24D-326 (3) w
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9oara at Building Regulations ana Standards
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o .
JOHN A PERRIEW
39 EAST MAIN ST' ��� �
STAFFORD SPRfCVt""#
Lxpiratlon
122 V2015
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JOHN PERRIER
JOHN PERRIER
69 EAST MAIN ST
STAFFORD.CT 06076 LlndrnrrtctAry
i
i
CERTIFICATE OF LIABILITY INSURANCE °"wo'mw"
12117/14
THIS CERTIFICATE IS ISSUEO AS A MATTER OFINFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NENATIVELY AMEND,EXTEND OR ALTER THE COVERA08 AFFORDED BY THE POLICIES
BELOW: THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURMS),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT. N 00 eirifffia ►holdar'is an ADDITIONAL INSURED.the you cY(in)mat bo sndoel OCL a SUBROGATION IB WAIVED,subHet to
ala terms and gondiGorse of oo poEaY,06"n 1+0401011 maY r,tluirs an aWarsement. A stI1114 t on this Cartl(I doss not comer lights to the
ceMcats hokbr h1 bu of such ondom ment(s).
PRODUCER cT
Pai d w Financial&Ins SNS,LLC aNal 860)684-5270 880 86149564
8 East Main Street L cparecoweparedlaain:mme.com
Stafford So fts,CT 08076 INSURER 8 APPOROW COVERA 11 1 Phone 880 884.5270 Fax 860 651.9564 INSURER A: NAU71LUS INSURANCE COMPANY 17370
nlsur;El
IraUR R Al�,ts 18232
New England careen ti matt LLG . TOWS NIMI" 25480
68 East Main St I
Stafford Springs,CT 08878 I"$- URA a
Ib., URER F
COVERAGIES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF 94SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE'FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REOUIREI4ENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Iran
AM TYPE OFBIBURAI U im �`I� oa Ie" Uwm
09W. ,LM�xrY 1000000.00
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COMMERCIAL GEtERA1.UASHUTY Is 100,000.00
❑ ❑ CLAIM$MADE 2] OCCUR NN386246 M4" L rt s 5,000.00
A ❑ Y 09Hat2014 08NBI2015 RY i 1,000,000.00
S 2 000 000.00
LGEWL AGGRE"TE Lwrr APPLES PER: ccr s 2,000.000:00
R)POLICY ❑ P ❑ LOC Is
AUTOMOBILE WBRm LIMIT 1,000.000.00
❑ ANY AUTO SOOIIY wAm(Per penal $
ALL CwNEO H Lea 048188456 BODILY INJURY(PW e
B ❑ AUrE$ ® MU Y 10!04!2014 10104/2015
Q iaRETI AUt09 NON-OWNED s
UMMUA LIAR Q OCCUR 2358513140AL1 EACH OCCURRENCE i.000.000.00
G 0 J!"E"U" 0 CLOUM34MADE Y 04/23/2014 04/23/2015 AQQREOATE $ 1,000,000.00
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DESCRIPTION OF PERATIOS I LOCATIONS I VOWLEB(Aft eh ACORD lot,Addaiohld R,m,rks BChWUK a mo»apses Is r quUSd)
Consmation Services Group. WMECO and NSTAR are named addllf"insured
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE OUMREC IN
ACCORDANCE MTN THE POLICY PROVISION&
AUTNORI2EaaEPRESENTATIVB j �������
018884010ACOt M'MINI 0K-,Aid# 1 W0.
ACORD 25 j20lO108)IaF' Tito ACORD, i tl'IoBIt:EI±ei r Tr a:riw 41t A+ iD
,.�"""" NEMOL 20 CLEISENRING
'` CERTIFICATE OF LIABILITY INSURANCE °�TM "'
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION-ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE Af rORDED BY TILE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOE'S NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING niSURER(S),AUTHORIZED
REPIUUTAYM Oft PRODUCER,AND VHS CERTIFICATE HOLDER.
IMPDRTANTi if the cor0cato holder Is an ADDITIONAL INSURED,the pollcy(tes)must be endorsed. if SUBROGATION IS WAIVED,subjeotto
ft teens vul condltldns of dw policy,certain policies may require an ondommsnt. A staftmant on this i:erttflcatrr doss not confer d9ift to the
certificate holder In Ilau of suctt endorsame s.
PRODUCER Sharon Johnson
AP i o Insurance Group,LLC
144 Noah Road fte.21AS00)274 4832
Suite 2050 ,In a int o.com
Sudbury,MA 01778 INSURMAMORIMCOVERM NAILS
II,SWERA.Guard Insurance Group"* 25844
INStaISO INSURER B.,
NEW ENO EN C IN RER C
50 E MAI INsuRERo
$tE eta R e
INSURER R
COVERAGES I MBER: Ro N NUMBER:
THIS IS TO CERWY"T9 E D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, 14070ITHSTANDINt3 ENT' ONDITION OF ANY CONTRACTOR OTHER DOCUMIENT11M RESPECTTO WHICH THIS
CERTIFICATE MAY BE ISSUED OR N, AFFORDED BY THE POLICIES OESCRISEO HEREIN IS SUBJECTTOALLTHETERMS.
EXCLUSIONS AND CONINTIONS OF !ES HAVE BEEN REDUCED BY PAID CLAIMS.
L r toFMORO" OEM% Ulm
COMM1 ACIALOW40ALUA61f41TY A, EACHOCCURRENCE 3
Clurrffi IuDE Q acd E L�s
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$
PERSONAL&ADVWJWRY 11
Ot tJ L At1GREpATE OENEM AOOREOATE II
POLICY L PROOUCtB-OOMPIOP A00 S
OTHER: [ $
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pw MI NNI Esca voE°' C - EAR t _._100,00
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1 AN
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CERTIFICATE HOLDER CANCELLATION
$MOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PROOF OF COVERAGE THE EXPIRATION DATE THEREOF, NOTICE' WILL 89 DELIVERED IN
ACCORDANCE WITH THE POLICY'PROVISION&
AUTMORWM RCPREAMWATIVE
ACORD 26(204101): The ACORD name and logo are regislarod marks Of ACORO
SECTION S: CONSTRUCTION SERVICES
&I contrudlet Snpervlsor Lieense(CSL)
0
ltU t L1==Nombec Fatpirstion Date
Nam ofCSL Holder i W1 List GSL Type below).
No.sod'SUVO Type taoaarlptaa
u UmeadoW S i to 3 en.&
Cltylfbwn,State,ZIP �r T R R `� P i lit
RC Roollnit caverinit
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SP Solid Puet Buming Appliancca
low
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lu Reoftro H ootelmprovenrrn#Contractor(NIC) L-4
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SECTION 6t WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.ISL#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 orthe building permit.
Signed Afriidavit Atitache d? Yes..........111 No...........O
SECTION 7at 6WNER AUTHORIZATION TO BF COMPLRTED'WHEN
OWNERI&AGENT OR CONTLtAMB APPLES FU .BUILDING'PERMIT
I,as Owner of the,subject property,hereby authorize bk EW__4 r 0 CxQ l muss
tout on my behalf,in ail rnattors relative to work authorized by this building permit ap llcation.
,b)w V)C� e_.'�
Print VwnW s Nam(Ecctroolc.Signature)
SECTION 7bt OWNEW OR AUTHORIZED ACEWDECLARATI(W
By entering my name below,I hereby sliest under the pains and penalties of perjury that all of the information
eont*W in this.awitcation is true and accurate to the best of my knowledge and understanding.
r
PrinC ors or,Authorized Agent's Nome(Sioctmniv Sigrwture) Date'
NOTES:
I. An Omer,who.obtaina a bu iding permit to do hWW own Work,or an owner who hires an unreg coaawtor'
(not reg&te W In the Horne Improvement Conttnctor(HIC)Program),will ad have MW to the arbitration
program or guaranty fund under M:G.L.c. 142A.Other important Information on the HIC Program can bo1ound at
Sy,}i(w.mass pay1 ea Information on tho-Construction Supervisor License can ba fvmd u www.mass.aov/dam
2. Who substantial work'is plaatned,provide the information below:
Totul,floor MA(sq.ft,) (including garage,finished basempWattics.decks or porch)
Groea 1lvin$area(sq.ft,) Habitable'room count
Number of fhptaces Number of bedrooms
Number:of bathrooms NumUr of halfibatite
Type of heating system Number of dedW porches
Type ofcooling system Enclosed Open
3. "'iota)Project Squans Footage"maybe substituted for"Total ProjectCost"
The Commnwealth of Massachusetts
Departwnt of IndustrialAccidents
Offlee of Investigations
VL 1 Congress Street,Suite IOU
Boston,MA 02114.2017
www.mass gov/dla
Workers'Compensation Insurance Affidavit!Builders/Contractors/Etectriciattf'tumben
i P t. b
Nttilm(ausinoworgnnizationrtndividuaU:New England Green homes
4,(lkz41 Address. . �/
C Saie/Li 9igow.CY Oi07
-930.77 Phone#:8u
Am you as easployrl0 Clerk the approprrinte box: Type 0f PrQj (r0gM1 ):
1.0 1 am a employer with 4 4. [] I am a general contractor and 1 6. (�New�+jtlsttttcti4n
employees(full"or part-time)*a have hired the sub-contractors
2.Q 1 im a sole proprietor or partrier- listed on the attochod sheot. 7. Q Remodeling
ship And have no emplclYees These sub•contructors have g. Mmolition
working far me in say capacity. employees and have workers'
Y�P Y 9. []Suiiding addidan
� len'eoinp.insurance w rip.insuriince.t
s. (] We ery a corlsoration arnt its 10.❑Electrical repairs orsdditions
3,C]t am s boinoowner doing all work offices have exercised their i Q:)Plumbittg rapah or additions
myself:(No workers'comp, right of exemption per MOL 12.[ Roofrepairs
insmuce required.]r
C. 152,,j 1(4),and wo have no
employees.(NO workers' 13.0 Other
corn .insurance required..)
'Ally soptittlat that chocks box A 1 must also fill out the motion Wow showing thsir worfian'compensstton policy iftro film,
t Ho ubwsim who su/alit this affidavit indicating they arc doing all wori,oud than him volWo roatraawrs must submit s now sn*vb b abed g tvah,
tC ta�xors that chxk this tax must attached as sdditional shear showing the name or the sub-mat uion and sate whether or not those enlidattsve
w"playsim Our wb aasbseioa have employm,they mun provide their workers'comp policy numbet.
1 ciao a»teploys►tkad ' p arncfprvvdyg works Below It NYdP0fiV W jeb tells
wornastbn,
Witurat4ge Company Nettle..lnt*g0
Poligy N or Scif-ins.Lic.K:NawC424991 Expiration gate:
Job Site Arid a•f111$tt3@C6lli Gity/SMI'V P:
Abet r+s m*(the woriterst consinnsation policy declaration page(showing the polity BMW Ud ax a data).
Faliureto satntre covatage as required under Section 25A ofMOL c. 152 can lead to the imposition of criminal penaitieg of a
Fla@ up to$1,500.00 and/or ontt-year Imprisonment,as well as civil ponalties in the form of s STOP WORK ORDER and a fine
of up to$250.00-a day aping the violator. 'Be advised that a copy of this statement may be forwarded to the Ofl"rctl of
Inyesuptiorts of tft DEA ror tnau"nca vuvcreve-wirtaarrut,
ure>t maani
1 do bcr` cent Urine tat airs den rigs o er stn'that der to orrrartor Provided above h tone riuutal Camax
,p�cJai into taai,� pp notwrUe in this area.to be eo»tpietad'by city or town aJjlciat
City or Town. Permit/Ucense N
issulas Authority(circle on*):
j,Bosrooftisantt 2.Building Dopartrnonr I Ciry/Tuwn Clerk J. Mv.trieal inspector A.Wumblav lospeeter
6,Ut6rer �.
rlxttDe#:
f L
w�
a ,
' '
E , The Commonwealth of Mlassachusolts
FR
l mom Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code,780 CMR
Use
LT z Building Permit Application To Constant,Repair,Renovate Or Demolish a Rovised'Uv 2011'
4 One.or Two Famfly Dwelling
This Section For Official Use Unl
Building Pertttit'Number. Date Applied:
Bur1lft Official(Print Nano) Signature Diu
SECTION 1;SITE INFORMATION
I Pro 1.2 Assessors Map&Parcel Numbers
I 1 is,tkss an ted met? es no Map Numbar ParcetNumber
1.3 Zoning Information., 1.4 Property Dimensions;
Zoning District Proposed Use Lot Area(sq it) Frodoge(A)
1.5 Bullding Setbacks(ft)
Fresh Yard Side Yards Rest Yard
Required Provided Re quircd ProYidcd Required Provi ied
1.6 Water Supply:(M.G.L c.40.;s4) 1.7 Flood Zone Informition; 1.8$*wag#DisposatSystem:
Public 0 Private O Zone: Outside Flood Zone? Municipal C) On site dispow System O
Check if
SECTION 2: PROPERTY OWNI:RSHIP`
2 wne 'o titer
aaw{Print Ci Ststa.ZIP
�0?d a a)
No.Sid Street Telephone Finsil,Address
$=ION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
Now Construction O Existing Building D Owner-Occupied 0 1 Repairs(s) C1 Alteratlott(s) 0 1 Addition 0
Demolition 0 Accessory Bidg,0 Number of Units I Other ❑ Speclty
Brief v0scription of Proposed Work
SECTION 4:ESTIMATED coNSTRucriQN co
Item estimated Costs; Oflldal Use Only
Labor and Materials
Building I. Building Permit Fee:S Indicate low fee
1.Bui S is destettninad:
Electrical $ 0 Standard City/Town Application Fee
2.Bu lding
O Total Pmjeet Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: S
4.Mechanical (HVA.C) S List:
5.Mechanical (Fire $
5 ressan Total Ail Fees;S
,J� Check No. Check Amount: Cash Amount:
6.Total Project Cost: S ✓f v 0 Paid in FAVI O Outstanding Balance Due;,,___,.__,_..
f[l NECiN
f 28 Spellman Rd.
Stafford Springs,CT 06076
icry,.,
File#BP-2016-0368
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794
PROPERTY LOCATION 5 PROSPECT CT
MAP 24D PARCEL 326 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Z12
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
4_.-0=roved 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
i
NPINTU—re o Building O icial 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.
5 PROSPECT CT BP-2016-0368
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-326 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoa: INSULATION BUILDING PERMIT
Permit# BP-2016-0368
Proiect# JS-2016-000599
Est. Cost: $1889.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 4399.56 Owner: CHIARA GREGORY J&ANN W
Zonin_g_URC(100)/ Applicant: JOHN PERRIER
AT. 5 PROSPECT CT
Applicant Address: Phone: Insurance:
18 BROADWAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON.912312015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
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 OccuRancy Signature:
FeeType: Date Paid: Amount:
Building 9/23/2015 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner