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36-036 (6) ✓!ee eommoazeueald a�✓�i'aeaac�iue�l a Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards _ = Registration: 134740 One Ashburton Place Rm 1301 Expiration: 1/11/2010 Tr# 262024 Type: Private Corporation Boston,Ma.02108 U.S.METAL ROOFING DISTRIBUTION,INC. GARY REHBEIN 740 HIGH ST.SUITE 2 ...` HOLYOKE,MA 01040 Administrator Not valid without signature s AGORDCERTIFICATE OF LIABILITY INSURANCE ii1o/2ooe PRODUCER (781)273-3200 FAX: (781)273-0600 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION AND Bonacorso Insurance Agency LLC HLLDER. THISOCERTIFICATE DOES NOTE OO AMEND, EXTEND R 83 Cambridge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 1502 Burlington MA 01803 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Seneca Insurance Co. 0077 US Metal Roofing Distributors, Inc. INsuRERS_Granite State Ins. Co. 740 High Street INSURER C: INSURER D: Holyoke MA 01040 INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN 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. STE LIMITS SHOWN M&Y HAVE N REDUCED BY PAID CLAIMS. INSR ADD`L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH $ 1,000,000 rX —CDG MERCIAL GENERAL LIABILITY DAMAGE TO RENTED I a $ 50,000 A X CLAIMS MADE FX OCCUR SGL30o0109 11/7/2007 11/7/2008 MEDEXP one $ 10,000 2010 10/01 PERSONAL&ADV INJURY $ 1,000,000 X 1$2,500 Deductible GENERAL AGQ4tEGATE- $ 2,000,000 GENT,AGGREGATE LIMIT APPLIES PER: $ 2,000,000 POLICY X Loc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Es accident) $ ALL OWNED AUTOS 130DILY INJURY ` SCHEDULED AUTOS (per p—) S HIRED AUTOS BODILY INJURY NON-DINNED AUTOS (P- ) $ PROPERTY DAMAGE $ (Per accident) [TGE LIABILITY AUTO ONLY-EA ACCIDENT S NY AUTO OTHER THAN EAA $ AUTO ONLY: $ EXCESSIUMBRELLA LIABiun EACH OCCURRENCE $ 3,000,000 X OCCUR �CLAIMSMADE CDP3000109 12/7/2007 11/7/2006 A REGATE $ 3,000,000 a A OEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND AR STA OTH EMPLOYERS'LIABILITY — ANYPROPRIETORIPARTNERIEXECUTIVE MC3798224 12/1/2007 12/1/2006 E.L EACH ACCIDENT $ S00,000 B OFFICERMIEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE$ 500,000 X yes,describe under SPECIAL PROVISION$below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERUITIONSII OCA USNNi4 ADDED BY ENDORSEMENT/SPECUAL PROVISIONS I is named as the additional insured by means of I90 CG2010 1001 Blanket Waiver of Subrogation is provided. Additional Insured is named on a Primary and Non Contributory Basis, for ongoing and completed jobs. There is No Residential Exclusion. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUNG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ITS AGENTS OR REPRESENTATIVES. AUTMORMED REPRESENTATIVE Michael Bonacorso ACORD 25(2001108) 0 ACORD CORPORATION 1988 F Board of Buildin ulations One Ashburton Place, Ism 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/19/1944 Number. CS 031003 Expires:05/19/2008 Restricted To: 00 GARY C REHBEIN 16 JONATHAN JUDD CIR SOUTHAMPTON, MA 01073 Tr.no: 795.0 Keep top for receipt and change of address notification. 3&CAt v SDM-05f06-PC8490 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number.,CS 031003 Birthdate: 05/1:911944 Expires:05119/2008 Tr.no: 795.0 Restricted: 00 GARY C REHBEIN 16 JONATHAN JUDD CIR SOUTHAMPTON, MA 01073 commissioner O�(Iv}f F F (rTL� of I f Ila In p 011 � 1 DE PAR iMf1.f7 OP DUILDOIG INSPECTIOI:s 212 Alain Strcct ' Afuoicipal Building Northampton, Mass. 01060 «'0FUCL1CS CONCI'ENSATION CtSUIZANCE AFMI AVIT (liccnsxl,•PC rice) wlLb a pancipaJ place of busioessJresidcn�or: hon •; e !, �/ (srr�.Uc1 f/nak�llP P) do hereby certify, under lhe.pUrls and pcimkes of perjwy., iJla I am an employer providing tic following \Yorker's co1nocusZ don cove zc for In), C,wployces worung on this job. CL SW-am=Comr::u)•) (Polio-: Nu.-abcr) IT:pirroo„ IDac) ( ) I am a sole proprietor, generaJ cont7actor or homeowner(ci:cie one) and have hued the coocractors listed below rqbo have the follow-Lue worker's compensation policies SrllC O.Con. nci(>") Otisumnc:Compa i)-Mr,lc-, N'Li it—) (t.N 0.11C) (Nzmc of Coocraclor) Msw-?-oe: Comoan.vPolicr Numcct) (EN.-DT uon Dale) (N;mc of Conn-and,) (insuraac: Comp2Dy/polig. Numb:j) (Expira600 Datc) (Namc of Coacraetor) OAuuraac-- Comcaay/PoLcy Numt>r) �—E.xpiraiion Dale) (.oacb 13!itioclJ duo irococ.ry to znfo m.aoo peruitua{to.0 oomzcnn) I O I am a sole proprietor and bave no one worlang for rue. ( ) I am..a home owDer performing all the work myse-T NOTE:plr�be.a uc th+ i i)c bomcw vm wbo employ PC, •om co S3¢,=�orrw r�oo r trxa or c on,e„<11_t of ant coc”lbra tune xwu La"tDc'b Lbc boco w- cl rt=dm or oc the Drouo6>,ppuftcC'11 Lbcco LT c),%(,^,_.o-any oeco,dzred a t< ciiployc'undo the ue km 3 oc=pc--boa!rs(GL152ss 1(S)) W4mco by•bovuo.vc(u r U,mr c of P"mn=y c-,6caoc Lbc )clpJ rtaau of n.L eaployx node(d.o WorSt.oe.C.o07(lomat Aa- 1 yodartaod tba a oopy of(hi, mu000 o m,.y b.fo.-,.ar�f..d to tba Ocgv+mm.of codcaci M—or lro..r�far tb. oo—.ec vvri(ic%tioa,ad aw Uum to wcLio( 15 n of 1.101.131 on lad to Lb,i V.Aioo of crmiaJ Vc°-.W° 000uactg of r God of up Lo S 1,}00.00 andror in�al o(up W ooc yev cod o,-j po..liio in cx form or.Swo 14o04 Order.ad. Gm of S 100.00.day L f}ia:d LOG For dcp.rur+=..a1 u.c only Pcrmil NUMLcx Lot " Sib'$1.'wm of Licz3LSCcJPCrmiucc -- � - do;R � T fl bfl b S ddc s d SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Constructlon SSu`pervisor: /1 Not Applicable ❑ Name of License Ijolder: l 4/C I / 46/ / 7 Ucense Number zi Address Expiration Date Signature ��/ Telephone Not Applicable ❑ Company Name i Regis ration Number / r! 440/ 0 AddreW % /r j Expiration Date t✓ Telep/hoie/:�y 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-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 782. 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 ho in a two-year period shalt 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 bulldine 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 d dSErIO bD bt dag SECTION 6-DESCRIPTION OF PROPOSED WORK( heck all agnlicable) New House ❑ Addition [] Replacement Windows AkeraUon(s) ❑ Roofing or Doors 171 Accessory Bldg. ❑ Demolition ❑ New Signs 1131 Decks (p Siding[tom] Other[O] Brief Description of Propose Work: co�mtsh �e 1AiSJ&.f- S1�1i1 ?��J �E4-a3 ��1�"1dl ,[ 1�f — rG f C��i t ��✓ " � f ,i✓i/Uji !j Alteration of existing bedroom Yes�No Adding ne6eibedroom Yes �N Attached Narrative Renovating unfinished basement Yes No l Plans Attached Roll -Sheet ;AA149%E 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. fioodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No_ 1. 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 I kc—/i'v \j. (-'/*) 4 P,, ',- as Owner of the subject property hereby authorize to act on my be If~i all matters relative to work auth rized by this "ding permit application. Signature of Owner Data I, � _ ._. a. rsT/Authorized Agen here declare that the statemebts af�d)nformation n the foregoi applicati are rue d accurate,to the best of my knowledge and belief. ' C. Signed underyfy y pains and penalties of ry. Pri Na ' M ature of O dAgent Date r a E -d dcr` to Ln T J�� 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--_-_J I.: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved kin of Parking Spaces ------- -- -- Fill: ! I volume&Location) —_.--._. __. i_.-_..._ _.....____..__1� —----- A. Has a Special Permit/Variance/F ding ever been issued for/on the site? NO O DONT KNOW YES Q IF YES, date issued: IF YES: Was the permit recorded at th Re istry of Deeds? NO O DONT KNOW YES IF YES: enter Book ' Page; and/or Docu ent # B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained +Q Obtained ® Date Issued: C. Do any signs exist on the property? YES 0 NO 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 IF YES, desdribe size, type and location: t E. Will the construction activity disturb(clearing,grading, vation,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. of dSE : in in b T cl aG Clty'of Northampton F APR 2 2 2008 BuiJc )ding Department k �-fl'Main Street Ro m 100 . ,�.�� _�i4o6 harrtp on, MA 01060 0 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR T*FAMILY DWELLING ' SECTION 1 •SITE INFORMATION APR Z L 20,08 1.1 Property Address: ThFA sectlon be c6.f-fi0jdted by office ; '�� l �S Ma LRY Unit, l //�lr` �af.ilEJ f P C f _ J - — EIrviSt:District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name( �,,_ � '�'.Y Current Mailing Address; f � Telephone Signature' 2.2 Authorized Agent: N i Current Mailinj Ad s: gnature Telephone SECT10 3-ESTIMATED NS RUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only com feted by ermit 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=0 +2+3+4+5) Check Number Q This Section For Official Use Only Date Building Permit Number: Issued: Signature, Building Commissioner/Inspector of Buildings Date I -d cl E 1n bn t,i ci File#BP-2008-0925 APPLICANT/CONTACT PERSON U S METAL ROOFING DISTRIBUTORS, INC ADDRESS/PHONE 740 HIGH ST, SUITE 2 HOLYOKE (413)536-5474 PROPERTY LOCATION 5 WINCHESTER TERR MAP 36 PARCEL 036 001 ZONE URA THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid uild n,Permit Filled out ee Paid (i •� Typeof Construction:_roofing, New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FgLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO)KMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay q1Z,d0 Sig iature of Buil ing Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information. BP-2008-0925 `GIS#: COMMONWEALTH OF MASSACHUSETTS 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-2008-0925 �Ct# JS-2008-001384 Est. Cost: $0.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: U S METAL ROOFING DISTRIBUTORS, INC Lot Size(sq. ft.): 11020.68 Owner: BERUBE CYNTHIA L&EDWARD A zonin,i4: URA Applicant: U S METAL ROOFING DISTRIBUTORS INC AT: 5 WINCHESTER TERR Applicant Address: Phone: Insurance: 740 HIGH ST, SUITE 2 413) 536-5474 HOLYOKEMA01040 ISSUED ON:412212008 0:00:00 TO PERFORM THE FOLLOWING WORK.roofing 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 4/22/2008 0:00:00 $25.005092 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo