12C-004 (5) 47 NORTH FARMS RD BP-2020-1295
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map Block: 12C-004 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category. ROOF BUILDING PERMIT
Permit# BP-2020-1295
Proiect# JS-2020-002167
Est.Cost: $11000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: NRB EXTERIORS INC 99565
Lot Size(sa. ft.): 32234.40 Owner: MACDONALD BETSY P TRUSTEE
Zoning:RR(100)/WSP(100)/ Applicant. NRB EXTERIORS INC
AT. 47 NORTH FARMS RD
Applicant Address: Phone: Insurance:
510 NEW LUDLOW RD (413) 563-6354 WC
SOUTH HADLEYMA01075 ISSUIED ON.6/26/2020 0:00.00
TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE 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:
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:
FeeType: Date Paid: Amount:
Building 6/26/2020 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
` Department use only
City of Northampton t ,s of Permit:
Building DepartmentCurb Ciit/Driveway Permit
A 212 Main Street �iJN S>e /Septic Availability
Room 100 oFa �(, Water/V"
'Availability
v Northampton, MA 01Q6(�o� Two Set of Structural Plans
-�. phone 413-587-1240 Fax 413- � Plot/Si Plans
the Specify
�. -,
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE �Ll A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
,M
�}r { 1�jR�S`� 1 `c�c (� ^� Map 1 Lot Unit
4 M S d , Zone Overlay District
e, 7u r� ( L` Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(P t) i Current MailingAddr ss_
J , s
Te ephone
Signature
2.2 Authorized Agent:
Name(P' C(u�rrent Mailing Address:
nature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total=(1 + 2+3+4+5) o > Check Number ad?
This Section For Official Use Only
Building Permit Number: �d �dtll`� Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alterations) Roofing
Or Doors F-1
Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [C] Siding[O] Other[O]
Brief De ription of Proposed
Work: GJ►i.`� eY � t''1
Alteration of existing bedroom Yes No Adding new bedroom Yes _ No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENTOR CONTRACTOR APPLIES FOR BUILDING PERMIT/A
I, / 1 `kc, L.4(, l/ as Owner of the subject
proPe Y
hereby autho ' C 1 / /l/� v `
to act on my in all matt relative toArk auth e y this building permit application.
b
Signature of Owner Date
I, �n o � \
\ �1 � /I J/S iyq ` , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed un eins and penalties of perjury.
P' ame
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. /J Not Applicable ❑
Name of License Holder:.
License Number
Address C Expiration Date
7X
Telephone
9 Reelsterred Home Improvement Contract:` Not Applicable ❑
Co pane Name Registration Number
1 _
�Adress G, Expiration Date
l Telephone
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit m t be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin ermit.
Signed Affidavit Attached Yes....... No...... ❑
City of Northampton
�S F/
" Massachusetts ?S c'"`
AI c
DEPARTMENT OF BUILDING INSPECTIONS z
212 Main Street •Municipal Building
v D�
Northampton, MA 01060
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building
permit all debris resulting from the construction activity governed by this Building Permit shall be disposed
of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
The debris from construction work being performed at:
c4 ? G/J KeA/"A 5
Z
(Please print house number and street name)
Is to be disposed of at:
S S A s q'� 4'� ( J
(Please print name and location of facility)
Or will be disposed of in a dumpster onsite rented or leased from:
(Company Name and Address)
Signa re of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Lceibiy
Name(Business/Organization/Individual): t /�V `
Address: �Vb G") 1
J "
City/State/Zip: Phone
Are you as etnployer?Checkthe appropriate box:
Type of project(required):
Lam a employer wtith_ ____employees(full and/or part-time).' 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in g. Remodeling
any capacity.[No workers'comp.insurance required.)
9. ❑Demolition
3.[]l am a homeowner doing all work myself:[No workers'comp.insurance required.]t
10 Q Building addition
4.[:]l am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 I.Q Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
50 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof i airs
These sub-contractors have employees and have workers'comp.insurance.t
6.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information,
Insurance Company Name:'"U"—, ZU ie C �,
Policy#or Self-ins.Lic.#:L22 "4 7 Expiration Date: 0t
Job Site Address: /-7 �/�° ('U ^'� P�c%� City/State/Zip: VP' t�'C"1
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
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 forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby Gerd wAe pains and penalties of perjury that the information provided above is true and correct
Si na T Date:
Phone#:
Official use only. Do not write in this area,to be 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 5.Plumbing inspector
6.Other
Contact Person: Phone#:
1u11± ficrnsecl and lnsttrt-(1 „ckz� ra,,.a 510 New Ludlow Rd.
�F •
�-JA Re-,#20-2015718 South Hadley,MA 01075
SIA Lic#: 147961 .trt►�tt : �itartl�
MA CSI,#:99;65 Cell:413-563-6354
?07-�
413- (7663) Office:413-707-ROOF(766-'
!ai i/1 Fat:413-367-9748
SHINGLE -RUBBER
SBtECTGuffERS NICHOLAS SERti[Et2
ShiregleMas#er
Ra of rosMaci:fOitweer)
RoofPros comcast.nct
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Propnsaal, bmittt;tlto: Phoney h: •. � � �>G(3 c: �-� �
Special requirements
City,state,zipcode
........_...... - -- l:a{� t ti c•- j�, -�1 cC 1%JtQ
Proposal to furnish and install the following
Re-root, ':'r"t-c.tr-olit L.1 Gutters
I_y/NVc shall acquire nrccwaar.periniis for all work
Complete Roof Preparation
L Iloine's exterior to be protected by tarps and plywood
D" Sha ibs. landscaping,trees tob-.protected,roofers buggy used
L)` Pti ire existing roofing materials it)Ix removed to existing decking including flashing,etc.
i Site to be cleaiwd on a daily basis with roll mag:tet,debris to be removed at project completion by dumpster
Delcrionitcd existing;.decking to be replaced at$50 per sheet of plywood
Complete t.'rrtaiti feed Integrity Roof System f
Install Wia)ac rguard ice&water barrier along bottoin L 3 A.of al l roofs,96 ft.
I: Install 1'c im rtu'Llard ice& :valor barrier around penetrations,in Valleys and all critical areas
131itall L��rkallFt 1t�il S'i3lht:tii:itituc-dayment to i:tque dec:kina/
Install S"perimeter metal flashing to all edges of all roof~,{'white P.brown
Install Six,ittS(art starter shingle to bottom and rake edges of all roofs
�R Install Certain leed shingles to manufacturers specifications,❑6 nails N4`nails
it
Install CertainTeed 1'VC'ridge vent to all peaks in heated areas
�u Install Shadow Ridge to all hips and ridges,over ridge vent where applicable
L" Install ne-w lead taiumer flashing to chimney
New tlashia-installed where nece%saty
Install Itch'pipe flashing to waste vent stacks
Warranty options
We piaaanfec our labtu;workmaanship for 20 year,
Upgrade CertainTeed 4-Star S - , rage
C'ertainTeed l a ndinark-colo . _... _ '-tab-- --
U CertainTeed Landmark Pro-color
., E%v pr%q,rh 11CTChv kr iiv;tli%!;;lopiee ili.F aild liatx,r-complete in acculdance%cit It almne spcciaicatio/L9 Air alit sunt of. Total Dite S• IP
ACC'EP-t':1 NC'E:OF#'tt(}P(}ti:{#.:'t'hc ahos•r prices,stncificatiotes and conditions arc - 113 Lk)wi) payment s_�_•�_.
satisfacaory aur#:arc hvreh arrepled.Nou arr authorized to do nark as specified. Balance due
Ps}tncnt)%s#1 tic t+downat start i3r nh r3nd halauci ue upon c ptctio� {�, upon completion 5_ •L�j
I�:IIc' tV- - �i-i3i33FtF ;
l.hue: 'IGi ` -tstiuiatur:(I'rini amc} :C �1Vt �' (Sign Namej -
Estimates are lionored tUr thinly(30)days 1•roin above date
:ATI ENTION IU\ HO;!'fEOWNE;RS: Please cover all personal belongings in the attic,garage or storage areas due to the
possibility of roofing debris or dust in through cracks of the wood.NRS Exteriors inc.will not be responsible for
debris or dust in the attic or storage areas.
A Finance C hzm4c ui'i ";,n%%nulily(ANNUAL PEACE NIA61-i RA'I"t:OF IX%)will he added to the unpaid punion of the balance due.1
agree to p:t%:nut:rte gust:nice paymeul tat IhCx char_rs.ht the event of deibuh of paynten4 i acrce to pfn rcas%aaable Attorney's tees and
r:emn Cast:_T . n:C;tten3 Hires aura rnalstitute a relea.''r �3hilitt.13y any signature txacxv,acknowledges an agrecmuu o1lhC abu%e is
hcrchy tnadc.
coRvP CERTIFICATE OF LIABILITY INSURANCE DAM(MMMWYYYY)
03/13/2020
THIS CERTIFICATE 13 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: H the Certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. H 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
MVACT Denise Sawicki
AMHERST INSURANCE AGENCY INC PHONE 413)253-5555 Fla.
dsavvicJd@nathanagencies.com
PO BOX 48 INSURER(S)AFFORDING COVERAGE NAIL s
AMHERST MA 01004 SRA: AMERICAN ZURICH INSURANCE COMPANY 40142
INSURED
wsuRert s
N R B EXTERIORS INC INSURER C:
INSURER D:
7 PHILIP CIRCLE INSURER E:
GRANBY MA 01033 INSURER F:
S _ T TEN 1
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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE AWL POLICY NUMBER M Y LIMITS
COMMERCIAL GENERAL LIABIUTY 500,000
EACH OCCURRENCE {
CLAIMS-MADE ®OCCUR PREMI S Me occarence = 100,000
MED EXP one i 5,000
A 101 GLOO9938302 12/23/2019 12/23/2020 500,000
PERSONAL6ADV INJURY i
GEN'L AGGREGATE LIMITAPPUES PER: GENERALAGGREGATE $ 1,000.000
POLICY ❑JECT LOC PRODUCTS-COMP/OPAGG $ 1.000,000
OTHER: Employee Benefits s
AUTOMOBILELu91LftY COMBINED SINGLE L $
a _
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS N/A BODILY INJURY(Per accident) $
HIRED AUTOS AUTOS NON-OWNEO PROP DAMAGE y —
r acdclent) $
UMBRELLA LIAR OCCUR
EACH OCCURRENCE $
EXCESS L'S CLAIMS-MADE N/A AGGREGATE I$ _
D RETENTION $
WORKERS COMPENSATION H-
AND EMPLOYERS'LIAmTY YIN
N X SAT TE R
ANYPROPRIETOR/PARTNERlEXEC 1771 VE
A OFFICER/MEMBEREXCLUDED? wA NIA NIA 6ZZUB9F59788620 02/13/2020 02/13/2021 E.L.EACH ACCIDENT i 100,000
(Mandatory In NH)
E.L.DISEASE-EA EMPLOYE S 100,000
rc yam,des«Iba under
DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $ 500,000
N/A
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddlUonal Remarks SdNdvl.,my be attached N mors space M required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 08 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.gov/twd/workers-compensation;investigations/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Roof Pros ACCORDANCE WITH THE POLICY PROVISIONS.
510 New Ludlow Road
AUTHOIIQEDREPRESENTATIVE
Y MA 01075 L4�y,
South Hadley fy Daniel M. CPCU,Vice President—Residual Market—WCRIBMA
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
Type: Corporation
Registration: 147961
NRB EXTERIORS INC Expiration: 08/22/2021
510 NEW LUDLOW RD
SOUTH HADLEY,MA 01075 '
Update Address and Return Card.
SCA 1 $ 20M-05/17
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 08/22/2021 1000 Washington Street -Suite 710
NRB EXTERIORS INC Boston,MA 02118
NICHOLAS R.BERNIER
510 NEW LUDLOW RD
SOUTH HADLEY,MA 01075 Undersecretary Not valid without signature
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor Specialty
CSS L-099565 Up ires: 05/28/2020
NICHOLAS R BERNIER
610 NEW LUDLOW RD
SOUTH HADLEY MA 01076
Commissioner �/"`"