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18-039 (2) BP-2022-0809 27 EMILY LN COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18-039-001 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-2022-0809 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est. Cost: 10218 THOMAS ROBERTS 100333 Const.Class: Exp.Date:07/03/2024 Use Group: Owner: BRENNAN MAURA JO &DENNIS T IYASUTOMO Lot Size (sq.ft.) Zoning: RI/RR Applicant: ROBERTS ROOFS CO INC Applicant Address Phone: Insurance: P O BOX 1312 (413)283-4395 2008W6216 BONDSVILLE, MA 01009 ISSUED ON:07/11/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE ROOF ON FRONT OF HOUSE, FRONT OF GARGE AND REAR LOWER ROOF OVER DECK ONLY POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: )2 • (Pi Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / DocuSign Envelope ID:1ACAF470-279E-4C2E-6515-92AC9A3C94A9 / /,N / '��- �� The Commonwealth of Massachusetts /fin ( ` W Board of Building Regulations and Standar�iF °2G� CPR I T Y Massachusetts State Building Code, 784.1CMIPT op, wiini US Building Permit Application To Construct,Repair, Renovate Re, ised ar 2011 One-or Two-Family Dwelling �'q o ooNs This Section For Official Use Only Building Permit Number: AP` 01 A U Oq Date Applied: 4,,, l Koss /�� -7-1l-26ZZ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 27 Emily Lane IS a /i 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 El Municipal Outside Flood Zone? Municipal 0 On site disposal system 0 Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Maura Brennan Northampton,MA 01060 Name(Print) City, State,ZIP 27 Emily Lane (413)478-7936 maura.brennan@bhs.org 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) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': Remove and replace shingle roofing on front of main house,front of garage and rear lower roof over deck only 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: ❑ 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 (Fire140 $ Suppression) Total All Fees: Check No.11 tJ Check Amount: Cash Amount: 6.Total Project Cost: $10,218.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID: 1ACAF470-279E-4C2E-B515-92AC9A3C94A9 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 100333 7/3/24 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 A M Masonry S-S P. * �- RC Roofing Covering �# ►e WS Window and Siding SF Solid Fuel Burning Appliances 413-283-4395 info@robertsroofsinc.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 128264 3/16/23 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 0 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 aQt or'mx behalf,in all matters relative to work authorized by this building permit application. -- ocu ign by: A, ,a f�utum� 6/29/2022 ''rinPOrOffillaae(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. Pri er's or horized Agent's ',ame(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" Division of Professional Licensure Board of Building Regulations and Standards Constructs n:S*14iViSpr Specialty CSSL-100333 l spires: 07/03/2022 THOMAS R ROBERTS, JR 400 FRANKLIN STREET 5 BELCHERTOWN MA 01007 Commissioner dciA A'. 8)6vri 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/dp1 friV m a i i Brian Blanchette<info@robertsroofsinc.com> Your OPSI License has been renewed 1 message NoReplyLicensing (REG) <noreplylicensing@state.ma.us> Thu, Jun 16, 2022 at 12:32 PM Reply-To: opsi-info@mass.gov To: info@robertsroofsinc.com THE COMMONWEALTH OF MASSACHUSETTS DIVISION OF OCCUPATIONAL LICENSURE Office of Public Safety and Inspections www.mass.gov/dpl/opsi June 16, 2022 THOMAS R ROBERTS, Jr 400 Franklin Street Belchertown MA 01007 Your license CSSL-100333 has been renewed. The status of the license can reviewed on our verification site at hops://madpl.mylicense.com/Verification The physical copy of your license will be printed shortly and mailed to the address above. Please allow two weeks for USPS to deliver the license. If you do not receive it, reply to this email. Regards, Licensing Unit 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-05/17 .74 `hiiiiireqiiiivir///if. /Iiai•:oe/ii..(//i 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 Up..hTHOMAS R.ROBERTS JR /J 2. 400 FRANKLIN ST i‘ `k BELCHERTOWN,MA 01007 Undersecretary Not valid without signature DocuSign Envelope ID: 1ACAF470-279E-4C2E-B515-92AC9A3C94A9 The Commonwealth of afassachusetts nr.l —(/ Department of Industrial Accidents 1 Congress Street,Suite 100 __;t!_ Boston, MA 02114-2017 �'•.:,.�=„i www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. 7O BE FILED WITH THE PERMUTING AUTHOR11'1'. Applicant Information Please Print Leeihls Name I dusincss Organtzationrind.vidual): Roberts Roofs Co.,Inc. Address: PO Box 1312 City/State/Zip: Bondsville,MA 01009 Phone#: 413-283-4395 Are you an employer?Cheek the appropriate but: Type of project(required): 1 1 am a employer with .__2 employees(full and'or part-final.• 7. O New construction 20 1 am a sole prupnctur or irannership and have nu empluyst-s working fur me in K. Remodeling any rapacity.[Nu workers'comp.insomnia: required.] 9. Demolition 30 lam a hum n wcr doing all work myself.[No workus'cum_insurance may ❑ 'u 4.0 1 am a homeowner and w ill be hiring contra tors to conduct all work on my pnip rty_ I will I tl Building addition ensure that all contraeturs either have workers'compensation insurance or an sole I I. Electrical repairs or additions proprietor,with no employees. 1`.❑Plumbing repairs or additions 5CI I am a ecnuural contractor and 1 hay c hired the sob-cunt:actun listed un the attached sheet. These sob-contractor,have employees and have worker,'comp.inurance. 13.1S1 RW f repairs 6.0 We area corporation and officers have exercised their nen of exemption pen MGL c. 14.Q Other 152,i I14I.and we have nu employees.[No wurirrs'camp.Insurance required.] •Any applicant that checks but a I mint aisu fill out the section below show ing their workers'cornpensatiun puli y infurmatiun. /Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractor.must subnut a nett affidavit indicating such. :Contractors that check thu but must attached an additional sheet show ing the name of the sub-contractors and state whether or nut those enlities have employees. If the sub-contractors have employees.they must pro..idc their workm'comp.pulrcy number. I am an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Farm Family Casualty Insurance Co. Policy#or Self-ins.Lie.#: 2008W6216 Expiration Date: 4/17423 Job Site Address: —1 E tad Lie, CityiState/Zip: Mviti,c,v136, ,mA ©i060 Attach a copy of the workers'competition policy declaration page(showing the policy number and expiratIon date). Failure to secure coverage as required under MMGL c. 152, §25A is a criminal violation punishable by a fine up to S1,500.00 andor 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 coverage verification. I do hereby certify under the pains and penalties of perjury.that the information provided above is true and correct. Signature: _ Date: 7r/I/4 J- Phone S Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3.('ity/Tow'n Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone 0: AccoRD® CERTIFICATE OF LIABILITY INSURANCE 04%0( %' D 22 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 FACT Sean Rooney Sean Patrick Rooney,Sr.dba PHON No. ). 413-887-8817 I(A AX J: 877-771-6087 lAIRooney Insurance Services EAn""DA_R'E_ss, sean.rooney©farm-family.com 2341 Boston Rd. INSURERS)AFFORDING COVERAGE NAIC S Wilbraham MA 01095 INSURER A: Farm Family Casualty Insurance Company 13803 INSURED INSURER B: ROBERT'S ROOFS INC INSURERC: 40 Franklin St INSURERD: Belchertown MA 01007 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. W$R AWL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE DASD WVD POLICY NUMBER (MMJDD/YYYY) (MWDWYYYY) LBWS X COMERCIAL GENERAL LIABILITY EACH OCCURRENCE $2,000,000 DAMAGE TO CMS-MADE X OCCUR PREMISES(EaE NTED LAI occurrence) $ A X BOP X X 2007X0329 04/17/22 04/17/23 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY !El LOC PRODUCTS-COMP/OP AGG s 4,000,000 OTHER: S AUTOMOBILE LIABILITY (Ea CO aid D SINGLE LIMIT 1.000.000 ANY AUTO BODILY INJURY(Per person) S A X ALL OWNED SCHEDULED X 2001 C4685 04/24/22 04/24/23 BODILY INJURY(Per accident) $ AUTOHIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ RED AUTOS X AUTOS (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB C AiMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION X PERSTATUTEER AND EMPLOYERS'LIABILITY A ANYPROPRIETOR/PARTNER/EXECUTIVE 2008W6216 04/17/22 04/17/23 EL EACH ACCIDENT s500,000 Mandatory In NH)EXCLUDED? ' I N 1 A X E.L DISEASE-EA EMPLOYEE S 500,000 If dcribe under DES RIIPPTIION OF OPERATIONS below EL DISEASE-POLICY LIMIT S 500,000 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 POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sean Patrick Rooney,Sr. I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 1ACAF470-279E-4C2E-B515-92AC9A3C94A9 City of Northampton 1 �T H_A M!`oti, Sys,....... SAC Massachusetts 4? - !<< DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yti Northampton, MA 01060 sI% ......... 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: USA NGvk(%n (Z-QC )Ck\,• The debris will be transported by: Name of Hauler: (--)5 \ cy keC(3CI\ Signature of Applicant:, _-�SQ Date: 7/1/n,