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14-014 (2) BP-2023-0732 830 CHESTERFIELD RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 14-014-001 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-2023-0732 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 9600 MATTHEW CARRIE CSLI 17335 Const.Class: Exp.Date: 06/03/202 Use Group: Owner: M THI AULT WAYNE G&FRANCES Lot Size (sq.ft.) Zoning: WP/WSP Applicant: STONE OUNTAIN ROOFING LLC • Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 06/06/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-ROOF UPPER MAIN 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: ' q • 5%4T Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissii ner DocuSign elope ID:FnOD,1 FE2/A-C4E5-4657-B85F-831972A0B50F 1roy ` f J E/ JUN The ommonwealth of Massachusetts 6 Z023 Bard f Building Regulations and Standards FOR ssa usetts State Building Code, 780 CMR MUNICIPALITY of r1 SApp cation To Construct,Repair Renovate USE .-:IH cn iOr Demolish a Revised Mar 2011 �-- _ _ One- or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Lam'' d 3 ',1.3 Date Applied: 4/1_,)42->c I/& 6- -z6z3 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 830 Chesterfield Rd. Florence 14 -014-001 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 Owner'of Record: Wayne Thibault Florence, MA 01062 Name(Print) City,State,ZIP 830 Chesterfield Rd. 413-586-1779 waynethib@comcast.net No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2 (check all that apply) New Construction 0 Existing Building i/Owner-Occupied ❑ Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition ❑ Accessory Bldg. ❑ Number of Units _ Other pecify: Roofing Brief Description of Proposed Work2: strip and replace upper main roof only (currently asphalt) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1. Building $ 9,600.00 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 (Fire $ Suppression) Total All Fees: Check No. Chec Amount: 44° Cash Amount: 6. Total Project Cost: $ 9,600.00 ❑Paid in Full Outstanding Balance Due: DocuSign Envelope ID:FOD1FE2A-C4E5-4657-B85F-831972A0B50F SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-117335 06/03/2026 Matthew Carrier License Number Expiration Date Name of CSL Holder 36 Lyon Hill Rd List CSL Type(see below) U No.and Street Type Description MA 01011 U Unrestricted(Buildings up to 35,000 Cu.ft.) Chester, City/Town,StateMA ZIP R estricted 1&2 Family Dwelling M asonry RC oofing Covering _ WS indow and Siding SF olid Fuel Burning Appliances 413-998-9010 stonemountainroofinglic@gmaii.com I sulation Telephone Email address D emolition - 5.2 Registered Home Improvement Contractor(HIC) 20 447 09/15/2024 Stone Mountain Roofing LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 36 Lyon Hill Rd st nemountainroofinglIc@gmail.com No.and Street Email address Chester, MA 01011 413-998-9010 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 NO 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 Stone Mountain Roo ing LLC/Matthew Carrier to act on my behalf,in all matters relative to work authorized by this building r ermit application. r—DocuSigned by: 6/1/2023 Wayne Thibault OJty tAt, ltilicwif Print Owner's Name(Electr ii kile Date SECTION 7b: OWNER1 OR AUTHORIZED AGEN DECLARATION By entering my name below,I hereby attest under the pains and penalties of p jury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Matthew Carrier Alial "' 5/18/2023 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" DocuSign Envelope ID:FOD1FE2A-C4E5-4657-B85F-831972AOB50F City of Northampton • � /4 .> Massachusetts �� •<<G 9.: . 14, 0 DEPARTMENT OF BUILDING INSPECTIONS S 4 �f ? 212 Main Street • 17* Northampton, MA 01060pal uilding �S�frj 3 `• 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: Valley Recycling, 234 Easthampton Rd., Northampton MA 01060 The debris will be transported by: Name of Hauler: Aaron's 24/7 Towing & Roll Off Services Signature of Applicant: Date: 5/18/2023 The Commonwealth of Massa husetts Department of Industrial Ac 'dents Nii . —iliT....: Office of Investigations ,i_• `4-t Lafayette City Center k r 3i 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): Stone Mountain Roofing LLC Address:36 Lyon Hill Rd. City/State/Zip: Chester, MA 01011 Phone #: 413-998-9010 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 1 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached she t. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 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 12.0 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'co npensation 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-c ntractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.polity number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Travelers Policy#or Self-ins. Lic. #: 7PJUB6R27941623 Expiration Date:02/17/2024 Job Site Address: SRC) ONCIS—i-Q.Xf\0. C1 ed City/State/Zip: F OQ 1 C1_ m 6 Gtc L 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 ca 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 st ement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 4 I do hereby certify under the pains and a al •' perjury that the information provided above is true and correct. .A.. Signature.I Date: (.0 I(1 aoa.3 ' Phone#: 413-998-9010 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 3E1City/Town Clerk 4.0 Electrical Inspector 5 Plumbing Inspector 6.0Other Contact Person: Phone #: Commonwealth of Massachusetts Division of Occupational Licensure '' Board of Building Re ulations and Standards Cons ion rvisor s CS-117335 Spires:06/03/2026 MATTHEW CARRIER �, s 36 LYON HILL ROAD j 3 i CHESTER Mit01011 • Commissioner I aOA �i• �Frnt�ea THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affi „a, Business Regulation 1000 Washingtgrtpt-Suite 710 Bostor�,-Massach usetts=0 118 Home Imaro e e F racfoFr a istration tarrt�� tttAlnritt�ili tata�atr Type: LLC STONE MOUNTAIN ROOFING,LLC a:is ation: 206447 36 LYON HILL RD al E 6 ation: 09/15/2024 CHESTER,MA 01011 "�— Q1 at is < . jai=iar 14IMP tint Update Address and Return Card. • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs d,Business Regulation Registration valid for Individual use only before the HOME IMPROVEMIE�N�tCONTRACTOR expiration date. If found return to: TYPErLLC_- Office of Consumer Affairs and Business Regulation Realstratlon -_Explratlop 1000 Washington Street-Suite 710 2$644 csr 09/15/2044 Boston,MA 02118 STONE MOUNTAIN a (` Li '-' MATTHEW CARRIER i4 s + 38 LYON HILL RD , _I Iww• CHESTER,MA 01011 a Undersecretary Not valid without signature ACC. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"'"Y) V 02/13/2023 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 Michelle Lastowski NAME: Alera Group,Inc. PHONE (413)586-0111 FAX 413)586-6481 (A/C,No,Ext): (A/C,No): Webber&Grinnell Division E-MAILOss: mlastowski@webberandgrinnell.com 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC a Northampton MA 01060 INSURER A: Berkley Specialty S ecialt Insurance Co INSURED INSURER B; WCAR-Travelers Stone Mountain Roofing,LLC INSURER C: 36 Lyon Hill Road INSURER D: INSURER E: Chester MA 01011 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 2/2024 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 ADDL SUBK LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY (MMIDD/YYYY) {MM/DD/YYYY) LIMITS 1 000,000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A CGL0159193 02/18/2023 02/18/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 X POLICY PRO PRODUCTS-COMP/OP AGG $ JECT LOC 2,000,000 ^^ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILYINJURY(Per $ AUTOS ONLY AUTOSaccident) HIRED NON-OWNED PROPERTY DAMAGE $ - AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE_ AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH STATUTE ER AND EMPLOYERS'LIABILITY B OFFICER/MEMBER EXCLUDED?ANY PROPRIETOR/PARTNER/EXECUTIVE Y N Y N/A 7PJUB6R27941623 02/17/2023 02/17/2024 E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E,L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD FOD1FE2A-C4E5-4657-1385F-831972A0B50F Stone Mountain Roofing LLC 36 Lyon Hill Rd., Chester, MA 01011 413-998-9010 stonemountainroofingllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT# 1126 Wayne Thibault DATE 05/18/2023 830 Chesterfield Rd. Florence, MA 01062 waynethib@comcast.net 413-586-1779 DESCRIPTION - This contract is for the upper main roof only (currently has shingles) 1. Remove the existing roofing shingles 2. Inspect the existing plywood for any rot or deterioration. Any ew plywood will be $85 per sheet installed. (Wood prices subject to change) 3. Install six feet of ice and water shield on eaves and three feet ound all penetrations 4. Cover remaining roof with synthetic underlayment 5. Install new 8" aluminum drip edge on all eaves and rake edge (Brown) 6. Install architectural shingles by CertainTeed(Landmark PRO) https://www.certainteed.com/residential-roofing/products/landm rk-pro/ Color Choice: MAX DEFINITION DRIFTWOOD 7. Install Shingle Vent 11 ridge vent on peak of roof(where appli,able) http://www.airvent.com/index.php/products/exhaust-vents/ridge ents/shinglevent2 8. Complete all necessary flashings including new LIFETIME pi.e boots and base flashing around the chimney https://lifetimetool.com/product/ultimate-pipe-flashing-shingle- ar-coated/ Includes CertainTeed Lifetime Limited Warranty (Transferable) ith 10 year SureStart period. https://www.certainteed.com/resources/Asphalt-LowSlope-Res- ' arranty-e-2201 ctr.pdf Remove all debris from premises, and throughout the job, contin e cleanup and keep the premises undamaged. WE ARE NOT RESPONSIBLE FOR DEBRIS TH T MAY FALL INTO ATTIC. Please be proactive and prepare for the worst by covering everything in th; attic. We recommend covering with tarps or plastic sheeting. Please use reasonable caution during th• installation process: do not walk or drive under active work, or on areas of potential roofing debris. Stone I ountain Roofing will obtain the building permit if necessary. Installations are weather permitting; inclement weather will cause scheduling MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 a:FOD1FE2A-C4E5-4657-B85F-831972A0B50F DESCRIPTION delays. Total: Landmark PRO shingles= $9,600 Thank you for choosing Stone Mountain Roofmg. A one-third deposit of$3,200 will secure contract,permitting, m.terial order, and priority scheduling. The balance shall be due upon completion,within 10 days of invi ice. Accounts outstanding over 30 days subject to 2% finance charge monthly. Warranty confirmation shall be provided upon final payment. In.tallation and manufacturer warranties are not in effect until Paid In Full. TOTAL $9,600.00 DocuSigned by: 6�1�2 2 3 Accepted By mait,t, 1,itictu.f Accepted Date BBDF5664F2EB4C3... MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321