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17A-039 (6) B P-2021-2050 200BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17A-039-001 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-2021-2050 PERMISSION IS HEREBY GRANTED TO: Project# 2021 ROOF Contractor: License: BUNNELL'S HOME IMPROVEMENT, Est. Cost: 11000 INC CSFA102433 Const.Class: Exp.Date: 10/24/2022 Use Group: Owner: BERTRAM PAUL E&TRUDY-JANE Lot Size(sq.ft.) Zoning: RI/URA Applicant: BUNNELL'S HOME IMPROVEMENT, INC Applicant Address Phone: Insurance: 123 MALLARD CIRCLE 413-786-3300 6ZZUB0K99589820 AGAWAM, MA 01028 ISSUED ON:10/22/2021 TO PERFORM THE FOLLOWING WORK: STRIP&REPLACE 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. Signature: I; 5ni • {' It Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner �EiC The CommonwealthngRegu of Massachusetts I` I Board of Buildilations and Sta'lord OCr Jr 20��M ICI O ALITY Massachusetts State Building Code, 78 CIv R U t Arr1 Building Permit Application To Construct,Repair, R6c kat , Mr, . R ised ar 2011 One-or Two-Family Dwelling -�-4�. nh k44 olo oloNs This Sectitth For Official Use Only Building ermit Num : -202(—205b Date Applied: 10 151 ZI &Ulm �5 /____ : lb- IC11021 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 600 iL.1are., �d 17( -0311 -OD 1 1.1 a Is this an acce1Aed street?yes r✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 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: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 1 Owner'of Record: Name(Print) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Ill Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': $r ,p and ReipLa tZX P SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire 1/ Suppression) $ Total All Fpesi,�J Q1 Check No I./ .Check Amount: Lia Cash Amount: 6. Total Project Cost: $ 1 1 t 0p 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ' 4 33 ""hig,14-exc_ r a,t'J cap( License Number Ex ratio ate Name of CSL Holder List CSL Type(see below) R ,y(, Yn aple,ShAj,e_ ...Are_ - No.and Street Type Description � Unrestricted(Buildings up to 35,000 cu.ft.) I �� �a C)I C) (R Restricted 1&2 Family Dwelling City/Town, ,te,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) t —I( S kTie Trn p . HIC Registration Number E irat' n Date HIC Company Name or HIC Registrant Name Oi�I 1 a I I A K.A Ci r. �`1 L' 1 J (rCp gi r c (O-L . CO M o.and Street t,l�, ..3� Email dress t own,State,ZIP Telephone 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 Issuancean of the building permit. Signed Affidavit Attached? Yes Ef No .❑ 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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 accurate to the best of my knowledge and understanding. 1)1,6 r3 OCR. . i a, aaa Print Owner's or Authorized Agent's Name(Electronic 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 not 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.ft.) (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 half/baths 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 Cost" Proposal Page No. of Pages / BUNNELL'S HOME IMPROVEMENT, INC. SPECIALIZING IN ROOFING A Member Of The Better Business Bureau 123 Mallard Circle, Agawam, MA 01001 (413) 783300 www.bunneilroofing.com P OSAL SUBMITTED TO PHONE DATE � iiiA a��� PHt .''I1 ( -oqS,-/_ e i L^ c r 1oz:7— I STREET J B NAME o aCC) ALA.0,a ZL _1 ant.U.— CITY,STATE and ZIP CODE Q JOB LO ATION 1 Lfrk , ARCHITECT DATE OF PLANS JOB PHONE We hereby submit specifications and estimates for. ..i•JA...p._..a...1.0-y?‘4)...ot..1... p.a.) L...... c i ...c.x. .i..C.14, a/d,_._.. .,L_- ...c :-., i t\eseo0oct.... ......_.t ....ac. -t-n.Qt.. sg px Lr A. a_,m, .«s.i. dip A-..)...c...}- __LcA „ __._... ... ..........._ . ____ .......______............... . � c t+' .�.;ur-- 1- wQ be u.�;f*ti_o 5-10 Q&-i ,,. 1 VaA yi, die - _._f2,or 1)--):Rit , akumAAA.AT 4- 3.1<:. yL.6)..-.k. . a-A.kaiLQ.. 60 �>�. Cam. _ �O c�e,� -CamkD o E 51 rs4 ��er i 0 _ a.0 (c(> ..A-4.4 vat,. .. . _._-- .itAik.,004.. y.„04,Lik ÷,luLA oki,e4Lrbik.,4c L i•-ioa) ..a aulfx- C.i._l+.A.6e..<<g)---------.---.._.____ .._..._.__.._._.-- 10 ", 106% k- . .p .1 L r 1 bay- L)L -lat p„L. , _ -- 71.4 /c �/� a Propose hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: 49 (.XRAt?tivNA- Ci'1C4t140. dollars($ // Ca)_ )- Payment to be made as follows: / 50°1n CI-Cl.' £3 AW Z 5o 14 LL(DO4 . cQ DOA . All material is guaranteed to be as specified.All work to be completed in a workmanlike , manner according to standard practices.Any alteration or deviation from above specifications Authorized 6.� r)n involving extra costs will be executed only upon written orders,and will become an extra Signature (� /1�/yLQj/x charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tomado and other necessary insurance.Our Note:This proposal may be \workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days/ / ,Arreptanre of Proposal-The above prices,specifications WVA-g E�'.rand conditions are satisfactory and are hereby accepted.You are authorizedgnature to do the work as specified.Payment will be made as outlined above. \ Date of Acceptance: g ` elle 9 c'3- al?a/ Signature / AC�® DATE(MMIDD YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2021 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 confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME:CT Alexandre Carvalho IDEAL INSURANCE AGENCY INC (THE) (i"vc°."No,EXt); (413)589 0901 FAX (A/C. E-MAIL ADDRESS_ aleX ideallnSUrance.Com 187 EAST ST INSURER(S)AFFORDING COVERAGE NAICN LUDLOW MA 01056 INSURER A: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: BUNNELLS HOME IMPROVEMENT INC INSURERC: INSURER D: 123 MALLARD CIRCLE INSURERE: AGAWAM MA 01001 INSURER F: COVERAGES CERTIFICATE NUMBER: 700588 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - I R ADDL SUBR POLICY EFF POLICY EXP LT TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDnrYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO $ CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEM.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY I II PROT LOC PRODUCTS-COMP/OP AGG $ JEC OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS N/A BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) - $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY " ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6ZZUB0K99589820 10/19/2020 10/19/2021 (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 N/A DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is 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.gov/Iwd/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 CITY OF NORTHAMPTON /VILLAGE OF FLORENCE ACCORDANCE WITH THE POLICY PROVISIONS. 210 MAIN ST AUTHORIZED REPRESENTATIVE NORTHAMPTON MA 01060 Ltrk Daniel M.CroWley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts ilk =t Department of Industrial Accidents . .... = ,; 1 Congress Street.Suite 100 Boston.MA 02114-2017 _1r www.mass.gov/dia 1 - 11i»kers'( umprnsaliun Insurance Aflidasit:Buildrrsl("ontractorslEleetriciansiPlumbers. It)111.11Lk.1)V11'111 Ills.PERNtrl'rIM;AI!TH(HUTY. Applicant Information -(Please Print Legibly ss t Name(llustne rganeiate.,n Ind el.edual 1: 13 L x nP.1 I Is c 140 M e LM p . J�1'1C-- Address: Ia3 I'ElaI Iara C:► rake. 1 Cdy/Statt p:_A Ai ►A Ciao l Phone#: r1lo•370Cz Are pan an eanploy rr''It beat/the'appropriate boa: Type of project(required): I.Q 1 am a employer with employers(full and or part-time t.• 7. 0 \cv► construction 20 lam a sole popri cur Of prntnenbip and have nu employes%orlmg for m.in It. O Remodeling any capacity.lt`iu workers'cow.oasuaanc n pired.l 301 am a hurrrouner doing all work max-If(Nu notion'cone.insurance requuaal 1" 9. Ikmulltton 1.0 lam a hunsooun r and will be hiring contractors rs in conduct all work on my pnige-rty. I will loci Building addition erasure that all contractors either beige%osiers'CONINNUNSION insurance or an sole I 1.0 Electrical repairs or additions proprietors with nd,emploseea. 12.0 Plumbing repair's or additions 30 lam a general contractor and I base hued the sul*centraetaai listed on the attached sheet. I 3.0‘of repairs -hese sub-contractors base employees and lose%miters'comp.msuranee. b. We arc a corporation and its utliecns luxe exercised then right sit exemptionper MI it.e. 14.0 Othrt 152.lit(4).and we base no emplusees.[\o wur►en'comp.insurance re(uued l 'Any applicant that chocks but al must also fill out the section helots Aiming then wur►ers.oompcanatnw policy infatuation'. «Rome00%nen who submit this affidas it us/heating DLL's an dkm it all work and then hire outside contractors last submit a net affidavit ishraMas suck :km1ractors that check this box must attached an additional sheet show mg the name attic sub-contractors and stale thither or out dam.:entities bag employees. It the sub-contraek*s has curiosees.they must pro%nic their workers-comp.polies number. nammaim t am an employer that is providing workers"compensation insurance for my employees_ Below is the polity and job site information. Insurance Company Name: ` rt ?..L tr 5 _ ( j , — Polley#or Sell-ins.Lie.»: Expiration Date: LO//9/c9-1 Job Site Address:p9m at-i do hrt-' Rr City�'State'Zip: cI c*Z nee -i date). Attach a copy of the workers'clpensation policy declaration page(showing the policy number and a ipila Failure to secure coverage as required under\KiL c. 152.*25A is a criminal violation punishable by a fine up to S1.500.00 and+or one-year imprisonment.as well as en tl penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 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. t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 70 411.4.0,rjX i3l-(,icr(jJ4) Dale:. Oa. . /cc 1 3 -CX;z.1 Phone:. rkt, -3 0 Ojfcial use only_ Do not write in this area.to be completed lit city or town offi at 1 City or Town: Permitil.icense Il Issuing:Authority(circle one): I. Board of Ilealth 2.Building Department 3.(Ay/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ti.Other ( 'intact Person: Phone#: City of Northampton r .s s, Massachusetts ., 3•- '<<G .4,• ..„ r go, k DEPARTMENT OF BUILDING INSPECTIONS S. 4 yy V ;i .' 212 Main Street • Municipal Building c..0,+-- Northampton, MA 01060 'rs'Iryy .3 o0 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: Du rr - cD 12 _<-k Location of Facility: ineva. e,;,+ inAc-s--cteS 13i0* ic-ir le C:�. - The debris will be transported by: Name of Hauler: 0lot it 'n 1.bi'-,e Tn.\p , .nC - Signature of Applicant: 7;;leis arrrt (2),LC,Kl,y 0 L Date: Q ., /a yo 14.4