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23D-022 (4) BP 2022-1074 498ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-022-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1074 PERMISSION IS HEREBY GRANT I TO: Project# 2022 ROOF Contractor: License: CDA ROOFING & SIDING Est. Cost: COTRACTORS, LLC CSL l 0892• Const.Class: Exp.Date: 10/07/2022 POWER-GREENE MELISSA D& OUS ANE K Use Group: Owner: POWER-GREENE Lot Size (sq.ft.) Zoning: URB Applicant: CDA ROOFING & SIDING COTRACT•'S, LLC Applicant Address Phone: Insurance: 1775 Main Street 413-786-4081 46-544117-01-12 AGAWAM, MA 01001 ISSUED ON:09/01/2022 TO PERFORM THE FOLLOWING WORK: STRIP&REPLACE 13 SQUARES OF ASPHALT SHINGLES 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 VIOL TION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fees Paid: $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildine Commissioner , Department use only' ier-y-444, City of Northampton Status of Permit: y� Building Department Curb Cut/Driveway Permit I ( .i , 4 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans _- phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans �= Other Specify • • APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office pt LiggE,LM sY �v�1 Map Z 3 Lot 02� Unit NAp7pioti • M/ 5 5 Zone u R (3 Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ME LISSA PowC2,, - G 1CCAI c-/98CLM 57-- Name(Print) Current Acryilii3 id6 qq 8,1 PLEASE sr" A 7TAcHEO (oArTRA cT Telephone Signature 2.2 Authorized Agent: C R 03 DO RE / 7 7 S Pi A w s r A6-4 4„q,n,,,4 Nam rint) Current Mailing Address: 11/3 "?8,6yo8't ture Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only , completed by permit applicant 1. Building I , 8 OCR (a) Building Permit Fee I 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee aj Lb vfl 4. Mechanical (HVAC) LJ 5. Fire Protection 6. Total = (1 +2+3+4+5) Ciro -C6. Check Number $y ' This Section For Official Use Only Building Permit Number: 019—Uri— (07Li. Date Issued: Signature: / /10 `7- /1022 Building Commissioner/Inspector of Buildings Date C D KCX) e � @ Co Al c A S�. ,t6 T' EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) • Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage Open Space Footage (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW (P` YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO . DON'T KNOW 0 i'ES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained O Date Issued: C. Do any signs exist on the property? YES O NO N. IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO Zrr IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors C] _ Accessory Bldg. ❑ Demolition ❑ New Signs [El] Decks [Q Siding [El] Other[d] Brief Work:Description of Proposes7R/P A Ai J �R PL C£ 3 uAe', G J / f 1^J" 1 �Sl� � C S a /45-t'8/41-TS1-1«/GI E-9iS� Alteration of existing bedroom Yes No Adding new bedroom Yes A No Attached Narrative Renovating unfinished basement Yes X' No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building : One Family _ Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT / I I, . 0— /cc 1` ` 0 E ?'- 6- ize , as Ownek-of the subject property /� A r hereby authorize C D I ROOc`/J t,/� " L L C_ to act on my behalf, in all matters relative to work authorized by this building permit application. PL E RISE .S(-E ITTA CH SI Co iv/OCT Signature of Owner Date I, C H ?IS C t A ROOrkV G-- LC C , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CttR\S` ° RC- 1Z t o Q i Prin e Signature of Ow*Agent Date SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor:y [(� pen Not Applicablepl ❑ I Name of License Holder: C KI S 1 °P�G14 3 Vole 3 ( C J I V$ (� " ber S O ! LN\ 1 I CLU 3T' J ?1 I D / -1/ 1 / o /to Licenseum a--) ' Address r Expiration Date 1-1 3�s 614.0 \ ignatu Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ C \) f\ booF Diu&- LA_C- / ° go01 Company Name Registration Number I >-3 S Al A 1ti 5T AGp w A✓1 am 4 o is o / i d-- 1 f-de? Address / / (/ Expiration Date Telephone v/3 74 b (orpI SECTION 10-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 1 No 0 City of Northampton Massachusetts �{ i�_ -fit , m l ' N DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building 5Jf hb� Northampton, MA 01060 sse,' "s' AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes. Prior to performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner/� has contracted with a corporation or LLC,that entity must be registered Type of Work: P cO (v 6- Est. Cost: ICI(3 Address of Work: 11 9'3 s-r Date of Permit Application: b ' O `— I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(explain): _Job under$1,000.00 Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: g' 4- g)- CDA /m000ko- f Sunj,v&- LLC ' o 0y Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton / ' > ' Massachusetts ,��55 ', Sr � J .>1" DEPARTMENT OF BUILDING INSPECTIONS 1.1 I'• eAv'-•• . 212 Main Street • Municipal Building v¢ Northampton, MA 01060 �.tsji;.--< �.v Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s) who own 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 homeowner. Section 110.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton Massachusetts • A DEPARTMENT OF BUILDING INSPECTIONS a r 212 Main Street •Municipal Building ` `""c% Northampton, MA 01060 jY ar50. Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: 144 CLAAsT (Please print house number and street name) Is to be disposed of at: Kw 1(ECy6L►N6- wes-T sPfin (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: C Dfk �oc�e\k c - (Company Name and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall rotify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of Industrial Accidents 1= Office of Investigations IELtif= Lafayette City Center -1 0= r 2 Avenue de Lafayette,Boston,MA 02111-1750 www.mass.gov/dia - Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual):CDA Roofing & Siding Contractors, LLC Address:1775 Main Street City/State/Zip:Agawam, MA 01001 Phone#:413-786-4081 Are you an employer?Check the appropriate box: Type of project(required): lit I am a employer with 10 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.D I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing 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.❑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. *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:Pennsylvania Insurance Company Policy#or Self-ins.�Licc..#:46-544117-01-126- Expiration Date:06/19/2023 , Job Site Address: -l`I g £ L City/State/Zip: ./oR7 41'1P 1.44 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 cent' unde al and penalties of perjury that the information provided above is true and correct. Si ature: • Date: Phone#: 413-786-4081 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): 11:1Board of Health 20 Building Department laity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: ------"'1 CDAROOF-02 JCHOINIERE A�R�� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDiiiiY) 6/21/2022 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 poiicy(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). McClure Insurance Agency,Inc. wrDnEI FAX 103 Van Deane Ave. No.Ext):(413)781-8711 I ipc,Noj:(413)731-8548 West Springfield,MA 01089 :__ INSURINIAMELFORDWO COVERAGE NAIL se sISURER A:Continental Indemnity Co. 28258 INSURED INSURER B: CDA Roofing&Siding Contractors,LLC INSURER C;__ 1775 Main St INSURER D: Agawam,MA 01001 INSURER E: INSURER F: ICOVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIE 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 7,3 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCEPOLICY NUMBER LIMITS INSR ADDL SUER POLICY EFF POLICY EXP LTR INSD WVD IMMlDDIYYYYI fMM/DDlYYYY1 COMMERCIAL GENERAL UASILnY , EACH OCCURRENCE $ CLAIMS-MADE OCCUR , DAMAGE TO RENTED PREMISES(Ee ocan_nce) $ MED EXP(Any one person) $ PERSONALS ADV INJURY $ GENT UMIT ES PER: GENERAL AGGREGATE $ t POLICY I ,lCCT I ROC i PRODUCTS-COMP/OP AGG $ I OTHER _ $ AUTOMOBILE UABI JTY l BI COSMSSINGLE LIMIT $ ANY AUTO BODILY INJURY(Perpareon) $ OWNF_AUTOS DOfLY MVP BODILYBO INJURY(Per accident) $ rffS ONLY AUTOVY • (Per acadent) $ $ UMBRELLA LAB _I OCCUR EACH OCCURRENCE $ I EXCESS UAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ 1 $ A WORKERS COMPENSATION AND EMPLOYERS'LIABNJTY _STATUTE FOR I ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 46-544117-01-12 6/19/2022 6/19/2023 EL.EACH ACCIDENT $ 1,000,000 QFFlCERIME�,1gER EXCLUDED? N/A pMendaXcry Xn N►Xl .L.DISEASE-EA EMPLOYEE$ 1,000,000 tf yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 1 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 POLICES BE CANCELLED BEFORE THE EXPIRATION DATE City of Northampton ACCORDANCE WITH THE POUCYYPPROVISIONSCE WILL BE DELIVERED IN 210 Main St Northampton,MA 01060 AWHORQED REPRESENTATIVE ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® DATE(HMO/VW() (�,� CERTIFICATE OF LIABILITY INSURANCE 8/8/2022 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 CONTACT NAME: Andrea Hills KovetageInsurance Group PHONE (860)745-4222 FAX A/C No,Ext): WC,No): 657 Enfield Road (AM, ADDRESS: certificate@koveragegroup.com INSURER(S)AFFORDING COVERAGE NAIC# Enfield CT 06082 INSURER A: STATE AUTOMOBILE MUT INS CO 25135 INSURED INSURER B: SELECTIVE INS CO OF SC 19259 C D A ROOFING AND SIDING INSURER C: 1775 MAIN ST INSURER D: INSURER E: AGAWAM MA 01001-2516 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I 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. LTRINSR TYPE OF INSURANCE IN D WVD POLICY NUMBER PULICY EI-IYY PM/DD/YYRP (MM/DDlYWY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PR IUKtNIt PREEMISMIS ES(Ea occurrr ence$ 100,000 MED EXP(Any one person) $ 5,000 A Y Y 10143570CP 08/09/2022 08/09/2023 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ _ OTHER: $ I AUTOMOBILE LIABILITY COMBINED SINGLE $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ B OWNED -SCHEDULED Y Y A 9108753 06/12/2022 06/12/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ! -HIRED --NON-OWNED PROPER I DAMAGE $ AUTOS ONLY -AUTOS ONLY (Per accident) I $ X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LAB CLAIMS-MADE Y Y 10143572CU 08/09/2022 08/09/2023 AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER O(H- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT l $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 1 I 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Holder is additional insured as per written agreement not to exceed the limits,terms or conditions of any policy noted herein. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 712 Main St AUTHORIZED REPRESENTATIVE Ar.d.ro, HJLS I Northampton MA 01060 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD z...- tell Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Rnulations and Standards Constructige§upg4043r Specialty ....I..' tP CSSL-099424 --••:: . 1 EMpires:03/05/2024 f.. . JAMES S ACpRFtA , ,--- •:::,; 73 BILTMORE STRE SPRINGFIELk,MA 0117 4 . .„ .... t•'.•- 4 ,) . ..?,.... ..,3 .,,., . , Commissioner d, t K. FiEniiiLaL i _-..i . . . . ... _ i t Commonwealth of Massachusetts ') Division of Professional Licensure Board of Building Regulations and Standards Constructiec41160_41Spr Specialty CSSL-099561 :,) 4. Kirpires:07/15/2023 • CLARK L DORE '•• .`It 7 ' . 948 SOUTHWEST FEEDING HILLS MA . 03 0 . •//•,i, . . 'f)/s\'•110' Commissioner & e. ciA"Li..., • I . — _ 1., II Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards • • COnStOtI4AikpA5visor ,,.... .1 I CS-108924 ..-..... * K5pires: 10/07/2022 . f CHRISTOPH 570 PLAINFI • SPRINGFIE * . .. • - -;„.'' 't ' OFSNI3(-1 Commissioner d, t K. b/6,7,12,A •• . . _, , .. _. . Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration • F 1 - Type: LLC C.D.A.ROOFING&SIDING CONTRACTORS LLC ` f: Registration: 170804 1775 MAIN STREET Expiration: 12/18/202 AGAWAM, MA 01001 � - SCA 1 0 20M-05/17 Update Address an. Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 170804 12/18/2023 1000 Washington Street -Suite 710 C.D.A.ROOFING&SIDING CONTRACTORS, LLC Boston,MA 02118 CLARK DORE /2 1775 MAIN STREET °f a'i'/zGlusrtc' AGAWAM,MA 01001 Undersecretary Not valid without signature re/iw -rmo-eaai � �i���'/ 4U4//��/�2�cle14- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration t Type: Supplement Card C.D.A.ROOFING&SIDING CONTRACTORS, LLC Ttz Re 170804 1775 MAIN STREET Exxppiration:ration: 12/18/2023 AGAWAM, MA 01001 SCA i 6 2nia.nsit7 Update Address and Return Card. 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 170804 12/18/2023 1000 Washington Street -Suite 710 C.D.A.ROOFING&SIDING CONTRACTORS,LLC Boston,MA 02118 JAMES ACERRA /' 1775 MAIN STREET ,„kif�rf' �tDk' AGAWAM,MA 01001 Not valid without signature e ROOFING & SIDING CONTRACTORS, «C-v X - • CDA Roofing and Siding Contractors,LLC•(MA Reg.#128355/CT Reg.#603213) 1775 Main St.,Agawam,MA•(413)733-4080•(413)786-4081 •1-844-786-4081 •FAX 413-786-2196 ,. cdroofer@comcast.net �® 1 Carney Avenue West Hartford,CT 06110(860)953-5730 WWW.CDAROOFING.NET Proposald •Submitte Date: .—`/-^2 Z Phone Ws GM /l LISA r.o tom/ K; •tQ_o-) Home:,R 6 9 9 S Mail To: 98 � • City,Attit e,Zip Code: Special Requirements: vo " ca.A,%ofo h /VL'd- kc-c)c.c Proposal to turnish axed ietlsts,li the fo$iiuvat 6 ❑ Re-Roof U- ar-Off Complete Roof Preparation 04Iome exterior to be protected by tarps and plywood iiKhrubs, landscaping,trees to be protected t ire existing roofing material to be removed to existing decking O—to to be cleaned everyday with roll magnet debris removed at project completion eteriorated existing decking replaced at S_per sq.ft./$/ Iper sheet of plywood -MetaI drip edge installed at eaves and rakes gwitite❑ Brown 0 5 inch 0 8 inch ew flashing will be installed where necessary ctit lead into chimney $ 3 C O• Arirriai stall new pipe boot flashing a-We shall acquire all appropriate permits ect.for all roofing work ❑'roof related debris removed by means of dumpster Completeom Roofing System rl Ice,water shield installed at all eaves to protect against ice dams(and meet codes in the north) 0 3ft greff---- ,, c-e,water shield installed at valleys,around penetrations and chimneys to protect critical Cit S,ynthetic reinforced underlayment installed over entire decking Shingles ❑ CertainTeed ❑ OAF .®Tam��ko ❑Owens Corning t30 year (3 50 year 0 Color C Nai a ble ridge vent will be installed Ridge cap shingles Warranty Options t4.Wo guarantee our workmanship for 10 full years 1 a'}fd' All prices include dumping fees unless noted otherwise. 8/`?-/a We Propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: 47° Total Sale Price$ �i- Down Payments 7:3; ✓ " Upon Completion$ ACCEPTANCE OF PROPOSAL:The above prices,specifications and conditions are satisfactory and are herby accepted.You are authorized to do work specified.Payment will be 113 down upon signing and balance due upon corn•letion.Unpaid balances shall accrue with interest at 1 %,per annum. Purchaser(s)will pay for all costs,expenses and reasonable attorney's f red by C ofing and Siding Contractors LLC t recover sums due under this contract. Date: G$i 1 (Ltd ' Signature.;—'1cYJP.{ 4 4,1e/ hone: . �ile Date: —1/-22_Estimator's Signature: / Estimates are honored for (30)days from above date ATTENTION HOMEOWNERS.Please cover all personal belongings in the attic,garage or storage areas due to the possibility of roofing debris or dust coming through the cracks of the wood.CDA Roofing and Siding Contractors LLC will not be responsible for debris or dust in the attic or storage areas.