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35-193 - -- • V `- j-7, 1;7 _ - ;. Office of Consumer Affairs and usiness Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 101718 Type: Private Corporation Expiration: 6/29/2012 Tr# 200477 S.E. SULENSKI ROOFING & SIDING, CO John Rigalis 103 South St Holyoke, MA 01040 - -- Update Address and return card. Mark reason for change. n Address Li Renewal L j Employment ( I Lost Card DPS -CA1 C, 50M- 04/04- G101216 , Office 27--,7. o> me rr & B dsi uess Re gu p Yo n L or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �) Registration: 101718 Type: Office of Consumer Affairs and Business Regulation E Expiration: 6/29/2012 Private Corporation 10 Park Plaza - Suite 5170 ` i P p Boston, MA 02116 S te. SULENSKI ROOFING & SIDING, CO John Rigalis 103 South St _ Holyoke, MA 01040 — -- -- Undersecretary Not valid without signature 'Massachusetts - Department of Public Safe Board of Building Regulations and Standards 7 s Construction Supervisor License License: CS 22840 JOHN R RIGALIS 103 SOUTH STREET HOLYOKE, MA 01040 , � �''`.. Expiration: 6/22/2012 ( unmiis•iuner Tr=: 28670 uete: ED/ 5/2010 Time: 3:29 PM To: Jason Ed 1-413-536-8354 CIayoo C l 1/2 4OORQ CERTIFICATE OF LIABILITY INSURANCE o�j 0 ' 1 PRODUCER (413) 536 -0804 FAX (413) 534 -7874 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1 Martin 3. Cl ayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1649 Northampton Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR F. 0. Box 989 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hol yoke, MA 01041 -0989 INSURERS AFFORDING COVERAGE NAIC # t INSURE`? 5. E. SLllenski Roofing & Siding INSURER .A ATLANTIC CASUALTY INSURANCE CO. - 103 South Street INSURER ACE PROPERTY & CASUALTY INSURANCE CO Ho] yoke, MA 01040 INSURER C INSURER D ( INSURER E J I COVERAGES J 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, T. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH E , � I POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IINSRIADO .._.. -. - -.. _ ._._.____._ _-- -. - -_.._-- -- POLICY EFFECTIVE POLICY EXPIRATION -- R d"JSRu TYPE OF IN OF POLICY NUMBER LIMITS DATE MMIDpfYYI DATE t ' i GENERAL LIABILITY L081000553 06/04/2010 06/04/2011 E:vc- +ccci1FIRENCF 7--- 5.7000,000 1I ! +i h'E , _1J X 1 CO.,' iAL 'LR:,L LI:,BILIT I CAMAG= TD RENTED _- i PRI - MIFFS I Fa nc<! Ir.-leM__ J0, 000 I i , I MS M..DE CX 1 OCCLIP. MED EYP (A ore parson) !$ 5,000 A PERSONA. & AD' INOIP/ $ 1,000,000 I I GENERAL AGGREGATE $ 2 , 000 , 000 f I r ,i- :N :.PEGATE LIMIT APPLIES PER PPOJJCTS - COMP /OP'- $ 1,000,000 PRO- 1 1 I . "— t'LICY JE,_T I LOC i AUTOMOBILE LIABILITY 1 _ — CC.N(;INEC SINGLE UM T , 4 (Ea acc dint; ALL .. avrED :y r' ,- IS • 1 BODILY INJUFr` $ I (Per pHsor) NSBLC A! 1. b BODILY INJURY $ ( ? I I N(;N -OWN( I) AUTOf; ( ar accident) P I 1 PROPERTY DAMAGE $ - �. (Per a 1 GARAGE LIABILITY AUTO (Id.` - EA ACCIDENT $ - -- 71, AUTO (...1 -IER I HAN EA Aia, 1 ;$ I- 1 A11(V (XJ_" EXCESSIUMBRELLALIABILITY EAL: CCCLRRENCF I $ ` I 1 C ` 1 - _( , ,IVIS MADE AGGREGATE • ( `` LEL.J. i 131 t. $ — ! WORKERS C�ENSATION AND 1 PMICC45847901 12/31/2009 12/31/2010 TORY STAID- .S `E - � 'EMPLOYERS' LIABILITY E L EACH A>_ CENT $ 500,000 d!. P lPNi i,P-c RTT - nfFXECIITI /c ■ 1 r £ISFi:u l_DEC^ EL DISEASE -EAENPL' YEE $ 500,000 PECI,,,.":0'!"3 - .ata +.r; EL DISE .S -P1 ICY LIMO' :'r 500,000 OTHER I D =SCRPTION OF OPERATIONS t LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORI REPRESENTATIVE -_ „_{ - Harol d Clayton Jr. /SANDY ACCRO 25 (2001/08) FAX: 413. 259.2402 ©ACORD CORPORATION 1988 gto 04, (f�7 Q ±f Xorf1wnipt t - = ## _ * :j p -_ % < � 0 jiii assacbnsetts =: � ' DEPARTMENT OF BUILDING INSPECTIONS _ �= 17... INSPECTOR 212 Main. Street • Municipal Building ' '0 , , y = Northampton, MA 01060 - e HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction sups: sor. 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 struct 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 any 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 regulations. The inspection process requires that the building 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 permits in conjunction to the building permit 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. Date Address of work . location 2. .e. +TO _ A g , ___,4:; E �Z.s.wrE[ncrtle � DEPARTMENT OP BUILDING INSPECTIONS , - 212 Main Street • Municipal Building Northampton, Mass. 01060 r' WORKERZ'S COMTENSATION £ SUI&NCE Ai'I�NJ)AV1T (liccns ipermitux) . with a principal place of business/residence at: • lad ti1 Siiat lta Liz /C.e_ h-, a, 0/Di-/d (phone) 4/3 - 53 Q - 3G'so (s c Jcdty /statr:'ap) do hereby certify, under hc.pains and penalties of per th31 • ( ) I am an employer providing the following worker's corn pensation covc 2SC for 1ny employees wott.ng on this job: . • Co (lnsur'nc Cor znv) (Policy ?: :p D2) ( ) I am a sole - proprietor, general contractor or homeowner (circle one) tad have hired the contractors listed below wbo have the follolvvtoQ worker's corhnen a ion pobcies: , (Name of ConL'7!cio) (III urant.^. CoinoaS1} Nu ." (r :pins on Date) • -- (blame of Contractor) (nsura_n compan Ntunccf) . (L. Due) (Name of Contractdr) (Insurancz Compaz Number) (Expir000 Date) (Name of Contractor) (I. sutaaca Company/Policy Number) (E... oat_.) - (nntd .daitiocal rbo:I.tfaoc-.• -- to inch inforz..noe pcsaiaias to .11 ooh -r--a) - •( ) I am a sole pro rietor and bave no one wort .0 for me. P 3 ( ) I am,a home owner performing all the work m yself: N°1 ' pl.- c be c art: d'-' '"'...1c htm o era ' ccaaloy pc- oas to d.., rl �- - -, - � - : �:.c) c rc�au work co • d••cl of clot naocc 1_7 t.,.... Imits io . .t9(.,1 the bOcoowDC laid= or CC tb.c p 2p'pt.1r1.CS -T1 tbc- ..o CT oat �� --IIY occ-: ."Oj to bC czjployc -a und.c- the •krea �=c) • AG (GL152 1(S)). spplitaaoa by • bow for = i = cc PCB �y c,klcoc` t lcpl ctasu of ea =ploy.- uod.r dto Warta'. cooapooa.iion Act_ • 1 uadcn.ad that x copy of thi, caz.a,m act.y b. forh-erdrd w the poq.«meoa of lndusn.l AccdcaII3' OfGo. or lmo.000 for th. cove xsc , ci6C ioa aid thou Eat= to come for under suction 25A of MQL 152 cum lad to the *O - ^hon.. Stop ^ inal P'sI'i= coani:.ag of t fine of up to S 1, 00.00 .odor year or up to one yr r od d.il pcaa O l'J to 64 form of n Stop W orlt Oricr ..od • , 1= orSt 00.0O a day L .LO$t tae for dcp.+tm-5:.1 u.c Doty Pcrmil Number • .fi __ Lot ° - -- - -� • Si of LiJPcctnitt� . SECTION 8 - CONSTRUCTION sggy CES 8.1 Licensed Construction Supervisor: n Not Applicable ❑ Name of License Holder. Solt /7% tC OQ1f s CS o°Za $ 1(0 License Number a 01). )03 Sv;t_tA,, Strut -as- ate. Address Expiration Date �b c l.yclC2 a, 010Yv Signature Telephone �:. .A • - s �- 3 6 3 ' . „._ Not Applicable .0 S. £ ca r irvs c►- sicGivs - /0/7/0 Company Name y Registration NumberQ • ) D3 SC �TN32.L 6 zst Address __ Expiration Date Ibo k�L i c if ill a. DID i/D Telephone 2 113 SECTION_ 10- , WORKERS' • 1010 -ERS/ TION4NS.URANCE IFFJQ, 1FFOL L.c. -' 52;, 2 5C(6) j 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 t No ❑ The current exemption for "homeowners” was extended to include Owner-occupied 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 108.3.5.1. 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- ear • eriod shall not be co sidered 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 Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. • . Homeowner Signature - • SECTION :5- :DESCRIPTIONI.OF RROPO :SEOWORK4check:all:appHcablej New House [❑ Addition ❑ Replacemen_t_V�i:ndows Alteration(s) ❑ Roofing Or Doors 'L Accessory Bldg. E1 Demolition ❑ New Signs ID] Decks [E] Siding, Other [CA Brief Description of Proposed Q`, 1 �/'. \. Work: �, �. w_ ``ac vv +a L .� i N Alteration of existing bedroom Yes )` No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll - Sheet 6a- 'fllevg tQ iSe' 3 C - clew o� w3 t - 4 ` e P • 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 . L Septic Tank City Sewer Private well City water Supply S ECTION-7a OIt NER-/►t fOR[00 *OM kE`WifEN OSIERS AGEN0UR R,AP 1 Ottattl T 1, r. V -, as Owner of the subject property AA hereby authorize �. i" SQL & S/Ct. �on FI N 3 Si CLt w? Co to act o y behalf, in all matters relative to work authorized by this building permit application. Signature of Owner - - -- - -- - - - - - . Date 1, d -„ \ r t e s as Owner /Authorized Agent hereby declare tht 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 i ture of Owner/AAV 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 Lot Size L , ' • • Frontage - .. - Setbacks Front • Side L:' R: L I R_ Rzar - f . Building Height Bldg. Square Footage % 1- -- Open Space Footage % (Lot area minus bldg &pawed i . Parking) # of Parking Spaces ' Fill: y i volume & Location " . A. Has a Special Permit/Variance /Finding ever been issued for /on the site? • NO © DONT KNOW (2) YES. 0 IF YES, date issued:. IF YES: Was the permit recorded at the.:Registry of. Deeds? . NO ® DONT KNOW 0 YES IF YES: enter Book I Page` I and /or Document # B. Does the site contain a brook, body of water or. wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: C_ Do any signs exist on the property? YES © NO 0 • IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? . YES Q NO OD 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 ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. f Nort ton -te � , -. = ' �. o Kamp �X- -,- _ City t s s T�epartmen " ,� f - } • uitdin ti > M ain Street a,. K - �- �- �. 2 12 Q � 7„-� :,*. .. .. r Room 01060 - , s ,,r, Northampton, 0 Fa 413 -5 -12 72 "' " '— O FAMILY D WG -LWG prone 413 -587- OUSH A ON OR � A I R S estiovA OR DES RFC ONST E . .. APPLICATION TO C a a a � � s � -y mss ` c t• Address: rl _ 1.1 Pro ` - - -�:`" tiling A ddress. • 2.1 Owner of Reco rd: C Ma �l if\ YN w. Tefepno Name (print} ill (2-1 Qt C�l Si Kure Si �1 Y11 � Current Mailing C ) . s�<I `� cor)ti v 13 �3a' 3 ' 2.2 A cone (yam (print) - _ • Tetep ��. - use OR g LO �llats)t° be _ CFfi = E n t. feted ma ted Cost ( ..4ica e C f a b rmit a 11431:49f, -. h f • 1. Building w '>g%t[dti?� 2 Electrical kit 3, Plumbing 4. Mechanical (►-NP`C) .Check Number tection • "") "" O - .. � cia1� g Fire Pro + + 4 4 5) 1110V- 6. Total `= ( * 2 - - - a l e : g= P Nurc►be - - -==' ' --� pate Buildin Signature: r Blitldi B.0d'utgS onertrnsp ng �snmsssi BP- 2011 -0442 s #: COMMONWEALTH OF MASSACHUSETTS 191 : CITY OF NORTHAMPTON )t: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS 2rmit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) 'ategory: BUILDING PERMIT ermit # BP-2011-0442 project # JS -2011- 000720 Cost: $14975.00 ?ee: $105.00 PERMISSION IS HEREBY GRANTED TO: �onst. Class: Contractor: License: Use Group: S E SULENSKI 022840 Lot Size(sq. ft.): 10497.96 Owner: VENNE RICHARD W Zoning: SR(100) //WSP II Applicant: S E SULENSKI AT: 1198 BURTS PIT RD Applicant Address: Phone: Insurance: 103 South Street (413) 532 -3630 Workers Compensation HOLYOKEMA01040 ISSUED ON:11 /10 /2010 0:00:00 TO PERFORM THE FOLLOWING WORK: STRIP & SHINGLE ROOF,SIDING & REPLACEMENT WINDOWS 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: FeeType: Date Paid: Amount: Building 11/10/2010 0:00:00 $105.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner