Holder List C'SL Type(see below)R___. _ 4{18 Somers Rd. 'Type De x atptiun No and Sttret CT Unrhsari tedigiii dittos up to 5.000cu.ft.) Elli-- ----on.CT 06029 R Restricted l&2 Nola),Dwelling — __-- City 1o.n. Staid.ZIP M Masonry RC RoctlaaCovering ...—____ ,._._. WS Window and Selina SF Solid Fuel Burning Apptianes 860-978-5911 OFF ICE@EXTERIORASSOCIATES.COM I lastjlation Totop Bone___._.. Emaitadklr ss D Demolition 5.2 Registered )tome lnptovrttoeot Contractor CHIC) 10 H1 31178 4/28)2023 Exterior Associates, Inc. esestration Number -txptrattoa Date BIC C'otnpauy Name or IlIC Registrant Name } 408 Somers Rd. OFFICE@EXT'ERIORASSOCIATES.COM No.and Strt.set T;riud ad tit ,, E II ingio n,CT 06029 88Q-987-tt911 _ City/Town.State,ZIP — ¢ _Toe hone SECTION I:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152.g 25C(6)) Workers Compensation Insurance affidavit must becotnpleted and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance o f the building permit. Signed AFfidaiit Attached? Yes ..... .... 51 No 0 SECTION 70:OWNER AUTHORIZATION TO BE COM PLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject p operty,hereby authorize Exterior Associates, Inc. to act on my behalf,in al . utters relative to work authorized by this budding permit application Pr, "r-s Naro;at1 ctranic ignature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties f perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. .loin Downes IIIIIIIIIIIIIIMIIIIIIIP hint Owner's or Authorized Agent's Name(Electronic Signatunal Dale 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).wdl nor have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program ran be found at www.masss4tov/oca Information on the Construction Supervisor License can be found at www,mass.govidpa< 2. V en substantial work is planned.provide the information below:Total floor area(sq. ft.) (including garage.finished basementvattics.decks or porch) Gross living area(sq. ft,) Habitable root,count Number of fireplaces Number of bedrooms Number of bathrooms Number ofhalf`batbs Type of beating system Number of decks/ porches _ v Type of cooling system Enclosed Open__ 3. "Total Project Square Footage"may be substituied for"Total Project Cot' it �N roA The C ommor 1pealth of lkfas..cackusetts ' T)cltnr trscettl of Industrial�lc'c e�tls ` 1:q •;; , .1 Congress Street,Sulk 100 Fti= '1' 4,' �3t��stt�rl, i124 O .T.I 2017 • t a �1 www.r�rrrss go vt(7lu • ` 1:4.oi-icers'Compensation.Insurance Affidavit;:0ailtlers/Cotntractor's/1f;iccf.iciaw/Plunxltcrs. TO DE FALCO li'i:i:FI 13]1 PERIM:CTING A.T)TX ORlTY_ AD Rile lira Inft;nnotion. -.._. ?1rasePrint l tj.L1 !: • Na'l 10 fflusit:ass/0rl;ant ratiotd[ndivkduttz;: EXTERIOR ASSOCIATES. INC. ' __ . Address: 408 Somers Rd. - . ' City/Stato/Zip: Ellington,CT 06029 :Peon.#: 860-978-5911 _ • Qalt you nn employer?Check the appropriate box; j I'ype of project(required.): j i I.FI i am a cm ploye:with 12 _employees('_hhl antler parr-time).* t r, J New cimstructioa 2.n I o'n a sole proprietor or pnmtcraltip'cud la we t:o arnatoycas working far toe in , ❑Remodeling g any capacity,ilk'workout'comp.insurance required: . p Demolition :I,0'!ant a hornsowner<`niug all work ruyroif,NO WorIcn:'comp.Erzurum:ri tircil?I 0 n BitJ.ding addition 'I.j I am u homeowner and will be hiring connectors to=ondtxt all work on my property, I will t casino that all cantata's either hoar workers'compensation inauTunco or are auk) '.t.[J l:'electrtcol repairs or additions • pzcpriutors Whit no carployets. T 2.0Phunbinr,repair,or additions 5.0 I am a genemt contractor and=have hired the attI,-ca-.Iraeto:a:listed ou silo attached Shee4 3 JRoo ropairg Thcao sub-nankin:1 is have employrzea'Ltd brill workr,ts'comp.imituattee,4 5.�`rile arc a cT:rporaticn and its olEenrs have Mtcroised their right of exemption per MGL c. ?.©Other HI(; ... ! 132,§1.(4),tart we have no employuos.[fro workers'comp.inauratce required.] t_ ___ _,._. • _......._ aAay applicant that oheoke box lit most also frill out the section hanw shoving emir workers'compensation poi y information. .1 ktorneowtors who artbmit this affidavit Indicating they etc doing all work and then biro ontiidocantrac;crs rnu, submit a new it_Gdnvitindicating such. • ;I:onlrncrartt that chuck this box:r.uit.:attuuhod as a<tdilinnni shoat tluming Ibe'tarna of the sub-eates actors null S Tn viIteIht.•s or net those ontitica have cutpluyt es. JfThe a::it-cut:tree:oar.have employees,they tuna;pwovide their workout'comp.policynttmbcr. I am an employer that is,providing workers'compensation insurance fir my employees. Below is the policy and jo/;she inforizaila i. .t.,..,surance CollthanyNatrte:Berkley Insurance Co. • 'Policy;(or Self ins.Lic.it: BNUWCOI38570FY - Flspiratio .Date: 11;14122 • kb Site A.dr?rosy: /DC _.�e3 c-i- Ciy/Stat.Attach a copy off. cworkers' compensation parlay declaration page(showing the po ay ntu'crlber an tapir* rots.(ate . �� a Failure to secure coverage as rca.dred racier 31dGL c.15?,§2 S.A.is a criminal violation.pt ishable by a up to$1,500.00 acid/or ono-year imprisonment,as well as civil penalties in the form of a STOP WOlitl:n:DER and a tiro of up to 8250A0 a day against:the violator,A.copy offnis statement may be forwarded to the Doter of Intros igations oftbo?7IA for insurance coverage verification. .l.do hereby cartllf tantder the:pains and penalties of'pel jury that the iizfornraiio .provid above.is true ui correct. Can;!art;: Dennis Audel mate: ..,. c2Q a . 860-97 -r 1 i nfcirrt Ilse only. Do not write in this area.,to be completed by city or town.official. City or Town.:... . Permit/License# — t Issuing Authority(circle ono); 1..Board a f]lealth 2.Buil.di.ugl)epartment 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbinglctspeetot' G.Other I ContactPcrsou: _ _ __ Phone# Client#: 98251 EXTERASC DATE(MMIDD/YYYY) ACOR1,,., CERTIFICATE OF LIABILITY INSURANCE 11/10/2021 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lynn M. Paparazzo Starkweather&Shepley(CT) PHONE 860 583-0943 FAX 860-709-9354 Insurance Brokerage, Inc. E-MAIL IPa arazzo starshe .com — _ ADDRESS: (' _—____ --..... PO Box 549 INSURER(.9AFFORDING COVERAGE NAIL 8 Providence RI 02901-0549 ~-- _ INSURER A:_Selective Insurance Co of New England 867 INSURED INSURER 8 Exterior Associates, Inc, •. --._—..__....__.___....-...-_.._.__....___.._..—.__._.._.._._.__....�___ ......_.. _._.___ .—_ 31 Overbill Road INSURER C: ....... ___.-_..__._._INSURER D: Ellington, CT 06029 — _..__......._..�_ —_......_._._. _..___..__._... INSURERE: ..._..._.._....._.._..._.....___._......_._. ___.......-..._._ ...._..._.._..__. _____ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUP(ED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER 7OCUMENT 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 SI•IOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN R AUDL SUER POLICY EPP POLICY E —'_--._.._. .._.�_.__.---_LIMITS • TYPE OF INSURANCE.--_-_-, --_,-. INSR WW1.•IPOLICY NUMBER-.•-_—_—,(MM/OOIYYYY)-{MMIDDIYY )_— __ A X COMMERCIAL GENERAL LIABILITY X S2442015 04/01/2021 11/14/2 2 EACH OCCURRENCE S 1 000,000 { DAMAGE TO RENTED ••----- CLAIMS-MADE .,•J,, OCCUR PREMISES(Ea occurrencml _-S500,000 MED EXP(Any one person) _ S 15,000 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATELIMITAPfPLIESPER: GENERAL AGGREGATE 52,000,0_OO __ X POLICY I J.PIECOT I'_,__1 LOC I PRODUCTS-COMP/OP AGG S 2,000,000_ �^ OTHER: IY _ 5 AUTOMOBILE LIABILITY r COMBINED SINGLE LIMIT 1 OOO DO A X S244201 5 04/01/2021 11/14/2022(En necidenl• _._..S. O X ANY AUTO BODILY INJURY(Par person) 5 ._• OWNED I SCHEDULED BODILY INJURY(Par maiden!) S —__ R_..___ AUTOS ONLY _. AUTOS Q __onl) — _.—.._-__....—_...—_ X nuros ONLY X DION-OWNED PROPERTY DAMAGES AUTOS ONLY ,(Per accl(Icnt)-•._,-•___..._-.,,,___.._-_....—.�., S A X UMBRELLA LIAR 1 X OCCUR X S2442015 04/01/2021 11/14/2022 EACH OCCURRENCE S2 000 000 EXCESS LIQH •--------_-____._-._•- - _r.�r_—�._.____. GLAlfvlsdv_)ADE AGGREGATE 52 000 000 DED I J RETENTION 5 _ 5 WORKERS COMPENSATION PER '�}} OTH- A AND EMPLOYERS'LIABILITY ,,/N WC9097314 11/14/2021 11/14/2022 X_STpTUIE...__f.._ER —_ ANY PROPRIETOR/PARTNER/EXECUTIVE---- , E.L.EACI_I ACCIDENT 5500,000 OFFICE-RIMEMBER EXCLUDED? ( y l N/A - --•----- (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE 5500,000 If yes,describe under __•_'DESCRIPTION OF OPERATIONS Wow__ E.L,DISEASE-POLICY LIMIT 5500 000 DESCRIPTION OP OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional RomarLa Scltedulu,may be attached If morn space Is rotiulrod) Home Depot USA, Inc., dba THD At-Home Services, Inc., its parent, affiliates and subsidiaries are added as additional insured including On-Going & Completed Operations as required by written contract/agreement CERTIFICATE HOLDER CANCELLATION Home Depot USA, Inc., dba THD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN At-Home Services, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Home Services Compliance C-11, 2455 Paces Ferry Road AUTHORIZED REPRESENTATIVE 1 Atlanta,GA 30339 ,_ i I 4. 01988-2015 ACORD CORPORATION.All rights resolved.— ACORD 25(20'16/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #51811758/M1808232 CTLMP I 'Comm-;n p Im.' t f foissiactuisOtts. 1111; <e,; k�!''#9x9t o`•P3f`t?f'1`ss4crt 1 .)c. t s' `re ding R e qu tions .artd Stalidaftki r' ' 1' '1 4 .,(p1re$ : ` 44"42. (.Ytr.E N &F' 30 LAtiSZ LANE i' .. ,., , ELLINGTON 0i0P2DI y Sir,, 3 ' • stir -. Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: CorporaUcn Registration. 103175 EXTERIOR ASSOCIATES INC Expiration. 0•412e/2023 31 OVERNICE.RD ELLINGTON, CT 00O20 VM�Update Address and Roturn Card. Offlco of Consumer Alf:lira S.Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Col ointmn beforo tho oxpiration data. If found return to: Ragin1rRlion Expiration Offico of Consumor Affairs and Business Regulation 1 :i!75 04'28 2023 1000 Washington Stroot •Suite 710 i EXTERIOR A SOCIATE INC Boston,MA 02118 DENNIS Ati:)F.T 31OVERHIL RD :i,-.Jrr •.1.'•.•rr.: Jf ELtwGTON.CT ono?n Not valed without signature Undersecretary