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25A-089 (3)
50 COOLIDGE AVE BP-2021-1038 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A-089 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-2021-1038 Project# JS-2021-001767 Est.Cost: $11020.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ROBERTS ROOFS CO INC 100333 Lot Size(sq.ft.): 6795.36 Owner: CAROL CARSON-LEINHART Zoning: URB(100)/ Applicant: ROBERTS ROOFS CO INC AT: 50 COOLIDGE AVE Applicant Address: Phone: Insurance: P 0 BOX 1312 (413)283-4395 Workers Compensation BONDSVILLEMA01009 ISSUED ON:3/23/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & 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. I Y 9-1'I • Certificate of Occupancy Signatu ': 10 FeeType: Date Paid: Amount: Building 3/23/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner '4\NN‹<\ The Commonwealth of Massachus s S Board of Building Regulations and.San rdsPRALITY Massachusetts State Building Code, 71SSE Building Permit Application To Construct, Repair Reno e^ viMar 2011 One-or Two-Family DwellingjThis Section For Official Use Only ✓ , Building Permit Number: �j a Yl s )- I Q 3 Date Applied: / kEu Ik) 1203 ________716Z3-Z -7-0ZI Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assg ''�Iap& Parcel Num e 50 Coolidge Avenue ASS JJ 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 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: Carol Carson-Leinhart Northampton,MA 01060 Name(Print) City, State,ZIP 50 Coolidge Avenue 320-9331 c.carsonleinhart@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building El Owner-Occupied IR Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: Remove&replace existing shingle roofing with new lifetime architectural shingle roofing complete with all associated flashing details. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: i Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees hi 2 c (�Qash Check No. heck Amount: 6 Amount: 6.Total Project Cost: $11,020.00 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 100333 7/3/22 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 Belchertown,MA 01007 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry ‘ n P. N� RC Roofing Covering S WS Window and Siding SF Solid Fuel Burning Appliances 413-283-4395 info©robertsroofsinc.com I Insulation Telephone Email address D Demolition L� 5.2 Registered Home Improvement Contractor(HIC) 128264 .3 4 l 1_ .3�103 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 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 Roberts Roofs Co.,Inc. to ac 7 my behalf,in 3 matters-relat've t or authorized by this building permi a li a / a ' /Le. .zaz Print Owner's Name lectronic Sign re) Date SECTION 7b: OWNER'ORAUTIiORIZED 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. Pri t ner's or Authorized Agent's Nam 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" Commonwealth of Massachusetts tif Division of Professional Licensure Board of Building Regulations and Standards Construct t4S i6ptr Specialty CSSL-100333 E spires: 07/03/2022 THOMAS R ROBERTS, JR �- 400 FRANKLIN STREET, BELCHERTOWJJ MA 01007 ' C11-11 Commissioner daA ifs" Construction Supervisor Specialty Restricted to: CSSL-RF - Roofing Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl 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.05117 .Tr' Irvii7iir7uivvi/// 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 teizort qzok THOMAS R. ROBERTS JR ✓ � � 400 FRANKLIN ST r. sOtt i tdc BELCHERTOWN,MA 01007 Undersecretary Not valid without signature City of Northampton <9•y 44,:i1 S`5 «..`sic "yy" Massachusetts „? _ 4 • � DEPARTMENT OF BUILDING INSPECTIONS r fi 212 Main Street • Municipal Building sJi ,I,�. �. .;. Northampton, MA 01060 JIh 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: 0 S- \-\c t \ v-, A Rse c Ats t^c, The debris will be transported by: Name of Hauler: 0 k \o,VVv,y A -ec �\' 1 Signature of Applicant: ---- --) Date: 3 f i 41k.1 fc ' The Commonwealth of.Massachusetts 1:4 _ .G Department of Industrial Accidents —" ► "'11 1 Congress Street, Suite 100 MN A)v � '=z. — ,r Boston, MA 02114-2017 '' lr►v►w.ntass.gov/dire lt'utkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. It)BE FILED%% flIE PERMITTING At IllORI l 1. Applicant Information Please Print Lerlibis Name i Bus Inds Organization Individual): Roberts Roofs Co.,Inc. Address: PO Box 1312 City/State/Zip: Bondsville,MA 01009 Phone p: 413-283-4395 Sri tau an employer?Clerk the appropriate hot: Type of project(required): 11E1 I.ut a eupluytr with -__2 .-_. employees tfull and ur part-time).* 7. 0 New construction `.D I am a sole prupnetur or punnerahip and hate nu employees wurking forme in fl. O Remodeling any cap-icily.[Nu v.urkcrs'comp.insurance required] 9. 0 Demolition t0 I am a h umeowrun cluing all work myself.[No wurkats'comp.insunoue n�yuinyl.]` :.0 I am a lortstvw nit and will be hiring contractors to conduit all w oiL on my property. I will 10 El Building addition enure that all comm.-tura either hate worker;compensation in urantc or are sole II.[3 Electrical repairs or additions prupnetu s w ith nu employees. 12.0 Plumbing repairs or additions sinI am a 4't-ncral cunuactur and I hate hired the sob-contractors listed un the anachod sheet 13N Roof repairs These sub-cuntr3cturs h»e employees and hate workers'cuinp.ra uranic.' 6.0 We arc a corporation and officers hate exercised their nghrt of exemption per M(il. 14. Other 1 y';1(41.and we hate no employees.[No workers'comp.insurance required.] *Any applicant that checks box a I must also fill out the section below show ing their workers'compensation policy information_ r Homeowners who submit this atltdatit indicating talcs arc doing all w ink and then hire outside contractors must submit a new affrdat it indicating such. :Contractors that check this but must attached an additional sheet show ire the name of the sob-contractors and state whether ether or not dose tatitie-s hate .-inpLnec, It the sub-contractors Lose enplutccs.tho must pmsidctfieir workers'comp.policy mmmbcr. I am an employer that is providing►corAers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Farm Family Casualty Insurance Co. Policy#or Self-ins.Lie. #: 2008W6216 Expiration Date: 4/17/21 Job Site Address: SO Coo\.a3e Nve City State.Zip: Nc,r 1 Mi4 O1060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under`1GL c. 152. *25A is a criminal violation punishable by a fine up to S1.500.00 and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DR 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: Dale 3f14/J-I Phone z: Official use unit'. Do not write in this area. to be completed b1'city or town official ('its or Town: Permit/License Issuing:Authority (circle one): I. Board of Health 2.Building Department 3.('icy. Tossn Clerk 4. Electrical Inspector 5. I'Iunihiti Inspector 6. Other Contact Person: Phone#: ACG'RIE) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/15/2020 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 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: Sean Patrick Rooney,Sr.dba PHONE 413-887-8817 FAX 877-771-6087 INC.No.Extl: WC,Nok Rooney Insurance Services ,,,Do Imo, sean.rooney@fam)-family.com 2341 Boston Rd. INSURERS)AFFORDING COVERAGE NAIL/ Wilbraham MA 01095 INSURER A: Farm Family Casualty Insurance Company 13803 INSURED INSURER B: Roberts Roofs Company, Inc. INSURER C PO Box 1312 INSURERD: Bondsville, MA 01009 INSURERE: 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. INSR ADDL SUBR POUCY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIAINUTY EACH OCCURRENCE $ 1 000,D00 DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ 100,000 MED EXP(Any one person) S 5,000 A _Business Owners Policy 2007X0329 04/17/20 04/17/21 PERSONAL&ADVINJURY S 1,000,000 GENL AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY Ec LOC PRODUCTS-COMP/OPAGG $ 2,000,000 I OTHER: _ AUTOMOBILE LU181LI Y COMBINED SINGLE LIMIT $ _ (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE s HIRED AUTOS .. AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS I IAB CLAIMS-MADE AGGREGATE S DED RETENTION S S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 2008W6216 04/17/20 04/17/21 E.L EACH ACCIDENT S 100,000 A OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 100,000 It yes,descnbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ 5005)00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it 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