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31B-053 (9) BP-2023-0504 26 LANGWORTHY RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-053-001 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-2023-0504 PERMISSION IS HEREBY GRANT D TO: Project# ROOF 2023 Contractor: License: US METAL ROOFIN Est. Cost: 58500 DISTRIBUTORS, IN 115825 Const.Class: Exp.Date: 12/31/202 Use Group: Owner: YANG iGULLERUD STEVEN 0&BEI I Lot Size (sq.ft.) Zoning: URA Applicant: US METAL ROOFING DISTRIBUTOR INC Applicant Address Phone: Insurance: 740 HIGH ST,SUITE 2 4133749470 WC2-31S-616974 HOLYOKE, MA 01040 ISSUED ON: 04/25/2023 TO PERFORM THE FOLLOWING WORK: REPLACE 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: i 6 ilo ! , • Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fa : (413)587-1272 Office of the Building Comm' ioner rNF RE' _ i sZ, The Commonwealth of Massach setts pp p 2 1 2023 OR Board of Building Regulations and S ds Massachusetts State Building Code, 0 C R -._EC �oNS IPALITY D PT. F BUILDING INSA 01Ooo SE Building Permit Application To Construct,Repair, nova �rr> !fltl a--'---�ewse Mar 2011 One-or Two-Family Dwelling--s _ This Section For_ Official Use Only Building�Permit Number: q P' J+.� SJy Date Applied: /uii..> /j5 //Z y-25.2023 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 aG Property Address: 1.2 Assessors Map&Parcel Numbers 1.la Is this an accepTed street?Ws 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 CI Private CI Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1t�i! Y ofRetortn Ndrlham /lit, ftA Name(Print) City,State,ZIP a o 1 a,n wormy ad, z I/6 - is' be/Ii (Inge�nueit •cci'►'l No.and Street Telephone E Ad ss SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other pl Specify:1E19kt P at, P Brief Description of Proposed Work': S e-e 411-42G/eat 14ropoS4, SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 5-g 5bD 1. Building Permit Fee: $ Indicate how fee is determined: + CI Standard City/Town Application Fee 2.Electrical $ 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees pp Check Not `W�I"Check Amount: Cash D Cash Amount: 6. Total Project Cost: $ .58 i 000 ❑paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- 115 s)5 1 a/3//aaa tt k. �-,-� Pell,bet A- License Number Expiration Date Name of CSL Holder c List CSL Type(see below) 1.1 �a�s ��No.and Street Type i Description MOCI5br 1Y1 iq 01 a 7 D U Unrestricted(Buildings up to 35,000 cu. ft 1 R Restricted 1&2 Family Dwelling City/Town,State,ZIP / M Masonry RC Rcofmg Covering WS W,ndow and Siding Li/3-37Y-9y7v Keith usmeialito ra�, SF Solid Fuel Burning Appliances I Irilulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) i, U M.e 44 l 1?0 f vl D.is+ *an(( l tii n . 1 may � � HIC R gistration�Number Expiration to HIC Company N or C Registrant Nam No7 s0 t ' ' `S/ GI Tr a teepiAj US2�!'Y16A' .4Ci�ti 0 e`�,Pit) ©JO4 D 1// s3�0 J ti7 Email address y City/To , 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 .❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIESFOR BUILDING PERMIT J I,as Owner of the subject property,hereby authorize l�. , k c rib-el Vl [is`f to act on my behalf,in all matters relative to work authorized by this building permit appli . 13a I i Yet Apr� I III aoa3 Print Owner's Name(Electroni.ignature) 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. \< � Rett.beU Aril 1LI( e & 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 canbe 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 -HAM..› c oti CD St C ?•" M, Massachusetts ,m? L < i I 1.t' , DEPARTMENT OF BUILDING INSPECTIONS S1s :,�; IS ry`1; 212 Main Street • Municipal Building vi} Northampton, MA 01060 s..-""104.0 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: r aSe/iQ G!/a51e 6 allo f1ain s f Ilo yak/ma The debris will be transported by: Name of Hauler: U, 5, ri e fa / goof V 0f s f 7n C- Signature of Applicant: K, -1, (,.., Date: Ile('I L//p 3 _ The Commonwealth of Massachusetts ►*_+` Deportment of Industrial Accidents or ljl�l_="' 1 Congress Street,Suite 100 `-:.T t ,"j Boston,MA 02114-2017 www mass.gov/dia .mi, N14.4 kers'Compensation Insurance Affidavit:Builders/('ontractorsl'Eketricians/Plumbers. 1 U HE I-Hip WITH 1 HE PIR1117T11G At!THORii . Applicant Information t Please Print Lreibh Name I Husirk srOrganw4tir.n individual): Us. t 1 'ek0. Voo- 1.1 .0IS -3,-t`L`',- Address: -1 Ac) \ 1(L, S-c- sV(,ke , ia' City/State/Zip: t-‘01 y© I m j otb Phone 0: q 13 -5-36-5-14 r7 q1 Are ion an CIII2pime.?Cheri the appropriate Iran: Type a project(requirrik 1.l I am a enylkwca with carrphr)st's(full anti'errpart-titan' 7. 0 New construction 2.0I ant a sole Erupt ockw ur partn.rshop,and has.:no erns hares workunlr for art.III 8. (J Remodeling ma ealracttti.patio wtxkets'contr.insurance minuet!" i"j 3O I am a lurnktru nor dome all wort mtselt. [Nu w orkers'comp.ritsu c ran. required" 9. 0 Demolition 10 D Building addition 4.(`] vt I am a honks nor and wail be het nhg rtina.t tirors w to conduct all rrk art no,prop rts. I will t--+ensure that all contractors either lace winker.'col 1.nsattun tnwranee or are :..ale 110 Electrical repairs or additions ph,>ttrittros with no t iup.secs.. 12.0 Plumbing repairs or additions 5C]I am a garncral contractor and I hasc hired the sub-contrark.rs lasted on the attac-hod sheet. 13 ♦ t h airs These IIII-Crxtttactuts have employees and leas. Insurance) ropInsurance) 1�4 f rep AEIWe Sae aenqscroios a d its uffrece%has c%crcurd then nght of exemption per IOW_c. i Other 152,.1(4).aidwe have no,a4loyers.1Na wurkcrs'cramp.insuratxercyuirctll *Any appWat that elticrk%boa ill must also till oruI the reclean below shoo mg dim thorium'cotrtpautitiapolicy iefintnaii a_ +Honicowrkrs who,stand this affairs it itrrlkaiug they art dews all work and them brae rooks&contractors malt salon a rk-w affidavit ordidiing safe. -(onu:rewrs that check its hot must attarhn1 an ahlitinial sheet shooing the none oft the sal-e.vitrartirrs and tale whtller or nut those sunk.,have essuritees.. It the sulrcimaraekrs Icosr snttployres.then must pars wit:thane workers-tamp.popes number. I urn on employer that is providing workers'compensation insurance for her employees. Below is the policy and job site in ft►rhtution_ Insutats:c l stinpany Name: L t-e r4 rn ulvt't.l -h.s'vra✓)c Pul►cy#or Self--ins_Lic.#: \ J C a" S -b!b cV/1 -0 i dl Expiration Dale: (ff h/90, � Job Site Address: a ? Lai wD r i- 1'� iL city�'StatelZip: N o r1I um join, mil Attach a copy of the workers'comps Bon policy page(showing the policy number and eipi tioa disk). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable'by a line up to$1.500.00 ant/'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 certtfiv under the pains and penalties of perjury that the information provided above is taste am corms Signtature: 12N-d-4-1--- Date_ Lj l /7 /30d 3 Phone#: Y/3- 536,y 6 Lis/ Official use only. Do not write in this area,to In'completed bi•c11r or town official Y City or Town: Permititicense* Issuing Authority(circle one): s I.Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: — - .. _ • Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards } Construction Supervisor CS-115825 Expires: 12/31/2024 KEITH A REHBEIN . 249 BATES RD WINDSOR MA 01270 • � r✓ Commissioner (I/it K. YEer . • USM ETAL-01 LAURA AC-OR DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 2/10/2023 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 Laura Misseri NAME Phillips Insurance Agency,Inc. PHONE FAx 97 Center Street (ANC,No,Ext): (413) 594-5984 (ac,No):(413) 592-8499 Chicopee,MA 01013 AooREss:(aura@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:State Automobile Mutual Ins Co INSURED INSURER B:State Auto Property&Casualty US Metal Roofing Distributors,Inc. INSURER C:Liberty Mutual Fire Ins Co 740 High St. INSURER D: Holyoke,MA 01040 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRINSD WVD IMMIDD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2910552 6/1/2022 S/1/2023 DAMAGETORENTED 500,000 PREMISES(Ea occurrences $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY X JECT X LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BAP2483772 6/1/2022 6/1/2023 BODILY INJURY(Per person) S OWNED SCHEDULED AUTOS ONLY _ AUTOS BODILY BODILY INJURY(Per accident) $ _ HIRED ONLY _ AUTO ONLYY (PerP PROPERTY ) S A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PBP2910552 6/1/2022 6/1/2023 AGGREGATE S 1,000,000 DED X RETENTION S 0 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER WC2-31S-616974-012 6/1/2022 6/1/2023 500,000 ANY gER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE Y N/A EL.EACH ACCIDENT $ (Mandatory In NH} EL.DISEASE-EA EMPLOYEE,$ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Keith Rehbein is excluded/exempt from the Workers Compensation Insurance as an officer of the corporation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ®1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 9F U.S. METAL ROOFING D 1 8" T R I B U T O R 8 . I N C . 740 High Street•Suite 2•Holyoke,MA 01040 1-800-232-0399•1-413-536-5474•Fax 1-413-533-8166 p,,, .pNp ro., _u. www.usmctalrooring.net�/ � 53/Q-/ wean.,ro Z7///snort JOB`wuunr nc /7Q d 17// /�/- /isi �+ � yiCN/j l/ non ,2Gy / iy fl • a rv.,TarF Arno Da coos / , 9 i/.Crrvv. /(/a A/rx)/ar/, AdA 6Q/// . Va N p 7+ oxucrxw, We will furnish and install new Engler1rt Standing Seam mechanically locked system,24 gauge as listed below. work ls guaranteed kx /` yews and Ow manufacturer wen.Mhs Be finish on be meta for 35 yews. COLOR:C'4.4/1C' 0141 SPECIAL INSTRUCTIONS/COMMENTS ROOF. yes asa( /rat/tldeS Sfr� irx dial f//Sl si/4f — SOFFIT: - f� hr7 .af/`/� 11't1ke /-. 7h'-C- FASCIA: — Sr7/4 1-h P/P71 e7/r-ceJ /A I-aid f 1,✓7//he7�if PLYWOOD. — /�.4 n/e. - , . , &-A eex hnt" /re /LuJ RIP/REMOVE: / PS l,//!,}-fir L�/.t/d J1 7// h! L'�fi//�' /he OTHER. 61x L 1-T q each-ft/9/-J (/tom/,/eys/ �,/ 'o' HOUSE: ra-5 An/ /, //r71I�/TZ 4 Gt/y P�6:h e C! r777e/�- PORCH: S}�nTh1T/L /�! (�f //r/i< <n%/ G3v-?r the_ ADDITION: _ /zhns�/i7i:7 Pc ./ 1/7r. /3C7L. G✓7//(f//5� GARAGE: r°S ---hv ch/q-7ney r/?he mfi/,r vprf3 .J 7/h�- GUTTERS: r/ 5Y:v- 77,-4 rip 5e eIT1S a7//,mac / 4 7 // arn7 /(v !r DOWNSPOUTS J / REPAIR: 'S//O///7' S� /'/e/2 �!!>/7Ll0-S A7%/Abe-/.?",,Dl/eV 2nr/ 7 /X,ea� A17f-6 a'' s/ra hein9 9.«'We-T.Al,i-/i h.nor rr / .s/a//,, , ul,i« /2e ) ya.nsiJl79 SAs;- /a f. -Ex/sf7.-r9 elo!✓YJ.S�u.7. /5 /J/%// € - , '-i.x • 1-r7'a" :s 51 6EK -f<J ch4,T9e. ,e -17/./y54y Z (91/As Contractor will begin work on or ab (date).Barring delay caused by circumstances beyond Contractor's control,the work wit be completed by date). All roofing panels are custom fabricate on-site with state-of-the-art roliorming equipment. 'As with any rollform steel panels,a certain amount of waviness or oil canning may become evident at certain times of the clay when sunlight hits them.This is standard In the Industry and does not affect the integrity of the metal.This shall rat be construed as a product defect and shall not be cause for rejection. Contractor does not perform or assume any responsibility for any painting,staining or wood or wall finishing on interior or exterior The contractor does further agree with the owner that(a)he will begin work within a reasonable time after the execution therool,and will prosecute It diligently and with due care,and in a good and workmanlike manner;(b)In doing the work,he will comply with all statutes, rules.regulations and ordinances applicable thereto: Contractor to procure all permits required by law.Contractor shall provide public liability Insurances. Owner warrants that he is the owner of the property on which the work is to be performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. We Propose hereby to furnish material and labor-complete in accordance with above specifications for the sum of: ///y E' hf 7hdrks417e/f✓.47f�uh/n1/ crows(s S8/Sdo•0U Payment to be made as follows: �,,,r'('J D er-11)j RAJA —) 30 1755a - 145)¢/I oJaba3 i7550.00 waeofCc lc•a•.owvwr•nnaww+ y' %a / I upon signi g Contract; U.S.METAL ROOFING DISTRIBUTORS.INC. / ) %Is�..5Y d I��a lob; saw Street.Suite 2,Holyoke,MA 01040 x,($//y/�/)1 I upon 1/2 fob canpiatian; 'r 2n ifo. g _L%(s'515 )shall be made brewers upon completion �el• CT'602546 Li / won undo this contract R. ; Nohow No agreement for home enprowrrwa contracting work shell require I doer payment wmm»a 5geva JJJ"M1ll�����/LLL — -- (advance depoai11 or more than One-third or Ina blot contract pow of tie row anem u Of all b,i.mns r pa in rich ac onts*/ e contractor must make.in advance.Io order 1M'or came ice .//P ,� .' i re�ft1.e- a.ta•M-dnir,a sp.c:al order materials and xiumen&whichaffim(Jgtranotesle! J To to eppn—a nv Oft* Acceptance of Proposal I have read both sides of this document and accept the prices,specifications and conditions staled. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified.Payment will be made as outlined above. You,the Buyer,may cancel this transaction at any time prior to midnight o fthe third business day atter the date of this transaction.Cancellation must be done In writing.See accompanying cancellation. �� JD� DO NOT SIGN THIS CO TRACT IF THERE ARE ANY BLANK SPACES Sleevef.�'.9e L-G Date �r/� �3/•,C� Si atcre _ __ . _ . - Date / IMPORTANT INFORMATION ON BACK 1