16B-034 mw rut(wll"k)p%'
Liconre'
J0iiN A PVKKIV'lJ'
19 EAST MAW ST
s,rAFFORD SPRMG�
12112/2015
To IMpH()Vf--.Nij._NT CONTRACTOV
102,oOnuAron
j0mN NeRHILH
JOHN PERRIER
59 EAST MAIN Sl
STAFFORD,CT 06016 Vodrescnrtary
NEWENGL•20 CLEISENRING
ACORD' DAT Imwoo(YYYY)TI
�- CERTIFICATE OF LIABILITY INSURANCE f 7/2712016
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.
IMPORTANTi If the certificate holder is an ADDITIONAL INSURED,(he pouey{IOS)must po sndorsgd. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,cortaJn pollclos may requlra an andorsemont. A statement on this csriff(cate do**not confer rights to the
coruneate holder In Ilou of such endorsoment s.
°RODUCZR n�c Sharo_n_Johnspn
AP Intapo Insurance Group,LLC F"�p.. 800 27d
144 North Road �i4.ext:
Suite 2050 Aosf Info a into o.cam
Sudbury,MA 01776 f--_4rt ..:_ ....�_�-g__._ ----.____.__._ .___..._
IxJURER{SI AA110K.1,40 COYERAA___ NAICi
wauRERA Guard Insurance Grou "' 258d4-
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_
INauREO y INSURER a
NEW ENO EEN LC uILYRERC
69 St J?MAl 66$� wsuRen o _ �_�__ __
titarf0 _ _.__
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.t----.5 " iJU`*jE(t _ INSURER r ___
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COVERAGES �C 14C.. MEIER:_ REVISION NUMBER: _
T'f11S IS TO CERTIFY THAT*HH VWIA fi0 BELOW HAVF BEEN ISSUED 1-0 IHE INSURED NAMED A80VE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING A EN7 QONOITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED C42 , AFFORDED BY THE POLICIES DESCRIBED HEREIN tS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONWTONS Of& U H HAVE BEEN REDUCED BY PAID CLAIMS.
__.
Lyn Tyre OFINSURA)fca ` aER MwD�o mrY MAUDtuYVrr UtaT1
COMMERCIAL aENERAL LIABILITY , �' Y EACH OCCURRENCE I
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MED EJCP fAn
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GLxtAOGfiE4AlEl $�,1„Ft�f iY�,•{, ���#J'' GENERAlA04REOATE -t
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CERTIFICATE HOLDER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PROOF OF COVERAGE ACCORDANCE WITH THE POLICY PROVISIONS.
AU nfOR12CU RCPKL$ENTATN!
0 1880.2414 ACORD CORPORATION. All rights rosorvod.
ACORD 26(2014101) Tho ACORD name and logo are registered marks of ACORD
NEWE-GC OP ID: LM
,4c orr° CERTIFICATE OF LIABILITY INSURANCE DATE 10//2012015 2012015
�--"'
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 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 Confor rights to the
certificate holder in lieu of such ondorsement(s).
PRODUCER CONTACT
Wilcox&Reynolds L.L.C. NAM Joseph A. Barrett FAX
922 Stafford Road,PO Box 521 (A/c,No,Ext) 860-429-9387 (,,c No) 860-429.2394
Storrs-Mansfield,CT 06268-0521 EMAIL
Joseph A. Barrett ADDRESS barrett @wilcox-reynolds.com
INSURER(S)AFFORDING COVERAGE NAIC 11
INSURER A:Ohio Mutual Insurance Group 10202
wsURFD New England Green Homes LLC INSURER B
59 East Main Street
Stafford Springs,CT 06076 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 10 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 10 WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO At I THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
NSR - - - ADOLSUOR'!. POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD - POLICY NUMBER (MMIUDIYYYY) '(MMIDDIYYYY) LIMITS
A X COMMERCIAL GENERAL.LIABILITY
f A('F1 nC'.uFdREPK:E S 1,000,00
CLAIMS MADE X OCCUR .BP 0028743 07/1412015 07/14/2016 DAM I CTORENTED
S 100,00
PREtAISL.� Ea occur o ce:
X Business Owners
Mr ti r XT, ny one pr soni 5 5,000
i
PERSONAL,a ADV IN,UPY s 1,000,000
001 AGGREGATE LIMI T APPLIES PER ;
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
—Pc--�k License Expiration Date
I cc�, , -R)D4Vx(4 P, ncl List CSL Type(see below)
Wo. 'and Street Type Description
Unrestricted(Buildings up to 35.000cu.ft)
Cityfrown,State,ZIP Restricted 1&2 Family Dwellip�_—
Masonry
Roofing Covering
INS Window and Siding
5.2 Registered Home Improvement Contractor(HIQ
HIC Registration Number
City/Town,State,ZIP T�lcphone
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 ofthe building per-mit.
SECTION 7a: OWNER AUTHORIZATIONTO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize S
to act on my behalf' It matters relative to work authorized by this building permit aj�plication.
'
in'
P ,e(Elw,�nic Signature)
SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLARA,riON
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information
coiltamed in this applicatt n i's tru andaccurate to the best of my kiiowledge and understanding.
ul
Authuri4- Agent
—5zl's Name(E.Iectronic Signature)
an unregistered contractor
I, An 6—w�e�rho ob—tains a bu--ilding-p-ein-nit to do his/her own work,or an owner h hire;'-
(not registered in the Home Improvement Contractor(I I IQ Program), will noi have access to the W-bitration
program or guaranty fund under M.C.L.c. 142A. Other iniportant information oii the 141C P(ogram L;an be found at I
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage, finished base inunt/attics,decks or porch)
Gross living area(sq.tt.), 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 orcooling system Enclosed 'Open
3. "Total Project Square Footage" may be�ubstin.aed for"total Proje�l COst"
The Commonwealth of'Hassachuserts :�71
Department oj'Industrial Accidents
Office of Investigations
I Congress Street,Suite 100
Boston, MA 02114-2017
It lVWw,mass.g0V,1dia
Workers' Compensation Insurance AffidAvit, Btjil(iersjl('ontractorsiEltctricianst?lurnberi
Applicant Information Please Print LQibly
Name (Husiness/(Drgtjt,,iniori/inLiividuai):New England Green homes
Address-IF
V C
Cl /State/' i_P:Stafford. CT 06076 !'hone #:860-930-7794
Are you an cruploytr?Check the appropriate box:
I. w,a cmpj()YcF_with 4 4. 1 ull, it general cunl;ae:tor and Type of project(required):
efliploycl:5(full and or pan
D Nt�w
2,0 listcd on the attui�hvd sheet,
A _71
you"a c"
I _' - ct
20
I am a sole proprietor or partner- Reotodtling
ship and have no employees I hese 8. Demolition
working for me in any capacity. Qrriployves and have workers'
(No workers' comp, insurance comp. 9, Building addition
required.) We are o cut put at iun and i(s 10 Electrical repairs or additions
3. 1 am a homeowner doing ull work 0*tjicevs have exercised their I F Plumbing repairs or additions
myself. fNo workers' comp. rl&ht of exemption per MC L 2.❑ Roo f repa i rs
insurance required.] L:, 152. §1(`t),and s+L:hi�,c i i u
�No 'Aurkcrn 1 13 cAher
Coo P jrlsurar,ce required.
*Any applicant that checks'box#1 hnu3tajj,.)fal out the section Oelow3hcwms fjJ'!,y info n,tinn
I Homemyncri who submit this affidavit tildi"lio6 they tire doing 4il,,vtt,wij ihvii jmv ,wsjdc contrnaon niuii submit a new affidavit indicating such
lContraciors that check this box must attached in addmortjl sheet slurs ng the na,itc of Jit sub-contractors and stail;whether or not tW4 entities baye
crnpluym. little cab-contractors have crnploycci,they must provide thrfr %vorl,eWcotrp pol;cv number
I am an employer that is providing workers'compensario n Insurance for my employees. Below is the polky and Job site
informcurion.
Insurance Company Narne:)nte90
Policy#or Self-ins.-im. L4(:. O.NevvC424991 ExpiratiQf) Date,
Job Site Address:All Steets in
nu-
Attach a copy of the workers' compensation policy declaration page(showing the policy number and cxpiratiou dule).
Failure to secure coverage as required under Section 25A u!'MGL c I S2 can lead to the imposition of criminal penalties of a
fine kip to$1,500.00 and/OT one-year impriSUHITleill,as well as civil p1,;jajtjc5 In tj,,C foMj of a STOP WORK ORDER and a tine
ol'up to$250.00 a day against the violator. be advised that Ei copy i)Fthts statement may be forwarded to the Office of'
111yostigationt,or thc Die, fOr iroutwwc
I do hereby certify under the pains andgenati 'v erjury Mat Me inlormatlum provided abu ve is rrue and correct�
Datc
Phone 9:
Official use only. Do not write in(Isis area,to he completed by city or rown qo7cial
City'or Town:
Issuing Authority(circle une):
1.Board of Heal(b 2. Building Department 3. O(Y/"l vt,ji Clcr-k 4 Vlek triva) lrispvctoi- S. Plumbing Inspector
6.Me
Contact Person: Phone 0:
BEG — Coi nionwealth ofMussachusett!5 —— ------
I)EPT.Ct-Bj11-t,,1NG NS� FOP,
t4oR1..A,1p'T0N,M . I uilding Regulations and Standards MUNICIPALITY
Massachusetts State Building Code, 780 CMR
I USE
Building Permit Application To Construct, Repair, Renovate Or Demolish a R /Vu r20
I
One- or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
erP., Address: SV
1.2 Assessors Map& Parcel Numbers
-
I.I a Is this an accepted street?yes.. no N lap N urnbei Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Ilse Lot Area(,sq It) Frontage(ft)
........... ..................
1.5 Building Setbacks(ft)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
...................
1.6 Water Supply: (M.G1 c.40,§54) l 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private❑ Check it'veso Municipal 0 On site disposal system ❑
L SECTION 2: PROPERTY OWNERSHIPI
Ll-/Owtierl of,Record
Nan w,(I rint) Cii S. 181e,ZIP
4-
15-7
and Strcey -1 Frnall Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction l] Existing Building❑ Owner-Occupied ❑ Repaim(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. 0 Number of Units ! Other ❑ Spccif}-
—Brief Description- of Proposed Work'`:
SECTION 4: ESTIM A IT I)CONS izucl-10N COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
1, Building $ 1. Building Permit Fee: S Indicate how fee is determined:
❑Standard City/Town Application Fee
—2-. Electrical ❑Total Project Cost-3(Itern 6)x multiplier x
3. Plumbing S 2, Other Fees:
4. Mechanical (HVAC) $ List:
5.Mechanical 'Ire
Suppression) S Toial All Fe S4
Chec ck A
6.Total Project Cost- lnouh)W .Cash Amount:-- — I
9�;t ❑Paid in ❑Outstanding Balance Due: _
NEGH Mr
28 Spellman Rd.
Stafford Springs,CT 06076
File# BP-2016-0628
APPLICANT/CONTACT PERSON JOHN PERRIER
ADDRESS/PHONE 18 BROADWAY POND RD STAFFORD SPRINGS06076(860)930-7794
I'ROPERTY LOCATION 78 FERN ST
MAP 16B PARCEL 034 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
f3uildin,,� Permit Filled out
Fee Paid- -- - —
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildin« Plans Included:_
O\�,ner'Statement or License 105319
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I FO MATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: _Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit fi-om Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
V, _ i Si- i Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning;& Development for more information.
78 FERN ST BP-2016-0628
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B -034 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
i'rr nit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
CateVorY: INSULATION BUILDING PERMIT
Permit# BP-2016-0628
Project# JS-2016-001102
Est.Cost: $2695.00
1 cc: S 6 5.00 PERMISSION IS HEREBY GRANTED TO:
CiOnst. Class: Contractor: License:
Use Group: JOHN PERRIER 105319
Lot Size(sq. ft.): 5140.08 Owner: FORD TODD
Zoning. URB(100)/ Applicant: JOHN PERRIER
AT. 78 FERN ST
Applicant Address: Phone: Insurance:
-18 131\1()A F)WAY POND RD (860) 930-7794 WC
STAFFORD SPRINGSCT06076 ISSUED ON.121212015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
t!uderhruund: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
F eCTN'pe: Date Paid: Amount:
Building 12/2/2015 0:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner