35-214 (4) 100 WEST FARNIS RD BP-2018-1355
GIS#: COMMONWEALTH OF MASSACHUSETTS
a :Block:35-214 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permsr. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory: ROOF BUILDING PERMIT
permit ft BP-2018-1355
Proiect# JS-2018-002412
Est Cost:$6500.00
Fee S40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group, NRB EXTERIORS INC 99565
Lot Size(sp.ft.): 84506.40 Owner: LESKO EDGAR 1 JR&DEBORAH 1
tonin : Applicant. NRB EXTERIORS INC
AT. 100 WEST FARMS RD
Applicant Address: Phone: Insurance:
7 PHILIP CIRCLE (413) 563-6354 WC
GRANBYMA01033 ISSUED ON.611912018 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 Occuoanw Signature:
FeeType: Date Paid: Amount:
Building 6/1920180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
1.,10,03
Dspertatern use artly
City of Northampton status of Penni:
Building Department Curb Callorhaway Permit
212 Main Street sawepSapichv*VsbMy
Room 100 Watliftei Avaiabirny�..
Northampton, MA 01060 Twn a of structtubl Pifm
phone 413-587-1240 Fax 413-567-1272 Plotl$ie Plans
Odteir;Spabry
APPLICATION TO CONSTRUCT,ALTER,REPW6FM"W6UOL1SI I A ONE OR TWO FAMILY
,IDWEW NG
SECTION 1 -SITE INFORMATION JUN ✓v- I "�//_( ✓�
1.1 PropertyAddress: This 'on to be completed by office
DEPT OF WILDI 6 Lot Unll
100 west farm rd. Florence , ma NORTPAMPTONlMA01000
.one Overlay DlSMet
Eft St DiaMet CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
ed lesko 100 west farm rd Florence me
Name(Prim) Current Mailing Address:
Telephone
SignaWre
2.2 Authorized Aaent:
7 Philip cir granby ma 01033 7 Philip cir granby me 01033
Name(Print) Current Mailing Add.
7 Philip cir granby ma 01033
S' Tekplwle
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Perrift applicant
1. Building 6500 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee / (,1
4. Mechanical(HVAC) 4 /Lv
5.Fire Protection 111
C Total=(1 +2+3+4+5) 1 6500 1 Check Number do H
This Section For Official Use On
Date
Building Permit Number: Issued:
Signal lF
Building mieaioner/Inspector of Buildings Date
EMAIL ADDRESS(REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
Naw House ❑ Addition ❑ Raplacament Windows Alterations) ❑ Roofing ❑J
Or Doo s ❑
Accessory Bldg. ❑ Demolition ❑ I Naw Signs 1171 Docks IQ Siiiding[ol Othw[/O:JBrief ,. n
Work: as 'poor � C/S.�'l fir, 1`�A? )''')M.� I UIIGJ fn1YgI y.)J� Hr^t }. M,CC ,
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No ' 1
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
ea.H New house and or addhlon to existlna housing connolete 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 Buikfing and Zoning regulations? Yes_No.
I. Sepfic Tank_ City Sewer Private well_ City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR (BUILDING PERMIT
1, 9=k C U L G S K o as Owner of the subject
property
hereby authorize 7 Y
to act on my behalf,in ere rele0vereed this building permit application.
Signium m,�olxm(a]r uI "n Deta
I, tl" 1` �C.)C T� ( I��S 1 '^C. .as OwnedAWha¢ed
AgeMthe by dedaie that thewtemente end imolm tion on the foregoing application are true and accurate,to the heat of my kmWedge
and belief.
Signed under the pains and pen of perjury.
lea\ x� r A , .i
Print Name
S Agent we
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Nader; nicholas bernier
License Number
510 new Ludlow d south Hadley me 01075 99565
Atltlress Expiration Date
05/28/20
slpn Telephone
5636354
S Replssared Noma ImorovemantComradan ` Not Applicable [3Aj �� -k- -.IV � r� , lu'7- %b
Company Name Registration Number
't PA, uf Cii !�/O�} (i - ) ; — 19 I
Address Expiration Date
Telephone S-Co'1-05^+
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT)M.G.L.c.152,g 25C(S))
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.......W No...... ❑
City of Northampton
% N888dttlll88tt9
L
'\ 'C DEPART OF BI ici di
INSPECTIONS
M�1n S
212 tu •aNunidpol Builng
8ezth�ton, 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 govemed by this Building Permit 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
foo we5)A k•'A' J
(Please print house number and street name)
Is to be disposed of at:
LkSI'r WN VCx .
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
MA U)uS M
(Company Name and Address)
Signature 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.
The Commonwealth ofMassaehusetts
Department of Industrial Accidents
1 Congress S(ree4 Suite 100
Boston,MA 02114-2017
ww omass.gov/dia
ulkirkers'Compensation Insurance Affidavit:Builders/Contractors./Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(BusincovOrglaniaetimJlndividuap:
Address: 7
City/State/Zip: vla�, Jlai-7 Phone
Are yog an employer?Check the appropriate boa:
—� Type of project(required):
I l am a empbyar with_ employees(full and4upantim- e)• 7. []New con morction
2. 1amasole proprimrorpartnership and havereemployees working formein 8. []Remodeling
any canards.[No workers.'com,arame we rpunned]
3.❑l am a homeowner doin nwe&niself. rkers'eo urmree required. 9. ❑ iligDemolition
Ba Y [No wo toll.ha ]'
4.]Iam a homeowner and will b,hiri yproperty (will 10 Building addition
ng contractors to conduct all work on m
ure mat ail comacmrs ciNv have workers compensation insurmce w arc sole l LE]Electrical repairs or additions
propnctors with no employees. 12,❑Plumbing repairs or additions
5,0 l am a general contractor and l have hired the subcontractors listed on the eneclied shat. 13.01toof repairs
Those sub-contrecmrs have empbyas and have workenS comp-iwtmervel
6,E]we are a cor mortars and its otKeers have exercised their mda.fexemptmn per MGL c. 14.QOther
152.41(4),and we have no employees.[No workers'comp.insum en required]
*Any applicannhat checks box 41 must also fill out the section beow showing their workers'compensation policy infomation.
t Homom ear's who submit Nis affidavit indicating they are doing all work and men hire outside contactors must submit a new affidavit indicating such.
tContacmrs that check this box at attzchitl an additional sheet shaw,io,the name of one sub-contractors not state whether or not those entities have
employees. Ifthe sub<on aaon have employee,they must pmvide thetr workers'comp.policy number.
7 am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob.site
information. 7
Insurance Company Name:_
Policy#or Self-ins.Lic.#: Z.2 N Expiration Date:
Job Site Address: (cos /L � b f.1�er in. ✓✓' City/State/Zip: ft IVU'Al ✓.Yrs ti
Atueh 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 of up to$250.00 a
day against the violator.A copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Ido hereby certify r the pains and penahies ofperjury that the information provided above is true and correct.
Signt�.� Date: G; ti-r y
v
Phone#: G
Oficial 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.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
ACOR& CERTIFICATE OF LIABILITY INSURANCE
psne zple
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFO TION 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 DOEG NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: N the certNlCa s holder is an ADDITIONAL INSURED,the POIICYUes)must have ADDITIONAL INSURED previsions or 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 codffl W holder in lieu Of such enclorsemands).
PRODUCER NAME. Tiemey Team
Tiemey Group NIOxNU EXO (413)562-7007 uc No: (888)271-2228
16 North Elm SeeM MAIL
ADDRESg:
PO BOX 750 INSUREWS AFFORDING COVERAGE SAO
Westfield MA 01086 IxguRERA: Russell Bond InslColony Insurance Company
INSURED IXSVRERB: 3alety nSUldpCa GO. 12808
N RB EMEND.Inc IxwRERC: WCRIB?rave eRlZUnCII
7 Philip CinDe INSURER D'
INSURERS:
G2nby MA OJD33 INSURERE:
COVERAGES CERTIFICATE NUMBER: CL183WD0351 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 MAV BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
UCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE Him pCLILY XVMSER MMPI MRENDG,Y La11TS
X LOMMERCUILOENERALLA&IJTY EACH CGLURRENCE S WO,000
CIAIM&MAGE OOCCUR PREMISE$ Ea oavrreuw S 100000
x SUblNtW$1000.DODeduLUble MEDEXPAn ore g 5000
A 101GLOO89353 12/2312017 12123/2018 PEREDNALSADVINJURY E 500,000
GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE E 1'WOOD
POLICY❑jEL LOC PRODUCTS-COMP/OPAGG E 1,000,000
OTHER $
ANTOMOaILE LMBNT! EOMaa Mn gINGLE LIMIT E 1000 D00
ANYAUTO INDICT INJURY(PBrpmson) S
B CMEo X gLnEWLEO 6244143 03/1512018 03/15/2019 eowly lwuav(P+rawe+ln) s
AUTOS ONLY AUTQS
HIRED NDN.ED PROPERTY AGE g
x AUTOS ONLY x AUTos oNLv P—.eem
Medical payments $ 10,000
UMgiEIyA LASTIX:CUR EACH OCCURRENCE E
EXCESS LIAB CLAIM$.MADE AGGREGATE E
OED RETENTION E a
WORRERs LOMP.M mx IPER OTn.
AM EMPLOYERS'LAMUW STATUTE E0.
YIN TO FOLLOW
C OANY FGDEFPnETORIESDLUGIUUx uirvE ❑ NIA EUU8-9F59768-6-18 02/1312018 11211312019 EL EACH ACCIDENT E
(Mnd,"I PIER ExcwDEm DIRECTLY FROM
(M+nWldyln NET EL.pISEPSE-EAEMPLOVEE b
nyea eaxnee unser THE COMPANY
pE$LRIPIICN OF OPERATIONS SeIox EL.DISEASEPOLICYLIMIT E
DESCRIPTION OF OR ERA .S I LOCATIONS I VEHICLES IACgID 101.AIH..lR.—.UINS.,rrcy M+x+cMe N mma eryw 1.SqU )
Sidin, window Inslellation,wrWrary and roofing
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Valle Home ED entlnc ACCORDANCE WITH THE POLICY PROVISIONS.
POBO 7
34 revs AUTHORIIED�REP^' ,rRE-SE^NEAINE_
_.. v/ any
Florence MA 01062
®1988.2016 ACORD CORPORATION. All rights reverted.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
Commonwealth of Massachusetts
Division of Professional LKensure
Board of Building Regulations and Standards
ConstructionSllpertisor Specialty
CSSL-099565 Expires:0512812020
NICHOLAS R BERN
NIt
510 NEW LUOLOW RO
SOUTH HADLE` IMA 01076
Commissioner C4
I �I
Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Corporation
NRB EXTERIORS INC Registration: 147961
510 NEN/LUDLOW RD Expiration. 08/27/2019
SOUTH HADLEY, MA 01075
Update Address and redum cod. Mark reason for change.
SOA1 v1 20XH5tl1 ���- n __.• r1 r1 • . ....
��r�i'nuni im•Po�/�/r`I�u•On�i nic//1
•a - HOME IYPROVEMENTadrT CTOR Refor.th onvalid forhation late. Ifoud only
I S _ TYPE:Corporatbn before f Consumer dale. and Bu inessrefunto:
Registration EaQUH1198 otilm
Park Consumer $17naM Business Regulation
14]061 00/22/2019 IO Park Waaa-Sulb 51]0
NRB EXTERIORS INC Bordon,MA 02115
NICHOLAS R.BERNIER �Q
510 NEW LUDLOW RD
SOUTH HADLEY,MA 01075 undersecretary,- Not valid Without signature
Fully Licensed and Insured 09 s,0111 111,c 7 Philip Cir Granby,MA 01033
MA Reg#20-2015718 'n'Pearlont Phone:413-563-6354
MA Lic#: 147961 —now Frobs:467 9748
MA CSL#:99565 spadahaloa hailed
NICHOLAS BERNIER
-.._- (Owner)
"'' `'"` """""" www.nrbexteriors.com
ERIOR NOME IMPROVEMENTS, Inc.
Shin9laklaster' ROOFING&SEAMLESS GUTTERS
Windows-Siding-Decks
Residential-Commercial
Pro °sial submitted to: Phone# h: c:
LrP LL'SkU Special requirements
Street pp p
I6' tJ <S xl- Per" /J . � or 1eJ
City,state,zip code
Proposal to furnish and install the following `f��( pia l (
❑ Re-roof �T'earoff 0 Gutters 1
❑ We shall acquire e,res ax.y permit,for all work
Complete Roof Preparation
Home's exterior to be protected by tarps and plywood
[$ Shrubs,landscaping,trees to be protected,roofers buggy used
(5] Entire existing roofing materials to be removed to existing decking,including flashing,etc.
Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster
[A Deteriorated existing decking to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
Install Winterguard ice&water barrier along bottom qf3 ft.of all roofs, D 6 0.
IP Install W imerguard ice&water barrier around penetrations,in valleys and all critical areas
fM hismll 15#saturated asphalt felt paper to entire decking
pQt°I'Install Roofers Select Premium underlayment to entire decking
Install DiamondDeck Synthetic underlayment to entire decking
® install 8"perimeter metal Flashing to all edges of all roofs,Pwhite O brown
® Install SwiftStart starter shingle to bottom and rake edges of all roofs
(g] Install CertainTeed shingles to manufacturers specifications, O 6 nails B 4 nails
YT Install Shingle Vent lI PVC ridge vent to all peaks in heated areas
5' Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
Install new lead counter flashing to chimney
New flashing installed where necessary
[� Install new pipe flashing to waste vent stacks
Warranty options
�c We guarantee our labor/workmanship for 20 years
❑ Upgrade CertainTeed 5-StarSure Stan Plus,50-year nonprorated coverage,including workmanship
10 Upgrade CertainTeed 4-Star Sure Stan Plus,50.year nouprQratcd coverage
CenainTeed Landmark-color: lie 'A
� � �I(^a' ❑ 3-rob
CertainTeed Landmark Pro-calor /rnr�
We propose hereby tot order mowerN and tabor—romptaa In accordance with above spved'eaivel tonnae'y'sgtm JS77intal DD,gKf$� SW
D.
ACCEPTANCE OF PROPOSAL:The above prices,spehficntionsand conditions ore - 1/3 Dow nP�me1COc , JO
weradary and ore hereby accepted.Y aro euthor'zM to o ark as ed(d. Balance due
Payment w 1 be I down at stud of nd bnau= du a mplet u upon completion $Va . d=
Date �� Signatur ' y
Date:_ Estimator: (Print Nam Nf k ��X'/nsm— (Sign Name<l
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.NRB Exteriors Inc.will not be responsible for
debris or dust in the attic or storage areas.
A Finance Charge of 1 V2%monthly(ANNUAL PERCENTAOB RATE OF 19%)will an added to the argued gonion of the balance due.I
agree to pay and/or guarantee payment of these charges.In the event of default of payment,I agree to goy reasonable Attorney's fees and
connends,This ugmennal docsnot constitute a release of liability By my signature below,acknowledges an agreement ofthe above is
hereby mad,.