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36-104 (4) BP-2023-0056 931 HURTS PIT RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 36-104-001 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-2023-0056 PERMISSION IS HEREBY GRANTED TO: Project# DOOR 2023 Contractor: License: Est. Cost: 1077 EXTERIOR ASSOCIATES INC 113456 Const.Class: Exp.Date: 07/23/2024 Use Group: Owner: DZIUBA WILLIAM M&BARBARA A TRUSTEES Lot Size (sq.ft.) Zoning: URA Applicant: EXTERIOR ASSOCIATES INC Applicant Address Phone: Insurance: 408 SOMERS RD (860)978-5911 WC9097314 ELLINGTON, CT 06029 ISSUED ON: 01/19/2023 TO PERFORM THE FOLLOWING WORK: INSTALL DOOR 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 VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: f„ Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner /1-';("\z„, The Commonwealth of Massachuy tts 1,4 Board of Building Regulations and7tandards i , MUNIC 'ALITY Massachusetts State Building Code; 7it0 R :`.., U'E Building Permit Application To Construct,Repair,1.e ovate�Qr coolish a... Redesed ,ar 2011 One-or TWo-Famity Dt+rlling"; .. 1 This Section For Official UseOn1)",-; �/ Building Permit Number. go -.A 55 Date Applied: "'i:''^ ..../ ) ----,, .,,,, ......_.... l • a3 Bui ld mg Official t Print Name) Signature rw a to SECTION 1: SITE INFORMATION 1 1.t Pro ert Add✓ manammon 1.2 Asseasors Map& Parcel Nu Vrel l.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: IA Property Dimensions: i Zoning District Proposed Use Lot Area 4sq ti) Frontage{ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supp y:{M.G.L c.40,§54l 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: _ Outside 'lood yes❑Zone? Municipal 0 On site disposal system ElCheck if es SECTION 2: PROPERTY OWNERSHIP° . t OIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIMIIIIR • ame in City,State,FP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Aheration(s) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other el Specify: Door gramilimingi Insta ling one entry door,no structural changes. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $111111111111. 1. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List 5.Mechanical (Fire $ Total All Fees: $n �(/1 Suppression) Check No$b 1 `1 V Check Amount: Cash Amount n.Total Project Cost: IIIIIIIIIIIIII 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5,1 Construction Supervisor License(CSL) 113458 712304 _ Kyle Nielsen License Number Expiration Date Name of CSL Holder 31 Overfill Rd List CSL Type(see below) R No.and Street Type Description U Unrest icted(Buildings up to 35,000 cu.ft.) Ellington,CT()59 Restricted t&2 Family Dwelling Citytfown.State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-978-5911 OFF ICE@EXTERIORASSOCLATES.COM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 103175 4/2$123 Exterior Associates,Inc. _._ HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 31 Overfill!Rd f•- OFF ICE@EXTERIORASSOCIATES.COM No.and Street Email address Ellington,CT 08029 860-978-5911 C it}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 K 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 Exterior Associates,Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. rim Owner's Name(Electronic Signature) ate 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 contained in this application is true and accurate to the best of my knowledge and understanding. Dennis Audet Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: l. An Owner who obtains a building permit to do histher 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 HIC Program can be found at www.mass./ovloca Information on the Construction Supervisor License can be found at www.mass.gov//dps 2. When substantial work is planned.provide the information below: Total floor area(sq.ft.) (including garage.finished basementlattics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of halfbaths 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" City of Northampton Massachusetts ,.. '.r; fopt DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01068 A. w w r: Via\ CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, a condition of Building Permit Number eligiat 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: USA Hauling, East Windsor,CT The debris will be transported by: Name of Hauler: Exterior Associates, Inc Signature of Applicant: t__ 1 Date: Client#:98251 EXTERASC ATE(MM/DDIYYYY) ACORD.. CERTIFICATE OF LIABILITY INSURANCE D1m20/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FOLDER.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 CONTACT Lynn M.Paparazzo Starkweather&Shepley(CT) (N E�Y 860 5$3 0943 Mok 860-709-9354 Insurance Brokerage,Inc. EMAIL . IPaparazzo@starshep.com ADDRESS PO Box 549 — _- Providence,RI 02901-0549 DISURER(S)AFFORDING NAlcs pR A:Selective Insurance Co of New England 11867 INSURED INSURER B Exterior Associates,Inc. -- 130 Old Town Road INSURER C: Vernon Rockville,CT 06066 INSURER E: � INSURER F COVERAGES CERTIF uAMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T 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 L THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE RFFN REDUCED BY PAID CLAIMS. LTRLTR 'TYPE OF INSURANCE INSR YWD POLICY RIMER pMAIDW MB YYYY) — A X COMMERCIAL GIB LIABILITY X S2442015 11/14/2022 11/14/2023 EACH OCCURRENCE S 1,000,000 CLAILISMADE X OCCUR Man s500,000 MED EXP(Any one person) $15,000 PERSONAL a ADv INJURY $1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 PRO- X POLICY X JECT LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER: _ A AUTOMOBILE CITY X S2412015 11/14/2022 11/14/2023 I ameINED stNGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per ate) $ AUTOS ONLY AUTOSPR $ A O X S ONLY X AUT (PerO DAMAGE $ A X UMBRELLA Li" X OCCUR X S2442015 - 11/14/2022 11/14/2023 EACH OCCURRENCE s2,000,000 EXCESS LIAR CLAIUSMADE AGGREGATE $2,000,000 DED RETENTIONS _ A WORKERS COMPENSATION WC9097314 11/14/2022 11/14/2023 X ME AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? y NIA (Mandatory in NH) E.L DISEASE-EA EMPL• _: s500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL fa-SFACF-POLICY LAST $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 181,Additional Remarks Schedule,may be attached if more space is required) 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 per policy terms and conditions CERTIFICATE HOLDER CANCELLATION Home Depot USA,Inc.,dba THD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p 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 A 6 /,�- ©1988-2015 ACORD CORPORATION.All rights reserved. -- uommonweann of nnassacnusetts � IC Division of Occupational Licensure �.,I Board of Building Re ulations and Standards Cons ionr*rvisor • ss CS-113456 "_ , spires: 07/23/2024 KYLE NIELSO ' N. 31 OVERHILtiRD ELLINGTON `��T 060: t? list f -4r7I,T, (1.' D. %I� /V' � ' (i t' Y-r! -'fl"VVI .l . JJIG v i I,. .' ' - 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: 103175 31 OVERNICE RD Expiration: 04/28/2023 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 1,(„,,,,_f4.//,a,,,et' ELLINGTON,CT 06029 Undersecretary Not valid without signature The Commonwealth of Massachusetts A /, Department oflndustrialAccidents ,`�;: I 1 Congress Street,Suite 100 itti r iL5 .Boston,MA 02114-2017 -d.,;— www.mass.gov/dia 4r„z Workers'Compensation Insurance Af0davit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH t l PEIIMITrLNG A U'iti012TTY. Applicant Information Please Print LegiibIy Name(Business/Organizauon/Individual): Exterior Associates; Inc. • Address: 31 Overh i ll Rd. City/State/Zip: Ellingt 06029 Phone#: 860-978-5911 Are an employer?Check the appropriate box: Type of project(required): ill,am a employer with 1 2+ employees(full and/orpart time).* 7. ❑New construction 2.01.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.]t 9. ❑Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. Iwill ensure that all contractors either have workers'compensation insurance or are sole ILO.❑Electrical repairs or additions proprietors with no employees. . 12.0 PIumbing repairs or additions ' 5.0I am a general contractor andIbave hired the sub-contractors listed on the attached qheef. These sub contractors have employees and have workers'comp.insurance t 13•0 Roof repairs 6.Q We are a corporation and its officers have exercised Moir right of exemption per MGL G. 14.[ Other Door/s _____ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 mast alsp fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are'doing it work and then hire outside coritmaks 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 providingworkers'compensation insurance for my employees. Below is the policy and job site information. Insurance Comp any Name: Berkley Insurance Company Policy#or Self ins.Lie.#: BN UWC0138570 Expiration Date: 1 1/14/2023 7.. .-e Job Site Address: A I ( i 1-' ' O ^ • City/State/Zip: t List A _.a. ►i I , ill r--_ Attach a copy of the workers'compensation policy declaration page(showing the policy number anti expiratio+ da >). �1 Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 l ' and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a day against the violater.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . Ido hereby certify under the pains andpenalties ofperjury that the information pro ab a is true and correct Sientiture: P¢ �4 Date: , r __ Phone#: (&( o) i .... ] /Official use only. Do not write in this area,,tto'(bee 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: