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22D-117 (13) 30 AVIS CIR BP-2020-0584 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:22D- 117 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-2020-0584 Project# JS-2020-00100 Est.Cost: $10000.00 Fee: $40.00 PERMISSIONIS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: NRB EXTERIORS INC 99565 Lot Size(sa.ft.): 21300.84 Owner: NORTH SUSAN Zoning: URA(100)/WSP(100)/ Applicant. NRB EXTERIORS INC AT. 30 AVIS CIR Applicant Address: Phone: Insurance: 510 NEW LUDLOW RD (413) 563-6354 WC SOUTH HADLEYMA01075 ISSUED ON.11/6/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF i 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 D artment 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: Feer e: Date Paid: Amount: Building 11/6/ 0190:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner L� Department use only , . fes -..• City of Northa ton '�—�/ # f Permit: Building Depa men N Cur t/Driveway Permit 212 Main S eet �� Sewer Septi 'Availability Room 1 0 Nate/Well vailability w ' North mpton, 0 0i`rTwo ets Structural Plans ". phone 413-5888-1240 Fax ��t�rl�In�SP Site ans QA°' ©tkgr Sp cify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 610. A0'-fel el 1.1 Property Address: This section to be completed by office Map Lot 1/ 7 Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current M�ailing,A dress I Telephone Signature 2.2 Authorized Agent: Name(Prin Current Mailing Address: y0 1�_(_3 -G3 ��! gnature 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 6. Total=(1 +2+3+4+ 5) 0 ) 8695 Check Number JIM This Section For Official Use Only Building Permit Number: Date Issued: Signature: I t 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 Ea-- Or Doors M Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[p) Brief Description of Proposed ( Work: o '•-��. �!� /amu M�-t r ( v' �— 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 1, 5'-4-g as Owner of the subject property hereby authorize to act on my behalf, inall matters relative to work authorized by this building permit application. 6 dtWAA- �Aipl � f i Signature of Owner Date 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 / C Si atu of Owner/Agent Date -Rill -Licensed and Insurof 51Q Nei`Ludlow.Rd. SIA Reg#lJIte-50-15118 South Hadley,MA 0I075 A Lic#:147961 MA CSL#:99565 Cell:413-563-6354 413-707-ROOF( 863) Office:413-707-ROOF(7663) Fax:413467-9748 tSHINGLE . GUTTERS NICHOLAS BERNIER Sltinglebt�aster (Orveer) ReafftosM.c RoofProsd:comcast.net Pr osal subVitted to: Phone# h: 5-$q-- 7 c: Sr k) pecial requirements fl =�— ` © Oka City,state,zip code Proposal to furnish and install the following.f(� S� �'� , CIL ❑ Re-roof Efesr ❑ Gutters Cr We shall acquire necessary°permits for all work Complete Roof Preparation Home's exterior to be protected by tarps and plywood Q/ Shrubs,landscaping,Irees to be protected,roofers bug"y used [/ Entire existing roofinly materials to be removed to existing decking,including flashing,etc. Site to be cleaned on a daily basis with roll magrtet,debris to be removed at pMiect completion by dutnpster bj,'Deteriorated existing ecktng to be replaced at$50 per sheet of plywood Complete Certain ted Integrity.Roof System f r install Winterguard ice&water barrier along bottorn ❑ 3 8.of all roofs,U 6 ft. Install Winterguard i &water barrier around penetrations.in valleys and all critical areas (g/Install CertainTeed S nthetic underlayment to entire decking (�Install 8"perimeter etas flashing to all edges of all roofs,❑white ❑brown Install SwiftStart star er shingle to bottom and rake edges of al roofs Install CertainTeed sl ingles to manufacturers specifications,❑6 nails❑ l nails (Install CertainTeed PVC ridge vent to all peaks in heated areas Qr Install Shadow Ridge to all hips and ridges,over ridge vent where applicable bT Install new lead coup er flashing to chimney lVNew flashing installeJ where necessary Ne"Install new pipe flashing to waste vent stacks ,-Warranty options yVe guarantee our la r/workinanship for 20 years ,,w CertainTeed 4-Star SurePlus,50-ye r nonprorated coverage CertainTeed L.andm -color: ffalwidCt 3-tab -.- -- ❑ CertainTeed Landm k Pro-color We propose hereby to furnish materials and labor-complete in accordance with above specification.-,for the sum of Total Due Sx j 0,Oo c`�V ACCEPTANCE OF PROPOS4:The above prices,specifications and conditions are - 1/3 Down Payment S 4-1)S-0 6 -60 satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due Payment will be 1/3 down at start of job,and balance due upon completion. upon completion S 756 d -tZ Date: Si true: (,t/ ,/LI' r Date: U I Estimator(Print Name) t`� lJ, ��=�t--, (Sign Nance) _ Estimates are honored for thirty(30)days from above date ATTENTION HOMEOR ERS:Please Cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debt-ii 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 i '.%r%nw [lily(ANNUAL.PERCENTA(it:RATE OF t K"a)will be added to the unpaid lxwniun of the balance due.I nxt agree to pay and/or guarantee aynt of these charges.In the event of default of payment.I agree to Pity rca.+onable Attomey's fees and court costs.This agreement d not constitute a release of liability.try my signature hdo v,ack-nos 1mL_cs an ag-cernent of the above e is hereby made. Signature�—1 _._... AW; SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License HoldeL, \ �n LQ 1/1 j ✓ % I C- License umber to At 1 / �� -� ��1 � 5- a?--� Address Expiration Date r3 00411gaefure Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ 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...... ❑ City of Northampton yR Massachusetts DEPARTMENT OF BUILDING INSPECTIONS a= Al"0212 Main Street •Municipal Building Cam 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: LA s (N-) e'-1 - V (Please print house number and street name) Is to be disposed of at: U - (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: � A w C� � �—.-,?, ( o , (Company Name and Address) 8igr46t6re 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 1 Congress Street, Suite 100 UT 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 4 Please Print Letibly Name (Business/Organization/Individual): ( Address: �- ( J,) - City/State/Zip:St) Phone#: 3 `� Are you an employer. Chethe appropriate box: Type of project(required): 1. am 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 ❑ 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q 1 am a homeowner doing all work myself:[No workers'comp.insurance required.]1 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.Q 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: Lao' I�✓ G/ ( ✓ �j Policy#or Self-ins.Lic.#: F570-7 Expiration Date: - /3 _ U Job Site Address: 3° P-V, t C r ✓ City/State/Zip: a `7 -I 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify andthe ins and penalties of perjury that the information provided above is true and correct. Signature: J� Date: 11 - 3, ! e) Phone#: TC, 3 / Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CORNt7�' CERTIFICATE OF LIABILITY INSURANCE °A"`"'"'°°" M 06/12/4019 THIS CERTIFICATE M OWED AS A MATTER OF INFORMATION ONLY AND MERE NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIRICATE DOB$NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIEA BELOWW? THIS CERTIFICATE OF INSURANCE DOES NOT COWTKUTE A CONTRACT BETWEEN THE MUM PGURERtj AUTHORM REPIIEEENTATIVE OR PRODUCER.AND THE CERTHWATE!COLDER hOWer Us an dw )rnllst haw L MUIRED pfatlalons or be If SUBROGATWN M RAINED,suW sa to the tternts and cond""of the policy,owWn pol do may ngWre an ondorMnNnt A stmemont on "a- "fieaN elan not conlbr rlshb to tits a 1111ab hoidsr In Mau of such s PRODUCER T1Knsy Term TAY Gmw (113)sez-7tto7 1668)271-2228 16 Moth Elm S& M PO Soot 750 NAac e WVsM1ew MA 01086 egWfeltA: RUVW Bona a CompfnylCobny Inswunce Co INSURED ossum s: Babb'Inwrana Company 12606 N R B E4viors Inc INSIrmc: VIICRJBllravebrs 7 Phtlip Gras INalNtlR o: ONKWAR E: firenby MA 01033 F, COVERAGES CERfr"TE Niall; CL1981200410 Imo: THIS IS TO CERTIFY THAT THE POL1C=OF BrBURANCE LISTED BELOW t1AVE BEEN ISSUED TO THE 94SURED NAMED ABOVE POR THE POLICY PERIOD 1NWATED. NOTIANTH111TANDING ANY RECIUN NW,,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH RESPECT TO W410H TNS CERTIFICATE MAY BE SOUIED OR MAY POMM.THE INSURANCE AFFORDED BY TME POLICIES DESCRIBED HEREIN E SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH PONCES.LIMITS BtROWIN MAY NAVE BEEN REDUCED BY RAID CLAW. TYPE011011RANCE POLICY tlMlTa COMMWANALOOMPAL UASa.ITY SACHOOCUIVANCE 500.000 CMIMe.AMOE ®OCCUR 100,000 Staysa 10 31.000.00 Deductrbb imullum an 3.000 A IOIGLOOMM301 12rAMIS 12123=19 s Soo,oOo 0MAOOR6 ATE LWITAPPLIES EER 1.000.000 POLICY❑JlCT t OC 1.000,000 CITHOW f AUTOMOI LA UA§RM UkIlT s 1,000.000 ANY AUTO SOCLYRAW oPers BAUTOS o014r AUTO 5244143 03116=19 03115=20 sotltLrtNltNK{FraooeMrl f Mw NON40v& AUTOS ONLY A{JfOG Y M12EFUN f Me"psym" s 10,000 11MIRaLLA LMaH0=mwMAQK SxCIN UAS WSe110eW OOSN6iSA1fON AND aMFLOYSRe'LIAMILITY YIN CANY�ROFR ❑ NIA UZUB-9F6976841.19 02/13/2019 02/13/4020 TO Fabw srY Nt i1Xp v0� D4*cdy From a assaBe crow Pxcy Limit The Company T-1 OgCMMON OP IDPW IONS r LOCA110Ne I VEM CM IACOI10*I.AeefasMl ANNft Sda*AR a"M AftWee a mn Mow Is NOW" " V W 1�InSWOOM,CarpwWy uW Roo&V and G~Insiallebom Colo"VNbpe ApaAn ants,141 VUtst Street VWan.MA CERT SHOULD ANY OF THE ABOVE DESCRIBED POUCIES ISE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN VY*On Corp ACCORDANCE WITH THE POLICY PROVIiKM 131 Ashby Avenue Suite Al AUT11OMM RSIlVA 10M?NE V" MA 01059 I s Ci I$ACORD i l ,v ACORD 26(MGM) The ACORD Hans and lope ars repieisnd nada of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 147961 NRB EXTERIORS INC Expiration: 08/22/2021 510 NEW LUDLOW RD SOUTH HADLEY,MA 01075 Update Address and Return Card. SCA 1 Co 20M-05/17 office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: TYPE:Corporation office of Consumer Affairs and Business Regulation Registration it t n 1000 Washington Street -Suite 710 147961 08/22/2021 Boston,MA 02118 NRB EXTERIORS INC NICHOLAS R.BERNIER a/CL �j�tL 510 NEW LUDLOW RD �rl� Not valid without signature SOUTH HADLEY,MA 01075 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards onstructioo Supervisor Specialty CSSL-099565 Expires:05/2812020 ,7 NICHOLAS R BERNIER ' 510 NEW LUDLOW RD SOUTH HADLEY MA 01075 Commissioner v""—