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44-111 (4) BP-2023-1023 982 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 44-111-001 CITY OF NORTHAVIPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1023 PERMISSIO IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 12150 MATTHEW CARRI:R CSL117335 Const.Class: Exp.Date: 06/03/20 46 Use Group: Owner: OLSE -SHAVER SHAVER DANIEL J&ERICA Lot Size (sq.ft.) Zoning: SR Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: • 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 08/01/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF 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 NO THAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: ' )7-r • >2 . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commiss ner DocuSign Envelope ID:3A4509B3-0077-4CA3-BC92-A3A5913EDC32 ��' 'K / { /9V ./V The Commonwealth of Massach setts JO/' 0 trO/ Board of Building Regulations and :tan rds 3i FO Massachusetts State Building Cod: 78 ICI'ALITY No.Ot j .E Building Permit Application To Construct,Repair,Reno : .-T • a evise, Mar 2011 One-or Two-Family Dwelling TON Mq�E bro This Section For Official Use Only Buildin Permit Number: 80°"�.'" CUTi3 Date Applied: JWP Z, ��/� 8-1-zou Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers _982 Florence Rd. 44 -111-001 — 1.la 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: l.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 Ownerl of Record: Daniel Shaver Northampton MA 01060 Name(Print) City,State,ZIP 982 Florence Rd. 315-717-7021 dandeshav@yahoo.com No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(Check all that apply) New Construction 0 Existing Building Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Q/Specify: Roofing Brief Description of Proposed Work2: strip and replace asphalt rood. We are NOT replacing existing skylights. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 12,150.00 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ CIStandard 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 Fees: Check No.1 Z64neck Amount: 1DCash Amount: 6.Total Project Cost: $ 12,150.00 0 Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:3A4509B3-0077-4CA3-BC92-A3A5913EDC32 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 List CSL Type(see below) 156 Northampton St., No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Easthampton, MA 01027 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-998-9010 stonemountainroofingllc@gmail.com I insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 206447 09/15/2024 Stone Mountain Roofing. LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 156 Northampton St. stonemountainroofingllc@gmail.com No.and Street Email address Easthampton, MA 01027 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 vv}ith this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .Se No .❑ 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. "--oocuslgned by: 7/2 5/202 3 Daniel Shaver Vajnit,t s( i Print Owner's Name lec EeS are Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pe jury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Matthew Carrier ' I° \"""' 6/7/2023 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),wil' 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:3A4509B3-0077-4CA3-BC92-A3A5913EDC32 City of Northampton Massachusetts * G, e DEPARTMENT OF BUILDING INSPECTIONS .72 #r 212 Main Street • Municipal Building �.. Northampton, MA 01060 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: ew.=,—• Date: 6/7/2023 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center, •maw 1=•- 2 Avenue de Lafayette, Boston,111,1 02111-1750 wwn.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/bontractors/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. ✓❑ I am a employer with 1 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contr.ctors 6. New construction 2.0 I am a sole proprietor or partner- listed on the attached sh:-t. 7. ❑ Remodeling ship and have no employees These sub-contractors h. e 8. ❑ Demolition workingfor me in anycapacity. employees and have wor ers' p tY 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. 0 We are a corporation an. its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised t l eir 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per GL 12.❑✓ Roof repairs insurance required.] t c. 152, §1(4),and we ha e no employees. [No workers 13.❑ Other comp. insurance require.] *My applicant that checks box#1 must also fill out the section below showing their workers'c. pensation 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-.Intractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.poli y number. I am an employer that is providing workers'compensation insurance for m 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: l8 a r Q.,OCQ City/State/Zip' 4 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: a ei th o ( 4.. -eS- Date: 1—a() — Doak? Phone#: 413-998-9010 Official use only. Do not write in this area, to be completed by city or to n official. City or Town: Permit/Licen e # Issuing Authority(check one): 11=1Board of Health 20 Building Department 3fCity/Town Clerk 4.0 Electrical Inspector 5Eilumbing Inspector 6.0Other Contact Person: Phone#: — Commonwealth of Massachusetts laDivision of Occupational Licensure Board of Building Regulations and Standards 1` COnSt lOfIin$ (Visor CS-117335 -; i cpires: 06/03/2026 r ". MATTHEW CARRIER , s 36 LYON HILT'ROAD , CHESTER MA:01011 O cam/ 1 Commissioner c7� '. �7&1� THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washingtog$Zret-Suite 710 Boston Massachusetts 02118 Home Im ro ein,�en .4 fractorReg Registration i r m ...,., ,_ r,_, r Type: LLC STONE MOUNTAIN ROOFING,LLC egiVation: 206447 36 LYON HILL RD �° E pj alien: 09/15/2024 CHESTER,MA 01011 -x,,,, ".C." o C 451 114 AN, "W Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for indivi.-lual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYEEftrC Office of Consumer Affairs and Business Regulation Registration a expiration 1000 Washington Street -Suite 710 296447'`}:,i i.09/15/2024 Boston,MA 02118 STONE MOUNTAIN ROQFING,•LLC, it 4)6 w MATTHEW CARRIER . 36 LYON HILL RDA ���r��i O�w. CHESTER,MA 01011 Undersecretary Not valid without signature C ® DATE(MMIDD/YVYY) 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. (A/C, EXt): (413)586-0111 FAX No): (413)586-6481 Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURER A: 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 O�HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESC TER HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDIYYYY) ` LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGEREED CLAIMS-MADE X OCCUR P EM SES0(Ea occur ence) $ 100,000 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 POLICY JECT pi LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: ' E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED AUTOS ONLY X SCHEDULED 1020114776 02/18/2023 02/18/2024 BODILY INJURY(Per accident) $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 AND EMPLOYERS'LIABILITY X STATUTE OTH- ER/N 100000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y NIA 7PJUB6R27941623 02/17/2023 02/17/2024 ( E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - DESCRIPTION OF OPERATIONS/LOCATIONS I 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 • . w DocuSign Envelope ID:3A4509B3-0077-4CA3-BC92-A3A5913EDC32 Stone Mountain Roofing LLC 156 Northampton St Easthampton, MA 01027 I ��� //� }' 413-998-9010 stonemountainroofingllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ \, ROOFING Contract ADDRESS CONTRACT# 1123 Dan Shaver DATE 06/07/2023 982 Florence Rd. Northampton,MA 01060 dandeshav@yahoo.com 315-717-7021 � 7714-42-. DESCRIPTION � � e. 4,41 , ** Stone Mountain Roofing is not liable for the existing skylights that are not being replaced. 1. Remove the existing roofing shingles 2. Inspect the existing plywood for any rot or deterioration. Any new 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 in valleys/around all penetrations 4. Cover remaining roof with synthetic underlayment 5. Install new 8" aluminum drip edge on all eaves and rake edges 6. Install architectural shingles by CertainTeed(Landmark PRO) https://www.certaint eed.com/residential-roofing/products/landmark-pro/ Color Choice: TO BE DETERMINED 7. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) http://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/Shinglevent2 8. Complete all necessary flashings including new LIFETIME pipe boots https://lifetimetool.com/product/ultimate-pipe-flashing-shingle-kynar-coated/ Includes CertainTeed Lifetime Limited Warranty(Transferable)with 10 year SureStart period. https://www.certainteed.com/resources/Asphalt-LowSlope-Res-Warranty-e-2201 ctr.pdf Remove all debris from premises, and throughout the job, continue cleanup and keep the premises undamaged. WE ARE NOT RESPONSIBLE FOR DEBRIS THAT MAY 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 th installation process: do not walk or drive under active work, or on areas of potential roofing debris. Stone ountain Roofing will obtain the building permit if necessary. Installations are weather permitting inclement weather will cause scheduling delays. MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 DocuSign Envelope ID:3A4509B3-0077-4CA3-BC92-A3A5913EDC32 Akan „, DESCRIPTION - 4 � `z ��. Landmark PRO shingles=$12,150 Thank you for choosing Stone Mountain Roofing. A one-third deposit of$4,050 will secure contract,permitting,material 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. Installation and manufacturer warranties are not in effect until Paid In Full. TOTAL $12,150.00 Accepted By °0cu59ned bY. Accepted Date 7/25/2023 P Patiuit,t, S \--DB89AE6E9501452... MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321