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31A-145 (2) BP-2023-0989 24 FORBES AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 31A-145-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGIS ERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0989 PERMISSION S HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 4950 MATTHEW CARRIE: CSL117335 Const.Class: Exp.Date: 06/03/202 c Use Group: Owner: HART ANN HOLLY E Lot Size (sq.ft.) Zoning: URB Applicant: STONE OUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 07/27/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF GARAGE ONLY 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 NORfHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Q ( ' I , y0 - d' Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:OEBDC041-2B55-4977-963A-60FE70095380 191...1 The Commonwealth of Massa, ruse . �G! � g, 6 Board of Building Regulations an. an s„ ?6` O FO' Massachusetts State Building Code, 78 t, /� <4201 , ICI E ITY Building Permit Application To Construct,Repair,Renovate "°w .,• • h a •evis.!Mar 2011 One-or Two-Family Dwelling •tr4ci, s ton For Official Use Only �'O hs Building ermit Number: 9 ?3' Date A plied: ev,� Zi //7 7-27-ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 24 Forbes Ave., Northampton - 1.1 a Is this an accepted street?yes no Map Number I Parcel Number I 1.3 Zoning Information: 1.4 Property Dimen$ions: 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? 1.Iunicipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHI'1 2.1 Owner'of Record: Dave Russell Northampton, MA 01060 Name(Print) City,State,ZIP 24 Forbes Ave., 413-374-0789 J daverusse11413@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building Owner-Occupied 0 Repairs(s)1 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other c/Specify: Roofing Brief Description of Proposed Work2: strip and replace asphalt roof on garage only SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 4,950.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fee Check No.%k Check Amount: - Cash Amount: 6.Total Project Cost: $ 4,950.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:OEBDC041-2B55-4977-963A-60FE70095380 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-117 35 06/03/2026 Matthew Carrier License Num,-r Expiration Date Name of CSL Holder 36 Lyon Hill Rd List CSL Typ' (see below) U No.and Street Type Description U I nrestricted(Buildings up to 35,000 cu.ft.) Chester, MA 01011 R :estricted 1&2 Family Dwelling City/Town,State,ZIP M asonry RC :oofing Covering WS indow and Siding SF 'olid Fuel Burning Appliances 413-998-9010 stonemountainroofingllc@gmail.com I I sulation Telephone Email address D It emolition 5.2 Registered Home Improvement Contractor(HIC) 206447 09/15/2024 Stone Mountain Roofing LLC HIC Zegistration Number Expiration Date HIC Company Name or HIC Registrant Name 36 Lyon Hill Rd stonemountainroofingllc@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 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 Roofing LLC/Matthew Carrier to act on my behalf,in all matters relative to work authorized by this building permit application. r—DocuSIgned by: 6/1/202 3 Dave Russell Print Owner's Name { } ;� ,,tire) 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. Matthew Carrier 5/30/2023 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 informatipn 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:OEBDC041-2B55-4977-963A-60FE70095380 City of Northampton �''*, Massachusetts ? 'ee, W : '•� � , ``si DEPARTMENT OF BUILDING INSPECTIONS 'y .`: .. D. - 212 Main Street • Municipal Building . mr' E P S y�s Northampton, MA 01060 s3`Nw '[)' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, 554, 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: 5/30/2023 DATE(MM/DD/YYYY) I?ACL IJ� CERTIFICATE OF LIABILITY INSURANCE �..�- 06/27/2023 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 8 Grinnell Division E-MAIL mlastowski@webberandgrinnell.corn ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Berkley Specialty Insurance Co INSURED INSURER B: WCAR-Travelers Stone Mountain Roofing,LLC INSURER C: 156 Northampton Street INSURER D: INSURER E: Easthampton MA 01027 , 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 ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 100,000 CLAIMS-MADE OCCUR 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 n JPRC- n LOC PRODUCTS-COMP/OPAGG $ 1000.000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED >/ SCHEDULED 1020114776 02/18/2023 02/18/2024 BODILY INJURY(Per accident) _ AUTOS ONLY /—'s AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) PIP Basic $ 8,000 UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N II 1 00000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA 7PJUB6R27941623 02/17/203 02/17/2024 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if mdre 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 9 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massa husetts Department of Industrial Ac idents - 1' Office of Investigation lt, `' Lafayette City Center 2 Avenue de Lafayette, Boston,M 02111-1750 wwx.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: 156 Northampton St. City/State/Zip: Easthampton, MA 01027 Phone #: 413-998-9010 Are you an employer? Check the appropriate box: Type of project(required): 1.E I am a employer with 1 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contra tors 6 New❑ construction listed on the attached she t. 7. IDRemodeling 2.El I am a sole proprietor or partner- ship and have no employees These sub-contractors ha a 8. ❑ Demolition working for me in any capacity. employees and have wor ers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation an its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised t eir 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per M L 12.❑✓ Roof repairs insurance required.] t c. 152, §1(4),and we ha a 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. tContractors 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: Travelers Policy#or Self-ins. Lic. #: 7PJUB6R27941623 Expiration Date:02/17/2024 Job Site Address: au Fbv 1.S my. City/State/Zip: Ivan 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 certify under the pains and penalties of perjury that the information provided above is trueand correct. Signature:�ieca (1 4u e4 Date: ~7 /c 1 c d a a Phone#: 413-998-9010 Official use only. l)o not write in this area, to he completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 10Board of Health 20 Building Department 3.0City/Town Clerk 4.0 Electrical Inspector 5Fll'luntbing Inspector 6.0Other Contact Person: Phone#: Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Co nstion Srvisor rti. Tr CS 117335 145pires: 06/03/2026 MATTHEW CARRIER :A 36 LYON HILit ROAD CHESTER Mit,01011 421 Commissioner juera p -. I7�vn[�hi THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingto,a:S re,,pt-Suite 710 Boston,.Massachusetts_92118 Home Im ro ement:6 racfor=fie istration ,,_y„ 7, Type: LLC 'a = a'isf ation: 206447 STONE MOUNTAIN ROOFING,LLC ^' E p'lration: 09/15/2024 36 LYON HILL RD = CHESTER,MA 01011 ,_ ,.. Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consuvi r Affairs&Business P.egu!atic:: Registration valid for in.dividaa:use only brfore the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE'LCC Office of Consumer Affairs and Business Regulation Registration P Exoirathj 1000 Washington Street -Suite 710 2Q6447'", :i 6.09/15/2024 Boston,MA 02118 STONE MOUNTAIN ROOFING,LLC, s«_. 17< 1 , MATTHEW CARRIER Y ,' " ' Ai) - 36 LYON HILL RD t ' "ol Ou►�. CHESTER,MA 01011 - Undersecretary Not valid without signature DocuSign Envelope ID:OEBDC041-2B55-4977-963A-60FE70095380 Stone Mountain Roofing LLC 36 Lyon Hill Rd., Jk .'''410Stli Chester, MA 01011 413-998-9010 stonemountainroofingllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ ROOFING \oXw, Contract ADDRESS CONTRACT# 1 124 Dave Russell DATE 05/17/2023 24 Forbes Ave. Northampton, MA 01060 daverusse11413@gmail.com 413-374-0789 DESCRIPTION �,t� � yy���' i �' � - This contract is for the detached garage 1. Remove the existing roofing shingles 2. Remove the existing rotted fascia trim(located on one side of the overhang) 3. Install new 1/2 inch CDX plywood overtop the existing boards 4. Cover entire roof with synthetic underlayment 5. Install new Azek PVC fascia trim on one side of the overhang 6. Install new 8" aluminum drip edge on all eaves and rake edges 7. Install architectural shingles by CertainTeed(Landmark) http://www.certainteed.com/residenti al-roofing/products/landmark/ Color Choice: Pewterwood 8. Install Shingle Vent 11 ridge vent on peak of roof(where applica le) http://www.airvent.com/index.php/products/exhaust-vents/ridge-ve ts/shinglevent2 9. Install new Mule Hide rolled roofing on low slope section Includes CertainTeed Lifetime Limited Warranty(Transferable)wi h 10 year SureStart period. https://www.certainteed.com/resources/Asphalt-LowSlope-Res-W anty-e-2201ctr.pdf Remove all debris from premises, and throughout the job, continue cleanup and keep the premises undamaged. WE ARE NOT RESPONSIBLE FOR DEBRIS THATMAY FALL INTO ATTIC. Please be proactive and prepare for the worst by covering everything in the attic. We recommend covering with tarps or plastic sheeting. Please use reasonable caution during the installation process: do not walk or drive under active work, or on areas of potential roofing debris. Stone M untain Roofing will obtain the building permit if necessary. Installations are weather permitting; i clement weather will cause scheduling delays. MA-CSL#I 17335 MA-HIC#206447 CT-HIC.0668321 I I • DocuSign Envelope ID:OEBDC041-2B55-4977-963A-60FE70095380 DESCRIPTION Total: Landmark shingles= $4,950 Thank you for choosing Stone Mountain Roofing. A one-third deposit of$1,650 will secure contract, permitting, m. erial order, and priority scheduling. The balance shall be due upon completion,within 10 days of invoice. Accounts outstanding over 30 days subject to 2% finance charge monthly. Warranty confirmation shall be provided upon final payment. Ins allation and manufacturer warranties are not in effect until Paid In Full. TOTAL $4,950.00 to—Docuslgn.d by:Accepted By ch C n ,l Accepte s Date 6/1/2023 —13B718104BOD0400... MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321