25A-032 48 MARSHALL ST BP-2020-0476
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25A-032 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 I BUILDING P E R M I T
Permit# BP-2020-0476
Project# JS-2020-000812
Est.Cost: $12000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sg.ft.): 11891.88 Owner: SILVA ERO
Zoning: URB(100)/ Applicant: NRB EXTERIORS INC
AT: 48 MARSHALL ST
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON:10/11/2019 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 10/11 2019 0:00:00 $40.00
�12 Main Street Phone 413 587-1240 Fax: 413 587-1272
Louis Hasbrouck—Building Commissioner
I
V00
F-- Department use only
City of Nort�am4P(`�"� Status of Permit:
Building D artr��n `-��_ 1 VE rb /Driveway Permit
t,
{ 212 Mai Strdet _~`� wer/ eptic Availability
ROOrnI 100 n r T ' ater ell Availability
Northamptoh, MA 01064 '019 wo S is of Structural Plans
.rr phone 413-587-1240 F -587-1272 lot/S to Plans
riSt nen,,J Je Othe Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, REN a EM LISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION �7(/
1.1 Property Address:
This section to be completed by office
l J S Map Dr Lot Ol�� Unit
_I I ' Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Cu`�rMailing QgdrI s:
r U
_ LTelephone
Signature
2.2 Authorized Agent:
Name(P" Current Mailing Address:
7-q
Signature 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) t l��
5. Fire Protection
6. Total =(1 + 2+3+4 + 5) j V C 8695 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: Z)
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing El
Or Doors 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[p] Other[CQj
Brief Description of Proposed
Work: •M ALX �N� �. t b�l✓�✓ t�J'� � /,�� v''�n� ,� - j/22(
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 c/ 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
2—, I, as Owner of the subject
property
hereby authorize �'�J 1� `� ✓ �� ( n
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, /`�`� r/ � �C �,�` S 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.nn
)� L &/A
Print Name
Sign r/Agent Date
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): �/, -e tj�S K C
Address: �1(J 'V CJ L-4 J
City/State/Zip: Phone#: CO
Areyta
mployer?Check tjappropriate boa: Type of project(required):
1. lmployer with V 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 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]r
10❑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 11.❑Electrical repairs or additions
proprietors with no employees. 12.E]Plumbing repairs or additions
5.❑I 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.1
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,
tContractors 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:
Policy#or Self-ins.Lic.#: Z�'tt —� �- i Expiration Date:
Job Site Address: `f l� ` 1 I 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 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 unde a pains and pe es of perjury that the information provided above is true and correct
Signature: Date:
Phone#: 5Z, 67
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#:
City of Northampton
Massachusetts
40
DEPARTMENT OF BUILDING INSPECTIONS 7
p? �. 212 Main Street •Municipal Building
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:
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location bf facility)
Or will be disposed of in a dumpster onsite rented or leased from:
C( S 1-' - �6 S �-c.
(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.
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable (❑
Name of License Holder: 1" 1 (� -` 1 tc /►� I C1 (
License Number
Address Expiration Date
-C p3 S-
S na ure Telephone
9.Reallatered Home Improvement Contractor. Not Applicable ❑
(j vl—r/ 6 (
Company Name Registration Number
(t �-
Address Expiration D to
Telephone J`yrv3
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 permit.
Signed Affidavit Attached Yes....... No...... ❑
ACo& CERTIFICATE OF LIABILITY INSURANCE DATE 0811 2120 1/1212019 9
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(ft AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT M the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
N 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 NAYS: Tierney Team
Tierney Group P (413)582-7007 (888)271-2228
16 North Elm Street
PO Box 750 AppgR0D1p ppVpE NA1C N
WtesMeld MA 01086 INSURERA: Russell Bond&Company/Colony Insurance Co
INSURED or
a: Sdety Insurance Company 12808
N R B Exteriors Inc W RC: WICRIBfrreveters
7 Philip Circle BNIURlR D:
L%VJRBR E:
Granby MA 01033 P;
COVERAGES CERTIFICATE NUMBER: CLI961200410 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.
LTR TYPE OF INSURANCE POLICY NUMBER lmwooryyyyi 1111111111,010ftym Lam
rS.b
pAL OBNBRAL LIABILITY HOG NCEMS-MADE ®OCCUR 100,000
to $1,000.00 Deductible ME EXP 51000
A I IOIGLOO8936301 12/23/2018 12/23/2019 PERSONAL&AOMWJURY f 500,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 6 1'000'000
POLICY ❑P�RCOT F7 LOC PRODUCTS• S 1.000,000
a
AUTOMOBILRLIABILITY COMBINED SINGLELIMIT S 1,000,000
ANY AUTO BOINLY INJURY(Per Pereer8 f
g OVWED SCHEDULED 6244143 03/15/2019 0311512020 BODILY INJURY(ft abaderq S
AUTOS ONLY AUTOS _
HIRED ON-OVWtED
AUTOS ONLY AUTOS f
Mediad payments S 10,000
UMBRELLA Uuul OCCUR EACH OCCURRENCE f
EXCESS LIAR CLAM-MADE AGGREGATE f
DW R $ f
VIMMM OOMPENSATION H.
AND OOLOYEW LIANUTY
ANY TNERIExECUT1VE Y/N E.L.EACH ACCIDENT f To Follow
C OFF�jC�CLUDED7 MIA 82ZU8.9F397886 t9 02/13/2019 02/13/2020
NN) E.L.DISEASE.EA EMPLOYEE S Directly From
A eaftebe uncw
OF OPERATIONS bob* E DISEASE-POLICY LIMIT The Company
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AOdltlonal Ranarb Sde diff may be sued"N Mort GP"o Is 1"48400)
Siding,Window Installation,Carpentry and ROO&tg and Gutter Installation
RE:Buildings 1,2,and 4
Colonial V71age Apartments,181 Obst Street,Ware,MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE HALL BE DELIVERED IN
Winton Corp ACCORDANCE WITH THE POLICY PROVISIONS.
131 Ashley Avenue Suite Al
AUTHORIZED REPRESENTATIVE
Voest Spnngftld MA 01089 � �babt
01 2015 ACORD CORPORA ghts reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
f Type: Corporation
NRB EXTERIORS INC ij4i r f Registration: 147961
.- tm Expiration: 08/22/2021
510 NEW LUDLOW RD i S f
SOUTH HADLEY,MA 01075
Update Address and Return Card.
SCA 1 ty 20M-05117
k,
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
147961 08/22/2021 1000 Washington Street -Suite 710
NRB EXTERIORS INC Boston,MA 02118
NICHOLAS R.BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature
Commonwealth of Massachusetts
® Division of Professional
Board of Building and Standards
rV1r:Or Specialty
Construction S'up�
Expires: 0512812020
CSSL-099565 ,
NICHOLAS R BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY MA 01075
Commissioner
- - South Hadley,MP►utu/J
Reg#20-2015718 19NWB
MA Lic#: 147961
MA CSL#:99565 fmirCell:413-563-6354
413-707-ROOF �7663� Office:413-707-ROOF(7663)
Fax:413467-9748
Tl
SELECT NICHOLAS BERNIER
ShingleMaster (Owner)
CeAainreed RoofftosMaom RoofPros@comcast.net
Pro sal submitted to: Phone# h: (-I d �_ �> c:
o Std ✓ -- Special requirements
Street S�
q1?
City state,zip code /Gt ..Q
i
Proposal to furni7Ted inst 11 the following
�ZjaO - d a
❑ e-roof ar-off ❑ Gutters
M e 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
(� 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
5---Deteriorated existing d king to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
stall Winterwar
gd ice water barrier along bottom �3 ft.of all roofs,❑ 6 ft. ---�
�It
stall Wmterguard ice &water barrier around penetrations,in valleys and all critical areas
[} nstall CertainTeed Syr'thetic underlayment to entire decking
[Install 8"perimeter meal flashing to all edges of all roofs, white ❑brown
VlnstalI SwiftStart starte shingle to bottom and rake edges of all roofs
pnstall CertainTeed shingles to manufactii a s-specif eatiorig ❑6-nails
lin
nstall CertainTeed PV' ridge vent to all peaks in heated areas
[YInstall 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 flashi g to waste vent stacks
rranty options
Nr,,We guarantee our labo/workmanship for 20 years
Upgrade CertainTeed -Star Sure Sta
g Plus,50-year nonprorated coverage
EV CertainTeed Landmark-color: 00y le 1 ❑ 3-tab
❑ CertainTeed Landmark Pro-color
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of:Total Due $
ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are - 1/3 Down Payment $ d
Soy -oJ
satisfactory and are hereby accepted.You are authorized t o work as specified. Balance due _7&7 ` cid
Payment will be 1/3 down at start of job,and balance due upon completion. upon completion $ !��
Date: D- Signature: L
Date: w 9 Estirr iator:(Print Name) 1 V i 1T✓(t i'✓ (Sign Name),,_AW
Estimates are honored forthirty(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 ''/2%mo thly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.I
agree to pay and/or guarantee p ayment of these charges.In the event of default of payment,I agree to pay reasonable Attorney's fees and
court costs.This agreement doe not constitute a release of liability.By my signature below,acknowledges an agreement of the above is
hereby made.
Signature: