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16A-020-033 BP-2022-0283 303 FAIRWAY VILLAGE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 16A-020-033 . CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0283 PERMISSIONISHEREBYGRANTED TO: Project# KITCHEN RENO Contractor: License: Est. Cost: 11711 EXTERIOR ASSOCIATES 113456 Const.Class: Exp.Date:07/23/2022 Use Group: Owner: POYNER CRONYN, ANDREW & RICHARD Lot Size (sq.ft.) Zoning: URA Applicant: EXTERIOR ASSOCIATES Applicant Address Phone: Insurance: 408 SOMERS RD (860)978-5911 BNUWC0138570 ELLINGTON, CT 06029 ISSUED ON:03/22/2022 TO PERFORM THE FOL LO WING WORK: KITCHEN RENO 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: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • . ":, Fees Paid: $78.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner o _ m z6� il3 71 OThe Commonwealth of Massachusettso z Board of Building Regulations and StandardsFOR A° Massachusetts State Building Code. 7S0 CMR MUN1( ALITY v USE om tiBuilding Permit Application To Construct.Repair. Renovate Or Demolish a Raves{'!Afar'nil o o Oire-or Ma-Family DH�IJng This n For Official Use Only Balding P it Number (709' 4 a "Date Applied: .4.1)10 iZr5c 0/.4.7 3-ZZ-zozz Building Officisl(Print Name) Signature Dale SECTION 1:SITE INFORMATION 1.1 P .erh•Address: 1.2 Assessors Map& Parcel Numbers I I.l a Is this an accepted street"yes X no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning Dutrict Proposed Use Lot Area IN ii) Frontage(nil 1.5 Building Setbacks(ft) From Yard Side Yards T Roar Yard i Required Provided Requited I Provided Required Provided I. I 1.e Water Sup :(M.GI.e.40.454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private° Zone: _ Outside Flood Zone? • Municipal 0 On sue disposal system 0 _T _ _W Check if�es❑ ______. SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name{Print) City.Slate.ZIP IIIIIIIIIIIIIIIIIIIIIIIMIIIMINMIMIMD iIIMIIIIMIIIIIIIIIIIIMIIMI No.and Stra't Telephone • Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK!(check all that apply) New Construction❑ Existing Building I,R Owner-Occupied 0 ! Repais(s) ❑ Akeratson(s) 0 Addition 0 Demolition 0 Accessory Bldg.0 Number of Units_ ' Other 0 Specify:... Brief Description of Proposed Wo SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Esnmated Costs•_ Official Use Only (Labor and Materials) I.Building sMID I. Building Permit Fee:S Indicate how ke is determined: 2.Electrical S 0 Standard City'Town Application Fee 0 Total Project Cost`(Item b)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Total All Fees: $� Suppression) /� Check No. 91 Check Amount. o Cash Amount: 6.Total Project Cost $M. ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 113456 7123f2022 Kyle Nielson _, — License Number Expiration Date Name of CSL Iiolder List CSL Type(see below)R_ . 408 Somers Rd. No.and Stress -- -- Tape , Description U ? UnrestrutedtB-utdingsupto.l5.ot0O cu. ft.) Ellington,CT 06029 R l Restricted 1fi2 Fatuity Divdlirn City,Tovm,State.ZIP M Masonry RC Roofing Covering iltr'indow and Siting SF Solid Fuel Burning Appliances 860-978.6911 OFFICE@EXTERIORASSOCIATES.COM I Insulation Telephone Email address D i_Demob owl. 5.2 Registered Home Improvement Contractor(HIC) 103175 M28/2023 ExteriorAssociates, Inc, .___--- .f._..__. HIC'Registration Number Capu1su0n Date HIC C'onipany Name or IIIC Registrant Nan: 408 Somers Rd. OFFICE@EXTERIORASSOCIATES COM No.and Street Emud address Ellington,CT 06029 860.987-5911 CayeTown,State,ZIP Telephone SECTION•:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.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 o f the butklaig permit. Signed Affidavit Attached? Yes Cil No . 0 SECTION 7o:OWNER AUTHORIZATION TO BE COMPLETED WHEN --' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject p party.hereby authorize Exterior Associates,Inc. to act on my behalf,in al loiters relative to work aurhonzed by this binding permit application. P s Nam vtronic igniiture) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below.I hereby attest under the pains and penalties o f perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Richard Poyner 111.1111111111111. Print Owner's or Auihonxed Agent's Nano(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 no/have accessto the arbitration program or guaranty fund under M.G.L.c. I42A. Other important information on the HIC Program can be found at www.mass.&ovlost Information on the Construction Supervisor License can be found at www.matto,novidos 2. When substantial work is planned.provide the information below: Total floor arca(sq. ft.) (including garage.finished basemen attics.decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces _ Number of bedrooms Number of bathrooms Number of half`batbs Type of beating system .._ Number of decks' porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for-.Total Project Cost" City of Northampton _ oa�HnM:o �s '' .r� . f�� "� Massachusetts �,, - c'en 11 . 'I ' 4E 4 DEPARTMENT OF BUILDING INSPECTIONS '` j' PcE 4s' t d 1.w *' 212 Main Street • Municipal Building Jtis OC`D 2.1 Northampton, MA 01060 s'd�y \^ CONSTRUCTION DEBRIS AFFIDAVIT (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: 0-(-41- Location of Facility: 1 tt'ALil i (lC; ) t.--,011)1- . ) t t1 A,- The debris will be transported by: Name of Hauler: (---cr-;Dcjak) %1 Signature of Applicant: ),,,,,, Date: )1c) dQ Floor Plans 12,4" ,. I, 3 11 33" i 21" 30" 12" 24" 18;" 27II r_ 7 „ E ,, 33 " 1 " 30" 36" W21361 W30188UTT _ ( W1236P CW21361 SD W3318X21DPBUTT " 1 I ' :, w need to add on3 out i4 F3s6 DISHW18 SK.23-180WL \___. side corner molding 1 _s - l y __ �� -please add 3 pcs 6x364011Lle, + a W N filler . ��fm +� m A +� .v N Please confirm customer does not want - "'� �-1 crown to the ceiling, ±' w I think this molding m ti �'� p stack comes with a 3 — -- — o inch filler we will need a �/ N/ >*f B302FWTBUTT B242FWTWTCDR 6 inch filler to securely + mount the crown I7" 1 \ N. molding — m —� —a r ' 1,',-..,_T CO CO rvscu ���1- II30" 24" „ '°"` The Commonwealth afMassachuseetts €- Department r�jlitdi1slrialhlccide�tts �-- Is;, �,� .(Congress Sheet,Suite 100 F l3ostorr, 02114 2017 _ JY ?,r:s; :� www.mass govidia C` Was-ters'Compensation Insurance Affidavit;J3arildors/Contractors/.CIectricians/Plntubers. TO BE MD)yarn TFiE PERMITTING ING t1.OT)(O1UTY. Anrilicant Information Please Print 'LCRii ly Name(Business/Organirationlfodiv?dual): EXTERIOR ASSOCIATES. INC. • Address: 408 Somers Rd. City/State/Zip:_Ellinglon,CT o0029 .Phone#: 860-978-5911 __-_..� - —1 Are yea an employer?Mock the appropriate box: Type of project(required): 1.]I am a employer With _employees(Nil and/or parr-time).* 7. 0 New constluctio:! 2.nconI o a sole proprietor or permcrship tend have no a iploycos working forme in 8. Q Remodeling ng any capacity.[No worcots`comp.iasnraucr,required] 9. 0 Dt.it]011rlorS 3.0/ant a botn^ownertieing ali work ruy.1f.(No worker'cony).insuriucc rcgsrircd.1 I 1.D I urn a homeowner and will be hiring cuuttarto+rc to conduct all work on my proporty. f will 1.0 Building addition" ease re that all rotruaclois eitlrc.-hmc Workers'compensation innrrnce orate sole 11.[]13,1eetrical Yepairti or additions proprietors with no employees. 12,Eina nbing repairs or additions 50 I em a p:nerat eontracior sad r Lave hired Ito sub-enntraelore!?rice on the attached sheet, 13.�Roof repairs Those sub-contractors have c uplayees and have workras"comp.ir_tuoi e.4 6.0`,ire em a curporaticn and its nfgoarshavc exercised their right of exemption per MGL c. la Oilier HI C. { 152,xr 1(4),and we hove no employees.(2do workers'cavil.insurance required.] sAny applicant that oheukr�box;1.must also fill ninth,section batnw showing tuuirwarkers'compensation pulley information. . 'ri;-lgateowraesw 4,sohntir this affidavitirdicatiafrtheya_udoingallworkandthenhirenutidocontrac;orsneettm)bnutanewladavitindicaingsuch. jConiraoto;a that chuck this box M.us utloaltud en a<;rlitianal short she\ving the aetna aA t e sub-contactors anti state Vlhetlice or net thew entities have e.nployees.ifrhe ati:)-eentractear,have employees,they trust provide their worker.;'comp.policyntunbcc I ant an employer that is providing workers'compensation insurance,for ray employees. Below is the policy and job site • information. • Jn ur't nco Compeny Name:Berkley Insurance Co. _... • 'Policy ri or Self ins.Lic.ii: BNUv1+C0138510 Expi Expiration Thee: 1111a12� _ Tel)Site Adcxass= City/StaiclZip: 3 • Attach a copy of the workers' cotnpensttti poi cy t et aration page(showing the policy number au oxpara.zoo slate). Failure to seem'e coverage as rcguired.under MGI,c.'152,§25.A_is a criminalviolation.pt_>ziishable by a line tip to$1,500,00 and/or one-year imprisonment as well as civil.penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy ofihin statrauent may be,i'orwarded to the Office of Investigations of the I IA for insurance coverage verification. .I do hereby c:er'tity router the pains and penalties of perjury drat the I ormatiorc pravirled abut' is true and car'reeE. S.ignalure: Dennis Auden 3�"tte• 1 T'i:le 0: 060-978.5911 , • of fftciat rise any. .0o not write hi this ewer, to be completed by city ar toltwn official. i 1 City or'fown.:.._ Permit/License# - _ _ Issuing Authority(circle one): 1 1.Board af:C ealtb 2.Buildin Department: 3.City/Town Cloric 4.Elccfric;:l.Inspector 5.Plurb big btaspcetot' 6.Other Contact Person: Phone _.,., _ _. _ .. _ Y_ 'Commonwealth ofVassaohht:$setts. .` • I 11 DivIsion of Professional I.t: :ensure• Board f Bilitding Rt9ulations .and Standakis. e ;ri 14 . '.µ i , 1Ip4rec 7 KYLE 1', ELSFfa�it �' _ � . q 30 LAZ LANE, �t ,� : ' , EU INGI S n 1., �- y �Q Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporaticn Registration 103175 EXTERIOR ASSOCIATES INC Expiration 04/2B/2023 31 OVERNIL.L RD ELLINGTON, CT 0E020 Update Address and Return Card. Offico of Conaumar Affairs&Businoss Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Cornointinn before the oxpiration date. If found return to: Reglatralion Expiration Office of Consumer Affairs and Business Regulation lo31.+a Cl t'a'1r1-' 1000 Washington Street -Suite 710 EXTERIOR AMSOCIATES INC Boston,MA 02118 17ENN:S ALIDET I27 v\ 31 OVERHILL RD ,i u,:.a.r ..,'irr. ELLINGTON.CT ghn 0- Not valtid without signature Undersecretary Client#:98251 EXTERASC DATE(MMIDDIYYYY) ACORD„., CERTIFICATE OF LIABILITY INSURANCE 11/10/2021 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(ies)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 NgNI[l1CT Lynn M. Paparazzo Starkweather&She le (CT) PHONE FAX 860-709-9354 P Y (ac,Na.Exq;860 583-0943 _ Alc No Insurance Brokerage, Inc. EMAIL IPa arazzo starshe com PO Box 549 INSURER(S)AFFORDING COVERAGE__ ___ _NAIC U Providence, RI 02901-0549 Selective Insurance Co of New England __ 11867 INSURER A; 9 ..____— INSURED INSURER B•Exterior Associates, Inc, ..-_.—•---_.._...._._.____...._.......---..__. _.—__._.. -----...--•—__—•�- 31 Overhill Road INSURER C ..___... ______ Ellington, CT 00029 INSURER E: „_......_..__.......___—__._. ..__ INSURER F: 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. INSR . ADDL SUBIi1Y—.__....._._.._-......,....---•—_.--.------POLICY EFF POLICY EXP II LIMITS LTR TYPE OF INSURANCE INSR WVD _ POLICY NUMBER _---IMMIDD/YYYY)_(MMIDDIYYYY)_1_-- A X COMMERCIAL GENERAL LIABILITY X S2442015 04/01/2021 11/14/2022 EACH OCCURRENCE J- S 1 000L ,000 DAMAGE TO RENTED 5500 000 ___I CLAIMS-MADE I..X I OCCUR PREMISES(Ea occurrenceL_•,- , _ MED EXP(Any one person) _ S 15,000 PERSONAL S ADV INJURY_ __ S 1,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,600 XI POLICY I J JECT I._ I LOC PRODUCTS-COMP/OP AGO S 2,000,000 7.1 OTHER: S AUTOMOBILE LIABILITY r COMBINED SINGLE LIMIT 1,000,000 A _ )C S244201e 04/01/2021 11/14/2022(Enncod�nl)_ .__.. _ .-._-...__.. — X ANY AUTO BODILY INJURY(Per person) S AUTOS SCHEDULED ' BODILY INJURY Par accident) 5 _,,. AUTOS ONLY ...,. I AUTOS ( x HIRED ONLY v NON-OWNED PROPERTY DAMAGE 5��—•�'__.._.__...__ AUTOS ONLY ,(Per acclrlcnl)...,_,._-,-_ A x UMBRELLA LIAR I X OCCUR 1 X S2442015 04/01/2021 11/14/2022 CACH OCCURRENCE s2 000 000 EXCESS LIAB I CLAIMS•M_A_D_E AGGREGATE s2 000 000 DED I_—_ RETENTIONS _ _ 5 WORKERS COMPENSATION — A AND EMPLOYERS'LIABILITY YIN WC9097314 11/14/2021 11/14/2022 X sT4TUT.E.__ _ ER_ANY PROPRIETORWARTNERIEXECUTIVE'--- �— OFPICER1MEMBER EXCLUDED? N 1 A E l..EACH ACCIDENT S500t000 Mandator In NH I— I (Mandatory ) EL.DISEASE•EA EMPLOYEE 5$00 O00 II yes,describe undar - • _ DESCRIPTION OF OPERATIONS bolovr E•L,DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonol Remarks Schedule,may bo attached If morn space Is raqulrod) Home Depot USA, Inc., dba THD At-Home Services, Inc., its parent,affiliates and subsidiaries are added as additional insured including On-Going & Completed Operations as required by written contract/agreement CERTIFICATE HOLDER CANCELLATION Home Depot USA, Inc„ dba THD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN At-Home Services, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Home Services Compliance C-11, 2455 Paces Ferry Road AUTHORIZED REPRESENTATIVE Atlanta, GA 30339 I �i-4. l ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1811758/M1808232 CTLMP