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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- �.. -- _ INauREO y INSURER a NEW ENO EEN LC uILYRERC 69 St J?MAl 66$� wsuRen o _ �_�__ __ titarf0 _ _.__ � � �y+,^ IN 3VRlR a .t----.5 " iJU`*jE(t _ INSURER r ___ _4— 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 I�ii�TDRFNTE6..T.- �CLAIUSUADE El lOCrwt PREMISE* MED EJCP fAn PERSONAL A ADY INJURY 3 .�: GLxtAOGfiE4AlEl $�,1„Ft�f iY�,•{, ���#J'' GENERAlA04REOATE -t fyT{,1LY RR OA, IRi T'�3i+r' f`Y PRODIM..T S-__C{)i.I V_.dP nUO f OTHER. 7 =.{i� 'i'f1J � +•S} � S AVTOMOa{LE1 `�it t V "jar t N y • T: J*T+ij 9 jw o'ii t p a e�wntl _ _ _. ANY AUTO }' {1t t��aX 000 Lr ixJvnv IP«y.. y ALL AUTOS r S D } '' NpF �i If, i, �& IR�� 14 D004LY INJURY(PM.add.9 + N wie aieD AU 5 fJ � t F. rY (� °6�, Y vFIOPE�tTMWaRCE__ ',. UtaItRELLALIAe OCC r� p sALiH — RRENGE� f EACea6tHe �CtN N OE AOG f __. 010 _". RETENTIONS WOWfER$COMPSH&ATION r ._ tt , y '.1 w" °i+ 't i AND IuV'LOYCIIIe'LIAe1LnY i� A ANY PROPRfFTOri+PARTNER/E%EGLnIVE 68 ., 08101120112;' 112416 s'..".� tACC10¢ttT�.-, f � 100,00A orrlrewuewaeA CMLVOCDT N 1, u r� ------___ _ (wraltory In NR) t; r L.4 100,04 b oosf c RdolP—trong"N.urKfr noN6 aw. a tyii t y rf%'. Y. '�; Y•. E.L.x' L -- 600Of QPC U ,00 rr Al�I X11 A MSCRIPTION O.OPCRA TiONaf LOWnONaI Vl1eC411!{ACOS1n 1o+,ww11..,.+R...» • �.�•" � eL�;�l(� .P+.•w +v�+•� i I 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