The URL can be used to link to this page

32C-232 ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 WANED,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 CISR, Cheryl McIntosh NE Webber & Grinnell Ins. Agency, Inc. PHO,No,E t): 413.586.0111 x117 ) FAX Not:413.586.64$1 8 North King Street ADDRESS: CMcIntosh@webberandgrinnell .com Northampton, MA 01060 PRODUCER 00023438 CUSTOMER ID N: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Berkley Assurance/REU A&J Home Improvement, Inc. INSURERB: Chartis/Cluett Attn: Andrew Deren INSURERC: 60 Washington Avenue INSURERD: -- ---_ - South Hadl a -_—__---_-.-_ Y MA 01075 INSURER E: INSURERF: I COVERAGES CERTIFICATE NUMBER: EXP 2014 GL & WC PDF 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 INSR TYPE OF INSURANCE ADDL.WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MMIDDJYYYY) (MMIDDfYYYY) GENERAL LIABILITY VUMA0032600 04/22/2013 04/22/2014 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES 100 000 PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) s Excluded A PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE _5 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PELT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) 5 ALL OWNED AUTOS - __— BODILY INJURY(Per accident) S SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) NON-OWNED AUTOS - UMBRELLA LIAB OCCUR EACH OCCURRENCE S - EXCESS LIAB CLAIMS-MADE AGGREGATE S DEDUCTIBLE S RETENTION 5 S WORKERS COMPENSATION WC003796174 05/11/2013 05/11/2014 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TQRY Lt At17S ER B ANY PROPRIETOR/EXCLUDED?ECUT7VEr., N!A E.L.EACH ACCIDENT 5 100,000 (Mandatory in NH) L E.L.DISEASE-EA EMPLOYEE S 100,000 If es, IPTI he under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Nancy Horan/CHERI ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 5`' A&J Home Improvement Inc MA Reg# 135399 60 Washington Ave Conn Reg#600705 South Hadley, MA 01075 Phone: (413) 467-1500 Customer Address Lt' .1kiehitrtl Metzger 15 Hancock Street Northampton MA Description of Duties: Slate Sections and Front Porch and Front Bay window 1. Remove existing shingles and slate from Specified areas 2. Protect home and landscaping with tarps and plywood 3. Damaged or missing wood will be replaced at an additional cost of$45 per sheet 4. Install 6' of Ice and water barrier at all eves as well as in all valleys and around penetrations 5. Install synthetic underlayment over rest of roofing deck 6. Install new 8" drip edge on all eves and rakes 7. Install new GAFELK starter shingles at eves 8. Install new GAFELK(30/lifetime) asphalt shingles to match (pewter Grey) 9. Install new GAFELK Ridge vent 10. Install new GAFELK Cap shingles 11. Clean up all debris(removal fee included) 12. Pull permit for all work Agreement bonded to furnish materials and labor according to the description above. Roofing Cost $ 9700.00 New 6" gutters and down spouts entire home $ 3800.00 This quote guaranteed for 60 days. Signature Brian Cauley Date 12-7-2012 Accepted: I hereby authorize A&J Home Improvement to perform work to the above specifications. Payment is agreed for 1/3 down deposit and balance to be due upon completion. Please sign and return one copy and return to the above address. Thank You. _ Date ,`,/2/9//3 Signature,*„e? / ,I2 ��Phone SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:� Not Applicable ❑ Name of License Holder: t 6 I Oil License Number LO Wr-IS -I?Jr T.11 10,1i Address Expiration Date 116- / Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ g f I V' t■ �, :� qg Company Name Registration Number ( O GOZ/ in,.rk _ c.SDU11/N /IA 0/0'n `'l - Address Expiration Date STelephone 4'716-2 IJ 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 issuance of the buildi ermit. Signed Affidavit Attached Yes I No ❑ 11. - Home Owner Exemption 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-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 Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition [] Replacement Windows Alteration(s) n Roofing Er Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [Ej Siding[D] Other[0] Brief Description of Proposed „ Work: &. + 9-6\01,3 o Sed ra,s n'- �Cy Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ba. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family y 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 L1hi3-a , as Owner of the subject property hereby authorize 4 1 to act on my behalf, in matters relative to work authorized by this building permit application. Signature of Owner F Date , 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 a enalties of perjury. d [�i►' , C.(A 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 Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW Q YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW Q YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued: C. Do any signs exist on the property? YES NO Q 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 Q 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 Q NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SC Department use only RECEIVED City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit MAY 2 " 20{3 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans DEPT.OF BUILDING INSPIrytife 413-587-1240 Fax 413-587-1272 Plot/Site Plans NORTHAMPTON,MA p'060 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 LS i+�nco`k ��- Map Lot Unit t Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ^ i r n+ 1 , �7 LiAk ti{..i'ZC�A ai-SOk ` r\ Ghi ct Ptt t Vck..LPtfi4 CA cu3s5 Name(Print) Current Mailing Addre s: � 1L r''Z�.�- Telephone Signature *� 2.2 Authorized Agent: Name(Print) Current Mailing Ad ss: «�� ^ L/6 70 pt. Signature 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 6. Total=(1 +2+3+4+5) 97O0,ov Check Number 3.3q1 03s- This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 15 HANCOCK ST BP-2013-1109 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 32C-232 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-2013-1109 Project# JS-2013-001830 Est.Cost: $9700.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: A & J HOME IMPROVEMENT INC 101017 Lot Size(sq. ft.): 7013.16 Owner: METZGER LINDA T Zoning:URC(100)/ Applicant: A & J HOME IMPROVEMENT INC AT: 15 HANCOCK ST Applicant Address: Phone: Insurance: 60 WASHINGTON AVE (413) 467-1500 () WC SOUTH HADLEYMA01075 ISSUED ON:5/20/2013 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 5/20/2013 0:00:00 $35.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner