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24C-178 (7) BP-2024-1 171 187 CRESCENT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 24C-178-001 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-2024-1171 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est. Cost: 17550 BRUCE TETRAULT 096193 Const.Class: Exp.Date: 12/19/2024 Use Group: Owner: PANNONI PAULA A&ELIZABETH G POWELL Lot Size (sq.ft.) Zoning: URB Applicant: BRUCE TETRAULT Applicant Address Phone: Insurance; 1616 S BRANCH PKWY 4133481637 SPRINGFIELD, MA 01129 ISSUED ON: 09/11/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 1// � Fees Paid: $60.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts ii-CA I/ Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR MUNICIPALITY USE Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 iv One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: . 2 ?-`f i 71 __ Date Applied: ___ ----__ - - "-- ilding Official(Print Name) S gnature Date SECTION 1: SITE INFORMATION 1.1 Pioosiy. address c — 1.2AssessorsMap & Parcel Numbers 6 ` �ti cry -� ___ _________ __ — _______ 1.1a 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 Reer 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 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' i greil c. 61f f��-z_ A/O111 ^4----- - PUG Dl0612 Nerve(Print) City,State,ZIP ��0'd 3 2-4 c No.and Street _ Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Speecciifyy:_�� ________ Brief riptio of Pr. ..�-. ork2:—A 1d� ., -� `r�`�_`XaiS _...,,get__‘-{rediv_WCAta../ liEfi-,±61. - ! S ' iSr DSS COrth1 b Vie- Cli SECTION 4: ESTIMATED CONSTRUCTION COSTS � Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$_— Indicate how fee is determined: 2. Electrical $ ' 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6) x multiplier x_____ 3. Plumbing $ 2. Other Fees: $___- 4. Mechanical (HVAC) $ List:_ __ ________ 5. Mechanical (Fire $ -------------------------------- Suppression) Total All F __-- Do Check No I __—Check Amount: _Cash Amount: 6. Total Project Cost: $ j -1 � 7i(- ❑Paid in Full 0 Outstanding Balance Due: _____ • SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS JC,, IS a II q bi 1 L __ fr e_ _1_Ie�a ) Et _-___ License Number Expiration Date Name of CSL Holder List CSL Type(see below) ---411--__S__' iCa-In_c_-_k_eal2y___No.and Street T Description U --- - -��D ---t�----i- ---�1 U Rest�riicted 1&2 Family Dwell ng000 Cu.ft.) City/Town,State, ZIP ,�y� M Masonry ___—_—_ C-" !4(4 C RC Roofing Covering -lE� Z�A��-- WS Window and Siding -- i SF Solid Fuel Burning Appliances 1 - � _ _ 2�_—�__---___ I Insulation Telephone Email address D Demolition 5.2 Regist ed Home Improvement Contractor H IC) ` , r } __1�. �-_ _i-La o �2$ ____---O _CLLLe=--_L� 2_ _-- __ ,-,IC Registration Number Expiration Date HIC C y%pie or C Registrant N ------- 13n)rZi_LeICW21/aCitt 'I No. r t O . n1 A • D fai �( 3y� I( T? Email address City/Town,State,ZIP( ` 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 the building permit. Signed Affidavit Attached? Yes % No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize _ �_ _l_ Ca__UL to act on my behalf, in all matters relative to work authorized by this buil •ng permit applicationth E/`zA 64_6i31,..�`t1 X "sal /?4 _ 1'rint Owner's Name(Electronic Signature) 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 this appli • is true rate best o • , I- and understanding. .A0 - 4t.-''' ___ ____9/d__.,22.0i27 Print Owner'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 Horne Improvement Contractor(H IC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the H IC Program can be found at www.mass.qov/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" „�, Commonwealth of Massachusetts �wJ Division of Occupational Licensure Board of Building Re ulations and Standards ConsriliQervisor CS-096193 , ”. - Dins: 12/19/2024 • BRUCE L 1818 souni r A zA sPR1NGFJ . Y Commissioner doe • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ter Type: Individual BRUCE TETRAULT Registration: 169778 S BRANCH PKWY ak r= Expiration: 01/20/2026 1616SPRINGFIELD,MA 01129 • �✓•' Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:individual Office of Consumer Affairs and Business Regulation l;gg(8trat&o E%PIr en 1000 Washington Street -Suite 710 169778 01/20/2026 Boston,MA 02118 ICE TETRAULT ICE TETRAULT 6 S BRANCH PKWY 21NGFIELD,MA 01129 Undersecretary Not valid without signature The Carmltonit earth of Massadiusetts Department of Industrial Accidents 1�=!• Office of Investigations _ ?eve 600 Washington.Street f Boston,MA 02111 � }ttuumass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Butsiness/Organization�/Individual):___-- C- rail 1 Address:--- ------- City/State/Zip:--j a evi pALLA m ft Phone#:_--y I 3 1 ( 63_7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑ New construction yi employees(full and/or part-time).* have hired the sub-contractors 2.$ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑ erode ling ship and have no employees These sub-contractors have 8. ❑ Demolition vwrking for me in any capacity. waiters' corm.instance. 9. ❑ Building addition [No wrrites' comp.instance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ] officers have exercised their a homeowner doing all work right of exemption per MGL 11.❑Ph$nbing repairs or additions lf. [No workers' corm. c. 152,§1(4),and we have no 12.❑ Roof repairs insuance required.] t employees.[No%writes' comp.insuance required.] 13.❑ Other--- *Any applicant that checks box#1 mat 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 that hire outside contactors mat submit a new affidavit indicating such t Contractors that check this box mat attadied an additional sheet showing the rune of the sub-contactors and their voices'camp.policy infomaticn. I tuna enployer that is pvvtaling writes'cormenation insutunce for my eiploytees. Below is the policy and job site information Insurance Company Name: — --___-- Policy#or Self-ins.Lic.#: —__ 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 Section 25A of MGL c.152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby Titter the pains ondpardties perjury that reflation provided above is true and caret Signatue: ' Date: q / 6 /2-69y Phone#: (t (c 3 (8' /etc3 Official use only. Do not mite in dtis crew,la be aarapleted by city or tart official City or Town: Pezmit/Lic nse# Isstnng Authority(circle ore): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical bevectui 5.Plumbing Inspector 6.Other Contact Person: Phone#: BRUCTET-01 BSWAIN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/10/2024 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 ri hts to the certificate holder in lieu of such endorsement s). _ PRODUCER CONTACT First American Insurance Agency NAME PO Box 147 ac°O,,"ri,Exti:(413)592-8118 i c,Noy(413)592-0995 Chicopee,MA 01021 A DRESS: -- SOURER(S)AFFORDING COVERAGE NAIC INSURERA:Atlantic Casualty Insurance____ INSURED INSURER B: Bruce Tetrault INSURER C 1616 South Branch Parkway INSURERD: Springfield,MA 01129 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POUCY EXP LTR TYPE OF INSURANCE tV D POLICY NUMBER • y) IDO/YYYn UMITS A X COMMERCIAL GENERAL UABIUTY I EACH OCCURRENCE 1,000,000; _ CLAIMS-MADE X' OCCUR L281004938 5/23/2024 1 5/23/2025 DMGORvursDe n ) ; 100,000 5,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY ; 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ; 2,000,000 POLICY u LOC PRODUCTS-COMP/OP AGG $ 2,000,000-- I OTHER: $ AUTOMOBILE LIABILITY (EaaMBINEnt INGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED $ AU RTEO�S ONLY _ AUTONON-pSyy►IE p BODILYY INJURYY(Per accident) — MAGE AUTOS ONLY _ AUTOS ONLY Ire 1 $ ; ^_ UMBRELLA UAB _ OCCUR EACH OCCURRENCE 3 EXCESS LAB CLAIMS-MADE AGGREGATE 3 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN I STATUTE ER ANYPROPRIIETgORIPARTNERIEXECUTIVE r 1 E.L.EACH ACCIDENT $ Aend Rory in NH(M )EXCLUDED? I N/A E.L.DISEASE-EA EMPLOYEE ; -_ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UNIT, $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bruce Tetrault THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1616 South Branch Parkway Springfield,MA 01129 AUTHORIZED REPRESENTATIVE c2m,usituk ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: l�( recce( S4 The debris will be transported by: l,-SV ()00„v(16us The debris will be received by: S " (--/, j(i Art Building permit number: Name of Permit Applicant gr&C c� (a 44' q/(* Date Signature of Permit Applicant