12C-003 (2) 53 NORTH FARMS RD BP-2020-1296
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 12C-003 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-2020-1296
Project# JS-2020-002168
Est. Cost: $9000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq. ft.): 20865.24 Owner: FAERSTEIN HOWARD
Zoning: RR(100)/WSP(100)/ Applicant: NRB EXTERIORS INC
AT: 53 NORTH FARMS RD
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON.6/26/2020 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 6/26/2020 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 4/^. Status of Permit:
Building Department., ,curb Cut/Driveway Permit
212 Main Street' `:� Sewer/Septic Availability
Room 100 ater/Well Availability
Northampton, MA 0 Two ets of Structural Plans
phone 413-587-1240 Fax -1272 �0� Plo ite Plans
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RE �EMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
t
,A(L) ;
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors E]
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks Siding[p] Other[CI]
Brief Dej�qiption of Proposed
Work: k>( ,� 01,64 414
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
I, AI)IA/' f. e✓ �� �<I^ __ as Owner of the subject
property
hereby authorize id ff / ✓�
to act on y behalf, in al m iters rela ive to w rk authorized by this building permit application.
S nature o wner Date
as Owner/Authorized
Agent ereby declare fhat a 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.
Prit me /l
Sign o r/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Sunnprervisor: 11 n o- Not Applicabbl'e ❑
Name of License Holder: v i(. 1� ,1/l ?C9 (�
License Number
Address ( Expiration Date
J
n Telephone
9. Reaistered Home Improvement Contractor: Not Applicable ❑
I)V �
J `(-k K � A� -� j -, ( y7 (
e Name Registration Number
wA 4 3
A dress Expiration Date
L4` ,� l Telephone
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6))
Workers Compensation Insurance affidavit m st be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the build inermit.
Signed Affidavit Attached Yes....... No...... ❑
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):
Address: �7A G� 1
City/State/Zip: LA4 Phone#: L
Are you an employer?Check a appropriate box: Type of project(required):
l.�am a employer with Li 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. ❑Demolition
3.❑I am a homeowner doing all work myself:[No workers'comp.insurance required.]t
10 C]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.❑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.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.
$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: SCi1�?Polic #or Self-ins.Lie.#:L � CG
� Expiration Date: 6t
/ /
Job Site Address: (/� ��/ "� S r City/State/Zip: T=41--a
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 cerci a pains and penalties of perjury that the information provided above is true and correct
Si na Date: h^ d
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#:
City of Northampton
y. Massachusetts
c
DEPARTl►MNT OF BUILDING INSPECTIONS
* 212 Nain Street a Municipal Building yd•, Q°
North, ton, W► 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:
r
(Please print house number and street name)
Is to be disposed of at:
Q �9 .. L�le-,, �)-f,- U
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
S � �---�
(Company Name and Address)
Signa re 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.
MA Reg#20-2015718 1111111M ---y
South Hadley,MA UIU75
MA Lic#: 147961
MA CSL#: 99565 Cell:413-563-6354
ru Office:413-707-ROOF(7663)
4i3-7�7-ROOF (7663) Fax:413467-9748
SHINGLE RUBBER
144
NICHOLAS BERNIER
(Owner)
Certain RoofProsM om RoofPros@comcast.net
Proposal submit ed to: , Phone# h: �6�y3& c:
t o wt kX64 k i— Special requirements
Street
Cit ,state,zip code'FL,D�r�-�
�0!Yln.,..r,R�.•. M� O t o L 2
Proposal to furnish and install the following
❑ Re-roof <e
TT�ar-off ❑ Gutters
n/
l� We shall acquire necessary permits for all work
Complete Roof Preparation
Ct"Home's exterior to be protected by tarps and plywood
Shrubs,landscaping,trees to be protected,roofers buggy used
H,' 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
[�Deteriorated existing decking to be replaced at$50 per sheet of plywood
Complete CertainTeed Integrity Roof System
Q` Install Winterguard ice&water barrier along bottom ❑ 3 ft.of all roofs,C1 6 ft.
[�Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas
[� Install CertainTeed Synthetic underlayment to entire decking
, o n
Install SwiftStart starter shingle to bottom and rake edges of all roofs
[�Install CertainTeed shingles to manufacturers specifications,❑6 nails 94 nails
[� Install CertainTeed PVC ridge vent to all peaks in heated areas
Q/ 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
arranty options
Zweg
uarantee our labor/workmansh' 0 ears
grade CertainTeed 4-Star re Start Plus,50-year �ted coverage
CertainTeed Landmark-col 3-tab
❑ CertainTeed Landmark Pro-coo {" wQ` "' 1z se sa
We propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of.Total Due $ 96M
ACCEPTANCE OF PROPOSAL:The above prices,specificatioas and conditions are - 1/3 Down Payment $ S DOD•w
satisfactory and are hereby accepted.You are authorized to do work as specified. Balance due p -,r 1
Payment will be 1/3 down at start of job,and balance due upon completion. upon completion $ l(�C J�•W
Date: e� Signature:
Date: / Estimator:(Print Name) /t/ ( �✓` v- (Sign Na
Estimates are honored for thirty(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 %z%monthly(ANNUAL PERCENTAGE RATE OF 18%)will be added to the unpaid portion of the balance due.I
agree 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
court costs.Thilease of liability.By my signature below,acknowledges an agreement of the above is
hereby made.
Signature:
Cod CERTIFICATE OF LIABILITY INSURANCE DATE(MMfODNYM
0311312020
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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If 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 endorseman s).
PRODUCER Denise Sawicki
AMHERST INSURANCE AGENCY INC PHONE 413)253-5555 IF No:
' . dsawicki nathan ences.com
PO BOX 48 INSU S AFFORDING COVERAGE NAIC 0
AMHERST MA 01004 INSURER A; AMERICAN ZURICH INSURANCE COMPANY 40142
INSURED
INSURER B;
N R B EXTERIORS INC INSURERC:
INSURER D:
7 PHILIP CIRCLE INSURER E,
GRANBY MA 01033 DWMgRF:
_ s T TE,x _
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 VIMICH 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.
lm
LTR TYPE OF INSURANCE &a WVD POLICY NUMBER M M LIMITS
COMMERCIAL GENERAL LIABLI lY f 500,000
CLAIMS MACE ® EACH OCCURRENC�E100.000
OCCUR PREMISES Me acwrtenos S
MED EXP one $ 5,000
A 101GLOO8938302 12/23/2019 12/23/2020 500,000
PER$ONALBADV INJURY $
GENTAGGREGATE UMITAPPUES PER: CiENERALAGGREGATE $ 1,000,000
RPOLICY 0 JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000
OTHER: Employee Benefits S
AUTOMOBILE LIABILITY aNGLE LIMIT
S
ANY AUTO BODILY INJURY(Per Person) $
ALL
S
AUTONED AAUTOESDULED N/A BODILY INJURY(Per accident) t
HIRED AUTOS NON-OWNED PROPERTY DAMAGE
AUTOS Per accident S
a
UMBRELLA LAAa OCCUR EACH OCCURRENCE $
EXCESSLIAB CLAIMS-MADE N/A AGGREGATE $
RET&IMON I $
WORKERS COMPENSATION XS RTl1TE R
AND EMPLOYERS'LIABILITY Y I N
ANYPROPRIETOR/PARTNER/MCUTIVE E U EACH ACCIDENT i 100,000
A OFFICERIMEMBEREXCLUDEDT wA N/A N/A t>ZZU89F59768620 02/13/2020 02!1312021
(Man tory In NH) E.L.DISEASE-EA EMPLOYEE S 100,000
tt yyes,
under
desaibe
OESCRIPTI N OF OPERATIONS below E.L.DISEASE-POLICY UMT IS 500,000
NIA
DESCRIPTION OF OPERATIONS i LOCATlONB/VEHICLES IACORD 101,Additional Rsmrks Sdm did,my be adulwd N more space Is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay
claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This Certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the
issue date of this Certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search tool at www.mass.gov/iwd/workers-compensetion/iinvestigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Roof Pros ACCORDANCE WITH THE POLICY PROVISIONS.
510 New Ludlow Road
AUTWMED REPRESENTATIVE
South Hadley MA 01075 C,S
Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA
®1988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) 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
Type: Corporation
NRB EXTERIORS INC ,' Registration: 147961
510 NEW LUDLOW RD Expiration: 08/22/2021
SOUTH HADLEY,MA 01075
Update Address and Return Card.
SCA 1 0 20M-05117
i
�Tv�a�u�xaxuwa�/�t����at:����ru�ll3
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 mow! lc
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 Expires: 05/28/2020
NICHOLAS R BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY MA 01075 _<
a
Commissioner CIL