31A-263 71 DRYADS GREEN ST BP-2017-1093
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block:3IA-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-2017-1093
Project JS-2017-001868
Est.Cost: $17900.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
llse Group NRB EXTERIORS INC 99565
Lot Size(sq.ft.): 20211.84 Owner: SMITH COLLEGE OFFICE OF TREASURER
Zoning: EU(I00)/URC(100)/ Applicant: NRB EXTERIORS INC
AT: 71 DRYADS GREEN ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563-6354 WC
G RAN BYMA01033 ISSUED ON:3/31/2017 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 3/31/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
___ Department use only
City of Northampton Status of Pornig: ..
II Building Department Curb Cut/Drivesray Permit
•
MC 3 0 2011 212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
p hone Northampton, MA 01060 Two Sets of Structural vkrl9 �
*13-587-1240 Fax 413-587-1272 Plot/Site Plans
_- -.
Other Specify --
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY� DWELLING�
SECTION 1-SITE INFORMATION 3
1. n ' ' .- BP-P- 1 / -/(J�
1.1 Property Address: :T This section to be completed by office
71 brit4i (y-. Map Lot _ Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
t ZyLsd-028 04— rk aL((A L5R clo Chi 6a5 71 O' y4J1 6(am , l//e1me eitr_ 4
Name(Print „ti )1 10..— Current Ma/IjogAddress: ,
Signature
2.2 Authorized Anent:
& R6 C- /LJ4 AL- .i. c tic 0 twAc M4 Oaf$
Name(P'. Current Mail g Address:
i.,-
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
l
2 Electrical (b)Estimated Total Cost of
Construction from(6) i
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection J/�
6. Total=(1 +2+3+4+5) 17, 'co, 00 Check Number /906 ifi
This Section For Official Use Only
Building Permit Number: Date
Issued: /y
signature: ��S �/7 1/
Building Commissioner/Inspector of Buildings Date
Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete 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. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 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 0 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 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 5 acre or is it part of a common plan
that will disturb over I acre? YES O NO Q
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replacement Windows Alteration(s) ❑ Rooting r]
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [EJ Siding[O] Other[DI
Brief De,sgcription of Proe�oOsed nnI / n II
Work: KPwS..i ?IOW/ NOJenncKrl.I -F k0/15lkt a/erd gad( N`tAf
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. �a^-� L"'���-z u as Owner of the subject
property N n
hereby authorize R( 14ff jrc &-
to act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date
N
Tk 6 L✓7(/ {ekC _ ,as Owner/Authorized
Agent hereby declare that tie 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.
A C%-ktO , �,nrtr
Prim Name //y
'Signatu�e� Date 31
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder N LNo'4 3Q/ti-( ✓ 99rG
License Number
7 g f,/ G:rl�S rM'd d to3 S - )-b — '2
Addres ENyiretlon Date
—6 c
Telephone
9.Registered Home Improvement Contractor. Not Applicable 0
R r t is•'i 0.c , c- 1v7-9C/
Company Name Registration Number
Add ss / y
•
y S
7 (� Expiration Date
_ _— Telephone � V l-L [
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 wig result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes l11No 0
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-seen i I elm •s of one(1) or two(2)families
and to allow suc)rhpmcowner to engage an individual for hire who does n. .assess a license,provided that the owner acts
as su'ervisor.CMR ':0 Sixth Edition Section 1083.5.1.
Definition of Homeowne . •erson(s)who own a parcel of ran• in which he/she resides or intends to reside,on which there
is,or is intended to be,a one o o family dwelling,a • • or detached structures accessory to such use and/or farm
structures.A ierson who constrn • more than in• . me in a two- ear 'eriod shall not be considered a h eowner.
Such"homeowner"shall submit to the : 'Idin s cial,on a form acceptable to the Building Official that he/she shall be
res•onsible for all such work ierformed »er the buidin• ' •mit.
As acting Construction Supervisor yo • presenc in the job site will be required from time to time,during and upon
completion of the work for which permit is issue..
Also be advised that with refer- ce to Chapter 152(Work- 'Compensation) and Chapter 153(Liability of Employers to
Employees for injuries not ulting in Death)of the Massachus•- General Laws Annotated,you may be liable for person(s)
you hire to perform wo or you under this permit.
The undersigned"h. eowner"certifies and assumes responsibility for coin, I ce with the State Building Code,City of
Northampton 0 . ances,State and Local Zoning Laws and State of Massachuse a . i eral Laws Annotated.
Homeowner Signature
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,„1as defined by MGL c 111, S 150A.
Address of the work: 7 ( U” ci c 6.-con
The debris will be transported by: (c_Do-y Diced>ou
The debris will be received by: (Dn kjC ,1)lytjse,
Building permit number 1 ' /J
Name of Permit Applicant �/ "t ) X /✓tC ,
3- 31-
Date Signature of Permit Applicant
_ gift° WC�'fJ?/mcvnweat1 ofC%&laiiaacAf(/Je//J.
Office of Consumer Affairs and Business Regulation
-haj 10 Park Placa- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 147961
Type: Private Corporation
Expiration: 8/23/2017 14 267291
NRB EXTERIORS INC
NICHOLAS BERNIER
7 PHILIP CIRCLE - - -- - ----
GRANBY. MA 01033
Update Address and return card.Mark reason for change.
scar 0 2010,05/11I I Address I""""I Renewal [. I Employment , I Lost Card
r r 10Arr..O.t... /N cft^.1f::,.d uwz;
..--- Office or Consumer Affairs&Business Regulation License or registration valid for individul use only
M_BIOME IMPROVEMENT CONTRACTOR betnre the expiration date. If found return to:
e9i5[mtion: 147961
Type: Office of Consumer Affairs and Business Regulation
Expiation: 8/2312017 Private Corporation before
Tack Tisa-Suitt 5170
Boston,MA 02116
NRB EXTERIORS INC
NICHOLAS BERNIER yya+✓ - .
]PHILIL CIRCLE
GRANBY,MA01033 -_—_ _....._
Underseerctary Not valid Without signature
a Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-099565
Construction Supervisor SpeciaitY IIII
NICHOLAS R BERNIER
7 BailinCIRCLE
GRANBY MA 01033
NI aria- CA— Expiration:
Commissioner 08/282018
The Commonwealth of Massachusetts
Department of industrial Accidents
—"_I �_fl Office of Investigations
W . tel_
E _ ;t_ 1 Congress Street, Suite 100
=^Iii— Boston,MA 02114-2017
��� www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information ,, 11 Please Print Legibly
Name (Business/Organization/Individual): Ai 617 ,p c </fes ) I /vL
•
Address: ? IQ .fi (/r /
City/State/Zip: Q2A4 I D J Phone#: ST-CC — (Pt) S
A
ie you an employer?Check he appropriate box:
Type of project(required):
1 I am a employer with 4. ❑ I am a general contractor and I
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 8. ❑Demolition
workingfor me in anycapacity. employees and have workers'
n P ty 9. ❑Building addition
[No workers' comp. insurance comp. insurance.-
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.]' c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
"Any applicant that checks box PI must also till 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. yqJ,
Insurance Company Name: /I�{�il.�„ 7v/IZ L VV
Policy#or Self-ins. Lic. #: ‘772.6,(15-7/ S7,,,,/t..2
_7 7 Expiration Date: 3
�
-I '
Job Site Address: 7j Oi-p J.( 6r--84..4.-3- City/State/Zip: ']!L'/kc u4/W, Abu"
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 r the pains and penalties of perjury that the information providee/
d above is true and correct
y
Signature: - /' Date: - I -i 7
>
Phone#: Sc -3Co -- C 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):
I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone 4:
ccs over tno �„a a tiny I Kleter builders
- :al:ri a :� rmerine 71 dryads green
autu� Northampton ma
Complete no later than 5-1-17
EXTERIOR NOME IMPROVEMENTS, Inc..
`a Licensed cr ,"ox. MA 413/563-6354 House only
Roofing & Seamless Gutter Pros
Scone ofwari-
We will provide all necessary insurance certificates,permits, supervision, labor,materials,
euuioment.and suoolies as retained completing the following. All OSHA safety standards will be followed.
I.) Strip and remove existing roofing material and place into dumpster to be recycled
2.) Clean and inspect decking
3.) Install I'4"cdx olvwood over existing boards as needed
4.) Install new 8"aluminum drip edge to the perimeter of all roofs.
5.) Install weather watch ice and water barrier 6 ft.on eves and 3 ft.on valleys.
6.) Install deck armor synthetic underlavment to the remainder of the roof surface.
7.) Install pro start starter shingle to eves and rake edges of all roof
8.) Cut back all wood siding along flashing runs, leave weather proof for others to re install
9.1 Install new flashings as needed to walls.pines.chimneys.ect.
10.)Install GAF timberline architectural shingles to manf specs using 4 nails
COLOR: charcoal
I I.)Counter flash all chimneys with lead flashing.
12.)Install GAF rigid pve ridge vent to all peaks
13.)Install seal a ridge cans to match over all ridge vents
14.)Remove existing metal roof material from flat roof material from flat roof sections,bag up and
leave for smith college to remove.
15.1 Install 1"iso board and.060 re enforced endm rubber black mechanically attached to manf spec
16.)Make all necessary wall,perimeter,and penetration flashings
17.) Clean gutters
18.)Roofers buggy will be used for clean up and to keen iob site in a safe manner.
We will remove and properly recycle any contract work related debris and maintain in a clean and safe
T11 nn Pr
We purpose to provide the material, labor,waste removal,and permitting to complete the work to the
above specifications for the sum of:
Total: $17,900.00
Down payment: $7900.00
Balance upon completion: $ 10000.00
Authorized signature:
Customer's signature: