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35-271 (7)
165 WEST FARMS RD BP-2021-1101 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35-271 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-2021-1101 Project# JS-2021-001861 Est.Cost:$20000.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: U S METAL ROOFING DISTRIBUTORS, INC 018385 Lot Size(sq. ft.): 165092.40 Owner: OMASTA JOHN P&FAYE A Zoning: Applicant: U S METAL ROOFING DISTRIBUTORS, INC AT: 165 WEST FARMS RD Applicant Address: Phone: Insurance: 740 HIGH ST, SUITE 2 (413) 536-5474 WC HOLYOKEMA01040 ISSUED ON:4/2/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STR I P & 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. W)DiT h • Certificate of Occupancy signatur` . • '�' FeeType: Date Paid: Amount: Building 4/2/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner / 144 The Commonwealth of Massachusetts its vt Board of Building Regulations and S ards qp9 Y Massachusetts State Building Code, 7 C A:), ` 1 E Building Permit Application To Construct,Repair,Renov lish ac9 ftevis d Mar 11 One-or Two-Family Dwelling ltig2 L��+�� This Section For Official Use Only T�ry''q°pFCr Buildin Permit Number: 6r a71"//O� )&Date Applied: o,0so�'l's itEki ItU ,a),5 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Ad ress• 1.2 A�rs Map&Parcel g rs 1425 weS1 la(/7 g01 flOrth«,p 1.1 a Is this an accepted street?yes 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❑ Private CI Municipal_ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 0p ✓z,4—raj e Orna5-12 iJorMam pJo i f ill 14 Name(Print) City,State,ZIP /(05 ke<s J hors iqd 97 '-'sa- V/% At.,ma.54a eggyali coat, No.and Street Telephone Email Ad SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building VS- Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ilif Specify: 4ce Pool Brief Description of Proposed Work': see all ched Con/r 1.- SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ a D�DDD D--o 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No.r�p if eck Amount: L/6 Cash Amount: 6. Total Project Cost: $ ),V' o oC ❑ Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) a(�� lt LS- 018385 1 /3 i t r r Robe r 1 S License Number Expiration Date Name of CSI`H�Ider List CSL Type(see below) (J ROOi No. Type Description and Street Af7'1 I ers�' M ✓� (� U Unrestricted(Buildings up to 35,000 Cu.ft.) �1 t t R Restricted 1&2 Family Dwelling City/Town,State,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) I ,..�� 1 hy/ao U is M ' ' 12�Z vl 015+ U-h C— HIC Registration Number Expiration Date HIC Company N e or gi t Name -7 40 Hiq C Re S _Sul �- tee 1-Vtiauslr►ie lroo�in ,cone No. Street V Email address 1 1,2lr-e f 1 A O/Dyt) Y/3-39y-yy7a w City/Ton, te,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 Issuance of the building permit. Signed Affidavit Attached? Yes jaL No 0 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 U. S, PI e > I Poo C1 h a,s 4- 1 11 L to act on my behalf,in all matters relative to work authorized by this building permit applic ion. See q.-i-lacltt 'd S;cii4pd Con1r44f /114reb 3oaoa ( Print Owner's Name(Electronic Signa re) 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. l� 4 h3oi c_I Print Owner's or Authorized iz Agent's Name ec onrc 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" City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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. Address of the work: l Le 5 G0PS 1 T/oreixe/f)1 fl The debris will be transported by: (% 5, /e 4/ /?oo/,y p,S}- Z'c The debris will be received by: Ca s e/t u,4c/e Tao mih 5/ / /yKe,,I t. Building permit number: Name of Permit Applicant V, S. me Jaf Poo/ih D;s 4 -JoL Marc 3D, c�c � Date Signature of Permit Applicant AC^ ® DATE(MM/DD/YYYY) O CERTIFICATE OF LIABILITY INSURANCE 07/29/2020 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Brenda Klaus NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): 8 North King Street E-MAIL bklaus@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Continental Western/Acadia 10804 INSURED INSURER B: Union Ins/Acadia 25844 U.S.Metal Roofing Distributors,Inc. INSURER C: WCAR-Liberty Mutual Attn:Keith Rehbein INSURER D: 740 High Street INSURER E: Holyoke MA 01040 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 07/21 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. INSR ADDL-SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM!DD!YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED 1,000,000 CLAIMS-MADE ' OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 10,000 A CPA531260113 07/26/2020 07/26/2021 PERSONAL&ADV INJURY $ 1'000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 PRO 2.000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B ^ OWNED SCHEDULED MAA531260213 07/26/2020 07/26/2021 BODILY INJURY(Per accident) $ AUTOS ONLY /N AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Uninsured motorist BI $ 100,000 UMBRELLA UAB — _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'UABIUTY STATUTE ER YIN 500,000 C OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE Y N!A WC231 S616974010 07/26/2020 07/26/2021 E.L.EACH ACCIDENT S (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Keith Rehbein is Excluded from Workers'Compensation Coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01075 III,—. LD cr I �I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts no Department of Industrial Accidents s� .:� Office of Investigations uils' Lafayette City Center WOW# 2Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Annlicant Information Please Print Leeibly Name (Business/Organization/Individual): U, 5. P" e;4 I F?n oo.;✓l .015 f .3,r)C �s . Address: l L/O 5 -I' i; 4e City/State/Zip: ke- f 7 A DI oyc) Phone #: '7 q- `1`17v Are you an employer?Chec the app opriate box: Type of project(required): 112 I am a employer with is ❑4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P tY 9. El Building addition [No workers' comp.insurance comp. insurance.: 10.0 Electrical repairs or additions required.] 5. ID We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[,Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *My 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. :Contractors 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. ii Insurance Company Name: L.;,.e r t� f'1 t1-�v 4 Policy#or Self-ins. Lic.#: W L 013 I S fQ j(E?q 7.1 C 10 Expiration Date: 7!a(o/ova Job Site Address: t(2 UI rm S Rd -17preixe Ail City/State/Zip: MOdibepi p/04/ /rl A Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 and penalties of perjury that the information provided above is true and correct. Signature: - \ L/ a e. [ate: Mel rat .31), a&A l Phone#: 9 t 3-- 3 - (-I 7 P Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(check one): 10Board of Health 20 Building Department 3EICity/Town Clerk 4.0 Electrical Inspector 5Ek'lumhing Inspector 6.DOther Contact Person: Phone#: e 6-mmozmpeea416/ 1aJeZ44- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 134740 U.S.METAL ROOFING DISTRIBUTORS, INC. Expiration: 01/18/2022 740 HIGH ST.SUITE 2 HOLYOKE,MA 01040 Update Address and Return Card. SCA 1 CS 20M-05/17 .Tr K vm.Ne ,ff',W//I{J 4 7:-i i(lA(/4 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 134740 01/18/2022 1000 Washington Street -Suite 710 U.S.METAL ROOFING DISTRIBUTORS,INC. Boston,MA 02118 GARY C.REHBElN 124_5 ` - 740 HIGH ST.SUITE 2 HOLYOKE,MA 01040 Not valid without signature Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervise CS-018385 Expires: 07/13/2021 BARRY L ROBERTS '; 200 BAY ROAD AMHERST MA 01002 ; ' 1„ it ' 411. Commissioner .t - • ion U.S. METAL ROOFING 740 High Street•Suite 2•Holyoke,MA 01040 1-800-232-0399•1-413-536-5474•Fax 1-413-533-8166 DATE PROPOSED TO OE DONE ON faoma5 fat tnwN.Lo^s www.usmetalroofing.net a281 cb0l SUINNITEDTO PHONE NUMBERS Frtje 014'n'ahrt. OmaSVia. 978- 85;- yI8I7 sTrtEEr -JOB LOCATION /!0 5 Cops-I -firrms Rd Barrie en:SERE arm DP CDOE Florence pidevECTIONS We will furnish and install new Engiert Standing Seam mechanically locked system,24 gauge as listed below. Work is guaranteed br /0 years and the manufacturer warranties the fresh on the metal for 35 years. COLO SPECIAL INSTRUCTIONS/COMMENTS Rees ni+al fick Znc/ludeel ' To.Slrip /�x:sl�nq as Q/fRaaf� • SOFFIT: -- i po Se o4'. -L n s 11Q//1 6'o7 //):9k'rei l/o ws'kc FASCIA: — 1O.Yrier 4o ail Roo . 4,es . Cover rernarhd'rof Prnc PLYWOOD: 21/ S,ji hei4 c irnd,/imrni Tn s-%a//d y9r4e/,11 RIP/RE l^a/il�e SJ nd si14 csa,17 ? All Poi /i/�°s. si'i/ OTHER: new (/e5# n t me lift/Piro1;oas, .Znsfo//.s4ow HOUSE: jeS .QarS 7 a-T/ Avi Dines ?o fio/rcf r1/erS. /Peh'ove PORCH: GLII o/ tee/aied dein:3 gab.. ADDmON: f es All Permit T ,ceS Ore .7nC/'did z!Z p/'.r e GARAGE --- GUTTERS: DOWNSPOUTS A•P. ... -- — REPAIR: • Contractor will begin work on or about ''D / 'T"'"(ddtie).Bdhrin de ay caused by circumstances beyond Contractor's control,the work will be completed by (date). All roofing panels are custom fabricated on-site with slate-of-the-art rolltorming equipment. 'As with any rollform steel panels,a certain amount of waviness or oil canning may become evident at certain times of the day when sunlight hits them.This is standard in the industry and does not affect the integrity of the metal.This shall not be construed as a product defect and shall not be cause for rejection. Contractor does not perform or assume any responsibility for any painting,staining or wood or wall finishing on interior or exterior. The contractor does further agree with the owner that(a)he will begin work within a reasonable time atter the execution thereof,and will prosecute it diligently and with due care,and in a good and workmanlike manner;(b)In doing the work,he will comply with all statutes, rules,regulations and ordinances applicable thereto: Contractor to procure all permits required by law.Contractor shall provide public liability insurances. Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. We Propose hereby to furnish material and labor-complete In accordance with above specifications for the sum of: nine,fert. 7hevsand ,Eve 4fdred and U%o-- dollars(5 /9500 r" ). Payment to be made as follows sm. O .(J¢()o L3/7/; b-"J) . Name a DmaadoeDe,p.ar lRpWant st=%IS 5 W—- )upon slgnerg Contract, U.S.METAL ROOFING DISTRIBUTORS,INC. re %is 3100 W)upon Marl of lob; 740 High treet.Suite 2,Holyoke,MA 01040 Pharr D OC w 1-a00-232.0399 �f %(5730091)upon 1/2 job completion: R•paear rao MAe 4740 ID %($ i 75o )shall be made torlhwilh upon completion Narnaa13illesa , CTN 602546 work under this contract a Nonce:No agreement for hens improvement contracting work shall require a dam payment ,oraroaeca squa.e ladvance deposit)or more than one`Imrd of the total contreci puce Or the total amount DI all 4/1 - V.' /�QU�� deposes or payments which the contractor must make.in advance,to order and/or otherwise7 7 (7 detain delnery or special order matenats and agreement.whrch_pypt3mQ:Dl _maw 1b teappranaq one. Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight o fthe third business day after the date of this transaction.Cancellation must be done in writing.See accompanying cancellation. 1 J�ghIA/T SIGN THIS C a�;ACT IF THERE NK,DACE! S , � I� ]6 r C� G�7 /vJ.hrtw�„� ci Signature Dale Signature Oalo._ IMPORTANT INFORMATION ON BACK 1