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23D-007 (8) 58 NONOTUCK ST BP-2022-0007 GIS#: . COMMONWEALTH OF MASSACHUSETTS Map:Block:23D-007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONT ORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (I14IGLACT c.142A) Category: Door Replacement BUILDING PERMIT Permit# BP-2022-0007 Project# JS-2022-000007 Est. Cost: $1240.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: EXTERIOR ASSOCIATES 113456 Lot Size(sq.ft.): 62290.80 Owner: RIDABOCK Zoning: URB(100)/ Applicant: EXTERIOR ASSOCIATES AT: 58 NONOTUCK ST Applicant Address: Phone: Insurance: 408 SOMERS RD (860) 978-5911 WC ELL INGTONCT06029 ISSUED ON:7/2/20210:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL 2 REPLACEMENT DOORS POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Insde tor Underground: Service: Meter: Footings: I' Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimne}: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPO VIOLATION OF ANY OF ITS RULES AND REGULATIONS. I` . .>2 ✓ Certificate of Occupancy signature: I FeeType: Date Paid: Amount: Building 7/2/2021 0:00:00 $80.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner ,i ,fl, The Commonwealth of Massachus,efts Board of Building Regulations and S G� �`-`FOR t Massachusetts State Building Code,780 C9 0 , SE 'xi"( Building Permit Application To Construct,Repair, Renovate T lish tt Rev'.ed M 2011 One-or Two-Family Dwelling \�4,.:( • s ��j} This Section For Official Use Only :�qo�0 BuiliPermit Number: 5Ir'All'' IDaatte Applied: V io-1 Jos �/ C— zz( Building Official(Pnnt Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: ' 1.2 AssessRrs Ma & Parcel Numbers 58 NONOTUCK STREET 1.1a Is this an accepted street?yes . no Map Number Parcel Number 13 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage till 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone:Public ❑ Private 0 — Outside fyes0 sd lone:' Check if Flood Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 01%ner'of Record: F LORENCE. MA 01062 RIDABOCK,ANNE Name(Print) City,State,ZIP —_ 58 NONOTUCK STREET (413)695-8944 ANNRRIDABOCK@GMAIL.COM No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units Other El Specify:Ne' Exterior Darts) rief lion of Proposed Work2: New Exterior r Patio Door,NO STRUCTURAL CHANGES. Number of doors( 2 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only (Labor and Materials) 1. Building S 1240.00 1. Building Permit Fee:$ Indicate how fee is determined: Electrical $ 0 Standard City/Town Application Fee 2. 0 Total Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total it Al $ Check NCO-) Check Amount: 641 Cash Amount: 6.Total Project Cost: $ 1240.00 0 Paid in Full CI Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) € 113456 07/22/2023 Kyle Nielson License Number Expiration Date Name of CSL Holder List CSL Type(see below) R 30 Lanz Lane No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft_) Ellington CT.06029 R Restricted l&2 Family Dwelling City/Tim n.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-978-5911 office(aaexteriorassociates.com i insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 103175 04/28/2023 Exterior Associates inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 408 Somers Road office(alexteriorassociates.com No.and Street Email address Ellington CT 06029 860-978-5911 City.Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AEI.I I)\•1"I ("LG.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 of the building permit. Signed Affidavit Attached? Yes © No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize Exterior Associates Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. RIDABOCK,ANNE 6 g 2021 Print Ouncr's Name(Electronic Signal,re) Date SECTION 7b: t)*%a NEW OR AUTHORIZED AGENT DECLARATiON By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Dennis Audet 6 /9 /2021 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home improvement Contractor(HiC)Program),will tggj have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gcv/ocg information on the Construction Supervisor License can he found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basementiattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/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" The Commonwealth of Massachusetts Department of Industrial Accidents y - Office of Investigations Lafayette City Center J �" r ;%=f✓ 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Exterior Associates inc. Address:408 Somers Road City/State/Zip:Ellington CT 06029 Phone #:860-978-5911 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 12+ 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9 El Building addition [No workers' comp. insurance comp. insurance. required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §I(4),and we have no Exterior Door employees. [No workers' 13.11 Other 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:Berkley Insurance Company Policy#or Self-ins. Lie. #:BNUWC0138570 Expiration Date:1 1/14/2021 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year ilnprisomnent, 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjuly that the information provided above is true and/'i correct. Signature: j7Pv - Dat : ! 20L' Phone#: 860-978-5911 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.0 Electrical Inspector 51:Plumbing Inspector 6.D4ther Contact Person: Phone#: Client#: 98251 EXTERASC ACORD-, CERTIFICATE OF LIABILITY INSURANCE UA I t(MMrUU/Y Y YY)3/31/2021 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:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NpM LI Lynn M. Paparazzo Starkweather &Shepley (CT) Liar.wo b,,i 860 583-0943 FAX.; 860-583-0410 Insurance Brokerage, Inc, Email z .-____ — -- --__1 .No): PO Box 549 g ADDRESS: )Paparazzo@starshep.com INSUHtI(S)AI-FORDING CWt4Atit NAIL# Providence,RI 02901-0549 INSUHtHA:Selective Insurance Co of New England 11867 INSURED •Imsu *RIs:Berkley Insurance Company _...__..-- 32603 Exterior Associates,Inc. _._ 31 Overfill Road INSUKtRL. Ellington,CT 06029 INSURER u IN SUHtR t: INSURERI-: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 WHICH 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. INSK AUUL SUER .- - - - POUCY tFF POLICY tXP L I K _- I YPt OF INSURANCE INSR wvu POLICY NUMBER (MMIUU/YYYY) (MMIUUIYYTY), LIM!I S A _X COMMLRCIAL GLNtHAL UASILI I Y S2442015 I,/01/2021 11/14/2022 EACH OCCURRENCE S1,000,000 CLAIMS-MAUL X UccuR s t Vence) s500,000 MtU txp(Any one person) $15,000 PERSONAL 8 AUV INJURY S 1,000,000 titNLAGGRtLiAItLIMtI APRILS PER GtNtRALAGGHtGAIt :$2,000,000 • X ',LucyX JtC II • LUC PHODUC I s-cOMPiOP AGG .S2,000,000 O1Htt $ A AU OMUPSILt UAt 1LI IT S2442015 I,/01/2021 11/14/2022!)Mtii aU SiNbi t LIMI I `"g1,000,000 i X ANY AUt 0 '.BODILY INJURY(Per person) $ OWNtU St t1tUULtU .tiOUILY INJURY(Per accident) $ AUIUSONLY µ__ AMOS l.._v IUHWU NUN-OVYNLU PNOPtRIY UAMAGt ----._ X AU IUS ONLY X AU IDS ONLY- Per accident),_ $ S A x uMHHtLLALWtl X OCCUR i S2442015 04/01/2021 11/14/2022 LACHOC(,'URIttNct s2,000,000 EXCESS UM .CLAIMS-MADEI AGGRtGAIt $2,000,000 UtU NEIt.NI ION$ 1 -.. S WORKERS CiNAPSNSAI IUN B I BNUWC0138570 11/14/2020 11/14/2021 X titA4tuiE ^ LII H- ER , ANU tMPLOYtHS'LUiMU IT ANY PRUPWt tOWPARI NtWhxtCU IIVt YIN t L.EACH ACCWUEN I -$500,000 UFFI(ERNtM}tttEXCLUUtU'� Y N/A (Mandatory in NH) t L UIStASt-LA tMPWUYtt s500,000 if yes.descnbe under UtSCHIPI ION Of-OPERAI IONS below tLUIStASt-POLICYLIM It $500,000 UtSCHIPI ION t.)F OPERA I IONS I LUCA I IONS I VtIiILLtS(At.ORU 11.11,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION EVIDENCE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 114 """INFORMATIONAL PURPOSE ONLY*" ACCORDANCE WITH THE POLICY PROVISIONS. AU 1HURIILtU HtPRtStN IA I IVt . .c Vy.. -4- @ 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1703059/M1699731 CTLMP ... Commonwealth of Massachusetts Division ofProfessional Licensure 11„,, . q Board of Building Regulations and Standards - 11. ,. r KYLE �.: IEL LANZ30 LANE 3 . .. Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation EXTERIOR ASSOCIATES INC. Registration: 43175 Exxpi ration: 0 04/28/2023 31 OVERHILL RD ELLINGTON, CT 06029 Update Address and Return Card. 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 103175 04/28/2023 1000 Washington Street -Suite 710 EXTERIOR ASSOCIATES INC. Boston,MA 02118 DENNIS AUDET "'` / 31 OVERHILL RD �r '^`tfCL %zGtisdi" ELLINGTON,CT 06029 Undersecretary r Not veil without signature