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43-138 (3)
BP-2023-0320 56 LONGFELLOW DR COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 43-138-001 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-2023-0320 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 33500 THOMAS MORIN 112460 Const.Class: Exp.Date: 07/23/2024 Use Group: Owner: DERR VINCENT LINDA &THOMAS S Lot Size (sq.ft.) Zoning: WSP Applicant: VALLEY ROOFING AND RESTORATION Applicant Address Phone: Insurance: 143 PARKER LANE (413)230-8076 7PJUB6R27625422 LUDLOW, MA 01056 ISSUED ON: 03/13/2023 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: cg ,'I • e 6 • ' 1 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner rMAR The Commonwealth of Massachusetts 1 3 2023 FOR Board of Building Regulations and Standards;...0) _ MUNICIPALITY • Massachusetts State Building Code, 780 CMR :, --- i, ,, - USE; Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Buildini it Number: -/-3- .D Date Applied: ./4..)(14s /� 3- 13-ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 56 Longfellow Dr. Florence, MA 01060 1.la 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 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Linda Vincent Florence, MA 01060 Name(Print) City,State,ZIP 56 Longfellow Dr. 413-584-9468 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building El Owner-Occupied El Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ® Specify: Roof replacement Brief Description of Proposed Work2: Remove and replace asphalt shingles, see attached estimate if further detail is needed SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 33,500.00 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 Fee : y!I� Check No. Check Amount: 'l Cash Amount: 6.Total Project Cost: $ 33,500.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-112460 07/23/2024 Thomas Morin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 143 Parker Lane No.and Street Type Description Ludlow, MA 01056 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 413-230-8076 valleyroofingandrestoration@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 185148 08/08/2024 Tom Morin D/B/A Valley Roofing and Restoration HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 143 Parker Lane valleyroofingandrestoration@gmail.com No.and Street Email address Ludlow, MA 01056 413-230-8076 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 ® 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 Tom Morin D/B/A Valley Roofing and Restoration to act on my behalf,in all matters relative to work authorized by this building permit application. Linda Vincent 3/10/23 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. Tom Morin D/B/A Valley Roofing and Restoration 3/10/23 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.) $33,500.00 (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 Y•" Massachusetts �4v tttist, DEPARTMENT OF BUILDING INSPECTIONS y: ♦'0.` 212 Main Street • Municipal Building J�., OD Northampton, MA 01060 raj • .... 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: Casella Waste Systems 700 Main St. Holyoke, MA 01040 413-306-3929 The debris will be transported by: Name of Hauler: The Barnish Companies Signature of Applicant: Date: 3/10/23 The Contnu►n)s'ealth of?lassachnseits g___i.,", Department of Industrial.4ccidents 1 Congress Street.Suite 100 A,,..-�.:1 Boston. A1.-I 02114-2017 >` w vw.n►ass.go►/dia .,.ma . 11 ut kers'Compensation Insurance Affiidas it: Builders'('ontractursiElectricians4Plumbrrs. 10 Ht. 1-11.E11 1117 It 111E PERMI1111M; Al I h URl i 1. .tonlicant Information Please Print Lefihls Name iBusiness Organvauon 1nji.,Jua11: Tom Morin D/B/A Valley Roofing and Restoration Address: 143 Parker Lane City/State/Zip: Ludlow, MA 01056 phone#: 413-230-8076 Art ...t•eitepl.,err?Cheri the appruprlatt I.us: Type of project(required): LEI 1 am a employer wlth cnsloy.es tfull and or pat-dine)• 7. ❑New construction 2.CI I am a sole proprietor or purtn.rshrp and hase no curio!,e s working for me in M. CI Remodeling any capacity.[No wolcrs'comp.uuurance nquu al.[ 9_ ❑Demolition 3 j I am a humans n.i doing all work inys.if.(No wurk.T%.cum-insurance n_Nulr.11.[' 4.0 I am a hons..us%ir-r and w ill be hum;.untra turf to conduct all wol on my property, I vsill 10 a Building addition cnsun that all contractors either has.:workers'comps-mown insurance or an:sole I 1 Electrical repairs or additions prvprletun with w employees. 12.0 Plumbing repairs or additions 5CEI 1 am a general contractor and I his c hind du:sub-cuntracwrs listed on the attached sheet These sub-contractors he employees and ha.e wutkers cony+_insurance_ 130 Root repairs 60 we an a eorpiiraliun and its officersofficershose eaererxd dress e nhl ut c'.cnyitaa pet SK.L.. (4.®Other Roof replacement 152.,11d1.and we hose no employees.[Nu w Ulf lcrs'coop.insurance required.[ •Any applicant that.Ilocks box al must also till out the xtUun helms shuns tag their workers'cony.eruation pulse)intonation. •I Ioin.Vw nen w his sulunit this atti.Fa.it Indr.atatig dire are doing all work and Men hue outside contra:tu.must subnut a,hew atliijas it indicating awh. :(,onuact.rs that.hc.l this bul must attached an additional sh.xi shuns mg the n:une of the sub-contractors and state whdh.7 or not those Imes hase employccc. It the sub-c.Httractivs fuse employ.x-..they nuul pn,siJe their worlcrs-comp.policy number. I am an employer that is providing warners'compensation insurance for my ewrplgtes. Below is the policy and job site information. Insurance Company Name: Policy rY or Self-ins.Lie.#: Expiration Date: Job Site Address: 56 Longfellow Dr. City;State'Zip: Florence, MA 01060 Attach a copy of the workers'compensation policy declaration page(+horsing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152.*25A is a criminal violation punishable by a tine up to S1.5(10_00 and or one-year imprisonment,as well as cisil penalties in the fttnn of a STOP WORK ORDER and a line of up to S250.00 a d.i against the s solator_A copy of this statement tmiy be forwarded to the Office of Investigations of the DIA for insurance .u.crage seritication. I du hereby certify under the pain%and penalties of perjury that the information provided above is true and correct Signature: CI — -"--- -r Dale: 3/10/23 Phone a: 413-230-8076 Official use onli. Do not,i°rite in this area,to be completed by city or town afficial Ci(s or Town: Permit/License k Issuing Autliurit (circle one): I. Board of Health 2. Building Department 3.("icy;hewn Clerk 4.Electrical Inspector S.Plumbing Inspector G.Other Contact Person: Phone 0: ESTIMATE Valley Roofing and Restoraton, LLC Sales Representative Ruo IN 143 Parker Lane Tom Morin Ludlow,MA 01056 (413)230-8076 0� ' (413)230-8076 valleyroofingandrestoration@gmail.com CSL#CS-112460 HIC#185148 Linda Vincent Estimate# 1521 56 Longfellow Dr. Florence, MA 01060 Date 10/29/2022 Item Description Price Amount Asphalt/skylight •Strip all layers of roofing on the house-dispose of all $33,500.00 $33,500.00 debris • Remove and replace 2 existing skylights with 2 new manual venting Velux skylights •Furnish and install synthetic underlayment •Furnish and install starter strip •Change existing bath hood vent if needed •Furnish and install 6'ice and water barrier at all eaves, valleys,and all roof penetrations to meet MA code •Furnish and install new aluminum drip edge—Color: White •Furnish and install low profile ridge vent •Replace stack pipe collars •Furnish and install new lead flashing on chimney • Furnish and install new GAF Timberline HDZ Lifetime Shingle(color to be determined) Sub Total $33,500.00 When Paying by Cash or Check Total $33,500.00 When Paying by Credit Card Surcharge $971.79 Balance Due* $34,471.79 *Credit card payments include a surcharge of 2.9%+29¢per transaction. Document ID:4683BFD1-1580-4542-A376-59EE1A56E16F Page 1 of 2 ACL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 40.------. 03/07/2023 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 LEANDRO GUIMARAES NAME: POINT INSURANCE INC PHONo,Ext): FAX (508)552-8066 F No): (508)552-8065 424 BELMONT ST E-MAIL Iguimaraes@pointinsure.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# WORCESTER MA 01604 INSURER A: ATLANTIC CASUALTY INS CO INSURED INSURER B: TRAVELERS PROPERTY CAS CO OF AM CT HOME EVOLUTION LLC INSURER C: PO BOX 81328 INSURER D: INSURER E: SPRINGFIELD MA 01108 INSURER F: COVERAGES CERTIFICATE NUMBER: Master Cert 2023 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 EFF POLICY EXP NSR ADDL-SUBRTYPE OF INSURANCE INSD wvo POLICY NUMBER MPM/DDYIYYYY MM DDIYYYY LIMITS LTR INSD WVD ( ) ( ) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,DAAGE000,000 CLAIMS-MADE XI OCCUR PREM SESO(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A L307002444 03/02/2023 03/02/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,OOQ000 X POLICY PRO-JECT LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS- HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB - OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X MUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? Y N/A WCBTRV000195440 03/02/2023 03/02/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/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 Valley Roofing and Restoration LLC ACCORDANCE WITH THE POLICY PROVISIONS. 143 Parker Ln AUTHORIZED REPRESENTATIVE (..k‘me . ivsr� Ludlow MA 01056 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regqulations and Standards `7I Constion T Srvisor CS-112460 S E*pires:07/23/2024 THOMAS D PkpRIN 162 PENDLETON AVE CHICOPEE 14 01020 lb-, a - C�,..,,,;�s,,,..:>r �'2. # ,�-� � v� I, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 185148 08/08/2024 TOM MORIN D/B/A VALLEY ROOFING AND RESTORATION tom` THOMAS MORIN 162 PENDLETON AVE. CHICOPEE,MA 01020 Undersecretary Ate® D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDTYYYY) �/ 09/29/2022 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 Jennifer Hamel NAME: Southwick Insurance Agency PHONE (413)569-5541 1 FAX ) (413)569-6530 �!yNyE Ast l: (AIC,No): 562 College Hwy AIMOREss: ihamel@southwickinsagency corn - INSURER(S)AFFORDING COVERAGE '_ NAIC# Southwick MA 01077 INSURER A: Crurn&Forster Specialty Insurance Company 44520 i INSURED INSURER B: Thomas Morin,DBA Valley Roofing&Restoration INSURER C: 143 Parker Lane INSURER D: INSURER S: Ludlow MA 01056 INSURER E.: COVERAGES CERTIFICATE NUMBER: CL.2292904057 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 Ik-TYPE OF INSURANCE INSODL wvnSlIBR POLICY NUMBER lIPMJODY.YYYY POLICY EFF NDD//YYYY) LIMITS LTR INSO MD L I XI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE 70 RENTED 100,000 CLAIMS-MADE rX CCCUR PREMISES(Ea nccuneratel 5 MED EXP(Any one person) S 5,000 A BAK-69939-2 09/25/2022 09/25/2023 PERSONAL&ADV INJURY S 1,C00,003 GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2.000,000 /��POLICY PRO 1 LCC PRODUCTS-COMP;CPAGO 5 2.000,000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea acc4dent) ANY AUTO BODILY INJURY(Per person) S — O '-- acu -'SCHEDULED BODILY INJURY(Per dortI S AUTOS ONLY _ , AUTOS HIRED NON-OWNED PROPERTY DAMAGE c AUTOS ONLY AUTOS ONLY {Per ar 4cenIl S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MACE AGGREGATE -S ICED RETENTION S I - 5 — WORKERS COMPENSATION PER OTH. STATUTE ,ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERTEXECUTIVE f I NIA E L EACH ACCIDENT 5 OFFICER/MEMBER EXCLUDED (Mandatory in NH) • E L DISEASE-EA EMPLOYEE S If yes.describe under DESCRIPTION OF OPERATIONS ce(ax E L DSEASE-POLICY LIMIT S _1 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES IACORD 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 City of Northampton Dept of Building Inspections ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main Street AUTHORIZED REPRESENTATIVE , Municipal Building •\ • 1 ' ' Northampton MA 01060 '.y, `- i '` •` T'- t C)1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2015/03) The ACORD name and logo are registered marks of ACORD Valley Roofing & Restoration CSL# CS-112460 HIC# 185148 Please mail permit to: 143 Parker Lane Ludlow MA 01056 or Email to: valleyroofingandrestoration@gmail.com *If you cannot do either of these can you call 413-230-8076 so that we know permit has been issued Thank you ! Torn Morin • 143 Parker Ln. • Ludlow MA 01056 • (413) 230-8076 valleyroofingandrestoration@gmail.corn