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31B-089 (2) 152 STATE ST BP-2021-1053 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31 B-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-2021-1053 Project# JS-2021-001789 Est.Cost: $15700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: FREDDY CAMPOVERDE 106011 Lot Size(sq. ft.): 21039.48 Owner: JILL STERN Zoning: URC(100)/ Applicant: FREDDY CAMPOVERDE AT: 152 STATE ST Applicant Address: Phone: Insurance: 20 TATTAN FARM RD (508) 873-1884 Vv'(' WORCESTERMA01605 ISSUED ON:3/24/2021 0:00:00 TO PERFORM THE FOLLOWING WORK:STRI P & 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. Certificate of Occupancy sOnatur,"e; V'• _59 - 591F FeeType: Date Paid: Amount: Building 3/24/2021 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner /� c&- The Commonwealth of Massachusetts �,,j 'j 1 Board of Building Regulations andStandhr �Q9�,� 1 FOR �, Massachusetts State Building Code,7.80,s*, ����° �08 US ITY Building Permit Application To Construct,Repair,Renovate a ised ar 2011 One-or Two-Family Dwelling ..iv.",q p ,„ III This Section For Official Use Only oGti� Building Pe it Number:- 117 '1-/O6j�j Date Applied: k tv/C55 3-zi-i-2oz) Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Ad ess: 1D6 -a tclii9 ) 1.2 Ass sods Map&Parcel Numbaq 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: Zone: _ Outside Flood Zone? Public PI Private❑ Check if yesC Municipal E/On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O ner'of Record: lit. S- t .?" ‘Al lain n r )P DiaDO Name rint) City,State,ZIP 1 • 15� S'►ce 9I -(�ac-'-1 1� J111 pafc0>1 SS .,'n@ f-"' 6 .con, No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) a Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other a-Specify: I--('(XJ.( Brief Description of Proposed Work2: 1� 6A n a v!rbof SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ )5)106. bb 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fee Check No.3 . eck Amount `0 Cash Amount: 6.Total Project Cost: $ 15 I I DO. Ob 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES O 5.1 Construction Supervisor License(CSL) I UD O I a I LO(A,q U,U � \' License Number Expiration ate Name of CSL Holder rC A) �l rn List CSL Type(see below) No.and Street Rol Type Description t n, ( Q Sr rn& h 1 b(`� U Unrestricted(Buildings up to 35,000 Cu.It.) i V► n,S ' ' I 1 U` `J R Restricted 1&2 Family Dwelling City/Town,State,ZIP J Masonry M ( RC) Roofing Covering S Window and Siding n SF Solid Fuel Burning Appliances � O i Gi ,� et,A ctu '( I Insulation Telephone Email a ess V D Demolition Registered Home Improvement Contractor HIC) 11 91 I O 3 I a I at 1101 cn-miew LOT HIC Registration Number Expiration Date ponampy_Ngme or H Registrant ame tir In-feydr2Anyou,f)rha-fin3. n Street Email address (r (��-eX r( \to 6 s �$r3J18�1 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 id 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 @t)\()J2fl ` ea3ukAD :)j)(A. ,VIA.(i-11,0Y\ Lore to act on my behalf,in all matters relative to work authorized by this building'iermit application. 2� 4 a Ill. -( Print Owners ame Electronic Signature) ate 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 th4.pplica' n is true and accurate to the best of my knowledge and understanding. Print Owners 0thorized Agents Name(Electronic Si ature) I 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" City of Northampton HA�}F Massachusetts Q _ it ! � t 14, DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building +„ Cs� 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: -n1 -no Lokil CUner ServiCzs 3uq Lociram,n Hl l Rof ,, 3o<. b) -) , r The debris will be transported by: Name of Hauler: Signature of Applicant: �� Date: The Commonwealth of Massachusetts iii... liip Department of industrial Accidents I 1 Congress Street,Suite 100 ' -rri Boston,MA 0211 d-2017 www.mas,A ovidSrin W um kern'Compensation Insurance Affidavit:Buiklertl[:ontractorsiElectr'icianstPluntbers. It)HE PILED Vt11"Ii"I lik PRItM1TI`INC AI?1'IIORIT%'. Annllraitt Information Please Print LeiibIN Name(ltatiocs,Organ zaxion Indiridualt. �a 9x) .-,k .Li u _..__ _ Address �� ' t Dli!r\ .E ,I City/State/Zip.........._... ' ..^. '' ! aD_Fr....� 0. Phone#:...._. 1�_.. S-1 _ _1..t�.._� .__.._,.__. Art yea ea mial art!(Aril the appropriate boa 1y pe of project(Mildred):I.�l area employer with _employee*(full antiMi p aigime1." 7, D New construction 20 I ant a auk psuprrerua or partnership and have no enintoyeee wurkuts fur mew 8_Q Remodeling may capacity.[Nu wutktts'comp.itntanante rerttareai_t 30 I mt J huttatirvrter doing all pant r yhelf.NU wur►atss'comp_imiurance remlited.) 9. 0 Demolition I U 0 Building addition ,i(""t I am a luittrutar�att and will lar hinny uawttraudorr to rartndtcct all wrirk on my pn!erty I will e +ensure that dl connectors either bane aearteriC eutripeniut7txt unsuranew or wo xnle I I.0 Electrical repairs or additions pnvptiakrrs wain nu employee,.. i 2_Q Numbing repairs or additiotntt Sri I ant a general contractor and I but hired the iub-contraccutr hated on the mutated sett. These;sub-contractors haw employemand have workers'comp.insurance. 13.0 goof repairs 6.©We a.re a uenpuranun and it*officers have eaem."iteed then ngla at exemption per MC&c_ 1.4. Other Iti.§I{;'t.and we hint no engrlrryeer.[solo workers'comp.insurance reguired.l *Any uppltcin t tout c ua la box tri,rubs ahaz fill um the wawa beloir a6uwinns abcat outlets'tumpenwrtiva pulicy udurtrtnliva.. +Homeowners who submit thus affklak it ardicatin[t.they are doing all work and thin hire irat►hie contract mm turmoil a new affnla4 it itaL c: ng.urh >C..out:r:nc5ury sla:it check dux Ixak ntu>:I;dialed an axlaltlivatal abed alxnuinit thc nartx attic xub•turtttut'[urs end'stak vcitttOtz or nut tfwrtt ctc[n[ncx:lta:: ctnplu'.ccy If the gum urguta.r,n:4 hrrr cntpIbte+cs,rho,.Nlir.1 hai,ide this uurk.ers'o,nr policy nuink-r I am an employer that is'providing workers'compensation insurance for my employees'. Below is the policy and Job site information. Insurance Company Name: L1gA, 1 1 1 L` A IL I Policy#or Self-ins.tic.#lt-D- l 5 05 5 S-1 () a 9 Expiration Date: V' I et I a Job Site.Address:_1 � We-e_.4' City/Sutte'Zip,: N I V 1 a(,NI C1\AR OA V J O`U Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration duce$. Failure to secure coverage as required under NiGL c. 152,§+25A.is a criminal violation punishable by a line up to 51.59(I:00 am dior one-year imprisaannx:nt,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. - I do hereby certify a r the pa .t and pen 'es of petjary that the 'tformation provided above is trite and correct Signature: Date_ 3 1 LC, ( a-I Phone ) - '-12")1 l 65i Official are only Do not write in this antra,to he completed bp city or town ref frrinl Cit.', ur [own: Pernik/License tr l„uing!.tuthority(circle one): I. Rneird of health 2.Building Department 3.t'ityffowu Clerk 4.Electrttat inspector S.Plumbing Inspector 1,Other Cott tact Person: Phone#: • r owe OM of Nizes.1,..H.fo ,,ett.%Cornolo , MTDiosiort of Ploftessional Ltilt49,,40t, 11 ,. ci, °,4 o l3 f ol riff thlioo Refl000c,n find Stanel,o• , 'S,ofistroction-•,,,liper-ittof 5oer.1,tity CSSI-106011 Kipires-,06/02/2021 .: .• FREDaY C AMPOVERK4i.- 20 TATTAN FARM Rait0,i . ':•••••:',;', It. woRC ESTER MA 01641r, ` ,.. .„ ' \ Conimisstoner . ,.........,_ _._ before the expiration date.l and Business Regulation Officefl3°MCC iMnP"TRI'ny04::,V—EAHE:M°cBrtys.N00-LT(iluCat?son'INfiTe5fLI:e."T.k0dRali" RaglAtill= C`, LQ"n,,1 03 112073 114/18 Rcei:011;:ctsaewl nroaaf:s:C:Aoinnngvosat2O imi nd:easf rot Street elf len ptd Is Sk ii ut"I found taal us1 ee.return only to: GOLDEN GROUP CONST RUC..110N CORP A ___ ,,HEDDy cAmPoVERDE .:-.4,7-sr'' =,,VALLEYWOOD RD_.„ undersecretary HopKiNTON MA Oli-- Not valid wit out signature , .:. ,.. , ',••-• . -- - .,,:.. ..,,•„..„,,,.. ,,,..-,,,..,-;...,-.-,sw„..-,e.:•.',.,•°,•••„:•••••....,...,F..ii:.,•,,,,..pr.vk,...::<•:.,,,,,,.?•,',',' -',...,--••.:.`• . „, .- .,-, -,..*,, .*.•••.:ko, '•,-.11.4-•••i„:,,,,. .;Q,14%,•••„i':•,'s,,,,'•'•-,•-• •=.,,.,v-',,,',, :".-':;','•-i,''.,,,,,'',, ,' •.,„ .,.-,•„ :*,,,,,:i.i,.,;-•,,,i---;,'',.-.411*-PAvi'ii,A4..ve:.:,i,'•:',•,,,-,'-4•44':,,',Z.',?-'.',,,,:.::4:,',',!'. , . . 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',- , .,,:.-z-,:,,,-',: •,:uiFft:0,,1V,:; •,'•,,,,,,..;,-,,,,;3.m.',1 ; ,„:„.„,..,,, , ,,,,,,,,,,ti.„0..,,,N,..i.„4,,,atrksw TA i',''','''';';',;:lj'ig ' lf•.4-, •••,,,,':)..,t X.'.,..: .•;•,..•;;•,,,,,,:t,....VO".g.A..%,.,•'At,',,,v,,,'' P ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 03/16/2021 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 Shoshana Romanoff NAME: Fisher Insurance Agency,Inc. PHONE 508-853-2400 FAX (ALC.No. (A/C,No): 194 West Street, Suite 7 ADDRESS: sromanoff@thefiai.com INSURER(S)AFFORDING COVERAGE NAIC# Milford MA 01757-2274 INSURER A: Mesa Underwriters Specialty Insurance INSURED INSURER B Golden Group Construction Corp INSURER C: 20 Tattan Farm Rd INSURER D: INSURER E: Worcester MA 01605-1056 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. ILTR TYPE OF INSURANCE WgD WVD POLICY NUMBER WPOLICY EFF POLICY EXP LIMITS (MMIDD/YY ) (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO RENTED $ 1,000,000 CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A NN1163723 09/26/2020 09/26/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n Fin n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Deductible $ 2,500 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 PER OTH- AND EMPLOYERS'LIABILITY Y(N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Puchalski Municipal Building ACCORDANCE WITH THE POLICY PROVISIONS. Building Departement AUTHORIZED REPRESENTATIVE 212 Main Street �f1 Northampton MA 01060 I �✓ t� • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/16/2021 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 NAME: Jonatan Della Costa A-COSTA INSURANCE AGENCY INC (P.t,"cc°.No.Ex1): (508)875-3488 FAX (A/C, -- E-MAILa-costains.com _ ADDRESS: JonG 2 FRANKLIN COMMONS INSURER(S)AFFORDING COVERAGE NAIC# FRAMINGHAM MA 01702 INSURER A: LIBERTY MUTUAL FIRE INS CO 23035 INSURED INSURER B: GOLDEN GROUP CONSTRUCTION CORP INSURERC: INSURER D: 20 TATTAN FARM ROAD INSURER E WORCESTER MA 01605 INSURER F: COVERAGES CERTIFICATE NUMBER: 632512 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 SUBR POLICY EFF POLICY EXP LIMITS LTRINSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO D $ CLAIMS-MADE OCCUR PREMISES(EaENTE occu occurrence) $ MED EXP(Any one person) $ N/A PERSONAL s ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ JECT - _- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _ AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ I WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY eN STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A NIA NIA WC231S385387030 04/19/2020 04/19/2021 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached If more space la required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in slates other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. 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. Puchalski Municipal Building 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Daniel M.CroVey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD GOLDEN GROUP ROOFING GOLDEN GROUP CONSTRUCTION CORP. ADDRESS: 20 Tattan Farm Rd., Worcester, MA, 01605 OFFICE: 508-873-1884 EMAIL: info@goldengrouproofing.com WEBSITE: www.goldengrouproofing.com CONTRACT PARTIES: 1. GOLDEN GROUP CONSTRUCTION: FREDDY CAMPOVERDE&GRETA BAJRAMI 2. CLIENT: Jill Stern GENERAL CONTRACTORS AGREEMENT iiWe, the Owner(s)of the premises described below, hereby authorize you as contractor to furnish all necessary materials, labor, and workmanship to install,construct, and place the improvements described herein according to the following specifications, terms and conditions on the premises described below Property Owner Email: Phone: Name: Jill Stern jillparsonssternyahoo.corn 413-695-4070 Home Address: City: State ZIP Code Northampton MA 01060 152 state street Construction Address City State ZIP Code *Of Dtfferent From Above) 'The items listed below will represent the full extent of work to be performed.Any alterations or deviation from these specifications involving extra cost for material and labor will only be executed upon written orders, and will become an extra charge,over the sum on the contract. Home as a construction site: Your home will be a construction site during the installation of your products and it will be noisy. There may be a significant amount of job debris associated with your project installation, most of which will be cleaned up and removed at the end of each day, and fully upon job completion. However, it is possible some nails or debris may be missed during initial site cleanup. We recommend the homeowner use caution when walking around the construction site (especially children and pets) to avoid possible injury. Remove All Items from Interior Walls: Please remove pictures, mirrors and other items that are not securely attached to the wall areas inside the home. This includes items such as plates displayed on a plate rail and fragile items on open shelves. Preparation (Tear Off): Golden Group Construction Corp. will tear off existing product material and dispose of it properly, If hidden layers Not Included In Contract Terms are found, they will be removed at an additional $25 per square, per layer. Rotten or Deteriorated Wood; The exact Condition of your existing Roof Wood cannot be verified until we remove your products. If Rotten or Deteriorated wood is discovered After removing your existing product, additional charges will Apply. Repairs to your home may conflict with the original estimated completion date. Golden Group Construction Corp. has your Approval to replace or repair if any damage found, at an additional cost. Approximate costs for re-sheeting/new sheeting will be; • Fascia: 1 by 2 inch $4.50 linear foot • Fascia: 1 by 12 inch $11.50 linear foot • Plywood: $80.00 per sheet • Wood Boards: $8.00 per linear foot Skylight Installation;. When installing new Velux skylights units there may be a 1-2 inch gap throughout the interior frame. It is homeowner liability to finish any interior skylight carpentry interior finished work. Velux skylight units are manufactured in standard sizing and are not available in custom unit sizes. Golden Group Construction Corp. will select the best size to fit to the existing frame. Upon installation of Velux Skylights, Golden Group Construction Corp. will not be held liable for unknown product defects after installation. In the event that product defects are detected after installation, Golden Group Construction Corp. will direct the homeowner to the Velux Territory Manager. Cupolas: Golden Group Construction Corp. will take the necessary precautions to ensure that roof accessories are protected. However, Golden Group Construction. Corp will not be held liable for the removal and reinstallation of any existing cupolas. If there is an existing cupola, please inform Golden Group Construction Corp. for an inspection. Golden Group Construction will not be liable for roof cupolas, as these items are third-party accessory items that rot with time. Setup Job Access: Golden Group Construction Corp. has your approval to access the driveway for delivery of the products and dump truck (if applicable). Please let us know where you would like INITIALS: us to stage your materials (where to place the materials, dumpster, park vehicles, and where to store our equipment). Keep in mind that everything we use needs to be as close to the house as possible. Our workers need access to a grounded electrical source in order to run their equipment. Please ensure all pets and animals are properly secured. Please notify us prior to starting the job if you have a sprinkler system, septic field or well, and if so the location(s). Cleanup: At Golden Group Construction Corp., cleanup is important. We will remove and dispose of all product/project debris. It is possible some nails or debris may be missed during initial site cleanup, and the homeowner must notify Golden Group Construction Corp. to request a proceeding cleanup. Plants & Shrubbery: During the installation process some damage may occur to the surrounding plants and shrubbery. Golden Group Construction Corp. will take every precaution to protect plants 1 shrubbery. Golden Group Construction Corp. will not be held liable for any plants or shrubbery. Satellite Dish: Golden Group Construction Corp. will remove existing satellite dishes from the roof. It is recommended that customers have an appropriate satellite company reinstall to the side of house or facia board. Due to technical considerations Golden Group Construction Corp. is not responsible for alignment of dish to satellite. Attic Space: Golden Group Construction Corp. is not responsible for Dust or Shingle Particles in attic space. It is homeowner Liability to cover up and protect attic space prior to installation of roofing. Adverse Weather: The homeowner is to be notified 5 days prior to installation start date in order to Confirm and give approval for installation to Proceed. Roof install will be rescheduled in the event of Adverse Weather such as rain, unsafe temperatures, snow or hail. Ice Dams: Golden Group Construction Corp. does Not warranty against Ice Dams. Ice dams maintenance is the Responsibility of the homeowner. It is homeowner liability to ensure that snow and ice is not backed up inside gutters, valleys, transitions or side walls. INITIALS; DETAILS OF WORK AREA TO BE COMPLETED ON MAIN HOUSE 1. Install a tarp, or tarps from eaves of the roof to prevent damage to the house, landscape, plantings and lawn areas. 2. Tear off all existing 1 layers of roofing material and properly dispose of it into a dumpster. If hidden layers other than quoted are found, they will be removed at an additional cost. (Please refer to prices on page 2) 3. After removal of existing layers, decking will be reinforced if necessary using 8-Penny ring shank nails. 4. If wood decking is needed for replacement, please refer to prices listed on page 2. 5. Install F8 inch aluminum galvanized drip edge to all roof edges (eaves and rakes) along the entire roof line to protect the roofs perimeter and guide water off the roof and into gutters. 6. Apply 6 feet of Premium GAF leak barrier weatherwatch ice and water shield membrane to all eaves. 7. Apply 3 feet of Premium GAF leak barrier weatherwatch ice and water shield membrane to all valleys. 8. Apply Premium GAF weatherwatch leak barrier ice and water shield membrane to building code around all penetrations such as pipe boots, chimneys, skylights, and transition walls. 9. Apply GAF tiger paw Synthetic Underlayment to he remainder of the exposed roofing area. 10. Install GAF PRO Shingle Starter course to all roof edges to ensure proper sealing of all roof edges per manufacturer specifications needed for warranty of winds up to 130 miles per code. 11. Install new pipe flanges on all plumbing vents. 12.All shingles will be fastened with 1 V4' to 1 V2" nail. Utilizing exterior galvanized coil nails, 6 nails per full shingle. 13.Apply GAF Timberline HOZ Shingles. 14. install GAF Snow Country 12 inch filtered ridge vent using 3 inch ring shank roofing hand nails. 15. Replace all roof vent pipe boot flashing kits. 16. Install any existing bathroom roof vent kit with new roof Braun bathroom Aluminum flashing kit, exterior components only. Homeowner is liable for any interior connections, or electrical work. 17. Install GAF Seal a Ridge specialty hip and ridge caps to match shingles using 3 inch ring shank roofing hand nails. 18. Re-Lead Chimneys using ice and water shield (leak barrier), 8 by 10 inch aluminum step flashing and counter flash with 12 inci lead. 19. Cut down 2 chimneys to the roof line, Homeowner to ensure there are no active fumes venting from either chimney, 20. Work site will be cleaned during the daily operations, and all areas gone over with a magnet 2 times to pick up any nails. (If nails are found upon final walk through, homeowner can request a third magnetic sweep) 21. Contractor will apply and cover all costs for all permits pertaining to the job. 22.Asphalt Shingle recyclable Dumpster on job location will be Supplied by Golden Group Construction Corp. Plywood will be placed under the dumpster wheels to not mark the driveway. 23. Registered Golden Pledge Warranty with the manufacturer. This warranty is paid for by Golden Group Construction Corp. on behalf of the homeowner. This warranty is included under the contract terms and price. It is a 50 year labor, material warranty, and a 25 year workmanship warranty that is one time transferable to a new homeowner. Shingle Manufacturer Shingle Selection; Color Selection; GAF TIMBERLINE HDZ C iANItc01.- bttvE bstEctl 4t?) - 521- - lg ccxoratAlr,\-;- w/ Q0c..rrt Moss i\ .scA ckirnnet ,i c- START DATE: --1-66 nC '2,01` END DATE: PRICE: INCLUDES LABOR, MATERIAL, DEPOSIT AMOUNT DUE TO FOREMAN AT DUMPSTER: START AND ARRIVAL OF CREW: TIMBERLINE HDZ S14,950.00 'f3$5,233.33 7* CUT DOWN TWO CHIMNEY TO ROOF LINE — $750.00 -- w c S e_.►n (V1t.s s MC4St ►s _ Payment Method: TOTAL DUE: FINAL AMOUNT TO BE PAID UPON COMPLETION: $15,700.00 /3 S10,466,66 Payment Method: 'All home improvement contractors and subcontractors must be registered by the Chief Administrator of the Massachusetts Board of Building Regulations and Standards. Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director of Home Improvement Contractor Registration: Office of Public Safety and Inspections, Boston Office (617)-727-3200. Link: httpsalmadpl,mylicense.cormiv'erificationl The contractor shall obtain and pay for the building permit and other permits and governmental fees, licenses, and inspections necessary for proper execution and completion of work. If the owner elects to obtain the foregoing permits. or to deal with unregistered contractors. the Owner will be excluded from the guarantee provisions of M.G.L.c 142A. The owner shall obtain and pay for all necessary approvals; easements, assessments and charges. The Contractor and the Homeowner hereby mutually agree in advance that in the event the Contractor has to dispute concerning this contract, the Contractor may submit the such arbitration as provided in Massachusetts General laws, Chapter 142A, NOTICE: Golden Group Construction Corp. accepts full responsibility for any damage that may occur to the property during the construction process. Golden Group Construction Corp. will document any and all pre existing damage prior to the start of installation. Paint scuffs or paint that chips during the construction process will not be warranted. Golden Group Construction Corp. will not be held liable for any paint work due to the construction process of the roofing installation. Golden Group Construction Corp. will do all possible and take all necessary steps to ensure any such damage is minimized to any paint. Golden Group Construction Corp. will use Heavy duty black tarps to protect property and grounds. Golden Group Construction Corp. will use all equipment such as power ladder lifts, tarps, ladders, magnet rollers and blowers to ensure the property is protected at all times from any damage. The crew will demonstrate OSHA safety regulations at all times during the construction process. GOLDEN GROUP CONSTRUCTION CORP. is licensed, and insured company. • MA Home Improvement License#174718 • CONSTRUCTION SUPERVISOR LICENSE#106011. All material is to be installed as specified to code of MA State Building Code—780 CMR.All work to be completed in a workmanlike manner according to standard practices. All agreements are contingent upon strikes, accidents, or delays beyond our control. Homeowner is to carry fire, tornado and other necessary property insurance, Golden Group Construction Corp, workers are covered by Workman's Compensation Insurance Liberty Mutual WC2-31S-385387-029. Golden Group Construction Corp. is covered by a$2 million Dollar General Liability Policy MP0020006000343, Homeowners will not be held liable for any accidents or injury to any Golden Group Construction Corp. worker on the premises. By signing this Contract you are agreeing to the registered GAF Golden Pledge Warranty. The Craftsmanship labor warranty includes all technical issues considered to be Craftsmanship Application Technique Errors. If it is determined that a roofing error in installation has occurred, GAF Golden Pledge Warranty. will cover Material. Labor, Dumpster. and Interior or Exterior Damage caused by the Installation roofing error. Products such as pipe boots, skylights, siding transition walls, and chimneys will be water tested to ensure no such products have failed and have become an entry point for water. Products such as chimney bricks above the lead. and flashing line, exhaust vents (other than vents that are installed by Golden Group Construction Corp. at time of install), skylights (other than new skylights installed by Golden Group Construction Corp.), siding, window trims above the fleshings and roof line are not covered in the GAF Golden Pledge Warranty. It is homeowner liability to ensure and maintain the life of such products on the roof, and perform constant maintenance, especially in the event of major storms. There will be no diagnosis charge for the service call of any reported issues that are reported during the lifetime of the warranty. The warranty only covers the roofing system and any products installed on the roof by Golden Group Construction Corp. Product Failure is covered in the Manufacturer Product Warranty(GAF Golden Pledge Warranty). In the event of a product failure, Golden Group Construction Corp, will assist the Customer in Filing a product failure claim with the Manufacturer. The GAF Golden Pledge warranty does not Warranty against Ice Dams. It is the responsibility of the Homeowner to ensure that no ice backs up into gutters and other areas of the roof in order to prevent Ice dams from occurring, NOTICE. The signature of the parties above apply only to the Contract of the parties to alternative dispute resolution initiated by the Contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. No work shall begin prior to the signing of this contract and transmittal to the Owner of a copy of this contract. This contract constitutes the parties'total agreement. This contract may be amended or supplemented only by a written change order signed by owner and contractor.All surplus materials are property of Golden Group Construction Corp, NO ORAL AGREEMENTS ARE ACCEPTED. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES, You, the buyer, may cancel this transaction at any time prior to the midnight of the third business day after the date of this transaction IN WITNESS WHEREOF, the parties have hereunto signed their names this Date _12/14/2020 X Signed by Golden Group Construction Representative X Sign d b)i Property Owner General Specificationij 1 At the end of each day, the working area wit be made watertight to protect the building from normal weather conditions. 2. The work area will be cleaned of all roofing debris during and after each work day and job completion. 3. The work area will be magnetically swept to pick-up any leftover nails after each work day and job completion. 4.All gutters pertaining to the work area will be cleaned of all debris after job completion. 5.All Golden Group Install come with a manufacturer Registered Warranty.Your Warranty will arrive within 4-6 weeks upon final payment. (Installation of partial roofs are not accepted by the manufacturer for full registered warranty,only complete roofing systems are eligible for manufacturer registered warranty plans.) Job Site Preparation: 1. Expect crews to arrive anytime between 7 -8 am. Crews will begin to set up for removal of old shingles and protecting the property. This means,we will have our black heavy duty tarps up and ready for removal. The foreman will identify the project specifications and go over details of the job site but also job safety and how to guide you in and out of the property.You will be constantly updated throughout the project. 2. Upon the start of the job, we will place a job site yard sign on your property and at your approval we request that it stay for a period of up to ten days after completion of your project. We hope this will be approved by you, the homeowner, as it is our best way to let others know about our Golden Team! 3. We will provide a dumpster container for the disposal of roofing materials. We will need to locate and prepare a convenient place for the container. We will also need to provide distributor clear access to load materials onto the surface. We only use recycling asphalt dumpsters so we ask that you do not throw any household items in our dumpsters,that way we can continue to successfully recycle. 4. We may require the full use of your driveway during the course of your roofing project. it will also be necessary to have access to an external electrical power source. If your driveway is large and can accommodate a dumpster and your vehicle, please make sure the vehicles are not parked anywhere near the home and keep a 50 feet clearance at all times. 5. We will make every attempt to protect the siding,windows, doorways, porches,decks, patios, and surrounding grounds and shrubbery with tarps and/or plywood. Due to the large amount of debris being removed, there are times when damage may occur. If there is a particular tree or bush that you wish to protect. please note it or make sure to tell your foreman during our set up time prior to the start of your project. 6. We recommend that prior to the start of the job that you remove or secure all fragile or irreplaceable items on walls and ceilings that could be disturbed or damaged during the job, 7 We recommend that if you have any contents in your attic or garage ceiling that you cover them with a tarp or plastic. If your garage does not have a ceiling, please remove vehicles or cover them so debris does not damage them. We cannot be responsible for cleaning attics after removing the shingles,