25C-043 (4) 04-04-06 10:29am From-AIG +973 331 8599 T-242 P-002/002 F-251
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PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Bresnahan Ins Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
231 Triangle Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
Amherst,MA 01002
COMPANIES AFFORDING INSURANCE
INSURED COMPANY A GRANITE STATE INSURANCE COMPANY
N R 8 Exteriors Inc
98 Granby Rd
South Hadley,MA 01075-0000
-j:'GO -ER'-A� ry Mi .'Irll.�i�;' �,IiF MA• �-Tt'l R r.Y7 WE 1�Fy�'��
THIS IS To CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 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,
c0
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE
A ORKERS COMPENSATION
ND EMPLOYERS'LIABILITY LIMITS
HE PROPRIETOR!
FFIOM SAIRE; LITdVE
FFICERSARE:
IINC ❑ExCL❑ 8738202 3/19/2006 3/19/2007 TATLITORY LIMIT&
THER
000rfto AppWs to NA Operations ONy,
CH ACCIDENT $ 100100
ISEASE POLICY LIMIT $ 500,00
IsFA6EFACH EMPI.oYEE $ 100 00
ESCRIPTION OF OPERATIONSNEHICLES/SPECIAL ITEMS
CERTIFICATE(HOLDER CANCELLATION
ADAM QUENVILLE ROOFING&SIDING SHOULD ANY OF THE ABOVE DEBCRIBED POLICIES BE CANCELLED BEFORETHE
INC EXPIRATION DATE THEREOF.T14G MUING COMPANY WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT
160 OLD LYMAN RD FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF
SOUTH HADLEY,MA 01075 ANY IUND UPON THE COMPANY,ITS AGENTS OR RF.PRESENTATNES.
AUTHORIZED REPRESENTATIVE
03/31/2006 FRI 12:14 FAX 4135344291 Bresnahan Ins. 4001/001
ACORD,,, CERTIFICATE OF LIABILITY INSURANCE 31/06 '
PRODUCER THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION
Bresnahan Insurance Agency, In ONLYANDCONFERSNORIGHTS UPON THE CER TF[CATE
231 Triangle Street HOLDER THIS CERTIFICATEDOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Amherst, MA 01002
INSURERS AFFORDING COVERAGE NAIC 0
INSURED INSURERA Northland/S.H.Smith
N R B Exteriors INSURER B•AIG/GraniteStatalnsCo
Nicholas Bernier dba INSURER C
7 Philip Circle INSURER D. _
Granby, , MA 01033
INSURER E
COVERAGES
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.
INSR D' POLICY NUMBER POU E F£C TIVE POLICY DMDTVVA LIMITS
G EACH OCCURRENCE S 1 000,000
ERCIAL GENERAL LIABILITY CP49710701 6/2/05 6/2/06 A6FS(EswTEO A ( EMISES(E.acauencs S 50,000
LAMS MADE I n l OCCUR MEDEO(-y0r!tW m S
PERSONAL BADV INJURY $ 1,000,000
$500.00 Deducti GENERAL AGGREGATE S 2,000,000
GEMLAGGREGATE LIMIT PER: PRODUCTS-COMP/OP AGG Is 2,000,000
POLICY 17 jECpT LOC
AU71M08RE LIABILITY COMBINED SINGLE UMIT
ANr wro
(Eaawldwd) S
ALL OWNED AUTOS 800ILYNJURY S
SCHEDULFD AUTOS (PW WSW)
HIRED AUTOS BOOILYINJ RV S
i
NON-OWNEDAUTOS (�
PROPERTYDAMAGE S
(Par Wd&Wg)
GARAGE LIABILITY AUTO ONLY-EAACCIDENT $
t OTHER THAN IAACC S
NLY:AUTOO AGG f
ILA LIABILITY EACH OCCURRENCE f CUUMSMAOE REGATE S S LE S N S S
(7TH,
WORKERS COMPENSQ ION AND ORY UMITS
B ENItovERS'LMBILITY to follow directly 3/19/06 3/19/07 E.LEACHACCIDENT S 100,000
ANY PROPRIETORIPIRTNER/F7(ECUTNE SrODtt the company OFFICEWMEMBEREX(1llDETJ7 P y E.L DISEASE-EAEMPLOYEE S 500,000
eyw eawD*u-49r E L DISEASE-POLICY LIMIT I f 100,000
SPECIAL PROVISIONS bebw
OTHER
D E'SCRIPTIO N OF OPERATIONS I LOCATIONS 1 VEN CLES I EXCL US*NS ADDED Dr ENDORSEMENT I SPECIAL PROVISIONS
Installation of Window, Siding and Roofing
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLIC(ESBE CANCELLED BEFO R19 THE E]E(RATION
DATE TNEREOF.THE ISSUING INSURER W ILL ENDEAVOR TO MAIL 20 D AYS W RTT TEN
Adam Quenneville Roofing kNjODIC ET4YHEyjF:r-AT-E HOLDERNAMEDTOTHELE".BUTFAILU TOD030SKALL
Siding SEN OR LIABILITY OF AN ND UPON THE W45UR . AGENTS OR
160 Old Lyman Road E South Hadley, MA 01075
ACORD 25(2001108) O ACORD CORPORATION 1988
�•t11J.H.J\J.
p�, � �1.Ifli I,1f �-`i ttl".���t•111T�1'rR Ii _
D assAC kits Ctt3 e
m DGP!'UU'MENT OF BUILDING INSPECTIONS
212 Drain Street ' Municipal Builcling
Northampton, lfrt6s. 01060 '
WOMCER'S COiYITENI SATION 1NSURANC ' kF 4 c1VIT
(]leers°�'fcrmillcc)
NvIth a principal plau of business/res deuce
U3.. (phanc
_ -
do hereby ccr-df};, ua:{d.1 die n ills :.Z16 PcllalucC; of pef111t)t,
(1))`11 any all C.111ployer providing the iollo'.vi11C 'vOIr;CI1S Co111F)CnS3uon rovuzaLC `or Illy
ettlployces wo6drlg on this job:
( amxanG' CoIIpam') (cLc-,Number) (Fa:pir-t on Date)
j T a>?1 a sole propri *_Gr general conrr=cr honleo%v-oe; ; rcle one's and lave aired
the contractors listed. beiow v, II; the :Olio:. r
o t ms �v ke s cor pen�-,.Ion vo!1C.es,
(Mane of Contractor) (i..nsumncc Ccrppa-i -'PoGcf Nusnbc-r) (Lx;:::a;cr.Datc)-
(Na-me of Contr,coo) -- (1Jistlr_rcc Comoa;1v/PohC-" Nuntrr) (} ?:oir tiea Date)
(Nlame of Contractor) (Insumnc: (_-tit:,;:,].'./0I;C-, NIUl)b_-r) x;. r,:io Date)
(Name of Cont actcr) _ (1'nsur-Lu cc Compa-,w Policy Numb^Jj (E::r;i-tio-Date)
( I still it sole propric.,0i i'.i1;1 havC no 7i'.0
{, I Rill Lt home
NOTE.:ptGSsc be fm c[he 1\u'!lC�.CtiG:JN�1'�1 N�tJ !�jY.. u5(i) t_'r:.l].ClC C�CL.�_r.:.=.:�`Cl Cr::ySU\\'..IL r w_li\l�ltr^..^�C.
not uxcc Shan throe units i:-,tc dt he 1; .ti>;uzrj rc: s C'a;t:� •;-.^�: c-rt:c rt Lhcro:c o-.:<C-vJal1y a•:
C0,00ycz u.�:erthc wc:i;era cttrt—:_i.n l+r.{<ii!S�Va1(51 -atic;by a F.nt:ico\.-,rt`or e L1x-::c cc p:r.^.:i:: _ -..time Lin
legal;tabu of cn ccaployw under than Wociccrt is {a .lion t.ci
i undc.itan f tlai a copy of ihii t sate Gr1"•.y bo fotvwtio-!to ILo 1Ystwt—n:of Ini atri_l Az6,'_.t:f Oifioe of!:: .-s :e for ttx
COVi:mgc vc iBcZlioa and that r.tlurc to tcauc coti:r_;-un3.:::cCU-125A of MGL,152 can Ic--d to the iatpositiocs o. pct:a!t:c
oomistitg of it flux orup to S 1S00.00 etrdlcr i pr':�� :!of::p to cn:}.ar a:.1 civil]Km1uC3 in do ilxtn of n S!rl',Vai'.Ovz erd a
tit-oCS1W.W i day i fain:l m:. .
- Fur ciq;uutrrtnl u►c oily I
Lol
ba1UCT4Q_1 S��RYICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Not Applicable ❑
Company Name Registration Number
]
Address },� Expiration Date
G . 1 to d l� Telephone 91� 5�� Y 4
{SEG 10 1� 0 {f01 {rQ$,;' OMNPW$AT.ION-1NSU,.RANCE4AF.FiDAN.IT 152,
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....... t9�- No...... O
A
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"homeoNvner"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 fix 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 _
S 10 NOSEQ I]cali ayI',•�} �-�
R71@1100'17.MA=0
k 9Td>94r. ?L'Y!G.RTG6' Y�
New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ } Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: C;P-M�VRL. FF(Ste: Shsty\es
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative a Renovating unfinished basement Yes No
Plans Attached Roll ❑ - Sheet❑
6ai ;ifOnta a rrj � tv srngm'p ` °effil10
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. bimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck 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
1. Septic Tank City Sewer Private well City water Supply
' F k
E � 3 �R1�,4TfON 46 13 COMPE°TD!1111HN r
�O�K 1��T�R�APPL'IES°FOFt �IItL�D}1+#`G PERMIT ��
c �r
as Owner of the subject property
hereby authorize -ms ms to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner 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 and penalties of perjury.
N s C ( iL FO htT1
Print Name
Signature of Owner/Agent Date
J
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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. 1-las a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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-'(ES, describe size, type and location:
i-ty of Northampton
ilding Department
2 Man Street
Room 100
No ampton, MA 01060
phone 4133-587 71240 Fax 413-587-1272
APPUC,4TION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION -Su ITE INF:OIMATION ,-
..
1.1 Property Address: y
i v C)c-kcl-ry, �+ �,
EI r5:tI'Vistr ct ,�__..:."'R:., B, s 4c. .. _.._. F
SEGTION 2-'P;ROPERTY 0,V.VNERSi it AllTHORIZgl)gGENT
2 1 Owner of Record:
114 Ljq
Name(Print) Current Mailing Address:
Telephone
Signature _
2.2 Authorized Agent:
MA
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3 -.ESTIMATED CON'S'T_RU�TIO.N COSTS
Item Estimated Cost(Dollars) to be officia:Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
i 1 boo 0
2. Elec,rical (b) stimated Total Cost of
Construction,,fro;m- 6
3. Plumbing Building Permit fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 + 4 + 5) 0CX) ou Check Number
.This_S'e:ction-For Official Use O.n
Budding Permit Nlamber: Date Issued:
ignature:
I,. Building Commissioner/lnspector.of Buildings Date
A2$WOODBINE AVE BP-2006-1071
G1S#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Buildinq
Category: BUILDING PERMIT
Permit# BP-2006-1071
Project# JS-2006-1582
Est.Cost: $11000.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 147961
Lot Size(sq. ft.): 3920.40 Owner: O'CONNOR COLLEEN M
Zoning:URB Applicant: NRB EXTERIORS INC
AT. 28 WOODBINE AVE
Applicant Address: Phone: Insurance:
48 GRANBY RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON:41712006 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 4/7/2006 0:00:00 $25.00301
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo