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17C-255 (4) BP-2023-0051 90 PARK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-255-001 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-2023-0051 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 20000 NRB EXTERIORS INC 099565 Const.Class: Exp.Date: 05/28/2024 Use Group: Owner: FLORENCE CIVIC&BUSINESS ASSOCIATION INC Lot Size (sq.ft.) Zoning: URB Applicant: NRB EXTERIORS INC Applicant Address Phone: Insurance: 510 NEW LUDLOW RD (413)563-6354 6ZZUB-9F59768-6-21 SOUTH HADLEY, MA 01075 ISSUED ON: 01/17/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: 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: ' , Fees Paid: $140.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner • ‘:\ '9Tti6�, ,� /Th Commonwealth of Massachusetts ,.I 4"��' w Office of Public Safety and Inspections '!•A^<so / Massachusetts State Building Code(780 CMR) y ii g.4'ermi.t4ipplication for any Building other than a One-or Two-Family Dwelling ^ , • (This Section For Official Use Only) Building Permit Number:•'6/ Date Applied: Building Official: SECTION 1:LOCATION 90 ✓I SA- t=L.:., ("t.1 Ui O w.) (yC., t,C CI J,L C 4.r r No.and Street City/Town Zip Code Name of Building(if able) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED 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 131-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 0 No 0 Is an Independent Structural Engineering Peer Review required? nn ` Y 0 No 0 Brief Description of Pro goosed Work: Q.L&ib.-a extSs4 1co (Ui./ " -7 .1i5r l i VV(N osr61 I 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) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 . E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3❑ 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) IA El IB ❑ HA CI IIB ❑ IHA ❑ IIIB 0 IV CI VA 0 VB ❑ 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: A trench will not be Licensed Disposal Site 0 Public 0 Check if outside Flood Zone 0 Indicate municipal 0 required 0 or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed❑ 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❑ or No❑ Yes 0 No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of P operty Own r(t/e.,- (Ni C- (i-itry )Pik )d. , (oj(,.:, tt(fr, 0leG6 Namet) No.and Street City/Town Zip ✓ew I"`-�1' Su-, Property Owner Contact Information: Title Te ephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: rid,6 -1z.n.(40.4 .-1.,e_ _ SA IA-LakJ /,)( - c CfAi 144 4 6/4 A-- Name Street Address City/Town State Zip P 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) iU .tc 0 iN� (14 y - - 0sy Qv)fp'js F�caKeiy1i ur� IL - 4 - .. S 6 S-- Name(Re ' trant) Telephone e-mail ess ' 1 Registration Number Street Address City/Town r State Zip Discipline Expir 'on Date 10.2 General Contractor (LA 7nPYame . J 4H . </ (`17 qC ( CSL 75' As Name of Person Responsible for Constructioncense No. and Type if Applicable 5(0 �).�t.� L. i(6,, / a . c'D -cO ( 19 1 oloir Street ddress-63 Cy - - City/Town ( State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION 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 I � and Materials) Total Construction Cost(from Item 6)=$ OP 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 municipal ty) 5.Mechanical (Other) $ Enclose check payable to l� 6.Total Cost $ d O/O I (contact municipality)and write check number here ilf)a SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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. Please print and sign name Title Telephone No. I Date _ Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: �� sb� ,1 ' i • 14 // Name Date The Commonwealth of Massachusetts ,, ---.7 , ..4............ ei,,1( ) Department of Industrial Accidents , 1 Congress Street,Suite 100 Boston, MA 02114-2017 4.1 ....c,_ www.mass.govidia Workers'Compensation insurance A ffidas it:Buiklers/ContractorstEkctriciansiPlumhers. TO RE FILED WITH'11111 PERMITTING AUTHORITY. A uolica ii t Ittiortnutinti Pleust. Print 1.1.1.,ililt Name f Bus me Organization,'Individual I\J el i12 )64C,/..-IY, 1 '' k" Address: do 1,0...9,, city/Stateqip.co .4. __ 114 Phone#. . . _ ‘.. _ _ . ____,... ........_ Are yam employer?Cheek the II ppnipriate „t: Type of project(required). 1. I am a Cniployer with t° employees(tail 1101.110T part-trineis 7. C] New construction I atn a suit pqoptielLsr ut parmeraltip and lame no employees working fin ine in 8. CI Remodeling any capacity.(Nu workers'wimp.insurance required." 9. 0 Demolition 10 i 4111 a homeowner doing all work myself,fhio weartert.corm insurance required] i 0 El Building addition 40 I am a holisisikvnin and will he.hiring contractors to conduct all work on my property. I will ensure that all contractors tither hase workers'compensation insurance Orate sole i 1 a Electrical repairs or additions prim'ietora V.itli no employee,. • 12.0 Plumbing repairs or aililitions .,..E3 I am a 10.11.-721 contractor and I have hired the sob-contractors hated on the attached sheet. i 3.[:I Roof repairs These sub-contractors have employees and have wurktrs camp.insurance.; r:6E3 We are a corporation and asofficer,.have exercised then right fife-ken:pan pet Alt I 4. 10therai c. I IQ,-§I i it.and we have no enslilijvca.[Ns workers'caimp.insurance required.] 'Any applicant that char box at must also till out the section below infusing their worker.'compensation pulrey inforznation. t Mamma nem who submit this atfulo,it indicating they are dung all work and then hire outside contractors must submit a new Aida,.it iodic:114 such. ontractora that check 1111,4 1.,,,t must attached an additional sheet showing the name of the tub-esanisif•tors end.1..aic whether or nut those entities have .... employees If the allb•COnirJcwr,Iszisv employ t..Ti,Oat must pros ide thcir A orkyr.'ssonip polwy nun ths.r — ' I I am an employer that is providing ovorAerx'compensation insurance for my employees. Below is the Indio and job site information. Insurance Company Name: , fARAAA•%. --2/K/i tit\ Policy ti or Self rim Lie.# •1 2 2 (.4(Ili r s-- 748 6 a?-- Expiration Date: b). -I ; - d ...- Job Site Address: ei 0 ?cc.,A r)r- City/StateZip: fq()/{4 c Attach a copy of the/workers'compensation policy declaration page(showing the policy number and expirati I n date). Failure to secure coverage as required under:AGE c. 152,§25A is a criminal violation punishable by a tine up to S I.i00.00 and)or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to 50.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for in urance coverage verification. /do hereby certife tlre paif(gM ties of perjury that the information provided above is true and curt. Signature: 1)atc- I . 17 - 3 Phone.*: . C ---7 (//) . 2 1 5 7 Official use only. Do not write in this area,to he completed by city or town et ffit hit City or Tovin: PermitiLicense# _. _.... _ I! uing Authority(circle one): I.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts ; �5 sty t * c DEPARTMENT OF BUILDING INSPECTIONS . I.;212 Main Street • Municipal Building - A, Northampton, MA 01060 ,'!fti. ""�11`� 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: LA c v2 lt'i/ci S")-( 'e'1 6 `((j2 C f The debris will be transported by: 1)-/ ' S A .e,4( rd c -i--- Name of Hauler: LA S 14 1 Signature of Applicant: Date( "( t ) fe ro/27mr46v-mJeIII a �0:4 i a4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration (I i ' Type: Corporation INC {,t +: s Registration: 147961 NRB EXTERIORS i; Expiration: 08/22/2023 510 NEW LUDLOW RD `\, ,t ; SOUTH HADLEY, MA 01075 ( 1 ti i t ' :fill/ / • SCA 1 C' 20M-05/17 UpdateAddress and Return Card. (l Z 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 147961 08/22/2023 1000 Washington Street -Suite 710 NRB EXTERIORS INC Boston,MA 02118 NICHOLAS R.BERNIER 7 PHILIP CIR GRANBY,MA 01033 Not valid without signature Undersecretary Common"�ealth of Massachusetts Division of OccuP ational and sure Stan Board of Building ReaUla ons and Standards �i r Specialty Construct \ y I 6ipires:05/2812024 ',: CSSL-099565NICHOL-A5 E` �l 510 NEW WM* �t UTH HADeY • t O SO �j . 'b bYor.tv,0�{{a AA ,�,p' �Cy77[l� Commissioner UI AC OR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/28/2022 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Denise Sawicki AMHERST INSURANCE AGENCY INC PHONE ❑; (413)253 5555 (FAX WC.Ne1; EMAIL ADDRESS: dsawlckl©nathanagencies.com PO BOX 48 INSURER(S)AFFORDING COVERAGE NAIC U AMHERST MA 01004 INSURER A; AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: N R B EXTERIORS INC 'INSURSRC: INSURER 0: 72 WOODBRIDGE TERRACE INSURERS: SOUTH HADLEY MA 01075 INSURER F COVERAGES CERTIFICATE NUMBER: 829534 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POI ICY 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. INBR ADDL SUBR" POLICY EFF POLICY EXP 4TR TYPE OF INSURANCE INRn wvn, POLICY NUMBER IMMIDD/YYYYI,(MWODIyYI'Y) LIMITS COMMERCIAL GENERAL UAW UTY EACH OCCURRENCE S 1 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES --- (Es OmrrrencO) $ MED EXP(Any one person) $ N/A PERSONAL d ADV INJURY $ GENL AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE S POLICY JECT n LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea acddenI) ANY AUTO BODILY INJURY(Par person) 5 OWNED —SCHEDULED AUTOS ONLY AUTOS N/A BODILY INJURY(Per accident) S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per acddonl) S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS MAa CLAIMS-MADE N/A AGGREGATE DED RETENTIONS S WORKERS COMPENSATION X STATUTE I ER AND EMPLOYERS'LIABILITY YIN O A OF CER/MEMBEREXC UDEO ECUTIVE (NIA WA WA 6ZZUB9F59768622 02/13/2022 02/13/2023 E.L EACH ACCIDENT S 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 100,000 IfEye under D E.L.DISEASE-POUCY LIMIT $ 500,000 DESCRIPTIONIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedute,may be attached If more apace le required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensatioN(nvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LOOMIS COMMUNITIES ACCORDANCE WITH THE POLICY PROVISIONS. 246 NORTH MAIN STREET AUTHORIZED REPRESENTATIVE SOUTH HADLEY MA 01075 Daniel M.Cro y,CPCU,Vice President—Residual Molke!—WCRIBMA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD