Loading...
31A-194 (2) BP ► 022-1564 85 WASHINGTON AVE COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31A-194-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Penn it # BP-2022-1564 PERMISSION IS HEREBY GRANT, D TO: Project# ROOF Contractor: License: Est. Cost: 10500 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date: 06/03/2026 Use Group: Owner: FORMAN SUZANNE Lot Size (sq.ft.) Zoning: URB Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 STWC370718 CHESTER,MA 01011 ISSUED ON:12/06/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: 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: (L,449._ 9 T-0,, • • • r Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:9B694D8A-F201-4515-8D83-19C3AAB29F40 The Commonwealth of Massachusetts - " Board of Building Regulations and Standards R Massachusetts State Building Code, 780 CMR NOV 2 ML NIFOCIP ITY 3 FO 20Z2 utfiE Building Permit Application To Construct,Repair,Renovat Or Demolish a R¢vised.Ma 2011 One-or Two-Family Dwelling �i,ii 1r n 7� r ecf n For Official Use Only moos Building Permit Number: D/ Date Applied: 1 'EuIi !/�-+055 // Z II'30 2022 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 85 Washington Ave. 31A-194-001 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) r 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' 2.1 Owner'of Record: Suzanne Forman Northampton, MA 01060 Name(Print) City,State,ZIP 85 Washington Ave. 413-270-5160 lsuzanneforman@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Q/Specify: Roofing Brief Description of Proposed Work2: strip and replace asphalt roof SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 10,500.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee 0 Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: 1,0ll Q Check No.I(? Check Amount: I I r • Cash Amount: 6. Total Project Cost: $ 10,500.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:98694D8A-F201-4515-8D83-19C3AAB29F40 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-117335 06/03/2026 Matthew Carrier License Number Expiration Date Name of CSL Holder 36 Lyon Hill Rd List CSL Type(see below) U No.and Street Type Description Chester, MA 01011 U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-998-9010 stonemountainroofinglIc@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 206447 09/15/2024 Stone Mountain Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 36 Lyon Hill Rd stonemountainroofingllc@gmail.com No.and Street Email address Chester, MA 01011 413-998-9010 City/Town, 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 Issuance of the building permit. Signed Affidavit Attached? Yes QI 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 Stone Mountain Roofing LLC/Matthew Carrier to act on my behalf,in all matters relative to work authorized by this building permit application. —Docuslaned by: 11/15/2022 Suzanne Forman 51.4,501,11u, F61 Print Owner's Name(Electi'QUOiRVicai2o... 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. Matthew Carrier i°t .,=. 11/14/2022 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" DocuSign Envelope ID:9B694D8A-F201-4515-8D83-19C3AAB29F40 City of Northampton (if 'di?''�'" x•� Massachusetts fc t a` DEPARTMENT OF BUILDING INSPECTIONS � '. ,'� 212 Main Street • Municipal Building yJ`• b` Northampton, MA 01060 jsfrA, 73C's 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: Valley Recycling, 234 Easthampton Rd., Northampton MA 01060 The debris will be transported by: Name of Hauler: Aaron's 24/7 Towing & Roll Off Services Signature of Applicant: °��"""' Date: 11/14/2022 ,,',. a. L IIL lAIIIII MIVeUIi l Vf 1Y'UJJUt IiI)UIIJ Department of Industrial Accidents z 9Ofce of Investigations ea li— N Lafayette City Center =; ' 2 Avenue de Lafayette, Boston,MA 02111-1750 ""M www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibl Stone Mountain RoofingLLC T Name (Business/Organization/Individual): Address:36 Lyon Hill Rd. City/State/Zip: Chester, MA 01011 Phone#:413-998-9010 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 1 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in anycapacity. employees and have workers' P 13 9. ❑Building addition [No workers' comp. insurance comp. insurance.# required.] 5. 0 We are a corporation and its 10.❑ 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Berkshire Hathaway Guard Policy#or Self-ins. Lic. #:STWC370718 Expiration Date:06/13/2023 Job Site Address: 85 Washington Ave. City/State/Zip: Northampton, MA 01060 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 fme 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 penal'es of I erjury that the information provided above is true and correct. I 11/16/2022 Signature: '� oc� Date: Phone#: 413-998-9010 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): 11:1Board of Health 2❑Building Department 31:1City/Town Clerk 4.❑Electrical Inspector 5D'lumbing Inspector 6.0Other Contact Person: Phone#: C]L It1r)335 • ���' La_ - aoau Caxd- nok y9,� rQCQ-- Q Y\ mO\ THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration kJ M '=3=''- ' Type: LLC - . Registration: 206447 STONE MOUNTAIN ROOFING, LLC Expiration: 09/15/2024 36 LYON HILL RD ; «11== • CHESTER, MA 01011 -». t, __ 1' 14 g`e 1111. 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: LLC Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 206447 09/15/2024 Boston, MA 02118 ;TONE MOUNTAIN ROOFING, LLC c AATTHEW CARRIER L 'f /J s6 LYON HILL RD % _ _ *' �rtu "`e(G �/`rG� NESTER, MA 010114. ` 4,6 ` IJndersecretary Not valid without signature ®A DATE(MM/DD/YYYY) RQ CERTIFICATE OF LIABILITY INSURANCE 03/22/2022 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Mary Odabashian NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 ((A/C,No,Ext): (A/C,No): E 8 North King Street AD RIESS: modabashian@webberandgrinnell.com INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: Berkley Specialty Insurance Co INSURED INSURER B: Arbella Protection 41360 Stone Mountain Roofing,LLC INSURER C: WCAR-Travelers 36 Lyon Hill Road INSURER D: INSURER E: Chester MA 01011 INSURER F: COVERAGES CERTIFICATE NUMBER: LIAB EXP 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 :R 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 $ 1,000,000 DAMAGE CLAIMS-MADE n OCCUR PREMISESO(EaENTED occur occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A CGL0159193 02/18/2022 02/18/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ 2,000,000 PRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILYINJURY(Perperson) $ B OWNED N/ SCHEDULED 1020114776 02/18/2022 02/18/2023 BODILY INJURY(Per accident) $ _ AUTOS ONLY /• AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) PIP-Basic $ 8,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? Y N/A 7PJUB6R27941622 02/17/2022 02/17/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:9B694D8A-F201-4515-8D83-19C3AAB29F40 Stone Mountain Roofing LLC 36 Lyon Hill Rd., 01,/� Chester, MA 01011 .412ka. 413-998-9010 stonemountainroofingllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT # 1065 Suzanne Forman DATE 11/1 /2022 85 Washington Ave. Northampton, MA 01060 lsuzanneforman@gmail.com 413-270-5160 DESCRIPTION 1. Remove the existing roofing shingles 2. Inspect the existing plywood for any rot or deterioration. Any new plywood will be $85 per sheet installed. (Wood prices subject to change) 3. Install six feet of ice and water shield on eaves and three feet in valleys/around all penetrations 4. Cover remaining roof with synthetic underlayment 5. Install new 8" aluminum drip edge on all eaves and rake edges 6. Install architectural shingles by CertainTeed(Landmark) http://www.certainteed.com/residential-roofing/products/landmark/ Color Choice: Pewterwood 7. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) http://www.airveni.com/index.php/products/exhaust-vents/ridge-vents/shinglev ent2 8. Complete all necessary flashings including new LIFETIME pipe boots and base flashing around the chimney https://lifetimetool.com/productlultimate-pipe-flashing-shingle-kynar-coated/ Includes CertainTeed Lifetime Limited Warranty (Transferable)with 10 year SureStart period. https://www.certainteed.com/resources/Asphalt-LowSlope-Res-Warranty-e-2201 ctr.pdf Remove all debris from premises, and throughout the job, continue cleanup and keep the premise undamaged. WE ARE NOT RESPONSIBLE FOR DEBRIS THAT MAY FALL INTO ATTIC. Please use rea.onable caution during the installation process: do not walk or drive under active work, or on areas of potential ro I fing debris. Stone Mountain Roofing will obtain the building permit if necessary. Installations are weather pe itting; inclement weather will cause scheduling delays. Total: Landmark shingles= $10,500 DocuSign Envelope ID:9B694D8A-F201-4515-8D83-19C3AAB29F40 DESCRIPTION . A one-third deposit of$3,500 will secure contract,permitting, material order, and priority scheduling. The balance shall be due upon completion, within 10 days of invoice. Accounts outstanding over 30 days subject to 2% finance charge monthly. Warranty confirmation shall be provided upon final payment. Installation and manufacturer warranties are not in effect until Paid In Full. TOTAL $10,500.00 Accepted By °°`uS'g°edby. Accepted Date 11/15/2022 SW50&I.M., FOV1Ma�n "—1125429E614C542C...