24A-250 (5) 201 NORTH ELM ST BP-2020-0586
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A-250 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-2020-0586
Project# JS-2020-001005
Est.Cost: $6000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq.ft.): 7971 A8 Owner., CARILLO TERESA
Zoning: URA(100) Applicant. NRB EXTERIORS INC
AT. 201 NORTH ELM ST
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
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 11/6/2019 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 Nort mptt5n No t s of P rmit:
Building Depart ent a 5 Cur Cut/ riveway Permit
212 Mai St r 9 Se er/S ptic Availability.
Room NST cU��Oryr ater/ ell Availability
Northampton, MA 01 1an,�ti A^ls�ECT� wo S sof Structural Plans
phone 413-587-1240 Fax 413-587- iso° lot/S a Plans
Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION & (2 20 -61 6
1.1 Property Address:
This section to be completed by office Map HJA__
`�.-
Lot Z,SUnit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
—(-C✓d ) d CUA" ( k L)
Name(Print) Current Maili gAd esS:
// LX Q
T _ ^% ,c✓ Telephone
Signature
2.2 Authorized Agent: f
Name(Print) Current Mailing Address:
M-3 -G; t--�
S' a 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 = 0 +2+ 3 +4+5) O u� 8695 Check Number 1 3 t
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
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 l]
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding [p] Other[p]
Brief Description of Proposed
Work: ���. n kXlSr~� l/ � � \ ��( � t/\/� ot' dti •�� .� � i
,
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, < / < < D as Owner of the subject
property
hereby authorizey`� l� x ✓ J S
to act onbehalf, in all matters relative to work authorized by this building permit application.
C
DIV
S' lure 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
Sig re 7o-Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: V l/ t l) C, 1,4 2 q �—(,
n License Number
Address Expiration Date
00,
re Telephone
y - C�
9. Reallatered Home Improvement Contractor: Not Applicable ❑
AdA ��L�e� `�vs V-( y 3 r
Comp a v Name l Registration Number
,�- (U
Address{ 7 Expiration Date
CLu-` Telephone �)
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must a completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building it.
Signed Affidavit Attached Yes...... No...... ❑
City of Northampton
Massachusetts
,: DEPARTMENT OF BUILDING INSPECTIONS 7s�
ar212 Main Street •Municipal Building
Northampton, MA 01060 �1�
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) dJ L V, S-2�
(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)
Si o 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
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): t �(,/,V/✓S I
Address: S (b Uv t1,_/ LAI J zj
City/State/Zip: a t ? Phone k r
Ar�youa ployer?Check the appropriate box: Type of projec (required):
ployer 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
❑ S. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
IFJ jam a homeowner doingall work myself. t 9. ❑Demolition
y [No workers'comp.insurance required.]
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.❑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.insurenceJ
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.
r 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-contactors and state whether or not those entities have
employees. If the sub-contactors 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 andjob site
information. 1
Insurance Company Name:
Policy#or Self-ins.Lic.#: Co 2�- _�/ p 7�}f '( 5 Expiration Date:
Job Site Address: y � Vy P 1 �'� S City/State/Zip: AJ0`14
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.
Ido hereby certify under the pains and_penalties of perjury that the information provided above is true and correct
Signature: c_/ Date: Z/—�/7
Phone#: - G
Offu;ial 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#:
dCxio
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
NRB EXTERIORS INC Registration: 147961
510 NEW LUDLOW RD Expiration: 08/22/2021
SOUTH HADLEY,MA 01075
f
Update Address and Return Card.
SCA 1 0 20M-W17
� ��f'�nt»ir.nuutiA/�f^�l�,uar�u�tll�
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 RDOG
SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature
® Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction SUpeftiSor Specialty
CSSL-099565
Expires: 05/28/2020
NICHOLAS R BERNIER = '
510 NEW LUDLOW RD
SOUTH HADLEY MA 01075
�3
Commissioner L"k
A CERTIFICATE OF LIABILITY INSURANCE
MM 202019
THIS CERTIFICATE N NSUED AS A MATTER OF INFORKATION ONLYAND CONFERS NO ROM UPON THE CERTIFICATE HOLDER TNN
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIN
BELOW. TINS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUM!R( AUTHORIZED
REPItESENTATTi/E OR PRODUCER,AND THE CEI"WICATE HOLDER
be andorged
E SUMMATION N VVJVED,subject to leans and condltlons d ,certain have Ilan endFtED peonprovieL �
f�w7 policies nay nqufn an endoasntsllt. A statalaent on
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COVERAGES CERTiHCATE mNMNgL- CL19612W410 REVISION NUMWL-
THIS 18 TO CERTIFY THAT THE POUCWS OF INSURANCE LISTED BELOW IMWE SEEN ISSUED TO THE INSURED NAMEDASONE FOR THE POLICY PERIOD
INDICATED, NOrMTHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO VYHICH THIS
CERTIFICATE MAY BE ISSUE OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESSUBJECT
DESCRIBED HEREIN 18 710 ALL THE TERMS,
EXCLUSIONS AND CONO(TIONS OF SUCH POLICIES,LIMITS SHOVWN MAY HAVE BEEN REDUCED BY PAID CLAWS.
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CERTIFICATE
SHOULD ANY OF THE At1ONE 0E9=11110D POLICE$BE OANOELLED OEFORE
THE EXPIRATION DATE THiR[OF,NONCE MILL.BE DELN MW IN
V**)n Corp ACCORDANCE W"M THE POLICY PROVISIONS.
131 Ashby Avenue Suite Al
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ACORD 25(201dN3) The ACORD new and 10W ars ngklered marks of ACORD
t Fully Licensed and Insured is OW-de
xdr. 510 New Ludlow Rd.
STA Reg#20-2015718 South Hadley.NIA 01075
A S 147961
MCL �i
1V1A S #:99565 , Cell:413-563-6354
413-707-ROOF(7663) Office:413-707-ROOF(7663)
Fax:413-467-9748
SELECT NICHOLAS BEPUNIFR
Sh teMaster (Owner)
RoofProsM.com RoofPros(d_,comcast.net
Proposal submitted to: Phone} h: - 0 c:
GS9. Cur` 110 Special requirements
Street
).D t 1Ne' T1s ��
City,state,zip code
Proposal to furnish a d install the following
[,]�e-roof Tear-off Q Gutters
IJ 1t'e shall acquire necessary permits for all work
Complete Roof Preparation
Home's exterior to be protected by tarps and plywood
[��r���....,,,�,,,//////Shrubs,landscaping,trees to be protected,roofers buggy used
Entire existing roofing materials to be removed to existing decking,including flashing,etc.
[rte to be-cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster
Deteriorated existing decking to he replaced at S50 per sheet of plywood
Complete Certain Teed Integrity Roof System /
Install Winterguard ice&water barrier along bottom C 3 R.of all roofs,ff 6 ft.
Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas
Install CertainTeed Synthetic underlayment to entire decking
Install 8"perimeter metal flashing to all edges of all roofs,a white ::brown
[Install SwiftStart starter shingle to bottom and rake edges ofall roofs
C✓Install CertainTeed shingles to manufacturers specifications.C 6 nails❑4 nails
Install CertainTeed PVC ridge vent to all peaks in heated areas
Install 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 flashing to waste vent stacks
Warranty options
We guarantee our labor/workmanship for 20 years
C ,Cpgrade CertainTeed 4-StarSure 50- ted coverage
LY CertainTeed Landmark-color ❑ 3-tab
0 CertainTeed Landmark Pro-color
we propose hereby to fwmish materials and labor-complete in auordance.with above specifications for the sum of:Total Due S_.l w�1 o
ACCEPTA.\CE OF PROPOSAL:The above prices,specifications and conditions are - 1%3 Down Payment$
satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due
Payment will be 113 down at start of job,and balance due upon completion. upon completion $ , )
Date: 1 Signature:
Dau: '� Estimator:(Print Name) kU bZ1"--- (Sign Name)
Estimates are honored for thirty(30)days front above date 1-1
AFTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the
possibility of rooting 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!h%monthly(ANNUAL PERCENTAGE RATE OF 180/e)will be added to the unpaid portion of the balance due.1
agree to pay and for guarantee payment of these charges.lathe event of default of payment,I agree to pay reasonable Attorney's fees and
court costs.This agreement dotes not constitute a release of liability.By my signature below,acknowledges an agreement of the above is
hereby made
Signature,_�� �'