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38B-109 (4) BP-12022-1282 29 MUNROE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-109-001 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-2022-1282 PERMISSION'S HEREBY GRANTE'a TO: Project# ROOF Contractor: License: Est. Cost: 58000 EAST COAST METAL ROOFING 106109 Const.Class: Exp.Date: 12/13/2022 MCCLUSKEY MARTHA T& CARL H Use Group: Owner: NIGHTINGALE Lot Size (sq.ft.) MCCLUSKEY MARTHA T&CARL H Zoning: URB Applicant: NIGHTINGALE Applicant Address Phone: Insurance: 378 CRESCENT ST BUFFALO, NY 14214 ISSUED ON:10/06/2022 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: 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: .52 - I6--)17( Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner / /J /iNN The Commonwealth of Mafssachusetts Off, f�,. ,,, Board of Building Regulations'and • Rdards l , <a, FOR ICIPALITY �� Massachusetts State Building Code, 7@)�� I' ,, USE y,e., Building Permit Application To Construct,Repair,Rei> f$,,' DemRsh a Rev' ed Mar 2011 One-or Two-Family Dwelling ' qte,s This Section For Official Use Only '�goTi `49Building PPermit Number:6 D•' 3— ! X Y 4)— Date Applied: N�s �V„� a>55 l0- G-Zo22 Building Official(Print Name) Signature Date j SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessor M &Parcel Numbers dui rYlu rr r O Q S� 3 ✓ ' ,,/fir 1.1 a Is this an accepted street?yes no Map Number Parcel Numberf 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 ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' Nic(),,)wnerl of Record rThar-rho McCl v�� o pk �prl , 0 oUA Name(Print) City,State,ZIP /� Cl m n U r vim. St— gl lo-L/'-1S--5101$ 1�10,Rheta P CC 105169 A w'ti 1 . C o14,1 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) a' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': st-r\Q v p Of k t Y1 S•t•G41( L Le./ GoGl�-Lr S h le 16% ,�C� 1 S3-�,I 1 Cr�n�ic� 1 o C V, it o c t- NI Ey S+-e nn. ' SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 5 g G n o 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: Check No. MCP heck Amount:'4 1, Cash Amount: 6.Total Project Cost: $5.6 O 0 0 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) LL)(.A0 j a JriL'()jr)Y MCthrin.u(J0v, License Number Exp atio Date Name of CSL Holder• (� 3 ( , ` t i i w e _\ List CSL Type(see below) �`-' No.and Stree U Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Iran 10 I , vvt Pr bad 3F3 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances �-D�7310��5' k,iit"t l CM►', D►M I Insulation Telephone Email address D Demolition 5.2 Registeredis Home Improvement Contractor(HIC) l e Li y R 1 ` a 4/ F o-s 1 C O(mil S+ -een t-I izo c( Nrui HIC Registration Number pir ion Date HIC Corn any e or HIC Registrant Na e a�� amU on ►�v Q1rvWSCk1/l r, co►�-) � 6S�(, �c1OLe /cEmail 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 provtde this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes CB 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 M 2()Y1 l(),)O n �C.4 h U J O Ir to act on my behalf,in all matters relative to work authorized by this building permit application. Pf-m ee) a 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 cont ' d in application is true and accurate to the best of my knowledge and understanding. 9/a` 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" City of Northampton r �h; Massachusetts ��'?S :LI_,.,,,,, ec, DEPARTMENT OF BUILDING INSPECTIONS .. kt)..,----4///'��, 212 Main Street • Munici al Buildin P 9'� Northampton, MA 01060 ss�;h... ,;�0� 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: 331 rA Su )+ '& m(' I (buy ` me, The debris will be transported by: l � \ nn 1�y nn Name of Hauler: V n l Z T J / V lcm rc�,l v �-l�C.vo.. ' rn-Q_A-4' Signature of Applicant: Date: 11°�' 9/3c3 The Commonwealth of Massachusetts Department of Industrial Accidents } — Office of Investigations SF a Lafayette City Center c :1 2 Avenue de Lafayette, Boston,MA 02111-1750 .;. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual):East Coast Metal Roofing Address:254 Sutton Ave City/State/Zip:Oxford, MA 01540 Phone#:508-731-0415 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. • I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ® We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL l 2.E Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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:Beacon Mutual Insurance Company — Policy#or Self-ins. Lic. #:00000079803 Expiration Date::9/14/23 Job Site Address:a 1 ('A U Y\V of, Si-- City/State/Zip:/V O ri atrY1 WY)I WI,0 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)0l OCD 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the O 1ce of Investigations of the DIA for insurance coverage verification. I do hereby cert ft under the pains and penalties of perjury that the information provided above is true and correct Signatur Date:ql 2.9/2,0 ZZ Phone#: 508-731-0415 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 5EIPlumbing Inspector 6.0Other Contact Person: Phone#: ACOR©® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ift...—''- 09/12/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Kevin Pires NAME: Platinum Insurance Agency,Inc. (n/co.No.Ext}: (401)272-5900 (NC,No): (401)272-5901 1990 Pawtucket Avenue ADDRESS: kpires@platinumins.com East Providence,RI 02914 INSURER(S)AFFORDING COVERAGE NAIC$ Phone (401)272-5900 Fax (401)272-5901 INSURER A: Western World Insurance Company INSURED INSURER B: Maxi Construction,LLC. INSURER C: 22 Cherry Street INSURER D: Beacon Mutual Insurance Company INSURER E: Pawtucket RI 02860 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 TYPE OF INSURANCE INSR WVD POLICY NUMBER (ADDLSUBR MM/DDY/YYYY) (MMIDDY�)_ UMITS © COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 AMAGE TO ❑ CLAIMS-MADE ❑� OCCUR PREMISES(Ea oNccurrence) $ 100,000 ❑ MED EXP(Any one person) $ 5,000 A ❑ NPP8747093 09/20/2021 09/20/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 © POLICY ❑ JE a ❑ LOC ' PRODUCTS-COMP/OP AGG $ 1,000,000 ❑ OTHER $ AUTOMOBILE UABILITY COMBINED tSINGLE LIMIT $ ❑ ANY AUTO BODILY INJURY(Per person) $ OWNED ❑ SCHEDULED - ❑ AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED ❑ NON-OWNED PROPERTY DAMAGE $ ❑AUTOS ONLY AUTOS ONLY (Per accident) ❑ ❑ $ ❑ UMBRELLA LIAR ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAR ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION Q STATUTE PER El❑ERH- AND EMPLOYERS'LIABILITY Y/N D OFFICER/MEMBER EXCLUDED?ANY ECUTIVE� N/A 0000079803 09/14/2022 09/14/2023 E.L.EACH ACCIDENT S 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE East Coast Metal Roofing,Inc. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 254 Sutton Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Oxford,MA 01540 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)QF The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS I i Office of Consumer My, a 1Business Regulation i 1000 Washing ,tre t-Suite 710 l Bosto ,-Massashusatt°s--92118 Home Im.ro -e. en__ : •tractor_I�e istration I �r W I > Type: LLC I EAST COAST METAL ROOFING,LLC r Re ipt anon: 184472 I 254 BUTTON AVENUE E pj/1ation: 01/19/2024 OXFORD,MA 01540 1 �, I St JJ --, ate/ 1 '6 4 tea, INN 5 Update Address and Return Card. I I I r- - I THE COMMONWEALTH OF MASSACHUSETTS , Office of Consumer AnJfs,Z,Business Regulation I Registration valid for individual use only before the I HOME 1MPROVEM NTCONTRACTOR I expiration date. If found return to: i i Office of Consumer Affairs and Business Regulation Re{1st ors i lion I 1000 Washington Street -Suite 710 l8 e Boston,MA 02118 i I EAST COAST META ,I — I e ..."7 I I 'AUL LECHIARA +� ,+ — I 254 BUTTON AVENUE OXFORD.MA 01540 ''%, '-y' ��.� i —q61 -\ 1 • UM"° e Undersecretary I Not valid without signature I DocuSign Envelope ID:7921249E-BF85-486B-A079-7D66CB7183F7 East Coast Metal Roofing, LLC. At H J l 1.U H J I 254 Sutton Ave, Oxford, MA 011540 METAL ROOFING Tel: 844-611-3267 eastcoastmetalroofing.com REQUIRED PERMITS Registered Home Improvement Contractor MA #184472 Registered Home Improvement Contractor CT #HIC.0644642 Rhode Island Registration #40663 Homeowner Information Name: Martha Mccl uskey and Carl Nightingale Address: 29 Munroe st City: Northampton ,Ma. Zip: 01060 Phone: 716-445-5618 Required Permits: The following building permits are required and will be secured by the contractor as the homeowner's agent and I/We as Owners of the subject property, hereby authorize East Coast Metal Roofing, LLC. to act on my/our behalf,. in all matters relative to work authorized by the building permit application: 9/7/2022 Owner's Signature Date 9/7/2022 Owner's Signature Date Owners who secure their own permits will be excluded from the Guaranty Fund provision of the MGL Chapter 142A This permit notice forms a part of the Purchase and Installation Contract of the same date. Commonwealth of Massachusetts . ttDivision of Professional Licensure Board of Building Regulations and Standards Construction iE 1 ispr Specialty s CSSL-106109 ii , Expires: 12/13/2022 MIRZOHIDJON MAHMUDOV 7 3 WYLLIE RD . . J v FRANKLIN MAC 02038 *l : �f `� t 4 Commissioner divG g. BlEkyli. Lcr,�