31A-308 (2) rt9PilV N A 1)t11,11
Phone:413-563-6354
14,,E,; Fax#:467 9748
MA CSL#•99565 a wrr,__
(Owner)WWI "Y°= � www.nrbexteriors.com
EXTERIOR HOME IMPROVEMENTS,Inc, !
ROOFING&SEAMLESS GUTTERS 1
sh-tngieMaster- l 1
cecaw�a
Windows-Siding Decks
Residential-Commercial
Proposal submitted to: Phone# h: L c:
( 06 _ry Special requirements
Street 9 f
City,state,zip code
Proposal to furnish and install the following
❑ Re-roof X)rear-off D Gutters
NQ We shall acquire necessary permits for all work
Complete Roof Preparation
H Home's exterior to be protected by tarps and plywood
kJ Shrubs,landscaping,trees to be protected,roofers buggy used
Entire existing roofing materials to be removed to existing decking,including flashing,etc.
Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster
® Deteriorated existing decking to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
Install Winterguard ice&water barrier along bottom 013 ft_of all roofs, 0 6 ft.
Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas
�4stall 15#saturated asphalt felt paper to entire decking
y Install Roofers Select Premium underlayment to entire decking
Install DiamondDeck Synthetic underlayment to entire decking
LV Install 8"perimeter metal flashing to all edges of all roofs,A white 0 brown
I4 Install SwiftStart starter shingle to bottom and rake edges of all roofs
Install CertainTeed shingles to manufacturers specifications, 0 6 nails �P4 nails
(C} Install Shingle Vent II PVC ridge vent to all peaks in heated areas
l� Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
@ Install new lead counter flashing to chimney
Ib New flashing installed where necessary
Install new pipe flashing to waste vent stacks
Warranty options
{� We guarantee our labor/workmanship for 20 years
❑ Upgrade CertainTeed 5-Star Sure Start Plus,50-year nonprorated coverage,including workmanship
Upgrade CertainTeed 4-Star Su Plus 50-year non rorawd coverage
❑ CertainTeed Landmark-color �rrAA11Tf 3-tab
❑ CertainTeed Landmark Pro-color
We propose hereby to furnish materials and labor—complete in accordance with above specifications for the sum of--Total Due $ t.
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are - I/3 Down Payment$ S�OizJ
satisfactory and are hereby accepted You are authorized to do work as specified. Balance due
Payment will be 1/3 down at start of job,a nc ue upon completion. upon completion $
Date: a Signature: ►
Date: -a 3-r Estimator:(Print Name) t- 4�t'i 1�.✓ (Sign Name
Estimates are honored for thirty(30)days from above date
ATTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the
possibility of roofing debris or dust in through cracks of the wood.NRB Exteriors Inc.will not be responsible for
debris or dust in the attic or storage areas.
A Finance Charge of 1'h%monthly(ANNUAL PERCENTAGE RATE OF i g%)will be added to the unpaid portion of the balance due.I
agree to pay and/or guarantee payment of these charges.In the event of default of payment,I agree to pay reasonable Attorney's fees and
court costs.This agreement does not constitute a release of liability.By my signature below,acknowledges an agreement of the above is
hereby made. /
Signature: Y \ 1�
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 81 U Z /4 6' S
The debris will be transported by:
The debris will be received by: (c,
Building permit number:
Name of Permit Applicant
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of Investigations
I Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information A I p Please Print Legibly
Name (Business/Organization/Individual): N �\ 13�
Address: -7 C,v
City/State/Zip: Phone#: ("16 s
Are you an employer?Check t e appropriate box: Type of project(required):
1.nI am a employer with 1 4. ❑ I am a general contractor and 1
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working or me in an capacity. employees and have workers'
g y p ty• 9. E] Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑ Other
comp. insurance required.]
'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy infonnation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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 workers'compensation insurance for my employees. Below is the policy and job site
information. A ?
Insurance Company Name: "1,i" w li
Policy#or Self-ins. Lic. #: Z Z k C -11-1 -1 Expiration Date:
Job Site Address: K7 City/State/Zip: A, L- h.: 'A,
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
die up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form 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 DIA for insurance coverage verification.
I do hereby certify under airs and penalties of perjury that the information provided above is true and correct
Si afore: !! Date:
Phone#: �y
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#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holier: 1 w4 i R k'yA 09 9 (-('
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
:7 0 L. ,n t ;'/ �V"G„ P'1� V--�) -5 — 17
Addr�— Expiration Date
Telephone ;
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...... ❑
11. - Home Owner Exem tion
The current exemption%"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeown'L,to engage an individual for hire who does not possess a license, r4v4d that the owner acts
as su rvisor.CMR 780 Siat dition Section 1083.5.1.
Definition of Homeowner:Person(s ho own a parcel of land on which h®lsffe resides or intends to resid ,on which there
is,or is intended to be,a one or two famil elling,attached or dejaelied structures accessory to such use and/or farm
structures.A person who constructs more tha ne home i"o-year period shall not be considered'a homeowner.
Such"homeowner"shall submit to the Building O n a form acceptable to the Building Official,that he/she shall be
res onsible for all such work perfor ed underAlre buMne nermit.
As acting Construction Supervisor your prpodhice on the job ' will be required from time to time,during and upon
completion of the work for which this p t is issued.
Also be advised that with reference Chapter 152(Workers'Compensa nd Chapter"153(Liability of Employers to
Employees for injuries not resulf g in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for y 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) ❑ Roofing
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [EI] Decks [Q Siding[0] Other[O]
Brief Descripbon of Proposed ,, I p�
Work: k z,r.�,r.,c. e U< V b®E �,+ 11 J1/L✓ V�a7 Z J ` `'�- T C .
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa. 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?
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
I, i n as Owner of the subject
property n
hereby authorize P�'
to act on my be f, i all ma ers relative to work authorized by this building permit application.
Signature of er Date
-Q-1�-����"r 1� 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 u r the pains and penalties of perjury.
L. �� �t�✓l .l�!
P nt Warne
'-.,
Signature of Owner/Agent Date rte"
y,J_ rr Department use only
City of Northampton Status of Permit:
�, 6 ;i "� Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
pEPT OF BULGING M A 01060 rthampton, MA 01060 Two Sets of Structural Plans
NORTI'AMPTON MA 01060
phone 413-587-1240 Fax 413-587-1272 PlottSite Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooerty Address: This section to be completed by office
Viw Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t3 .. v .,.J2.- � ( V P J� C._^ J�` cl,,ld►�tiy/Jrc-�. ��!
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
N tyC}- /�+y`C ��L "t e1 C. ✓ /c"��l �, d tcl� 3
Name(P' t) Current Mailing Addr ss:
. � = '�' C3
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by rmit 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) (1 (jo, l Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
87 VERNON ST BP-2016-0566
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A-308 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-2016-0566
Project# JS-2016-000950
Est.Cost: $15000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sg. ft.): 11194.92 Owner: DIONNE ROBERT R&DALE C
Zoning:URA(100)/ Applicant: NRB EXTERIORS INC
AT. 87 VERNON ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563-6354 WC
GRANBYMA01033 ISSUED ON.1012612015 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 Siunature:
FeeType: Date Paid: Amount:
Building 10/26/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner