23C-098 i
167 BAKER HILL RD BP-2021-0039
'GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23C-0.98 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate o : ROOF BUILDING PERMIT
Permit# BP-2021-0039
Project# JS-2021-000054
Est.Cost:$18800.00
Fee: $40.00 PERMISSION IS HEREBY GRAFTED TO:
Const..Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sa.ft.): 80586.00' Owner: COFFEY KEVIN F
ZoningURB(100) Applicant: NRB EXTERIORS INC
AT: 167 BAKER HILL RD
Applicant Address: Phone: Insurance:
.5 10 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 -ISSUED ON.711012020 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. Bu%ding Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire.Department Fireplace/Chimney: f
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 7/10/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272,
Louis Hasbrouck—Building Commissioner
nLzL;EIVED
JUL 10 2020
The Commonwealth of Massach etts DEPT OF g 1 1LOING INSPE TIONS FO
Board of Building Regulations and S and °gTHnnProN,nnq of
. :
Massachusetts State Building Code,780-CMR_ �0lIJNIC '
Building Permit Application To Construct,Repair,Renovate Or Demolish a R&ised-Man•2011
One-or Two Fandlp Dwelling
Thi ection For Official Use Only
Build' g Permit Number ate Applied:
C-V)rJ J Og5 -7- ID-ZOZ
Building Official(Print Name) ignatum Date
SECTION 1:SITE INFORMATION
1.1 Property,Pddress: ( 1.2 Assessors Map&Parcel Number
V7 r�`rbte, �� I
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Fmnt Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 17 Private❑ Zone: _ Outside Flood Zone? Municipal E3 On site disposal system ❑
Check ifyes❑ i
SECTION 2: PROPERTY OWNERSHIP'
2.1 Pwnerl of Recprd: i
r✓..1l L o 004441.4 .Rbn v,✓lC1
Name(Prin City,State.ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ FAddition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other ❑ Specify.-
Brief
pecify:Brief Description of Proposed Workz: . a
DOD
I
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
._(Labor and Materials) i
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plmbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee Am
Check Nop0Check Amount: I"" Cash Amount:
6.Total Project Cost: $ ❑Paid in Full 0 Outstanding Balance Due:
I
e
traThe City of Northampton
Building Department
n 212 Main Street
Northampton,Massachusetts 01060
Phone(413) 557-1240
Fax (413) 587-1272
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance with the provisions of MGL c40, s54,a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility as defined by MGL c 111, sl 50A.
The debris will•be disposed of in:
Location of Facility 7LL,, I lj /I 5
The debris will be transported by:
Name of Hauler
Signature of Applicant: Date: -�v
r r
i
i
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) -C S _ l
[d'-A ttq f— Li ense Number Expiration Date d—
Name of CSL Holder
List CSL Type(see below) W S
No.and Street Type Description
U Unrestricted(Buildingsu to 35,000 cu.ft.)
City/1own,Statt
S-07 a �`A, c, b Q 7 R Restricted 11&2 Famil Dwelling
State,ZIP M Masonry I
RC Roofing Covering
WS Window and Siding
SF Solid FuellBuruingAppliances
C�S I Insulation
e e Aone Email address D Demolition
5.2 Registered Rome Improvement Contractor(HIC)
// 4�
HSCRegistration Number O
HIC Company Name or HIC Relme g' nt NaExpiration Date
t� �� ���� �,�
N ,and Street Email address
U
'gel?
Ci /Town,State ZIP
Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(IVI.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 a building permit.
Signed Affidavit Attached? Yes.......... No...........1]
I
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
n / p 1Q�I'(. �
I,as Owner of the subject property,hereby authorize j/V�A ✓� ,�� )
to act on my behalf,in all matters relative to work authorized by this building permit application.ad rt- aQt:
t�
Print Owner's Name(Electro atu ) 7 ( Dat v
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
I
By entering my name,below,I hereby attest under the pains and penalties ofpetjury that all of the information
contained in thi plication is true and accurate to the best of my knowledge and understanding.
i
7- �o
s or uthotized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her oum work,or an owner who hires an unregistered contractor
i (not registered in the Home Improvement Contractor(RIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the TUC Program can be found at
wvsrw.mass.ttov/oca Information on the Construction Supervisor License can be fbund at www.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics.decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of hall baths)
Type of heating system. Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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The Commonwealth ofMassachuseas
Department oflndusirkdAccidents
.1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Mecti icians/Plumbers.
TO BE FILED WITH THE PERIVIITTING AUTHORITY.
Avulicaut Information Please Print LeQibl
Nide(Business/Organiizattiontlndividual):: of%fL3 i U✓� �C
Address: AA12 b-Ay✓i
City/State/Zip: Phone M S&3 —(S I-? `7
Are you oyer?Check the appropriate box: Type of project(required):
1, am a employer with Iemptoyces(fulland/or part-time).* 7. New construction
2.D I am a sale proprietor w partnership and bave ao emplcyees worldng for me in $. D Remodeling
my oap4y.(No workers'comp.iasu uo required
3.ElI am a homeowner do' all work 1£ 9. Q Demolition
mg lyse [No workers'comp.insurance required.]t i
4.[]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10[:],Building addition
ensure that all conuacoors either bave workers'compensation insurance ar are sole 11. ID Electrical repairs or additions
proprietors with au employees.
12.Q Plumbing repairs or additions
5.Q I am a general contractor and I have bired the sub-contractors listed on the attached sheet 13.QRoof r Sirs
These sub-eanwictors have employees and have workers'comp.irmnance.i
6.[—]We area corporation and its officershave exercised their right of exemption per MGL e. 14. IQ Other
152,§1(4).and we have no employees.[Aro workers'comp.iasuraace required.]
I
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
ZContractors 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 woriters'comp.policy number.
1 am an employer Hutt isprov'm coworkers'compensation Insurance for my employee& Below Is the policy and job site
information.
Insurance Company Name: Zit
Policy#or Self-ins.Ile.#: b ZL ct 6 9 iG 52 U G 6 G 2-6 Expiration D late: 4,1
Job Site Address: I LI& ke—s )17_6 City/State/Zip:l "o, j'l-? / e7
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$250.00 a
day against the violator.A copy,of this statement may be,forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify to airs and penalties of periury that the tnformadon provided above is true and correct
Si a e' Date: 7 `�
I
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspect I r 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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cod CERTIFICATE OF '. - ►T�t , .
LIABILITY INSURANCE : 03/12020
THIS CERTIFICATE•I$ISSUED ASA MATTER OF INFORMATIONONLY AND'C011FE93 NO RIG"T3 UPON THE RhFICATt HOLDER.THIS''
.
CERTIFICATE DOES" NOT*F WAnV ELY`!OR•NEGATKtELV AMEND, EXTEND Ott„ALTER;'THE,COVERAGE=AFCF-OORDED`13Y• 'THE`,,P QUCIE$'''
SELOK °TH13.CERTIFICATE`OF INSURANCE DbE8 NOt CQN3TITUTE A;+CONTRACT 13ETWEEN THE ISSUING.fN8URER(t3),.AUTHORIZED:;, '
REPRESENTATIYE;GR PRQDUCM-AND TH- ERTIF7CAtE•HOLDEt�
IMPORTANT It the'::cartiticats holdgr is aa:ADD01ONAL-INSIJRED,aita pollCy(las)mast bs endorsed, ;ff SUBRQGATION IS WAIVED;suttJact to
ttie tongs and conifitlon0 bf ha'p01 cy,,certsin poliales mahi'rsquire`an°endor�fement,A'statEmrnt`o>i tilts certificate dogs.not`'confar rigfits,tai'the;':
c®rlificat®fioldecIn Iteu of,80ch®ndorsame s
PRoouoEa Denise Sawidd
AMMERST`.INSURA'
NCE"AGENCY INC` P" 49 253�'S555. } Fnx
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INSURAMERICAN ZURICH INSURANCE COMPANY 40142
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N R B EXTERIORS INC'.
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MISURERD' _
7 PHILIP CIRCt.E B1suRaliE. .
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MA 01033_
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THI$IS TO CERTIFY THAT THE PWCIES OF'INSpRANCE LISTED BE[,OW.:HAVE BEEN ISSUEQ;TO THE INSURED NAMED ABOVE FOR THE'POLICYPE
INDICATED NO7WTHSTANDINGAW REQI,JI"ENt.,TERM OR',CONDMON OFAWCONT.RACT.OROTHER bi7CUMENT Y{ATH RESI?EC1 TO,WHICH THIS
CERTIFICATE MAY 8E ISS` D OR'MAY PERTAIN Tli INSURANCE AFFOROED 8Y--THE POLICIES DE3CIt{BED HEREIN IS'SUBJECT 7Q ALLTHETERMS
EXClU510NS i6ND CONDITIONS OF SUCH POLIQIES.LIMITS SHOWN MAY f' BEEN REDUCED BY PAID CLAIMS.
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Workers'CornpensaUon tiene(its wilt be paid to Massachusetts empiAyees o Pursuarit.to EndoraemeritlNC 20 03 06 t3+rto authgriaatton is given to pay
dairfi for beft66 to .
errlptoyees in states.other than-Massachusetts.ff theJnsui6d hires,or has hired those employees oatstde of Massachusetts.
This ceRiftcate of Insurance shows the policy fn force`on the date that.this certififtcate Was'issued,(unless tW expiration date ori the abtave policy precedes the
issue date of this oertlflcate ofinsuranrx�) The stats of this.„�overage can be°monitored-tlaily by`arces3irig the Proof of CoveCage `Coverage:Veriflcation
Seardti tool at www mass gov/lwrl7tivorkemcorrrpensatf0finh sttgatioi s%
>'CERTiE1CATE HOLDER` - ” CANCEL'lATtON
SHOULD ANY dP THE ABOVE,DESCRIBED,PCIL.16 BE CANCELiEO BEFORE
THE.,;EXPIRATION DATE THEREOF, Nd'hCE 'WIL 13E"_OELIVEtED IN `
RObf'Frbs ACddRDAMCE i IT THE 13OuCY PROvisIQNs ... ,.
510 NBw,Ludlow Road-:' -
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SouthHadley, :' MA 01075 G
Dania M Cr
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CPCU,vice President ;:itesidu"al`Maricet=WCRIBMA
r Y ®''Ig88.2014ACQR0 CORPORATION All rights recervad.'.
ACOR625(2014101) The ACORD name and logo are'rogis rod marks of ACORD
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• `T(YIIF Licensed and Insured
510 Newt Ludlow Rd.
3IA ReO.20-2015718 p/I>s South Hadley.NIA 01075
MA CSL 1.17961 �1.� �
11:\CSLfI:99565 ! ® P�V� Cell:d 113563-635.1
1413-707-ROOF (7663, Office- v 411,c;7-cal 97 171St v)
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114,111c"c\4•I nn it,be taolecled by Earp.and plywoml
`��hnlb•.lanrl�::q+utF,rice%Io lie puttecfed.roofers buggy used
✓ I-nlirc cm!-Illle ro,•ling materials al he removed loesislilig decking.includiltg llasiting,etc. I
_✓ Site to he clewed on a daily ha.is a ilh roll magnet.debris to be removed at project completion liy thimp-wicr
`Deteriorated deckmg to he repf:lced at S50 per duct u!'plywuud
Complete Ccrtainlecd integrity Ruof System
ht.tall\1 iatcrtuard rcc, \tater haricT abate voltunl ❑ 3 11.of all mots.Y(,fl.
In.t:dl\t Ilim lard we fi waler harrier around penetrations,in valleys and all critical areas
hi'lali t.'crl.unTccd S\ntltctic unticrl:plicnl htcntire decking
✓ Inial S"Perimeter tltctal 11aslting to a!1+dges oS'al.!rcofs,h\ah!!c [3 brown
hwafl SwifiSlari marter shingle to holhnn and rake edges of all ruufs
bwall('enainTccd shingles til±±lanuf'�cturcrs specifications,fl 6 nails:14 nails
Install Ccrz:un i cel[IV','ridge sent it-,a.!Peaks in beated areas
In.tall Shallow Ridge to all hips and ridges,over ridge vent where applicable
✓ hurall nett lead counter Ilashing ht chintncy,
✓/Nutt It slmig inmallcd wilcre necessary
'✓ liwAll nc\c pry,c Ilashing w waste vent stacks
11;•arr:uf,+ I,1tEiwn\
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we guar:mtcc one I:IhnrrtsorkntansI't fitr 20 years loo, rr b
.Sa sb ' et rtrt� ilei sosn •pp-rade f'erminTeed 4-Star Sy,
cilamTeed Landmark•coloFOR&L-T-0 Cl
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i� CcHainTct:d Landmark pro-color r 1a0 u
\tC Pt'T—C beech)h IllFBI Ill Inulcalal%krill 1,11%if•ct111111tell:Ill accordance NII II chose Spec ilic.ltit,l1,ri,I III C'11111 vl. lat:tI UU_
ACf EP'rR1(E CSB Ytif Dl'tDy .1 he atma,r prim.6-mvirmstilull!and ennrllU(Ill,III'e "J Down llaylllellt S
salkfoclurD and are heretay rarcrpeed.l'uw are mtthur'lled to du murk 45 mes ecifird. -
p
"e) Balance title
at mil!be w dut:n IIt start ur)uh,ettd elk cc dor n-jtntt t• lit d Alano
,
I Ellin completion S ( Xjo 4b
pate: �3D/?67ad Signature:
pate: j" ~7~ lisuutalur: !nl\'ante 4 11 t ` it? r
Estimates ore huntlrell liar Burly{JI))days from abutr Iliac / v
ti`'x►.:e!'15�1`!Ct f9d11_()11'Nl:Its:Mme s auger tall lsrrsdnlal hefttnl;ll+r s in lEta rattle,t sr:tgr,•Or floc to the
paz;llltllty rrrutsfing iatturl%ur duet I:t the::ut;h Tmeks of cit,'"Oud,:0l>W Fttwrlua•s laic.uoUl1 uv!be reststtn.11tic fur
debris or dust in the wile nr sturuge areas.
A Finnnee('Margo of! '-=`a morih!y(ANNUAL I't R &N!Alii:MA;1 OF I It"a)s,III be added w dw ort-.end portion If Itie balance Juu.!
uyrec to pay and!or guarantee payntcat of Ihcse rhrrgc...:w It,a+:•a:of'efauli vl';:ytnert,i agree to pay rca+o:sahie Amintey'.'Art:-Ind
court costs.This agreh cot docs not constitutc a Ideas of llabdip•.11%lily aignalum below;achnuwledges an aercenlena u1;dtc abase Is
hereby made.
SiErtalorc• '"�'_�� .