32C-078 (3) 14 CONZ ST BP-2017-0023
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-078 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-2017-0023
Project ft JS-2017-000039
Est.Cost:$15000.00
Fee: $105.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq.ft.): 7579.44 Owner: KEITER SCOTT
ZoZin: URC(l00)/ Applicant: NRB EXTERIORS INC
AT: 14 CONZ ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563-6354 WC
G RAN BYMA01033 ISSUED ON:7/18/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE AREAS OF ROOF & INSTALL NEW
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 7/18/20160:00:00 $105.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File 4 BP-2017-0023
APPLICANT/CONTACT PERSON NRB EXTERIORS INC
ADDRESS/PHONE 7 PHILIP CIRCLE GR.ANBY (413)563-6354
PROPERTY LOCATION 14 CONZ ST
MAP 3W PARCEL..,0_,7a ZCJNE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Fl LED IIUT
Fee Paid War -[l
Building Permit Filled out
Fee Paid
Typersf Constructimu REMOVF„AREAS OF ROOF& INSTALL NEW ROOF
New construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 99565
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
Demur >te
Signature o Bu ding 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.
Versionl.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Slaws of Permit:
��I ing Department Curb Cut/Driveway Permit -
12 Main Street Swear/Septic Availability 100 Water/Well Avagabilily
8 ' f ortY ampton, MA 01060 Two Sets of Structural Plans
phone 4'3-587-1240 Fax 413-587-1272 Piot/Site Plans
bet&R Innup wsrwnorm Ogler Specify
leffseiLIPEONIMillftitatrlitEPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
14 (0 n Z Sr)--
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
960*a- K& M '
Name(Print) /7 ,,,/// T/ / .{ � (! Current Mailing Address:
LIT Cao Signature �� 1.N -+4� `may)�o Telepho(�
2.2 Authorlz Aaent
itig6 4tiS , / C 7 flk \ , la c-/ Sfc,, ci d ty
c,
Name(Print) Current Mailing
yAddress: -y �/
Signature Telephone J -- s U�� � .�
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit 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 S
6. Total=(1 +2+3+4+5) (l5—CXXa)• C
)O Check Number /a5/ 105
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissionerllnspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Sco 'CQ&'�Q--- ,as Owner of the subject property
\kJ
S
hereby authorize 1\ Ib —('��-- to
act on my beha r fall m tters relative to work authorized by this building permit application.
�� �� p - `7- a-- (G
Signature of O�'y Date
I /\) 1\ rJ /Cl ( I DI C IA C— ,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 s and penalties of perjury.
Print Name
Sign-ie of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: QQ � Not Applicable/licID Nems of License Holder: kkJA 2 lZZK✓t,''� ��S
License Number
Address Expiration Date
Sign-tore Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(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 per/ No 0
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs ❑ Demolition❑ Repairs Additions ❑ Accessory Building
Exterior Alteration ❑ Existing Ground Sign 0 New Signs 0 Roofng$ Change of Use Other
Brief Description Enter� a brief description here. / Q
Of Proposed Work: 1`�np
tis,A O(/eaS O •� Q�, - 4-31 � (2
SECTION 6•USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-1 ❑ A-2 0 A-3 ❑ 1A 0
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A 0
E Educational ❑ 2B 0
F Factory 0 F-1 ❑ F-2 ❑ 2C 0
H High Hazard 0 3A ❑
I Institutional 0 I-1 0 1-2 0 1-3 0 3B 0
M Mercantile 0 4 ❑
R Residential ❑ R-1 0 R-2 0 R-3 0 5A 0
S Storage ❑ S-1 0 S-2 0 5B ❑
U Utility ❑ Specify:
M Mixed Use 0 Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1„
1"
2nd 2m
3rd
3n
4s 4m
Total Area(sf) Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.C.40,§64) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Versionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
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 Bite minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO e DONT KNOW 0 YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES O NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,exca ation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
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: IV (O N 7
The debris will be transported by: C p w p\ po ti
The debris will be received by: O.-.i O Le (i -1 (I S•ti
Building permit number:
Name of Permit Applicant
7 -
4.11v
Date Signature of Permit Applicant
•
The Commonwealth of Massachusetts
W— Department of Industrial Accidents
P—; 1
p e=# Office of Investigations
__ I Congress Street,Suite 100
=1ew Boston,MA 02114-2017
tt
%T_s www.mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ft N
Please
ease Print Legibly
Name(Business/Organization/Individual : t /- KAu/( 1 [/��
v
Address: .7 p r1e
C-Cwr I ' �/ f
City/State/Zip:IV-cm-el'Tj V1-15 _ Phone#: "� 1 3 ) l.>� G 3 C
Are you an employer?Check the Appropriate box:
Type of project(required):
t. 71 am a employer with Y 4. ❑ I am a general contractor and I
employees(full and/or part-time)."
have hired the sub-contractors 6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No workers' comp. insurance comp,insurance.
required.] 5. ❑ We arc a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
insurance required] r C. 152,§1(4),and we have no 12.0 Roof repairs
employees. [No workers' 13.0 Other
comp. insurance required.]
"My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors 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.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.e ^ �"- —
Insurance Company Name: ',{.1J-rz•r�'v---1
Policy#or Self-ins. Lia/ 1
. #: /�14( r )'°0-3 17 S Y-( S Expiration Date: -- / — 1
Job Site Address: (r`( l 0n? S�- City/State/Zipj a! i✓l c-
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
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 certify sued,. --.-� ins and penalties of perjury that the information provided above is true and correct
Si. a .. =: / �// Date: i — /C,
Phone#: l 'c CPI— tie
7'
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#:
Massachusetts Department of Public Safety
8 Board of Building Regulations and Standards
License: CSSL-099565
Construction Supervisor Specialty
NICHOLAS R BERNIER
7 PRIORCIRCLE
GRANBY MA 01033 111
N1-- -7 `-" Expiration.
Commissioner 05/28/2018
8 reit IW P
Cr4 n a 1o% tea
e= a Office of Consumer Affairs and Business Regulation
tft` 1-� 10 Park Plaza - Suite 5170
4-
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 147961
Type: Private Corporation
Expiration: 823/2017 Tot 267291
NRB EXTERIORS INC - __
NICHOLAS BERNIER _
7 PHILIP CIRCLE
GRANBY, MA 01033 -- -- _-- --
Update Address and return card.Mark reason for change.
L Address P. Renewal Li Employment V Lost Card
su, 0 20M-0511
stere o mmona It% lC sor/,efts
Office of Coosamer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egisfration: 147961 Type: Office of Consumer Affairs and Business Regulation
Expiration: 82312617 Private Corpora&n 10 Park Plaza-Suite 5170
Boston,MA 02116
NRB EXTERIORS INC ��
NICHOLAS BERNIER -.5/." � —_
]PHILIL CIRCLE
GRANBY,MA 01033 Undersecretary Not valid without signature
.4C Rd CERTIFICATE OF LIABILITY INSURANCE TEMAR
3/0/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF BIFORMA11011 ONLY AM)CONFERS NO RIGHTS UPON 711E CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ACID, MEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEIVIEEN THE ISSUING NIRS), AUTHORIZED
REPRESENTATIVE OR PRODUCER,ANO THE CERTIFICATE HOLDER.
NIPORTANT: a the carats%holder is an MX/TONAL INSURED,the Pf y(Na)must be endorsed. V SUBROGATION IS WINED,autism to
in.tame and condB06s MO*Policy,cerise)po6cNs may nome an wWaPiwel A sWNamH on this NNBGaae dais not confer dolt to the
urSScas holder hi lieu of such smwasmruge).
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Tierney Group rah (413)562-7007------�w,antra-gni
16 North Slat Street EaMx
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COVERAGES CERTIFICATE NLReR:Cs1511300214 REVISION NUMBER:
THIS IS TO CERTIFY THAT lilt POLICIES OF INSURANCE LISTED BELOW HAW BEEN ISSUED TO THE INSURED NAMED MOW FOR THE POLICY PERIOD
INDICATED. NOTARh9TNLONG ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'MTh RESPECT TO%MICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERMS, THE INSURANCE AFFORDED BY THE POt1CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS MD COMMONS OF SUCH POLICIES.LIMITS SHORN MAY HAVE BEEN REDUCED BY PMD CLAYS
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ERTFICATE HOLDER CANCELLATION
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7 Philip Circle ACCORDANCE
Granby, MA 01033
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EXTERIOR NOME IMPROVEMENTS, Inc- House and garage
Fully sane Oranby. Mn 413/563-6354
Roofing & Seamless Gutter Pros
Scope of work:
We will provide all necessary insurance certificates,permits, supervision,labor,
materials,equipment,and supplies as required completing the following.All OSHA safety standards will
be followed.
1.) Strip and remove existing roofing material and place into dumpster to be recycled
2.) Clean and inspect decking
3.) Install '/2"cdx plywood over existing boards as needed
4.) Install new 8"aluminum drip edge to the perimeter of all roofs.
5.) Install winter guard ice and water bather 6 ft.on eves and 3 ft.on valleys.
6.) Install diamond deck synthetic underlayment to the remainder of the roof surface.
7.) Install swift start starter shingle to eves and rake edges of all roof
8.) Cut back all wood shakes along flashing runs,leave weather proof for others to re install
9.) Install new flashings as needed to walls,pipes,chimneys,ect.
10.)Install premium certainteed landmark lifetime architectural shingles to manf specs using 4 nails
COLOR:
1I.)Counter flash all chimneys with lead flashing.
12.)Install Certainteed rigid pvc ridge vent to all peaks
13.)Install ride caps to match over all ridge vents
14.)Cut back existing flat roof material to transition of shingles.Make necessary repairs as needed
15.) Remove any debris from flat roof(concrete,satellite dish)
16.)Remove existing gutters and install new white seamless gutters and down spouts
17.)Roofers buggy will be used for clean up and to keep job site in a safe manner.
tional:Include Certainteed 4 star smart plus 50 year non prorated material warranty ADD$400.00
We will remove and properly recycle any contract work related debris and maintain in a clean and safe
manner
We purpose to provide the material,labor,waste removal,and permitting to complete the work to the
above specifications for the sum of:
Total: $15,000.00
Down payment: $5000.00
Balance u..n com detion: 10,000.00
Authorized signature:dsC
Customer's si v ature: ' a_te.
Please make checks ,I,able to nrb exteriors Inc and mail to nrb exteriors Inc 7 Philip cir Granby ma 01033