Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
22D-035
BP 2022-1239 55 CLARK ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22D-035-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1239 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 16000 THOMAS ROBERTS 100333 Const.Class: Exp.Date:07/03/2024 Use Group: Owner: ADAMS CHRISTOPHER F&CHRISTINE M ADAMS Lot Size (sq.ft.) Zoning: WSP Applicant: ROBERTS ROOFS CO INC Applicant Address Phone: Insurance: P O BOX 1312 (413)283-4395 2008W6216 BONDSVILLE, MA 01009 ISSUED ON:09/30/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE 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: I Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:F1EF68C3-92C5-4EC1-A647-A44E375B60A7 The Commonwealth of Mas hus Board of Building Regulations d S dards�P 2 2022 FOR Massachusetts State Building C e,7 N OF USE Building Permit Application To Construct,Repair, itre R ised Mar 2011 One-or Two-Family Dwelling • Ma 01060 N This Section For Official Use Only Building Permit Number: $l `2. .,-1.2. I 3 Date Applied: (>S )/ q.3o-2ozZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 A �ap&Parcel Numisr� 55 Clark Street Florence,MA 01062 1.l 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 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system b Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Christine Adams Florence,MA 01062 Name(Print) City, State,ZIP 55 Clark Street 413-626-4028 thristineadams@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied la Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other ❑ Specify: Brief Description of Proposed Work2:Remove and replace existing shingle roofing on house with new shingle roofing complete with all associated flashing details. Remove and replace existing EPDM roofing with new EPDm roofing on house complete with all associated flashing details. 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 $ — Suppression) Total All Fees: Check No.11 Check Amount:40 Cash Amount: 6.Total Project Cost: $ t 6 I dCX7 •CO 0 Paid in Full El Outstanding Balance Due: DocuSign Envelope ID: F1EF68C3-92C5-4EC1-A647-A44E375B60A7 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 100333 7/3/24 Thomas R Roberts,Jr License Number Expiration Date Name of CSL Holder List CSL Type(see below) RC 400 Franklin Street No.and Street Type Description lielchertown,MA 01007 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry S/1 P. �� RC Roofing Covering .�h r.1>D WS Window and Siding SF Solid Fuel Burning Appliances 413-283-4395 info@robertsroofsinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 128264 3/16/23 Roberts Roofs Co.,Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name PO Box 1312 info@robertsroofsinc.com No.and Street Email address Bondsville,MA 01009 413-283-4395 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE A1H DAVIT(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 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 Roberts Roofs Co.,Inc. to a tsign ti:Fhalf,in all matters relative to work authorized by this building permit application. LCI„,,„ ,,„e__ atm%) 9/28/2022 44tKne(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. c2I(actlaa wner's Authorized Agent's a(Electronic Signature) Date NOTES: I. 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" r .: Commonwealth of Massachusetts I Division of Occupational Licensure Board of Building Regulations and Standards Constructiq upef s'Qr Specialty CSSL- 100333 E,tpires: 07/03/2024 THOMAS R F BERTS, JR 400 FRANKL N STREET �a BELCHERTO N MA 01007 ,. A_ ' . \‘...41., 0' Co r.miss:cr.c K. v` 1.�., 6/21M-0/411)ea110-/A0:64.1ae. .441616(4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 128264 ROBERTS ROOFS CO. INC. Expiration: 03/16/2023 PO BOX 1312 BONDSVILLE,MA 01009 Update Address and Return Card. SCA 1 0 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 128264 03/16/2023 1000 Washington Street -Suite 710 ROBERTS ROOFS CO.INC. Boston,MA 02118 THOMAS R.ROBERTS JR 400 FRANKLIN ST � � %a,64,0 - BELCHERTOWN,MA 01007 Not valid without signature Undersecretary DocuSign Envelope ID:F1EF68C3-92C5-4EC1-A647-A44E3751360A7 City of Northampton at MT,lh •" Massachusetts DEPARTMENT OF BUILDING INSPECTIONS �`. •..1 1 . dti 212 Main Street •• Municipal Building1. y0y. D* " cs r��..' Northampton, MA 01060 Tilt 'rJ'hh, 4-)\'‘ CONSTRUCTION AFFIDAVIT DEBRIS (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: USk Lcse A R.'cy1 be-3 y1 1 IMPS-Sfi •W{4c..k`W 14 The debris will be transported by: Name of Hauler: USJk -`c,.oktv,y 4 Q ec c li►�� Signature of Applicant: i _ Date: `'lu,`kiy.1- The Commonwealth of Massachusetts Department of Industrial Accidents c= =CI Office of Investigations =n0- y 600 Washington Street • 'lil=.q Boston, MA 02111 `�-•.;•�+ www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Roberts Roofs Co., Inc. Address: PO Box 1312 City/State/Zip: Bondsville, MA 01009 Phone #: 413-283-4395 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 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 h 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other 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. i I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Farm Family Casualty Insurance Company Policy#or Self-ins. Lic.#: 2008W6216 Expiration Date: 4/17/2023 Job Site Address: 55 Clark Street City/State/Zip:Florence, MA 01062 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: Date: Ci L:ct(e)- Phone#: 413- 3-4395 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#: �ORO® DATE( M! D/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/0 /�022 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 CONTACT Sean Rooney NAME: Rooney Sean Patrick Rooney,Sr.dba HO No EXUc 413-887-8817 FAX No): 877-771-6087 Rooney Insurance Services ADDRess: sean.rooney©faml-family.com 2341 Boston Rd. INSURER(S)AFFORDING COVERAGE NAIL Wilbraham MA 01095 lNsuRER A: Farm Family Casualty Insurance Company 13803 INSURED --- INSURER B: ROBERT'S ROOFS INC INSURER C: 400 Franklin St INSURERD: Belchertown MA 01007 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 ITO 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 ADOL SUER POUCY EFF POLICY EXP LIR TYPE OF INSURANCE INSD IAND POUCY NUMBER (MWDDIYYYY) (MMIDDIYYYY) UNITS X COMMERCIAL GENERAL t.IABILITY EACH OCCURRENCE $2,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES(EaENTED occurrence) $ A X BOP X X 2007X0329 04/17/22 04/17/23 MED EXP(Any one person) s 5,000 PERSONAL a ADV INJURY $1.000.000 GENt AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE s4,000,000 X POLICY[---1 JPR(3-ECT LOC PRODUCTS-COMP/OPAGG $4,f)O0A00 OTHER: $ AUTOMOBILE LIABILITY (C.O a codenC31NGLE LIMIT $ 1.000.000 ANY AUTO BODILY INJURY(Per person) $ A X ALL OWNED SCHEDULED X 2001 C4685 04/24/22 04/24/23 BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) S UMBRELLA LNB _ OCCUR EACH OCCURRENCE $ EXCESS LI/1B CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PE TUTE ER AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N X 2008W6216 04/17/22 04/17/23 E.L EACH ACCIDENT $500,000 (Mandatory In NH)EXCLUDED? N/A E.L.DISEASE-EA EMPLOYEE $500,000 yes,If DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCY IJM IT s 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 Sean Patrick Rooney,Sr. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD