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36-035 (3) 4 WINCHESTER TER BP-2020-0390 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-035 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-2020-0390 Project# JS-2020-000670 Est. Cost: $8000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sq. ft.): 11020.68 Owner: CRAFTS ROBERT T&RUTH A Zoning: Applicant: NRB EXTERIORS INC AT. 4 WINCHESTER TER Applicant Address: Phone: Insurance: 210 NEW LUDLOW RD (413) 563-6354 WC SOUTH HADLEYMA01075 ISSUED ON.9/27/2019 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 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 9/27/2019 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 Northampt ��' ; us of Permit: Building Departm nt b'D i:uftQriveway Permit ,; 212 Main Stre t SFF Se S�pltic Availability Room 10 �5_ Water/Wll Availability \,t Northampton, - 01 14 Sel4 of SVuctural Plans phone 413-587-1240 Fax Plot/113'e Pla s tigMnT���Nsp� e Spec' APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE o m6 LISA ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION i P-':�x _6 G V 1.1 Property Address: This section to be completed by office Map Lot 0-3�5 Unit D ( � 4 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2..1C�Owner of Record: / Name(Print Current ailing A d e s: Telephone Signature 2.2 Authorized Agent: Name(Prin Current Mailing Address: —co 1 na Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit 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 Protection 00 6. Total = (1 +2+3+-4+5) L>v 8695 Check Number V1 I This Section For Official Use Only Building Permit Number: Date Issued: Signature: 27- ZOO Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) INdif" dDD�SE?.'�• (beofium). EUHEM HOWEOMVIF-;K 06 COL !_6VC.10E3} C g.�)Ict�ur�%:.tu 1:.,04•..,nr 5k:c;+;.ut c;;..I�;�tG2 }.r; `1�;,•1 � ,,. i.i •,�euQRl. i f •13132 L)"P III kfA CA41.^1111 rEab ptstr 177 j in � i ,�jR1U(';U'' � FjaltQOtJa j�6tlJt:(t iJ8 S j } fj^1}q.,r;• ���(�i� � (y � 1t1�1i;:7 ;��':;,;q p_; fl ld tt1 4 ij,U'bif i f({ �L C0 3' 111Y111E� H2.i YSt*1 'J 1 N C=0212 j 1 ' �': yntlt�Z.i36y Mdau: � ( i �r C.Jt tli ti bisobt7isi . fowEiisambivr i.HOom--D VeEAl 1 ' I gQitG�- --•- _..-_. ---.. . . 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D° SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding[p] Other(p] Brief Description of Proposed Work: ( r 1y-7, IU _C�C�J:1 Z �f�Srt+� { .c.✓ ., 1.. .r u Alteration of existing bedroom Yes No Adding new bedroom Yes _ No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. 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, P, V"A � k _ as Owner of the subject property I is hereby authorize ( h '� I ( . /S ✓`c to act on my be al , all matters relative to work authorized by this building permit application. Signature of Owner Date I, �/ 2 —� ,� 'll✓� 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 under the pains and penalties of perjury. Print Name j S ature of Owner/A ent Date City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Jl4• {�� \' Northampton, 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 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: ('/ [y cc--< S �t— k — (Please print house number and street name) Is to be disposed of at: (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) Signa 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 of Massachusetts Department of Industrial Accidents > I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ` Please Print Legibly Name (Business/Organization/Individual): Nt In, U✓S �1^� Address: .5 �& U i_,iw l u (0-_, J City/State/Zip:.. Pcj(" Phone#: 7G 1 Are you ane oyer?Check the appropriate ox: Type of project(required): 1. a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]? 10E]Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill 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. Insurance Company Name: ��-'t I ✓U✓t </� l 1i► C c) Policy#or Self-ins.Lic.#: �ZZ u -eiir tc,76�/" -(y Expiration Date: �f� Job Site Address: L/ IN ,-c" 1't� 1C � City/State/Zip: Lj✓t a /y "�. 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 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 certify un e s and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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.City/Town Clerk 4.Electrical inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address _rr ff Expiration Date at Telephone 9.Realstered Home Improvement Contractor: Not Applicable ❑ ;Qv � (-(- C Company Name Registration Number Address Expiration Date Telephone 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 will result in the denial of the issuance of the buildin ermit. Signed Affidavit Attached Yes....... No...... ❑ "I ulatlon C� Business 9 Of Consumer Affairs _ Suite 710 Office o 1000 Washington 02118 Massachusetts Registration Boston, ent Contractor Reg Home Improvement Type: corporation �; 147961 Registration: 08122)2021 ExPiratiot" 0812 NRB EXTERIORS INC "t." RD g�U H HAD EoMA 01075 a;k � w Via' s t Jnreturn Card. Update Address and R scn 2OM-0517If found return Ito.. ulation / + ,^j(�� .�,/„��uja8on Registration vadate.for indildu d use only 16 �� before the expiration Affairs and Business Reg Consumer Affairs&Business ACTOR Office of Consumer Suite 710 office of IMPROVEMENT CONTRA on street HOME TYPE;Corporation r n 1000 Washington x lr Boston,MA 02118 R i r i 0812 147961 NRB EXTERIORS INC nature Not valid wlthout S NICHOLAS R.BERNIER 510 NEW LUDLOW RD A 01075 Undersecretar`/ SOUTH HADLEY,M ® Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor Specialty CSSL-099565 Expires: 05/28/2020 NICHOLAS R BERNIER 510 NEW LUDLOW RD SOUTH HADLEY MA 01075 Commissioner Fully Licensed and Insured v c c -4- 510 New Ludlow Rd. MA Reg#20-2015718 ilk South Hadley,VIA 01075 MA Lemic,#.;. 47961 > MA(41.#:99565 Cell:413-563-6354 4913-70M '"3j Office:413-707-ROOF(7663) ! Fax:413467-9748 SELECTSHINGLE RUBBER NICHOLAS BERNTIER RoofiProS4l Mom (Owner) RoofPros@ comcast.net Pr oral yubmitecl to: Phone# h: c: Special requirements Street 9W•,, -cit., _.� ,Zlp Coale Proposal to furnish pal install the following ❑ Re-roof Tear-off ❑ Gutters Q We shall acquire necessary permits 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 Cr 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 Q'-Deteriorated existing decking to be replaced at$50 per sheet of plywood Complete CertainTeed Integrity Roof System nstall Winterguard ice&water barrier along bottom ❑ 3 ft,of all roofs,V6 ft. .Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas Install CertainTeed Synthetic underlayment to entire dec king,.- 'Install 8"perimeter metal flashing to all edges of all roofs, white ❑brown R—Install SwifltStart starter shingle to bottom and rake edges of all roofs Install CertainTeed shingles to manufacturers specifications,❑6 nails❑4 nails F nstall CertainTeed PVC ridge vent to all peaks in heated areasnstall Shadow Ridge to all hips and ridges,over ridge vent where applicable /Pfr Install new lead counter flashing to chimney Q �w flashing installed where necessary Install new pipe flashing to waste vent stacks W rranty options We guarantee our labor/workmanship for 20 years ❑ Upgrade CertainTeed 4-Star Sul tart Plus,50-year nprorated coverage �CertainTeed Landmark-color. •ra.^ t.✓�a� • ❑ 3-tab ❑ CertainTeed Landmark Pro-color We pr(giow hereby to furnish materials and Ialx)r-complete in accordance with above specifications for the,so i of Total ue $. 00 �, q- iy -> 9�J cyt ACCEPTANCE:OF PROPOSAL:The above prices,specifications and conditions are - I/3 DOwnYayrnent skl;i�� satisfactory and are hereby accepted. re authorized to do work as specified. Balance due Payment will he 1/3 down at starto lob,a balance due upon completion. upon completion $ (� Date: Signaturc: # '? - Date:?- L — q Estimator:(Print Name) L'�-4l'/,t t� (Sign Natne Estimates are honored for thirty(30)days from above date ATTENTION HOMEOWNER&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] '•°o monthly(ANNUAL PERCENTAGE RATE,OF 18%)will be added to the unpaid portion of the balance due.I agree to pay and for guarantee payment of these charges.In the event of default of payment,t agree to pay reasonable Attorney's tees and court costs.Titin� cMent does not constitute a release of liability.By my signature below,acknowledges an agreement of the above is hereby made. /\\\ �f Y�� Sismature: v .6 f-L v A A . �' j ® , DATE(MM/DDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 02/04/2019 THIS CERTIFICATE IS ISSUED AS A 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 have ADDITIONAL INSURED provisions 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 certificate holder in lieu of such endorsement(s). PRODUCERNTACT Tierney Team NAME: Tierney Group acNNo Exti: (413)562-7007 AIC No): (888)271-2228 16 North Elm Street E-MAIL ADDRESS: PO BOX 750 INSURER(S)AFFORDING COVERAGE NAIC# Westfield MA 01086 INSURER A: Russell Bond&Company/Colony Insurance Co INSURED INSURERB: Safety insurance Company 12808 N R B Exteriors Inc INSURER C: WCRIBITravelers Ins.Co 7 Philip Circle INSURER D: INSURER E: Granby MA 01033 INSURER F: COVERAGES CERTIFICATE NUMBER: CL192400390 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 IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM DDIIYYYY MNSR AIJUL1bUt5K POLICY EFF M DDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE TO RENTElT___7 CLAIMS-MADE Fx_]OCCUR PREMISES Ea occurrence $ 100,000 X Subject to$1,000.00 Deductible MED EXP(Any oneperson) $ 5,000 A Y 101GL008936301 12/23/2018 12/23/2019 PERSONAL&ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 JECT POLICY ❑PRO-- 7 LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED rx SCHEDULED 6244143&Renewal 2019to2020 03/15/2018 03/15/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ XAUTOS ONLY AUTOS ONLY Per accident Medical payments $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HEXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTI I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN To Follow C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A 6ZZUB-9F59768-6-19 02/13/2019 02/13/2020 E.L.EACH ACCIDENT $ (Mandatory in N ) EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ Directly From If yes,describe under The Company DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ p y DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Siding,Window Installation,Carpentry and Roofing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Boron Construction ACCORDANCE WITH THE POLICY PROVISIONS. 10 Philip Circle AUTHORIZED REPRESENTATIVE Granby, MA 01033 • © 5 ORD C RP ights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD