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24D-234 AC RD DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/18/2009 RODuCER (413) 536 -26.8 • FAX (413) 532 -0889 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION :haffee Hel l iwel l Ins. Agcy. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 416 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Holyoke, MA 01040 INSURERS AFFORDING COVERAGE NAIC # ISURED N R B Exteriors Inc. INSURER A: S. H. Smith & Co ?Northland 7 Philip Circle INSURER B: Travelers Insurance Company Granby, MA 01033 INSURERC: WCRIB of Mass /Americ:an Zurich INSURER D CT Underwriters /Max Speciality INSURER E: :OVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ASR ADD'L POUCY EFFECTIVE POUCY EXPIRATION ,TR (NSRI; TYPE OF INSURANCE POLICY NUMBER DATF ( minni Y) DATE IMMIflVYY) LIMITS GENERALUABILITY WS053135 11/03/2009 11/03/2010 EACHOC:CURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 00r�0 PRFMISFS (Fa rem vane) 1 CLAIMS MADE I X I OCCUR MED EXF' (Any one person) $ 5,000 A X Subject to $ 500.00 PERSONAL 8 ADV INJURY $ 1,000,000 Deductible GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT PER: PRODUCTS - COMP /OP AGG $ 2,000,000 — 1 POLICY n sEC n LOC AUTOMOBILEUABWTY BA 6953N101 06/23/2009 06/23/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ 100,000 B X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) $ 300,000 PROPERTY DAMAGE (Per accident) 100, 0 GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE $ I OCCUR ( I CLAIMS MADE AGGRE.GATE $ $ DEDUCTIBLE $ RETENTION $ $ _ WORKERS COMPENSATION AND 6ZZUB- 0347N31 -1 -09 01/30/2009 01/30/2010 I TO I MITS [ 1° R EMPLOYERS' PROPRIETOR/PARTNER/EXECUTIVE TO FOLLOW DIRECTLY FROM E.L. EACH ACCIDENT $ 100,000 C OFF CER/M I TOEMBER�EXCLUDED? ECUTNE THE COMPANY E.L. DISEASE - EA EMPLOYEE $ 100,000 If yes, describe under SPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT , $ 500,000 OTHER MAX012400001938 11/01/2009 11/01/2010 2,000,000 General Aggregate Snow Plowing Liability p 1,000,000 Each Occurrence Subject to $500.00 Deductible DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Siding, Window Installation, Roofing and Carpentry Snow Plowing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE THE CERTIFICATE HOLDER NAMED TO THE LEFT, G AF -ELK BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR UABILRY ° 4 Eagle Lane OF ANY KIND UPON THE INSURER, ITS AGENTS 1 / OR � R RAE PRESENTATTIII VEE S. Simsbury, CT 01070 ORIZEDREPR E ( /� /1►(\ ACORD 25 (2001/08) ©ACO D CORPORATION 1988 1 !! ) 0 ,76 ' --.• Q-• C 7 -1 \ + et t Fully Lic • - - ° • . • nsure i � `r "�'et i ti o r, J 7 Philip Cir Granby, MA 01033 MA Reg #: 20- 2015718 � ` p y� g x ���° ���� Phone: 413-563-8387 MA Lic#: 47961 m Specializing in Roofing ° ' ' Fax#: 467-9748 \\ L ��kl" f r 1 � ✓ i � ✓ v 2 EXTERIOR NOME IMPROVEMENTS Inc, ��� c a 5 L 3 `i ROOFING & SEAMLESS GUTTERS h b �, Windows - Siding - Decks i� ei , . 4 , ✓c C S Liv4J'' ' bnt\ ey_ -✓ . COL" Residential - Commercial Proposal submitted to: Phone# h: /' G c: 0 Chi, c (0, 1 � `C � ` _ � �l � (IS Cd � r �-- �7 Special requirements Street ! ecd /., L i Pk i ,t ,,t ->k,, (uA`-y x .-.1, 131', 4 Lt D V 0 S(\.2.-C :r '. :�) I ,.„ 1 i 4. i6 1-- .V 110c, / i`-- 4' w(.t I )- O.rt ' 1,, . City,state,2ipcode J 1 LI li I (.Z 1 V'. ? I Et/ R4, - - '� '< , ^ X2 .,1,-..1 //J ,7 _, q.t. L, 10 n-c. r r _ ^ ) Proposal to furnish and install the followi _ �'� ., n t) o.:, j ❑ Re -roof Tear -off ❑ gutters Complete Roof Preparation 1 1a LK 7 1-d (Iu L rft .G4 5 L-cck � Home exterior to be protected by tarps and plywood e" Shrubs, landscaping, trees to be protected Entire existing roofing material to be removed to existing decking, including flashing ect 1 Site to be cleaned on a daily basis with roll magnet, debris to be removed at project completion ('`Deteriorated existing decking to be replaced at $40.00 per sheet of plywood R'New flashing installed where necessary , C install new pipe flashing Complete roofing system ?Ice and water barrier installed at all eves to protect from ice dams C ice and water barrier to be installed in all valley's, around penetrations, and critical areas L t--541b. reinforced underlayment installed over entire decking L tdt, 1 v `I (" e ' t `" ` — - `" 1 -t-.) Warranty options We guarantee our workmanship for 10 full years C�t�' `^�` r\""4 "'``" c , ../...- 1 ` i i ,w w � 5r •_ ..vt- i,tc, ��, " ELK Prestige High Definition - color: 5 l d :,\ -z `730 year L i 50 year Acceptance of Proposal: The above prices, specifications, and conditiop satisfactory and hereby accepted. Payment will be ii down upon signing and balance due upon completion. 0 (7 \... ©oC� ,o o i - -- -) ` 40 & - Total sale price: ' down payment: 3 �L' ° cX � upon completion: .. Customer signature: _ . _ • _,, r fiI l � d t t j 30 1 0 phone #: C2 D-. y � c."."" 13 Q�%7 Authorized signature: ! C date: �' 1 • HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two -year period shall not be considered a home owner." The building department for the City of Northampton wants person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regnilations The insnec i rocess regtires that the buildin, department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour). a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper ------- permit-s-in- conjunction.to the. huildi :ng.pPrmir. issued, _ and _that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, understand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Address of work location I ` . The Commonwealth of Massachusetts Department of Industrial Accidents rii� = fl Office of Investigations _ -° ' ]�' 600 Washington Street =� Boston, MA 0 2111 t y ` www.massgov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibIv Name ( Business /Organization/Individual): 10 ISO 1. ' 7 \C Address: 7 ,91,,,(i-p City /State /Zip:o 7 4 ( t)1 Phone. #: C (0) S 1 Are you an employer? Check the appropriate box: /' ' 4.. I am a general contractor and I I am a employer Type of project (required }:. lo. er with ❑ d g Y have hired the sub- contractors 5. ❑New construction employees (full and/or part- time). * 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodel•img ship and. have. no Pnloyees These sub - contractors have. 8. ❑ Demolition for me in any capacity. employees and have workers' working Y aP ty 9. Q Building addition [No workers' comp. insurance comp. - Insurance_$. required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 I -am a honmeo- waer-doing- all -wo rk- c rs ve rextrcised that —1-1. ❑ P-lumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance requited. ] . *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. Contractors that check this box must arrarhed 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 the policy and job site information. Insurance Company Name: L l ! Policy # or Self-ins. Lic. #: CI 7 7 � B 0 5' 74/31 - I ` C7 . Expiration Date: t j B f JO i Q Job Site Address: c7 0 c2 C - `�� ` '�y t (, City/State/Zip:' tti / 1 11 2 t� Attach a copy of the workers' compensation policy declaration page (showing the policy nnnlber 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. )fie advised that a copy of this statement may be forwarded to the OMce of Investit=_ations of the DIA for insurance coverage verification I do her ertif z.ttn' the pains and penalties of perjraythat the information provided_above_is truenndcorr-ect__ _ _ Signature: Date: i 1 . Phone #: X1 C=.3 - 6-27 c (-1 - - Official use oiily. Do fiat write in this to be compk.ted by city or town off City or Town: PermitfLicense #__ Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other r Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : C "NOVA 5 )✓' i e--v y J (& S License- Number 7 P `\' ct r �'��� illeA Qlv Address Expiration Date Signature Telephone 9t Reui improvernen r fiGontracto � Not Applicable ❑ tl'U1� ( r-e✓:D /S - , vet N7 - c/6 Com any Name Registration Number A ress Expiration Date Telephone S SECTION 10 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 ❑ The_current_exemption for "homeowners" was extended to include Owner Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 1083.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two - year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference'to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of ort ampfon r finances, a e an • . - „ .r o . - its General -L- Laws -Annotated. - Homeowner Signature r SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [J Addition [] Replacement Windows Alteration(s) ❑ Roofing Ur Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other [0] Brief Description of Proposed Work: Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa if Nevin douse °and a= additionto existing housing. comxi(ete the foilowhig: 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 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date _ 111111111111111.111111111111=1111111111 , 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. Print Name Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department LotSize _.._ .__,_.. .,,.__.__,._ . ............ Frontage _ ._.._ _ >._.. ....__........_, _. Setbacks Front Side L. m_..._ R. L:, R. Rear Building Height Bldg. Square Footage % Open Space Footage (Lot area minus bldg & paved pafking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES W YES, date issued: YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book f Page' and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D retie a any prop c angel to or a rtions o signs intended - for the property ? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb {clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department 1✓i �t iu� r ; 212 Main Street Rio }o�m� 100 -_- {' f1 pto /� __ N� s ft1A- „1- '�ilf'iQ__— phone413- 587 -1240 Fax 413 -587 -1272 � e =t6 4�F �f s -i —_ APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office p p( °S r 2 t.+ C +- Map Lot Unit Zone Overlay District EIrn St? District Cs District SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Curreq,t Mailing Ad ress: Telephone Signature 2.2 Authorized Agent: /IVr Name (P ” Currenf Mailing Address: V Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION 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) 5. Fire Protection 6. Total= (1 +2 +3 +4 +5) 0 '0 Check Number This Section For OfficlaI Use Only Date Building Permit Number: Issued: Signature: !_ Building Commissioner /Inspector of Buildings Date 4 O6. QSPECT ST , BP- 2010 -0593 (is : COMMONWEALTH OF MASSACHUSETTS 3i. 24 - 234 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0593 Project # JS- 2010 - 000865 Est. Cost: $9500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq. ft.): 8712.00 Owner: COTE CHRISTOPHER M Zoning: URB(100)/ Applicant: NRB EXTERIORS INC AT: 206 PROSPECT ST Applicant Address: Phone: Insurance: 7 PHILIP CIRCLE (413) 563 -6354 WC GRANBYMA01033 ISSUED ON:12/11/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL RUBBER MEMBRANE 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 FireplaceiChimney: 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 12/11/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo