12C-105 43 RICK DR BP-2020-0581
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C- 105 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-2020-0581
Proiect# JS-2020-000993
Est.Cost: $8250.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sa.ft.): 10497.96 Owner. ALDEN BETSY
Zoning: RI(100)/URA(100)/WSP(l00)/ Applicant. NRB EXTERIORS INC
AT. 43 RICK DR
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON.111512019 0:00:00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF
POST TRIS 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 Si<(nature:
FeeTvim Date Paid: Amount:
Building 11/5/2019 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
f, POF
Department use only
City of Northaff�ptor<�'~.�C Z,,,- Status of Permit:
Building Department Cut/Driveway Permit
212 Mai Stre /'v tic Availability
Roo6 10,Q �
Vther
wellAvailabilitNorthampton;M�tiZ3 '�; ets Structural Plans
phone 413-587-1240 Fa_i 272 te sans
ecify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENO' ATE/61k,DEM LISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
Map y_ Lot Unit
C ,,. C�
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: f� o
Li L
Name(Print) Cut Mailing Addre s:
U) t7 — 91( G
Telephone
Signature
2.2 A,f/u�thorized Agent:
Name(Prin Current Mailing Address:
—C 5 `ter
t
re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS _T
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 49_
6. Total=(1 +2+3+4+5) 5 v3 _'L 8695 Check Number
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: i )W)9
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
Or Doors E3
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[C�
Brief Description of Proposed r
Work:_IZt�a�2
Alteration of existing bedroom Yes ---No Adding new bedroom Yes `moo
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 1-1 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
as Owner of the subject
propert nn
her y authorize
to ct on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner Date /
a ��a
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
Si re of Owner/Agee Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: N i t_,�l ws
Li a Number
> 1� - �-o
Address Expiration Date
Ll
Telephone
Si Telephone
8.Reolstered Home Improvement Contractor: Not Applicable ❑
N YZ P, _exp-( ., -c,' A v k Lf 7 - y
Company Name r Registration Number
Address / Expiration Date
Telephone 6
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit st 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
ll, : .• S
r' -"? Massachusetts
A
,t r DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street •Municipal Building C
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:
"C 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)
r
ure 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):
Address: IAA,, L
City/State/Zip: o kLi J14 v 1 -?�Phone#: "
Are you an em r?Check the appropriate box:
Type of project(required):
LcajAft 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.❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]t
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.❑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.t
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 ill 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: dG1�Q 'A �S' V-/ C,
Policy#or Self-ins.Lic.#: Z L (� -`/� �C!7(?Y ��o- f Expiration Date: •2-' 1340
Job Site Address: 7 �; o'`
City/State/Zip: j�Iy.2...
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 certifydindWthe pains and penalties of perjury that the information provided above ' true and correct
Si atur : Date:
Phone#: l9 2 `I .S`
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#:
Fully Licensed and Insured a+�^" "k c«,R.��kn 510 New Ludlow Rd.
MA Reg#20-2015718 South Hadley,MA 0107.5
MA Lir#: 147961
MA CSL#:99565 Cell:413-563-6354
,413-M- F{7663) Office:413-707-ROOF(7663)
1AWj Fax:413-467-97487-9748
Z. SHINGLE - RUBBER;
SELECT NICHOLAS BERNiER
ShingleMaster L (Owner)
C.W^Teed RoafPPo SMxo Roof Pros(.comcast.net
Pro)osal subn'it�dlto: Phonc# h:YAAJ( qLj r c:
' �i►-- GGtt
z Special requirements
Street
City,ste,zip code �
--I --
Proposal to furnish and install the following
❑ Re-roof Tear-off ❑ Clutters
9/%Ye shall acquire necew"my permits for all work
Complete Roof Preparation
[�
Home's exterior to be protected by tarps and plywood
(� Shrubs,landscaping,tris to be protected,roofers buggy used
Q� Entire existing rooting materials to be removed to existing decking,including flashing,etc.
V�,Deterioratcd
ite to he clamed on a daily basis with roll magnet,debris to be removed at project completion by dunipster
existing decking to be replaced at$50 per sheet of plywood
Complete Certain•1'eed Integrity Roof System �
hlstall Winter uard ice&water barrier along bottom ❑ 3 ft.of all roofs,2/6 ft.
Vlostall Winter�g-uard ice&water barrier around penetrations.in valleys and all critical areas
5/,'Install C ertainTeed Synthetic underlayment to entire decking _�
VInstall 8"perimeter metal flashing to all edges of all roofs,❑white C�'brown
g/Install SwiftStart starter shingle to bottom and rake edges of all roofs
e/Install CettainTeed shingles to manufacturers specifications,❑6 nails❑4 nails
[/Install C'ertainTeed PVC ridge vent to all peaks in heated areas
Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
('� $tall new lead counter flashing to chimney
NN-w flashing installed where necessary
Q/ln,talI new pipe flashing to waste vent stacks
arranty options
We guarantee our labor/workman for 20 yu„trs
❑ grade Cct a'ur 4-St ure Start �y�rrnmpreeate verage
CertainTecd Landotark-co r: "� - -+7• ❑ 3-tab
❑ CertaI Teed Landmark Pro-co
We protxwsc hereby to liunish material.and labor-complete in accordance with above specifications for the sum of Total Due g
ACCEPTANCE OF PROPOSAL.:The above prices.speciftations and conditions arc - 1/3 Down Payment S
satisfactory and are hereby accepted.You are authorised to do work as specified.
Balance flue
Payment will he 113 down at start of job,and balance due upon completion. upon completion S
Date: 10& Vll Signature: ') ' , ,.�•
Date: C) V Estimator:(Print Nanie) N C `�114 _- (Sign Nam —
Estimates are honored for thirty(30)days from above date
ATTEN"rION 110MEOWNEWS: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 Pittance Charge of! ".p monthly(ANNUAL PERCENTAGE RATE OF 1890)will be added to the unpaid portion of the balance due.t
agree to pay am!!or guaranice Payment of these changes.In the event of default of payment.1 agree to pay reasonable Attorney's tees and
court costs.'!his mucement docs no!constitute a rdease of liability.By my signature below.acknowledges an agreement of the above is
hereby made.
Signature.
DAYY)
T90001 DIYY
.4COR CERTIFICATE OF LIABILITY INSURANCE 061i2=19j
THIS CERTIFICATE M ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATNKY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONBT ITM A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTI 40ATE HOLDER
MUTANT. it to owdkaw holder us an MMMM imsupm,on poNcy(les)must have ADWOKAL INSURED p wiskm or be endomo&
E SUBROGATION 98 VVJVED,subject to the Wm and eondftm of the po ft certain poNcia ewy require an endormmmnt. A stoo mrd on
this coMicale doss not cooter rights to the twrNNDsb holder in lieu of such s
PRODUCAR Tlemsy Team
TMmey Gawp am (413)562-7007 1 MEMO (sea)271
16 North EIM SbVol
PO Box 750 COyq
VWI$doid MA 01086 NIRA: Russell Bond i CoxWwg4Colony Usurance Co
NauRro NEuueae s: sably In"waim Company
N R 8 Ermerias Inc WWJMR C: WCRisarevews
7 ftft Circle NNsuRSR 0:
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Granby MA 01039
COVERAGES CERTHWATE INJ!VWt- CLI9812OD410 REVLON NUMBER:-
THIS
UMBER;THIS 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUFD TO THE INSURED NAMED ABOVE POR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH RESPECT TO V*UCH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND C0NDffK NS OF SUCH POLICIES.LIMITS$HOYMN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
TYPE OF a1WRANCa - mmPOLICY tNAilTi
OalUl/RCIIN OBIIBIW LiAaWTY 500.000
CW10184"DE ®OCCUR 117- 100.000
$ubjed to $1.000.00 Dea,aabe soon
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OMAOOREGATE LOT APPLIES PER 1.000.000
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AUToeIDMu LIMPILMY a 1.000.000
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$MOULD ANY Of THE ABOVE DBaCRI ED POLICES BE CANCELLED B1114M
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVMD IN
Vkft cap ACCORDANCE VNTH THE POLICY PROVISIONS.
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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
'• `- irk-,°,
Update Address and Return Card.
SCA 1 15 20M-05117
Office of Consumer Affairs&Business Regulation Registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
TYPE:Corooration Office of Consumer Affairs and Business Regulation
Registration Expiration
147961 08122!2021 1000 Washington Street -Suite 710
Boston,MA 02118
NRB EXTERIORS INC
NICHOLAS R.BERNIER
510 NEW LUDLOW RD Not valid without signature
SOUTH HADLEY,MA 01075 Undersecretary
Commonwealth of Massachusetts
Division of Professional Licensure »
Board of Building Regulations and Standards
Construction Supervisor Specialty
C SS L-099565 I=gp i res: 05/28/2020
f ' ti
NICHOLAS R BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY MA 01075
Commissioner