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31A-117 (13) BP-2024-0692 32 VERNON ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31 A-117-001 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-2024-0692 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2024 Contractor: License: Est.Cost: 4600 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date:06/03/2026 Use Group: Owner: SAFE JOURNEYS LLC Lot Size (sq.ft.) Zoning: URB Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Eh= Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER, MA 01011 ISSUED ON: 06/04/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF SECTION A&B 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: 7 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:E0540BBB-5938-4286-B30D-F7462228B7E9 The Commonwealth of Massachusetts ' t/ F R Board of Building Regulations and Standa dssa IC ALITY Massachusetts State Building Code,;780 RAY 3 1 2024 1 SE Building Permit Application To Construct, Repair Ren to Or Demolish a evise Mar 20/1 One-or Two-Family Dwelling ntn,1-4.; n, jj y isj�� ction For Official Use Only --� on; rtq �Ns Building Permit Number: 6'/g4 -('/•24 Date Applied: Jai a'53 //i Z (o ..y-ZD2q Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 34 Vernon St Northampton 31 A-117-001 1.1a 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❑ On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Safe Journeys LLC c/o Mark Dean Northampton, MA 01060 Name(Print) City,State,ZIP 34 Vernon St. (413) 923-4992 markdean6@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 ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 4j"pecify: Roofing Brief Description of Proposed Work': Spring 2024 (or sooner if weather allows). Strip and replace asphalt roof on section A& B SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 4,600.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (IIVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fessji / Check No\ Check Amount: —1" Cash Amount: 6.Total Project Cost: $ 4,600.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:E0540BBB-5938-4286-B30D-F7462228B7E9 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 List CSL Type(see below) U 156 Northampton St., No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Easthampton, MA 01027 R Restricted I&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 156 Northampton St. stonemountainroofinglIc@gmail.com No.and Street Email address Easthampton, MA 01027 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 4/ 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. r—Docusigned by: 12/20/202 3 Safe Journeys LLC c/o Mark Dean Print Owner's Name(Electronic Signaturey`121E71cA4A8242F. Date SECTION 7b:OWNERS 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 t the best of my knowledge and understanding. Matthew Carrier °� �^- 5 Jac) o100?� Print Owner's or Authorized Agent's Name(Elec nic S► ature) late 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 H1C 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:E0540BBB-5938-4286-B30D-F7462228B7E9 City of Northampton • �' 5�5,"`"SIC Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jti CL 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: 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: of «►_-- Date: 51,�Cj 1ao9 I. The Commonwealth of Massachusetts tr= Department of Industrial Accidents __;`, =_ ' Office of Investigations "�i= Lafayette City Center ": =: 2 Avenue de Lafayette, Boston,MA 02111-1750 d www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (t3usiness/organization/Individual): Stone Mountain Roofing LLC Address: 156 Northampton St. City/State/Zip: Easthampton, MA 01027 Phone#:413-998-9010 Are you an employer?Check the appropriate box: I am a general contractor and I Type of project(required): 4. 1.❑ I am a employer with ❑ 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. 0 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, §I(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. :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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins. Lic. #:7PJUB6R27941623 Expiration Date:02/17/2024 Job Site Address: 3t-1 v Q!1'nx' &V" City/State/Zip: NOT"-i+Ct iVitn CICA 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 cee�'rtify y�under the pains and penalties of perjury that the information provided above is true and correct. Signature:G Zr1,l6fceco 64,1-ied, Date: 6 Jag ) aC L 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): 10Board of Health 20 Building Department 3.DCity/Town Clerk 4.1:Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: Ace OR CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDIYYYV) 01/23/2024 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 Michelle Lastowski NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 IA/C,No,Ed): _(A/C,No): _ Webber&Grinnell Division E-MAIL mlastowski©webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC 11 Northampton MA 01060 INSURER A: Berkley Specialty Insurance Co INSURED INSURER B: Arbella Protection 41360 Stone Mountain Roofing LLC INSURER C: WCAR-Travelers 156 Northampton Street INSURER D: INSURER E Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 2025 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. INSRR TYPE OF INSURANCE N°SD WVD POUCY NUMBER POLICY EFF POLICY EXP UNITS (MMIDO/YYvr) (MMIDDlYYYY) X COMMERCIAL GENERAL UABIIJTY EACH OCCURRENCE $ 1000, ,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $DAMAGE TO RENTED 100.000 MED EXP(Any one person) S 5,000 A CGL0159193 02/18/2024 02/18/2025 PERSONAL aADVINJURY $ 1.000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000,000 JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY OTHER S AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) S g OWNED X SCHEDULED 1020114776 02/18/2024 02/18/2025 BODILY INJURY(Per accrdeni) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY (Per acadent) PIP-Basic S 8.000 UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION T PER OTH- AND EMPLOYERS'LIABIUTY YIN I STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A 7PJUB6R27941623 02/17/2024 02/17/2025 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 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 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • ► DocuSign Envelope ID:C3F8DBF1-4786-4A03-8C3B-95A95F5724F01 1 f Massachusetts Department of Industrial Accidents a t Office of Investigations -? . Lafayette City Center vium,y- 2 Avenue de Lafayette, Boston, MA 02111-1750 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PINGUINS CONSTRUCTION LLC Address:39 Serwan Ave City/State/Zip:Willimantic, CT 06226 Phone #:413-799-0210 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 18 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. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* 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. ✓❑ 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. 1 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. Insurance Company Name: National Specialty Insurance Company Policy#or Self-ins. Lic. #:NXT7EUNZ21-02-WC Expiration Date:07/18/2024 Job Site Address: 4 \i QX rer\ City/State/Zip: N DO-NVI\O rn 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. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. f.�— uSl ned by: Si. �r nb� Date: 5131 1306L1 Phone#: 41'37 °UeY4f143E.. 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 3.DCity/Town Clerk 4.0 Electrical Inspector 5.0Plumbing Inspector 6.0Other Contact Person: Phone#: PAIGU-1 OP ID:DA ,4coRo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/08/2024 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 860-563-9353 Mi€ACT Charles G.Marcus Agency,Inc. Charles G.Marcus Agency,Inc. PHONE 860.563.9353 I FAX 860-257-8404 842 Silas Deane Highway (A/C,No,Eat): WC.No): P.O.Box 290756 gg: Wethersfield,CT 06129-0756 Charles G.Marcus Agency,Inc. INSURER(S)AFFORDING COVERAGE NAIL A INSURER A:MSA GROUP 14788 INSURED INSURER B: Pingguins Construction LLC 39 Serwan Avenue INSURERC: Willimantic,CT 06226 INSURER D: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADOL SUM LjR TYPE OF INSURANCE NSD POLICY NUMBER ( DpY'EPF I IPO YXYPYI LIMITS A X COMMERCIAL GENERAL I ABBJTY EACH OCCURRENCE S 1,000,000 CLAIMS MADE X OCCUR X MPJ9003D 07/23/2023 07/23/2024 DAMAGE TO _ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $ 1,000,000 GEM_AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY l JECOT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER AUTOMOBILE LIABILITY COD ac Ent) LIMB ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSRREE�� ONLY _ AUTOS yy Ep PBODILY INJURY(Per acddent) $ AUTOS ONLY AUTOS ONLY PRO pAMAGE $ Per ll S UMBREU.ALMB _ OCCUR EACH OCCURRENCE S EXCESSLYIB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y(N STATUTE ERA ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT S OFFICER/MEMBER F(Mandatory ER EXCLUDED' N I A NH) EL DISEASE-EA EMPLOYEE $ If yes,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Stone Mountain Roofing,LLC.is listed as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN STONE MOUNTAIN ROOFING, LLC. ACCORDANCE WITH THE POLICY PROVISIONS. 156 Northampton Street Easthampton,MA 01027 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) AC-ORE, `-O CERTIFICATE OF LIABILITY INSURANCE 07/18/2023 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 NAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 1 FAX PO Box 60787 (AIC.No.Ext): (ANC,No): Palo Alto,CA 94306 A support@nextinsurance.com ADDl7DRE3S: INSURER(S)AFFORDING COVERAGE NAIC U INSURER A: National Specialty Insurance Company 22608 INSURED INSURER B: PINGUINS CONSTRUCTION LLC INSURER C 39 Serwan Ave - Willimantic,CT 06226 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:648092494 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 TYPE OF INSURANCE ADDL 3--Uk POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM DI IDDIYYYY) (MMIDYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) S PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY Li JE-- Li LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ i' OWNED ; SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY I__ AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE_ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ 'WORKERS COMPENSATION XPER AND EMPLOYERS'LIABILITY AND _ ER Y N A ANYPROPRIETORIPARTNER/EXECUTIVE / E.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBEREXCLUDED? Y NIA X NXT7EUNZ21-02-WC 07/18/2023 07/18/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The Certificate Holder is STONE MOUNTAIN ROOFING LLC.A Waiver of Subrogation applies in favor of this Certificate Holder on the following policies:Workers Compensation. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION STONE MOUNTAIN ROOFING LLC LIVE CERTIFICATE 36 Lyon Hill Rd • I1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE , Chester,MA 01011 r.ti•� ol ! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN �`_• ACCORDANCE WITH THE POLICY PROVISIONS. OW # .; =+. ; AUTHORIZED REPRESENTATIVE ❑ '*:j fed ,-0,, Click or scan to view ©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 R ulations and Standards Cons t - ioniS visor y CS-117335 s- I pires:06/03/2026 MATTHEW CARRIER 36 LYON HILi�ROAD CHESTER Mit01011 .,.. 0 rill) 44��f.hVrliY3 Commissioner drId, K. 13tni.tiA, THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai and Business Regulation 1000 Washingt_ t-Suite 710 Boston,Massasttusetts 02118 Home Imlero:`en=c'• t`ctor'eistration r � - (9,0. 1ype: LLC =.? 1--'egisifation: 206447 STONE MOUNTAIN ROOFING,LLC -�L.= p'itation: 09/15/2024 36 LYON HILL RD _ CHESTER.MA 01011 = ,,, i ' '7., fY ' 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: TYPErliC Office of Consumer Affairs and Business Regulation Registration g -Expiration 1000 Washington Street-Suite 710 208447"•.44_09/15/2024 Boston,MA 02118 STONE MOUNTAIN R .1_ 14LC, - rj_ 36 LYON CARRIER __Li _, ,, /l+1 N 38 CHESTER, HILL 0 r.. . r//� ' I` \\\\\\ CHESTER,MA 01011 �- ..�� Undersecretary Not valid without signature v DocuSign Envelope ID:E0540BBB-5938-4286-B30D-F7462228B7E9 Stone Mountain Roofing IILC ° %% 156 Northampton St Easthampton,MA 01027 �/®�s• 413-998-9010 stonemountainroofingtic@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT# 1251 Safe Journeys LLC DATE 12/20/2023 do Mark Dean 34B Vernon St., Northampton, MA 01060 markdean6@gmail.com (413) 923-4992 DESCRIPTION This contract is for the areas labeled "A, B" See attached diagram. 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 ice and water shield on the slopes entirely 5. Install new 8" aluminum drip edge on all eaves and rake edges 6. Install architectural shingles by CertainTeed (Landmark PRO) https://www.certainteed.com/residential-roofing/products/landmark-pro/ Color Choice: MAX DEFINITION BURNT SIENNA 7. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) http://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/shinglevent2 8. Complete all necessary flashings including new LIFETIME pipe boots https://lifetimetool.com/product/ultimate-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 premises undamaged. WE ARE NOT RESPONSIBLE FOR DEBRIS THAT MAY FALL INTO ATTIC. Please be proactive and prepare for the worst by covering everything in the attic. We recommend covering with tarps or plastic sheeting. Please use reasonable caution during the installation process: do not walk or drive under active work, or on areas of potential roofing debris. Stone Mountain Roofing will obtain the necessary building permit. Installations are weather permitting; inclement weather will cause scheduling delays. Either party may cancel this contract for any reason,up until the time of firm scheduling and/or the second deposit, with a full refund of deposit less any permit fees paid. MA-CSL#117335 MA-HIC#206447 CT-111C.066832 I DocuSign Envelope ID:E0540BBB-5938-4286-B30D-F7462228B7E9 DESCRIPTION Section "A": Landmark PRO shingles=$3,900 Section "B": Landmark PRO shingles =$700 TOTAL= $4,600 Thank you for choosing Stone Mountain Roofing. Expected Installation: Spring 2024(or sooner). A $500 deposit will secure contract, permitting, material order, and priority scheduling. The balance of the one-third deposit, $1,000 will be due prior to installation. 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 $4,600.00 Accepted By _�wn�bY /�y-� Accepted Date 12/20/2023 121E71CA4A8242F MA-CSL#117335 MA-I-IIC#206447 CT-I-IIC.0668321 DocuSign Envelope ID:E0540BBB-5938-4286-B30D-F7462228B7E9 \IA A DS B Front of the house