36-267 (9) 235 MAPLE RIDGE RD BP-2020-1022
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-267 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-2020-1022
Proiect# JS-2020-001724
Est.Cost: $16000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq. ft.): 108900.00 Owner: LYNNE M SANER
Zoning: Applicant. NRB EXTERIORS INC
AT. 235 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON:3/13/2020 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 3/13/2020 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 Northampton Status of Permit:
y Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
r. phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
j 0 "r, I �{ � � (/ _Y` /J Map Lot �(,a 7 Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
v►.0 r ✓
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
T
ILI 6 A&-:o 0,/� /Lf L
Name(Print) Current Mailing Address:
Si 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) Yy�[
5. Fire Protection
6. Total= (1 + 2+3+4+ 5) 8695 Check Number
\ This Section For Official Use Only
Building Permit Number: 'd•o (04 j ?' Date
Issued:
Signature: oZ/�0
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 0
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [Q Siding [O] Other[O]
Brief Decription of Proposed
Work: ��`
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 ORCONTRACTORAPPLIES FOR BUILDING PERMIT
I, � V/] �i 4 J,ri '1 -e - as Owner of the subject
property I
I1�
hereby authorize
to act on my behalf, in matters rel to work authorized by this building permit application.
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 a d penalties of perjury.
Print Name
Si gent Date
SECTION 8-CONSTRUCTION SERVICES
8A Licensed Construction S�u�aer1vi_sor. NotAppticable ❑ _
Name of License Holder:
nLicense Nufnber
Address Expiration Date
e Telephone
9.Realstered Home Improvement Contractor: Not Applicable ❑
h1 A & �I � �� ( G9?-
Company Name Registration Number
s- D �� u - n -- I
Address Expiration Date
Telephone
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit m e 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
Massachusetts ��2S•s s,�?c
G
fil DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street a Nunicipal Building 9vi O�
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:
NJ � f I'( � rd J
(Please print house h6mber and stre t name)
Is to be disposed of at:
4'
'(Please( lease print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(k W', � �l V
(Company Name nd Address)
Si at 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.
Avylicant information Please Print Le 'bl
Name(Business/Organization/Individual):
Address: 5-
City/State/Zip: l Phone#:
Are you an employer?Check th appropriate bo : Type of proje t(required):
l.�a employer with (/ employees(full and/or part-time).* 7. E]New construction
2.M 1 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
31-11 am a homeowner doing all work myself:[No workers'comp.insurance required.]r
10 Q Building addition
4.❑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.Q 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.
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 providi workers'compensation insurance for my employees. Below is the policy and job site
information. '�4vn,
Insurance Company Name: �� 7 `� I v
Policy#or Self-ins.Lic.#: 11 1A - ( Expiration Date:
Job Site Address: r, Lt City/State/Zip: ✓-�'? L��
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 u d, pains and penalties of perjury that the information provided above isr true and correctSi nature: Date: I U O o
Phone
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#:
tvi,v xegff cu-cur<a ua IYRBSouth Hadley,MA 01075
MA Lic#: 147961 -,�
'MOT
MA CSL#:99565 ' Cell:413-563-6354
413-707-ROOF (7663) Office:413-707-ROOF(7663)
Fax:413467-9748
SELECT I NICHOLAS BERNIER
ShingleMaster m2mii� (Owner)
111. 1
RoofPros413.com RoofPros@comcast.net
Proposal submittd to: Phone# h: ,Z�1 �U.�fo c_
LU `' " e Special requirements
Street
13 S M la
Ci►ryy//J//,state,zip code v
Proposal to furnish and install the following V SU dv
ElRe-roofTear-off ❑ Gutters �/J ���✓ 14-,U/l
P/We shall acquire necessary permits for all work _57-1s,4,110 Y"
Complete Roof Preparation
11 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.
[y Site to be cleaned on a daily basis with roll magnet,debris to be removed at project completion by dumpster
Deteriorated existing decking to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
Install Winterguard ice&water barrier along bottom ❑ 3 ft.of all roofs,Er 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,❑white rown
[FK
Install SwiftStart starter shingle to bottom and rake edges of all roofs
Install CertainTeed shingles to manufacturers specifications,❑6 nails Q nails
(t].� Install CertainTeed PVC ridge vent to all peaks in heated areas
[� Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
nstall new lead counter flashing to chimney
New flashing installed where necessary
Install new pipe flashing to waste vent stacks
..,-Warranty options `L. J
^/We guarantee our labor/workmanship for 20 years A,
LY grade CertainTeed 4-Star Sure Start Plus,50-year nonprorated coverage
CertainTeed Landmark-color: QRZ Su✓� S K-1 11-4 ❑ 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 $ 111149601W
%CCEPTANCE OF PROPOSAL:The above prices,specificatiew and conditions are - 1/3 Down Payment$ SC x�
S.C
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 b nce due u ompletion. upon completion $ /�i (Jyt)
date: 1d ld- ( Signature:
date: �� I r_lEstimator:(Print Name) Jf C, " (Sign Name)
3stimates are honored for thirty(30)days from above date
kTTENTION HOMEOWNERS:Please cover all personal belongings in the attic,garage or storage areas due to the
)ossibility of roofing debris or dust in through cracks of the wood.NRB Exteriors Inc.will not be responsible for
febris or dust in the attic or storage areas.
6,Finance Charge of 1 %z%monthly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.I
tgree to pay and/or guarantee payment of these charges.In the event of default of payment,I agree to pay reasonable Attorney's fees and
:ourt costs.This agreement does not constitute a release of liability.By my signature below,acknowledges an agreement of the above is
tereby made.
signature:
I
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 rg'
Update Address and Return Card.
SCA1 fj 20M-05117
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 Licensure
Board of Building Regulations and Standards
Construction Supervisor Specialty
CSS L-099565 Egp fres: 05/28/2020
NICHOLAS R BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY MA 01075
Commissioner V44-' " "