24D-019 (2) 4-6 LAWN AVE BP-2021-1502
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-o l 9 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-2021-1502
Project# JS-2021-002493
Est. Cost: $22000.00
Fee: $154.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sq. ft.): 8494.20 Owner: BIRCH HILL LLC
Zoning: URB(100)/ Applicant: NRB EXTERIORS INC
AT: 4 - 6 LAWN AVE
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUED ON:6/16/20210:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & 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.
• 9
Certificate of Occupancy Si�;natur 1 ' r l
FeeType: Date Paid: Amount:
Building 6/16/2021 0:00:00 $154.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
/
The Commonwealth of Massachus .�
Office of Public Safety and Inspections <-0,9/
Massachusetts State Building Code(780 CMR) �,f 4,`/)//
Building Permit Application for any Building other than a One-or Two-tatty,,, ' g
`iS'
(This Section For Official Use Only) �70-6/oNs
Building Permit Number*a"'1 /91� Date Applied: I Building Official
SECTION 1:LOCATION
- I- (a -"1 V--k Litt) 11.c ,L t. ' 0( L t�
No.and Street City/Town Zip Code Name of Building(if applicable)
� yD -off
Accaccnrc 11Aan S Rlnrtf it and/nr T nt !k
SECTION 2 PROPOSE!)WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application: Yes u No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No ❑
Brief Description of Proposed Work 9� *tip v t�y �-- �`l F 1 S 1 ih t } u <<�/ I `1
!��► S �-j It (AJ.r..`) c
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing iFroposea
No.of Floors/Stories(include basement levels)Sr Area Per Floor(sq.ft)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly Al- 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 I B: Business 0 I E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 Cl H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 1-2❑ 1-3❑ 1-4 Cl M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
i.y u iu Cl iin u NB u I ::In u 111U u I i v u I v it u V u u
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal:
Public 0 Check if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No❑ Yes❑ No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Design Occupant Load per Floor and Assembly space: v w
t
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
g i r a,, \*,t\ lac- lob rQct- � 5 ke,_, LJz_is), ,p161 oho ) -
Name(Print) No.and Street City/Town Zip
Property Owner Co tact Information: l
c;" 5 (('(/9 Ok 116 --5 ?"Li? ) - -
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here CI.
Otherwise provide construction control forms(see section 107 in the code)as required
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
N :cLJ\4C (/r":t_, . tig- Val6,, (1 S6s
Na (Registrant) i i JQTelephon No. e-mail ad Q U1c___ Re trati n ber
Street Address City/Town State Zip Discip e Expiration Date
10.2 General Contractor
(J tZ 6 e)(e il(1,-c , i"_C
Company Name
J,l 7. t_ f"�CA ,w ( `mil ? - ci Cp i
Name of Person Responsible for Fonstruction " Li No. and Type if Applicable
Street Address City/Town State Zip
-=-3 -63V
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COMFFNSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ ` Enclose check payable to
6.Total Cost $ ,} opt) (contact municipality)and write check number here
SECTION 3:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering m e below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
applica - e and accurate to the best of my knowledge and understa ding.
t)/'Cf yq CC-g 6T.3.-4016- (
ease print and sign e Title Telephone No. Date
�.. :/(c,.- 6 f ins no? S,_
Street Address City/To State Zip Email Address
Municipal Inspector to fill out this section upon application approval: //�� 4- it ZQ Z j
Name Date
" City of Northampton
;,� Hn�N,;y: SS 7 sc
Massachusetts �Q? A_ %<<
DYPAI2TNT OF BUILDING INSPECTIONS ;':
-
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212 Main Street • Municipal Building �,,±�,cs
ii
° r S� v`Northampton. M) 01060 L..—«.:4d
t O S RU TI )1 DEBRIS
tFrYW i£t Y V1T
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 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, S 150A.
The debris will be disposed of in:
Location of Facility: qc-A- (Ha`1 1 I 41 / cAt-t ..(1 c
The debris will be transported by:
1�
Name of Hauler: �f`9 (� S Y'1 )A-a- \ , ."-A)
nSi nature of Applicant: Date: 6 - -- 10-), (
.R
•
The Commonwealth of Massachmsatt
• Department of industrial Accidents
M r1 �r I Con Street,Slthi 100
` _ Boston,MA 02110-•2017
wwlgtwas$ oWWdia
Workers'Compensation hiserance Affidavit:builders/ContraetotWEleetriciaus/Phimbers.
TO 11E FILED WITH THE PERMITTING AUTHORITY.
*nolicUt Information >l 7e14t iAldblv
Name(BusiaeplOreanisation4ndividuell: ifJ I`) <- (- , )••�, .---c.,' -
Address: ", r0 R :vJ.Q -- 1...E j �t.. , ' / (
City/State/Zip: ) AA n k IA I rill Phone 0: `11 f TS(5 J I 1 3 Z/
ChatAreIm ea fifer!Chat no spprapeiate boat Type of project(ro4 : F
in I ea a employer rid, employees Mg a"dror Pail-tinw).• 1. 0 New construction
2.0 1 ea a sole proriews a panne dup and law no ewpbyocs walkieea for me in
any capeciay.lido watt' wno comp_iaae►egeivedd S. Remodeling
3.0 tea a honhe l Mort myself.dote.e myself.(No*eskers'comp.whw oc lan requited.)' 9• CI Demolition
4.01 ate a homeowner and will be hying common to conduct all work at my property. 1 will 10 Q Building addition
aims that all common either have waders'compenseeien insurance or arc colt I i.Q Electrical repairs or additions
proprietors with 12.0 Plumbing repairs or additions
5.Q 1 no a dental oweuaaa r and 1 have hired the swaeoenatsort listed oa the reached sheet.
Thar sub•conuaciore here employees and have workers'comp.imieeics? l3.0 Roof repair:
6. We are 14,0Other
Q I f a c and oaken lave mistime ear aids of compiles per MOL e.
employees.(No"micas'comp,hammyeequirod.)
Any spplkaal Met cheeks hos et mast also rill an the section belen dewlap dais vacua'compcnsoti w policy in<amaieu.
Hooteeweas who sobs!*this afLdtvil itdieaeap they we debt ail wait sodden bit meek eaa submit a taw affidavit iadintiaa mob.
:Verandas dim deck title bra met easched so*Olden')shore allowing At lame art he udwaaa<acaoas and sate whales►a as those asides here
a nploysa.It the'st► taeeaore have eaep oytn,*et Ism provide their waken'comp.psoliey motet.
i aunt an employer that is providing workers'conipensoNon humane:for no employees. Mew Si the polity mulish sloe
Company Marne: . ike*'f 4i C 4.4a, Z we t
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,
Policy If or Self-ins.Lie.0: ,(D-7 7 c4 Al F cy7(.0 X(2 ) ) Expiration Dew . ii 1?)......
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Job Site A,i_ l. j,' L. f^, , , k.<._ • y (, (' `Ita... i . (/1.
Failure to secure coverage as required under MGI.c. 132,f25A is a criminal violation punishable by a Doe up to$1,500.00
and/or one-year imprisonment,as well as civil penalties hies in the farm of a STOP WORK ORDER and a tine of up to 5250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance €
covers"voiflation. C
1 eftnm hereby ea j�xat as aadparaisies of pa/tay dial the information provided above is tree and coast
i
5frwre: ...- , Date: jam' /0 `,, 1
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O1ficial use only. Oho not white in this area.to be completed ltr city or town official. [
1
City or Town: _Per mkJLkease ll
lands*Aetbority(trek one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other a
Contact Persons py ._ ..__._._....
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A`4 CERTIFICATE OF LIABILITY INSURANCE ante pusoWTYVYl
03/06/2021
1 THE CERTIFICATE IS ISSUED AS A MATTER OP INFORMATION ONLY AND CONFERS NO MONTS UPON THE CERTIFICATE HOLDER.THIS
I 4FJ 1F t1IGA'lt DOES NU I AI'PI ATIVELY OR NEQArIYELY AMEND, t*NU OR ALTER Ms GQVERAIMI AP ED MY THE PI:IM O
SEI.OW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE W$ DIC BISURER(S), AUTHOROZD
RQRMSENTATIVE OR PRODUCER,AND THE CBRURCATE HOLDER.
IMPORTANT: If the o waits%holder Is all AGGITIONAL.NOD,the po lssj must be sod rsed. II SUBROGATION IS WANED,subject to
the tonne and conditions of the policy,attain paMstes may require an endorsement. A itaUnnnt on this oertMcate does not oerdier rights to the
artkoels holder M Neu of such sndoreemaii s).
mow= Darr Mass Sawicki
AMHtKS 1 INSUMAN(:E AGENCY INC t",rl' s,r, (413)283.666E I Mt Rs
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PO BOX 48 ellasyle AMPS%00110.410g , WMC
AMFERST MA 01004 merapAl AMER CAN ZURICH INSURANCE COMPANY 40142
I MarMo PROMILIP F
N R B EXTERIORS INC cow c:
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7 PHILIP CIRCLE INIRIRIRS p
QRANBY MA 01033 P;
COVERAGES CERTIFICATE NUMBER: 82 231 R!VI$Ic*NUMBER:
ITEAS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE GENIE ISSUED TO THE INSURED NAND ABOVE FOR THE POLICY PERIOD I
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTH R DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED SY THE POLICES DESCEND moo IS SUBJECT TO ALL THE TERMS.
,.....norw..v nova,wrww r www ur own rww.ota.61141110 rniviiiw ilia i rIMIC MUM riii$Vr+ZU 0T MS.WOOD.
him TYPe W INSIMMSox .IIHse In, POLICY____ a ,-ai ' tams
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exeLuoeoT NIA Pere ILL.ares •eA , 100,000
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OMOIWPTIDNOPOPMATIONS(LOCATIONS(MOWN Issues lit.AdaMsdlhwrbTM-eMs.wearrrn.hdrs•r......r....+...•
"Mk"'Comperuetlon benaMs silt be paid lo MesMahlMEs employees only.Pursuant lo Endorsement WC 20 03 08 B.no auwortrallan is goon to pay
clime for benefits lo employsss In seas ogler Pin MissimhusMb If Me Insured hies.or hes hired Mose employees outside of Mlawehusses.
This certificate of Insurance shows the polio/In force an the dale Bret as eatMcee use awed(win the sxphatlon deli on the above poky precedes the
Issue dale of las oulliotle of insurance). The MMus of this coverage can be monitored daffy by aoosesklp the Proof of Coverage-Coverage Vertllcauon
Search tool at www.aliss .
CORTIPICATINDLOIR CANCELLATION
MOULD ANY OF THE ABOVE OUBCRESED POUCIEs U CANCELLED SEP011!
THE EXPIRATION DATE THERIOP, NOTICE WILL MI DILIVMOD IN
Certain Teed Select ShingleMaster ACCORDANCE t sH Oa Po 'PROassaorie.
PO Box 20128 Avnionosonenot wrATat I
Insiah Valley LIP ia002-0i2o 1{ '�>
I 1 Daniel M. ,CPCU,Vice President—Residual Market—WCRMMA
O 108S,2014 ACORD CORPORATION. Al tights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
cc-Y/4e (6904—ea a f,./(7)
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
Registration: 147961
NHti t_X 11_HIUHS IN(;510 NEW LUDLOW RD Expiration: 08/2212021
SOUTH HADLEY,MA 01075
sf*"
Update Address and Return Card.
SCA 1 0 20M-05/17
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 Hegulation
147961 08/22/2021 1000 Washington Street -Suite 710
NRB EXTERIORS INC Boston,MA 02118
NICHOLAS R.BERNIER
510 NEW LUDLOW RD / '
SOUL H HAOLEY,MA 01015 mu.,groom.wiiiwui aiviroi t
Undersecretary
Commonwealth of Massacnuseii5
( Division of Professional Licensure
,!' Board of Building Regulations and Standards
Construction Supervisor Specialty
28/2020
CSSL-099565 1111111.
empires:051
NICHOLAS R BERNIER
510 NEW LUDLRD
SOUTH HADLEY MA 01075
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