23A-051 (4) 22 WEST CENTER ST BP-2018-1228
GIS ft: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-051 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-2018-1228
Project# JS-2018-002191
Est.Cost:$9500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: NRB EXTERIORS INC 99565
Lot size(su.ft.): 10715.76 Owner: BROWN SCOTT&SIGELMAN KATHERINE
zoning URB(100)/ Applicant. NRB EXTERIORS INC
AT. 22 WEST CENTER ST
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563-6354 WC
GRANBYMA01033 ISSUED ON:5/21/2018 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:
FeeTVpe: Date Paid: Amount:
Building 5/21/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
em use on6'
City of NOrtha ptoZ0FBUILD1NGj1NSPQ
t:
/® Building Depa m permit
r 212 Main AvagaDNitp
\ ..: Room 1vapabft
Northampton, Ophone 413.587-1240 Fify
APPLICATION TO CONSTRUCT,ALTER REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY OWELU14G
SECTION 1 -SITE INFORMATION
1.1 ProoertvAddress: This section to be completed by office
MaP Lot Unit
Zone Oveday District
Elm St Dlelfidi CB DMtrkt
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
S k ro Jd- w "S} CeMc �
Name(Print) Currant 'ling Addmss:
� Telephone
Signature
2.2 Authorized Aaent:
N 6 zCFC/IVrS (�_ 7 ��11in c "' G i" ' C'.7
Name(FH
Cunent Mailing cess:
�I13 - S ca3-cQ3� y
Ignature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pennit 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) q
5.Fire Protection
6. Total=(1 +2+3+4+5) SCS C)6 f Check Number a pL
This Section For Official Use Only
Building Permit Numbe ' Date
Issued:
Signat
Buildin ommissioner/Inspsdor of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING All Infornadon Most Be Completed. Permit Can Be Denied We To Incomplete Infonuatim
Existing Proposed Required by Zoning
'R,is cuiumn to be 61kd in by
Building Depeebeenl
Lot Size
Frontage
Setbacks Front
Side U R L:.. R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot aee mwus bldg&paved
#of Puking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter BookPage and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O 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 0
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 O
IF YES, describe size, type and location: _.
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pan of a common plan
that will disturb over i acre? YES O NO O
IF YES,ton a Northampton Storm Witter Management Permit from the DPW is required.
SECTION S-DESCRIPTION OF PROPOSED WORK Icheck all asolicablel
New House ❑ Addition ❑ Replacement Windows AKentlon]s) ❑ Roofing 1;Z
Or Doan 17 C'r-�
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[] Other[M
Brief De caption of Proposed
Work: {�t-)a ny )_ f1�L I ill fuL nwF Xo V-', e� .
Alteration of e>asting bedroom_Yes_No Adding new bedmom Yes No
Attached Narrative Renovating unfinished basement yes No
Plans Attached Roll -Sheet
Ga.If New house and oraddlhon to existlna houslna, comolow the followlna
a. Use of building :One Family Twa 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 stones?
f. Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance forth attached?
h. Type of construction
i. Is construction within 100 fL of wetlands?—Yes —No. Is oonsWction within 100 yr. floodplakl_yss_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_ CitySewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, S(a k A- 3/6,, ,as Owrer of the subject
property
hereby authorize
to am on my behalf in afters relative to work authorized by this building permit application.
Signature M Owner V pate
OwnenAWarrsetlI,Age tAhyharee (the /am
information on the foregoing application are true and accurate,to the beet of my Imcni edge
and belief.
Signed under the pains and penalties of perjury.
1L
Print Neme
Sl
qrdi of OwnerfAgent Date
SECTION a-CONSTRUCTION SERVICES
8.1 Licensed Construction.. /1SuoerviaolIr: Not Applicable
/ E3Name M License l lder: N ' `t"�\� (J7/N hr t191Vbls—
License Number
AddAddrels Eaplrsbon Data
�_ // SLS "<"7T1
nature 1 Telephone
9.Reaisterod Nome Nnoravement Contraetor. Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(9))
Workers Compensation Insurance affidavit must be completed and submitted With this application.Failure to pmvide this affidavit Will resuk
in the denial of the Issuance of the hui ing permit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
S/
Massachusetts s} F4
S
DBP.VtTlDpIT
OF BUILDING INSPBCTIONB
213 Main .[beet •yunieipal Building i. C
Morthampton, MA 01060
Debris 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 Pen-nit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
�-a- l>JdS-1- CQnkC✓ S�
(Please print house number and street name)
Is to be disposed of at:
luv�� 5A �
(Please print name and to ation of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
� u� (Q wa1K ✓^—i �� Fid1 ,�h, , �/l61
(Company Name and Address) p (;
Signa ure of Permit Applicant or Owner Date
If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
p No
�\ The Commonwealth ofMassaehusetts
Department oflndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Vl\others'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Orgammtion/Individml): P-j A
Address: 7 I' to'� P c , /..,
City/State/Zip:&--c'4:3 Phone
Arc you an employer'!Chark the appropriate box: Type of project(required):
acmployerwilh ( employces(fall and/or part-lime).• 7. E]New construction rji
l am a sole proprietor or partnership and have no employees working for ne in g. ❑Remodeling
any copacity.[No wohers'com,insurance required.]
3.F1 I am a homeowner doing all work mym1f.[No workers'coW.inswame,requirad 1• 9. ❑Demolition
4.❑1 am a him sower and will be hiring cummctors to conduct all work m my propony. I will 10❑Building addition
..,list an contmmors either have work m compensation insurance of are sole 11.❑Electrical repairs or additions
proprietors with am employees.
12.E]Plumbing repairs or additions
s0n,se senemlmctom haecrapiyieiran have wrlonvaromp.muraneelmched sheet 13.E]Roofrepaim
These subcontractors M1ave employees and have workers comp.insurance.[
6.❑We are a continence and its officers have exercised their right ofexemptim per MGL a 14.[:]Other
152,§I(4),and we have no employees.[No worken'comp.Insmenee repaint]
'Any applicant not checks box#1 must also fill out We section below showing Weir workers'compensation polity information.
'Homeowners who submit this andavir indicating Ne,are doing all work and then hire oolcide conuactms..at snored a n w affidavit indicating such.
:Contractors Wet check this box at attached an additional shed showing the name of the subcontractors and state whether arms those entities have
employees. If the sub-eoommato s have employees,they most provide the. workers'comp.policy number.
Iam an employer that isproviding workers'compensafiren insumrrrefor my employees Below is thepolicyandjob site
Insurance Company Name:
Policy p or Self-ins.Lic.p: i 22u h— I�Si765,—G—/� Expiration Date:
11
Job Site Address: 2) ve'&,t- Q—Y— City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 ofup to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
zzz
Ido hereby ce der s pains and pen 'es ofperjury that the information provided above is true and correct.
Sienatu Date
Phone#:
OJfcial ase only. Do not write in this area,to be completed by city or town ojrciat
City or Town: Permit/License is
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.CitylTuwp Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person: Phone a:
0-4 4/2/2018 9:16:26 AM PAGE 2/002 Fax Server
CERTIFICATE OF LIABILITY INSURANCEDATEIMINODIYYYYI
FICATE E ISSUED"A MATTER OF INFORMATION ONLY AND CONFERS NO FIGHTS UPON TNS CERTIFICATE HOLDEN. THIS
CERTIFICATE DOME NOTAFFIRMAMELY OR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
THIS CERTIF"ATE OF INSURANCE ODES NOT CONSTITUTE A OONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORED REPRESENTAME
'FL11R
IMPORTANT.H the eedifcale holder is an ADDITIONAL INSURED,the policY(im)most be endorsed. H SUBROGATION IS WAIVED,subject to
he toms and conditions of the pa",carteln polktes rant,require and entlorsement A statement on this certK to does not corder rights to
he certi icaM hods,in has oI such end.nommentfith
PROWCGI COHGCT
NEE:
TIERNEY INS AGCY INC PHOIE FAX
PO BOX 750 (Aro,No,Ext); (aC,xor
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WESTFIELD,MA 01086 ADDRESS:
28DJH INeORNMId AFFORONO COVERAGE NAICA
INeYR® NIDVNERA: gM011CANZLIR[CRpISURANCR COMPANY
N R B EXTERIORS INC INSURERS:
lmRC:
NSURER O:
7 PHILIP CIRCLE l Nr e
GRANBY,MA 01033 1NBURERF:
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A IWOIt W8CORpW6AMNANO X WC;A-- OTTER
GIPLOYR'1LL181JTY YIN U&9 768618 0]/182018 OWWD19 LIMITS
v PnprFRrtIXtmHmEWE%EgRIVE a WA EL EACH ACCIDENT S 100000
6FICERMEa.ESClV .l
(MOdaoDMNm EL.DISEASE-EAEIJKC E S 100,000
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ELDISEASE FOLICV LIMIT IS 5p0,W0
DESCRIPTION OF OPMiATON6rLOCAP0N6N6a0.ia,Ap1RICTONeIePBIAL]TBE
71RS RACES ANY PRIORCTMCV[CATE MUEO TO TN9 CR =CA7E HOLDER AMCO WORMS COMP COVHRAGR
SIDNO.WINDOW INSfAMAMON,CARPENTRY AND ROO} G.
CERTIFICATE HOLDER CANCELLATION
N R B EXTERIORS INC ma
ANY OF THEAROVEOEC WPOLICIES BE CAN UM
7 PHILIP CIRCLE 'WORK THE EIVNATON DAIS THEREOF,NOTICEY/EL ME OBIVM1m
N ACCORDANCE MTH TIE POLICY PItOWBIONR
AUTHOREW —
GRANBY,MA 01033
ACORD26(201005) The ACOROnemeand"osrereglstwWmerbol ACORD IMS 10 ACORD CORPORATION. All rights reserved.
Fully Licensed and Insured 'iTio rhe C„ 7 Philip Cir Granby,MA 01033
MARebkr#20-2015718 Ov 'ar"o,m.� Phone:413-563-6354
MA Lic#: 147961 Fax#:467 9748
MA CSL#:99565 y aoof,.0
NICHOLAS BERNIER
(Owner)
EXTERIOR HOME IMPROVEMENTS, Inc. www'nrbexteriols.com
ShineNMantx- ROOFING fi SEAMLESS GUTTERS
rurn:a Windows-Siding-Decks
Residential-Commercial
Pro osal submitted fo: Phone# h: j D -� 7�- )4 c:
(� 3' Special requirements
Street
City,state,zip code P
Proposal to furnish and install the following
❑ Re-roof Tear-off ❑ Gutters
We shall acquire necessary permits for all we
Complete Roof Preparation
Home's exterior to be protected by tarps and plywood
Shrubs,landscaping,trees to be protected,roofers buggy used
I Entire existing painting materials to be removed to existing decking,including Flashing,etc.
`g Site to be cleaned on a daily basis with poll magnet,debris to be removed at project completion by dumpster
�1 Deteriorated existing decking to be replaced at$50 per sheet of plywood
r Complete CertainTeed Integrity Roof System
Install W in[erguard ice A,water barrier along bottom ❑ 3 R.of all roofs SCC,ft.
Install W inlerguard ice&water barrier around penetrations,m valleys a critical areas
Install 15#saturated asphalt felt paper to entire decking
Iwrl Install Roofers Select Premium underlayment to entire decking
Install DiamondDeck Synthetic underlayment to entire decking
F� Install 8"perimeter metal Flashing to all edges of all roofs, D white❑ brown
Install SwiftSlart starter shingle to bottom and rake edges of all roofs
Install CertainTeed shingles to manufacturers specifications, ❑ 6 nails O 4 nails
Install Shingle Vent 11 PVC ridge vent to all peaks in heated areas
Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
19 Install new lead counter flashing to chimney
New flashing installed where necessary
Install new pipe flashing to waste vent stacks
Warranty options
We guarantee our labodworkmanship of 20 years
❑ Upgrade CertainTeed 5-Star Sure Stan Plus,50-year reciprocated coverage,including workmanship
Upgrade CertainTeed 4-Star Sur art Plus rmed coverage
,QI CertainTeed Landmark-color: al X a f COLONq(, tr•n 3-tab
❑ CertainTeed Landmark Pro-color *, ItAY) JD
Wepropoxe hemnymr mise manuals and lahnr—complemin uceordanw wllh above sped0emlonc ranpemmoL Total Due $ /
ACCEPTANCE OF PROPOSAL:The idose prices,specifications a ad conlitionsare - 1/3DownPayment$
satisfactory and are hereby inceptd
e .You are t u l u
red to do work as sperifi, Balance due
Payment will be 1/3 down at startofjob,and bale a eopon completion. upon completion $ IIcco . cl
Date: /0 Signature: _ J
i
Date: I/L' ( Estimator (Print Name)W 1 �✓✓el`f'— (Slga 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.NRR Exteriors Inc.will not be responsible for
debris or dust in the attic or storage areas.
A Fnanne Ch 'y f I -% nlhly(ANNUAL PERCENTAGE RATE OF lh ,) vill beedded m the m,nnd Fenton 1 In,halm.due I
.'e.tot... Y' dl g yyyyyy,',','1 Paym t f0 h g s i thet fault f payment,l agree copy . 'tlAttorney -f and
eounwxr 'Ih. s...in NJ�smucnsl11 lla Ia,,dlh,M1lty_Bynysgnawru blow.ueknnwledgisno ab mem oflhe aM1ovels
hereby node A �//
VIN '� U fGlC'Office of Consumer Affairs and Business Regulation=� 10 Park Plaza - Suite 5170
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
NRB EXTERIORS INC Registration: 147901
510 NEN/ LUDLOW RD Expiration: 00/22/2618
SOUTH HADLEY,MA 01075
Update Adores and raturn avtl. Mark reason for cootie.
5CA 1 0 'NMg1!11
y" 11j
OMI.of Conellesr Anelrs a euslnep ReeeNeon
K� HOME IMPROVEMENT CONTRACTOR RegistrMlon vald for Individual use only
i�x mow;% TYPE:Corcoa0cm beton tins expiration date. Bfound return m:
9aghSndon ExpirationOffice of consumer Maine and Business Regulation
147981 06/29J2019 10 Pe*Plea-Sufte 5170
NPB EXTERIORS INC Boston,MA 02118
NICHOLAS R.BERNIER Xk "
510 NEW LUDLOW RD
SOUTH HADLEY,MA 01015 Undersecretary- NOF vift without slgnaturs
Massaohusetts Department of Public Safety
Board o18uiMing Regulations and Standards
License: SSL-0995b5 cult
Construction Su Tmsot Spa Y
NICHOLAS R BERNIER
7 PHILIP CIRCLE
ORAMSY MA 01073
EXpifatiorr.
Commissioner
06R9rtn19