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12C-042 (4) BP-2023-1002 228 SPRING GROVE AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 12C-042-001 CITY OF NORTHA PTON 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-2023-1002 PERMISSIO IS HEREBY GRANTED TO: Project# KITCHEN RENO 2023 Contractor: License: Est. Cost: 16200 EXTERIOR ASSOCI TES INC 113456 Const.Class: Exp.Date: 07/23/202 Use Group: Owner: YENT'CH MODENOD, LISA&KEEGAN J. Lot Size (sq.ft.) Zoning: RI/WSP Applicant: EXTER OR ASSOCIATES INC Applicant Address Phone: Insurance: 408 SOMERS RD (860)978-591 1 WC9097314 ELLINGTON, CT 06029 ISSUED ON: 07/28/2023 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 3-1 • Fees Paid: $110.50 • 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner 19$' c�� The Commonwealth of Massachuse • �� 5� O Board of Building Regulations and Stands :- o�At ? FO It) Massachusetts State Building Code, 780 CMR Np9Tya& 1[�IP TY q O, Building Permit Application To Construct,Repair, Renovate Or De ,i' .,, : s Revise Mar 2 11 One-or Two-Fa Duelling M• q o c This Section For Official Use On'y °off Building Pe ' Number: 9A ' ineA Dane A lied: —Utz i�c/ 7.Z7-ZOZ But klmg Official(Trutt Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 622 Assessors Map&Parcel Numbers imummos 1.1a Is this an accepted street''yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property D,mensious: Zoning District Proposed Use Lot Area(sq ft) Frontage 1 t1) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supp y:{M.G.L c.40.§54) ' 1.7 Flood Zone Information: ' 1.8 Sewage Disposal System: Public 0 Private CI Zone: _ Outside Flove Zone? Municipal CI On site disposal system CICheck if ye SECTION 2: PROPERTY OWNERSHIP' iiiiciiiiiiiiiimmimin • Name(Print) City.State.ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(cheek all that apply) New Construction 0 Existing Building E Owner-Occupied 0 Reps irs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: _ _ __,_ _. Kitchen renovation,new cabinets and flooring. No structural changes. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ .1 1. Building Permit Fee:$ Indicate how tee is determined: 2.Electrical $ 0 Standard CitylTown Application Fee 0 Total Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (IiVAC) $ List•. 5.Mechanical (Fire $ Total All Fees: $ Suppression) Check No;)3) Check Amount{iC''Cash Amount: 6.Total Project Cost: 9e l 6,20011r1 13 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 113456 7f23l24 _ Kyle Nielsen License Number Expiration Date Name of CSL Holder 31 Ovorhil Rd List CSL Type(see below) R No.and Street Type Description U Unrest icted(Buildings up to35,000cu,A.) Ellington,CT 06029 —___ - R Restricted I80 Family Dwelling City,ToWn.State.ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 860-978-5911 OFFICE@EXTERIORASSOCIATES.COM I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 103175 4J28+ _ _Exterior Associates, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 31 Overhil Rd OFFICE@EXTERIORASSOCIATES.COM 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.f 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 of the building permit. Signed Affidavit Attached? Yes III No El 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,In . to act on my behalf,in all matters relative to work authorized by this buildi ig permit application. Print Owner's Name i Elect ronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties o f perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Dennis Audet ■ IllIllB Print Owner's or Authorized Agent'sName(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do histher 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.Rovtoce Information on the Construction Supervisor License can be found at www.macs.gov/dps 2. When substantial work is planned.provide the information below: Total floor area(sq.ft.) (including gaage.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 halfbaths 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" City of Northampton F+.•�" Massachusetts DEPARTMENT OF BUILDING INSPECTIONS , 212 Main Street • Municipal Buildingtof i Northampton, MA 01060 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: Location of Facility: USA Hauling, East Windsor,CT The debris will be transported by: Name of Hauler: Exterior Associates, Inc Signature of Applicant: �-�-- ` "--�' Date: '( 4 2.-5,_ The Commonwealth of Massachusetts 6d t Department of Industrial Accidents. 1 Congress Street,Suite 100 • Boston,ll✓Irl 02214-2017 1, www mass gov/d'a Workers'Compensation Insurance Affidavit:Builders/ContractorsLElecirirrans/.f'1umbers. TO BE FILM WITH mit PERMITTING ADTHORITY. Applicant Information Please Print Legibly Name(iiusinesslorganization(Individual): Exterior Associates; Inc. Address: 31 Ove rh i I I Rd. City/State/Zip:_ Ellington, CT 06029 Phone#: 860-978-5911 Are you an employer?Check tie appropriate box: Type of project(required): Lill am a employer with 12+ employees(full aud/orpart-lime).* 7. Q New construction 2,0 I am a sole proprietor or partnership and have no employees working forme in $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance rcgnired.]t 9. ❑Demolition 4.[]I am a homeowner and will be hiring contractors to conduct all work on my properly. i wUl ICI❑Building addition ensure that all contractors either have workers'compensation insurance or am solo 11.0 Electrical repairs or additions proprietors with no employees, 12.❑Plumbing repairs or additions 54111 am a general contractor and Thrive hired the subcontractors listed on the attached sheet 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance,t y❑y p 6.0 We area corporation and its officers have exercised their right of exemption per MGL c. 14.[ Other Door/s 152,§1(4),and we have no employees.[No-workers'comp.insurance required.] *Any applicant that cheeks box#1 mast also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing ail work and then him outside contractors must submit a new affidavit iodinating sari., 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Berkley Insurance Company Policy#or Self ins.Lie.#: BNUWC0138570 Expiration Date: 1 1/14/2023 Job Site Address:'2C 8 ti r ��% _City/State/Zip: \ � i I 1 Attach a copy of the workers'compensation o'cy eclaratfon age(showing the policy number and expirati6h tee). w1 i _k.O n� Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 V a ' 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 certify under the pains andpesw1E s ofperjury that the information provided above is true an correct Signature: Zia '�"f � Date: Phone#: 7 A l 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#: • Client#: 98251 EXTERASC ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 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 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 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 NAOf1EACT Lynn M. Paparazzo Starkweather&Shepley(CT) PHONE 860 583-0943 FAX 860.709-9354 (A/C,No,Eat): (A/C,No): Insurance Brokerage, Inc. E-MAIL starshearazzo IPa com PO Box 549 ADDRESS: P G P• INSURER(S)AFFORDING COVERAGE NAIC C Providence, RI 02901-0549 Selective Insurance Co of New INSURER A: England 11867 INSURED INSURER B: Exterior Associates, Inc. INSURER c: 130 Old Town Road Vernon Rockville, CT 06066 INSURERD: 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, NN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCE) BY PAID CLAIMS. LTRR TYPE OF INSURANCE BR IIN R WVD POLICY NUMBER (MM/DDY/YYYYY) (FF MM/LDDYIY EXP YYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X S2442015 11/14/2022 11/14/2023 EACH OCCURRENCE $1,000,000 Ep CLAIMS-MADE X OCCUR PREMISEayoNc urenoe) $500,000 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 COT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY X S2442015 11/14/2022 11/14/2023(Ea aBCc J SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR X S2442015 11/14/2022 11/14/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ A WORKERS COMPENSATION WC9097314 11/14/2022 11/14/2023 X IPERATUTE I IEORTH AND EMPLOYERS'LIABILITY ST Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 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 II 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 P 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 ey ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1997930/M1997928 CTLMP THE COMMONWEALTH OF MASSACRUSETT'S Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Impro ement Contractor Registration twriONNONOMMIVO;OW -- Type: Out of State Corporation SLY 1 Registration: 103175 EXTERIOR ASSOCIATES INC. Au.Auweft . . Expiration: 04/28/2025 31 OVERHILL RD "= t AmmeR ELLINGTON,CT 06029 W ti18 a 11,44 S�� 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 e_. .,_. s4, a �lfiw�i LINGTON.CT 06029 Undersecretary Not valid without signature • uommonweattn or massacnu efts Division of Occupational Lice sure Board of Building Re ioulations and Standards Cons' nT ite,,rvis r CS-113456 icpires:07/23/2024 KYLE NIELS1 1, 31OVERHILt(RD ,; • >;. ELLINGTON`jT 0602*:• ' ' `' �rx'1p . ,a'�`�' Co]t missioner aer4 r�•