16A-013 465 SPRING ST BP-2019-1094
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao'Block: 16A-013 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-2019-1094
Project# JS-2019-001779
Est.Cost,$8695.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group NRB EXTERIORS INC 99565
Lot Size(sa.It.): 21649.32 Owner: WALKLIN MARY
Zoninz URA(100)/ Applicant: NRB EXTERIORS INC
AT: 465 SPRING ST
Applicant Address: Phone: Insurance:
7-PYI�C- E (413) 563-6354 WC
GR;0M YtoffcB' M ISSUED ON:4/3/2019 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 Deoartmen[ Fireplace/Chimney:
Rough: Qi 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 4/3/2019 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
P
Department use only
City of N rtha tatu of Permit:
.a Building epa men. 3 2019 rb bDdYewey Permit.
�.,' 212 Ma Str et QPfl r AveuaMlhy
` j Roo 100 star all AveileMllly
\
Northam pto MA r , ,nrwe INSPECT' of Structural Plans
phone 413-587-1240 Fai:rd,��''n5f """cc a Plane
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
7
SECTION 1 -SITE INFORMATION — (q(K(3C1
51 i
1.1 ProoerN Addross: [sThissectlon to be completed by office
Map l r1 Lot nit
465 spring st zone Overlay District
Elm St District CB Dletdot
SECTION 2-PROPERTY OV INERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Mary Welkin 465 spring St.
Name(Pdnb Guam!Mailing Address: leads ma
Telephone
Signature
2.2 Authorized Aeem: w r`
rJ n a �x � a,5 s l R . "uJk11
Nama�u Cument Mailing Address:
B' ure Telephone
SECTION b-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Dennift applicant
1. Building 8695 (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Pratection
6. Total=(1 +2+3+4+5) IS 6695 1 Check Number
This Section For Official Use Only
Date
Building Pam h Num r: Issued: L� 2
Signature:
Building CommasionerMspector of Buildings Data
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Aiterathm(s) ❑ Raanng
Or Doors O
Accessary Bldg. ❑ Demolition ❑ New Signs [0] Decks [[Zj Siding]0] Other[O]
Brief Desc,ppption of Proposed
Work: KeQ26� 1 N 0SPtr .I R60
Alteration of existing bedroom_Yes_No Adding new bedroom Yes No
Attached Naragve Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
5a. H Now houseur addi!!9q oxistinaIn le foltowilifla
a. Use of building :One Family Two Family Other
It, 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?
I. 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_ Pnvatewell City water Supply_
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I
I, N � ( R ' t)✓S /^-k - I /�.I �✓ /nI LSI ') as Ovmerufthesubject
property ^ ' �p L
hereby authorize Nil r` IJ l',, I"Al �✓t� '
to act on my behalf in a1I matt rs r Iive to work authorized by this building permit application.
Signature of Owner ( Data U
I'
h� R ,J Q ` 1 :y� as Ovmer/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 pains and penalties of perjury.
J
Print Name
Signature of Owner/Agent Date
City of Northampton
Massachusetts Fla. c`s
� 'I DaPARl9feiT OF BUILDING INSPECTIONS 2 n
212 Min atraat • Municipal Building
" NortLampten, NA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which am adjacent to such residence or building'be
done by registered contractors.
Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered.
Type of Work: I - J Est.Cost:
Address of Work
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law(explain):
Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
1- 30- 19 dy-& i'L
Date Contractor Name HIC Registration No.
OR:
Notwithstanding the above notice, II hereby apply
f�ora building permit as the owner of the above property:
Date Owner Name and6ignature
SECTION 8-CONSTRUCTION SERVICES
81 Licensed Construction'S`upervisc, � Not Applicable El
Name of License Holder: 1 'S V
License Number
5lo vk1 1 �.� \ ( So �Lt.— � o
Address Explmtian Date
eture Telephone
9.Repisterad Nome Impro"Mantt Contractor Not Applicable ❑
4
CompanyNa(m e z�C .)� ✓S � c
�J L1�G� V1��,JRegistration Number
s( .e,j i�j l„")
g2 a- 3- t 9
Address �-r 1 Expiration Date
Telephone 7,3— ID S�
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.157,§]SC(8))
Workers Compensation Insurance affidavit at be completed and submitted vnth this application. Failure to provide this a�davit vdll result
in the denial of the issuance of the buildin pernll.
Signed ANdanl Attached Yes....... V N....... ❑
City of Northampton
\ S
/ .ar
Massachusetts F2s .' ctcc
3
DSDARTlEaT1T OF BUILDING INSDSCTZONS
211 Main Street •Municipal Building
No thu ton, M11 01060 + aC
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 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:
(Please print house number an treet name)
Is to be disposed of at:
�- o v' Oye r� �^ 5A ((A �(C,
(P ase print name and ocatim at facility)
Or will be disposed of in a dumpster onsite rented or leased from:
C� c4 ( � 4 (,)t1 �
(Company Name and Address)
Sigif,ratafe 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.
S\ The Commonwealth of Massachusetts
*Vwirke"'Courponaturtion
Department ofIndustrialAccidents
I Congress Street, Suite 700
Boston, MA 02II4-2017
wwucmass.gov/dia
Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant If m tin Please Print Leeibly
Name(Business/OrgeniudoMvdividual): N (b QX�jIJ/S tr (
Address:—2 n c ✓
City/State/Zip: - /U Phone#:
Are you employer?Cbeek IIme appeoprtate boa: Type of project(required):
L employrsxiO. _L emploYces ffull and/orpan-timer' 7. C]New construction
2❑lamasole propriMrtrcparmmship and have no employees wotkwg fmmcin g. E]Remodeling
any capa:ity.[Nowurkaa'com,,insurance regwrW.]
9.
3.❑I am a homeowner doing all work cn af:[No wohcri 10 comp.wstvmce requked.]* Demolition
4.❑1 am a homeowner and will be hiring couradom to conduct all work on my propeny. I will 1Building addition
encore that all contractors either have wurkers'wmpensation inswance a,are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑1 am.general sitractor and l have hirM the sub-coutraaors lined on�c`inchedsh«t. 13. Roof repairs
Thew sub-conaactora have employees and bake workers'comp.inti
6.[]We area co,statimt ane its officio have exercised their right of exemption per MGL a. 14.[-]Other
152,11(4),and we have no employees.[No wvrkon"comp.ireutance ree n,ed.]
IL
'Any appliceutrhat checks box 41 must alba fill out the sccum below showing their workers'compcnaation polity information.
t Homeowners who submit This affidavit indicating they are dowg all work and crew hire outside convactmsmust submit a new affidavit indicating such,
tCoanacova that check this box mint atached an additional shccl showwg the name at the sotrcovuaaots and state whether or not those entities have
employees. if the sub-conaactom have emplayea.they must provide their workers omp.policy nutMcr.
[am an employer that is providing workers'compensadon insurance for my employees Below is the policy andjob site
information. nn
Insurance Company Name: Y lyytla . :I— �
Policy#or Self-ins.Lie.#: (9ZL t{ll-f( F S c, -1 ly' b Expiration Datej
:
Lob Site Address: S rr' �l �" City/State/Zip: �-o A 1 `tom l
Attach a copy of[he workers'compedsation olicy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up to$!,500.00
and/or one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a fine of up 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.
I do hereby cerdfy un //pp�ains and penalties ofperjuy that the information provided above is true and correct
v
S' fur ' yv/ Date' 3 — /U — 11
Phone#:
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 N:
CO d CERTIFICATE OF LIABILITY INSURANCE
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Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Type: Corporation
Registration: 147961
NRB EXTERIORS INC
510 NEW LUDLOW RD Expiration: 08/22/2019
SOUTH HADLEY,MA 01075
Update Address and return card. Mark reason for change.
scn, o zonnasm
Office of Consumer Me.6 Bueineae Reyultlloe
HOME IMPROVEMENT CONTRACTOR Rplsirallon vWd for Individual uss only
�q TYPE:Corporation before the expiration date. M found return to:
Rwletration Excitation OMro of Consumer Affairs shad Business Regulation
147961 08/222019 10 Park Plssa.Sults 5170
NRB EXTERIORS INC Boston,MA 02116
NICHOLAS R.BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY.MA 01075 Undersecretary Not valid without signature
Ca,monwealtb of Massachuselts
®' Division of Professional Licensure
Board of Building Regulations and Standards
Sonstr UctiOn Supervisor Specialty
CSSL-099565 EApires: 05/28/2020
NICHOLAS R BERNIER' '
610 NEW LUDLOW RD_
SOUTH HADLEY MA 01875
Commissioner L
Fully Licensed and Insured spec the qd 7 Philip Cir Granby,MA 01033
MA Reg A 20-2015718 �r'rion! Phone:413-563-6354
_JbIrc#:147961 Fax#:467 9748
MMArCSLB:99565 in
MIT NICHOLAS EERNHdR
(Owner)
ERIOR NOME IMPROVEMENTS,Inc. www,nrbexteriors.com
shkralakWalar ROOFING fi SEAMLESS GUTTERS
Windows-Siding-Decks
Residential-Commercial
Proposal submitted to: Phone# In °j GAJ O c
k�
(1�rxYu 9i k, Special miller,mens
Stream e y, C`r LSp 1 SLeeAt, 3/t1ti��1C
City,state,zip code Q\`� �J JJ J
Proposal to lurnish�d install the following
❑ roof IY Tear-off ❑ Gutters
CY We shall acquire necessary panders for all work
�, Complete Roof Preparation
Lyn Home's exterior to be protected by tarps and plywood
L[Shmbs,landscaping,trees to be protected,roofers buggy used
[Enthe existing mating materials to be removed to existing decking,including flashing,etc.
CYSite to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster
EVDetenorated existing decking to be replaced at$50 per sheet of plywood Dt!f( -7 lg,t j{
—/Complete CertamTeed Integrity Roof System /
LS Install W inlerguard ice&water barrier along bottom PJ 3 ft.of all roofs,D 6 ft.
[Insbdi W inlergunrd ice&water barrier around penetrations, in valleys and all critical areas
Mq Install 15#saturated asphalt felt paper to entire decking
i WA'Install Roofers Select Premum underlayment to entire decking
EK Install DiamondDeck Synthetic underlayment to entire decking
&�Install 8"perimeter metal flashing to all edges of all roofs,tk'�h its,C brown
E41/hlstall SwiftSbm stoner shingle to bottom and rake edges of all roofs
D. Install CertnlnTeed shingles to manufacturers specifications,O 6 nails 19(nails
[aY Install Shingle Vent 11 PVC ridge vent to all peaks in heated areas
GL Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
B' Install new lead counter flashing to chimney
5�New flashing installed where necessary
[Install new pipe flashing to waste vent stacks
armory options
We guarantee aur labor/workmanship for 20 years
❑ Upgrade CertainTeed 5-Star Sure Stan Plus,50-year nonppirated coverage,including workmanship
❑ Upgrade CenninTead 4-Star Surg tan Plus,50earneon pirated ccooverage
I�CemimTeed landmark-color.0 (flrn }e- Cx P... -)D 3-tab
❑ Ciaw inTeed Landmark Pro-color —r
were in a herchr m finish inmenws aw lalwr—wnaln a In mcumwm war,6rve spw:rom ro,we mm ur Total Duce,06'f� JO
yeti Ck3K-1pYl r A 300. Oe
ACCEPTANCEOF PROPOSAL:The above prices,speciGratimix mdemeditons art - 1/3 Down Payment$
vnsfaMry and are bercby accepted.You arc authorizedbdo work as specified. Balance due
Payment win he 0/down at start ofjob,nod balance due upon completion. uponcompletion $
Date: rl Signature:
Dale: FsL[dwlur(Print tire)_,QC jy y'/•[< Q� (Sign Name) ' y�
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 posting debris or dust in through cracks of the woad.NEB Exteriors Inc.will not be responsible for
debris or dust in We amic or storage areas.
A Finame Clangs,of I Wk momhly(ANNOAL PERCENTAGE RATEOF 18%)will he third w the on,ld pro en of the balance due I
agree to pay and/or gumantm payment of them charges.In the even of default of payment,I agme to pay reasonable Attorney's fees and
rein costs.This agmemem does not coasoure a release of liability-By my signature below,acknowledges an agreemem of the above is
hcrcbv mad,.
Signature'.