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17C-123 (3) 60 SHEFFIELD LN BP-2017-1175 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C- 123 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-2017-1175 Project JS-2017-001979 Est. Cost:$650000 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(so. II.): 24785.64 Owner: LARAREO JOHN M&CYNTHIA L Zoning: URB(100)i Applicant: NRB EXTERIORS INC AT: 60 SHEFFIELD LN Applicant Address: Phone: Insurance: 7 PHILIP CIRCLE (413) 563-6354 WC GRANBYMA01033 ISSUED ON:4/20/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:STRI P & 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 St 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 4/20/2017 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 Permit Building Department Curb Cut/Driveway Permit �- (6‘ 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability \ 0 fldrthampton, MA 01060 Two Sets of Structural Plans \ -- -phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify \ APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE/ // OR DEMOLISH A ONE OR TWO FAMILY DWELLING /P SECTION 1 -SITE INFORMATION — i 7 ' (/75 1.1 PropeM Address: This section to be completed by office 5101I 'Qc5I Map f7Cj Lot I) Unit L Zone Overlay District Elm St.Dishim CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Ph e(IU Current Mailing Address: sig 3> (o ) 1 Telephone Sig re 2.2 Authorized Agent: (14 „u{ S 7 flk I.. I-, Ct .i Name(Print Current Mailing Address: . ! 5-cel_(0 3 S" f dritinature 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 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) O + Check Number S/ - ear This Section For Official Use Only Building Permit Number: Date Issued: /'7 Signature: ' // /[/—//a/- / Building Commis�spector of Buildings Date SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Id` Or Doors 0 Accessory Bldg. El Demolition ❑ New Signs [CO Decks [p Siding[p] Other[Cl Brief Description of Proposed V 1AA1 /I Work: �/Me 6m Ras l4s`u5C Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea. 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 ORCONTRACTOR APPLIES FOR BUILDING PERMIT I, -3- 1.-gr�/gdti e , as Owner of the subject properly ft I hereby authorize ,t i� e moa to act on m half,in all matters relative to work authorized by this building permit application. Slgnatu 6Ovine Date (- �1f i 1 A �' -S f K t ,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 e pains and penalties of perjury. �i V- ' Y - j7 S attire at Owner/Agent Date SECTION 8•CONSTRUCTION SERVICES 8.1 Licensed Construction Su/Pervfisor':I Not Applicable 0 Name or License Noisier . r `' er: Ir' 't`I(4 \; g1 01 -4/ ?9 cl.e License Number 7 n\- 1i9r say -rg Address Expiration Date - � �( - cG3- c, ry atu : Tel one 9.Reolstered Home Improvement Contractor: Not Applicable 0 N �� CyJ-u •'a.-s , .-C i ti i 5 t ( Company Name Registration Number 7rvi1y c (� Fe-e )---S • 0 Address ) ` l�•., Expiration Date E("11 cs•'1 WA ' Telephone (0)- 1� “ ')i SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6f 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 Exemption The current exemption for'homeowners__was.extended to include Owner-occupied Dwellines of one o(2)families and to al m.• .I • -owner to engage an individual for hire who does not possess a license,provided that thdowner acts as su:erviso CMR 780 Sixth Edition Section 108.3.5.1. -- Definition of : •:eowner:Person(s)who own a parcel of Ian' •• e s e resides or intends to reside,on which there is,or is intended to •• a one or two family d. - •,a'. hed or detached structures accessory to such use and/or farm structures.A •erson w • constru ::ore than one home in a two- ear :eriod shall not be consid•red a .omeowner. Such"homeowner"shall s'llerto the Building Official,on a form acceptable to the Building Official that he/she shall be res•onsible for all sue,asor ormed under the buildin• :ermit. As acting Construct crit Superviso •ur presence on the job site 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 to Chapte (Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of th- • : sachusetts 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 responsibt - or compliance with the State Building Code,City of North ton Ordinances,State and Local Zoning Laws and State of ` .. achusetts General Laws Annotated. omeowner/ 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, as defined by MGL c 111, S 150A. Address of the work: Cj O S The debris will be transported by: r J ()LA tY 0,\) ,-I The debris will be received by: Ce'--"- QUR K Dspoc , Building permit number: n /[ l Name of Permit Applicant � V t 7 Q (< •7l 0 i A-- Date Signature of Permit Applicant �\ The Commonwealth of Massachusetts �, Department of Industrial Accidents I -- e / 1=" = " Office of Investigations . er E _it l 1 Congress Street,Suite 100 :7--141--747i =�'— Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /� Please Print Legibly Name (Business/Organitation/Individual): N (S 'b C we/13/c t '—C Address: 7 ()V: \ ', q t. t./ t I / City/State/Zip: b Li 11h - Phone #: (I(� - RP 3- co. 7 T L"( Are you an employer?Check the appropriate box: Type of project(required): 1.it 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 working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition 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 I I.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] ' c. 152, §I(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must So fill out the section below showing their workers compensation policy information. s 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- lithe 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. Insurance Company Name: /A r e:e' Ct. 7 Lri LL 7 Policy#or Self-ins. Lic. #: (., (a.7 4pQ6-Cj F 7 11X - I Expiration Date:qq �� �� --I3 — ' 8 Job Site Address: �r O L.L+LfLk Lr City/Slate/Zips_ IW"Nvt�)t�' t l it, Attach a copy of the workers' compensation policy declaration page(showing the policy number an 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 an, T ', iii d penalties of perjury that the information provided above is n e and correct Siang re: .� - / Date: i(i / se— Phone#: U 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#: ----, ® DATE(t.wDWYYYY) '��O . CERTIFICATE OF LIABILITY INSURANCE 3E(MWDD 2 THIS CERTIFICATE IS ISSUED AS to 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(ies)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 CCONTACT Tierney Team Tierney Group PHONEa_ (413)562-7007 tai NO .(088)_-2320 16 North Elm Street -E-MAIL ADDRESS: P O Box 750 INSURER(S)AFFORDING COVERAGE ' NAIC I _ Westfield MA 01086 INsuRERA:Russell Bond & Company Inc I INSURED IssuRER 13:Standard Safety Product Lines I 39954 _ N R B Exteriors Inc INSVRERC:Travelers Insurance Company R7 Philip Circle INSURER O: INSURER E: I Granby MA 01033 INSURER F: li COVERAGES CERTIFICATE NUMBER:CL172700288 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 I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ADOL SUER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER IMMNOXYYYY) IMMND/YYYYI, X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE .5 500,000 I ! DAMAGE TO A CLAIMS-MADE I X OCCUR PRM SES(EaEED occurrence) $ 100.000 I E50t00149131 12/23/2016 112/23/201/ MED EXP Me person) $ 5,000 PERSONAL&ADV INJURY $- _ 500,000 GENL AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 1,000,000 X POLICY LI PRO I LOC __ ECT _ PRODUCTS-COMPIOP AGG $ 1,000,000 OTHER'. $ AUTOMOBILE LIABILITYCOMBINEDLIMIT $ B ANY AUTO BODILY INJURY(Per person) 5 500,000 ALL OWNED SCHEDULED AUTOS _X_ AUTOS I 6222362 3/15/2017 3/15/2018 BODILY INJURY accident) E 1,000.000 AUOS NON-OWNED PROPERTY X ' HIRED AUTOS X AUTOS SEP- ace I E 200,000 I ' (immured motors(61 win limn $ 500,000 - UMBRELLA LIAB — OCCUR i EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE'. 'AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION ! PER ,OTH- ANDEMPLOYERS'LIABIUTY Y/X I STATUTE ER. ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT S L, OFFICER/MEMBER EXCLUDED? N/A. _ (IMOMOry In NIB I 61213E-91759768-6-17 2/13/2017 2/13/2018 EL.DISEASE-EA__EMPLOYEE $ Iy OescnLN unwr To follow from DESCRIPTION OF OPERATIONS below coo¢eny EL.OISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATORS/LOCATIONS/VEHICLES (ACORD 101,A66102BM Remarks Schedule.may be att ch d it more space Is required) roofing/residential/ three stories and under , Siding and window installation, Roofing / residential over three stories and/ or commercial, Carpentry - construction of residential property not exceeding three stories in height CERTIFICATE HOLDER CANCELLATION (413)331-4494 ___ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P- - .- __ `-`, ACCORDANCE WITH THE POLICY PROVISIONS. ._ t _ AUTHORIZED REPRESENTATIVE e(//3 �2'/-/'J� i— O 198840 /�f�14 ACORD CORPORATtON rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) • Granby,MA Fully Licensed and Insured ,peer rhe q,�ncnrir,ni 7 Philip Cir:413-563-6354 11133 MA Reg#20-2015718 G:'ic#: 147961 - - Fax#:467 9748 MA CSI.#:99565 a- Special' 9 in Roofing-- NICHOLAS BERNIER RAZ ,-, ,. (Owner) r - l�ts0, EXTERIOR HOME IMPROVEMENTS, Inc. WWW nrbexteriors.com ShingleMaster- ROOFING&SEAMLESS GUTTERS AWindows-Siding-Decks Cotheitod NT, Residential -Commercial Proposal submitted to: Phone# h: 5$ -5 7 3 1 c: :i1:41q L'C ✓-i/ r' Special requirements Street 9t' cck4 \Ji L.. City,state,zip code Proposal to furnish and install the following ❑ Re-roof l Tear-off Li Gutters Q We.shall acquire necessary permits for all work Complete Roof Preparation E Home's exterior to he protected by tarps and plywood- g Shrubs, landscaping,trees to be protected,roofers buggy used E Entire existing roofing materials to be removed to existing decking, including flashing,etc. E Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster g Deteriorated existing decking to he replaced at$50 per sheet of plywood Complete CertainTeed Integrity Roof System 72 g Install Winterguard ice & water barrier along bottom fl 3 ft. of all roofs ft. ( .�1/m'J$ E Install Winterguard ice&water barrier around penetrations,in valleys an critical areas 0,1-Install I 5#saturated asphalt felt paper to entire decking vkj p install Roofers Select Premium underlayment to entire decking ® Install DiamondDcck Synthetic undcrlayment to entire decking I Install 8"perimeter metal flashing to all edges of all roofs, Giqwhite U brown © Install SwiftStart starter shingle to bottom and rake edges of all roofs Install CertainTeed shingles to manufacturers specifications,U 6 nails 4 nails O Install Shingle Vent II PVC ridge vent to all peaks in heated areas g install Shadow Ridge to all hips and ridges,over ridge vent where applicable g Install new lead counter flashing to chimney © New flashing installed where necessary (4] Install new pipe flashing to waste vent stacks Warranty options g We guarantee our labor/workmanship for 20 years ❑ Upgrade CertainTeed 5-Star Sure Start Plus,50-year nonprorated coverage,including workmanship 0, Upgrade CertainTeed 4-Star SureSiart Plus,50- ear nonproryjLcoverage }N' CertainTeed Landmark-color:r 13c Rnf7 I•-)N 11 JU 3-tab ❑ Certain Teed Landmark Pro-color We propose hereby in rumbas materials and labor complete in accordance with above specifications[or Me sum of Total Due $ l Sy(.`- ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions arc - 1/3 Down Payment$ aSs-7 "- satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due Payment will he 1/3 down at start ofjdb,and balance due upon completion, upon completion $ t-(UCP. - .,� Date_'/-/-0/7 Signature i' 9.Yt Lc&IQ412ti C/ 7 Date:_)I 9J—IL, Estimator (Print Name) l✓ LL,oAt.y eis'os s/ (Sign Name)Y 6; 1, Estimates are honored for thirty(30)days from above date ATTENTION HOMEOWNERS: Please cover all personal belongings in the attic,garage ur 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 I Kia. nmonthly(ANNVAI-PERCENTAGE,RA EIi ON 15%)will he added to I he unpaid port ion of the balance due agree to pay and/or guarantee payment of dine charges-In the event ufdefaulk of payment I agree to pay reasonable Atronmy-s fees and art costs I his ay0.nmru d iaaitalea - lase of liability-R-lilya nature below,acknowledges an agreement of the above is hereby made. .., dn A.'.as. a,aC