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05-058 (3)
371 AUDUBON RD BP-2021-1203 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:05-058 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-2021-1203 Project# J S-2021-002011 Est.Cost: $15200.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: WILLIAM SAUNDERS 95459 Lot Size(sq.ft.): 203860.80 Owner: DEBORAH E SMITH Zoning: RR(102)/ Applicant: WILLIAM SAUNDERS AT: 371 AUDUBON RD Applicant Address: Phone: Insurance: 294 ELM ST (866) 961-7663 0 WC SOUTHBRIDGEMA01550 ISSUED ON:4/22/2021 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 Certificate of Occupancy Signature: • s. . FeeType: Date Paid: Amount: Building 4/22/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massachusetts n Board of Building Regulations and Standards / , , MUNIFOR PALITY Massachusetts State Building Code, 780 CMR (fl USE Building Permit Application To Construct,Repair, Renovate•Or_temolish a`' 1$evised Mar 2011 One-or Two-Family Dwelling ' ' •;. This Section For Official Use Only Buildingi lid it Number: , mil' i ad3 D te Applied: 1 ar35 ! 1;1-ZI-ZD Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assess Numbers .:,7f _,1,-ot -v RO 05rs Map& Parcel o5 7 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: Name(Print) City,State,ZIP 3'7/ 4t1h 4aM /?/.2 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)' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': iii p n el1Uo1F-- 4.lp/tvii- .m►fig, (.f SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees::��$ 1� 71 � Check No. ISM/Check Amount: l/ 6.Total Project Cost: $ /,, 0 0-- 0 Paid in Full 0 Outstanding Balance Due:_ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 95'45? o/- -�2 Or iI 11'/f/'7 f,4 v/fe/r c License Number Expiration Date Name of CSL Holder 3( t et-it- f List CSL Type(see below) No.and Street Type Description .f dLT7-�ff/l I DCP /l'1� d/ 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 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /5 3 o/,l.4-77 HIC Registration Number Expiration Date HIC Company Nobgetistr�nt e 6` �SUUIIVV SING. INC. No.and Street 394 ELM STRttr Email address SOUTHBRIDGE. MA 01550 City/Town,State,ZIP 866 961-ROOF 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 O 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 to act on my behalf,in all matters relative to work authorized by this building permit application. 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. w1rI't11/h Ai/0 ekr h I) -� I Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts �* 1 Department oJlttdastrial.-�ecidettts — � 1 Congress Street,Suite 1011 y Boston,MA 02114-2017 _ .'� wow. s.go►r/dia 11 miters'('unipeasatioo Insurance Aflidas it:Builders/('ante*rtors/EkctriciuutiiI'lumbers. 14)BE FILED WITH THE PERMITTING AI I HOR1-1'I. Applicant Information Pleas Print I.eeibh Name(Huiiness:Urgattt ation.ltullnidual S ROOFING, INC. 394 ELM STREET Address: SOUTHBRIDGE,MA 01550 966.961-ROOF City/State/Zip:_ Phone#: Are!era all mammy re tint*Ilia•appropriate inn: Type of project(required): h>�l am a employer with .02_employees(bell anrto 7. 0 New construction nI am a sok proprietor or partnership and Isar no employees working dor Inc in $. Remodeling airy capacity_[No workers:comp.io ui rune n-(whoa � 9. : I I)etllohUon 3�I am a Irunta tiwo r doing all work myself.[Na wurkas.coat(_insurance napared_[° lU 0 Building addition 4.(,1 am a Iiiu ouwmr and will be hiring c utlrsdors to conduct all weak on my property. I wdi �a--+r erIMnl'that all numeral-tors either lu a workers"compensation tion emulate or an:sole I 1.0 Electrical repairs or additions pi opt tours with no crriloycaa. 12.0 Plumbing repairs or additions 50 I am a general contractor and I hose hied the sub-contractors tasted oil the altaaitcal"beet f These nab-contractors bane cmplowe-s and lose workers'a anp.insurance) 13 t t repairs 6.0 an a evaporation ation and it+officers hate cMai rsed thew right of exemption pa MGL t. 14.0 a - 152 §l(41.and we lure no ouplo►ees.[No workers'comp_insurance required.) "And applicant that ebaxks boa 1I mum alas fill out the section below show tare their workers':tnnpensatinn policy wrfunnatira_ Ilavtictot tx t%who submit thus attida%it irtdrea not then arc doing all work and then hoc OIIIM le:aatttr:t:I r'miest sulmur a WV.:a[tidal.it ilydarstint:such- (-ontractors that check this hos must attached an adrhtional slwaxt slowing(lac name ate the auir,etntttogles,ana static it Itethrcr ot not those coastres bane. attplknct.. It the sub-cmaim:kts hate tar/Rio tt..they truest ptotadc their a.skeet.'lxiuip_hhllt:a matilscr. I am an employer that is preceding workers'compensation insurance jeermr miple r es Below is the policr and Job site information. Intiut.tna:c(aattpiity Name: Policy#or Scat-ins.Lit:_#: Expiration Date: Job Site Address: Cityt'StateZip: Attach a copy of the workers'compensation po&y declaration page(showing the policy number and espiration date). Failure to secure co crags as required under MGL c. 152,§25A is a criminal Violation punishable by a fine up to SI 300.00 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 DIA for insurance cco,crags verification. I do hereby certify tinder they paint and penalties of pe rjure that the injiarmatian provided above is true and correct. Signs I).:rae.: /) '2 ( Phone#: I 7 �7�—/299 Official use only. Do not write in this area,to be completed by city or hunt r4Jidat or Toga: rennet/license# Issuing,Anthorit%(circle I. Board of Health 2.Building Department 3.('ityll'owe Clerk 4.Electrical Inspector 5. Plumbingi Inspector 6.Other (lintact Person: Phone#: City of Northampton rr. e,............sic Massachusetts ��? . _ !<< ` DEPARTMENT OF BUILDING INSPECTIONS j,?212 Main Street • Munici al Buildin yv` a� . f Northampton, MA 01060x'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: OX(c-I4 The debris will be transported by: Name of Hauler: -,4Je ((* Signature of Applicant: Date: O 49 -1) ,2 ( City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS"� 212 Main Street • Municipal Building\ � Northampton, MA 01060 (I/]) HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT I, (insert full legal name), born_(insert month, day,year), hereby depose and state the following: 1. 1 am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.R3. 3. I qualify under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualify for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. If I engage any other person or persons for hire in connection with the aforementioned project or work on my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this / day of , 20 2( (Signature) PROPOSAL t/N/ pEAS � SAUNDERS & SONS ROOFING INC. T PROPOSAL NO. 9...712 ., 2 Family owned&operated MEMBER SHEET NO. tnW ' Accepting Discover,MasterCard,Visa 1-866-961-ROOF 1-508-765-0100 9 G & 0OFIN Owner:Bill Saunders LicensedCell: 1-774-272-1798 DATE Free Estimates Insured D 3 r /6- Saunders & Sons Roofing INC. PROPOSAL SUBMITTED TO 394 Elm St. Al 7�\ NAME-�e R� 3/lit mil{ Southbridge, MA 01550 Pinkfldl Qoutlook.com certalrireed ADDRESS 4 SELECT 6 -7/ p 62%)v13 ez.,, /I ShingleMaster- MA CSL 095459 MA REG 153955 "Ale/ ,�I� .r PHONE NO. CT REG 0638641 Proposal to fumispeand install the following 0 Re-roof Tear-off NOTES Er We shall acquire necessary permits for all work omplete Roof Preparation Mr/Home's exterior to be protected by tarps le Shrubs,landscaping,trees to be protected t Entire existing roofing materials to be removed to existing decking,up to 2 layers. ED/Site to be cleaned on a daily basis with roll magnet, idebris to be removed at project completion by dumpster Deteriorated existing decking to be replaced at.;,per sheet of plywood omplete CertainTeed Integrity Roof System nstall Wtnterguard ice&water barrier along bottom Eft.of all roofs ,Install Winterguard ice&water barrier around penetrations,in valleys and all critical areas 11T Install CertainTeed roof runner synthetic underlayment Ur/Install 8"perimeter metal flashing to all edges of all roofs Li white ❑ brown stall SwittStart starter shingle to bottom and rake edges of all roofs LW Install CertainTeed shingles to manufacturers specifications,6 nails ❑,Install Shingle Vent II PVC ridge vent to all peaks in heated areas LV install Shadow Ridge to all hips and ridges,over ridge vent where applicable -trjfnstall new lead counter flashing to chimney ew flashing installed where necessary Install new pipe flashing to waste vent stacks Warranty options TrdUpgrade CertainTeed 5-Star Sure Start Plus,50-year nonprorated coverage,Including workmanship CertainTeed Landmark-color: ❑3-tab _Q-CertainTeed Landmark Pro-color DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of ff`F t e e, T7/dc./4.-'O /W O /./4ln/!ti7C Dollars ($ / .2 v 0 ----- with payments to be made as follows:X S; 2 0° 4.P°5 t T S coo ezmioe,e c upov CU �✓ Svc '��Crtp Respectfully submitted 0I<„ Any alteration or deviation from above specifications involving extra costs Per -14v/✓io rn-+ 'S0N`2 will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents,or delays beyond our control. Note - This proposal may be withdrawn by us if not accepted within 7 days. ACCEPTANCE OF PROPOSAL 1 The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payments will be made as outlined above. Signature rate a3 — !E—g I Signature • nay cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor ting at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day ing the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. illCommonwealth o1 iNa:3sactnosetts Oivasion of Professional Licensure Board of Building Regulations and Standards C. r',str Coot! rvfSO, WILLIAM 0 SAUNDERS �;1!d5:202 53 LAUREL HILL ROADt* SOUTHBRIDGE MA 01550 1 1 ps c d 11/017N-4- 110.1VZ* 1,.. C..:cvriniissioner A 1178,4410,4--__ Office of Consumer /V. /'f.:•r HOME IMPROVEME Affairs NT R+Qulatfon CONTRACTOR TYPE:Individual i atitivatign 153955 01/28/2021 1 WILLIAM SAUNDERS { D/B/A SAUNDERS AND SONS ROOFING I I WILLIAM D.SAUNDERS �, 4. - SOUTHBRIDGE,MA 01550 ` 53 LAUREL HILL RD. Undersecretary i ® DATE(MMID ACOO OR CERTIFICATE OF LIABILITY INSURANCE o4MMOIYYVI) /Do2, 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 Melissa Lotter NAME: Hometown Insurance Center,LLC (PAH�CO��NNNEEo E (508)347-9394 (rAx No): (508)461-2035 590 Main Street EAtLss: mlotter@htownins.com ADDRE PO BOX 541 INSURER(S)AFFORDING COVERAGE NAIL S Sturbridge MA 01566 INSURER A: Penn America XSB013 INSURED INSURER B: Citation Insurance Co. 40274 Saunders&Sons Roofing Inc INSURER c: Liberty Mutual Agency Corp(Formerty Peerless) 394 Elm Street INSURER D: INSURER E: Southbridge MA 01550 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2081203766 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 IINNSD WVD (MMIDDCSUEIR YIYYYY) (MM/D EFF YDIYYYYl LTR EXP STYPE OF INSURANCE POLICY NUMBER LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE OCCUR PREMIDAMASESO(Ea occurrence) $ 100'000 MED EXP(Any one parson) $ 5,000 A MP0006001037761 08/23/2020 08/23/2021 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE UNIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 PRO- POLICY JJECT LOC PRODUCTS-COMP/OP AGG S 2,000'000 OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED LP6900 06/05/2020 06/05/2021 BODILY INJURY(Per accident) S AUTOS ONLY X AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE S AUTOS ONLY - AUTOS ONLY (Per accident) PIP-Basic $ 8,000 UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE $ _ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y NSTATUTE ER /E C ANY PROPRIETORrPARTNERXECUTIVE Y N/A WC5-31S-386235-020 06/23/2020 06/23/2021 E.L.EACH ACCIDENT S •100'000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more specs Is required) Roofing Contractor William&Patricia Saunders are not covered by Work Comp policy CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Sturbridge ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,. . Sturbridge MA 01566 ^ � `""_7c 21vlJ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Individual WILLIAM SAUNDERS Registration: 153955 Expiration: 01/28/2023 D/B/A SAUNDERS AND SONS ROOFING 394 ELM STREET SOUTHBRIDGE, MA 01550 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 153955 01/28/2023 1000 Washington Street -Suite 710 WILLIAM SAUNDERS Boston, MA 02118 D/B/A SAUNDERS AND SONS ROOFING WILLIAM D. SAUNDERS 394 ELM STREET SOUTHBRIDGE, MA 01550 Undersecretary Not valid without signature