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23B-068 (2) BP-2022-0374 105 SOUTH MAIN ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-068-001 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-2022-0374 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 26000 LONG ROOFING OF MASS LLC 050928 Const.Class: Exp.Date:05/14/2023 Use Group: Owner: 0 FYDENKEVEZ JOHN E JR& DONNA Lot Size (sq.ft.) Zoning: URB Applicant: LONG ROOFING OF MASS LLC Applicant Address Phone: Insurance: 24 WALPOLE PARK S UNIT 8 (240)473-1400 8005584 WALPOLE, MA 02081 ISSUED ON:04/12/2022 TO PERFORM THE FOLLO WING WORK: STRIP AND RE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Gas: Final: Final: Rough Frame: Rough: Fire Department Driveway Final: Fireplace/Chimney: Final: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: • Qf la 1 •�i Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massachusetts FOR i r-- Board of BuildingRegulations and Standards t ._ `? MUNICIPALITY"""' ---- Massachusetts State Building Code,780 CMR USE Y Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 AP n 1 ` One-or Two-Family Dwelling 2022 i This Sectio For Official Use Onl .____----.1 Building P rmit Number: "P-e),&2 37 Date Ap lied: runDIM;INSPECTIONST AMPTON.MA01060 f K� l,� �oS / LI-IZ-ZOLZ � __.,.... a �Si Signature Date Building Official(Print Name) ga SECTION 1:SITE INFORMATION 1.1 Property Address:f Dc . pmff: 1.2 AssesssoLr sMap&Parcel Numbers, 9 Li 1.1a Is this an accepted street?yes `/J no Map Number raj Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private CI _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ ',S/ECTIIO�N 2: PROPERTY OWNERSHIP' 2.1 Owned 'Iugcor : v D k�1,> f 2„42t,),J� I/t/]y� , 0)1 �2'"' Name(Print) !'- /'/ t City,State,ZIP ` / {����/ I S, nw'v I 62 ^7o No.and Street elephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) Alteration(s) 0 Addition ❑ Demolition ❑ Accessory Bldg.0 Number of Units Other 0 Specify: , n Brief D- criptioI ofPr$.os Work2: ! <ir A? ) i/ / A 0497 /� /� _,./_ 111(,-Iinz5r4,7- .AMINK" ti iiFill fiArtil, /1/17.;"7-_,A7AllrAr.Ar7-.13Wer ' SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $'��jj ppl•vv 1. Building Permit Fee:$ Indicate how fee is determined: f ❑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: 1 140 Check No.I heck Amount: Cash Amount: 6.Total Project Cost: $.;74 0 ❑Paid in Full 0 Outstanding Balance Due: A SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor Li , i se(CSL) /. ""0Z�(�20 5 -)5'2i .' 6tM'2 D i s477/ i Qv)ol/ik License Number Expiration Date Name of CSL Holder/ 04�1�d / b S (//I`/ List CSL Type(see below) No.and Stree i ) Description ,,,,A. G ,`yt4_, (3�l Unrestricted(Buildings up to 35,000 Cu.ft.) Q//� / R Restricted 1&2 Family Dwelling City/Town,State,ZIP / M Masonry RC Roofing Covering WS Window and Siding i3a -2)7P-EZe/ SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Regi I %v tContractor(HC) 7�, ��rV e / �s MC Registration Number Expiration Date HIC C.xaf .m q j�`(/L �t n: e fn L7�} 2,yv N l L�Veik5 ffro. z 7 3 .Jv(/,... Email address 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 a building permit. Signed Affidavit Attached? Yes No ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESPL,j� FOR BUILDINGPERMIT I,as Owner of the subject property,hereby authorize 11-C/r"y ' " 77/fQa/' " to act on my behalf,in all matters relative to work authorized by this building permit application. OA( D €VEz r7 if TT, T q-'-262z Print Owner's ame(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 c tamed in this lication is true and accurate to the best of k ledge and understanding. � >�ylrlf / - 1 2a - 22 Print Own 's or Authorized Agent's Name(Electronic Sign e) 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(MC)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 �`M M Massachusetts mow:• � ! DEPARTMENT OF BUILDING INSPECTIONS ay: R; (� 'tit} =j 212 Main Street • Municipal Building 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: The debris will be transported by: Name of Hauler: 717.197Z17 ,7 Signature of Applican : Date: � -22- MA HIC#187510 Long Roofing of Massachusetts,LLC •24 Walpole Park S Unit LONG HOME 8,Walpole, MA 02081 (800)470-LONG •(240)473-1400• LongRoofing.com PRODUCTS By Long Roofing of Massachusetts, LLC John Fydenkevez (413)626-7061 Date:03/29/2022 105 S Main St fydo428@comcast.net Product Specialist: Josh Ducharme Florence MA 01062 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Roofing Job Specifications 1. Obtain all necessary insurance V 2. Arrange for pre-installation measure V 3. Deliver all materials to project site. V 4. Clean up and dispose of all job related debris. (Note: Roof removal can cause considerable dust in attic area. Please cover or remove attic items as necessary as LR is not responsible for damage or attic clean up.) V 5. Long Roofing is not responsible for any interior trim work surrounding skylights.Any post installation dipping, bowing or sloping due to existing structural conditions of the roof.Satellite reception once reinstalled. Please be prepared to contact your satellite provider post installation. V 6. Long Roofing is not liable for any gutters/guard systems installed by another company and not taken down prior to installation of the new roof. V 7. Homeowner agrees to provide Long Roofing access to electricity. Initials Access To Driveway: YES Satellite: Not Applicable #Of Stories Above Ground 2 Multiple Structures On Property NO Roof Facets NOT To Be Covered N/A Solar Attic Fan Not Applicable Current Intake Ventilation YES Current Type of Intake Ventilation Ventilated Soffit Existing Skylights NO Any wood other than sheathing will be replaced at$17ft. Initials Asphalt Roofing Job Specifications Tear Off Existing Roofing Yes Removal And Disposal Of Multiple Layers Included Removal And Install Of Mansard Roof Pitch Included Install Shingles Landmark(130MPH) Shingle Color Moire Black Warranty 50 Year Non-Prorated Transferable Warranty This space intentionally left blank Furnish and Install Underlayment Diamond Deck/Winterguard Where Applicable Install Ridge Vent Yes Replace Pipe Collars YES Pipe Collars Color Mill Finish Pipe Collars Quantity 2 Furnish and Install Drip Edge White Install Apron (Horizontal) Flashing In All Applicable Areas. Color: Mill Finish Furnish and Install Lifetime Pipe Collars 2 Install Chimney Flashing (Roof Surface Meets Chimney) In All Applicable Areas. Color: Mill Finish Any Rotted Roof Sheathing Will Be Replaced At No Additional Cost Asphalt Roofing Project Notes RF-9 is showing as a 0 pitch it is not. Not PVC needed on project Additional Project Notes This space intentionally left blank • MA HIC#187510 Long Roofing of Massachusetts, LLC•24 Walpole Park S LONG HOME Unit 8,Walpole, MA 02081 (800)470-LONG •(240)473-1400• LongRoofing.com PRODUCTS By Long Roofing of Massachusetts, LLC John Fydenkevez (413)626-7061 Date:03/29/2022 105 S Main St fydo428@comcast.net Product Specialist: Josh Ducharme Florence MA 01062 The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed herein, in accordance with the prices and terms described in this "Agreement." Dumpster Required YES Dumpster Disclosure Long Roofing, LLC is not responsible for any driveway damage caused by dumpster.As Long Roofing, LLC uses third party providers for dumpster and disposal services, Long will request that the dumpster be placed on wood blocks to minimize the likelihood of driveway damage. However,as dumpsters are delivered prior to the commencement of the project, Long cannot adequately monitor whether wood blocks were used,and as such,shall not be liable for driveway damage in the event wood blocks are not placed under the wheels of the dumpster. I confirm that the above information is accurate .gra' Preferred Method of Contact Text Phone/Text/Email 4136267061 Donna Total Purchase Price $26,001 Deposit with Order $10,000 Amount Due on Substantial Completion $0 Amount Financed $16,001 Form of Deposit Check The Estimated Date of Commencement of the Work Is 3-5 Weeks The Estimated Completion Date Is 3-55 Weeks 04/ I am aware that the above dates are an ESTIMATE P The Project Is Contingent Upon Obtaining Permits,Approved Financing THERE ARE NO ORAL AGREEMENTS Promotion Selected(Cannot be combined with other offers) Cash Discount Customer Promotion Acknowledgment / C74- It is agreed and understood by and between the parties that this Agreement,constitutes the entire understanding between the parties, and there are no verbal understandings,changing or modifying any of the terms of this Agreement. Buyer(s) hereby acknowledge that Buyer(s)has read Agreement and has received a completed, signed and dated copy of this Agreement, including the two accompanying Notice of Cancellation forms,on the date first written above. Buyer(s) acknowledge that they were orally informed of their right to cancel this transaction. This space intentionally left blank Josh Ducharme John Fydenkevez 03/29/2022 03/29/2022 Date Date You,the buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the accompanying notice of cancellation form for an explanation of this right. This space intentionally left blank aptodigital.com 2.7.0 ne t�Vrrtrnt/nwt:ttttn VJ /YL ttJJu�++ts�eata Department of Industrial Accidents Office of Investigations Lafayette City Center =;: 2 Avenue de Lafayette, Boston,MA 02111-1750 4. • www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): LONG ROOFING LLC Address:24 WALPOLE PARK S UNIT 8 City/State/Zip:WALFOLE, MA 02081 Phone#:844-317-5664 Are yoti an employer?Check the appropriate box: Type of project(required): .1.0 I am a employer with 15 4. 0 I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in anycapacity. employees and have workers' P h' 9. 0 Building addition [No workers' comp. insurance comp.insurance.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 P bing 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.] *My 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. tContractors 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 anttn employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CHESAPEAKE EMPLOYERS' INSURANCE COMPANY Policy#or Self-ins. Lic.#:8005584 Expiration Date:01-01-2023 Job Site Address: I6 J J A- 4/ City/State/Zip: 814 (! 1/1/4 oii / 2- 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 certify mule the pain nil penalties of perjury that the information provided above is true and correct. Sienature: Date: 3) 77 Phone#: 84 -317-5664 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 30City/Town Clerk ,4.0 Electrical Inspector 50Plumbing Inspector 6.[]Other Contact Person: Phone#: Commonwealth of Massachusetts =f Division of Professional Licensure Board of Building Regulations and Standards Cons r: c ! r ,p; „r' ' CS-050928 Expires: 05/14/2023 GERALD R PATRIQUIN j JR.. 51 BURMA R J. ATHOL MA 0131 Yy �_ Commissioner ',1i(LI( ; Il. 11Fi;tr ►_� Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 187510 LONG ROOFING LLC Expiration: 04/20/2023 8530 CORRIDOR RD.SUITE 200 SUITE 200 SAVAGE,MD 20763 Update Address and Return Card. r ; Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 187510 04/20/2023 1000 Washington Street -Suite 710 LONG ROOFING LLC Boston,MA 02118 GERRY PATRIQUIN .- / ,i(L!. 8530 CORRIDOR RD,SUITE 200 �rr>v '.t/�clslc• �t'valid withotxsignature SUITE 200 Undersecretary SAVAGE,MD 20763 �...N LONGFEN-04 DHARRIS ACC)RO DATE(MM/DDNYYY) `-- CERTIFICATE OF LIABILITY INSURANCE 1/7/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#0C36861 coNTACT Danielle Harris Lanham-Alliant Ins Svc Inc PHO N Ext): I FAX,No): 9901 Business Pkwy Ste B (NCEa+lq�L Lanham,MD 20706 ADDRESS:danielle.harris@alliant.com INSURER'S)AFFORDING COVERAGE NAIL# INSURER A:Everest National Insurance Company _ 10120 INSURED INSURER B:Selective Insurance Company of America 12572 Long Roofing LLC INSURER c:Burlington Insurance Company 23620 24 Walpole Park S Unit 8 INSURER D:Chesapeake Employers'Insurance Company 11039 Walpole,MA 02081 INSURER E:Crum&Forster Specialty Insurance Company 44520 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 POLICY EFF POLICY EXP L9MITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDD/YYYYI IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILRY EACH OCCURRENCE S 1,000,000 CLAMS-MADE X OCCUR CF4GL01198211 12/31/2021 12/31/2022 PREMIISES CaEoc.cUrrrrettce) $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE UMIT APPUES PER: GENERAL AGGREGATE S 2,000,000 POLICY X ;Ea LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: EBL AGGREGATE $ 2,000,000 B AUTOMOBILE LIABILITY (Ea aide )SINGLE UNIT S 1,000,000 ANY AUTO S 242806802 12/31/2021 12/31/2022 BODILY INJURY(Per person) S OWNED ONLY X SCHEDULED BBpOO�DILY INJURY(Per accident) S X A�I ONLY X OMB (Perr accidreirMAGE S S C UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 5,000,000 X EXCESS UAB CLAIMS-MADE 600BE00525-02 12/31/2021 12/31/2022 AGGREGATE $ DED RETENTIONS Aggregate S 5,000,000 D WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY YIN1/1/2022 111/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTNE 8005584 EL.EACH ACCIDENT $ OFFICERIM MBER EX CLUDEDT I N I N/A 1,000,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yan,describe under E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS below E Pollution Liability CPL-113887 12/31/2021 12/31/2022 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tMid/& /t ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD