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36-263 (8) 01 �i//,- rtce of Consumer Affairs& Business Regulation -OME IMPROVEMENT CONTRACTOR ,, oegistration: 118751 Type; V,W txpiration: 4/18/2017 'DBA LYLE ROOFING&SIDING WILLIAM,LYLE 1851 NORTHAMPTON ST HOLYOKE,MA 01040 - Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction SuperI i,ur Sluci.jltN cease: CSSL-105508 WILLIAM T LYLE 1851 NORTHAMIPTOP(i HOLYOKE MA 81040 f' ✓�� � ( n !',4 Exoiraflon Commissioner 11/14/2015 f r r i i I C DATE (MUMDNYYY) ACORO' CERTIFICATE OF LIABILITY INSURANCE 09/2912015 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(les) must be endorsed, If SUBROGATION IS WAIVED, 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 Phone:(413)967-3327 Fax:413-967A607 cCOONNTACT Moulton Insurance Agency,Inc -- -- MOULTON INSURANCE AGENCY,INC. PHONE 413 967-3327 AX Ne):_ 413-967-4607 143 WEST STREET E-MAIL Exl)_( ) __. ADDRESS: - P OBOX 90 ____ . - INSURER(S)AFFORDING COVERAGE NAIC If WARE MA 01082 INSURER :Penn America INSURED INSURER B JOSEPH STARKOFF DBA UMBRELLA ROOFING INSURER 80 HITCHCOCK STREET INSURER D: HOLYOKE MA 01040 INSURER INSURER F COVERAGES CERTIFICATE NUMBER: 30934 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 PA!U CLAIMS. INSR POLICY EFF POLICY EXP LIMITS ADbl SUBR TYPE OF INSURANCE POLICY NUMBER LTR. INSR WVDL _-...- -_.__-.. .-_._.._ MWDO/YYYY7 LMMIDDIYYYY.1 A GENERAL LIABILITY PAV0057575 04118/15 04/18/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE (Rc,venceENTED $ 100,000 MI PRESES S Roc ) CLAIMS-MADE X-.00CUR MED.EXP(Any one person)-. $ -- 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY Via..-. LOC - $ COMBINED BINDLE LIMIT X AUTOMOBILE LIABILITY Not Provided (Ee.ccldenl) $ ANY AUTO BODILY INJURY(Per person) $ ffNCN--0WNEO CHDULED ALL OWNED UTOS BODILY INJURY(Per accident) $ AUTOS — —— P ar a-id Y DAMAGE HIRED AUTOS TOS ',, (!»recede^q a X UMBRELLA LIAB OCCUR Not Provided EACH OCCURRENCE $ Excess LIAe _ CLAIMS MADE AGGREGATE $ - - DED I !RETENTION$ $ - -- — we srATti=- _oili X WORKERS COMPENSATION Company To issue TORY LIMITS ER $ AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTMEWEKECUTIYE r/N- E.L.EACH ACCIDENT $ OFP CERIMEMBER EXCLUDED? NIA " E.L.DISEASE-EA EMPLOYEE $ (,(Mandatory M NHI It yes,daacnbe under E.L.DISEASE-POLICY LIMIT $ IDESCRIPTIONOFOPERATK)NSbelov -_.- X Not Provided DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ROOFING AND HANDYPERSON COVERAGE SUBJECT TO ALL POLICY CONDITIONS AND EXCLUSIONS CERTIFICATE HOLDER CANCELLATION CITY OF HOLYOKE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 KOREAN VETERANS PLAZA ACCORDANCE WITH THE POLICY PROVISIONS. HOLYOKE,MA 01040 AUTHORIZED REPRESENTATIVE Attention: Adam C.Moulton,Account Executive ACORD 25(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i ., I TRAVELERS, WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6HUB-5B95762-5-15) RENEWAL OF (6HUB-5B95762-5-14) INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA NCCI CO CODE: 13439 1. INSURED: PRODUCER: STARKOFF , JOSEPH DBA UMBRELLA MOULTON INS AGCY INC ROOFING P.O. BOX 90 80 HITCHCOCK STREET WARE MA 01082 HOLYOKE MA 01040 Insured is AN INDIVIDUAL Other work places and Identification numbers are shown in the schedule(s) attached. 2. The policy period is from 04-30-15 to 04-30-16 12:01 A.M. at the Insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA •s B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in s item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, If any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 066 n� D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required Information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 04-20-15 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: MOULTON INS AGCY INC 233RS 000173 L 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: 3 4 G e 1ADC The debris will be transported by: rl-61c - oS�`P� The debris will be received by: Building permit number: Name of Permit Applicant L&a Date Signature of Permit Applicant City o= Northampton g \ / y Massachusetts r. {, r .> - DEPARTlUF'NT OF BUILDINd INSPECTIONS F � 1 212 Main Street • Municipal Building Northampton, MA ',,01060 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT F f Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her n supervisor. The state defines "Homeowner' as " Person(s) who owns a parcel on which des or intends to be, a one or two family dwellrfng, attached or detached structures o such use and/or farm structures. A person who constructs more than one home in a two- year perod shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation/footings (before backfill) sonotube holes (before pour) a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificpte of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be i responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections, Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made 1, understand the above. (Home owner/resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date Address of work location i i The Commonwealth of4lassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 1J1y2 & Aj�� Address: C� iC City/State/Zip: Yalyq e C110 LO Phone#: 4F FT ©d Are you an employer? Check the appropriate bo Type of project(required): 1.❑ I am a employer with 4. am a general contractor and I employees (fall 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 8. Demolition working for mein any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. ❑Building addition required.] 5. F-1 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#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 mustprovide 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. T Insurance Company Name: I/_elela- Policy#or Self-ins.Lic. #:c*'p a�E>e 2 "-?--1,-r Expiration Date: O ;/ Job Site Address: 3 1W City/State/Zip: Attach a copy of the workers' compensa 'on 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 fine 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 certi under the pains Valties o jury th the information provided above is true and correct. Sim ature: Date: Phone w_7 a � 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 Holder: W( Y/-el i- 4/P I—J-2;7 P License Number ffo&0-6e Address T Expiration Date Signature Telephone 9 :Regisfered_Home'Improvement.Contractors _ _._ Not Applicable £ z-lde- Comp6ny Name Registration Number av-1 3a Address Expiration Date Telephone'dyS3 SECTION 10-WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affid it must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the b ' ing permit. Signed Affidavit Attached Yes....... £ No...... £ 11 =_Hone__4wner Ege><nptll'on 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 forks acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building prermit. 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. i i i i SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) ❑ Roofing Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs [[2] Decks [❑ Siding [❑] Other[❑] Brief De iption of Proposed work: ElelbUe t foot 4Leiz no ecl (-941H 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._orad dl: otr.tq existln housin` corn fefe fhe.foalowln' 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 L 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. as Owner of the subject property r LLIe hereby authorize 11(u,, to act on my behalf,in all matters relative 4o work authorized by this building permit application. Signature of Owner Date /O & . 1,— W,/b , as OwnerlAuthorized Agent hereby declare thaf 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. Wllle.— 1_v/e Print Name Signature of Owner/Agent Date ' x Section 4. ZONING All Information Must Be Completed. Perrhit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled,rjfi by Building Department P Lot Size i Frontage Setbacks Front Side L:' f R:= L: R:I t Rear ' Building Height F i BIdg. Square Footage Open Space Footage (Lot area minus bldg&paved arkin ) #of Parking Spaces l-- Fill: t e (volume&Location) I 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 0 DONT KNOW 0 YES Q_� i and/or Document# x IF YES: enter Book ! I Page I u � , B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained , Date Issued: C. Do any signs exist on the property? YES Q NO Q IF YES, describe size, type and location: f D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO 0 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 O NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. IryI I II S - �r-� °1 Deparfroent use only i <Yti „ City of Northampton Status,ofP�rmrt i'4 r - Building Department it `1 �� 212 Main Street SewerlSepeAuaira6✓hty ' UP �-� Ns Room 100 �/Vater/V�fei�Ruaila6ility o f G�SQ�tiO� Northampton, MA 01060 TwaSefsrafStruetorai Platys 0�0� oN�M one 413-587-1240 Fax 413-587-1272 P.;Iof/Site Plans t' ;Other Specify -t+ 1 1 ;� ' Jl __ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION "`"- This secfion f be cornplefed by office "` ._:. -..., e dress: —- - - 1.1 Prop rty Ad Y3 AL - y� • _ Zone _. _— ,__.:- _ :Overlay Disfrict=. -_. _-—� �- F EIm St Dstnct _ �.CB District SECTION 2.7 PROPERTY OWN ER SHIP/AUTHORIZED AGENT- 2.1 Owaer of Record- 3 e,�l i Na rint) Current 'li Address- Telephone Signa `re 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS. . Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building o d (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) Check Number This Section For Official Use'Onl Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings: Date 183 MAPLE RIDGE RD BP-2016-0573 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-263 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-2016-0573 Project# JS-2016-000957 Est.Cost: $4200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM LYLE 105508 Lot Size(sq.ft.): 108900.00 Owner: SYPEK JANICE M Zoning: Applicant: WILLIAM LYLE AT: 183 MAPLE RIDGE RD Applicant Address: Phone: Insurance: 1851 NORTHAMPTON ST (413) 533-6012 Liability HOLYOKEMA01040 ISSUED ON:1012712015 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 10/27/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner