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17C-027 (11) B ' 2022-1002 86 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-027-001 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-2022-1002 PERMISSION IS HEREBY GRANT to I TO: Project# ROOF Contractor: License: Est. Cost: 26785 BRIAN M LEBLANC ROOFING 104328 Const.Class: Exp.Date:05/30/2024 Use Group: Owner: P HALL PHILIPS&JANE Lot Size (sq.ft.) Zoning: URB Applicant: BRIAN M LEBLANC ROOFING Applicant Address Phone: Insurance: 27 CHERRY ST (978)870-6441 S1266224142422983 LEOMINSTER, MA 01453 ISSUED ON:08/17/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-SHINGLE 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: Ro ugh: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIO ATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 2 • 55-)93' Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 'AEG / The Commonwealth of Massachus ttst�" � • W Board of Building Regulations and Standar6� AUG 1 •�� Massachusetts State Building Code, 7S0 C ' / 2022 II�E ITY \ - r Building Permit Application To Construct, Repair,l enocat v `-is slish a R' ise.'Mar 2011 One-or Two-Family Dwelling--- "P7-1-AgATr�SINS e o his This Section For Official Use Only ' Building Permit Number: 314 off,.w Irv. - Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Num rs �Jara►oTe» 17G 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 0 Reca EState, Name(Print) ZIP / '' 4/A 42 91B 1-3. 4.,2G No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ Existing Building 0 Owner-Occupied 0 Repairs(s) Si Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Workz: G ill 721 '/e a .like C o &opyi 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 $ ElStandard City/Town Application Fee ❑Total Project Costa (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No.2�VCheck Amount: �D 6.Total Project Cost: $ _9/'-a CI4 e Paid in Full 0 Outstanding Balance Due: 3 • • • • • • y.` '4 y4rrw v. CON"..t wow • A SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C3• .l oc13•2 S ^3O..204if `Q W i,5 u j L( i a,1(n s License Number Expiration Date Name of CSL Holder(Or homeowner if owner applying) 7 G !'C� List CSL Type(see below) (de./No.and Street v Type Descriptio k0 !SrCr �� U Unrestricted(Buildings up to ;5,000 Cu.ft.) / 53 R Restricted l&2 Family Dwell I g City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appli. I Insulation Telephone Email address D Demolition 5.� Registered Home Improvement Contractor(HIC) /e•a/ i. v � 4t HIC Registration Number E piration Date HICCompany Name or HIC Registrant N e a ,evey S r m►ercra o/ 53 Sa/r 3 /«n Zt - c � �• N .an treet Email address / oyn%srer 94-.2 o-GO/ ���' ity/Town,State,ZIP Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25 (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 _to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name 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. ot?1 C 02)02.2, rmt Owner's or Authorized Agent's Name &Signature 780 CMR R105.3(6.) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered con ctor(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration pro or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. ov 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" - . • '• 4 t • . • • • f . i I 411. Commonwealth of Massachusetts 1®i' Division of Occupational Licensure ••-I Board of Building and Standards cons inn51.v r isor CS-104328 153lctpires:05/3012024 LEWIS R W141AMS 92 EDEN GL N LEOMINSTEIIf„OA 01463 • Commissioner Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Corporation Registration: 185748 • BRIAN M. LEBLANC ROOFING INC. Expiration: 03/17/2023 27 CHERRY ST. LEOMINSTER,MA 01453 Update Address and Return Card. office at Consumer Ailaks$Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only' TYPE:Corn+oration before the expiration date. If found return to: HiNtitiriebeExpiratlon Office of Consumer Affairs and Business Regulation 185748 03/1712023 1000 Washington Street -Suite 710 BRIAN M.LEBLANC ROOFING INC. Boston,MA 02118 BRIAN LEBLANC hl z7 CHERRY ST. LEOMINSTER,MA 01453 ob+ Not valid without signature Undersecretary City of Northampton jjr r .,L� SAS .,.....•SICi Massachusetts �'r c� tG t y! :IC }�. DEPARTMENT OF BUILDING INSPECTIONS y . 212 Main Street •• Municipal Building Jt+�� f� .�. Northampton, MA 01060 �1 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permi Number is that all debris resulting from this work shall be t isposed 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: &2 1b?6&fl zV&f €1a/?ir`,4e , /#1 ' The debris will be transported by: Name of Hauler: ,,,,/ ,/ /,;,, ; Signature of Applicant: Date: fio r2.0.7aZ- r II __ The Commonwealth of Massachusetts —`ll— 1 Department of Industrial Accidents __?bl= 1 Congress Street, Suite 100 ,"_ f= Boston,MA 02114-2017 � i www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ,�/� ���� Please Print Legibly Name (Business/Organization/Individual): nt-a` JV 1, k b/QYi C. �Q-01 j' ( 1'lQ- Address: c2 q C i\Q, “ t_ Sr U City/State/Zip: t(a n-m‘k 5-V e -% (pc( O 1°1(.33 Phone#: 61.4.&. $4 0. 6�-<..(j 1 1 Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.1=I I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.1:1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. El Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition. ensure that all contractors either have workers'compensation insurance or are sole 1 l.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.K I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.®Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any 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. :Contractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: So/,ln At *0(,vn hic Policy#or Self-ins.Lic.#: 57 eta e 4.2"/'e/vl4/Zp' 983 Expiration Date: ,I- 428" 0...z1Q2 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify1 under the painsle and penalties of perjury that the information provided above is true and correct. Signature: � 61/a/7 1 -2 Date: 04 " (1'i - 02.0 -2- Phone#: 4?-311 a4O 6Se'de, 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): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ;i T .t ACC)REi CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ---- 08/06/21 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 NAME: Maria ANGELA WESTEN INSURANCE AGENCY (aCNN No.Ext): 978-735 4094 FAX No): 978-735-4095 635 ROGERS ST.UNIT 9 EMAIL LOWELL,MA 01852 ADDRESS: maria@awesten.com • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: WESTERN WORLD INSURANCE COMPANY INSURED INSURER B: PROGRESSIVE INS KSB CONSTRUCTION SERVICES INC INSURER C: AMGUARD INSURANCE COMPNAY 71 BALDWIN AVE INSURER D: FRAMINGHAM,MA 01701 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 ICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LI ITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAGECLAIMS-MADE X OCCUR PRM SESO(Ea occurrence) I $ 100,000 MED EXP(Any one person) $ 5,000 A NNP8743445 08/14/21 08/14/22 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY n JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person)] $ 250,000 B —� OWNED SCHEDULED AUTOS ONLY AUTOS 07570592-3 04/27/21 04/27/22 BODILY INJURY(Per acciden') $ 500,000 HIRED NON-OWNED PROPERTY DAMAGE $ 100,000 AUTOS ONLY _ AUTOS ONLY (Per accident) I _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ — EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ i $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY /N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE V E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? NA N/A KSWC147698 07/30/21 07/30/22 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) BLEBLANCROOFINGINC@YAHOO.COM CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BRIAN M LEBLANC ROOFING INC ACCORDANCE WITH THE POLICY PROVISIONS. 27 CHERRY ST LEOMINSTER,MA 01453 AUTHORIZED REPRESENTATIVE I ©198 ia,&) 0 5 ACORD GORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 10 Brian a Customer Information Susan Hall Brian M. LeBlanc Roofing Inc. 86 N Maple St Date: 07/11/2022 Brian M.LeBlanc Northampton MA 01062 27 CherrySt. 9789737726 Rep: Jermane Stephinger B ranch@ ahoo.com Lepminster, MA 01453 do 9 Y 800-761-4296 GAF Timberline HDZ Architectural Shingles, StormGuard Premium Ice&Water Shield and choice of FeltBuster High Traction Synthetic Underlayment OR Deck-Armor Premium Synthetic Underlayment WORK TO BE PERFORMED AND MATERIALS TO BE USED Contractor agrees to furnish the materials and perform the project as described below for the clien 1) INCLUDES the GAF 30-Year Golden Pledge Workmanship Warranty, (Available exclusively from t.AF Master Elite Certified Roofing Contractors) and the 50-Year GAF Manufacturer Warranty on the Product. 2) GAF StormGuard Ice &Water Shield will be applied as follows: a) 6 feet up from the roof eaves. b) Along roof valleys. c) Around skylights and/or solar tubes. (if applicable) d) Around the chimney. e) Around vent pipes. f) Application of StormGuard Ice & Water will extend under existing step flashing. (Additional charges may apply) g) Other miscellaneous roof penetrations, where applicable. 3) Remainder of roof will be covered with client's specified choice of synthetic underlayment. 4) New 8 inch drip edge will be installed around the entire roof line. 5) GAF Pro-Start starter strips on the entire roof line FOR MAX. WIND COVERAGE. 6) Install GAF Timberline HDZ shingles using 6 nails per shingle for MAX. WIND COVERAGE. (Hurricane Nailing) 7) New pipe boots for all penetrations. 8) Install GAF SnowCountry ridge vent on all ventilation ridges. 9) Cap off hips and ridges with GAF Seal-A-Ridge cap shingles to match. 10)All debris removed daily and work site will be cleaned using high-powered magnets. 11) If necessary, plywood replacement will be $100 per sheet installed. 12) Pictures of any existing damage will be taken before repairs are made. 13) Project Photos will be shared via CompanyCam. 14) Properly ice and water, and install new aluminum step flashing (if applicable), and brand new lead around the chimney. Separate quote line item. 15) Homeowner to cover any personal belongings in the attic to protect from debris. HomeOwner InitialsvW Page 4 of 10 INVESTMENT Total Investment $26,785.00 Total Marketing & Promotions $0.00 Sub Total • $26,785.00 Estimated Monthly Payment $0.00 IF PAYING BY CASH, CHECK, OR MONEY ORDER Cash Deposit $8,919.40 Due Upon Completion $17,865.60 PAYMENT SCHEDULE Homeowner agrees to make payments according to the following SCHEDULE (Cash, Check, Visa, MasterCard, American Express and Discover are accepted. Import Note: Credit Card payments are subject to a 2.9% surcharge): • 1/3 upon signing the contract. • 2/3 upon completion satisfactory to all parties of all work described herein. WORK SCHEDULE The following schedule will be adhered to unless circumstances beyond the contractor's control arise: Work Scheduled to Begin: 4-5 Weeks Duration Of Installation: 1-2 Days *IMPORTANT NOTE: The dates above are ballpark time frames. An exact date will be given upon the return of this contract and all necessary permits are acquired. HOME IMPROVEMENT CONTRACTOR' REGISTRATION Brian M.LeBlanc Roofing Inc. 27 Cherry St. Leominster,MA 01453 %contractorPhone% MA CSL:CS10428 MA HIC:185748 I Susan Hall , , authorize Brian M. LeBlanc Roofing Inc.to act as my agent for the construction project taking place at 86 N Maple St Northampton MA 01062. I also authorize Brian M. LeBlanc Roofing Inc., to obtain a building permit for this project. I understand and accept the responsibility to comply with all regulations and required inspections. All home improvement contractors and subcontractors shall be registered in Massachusetts. Inquiries about registration should be directed to: Page 5 of 10 Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170, Boston, MA 02116 (617)973-8700 Homeowners who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. C% .\lali 1C� Susan Hall Jermane Stephinger Date 07/11/2022 Date 07/11/2022 Homeowner may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or branch thereof, provided Homeowner notifies the seller in writing at his ain office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight of the third busines day following the signing of the agreement. I cap odiclitw corn 2.9