06-044 (13) BP-2022-1263
241 HAYDENVILLE RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
06-044-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1263 PERMISSIONISHEREBYGRANTED TO:
Project# ROOF Contractor: License:
NEW HORIZONS HOME
Est. Cost: 11000 IMPROVEMENT 111998
Const.Class: Exp.Date:05/10/2023
Use Group: Owner: AL BISHOP EDWIN V& SHEILA V E 1
Lot Size (sq.ft.)
Zoning: RR Applicant: NEW HORIZONS HOME IMPROVEME T
Applicant Address Phone: Insurance:
2400BOSTON RD (413)279-3226 L185000992
WILBRAHAM, MA 01095
ISSUED ON:10/06/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-SHINGLE LEFT SIDE ONLY
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOL TION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $40.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
yo.
The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards MUNICIPALITY '�7
Massachusetts State Building Code,780 CMR USE
•Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011, ,; o
One-or Two-Family Dwelling N 5.8
This Section For Official Use Only f °Q
If � zz
Building Permit Number: GP 2..1+ 12,C/ '3 Date Applied: i W G e z
B 4,0 �ICin, /�� 10-(, j: z
Building Official(Print Name) Signature DataI LL
SECTION 1:SITE INFORMATION 1 a o
1,Pro erty Add ess: 1.2 Assessors Map&Parcel Numbers 7
it.i
cli
1.1 a Is this an accepted street?yes ✓ no Map Number
Parcel Number ___—'—.-
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1_40witerl of ord:
Ye--le'i 13 tShcy° Lc5 yv)A 01n53
Name(Print) City,State,ZIP
q I Haty/4 ►v;I L? 04. y13- 5 - yyoi Fk rsbusrress -c-a)
,s1rna -fri
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building,[ Owner-Occupied j$' Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other iii Specify:
Brief Description of Proposed Work2: Py2/yl()V-e C Y r p I ac—C.. �,, (4- s i c/e 0 i
roof- br)L1
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ 1 \ ()L20 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
0 Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fee
Check No. heck Amount "t- Cash Amount:
6.Total Project Cost: $ \ \ 000, 0 Paid in Full 0 Outstanding Balance Due:
I
SECTION 5: CONSTRUCTION SERVICES
Co truction Supervisor License(CSL)or�e fA c r t I Qn ol
License Number pZth
N fCL Holder
01 r/ J 0 Dr List CSL Type(see below) 1-1
No.and Street Type Description
01?)CA (� HA
0) F U Unrestricted(Buildings up to 35,000 cu.ft.)
1 �Vit 0b R Restricted 1&2 Family Dwelling
Ct y(�' wn,Stdte,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
PrpAueH04 t SF Solid Fuel Burning Appliances
q/3-g7q',3 . - r1PIA*Ionzol nonielNt�/Vv(�.VYlerli-, Insulation
elephone Email address 1 De/}.0 Demolition
5.2 Registe Home Imp ement Contractor(HIC) t(]9ee�/1 �_
°' r----� j"1�C �7S
Aka) r I Lon l�I°(YIe 1� 11'DVI VW2IW HIC Registration Number Exp ation Date
HIC Company Na�o,r`�HIC Registrant Name f
ob �WS 1 g is il�f► ��lr 1 k�r j1Lrne gat oc Vemerrf
an Street , Email address e�iyyj
City/Town.State,ZIP Telephone
SECTION 6: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 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 /
I,as Owner of the subject property,hereby authorize�e,L, ` -',i icy)J)/Y' Tmpre)veliv/7T
to act on my behalf,in all matters relative to work authorized by this building permit application.
, r /-;hao
Print Owner's Name(Electronic Signature) Date
9
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information 11
contained in this application is true and accurate to the best of my knowledge and understanding.
ig, (412- Date
Print Owner's or Authorized Agent's Name(Electronic Signature)
NOTES:
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 not have access to the arbitration program or
guaranty fund under M.G.L.c. 142A.Other important information on the H1C Program can be found at
www.mass.itov.!oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
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 half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
"Total Project Square Footage"may be substituted for"Total Project Cost'
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
=;M 1 Congress Street,Suite 100
r=_ Boston, MA 02114-2017
�e�elc
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):new horizon home improvement
Address:2400 boston rd
City/State/Zip:wilb. ma 01095 Phone#:413 279 3226
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working forme in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]
9. 0 Demolition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
10 0 Building addition
ensure that all contractors either have workers'compensation insurance or arc sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or auditions
5.0 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 13.0Roof repairs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.00ther
152,§1(4).and we have no employees.[No workers'romp.insurance required.]
*Any applicant that checks box kl 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 cmployecs.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:
Policy It or Self-ins.Lic.#:_ _ Expiration Date:
Job Site Address:69 �jd J1V1 l L R City/State/Zip: LeA ,S/ N�� 6/013
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 ce
rtify under the pains and nalties of perjury that the information provided above is true and correct.
Signature: /� � <l ' `— Date:
Phone#:413 279-3226
Official use only. Do not write in this area,to he 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 4:
x1.,
City of Northampton
<��_ r. S�f,•,...-sic
o Massachusetts 1:All
DEPARTMENT OF BUILDING INSPECTIONSy.;';'{ , " 212 MainStreet • MunicipalBuilding QD
� -4: Northampton, MA 01060 O
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:
Location of Facility: M/9(401
The debris will be transported by:
Name of Hauler: /4 FForcla!4 tA / -t-e
Signature of Applicant: ,,f ' Date: 70 62'!`
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Stregt - Suite 710
Boston, Massachusetts 02118
Home improvement Contractor Registration
...z Type, LLC
NEW HORIZON HOME IMPROVEMENT LLC (i* egisttationi 192602
‘ - . ,
— E*ptratton: 07/23/2024
2400 BOSTON RD SUITE 3
0--,-,
WILBRAHAM,MA 01095 .,
-., -
't-tr\ Niipieleieeely
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPl,LC Office of Consumer Affairs and Business Regulation
Realtafitton ' EXPKTIORP 1000 Washington Street -Suite 710
192602 07/23/2024 Boston,MA 02118
NEW HORIZON HOE*IMPROVIMENI LLC
' ‘1
JOSHUA W MESKILL
2400 BOSTON RD SU IE"i ,,,.,%,,,.„x, ! ,4,.-i,,,o,,,ii ,--' 4.—
WILBRAHAM,MA 01095
Undersecretary / N 1 valid with t signature
a Corntnonweaiih of Massachusetts
Division of Profesnai Licensure
Board of Bui%drng Regutat#cans and Standards
GcansVtIt~ � .1 srar
C .ttIg98
fires;4ttflf2tt23
BRUGE ALAN GAR*
23 OLMSTED'OR
SPRINGFIELD MA 01188 m
Ccxrtmissc3rter
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ACO aDATE"'"mo"nn'Y)
CERTIFICATE OF LIABILITY INSURANCE 05/12/2021
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 POLICES
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 rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT David H Jany
Neill&Neill Insurance Agency Inc PHONE 3 MAX
662 Riverdale Street Exti. (413)732-4137 (Arc.No1:(413)731 6829
West Springfield,MA 01089 4p s, dj@neillandneill.com
INSURER(SIAF FORDING COVERAGE RING
INSURER A: Northfield Solutions PIOF
INSURED VOCtOf Home,Inc. INSURER B: A.I.M Mutual Insurance Company All
38 Humphrey Lane
West Spnngfield,MA 01089 INSURER c
INSURER 0:
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.ry�p� LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L RI TYPE OF INSURANCE ,�»� MYYO POLICY NUMBER I POLICY EFF 3 POLICY EXP LIMITS
i(MOLIC YEFF lkN li Y EXPI
A f COMMERCIAL GENERALLJABILrrY WS517412 04/25/2022 04/25/2023 EACH OCCURRENCE S 1,000,000
CLAIMS-MADE OCCUR , DAMAGE TO RENTER 100,000f,....... 1 i ,..,eREVI E.R.LF,3,:4c .5Ac.1 $
.__._.__..-___.__.._.............»............._..._........__........___..»_ ,MED EXP(Any one person i 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPIJES PER: GENERAL AGGREGATE i 2,000,000
VIPOLICY 1 JECT [ i LOC PRODUCTS-COMP/OP AGO $ 2,000,000
OTHER:
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO BODILY INJURY(Pr preen) S
— OWNED »"-"SCHEDULED— AUTOS ONLY ^AUTOS BODILY INJURY(Per accident) $
HIRED NON-OWNED MI IIW 1TAI7 ......................._.S.m._..........._..........................»»...._..
AUTOS ONLY .,AUTOS ONLY (Pr acddeM} ._.,.,__..._._. ....
Smm
UMBRELLA LIAR OCCUR EACH OCCURRENCE I
EXCESS LIAR CLAIMS-MADE AGGREGATE —__— I
t)FD I 1 RETENTIONS I S
B WORKERS COMPENSATION AWC-400-7039926 101/19/2022 01/19/2023 PER
AM)EMPLOYERS'LIABILITY .1!,.t_STATUfE ( ER
N
ANY PROPRIETOR/PARTNER/EXECUTIVE YID N/A E.L..EACH ACCIDENT $ 100,000
OFFICER/MENDER EXCLUDED' t • f
(Mandatory in NH) E.L DISEASE-EA EMPLOYEE I 100,000
I It yes,describe antler .-,""."-...
500,000
I DESCRIPTION OF OPERATIONS beim E.L.DISEASE-POLICY LIMIT S
1
UL SCRIP(ION OF OPERATIONS(LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached I mere space is required)
CERTIFICATE HOLDER CANCELLATION
New Horizon Home Improvement,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
2400 Boston Rd,Unit 3 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Wilbraham,MA01095 ACCORDANCE WITH THE POLICY PROVISIONS. /�
AUTHORIZED REPRESENTATIVE •MM���E�Z LL,asM. „
r)1988-2016 ACORD CORPORATION. All rights reserved
ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD
I of I 8/3/2022, 10:42 AM
10/3/22,9:35 AM NHHI GL 22-23.jpg
ACCJRL 1 CERTIFICATE OF LIABILITY INSURANCE' SATE ININITA YYT)
2/9/2022
THIS CERTIFICATE IS ISSUED AS A NUTTER 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 POUCIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI,AUTHORIZED
- - RE/RESENTATEVEOR PRICER.,AND THECER1WTCATE HOLDER. - --- --- -- -
IMPORTANT: I the certificate holder is an ADDITIONAL INSURED,the policyllesl must he endorsed.I SUBROGATION IS WAIVED,subject to
the terms and conditions& Vie policy,eertidn policies may require en endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endosemenq►).
PRODUCER INN, C1 Debbie Ntc Neal, tat 103
coley Insurance Group ISC. NwNE (eE3)211-TY76 I .NOR�nnn.-+H-+ur y
37 Sim Street dlsaesealf foie lasuran ro
is: T CeY uD,con -- _
INSURERI*)AFFORDING COVERAGE MAIL a
west Springflaid Na MOSS-2703 1--- Atla
`*IMAM A: ntic casualty IRA. CO,
INSURED INOIWIA B:
—
New Horl tan Boma laproVemeat 1.LC INDARER C: _ -»
2400 Boston Nosd, Bra t 3 lINSURER O:
„� ..� __�
'I ESURERE:
Wilbraham WA 0109E i INSURES f
COVERAGES CERTIFICATE NUMBER:CL22291S0 S1 REVISION NUMBER:
THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE l:OTED BE!OW HAVE BEEN ISSUE()TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT TEEM OR CONDITION OF ANY CONTRACT ONOTI'iER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY ee ISSUED OR MAY PERTAIN,THE INSURANCE Ai,FORIIE.0 BY TEE POLICIES DESCRIBED HEREIN IS'SUEIECT TO ALL.THE TERMS
EXCLUSIONS ANO COND-TIOMS OF SUCH POLICIES CIMI I'S SHOWN MAY HAVE BEEN REDUCED$Y PAID CLAIMS
E I Il i� IYTE OF INSURANCE ADM mese
MEL SND' POLICY ROUSER ,B WD91MYESE
I Wt1EY Y<I LIMITS
X CONMERCIAI GENERALLLAIMLIrI FACIA gOECC oRFEN CF i1
S 11 OUO,000
1#4E OCC A CUG A :TE0n� B_ i $_ 100,000
1385000992 II90/2092 1/30/2010
NEO ErP;My not pelSary 5 5.000
PERSONAL A ACV%WRY S E.000,000
OFNI AGGREGATE LASTAIPSIES PER IEID GENERA.AA3REC.ATE S 2,000.000
Ri .__.'.�
= POLICY C CT I.00 I j tPR06UCT3-CXMSP.OP AGO.FS 2.000,000
9 OIER
0.470110BLF LIABILITY ! 2ArAe111FU YINGIP I.WIT ,5
-- iEt tCt70aIlI —
ANY AVTO i I SODA?VIAIRY Tel paiwn': I
ALL OWNED ILI SCREE/QUO
,�,.,,,AIMS I ALMS
i { R OOKY IRRUPT Te,.4.2e P S
NON00NEP
MNiEOAUTGO �_l AUTOS t4aLTAuF I=
OM amens;
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UNBRWIA LAB OCUR1 _ I ENDS OCCURRENCE (I
—
EXCESS USE tiAS11.AlA0E AGGREGATE `y^•S - --�
1 ceo I ;RETENTIONS S
WORNERSCOMP£NSATIOS* FER M.
ARO".NPI.UYERS.CREA..Y Y I31ATV; 1 t>R_.,_. •
_,-_.._
A NPN:ATtwEI:R x ir...4i1,,T. �n:n I I a+ec : EL OGE/£•Eh EMPLOYEE SIIHM1nWt Nam.
jt eau nON OF OPERATORS OMs _ EL DISEASE.POLICY UNIT I t
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DESCRIPTION OF OPERANONS'LOCATIONS r VFNICIAS TACORU NA,Additional Remain Scsedaw.Amy P9 MRUIIM 0 TRW spout a mVupt01
The car tificate holder named below is included es ea additional isaured for General Liability coverage
for ongoing operations if required by writtsa contract, permit, or Agreement executed prior to a lase.
A separate Certificate of Insurance fox Workers Compensation coverage will,be sent to the certificate
holder directly from the insurance carrier.
CERTIFICATE HOLDER CANCELLATION
SMOULOANY OF THE ABOVE DESCRIBED PM wIES C6 CANCELLED BEFORE
TEN EXPIMTION DATE TMENEM.NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH 719E POLICY PROVISIONS. •
WHORLED REPAESBBAINE
Brian Foley/LYNNE G�^�+
NI 19B2-2014 ACORD CORPORATION. All rights reserved.
ACORD 28(1D14/01) The ACORD name end logo ens rephLrmd marks of ACORD •
1NS024 Omom
•
1/2
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