17D-035 (7) i
BP-2023-1082
21 SUMNER AVE COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
' 17D-035-001 CITY OF NORTHA1f VIPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1082 PERMISSION IS HEREBY GRANTED TO:
Project# KITCHEN RENO 2023 Contractor: License:
Est. Cost: 19655 EXTERIOR ASSOC' TES INC 113456
Const.Class: Exp.Date:07/23/202
Use Group: Owner: A ENG L JOHN P&LORI
Lot Size (sq.ft.)
Zoning: URB Applicant: . EXTER OR ASSOCIATES INC
Applicant Address Phone: Insurance:
408 SOMERS RD (860)978-5911 WC9097314
ELLINGTON, CT 06029
ISSUED ON: 08/11/2023
TO PERFORM THE FOLLOWING 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:
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 NO HAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: ' ' ��
0 • j .
Fees Paid: S130.00
212 Main Street,Phone(413)587-1240,Fax (413)587-1272
Office of the Building Commiss. ner
REC&I V .D
AUG
1 D �423
The Commonwealth of ,
Board of Buildin RegulatioI I S FOR
gCING i ICIPALITY
Massachusetts State Building Code, :1 !1•';l' rON �p Per• oNS USE
Building Permit Application To Construct,Repair,Renovate Or 1 .11 . : . evised Mar 2011
One-or Two-Family Dwelling
This For Official Use Only
Build'Buildil Permit Number: f'"�J /U tca+• Date Applied:
Keo (ZS 5 ��/,2 8 20 3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
21 Sumner Ave,Northampton,MA 01062
1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: lA 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:(MALL c.40,154) 1.7 Flood Tame I.ftri n: 1.8 Sewage Disposal System:
Public CI Private CI Municipal Outside Flood Zone? Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
John and Lori Engel Northampton,MA 01062
Name(Print) City,State,ZIP
21 Sumner Avenue 413-875-2493 loriengeipt@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) al Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify
Brief Description of Proposed Work2: IGtdieli renovadon,replacing cabinets and flooring.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
stItem (F and bo Materials) Official Use Only
1.Building $ S19655_14 I- Braiding Permit Fe=S Indicate how fee is determined:
2.Electrical S 0 Standard City/Town Application Fee
0 Total Project Cost3(item 6)x multiplier x
3.Plumbing S 2. Other Fees: $
4.Mechanical (HVAC) S List
5.Mechanical (Fire
Suppression) Total All Fees
e 19655.14 Check No.?310 Check Amount 6 Cash Amount:
6.Total Project Cost: S 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 113456 7/2324
Kyle Nielsen License Number Expiration Date
Name of CSL Holder U
31 Overhill Rd List CSL Type(see below)
No.and Street Type Description
Ellington,CT 06029 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZiP M Masonry
RC Roofing Covering
WS Window and Siding
860-978-5911 officetaexteriorassociatieszom SF Solid Fuel Bunting Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Imprevemea t Contractor(HIC) 103175 4/28/25
Exterior Associates,Inc Dennis Audet HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
31 Overfill Rd
No.and Street Email address
Ellington,CT 06029 860-978-5911
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152-§25C(6))
Workers Compensation Insurance affidavit mast 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 0 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.
John and Lori Engel 8/9/23
Print Owner's Name(Electronic Signature) Date
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 . i 4..to the best of my knowledge and understanding.
Dennis Audet / 8/9/23
Print Owner's or Authorized Agent's .! 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 sot 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.gov/oca 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.IL) (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 half7baths
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 C "
City of Northampton
Massachusetts Y� {ram
•
IC
DBPAR4lffNT OF BUILDING INSPHCTIONS S )
212 Main Strut • Municipal Building �, $
Northampton, MA 01060
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 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: USA Hauling, East Windsor,CT
The debris will be transported by:
Name of Hauler: Exterior Associates, Inc
Signature of Applicant Y'p Date: 8/9/23
•
` The Commonwealth of Massachusetts
- Department of IndustrialAccidents
—::151_ ; 1 Congress Street,Butte 100
•_l.•• Boston,MA 02114-2017
. � www muss.govldia
Workers'Compensation Insurance Affidavit Bulders/Contractors/EIectricians/PIumbers.
TO BE FILED WITH run.PERMITTING AUTIhORiTY.
Applicant Information Please Print Legibly
Name(Businesslorganizationl 'dividmi. Exterior Associates;Inc.
Address: 31 Overh i I I Rd.
City/sip: Ellington,CT 06029 Phone#: 860-978-5911
•
Areyon an emplopri?Cherkhe appropriate box Type of project(required):
1.171 I am a employer with 12+ employees(full ).* 7. ❑New construction
2.11 I am a sole pmp►ietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No worlmrs'comp.insurance required]
9. CI Demolition
3.0 I am a homeowner doing all wodc myself[No workers'comp.insurance regrrerni 3 t
10❑Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property.S will
ensure that all contemns either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions
proprietors with no employees. 12.0 Phut:thing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.0 We are a corporation and its officers have exercised their right of exemption pe-MQ 4 14. Other D00 r/S
152,§1(4),and we have no employees.[No workers'comp.imanance required]
• *.Any applicant that chucks hox#1 mast also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they aredoing all work and then hire oxide contractors most submit a new affidavit indicating such
tContractors that cheek this box must attached an additional sheet showing the name of the sub-contractors and stnie whether or not those entities have
employees. Iftbe sub-contractors have employees,they must their warms comp.pri y nu mbe
I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site
if[OrmatiOIL
Insurance Company Name: Berkley Insurance Company
Policy#or Self-ins.Lie.#: BNUWC0138570 Expiration.Date: 1 Ill 4/20)3
Job Site Address: t c%J4 City/Si p: AU C)6t\j J l j� •
Attach a copy of the workers'comp s policy declaration page(showing the policy number and expiration ate).‘ I
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 ( I D C9
• 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 fur worded to the Office of Investigations of the DIA for insurance
coverage verification
I do hereby cerhify under thepains andpenaltles ofperjury that the information provided above is true at correct
P/ulalsd .r uc7d e" Date:
Signature: �to± t).161
phone# l 1— � t'�+► �1 1 —.
Official use only. Do not write in this area,to be completed by dty or town official
City or Town: .Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electricallinspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: - ___
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 10
Boston, Massachusetts 0211
Home Improvement C•ntractor Registration
Z _
>l
^- / Type: Out of State Corporation
p 111111111114111_ Registration: 103175
EXTERIOR ASSOCIATES INC. �^' llrflt
'' ; Expiration: 04/28/2025
31 OVERNICE RD
ELLINGTON,CT 06029 4 UM N �Vire' mar _ ..'
C
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:
TYPE:Out of State Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
103175 04/28/2025 Boston,MA 02118
TERiOR ASSOCIATES INC.
NNIS AUDET
OVERHILL RD .4..n,d r
LINGTON CT 06029
Undersecretary Not valid without signature
t:ommonweaim or Massacnusetts
ill Division of Occupational Li sure
Board of Building Re ul tions an- Standards
ons E�39! �,rvis•r
CS-113456 >: :'T l . fi ires:07/23/2024
KYLE NIELSf 1 .k , p
31 OVERHILVRD f; :it O
ELLINGTON` T
? �7
k�'C)1.rt'Ai1�•
Commissioner detect i . 5&7I I
Client#: 98251 EXTERASC
ACORD,„ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYY)10/20/2022
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
1 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 pollcy(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 CONTNAMEACT Lynn M.Paparazzo
Starkweather&Shepley(CT) PHONE 86D 583-0943 FAX 860-709-9354
(A/C,No,Est):
(A/C,No):
Insurance Brokerage, Inc. E-MAIL iDa arazz starshe com
PO Box 549 ADDRESS: P P•
Providence, RI 02901-0549 INSURER(S)AFFORDING COVERAGE NAIL Ir
INSURER A:Selective Insurance Co of New England 11867
INSURED INSURER B:
Exterior Associates,Inc.
INSURER C:
130 Old Town Road
INSURER D:
Vernon Rockville,CT 06066
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. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTRR TYPE OF INSURANCE _ INA gR WVD POLICY NUMBER - (MMOILDDIYYIE'FF YY) (MMMILOD/Yl�) LIMITS
A X COMMERCIAL GENERAL LIABILITY X S2442015 11/14/2022 11/14/2023 EACH OCCURRENCE $1,000,000
SES(RENTED
CLAIMS-MADE LX)OCCUR PREM 1 Eaoccurtence) s500,000
MED EXP(Any one person) $15,000
PERSONAL&ADV INJURY $1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000
X POLICY X JECT LOC PRODUCTS-COMP/OP AGG $2,000,000
OTHER: $
A AUTOMOBILE LIABILITY X S2442015 11/14/2022 11/14/2023 COMBINED SINGLE LIMIT
(Ee accident) $1,000,000
X ANY AUTO BODILY INJURY(Per person) $ f
OWNED -SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X AUTOS ONLY XAU NON-TOS OOWNNLY ED PROPERTY DAMAGE
(Per accident) $
_
$
A X, UMBRELLA LIAB X OCCUR X S2442015 11/14/2l22 11/14/2023 EACH OCCURRENCE $2,000,000
EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000
r DED RETENTION$ $
A j WORKERS COMPENSATION WC9097314 11/14/2022 11/14/2023 X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $500,000
OFFICER/MEMBER EXCLUDED? y N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,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
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 ....Q.
b 1988-2015 ACORD CORPORATION.All rights reserved.
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