Loading...
42-125 (2) To Page 2 of 2 2013 -01 -29 14:42:45 (GMT) Robin Tierney From: Robin Tierney Ac ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1/29/2013 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 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Tierney Team Tierney Group PHONE Ext1 AD (413) 562 -7007 I (AIC,NO): (413)568 -9720 16 North Elm Street A ' OR M: P 0 Box 750 INSURER(S) AFFORDING COVERAGE NAIC II Westfield MA 01086 INSURER A : Penn America INSURED INSURERBAmerican Zurich Ins Co N R B Exteriors Inc. INSURER Atain Specialty Insurance 7 Philip Circle INSURER D: INSURER E: Granby MA 01033 INSURER F : _ COVERAGES CERTIFICATE NUMBERCL1 31 2 9 00160 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NsR t LTR TYPE OF INSURANCE AO INSR wvn POLICY NUMBER (MMIIDDIYVYYY) (MMIID LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE IOHENIED $ 100,000 X COMMERCIAL GENERAL 1. IADILITY PREMISES (Ea occurrence) A CLAIMS -MADE I x I OCCUR PAV0000154 12/1/2012 12/1/2013 MEDEXP(Anyoneperson) $ 5,000 X $1, 000. BI Deductible PERSONAL & ADV INJURY $ 1,000,000 X $2,500.00 PD Deductible GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP /OP AGG $ 2,000,000 - I POLICY PI 8-f PI LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB (Ea occident) $ ANY AUTO BODILY IN JURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DED I l RETENTIONS T $ B WORKERS COMPENSATION 6ZZUB- 5B72413 -5 -13 12/1/2012 12/1/2013 I TORY A TU- J I AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTM I Y1 N NIA (Mandatory In N To Follow Directly From E.L. EACH ACCIDENT $ 100,000 OFFICER/MEMBER ryln NH) EXCLUDE D7 The carrier E L DISEASE - FA EMPLOYEE $ 500,000 If yyes, describe under DESCRIPTION OF OPERATIONS beiow E.L. DISEASE • POLICY LIMIT _ $ 100,000 C Snow Removal /Plowing Liab c1P159461 12/1/2012 12/1/2013 200.000 General Aggregate Subject ro $1,000.00 ded 100000EachoccurroncoS DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Siding, Window Installation, Carpentry, Roofing and Snow Removal / Plowing CERTIFICATE HOLDER CANCELLATION (413) 467 - 9748 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. N R B Exteriors Inc. / Philip Circle AUTHORIZED REPRESENTATIVE Granby, MA 01033 ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS075 rdmnnorn Tho A cm? n name and Innn are ranictororimarkc of ACr1Rl Vlassachusefts - _)epart E ,u ,> Board of Building Regulahr:)ns .arid `;tand,lis .ce:nse CSSL -099565 NICHOLAS R BERNIER 7 PHILIP CIRCLE GRANBY MA 01033 o � ,, rn�>.rrurr 05/28/2014 nj ( J) /C J1(0001/1 t '> �(% /ri,j,' l<II Gl .1G'l J 01=' Office of Consumer Affairs and Business Regulation cv rah 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 147961 Type: Private Corporation Expiration: 8/23/2013 Tr# 215929 NRB EXTERIORS INC NICHOLAS BERNIER 7 PHILIP CIRCLE GRANBY, MA 01033 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card SCA 1 c; 20M 05/11 � / /r' lr r »////r J //Prrl //// r/r i Nl ' � t. ill Office of Consumer Affairs & Busin€ss Regulation License or registration valid for individul use only ,pME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 eg istration: 147961 Type: Office of Consumer Affairs and Business Regulation �a t expiration: 8/23/2013 Private Corporatior 10 Park Plaza - Suite 5170 . Boston, MA 02116 NRB EXTERIORS INC NICHOLAS BERNIER 7 PHILIL CIRCLE GRANBY, MA 01033 Undersecretary Not valid without signature • UV(C\ L eopo\Q 4 \ Y U - 1 • t'3 �Lc,. V.. C1 \ A ..ect ({-L (0.- 1v--c ior reirtirgne ErfUCe RPnny^tias i.. z... 142 Glendale rd f,:` < Florence. Ma P 1 4 ; L s 1 ; c f d 473, 63 -6354 :. .'ti er . , w • , !` - l. ESTIMATE Scope of work: We will provide all the necessary insurance certificates, permits, supervision, labor, materials, equipment, and supplies as required to complete the following. All OSHA safety standards will be followed. 1.) Strip and remove existing roofing and dispose of in proper landfill. 2.) Clean/ inspect decking (rotted plywood or re sheathing replaced @ $ 50.00 per sheet extra cost) 3.) Install new white aluminum drip edging to rakes and eaves of roof (8 ") 4.) Install ice and water shield 3 feet on eaves, 3 feet on valleys 5.) Install synthetic deck protection to the remainder of the roof 6.) Install new pipe boot flashing 7.) Flash all chimneys 8.) Install Lifetime GAF 50 yr prestique HD timberline architectural style roofing shingles to manufactures specifications using 6 nails Color fi e't , -(. 9.) Install gaf ridged PVC snow country ridge vent and cover with gaf ridge caps 10.) Clean gutters and excess roofing debris 1 1.) Install new flashing where necessary 12.) Roofers buggy will be used for clean up and keep job site in a safe manner We will remove and properly dispose of all contract work related waste and debris daily and maintain in a clean and safe manner. We will guaranty this roof not to leak for 15 years under normal weather conditions. We also include the 50 -year gaf weather stopper roof system plus warranty We purpose to provide the material, labor, waste removal, and permitting to complete the work to the above specifications for the sum of: Main house : X 8:-88 ?5" `V a `(/ Garage only: $ 2450.00 Gutters and downspouts $ 750.00 $- 2500.00 down payment amount $ balance ue u on completion Authorized signature date ° K * /3 Customer's signature: 1Y' L-- ' date 3 - K - r3 Please make check payable to N.R.B. Exteriors, Inc. and mail to N.R.B. Exteriors, Inc. 7 Philip Cir Granby Ma 01033 No Slide Title aff- builders.pdf http: / /www. mass. gov /Iwd/ docs /dia/forms /f- aff- builders.pdf The Common of Massachusetts Department of Industrial Accidents io , -" Once ofIni•estlgatlons 1 t t�, ' 1 on� Street, Suite l DO Y tee . Boston, 314 02114-201 " a ■ ; MVP mass.goi' dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Le:ib1v Name {Business l )lguuzahon h1dnidual) 1\i/ k6 E_x i ' t (■ Address 7 if L, l k t c. City StateZip (C7f -4j 0/4 Phone Ste'/ " `-., 3 C Are you an employer? Check tla appropriate box: Type of project (required): 1 0 I aril a employer with 4 E I am a general contractor and I employees (fn11 and or past- tune► * have hired the :116- contractor: 6 ❑ New coustnicholi 2 ❑ I a a sole proprietor 01 partner_ listed on the attached sheet - ❑ Remodeling ll! ship and have no employees These sub - contractors have 8 ['Demolition working for the in any capacity employees and have \\Yorkers' 1 9 ❑ Budding addition [No \vorkel ' comp insurance comp. insurance t required ] - ❑ We are a corporation and its 10 ❑ Electrical repairs or additions 3 ❑ I am a honieo\vner doing all \volt; officer have exercised then 11. ❑ Plunibi ng repairs or additions myself [No \ Yorkers' comp right of exemption per MGL 1 12 ❑ Roof repairs insurance required] I c 152, `•1(4), and we have no employees [No «Yorkers• 13 ❑ tither comp insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit a new affidavit indicating such $Contractors that check this box must attached 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 a 'o1 ers' eennperrsation insurance felt my employees. Belem is the policy and job site information. Insurance Company Name. 4/Ile -Lt..__ t`C Policy = or Self -ins Lic = 2 Z't S 5 L ( (3 '" C-- (3 Expiation Date t °Z - ( — ). Job Site Address r 6( ) Ur d°tcX ztc --41 City State Zip 44.(A ct".- t ,�pis— ' Attach a copy of the workers' comp ensatiou policy declaration page (showing the policy number and exphatiou date). Failure to secure coverage as required under Section 2.5A of INIGL c 152 can lead to the unposition of criminal penalties of a fine up to $1.500.00 and or one -year imprisonment, as \yell as civil penalties in the foam 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 may be forwarded to the Office of Investigations of the I)LA for insurance coverage verification I do Hereby eeii ' under the paint and penalties. ofperjnrt' that the information presided above it tare and correct Signature � Date l Phone = _ -5' - C.. 3 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit License = Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone =: 1 of2 3/13/2013 8:35 PM Residential passive.pdf http: / /www.northamptonma.gov/ building / uploads /listWidget/2599 /Resi... SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor.: �, Not Applicable Name of License Holder tv ` c- �O : \ � License Number Address Expiration Date C.c_ 3 Co 3s` - I n ature Telephone 9. Registered Home Improvement Contractor: Not Applicable �! ! exry ;v. (Ca 7 96 Company Name Q Registration Number 7 �.. Y !ice ‘, Address � C .� � � � C� I �� � Expiration Da% Telephone CO `t — 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 issuanc e building permit. Signed Affidavit Atta Yes... .. No 11. - Home Owner Exemption The current exemption for homeowners' \v as extended to inchl(le Owner-occupied Dwellings of one (1) 01 two(2) families and to allow such homeowner to engage an individual for hire who (noes not possess a license, provided that the owner acts as supervisor. CAM 7 80, Sixth Edition Section 103.3.5.1. Definition of Homeowner Person (s) who own a parcel of land on winidn he she resides or intends to reside, on which there is, or is intended to be. a one 01 two family dwelling, attached or detached structures accessoiv to such use and or farm structures A person who constructs more than one home in a two - rear period shall not be considered a homeowner Such "homeowner" shall submit to the Building Official, on a foirn acceptable to the Building Official, that he she shall be responsible for all such work performed under the building permit. As actin_ Construction Supervisor Vour presence on the job site will be required from time to tune, (luring and upon completion of the NNnrk for NNiiicli this permit is issued Also be advised that with reference to Chapter 1 (Workers' Compensation) and Chapter 1531L iability of Employers to Employees for infirries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for persons) you lure to perfOirm 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 General Laws Annotated Homeowner Signature 4 of4 3/13/2013 8:22 PM Residential passive.pdf http:// www. northamptonma. gov/ building / uploads /listWidget/2599 /Resi... SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition Replacement Windows Alteration(s) ' Roofing Or Doors Accessory Bldg. Demolition New Signs [ ] Decks [ 1 Siding [ ] Other [ ] Brief Description of Proposed g h / / p 0 Work: - e. tJ"vl� ti a.rt. - C1C. - I " \� 1 l Alteration of existing bedroom Yes ?° No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing, complete the following: 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? l 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 13 T'tt , as Owner of the subject property t- hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. k Signature of Owner Date h J as Owner /Authorized Agent hereby declare that t 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. r ' Print Name - 3 - ( - / gna ure of Owner /Agent Date 3 of4 3/13/2013 8:22 PM ResidentiaLpassive.pdf http: / /www.northamptonma.gov /building/ uploads /IistWidget/2599 /Resi... Secti 4. ZONING I All Information Mast Be Completed. Permit Can Be Denied Die To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L R L R Rea' Building Height Bldg Square Footage 0 0 Open Space Footage 0° (Lot area minus bldg & paved parking) of Spaces Fill (volume &Location) A. Has a 4ecial Permit/ Variance/ Finding ever been issued for/ on the site? NO DCNT KNOJU YES IF YES date issued: IF YES: Wasthe permit recorded at the Registry of Deeds? NO DONT KNON YES IF YES enter Book Page and/ or Document # B. Does the site contain a brook. body of water or wetlands? NO DCNT KNO V YES 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 IF YES describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 2 of4 3/13/2013 8:22 PM Residential_passive.pdf http:// www. northamptonma. gov/ building/uploads /listWidget/2599 /Resi... Department use only C y of Northampton Status of Permit: T B aiding Department Curb Cut/Driveway Permit '12 Main Street Sewer /Septic Availability Zee 1 L 4 Room 100 Water/Well Availability . - T � ort a mpton, MA 01060 Two Sets of Structural Plans DE Np THAMPTd� __6' 7-1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify • 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 y J W.to fie- ‘rj Map Lot Unit F (oi e- L. t 14/ CI Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: \ , A 1 Name (Print) C r t MaiIin A r s: _ V) Vi, Telephone l � S ignature 2.2 Authorized Agent: AJ��3 .e .-,c.- 5 r el 1 c 1T 0-, C / V � vlU37 Name (Pen Current ibngAdd Sign re Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 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 t� z 6. Total = (1 + 2 + 3 + 4 + 5) c'f6J ` w Check Number 7Y6 V5 This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 1 of 4 3/13/2013 8:22 PM 142 GLENDALE RD BP- 2013 -0827 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 42 -125 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP-2013-0827 Project # JS- 2013- 001425 Est. Cost: $7400.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq. ft.): 37810.08 Owner: COMMUNITY CARE RESOURCES INC Zoning: Applicant: NRB EXTERIORS INC AT: 142 GLENDALE RD Applicant Address: Phone: Insurance: 7 PHILIP CIRCLE (413) 563 -6354 WC GRANBYMA01033 ISSUED ON:3/15/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE 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. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/15/2013 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner