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22B-036 BP-2023-1336 20 CORTICELLI ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22B-036-001 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-2023-1336 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: US METAL ROOFING Est. Cost: 39000 DISTRIBUTORS, INC 115825 Const.Class: Exp.Date: 12/31/2024 KOZLAKOWSKI JOSEPH A&JOSEPH A JR Use Group: Owner: KOZLAKOWSKI & STACEY MORIN Lot Size (sq.ft.) Zoning: URB/WP Applicant: US METAL ROOFING DISTRIBUTORS, INC Applicant Address Phone: Insurance: 740 HIGH ST,SUITE 2 4133749470 WC2-31 S-616974 HOLYOKE, MA 01040 ISSUED ON: 09/25/2023 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 NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: I ;AO �4 d� l • • I , Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 • Office of the Building Commissioner tli 9k10 frx...,.. /4 The Commonwealth of Mais‘achi�etts `SFi° `.: -(0): Board of Building Regulations and/8 ds <P S FOR Massachusetts State Building Cody;.7S9: (10 USC1PE Building Permit Application To Construct,Repair, Re'ne4t4,1rA olis evised Mar 2011 One-or Two-Family Dwelling ',,; -;10 This Section For Official Use Only ° vv Building/ a... ..,P Number: d�..3 l, jf Date Applied: /1L 10 M7 9•25ZOZ3 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 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: 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 OWNERSHIP1 2.1 Owner'of Record: -aae. .- 't'i-eCa.n+I kozlaVowsei f/Or'PIic / /l a OI( (o Name(Print) J City,State,7.TP )O ecr4eceIIl 51- si&-a70-oo35 '1u5k q IVA qinctiI. cvm No.and Street Telephone a Email Ackltess SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg. 0 Number of Units Other Specify: tte A0 f- Brig�Description of Proposed Work': VI^i� E X L _ CL5 hrz -�d &5 se, D k e '�vl • }a l/ (" ' 0 61 7e tva e- ba it e •/o all Ieaves a_wit +brq� e S. COL.-tie' `lhtter en• A.- f� 'yhiks Unit, k1yindf. � �`i my3ale .S'. i1cfh1 slogm /?oaf Cr",/e "F, v SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 3cia 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ i 0 Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All F �$ i00 !,� Check No. L Fees? Amount: `V Cash Amount: 6. Total Project Cost: $ "�l MO✓ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- 11553 a5 la/31 /aoal 14,0-v. tl Q(L License Number Expiration Date Name of CSL Holder �C v n n List CSL Type(see below) No.and Street (� Type Description titT�� r r(� 1 �/� D � O U Unrestricted(Buildings up to 35,000 Cu.ft.) d R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances `N-37q-9t17D / e f l hZ u s rne-t rot h,, torn I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) V, M et l f?od.4'z I'I.q tiS Vl L HICRegistration��Dumber Expiration 01 ti �Datey HI Co�y>ZI�e�or HIC Tgistrant�4(J s in b Wk No and Street Email address 416 yo '4I3-536-5'1 7y CityfFo ZIP State, 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 . S U , J f e I /p0/r l q 1. 1 ZINC to act on my behalf,in all matters relative to work authorized by this building permit application. o Ko2A, sis sep /9/ao33 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 contained in this application is true and accurate to the best of my knowledge and understanding. i{et-k�n ` �j,l��in ���— �e' ic)a.1.3 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" tZ.. The Commonwealth of:'fassachusetts ii. =, Department of Industrial Accidents i .,.• _...1:= - I Congress Street,Suite 100 __It� Boston, MA 02114-2017 •'' ;_,,+', www.mass.ovidia S%oikers'Compensadoa Insurance Affidavit:Builders/ContractorsfEkctrieians/Plumbers. TO BE FILED WITH 1'1W PERMUTING AUTHORITY. Applicant Information Please Print Levlbiv Name(BusinessOr anizationlindnidual): Ul >. M'e _..[!Roof, j Dts+ h,..._ Address: 9 L ct 1,* 5 l a, City/State/Zip: p p,p( MA 01©4tp Phone #: g13--5342 5`I ?L4 Are yrs an emaploye Cheek the but: Type of project(required): 1.6 am a employer with r:Rirj_employ,ees(full and,iu,pew-liras).• 7. 0 New construction 2.a I am a sole proprietor or partnership and have no employees working for me at 8. 0 Remodeling any capacity.[Nu workers'cormp.msunince requrred.j 30 I am a honieww nee doing all Kock myself.[No warlee^s'comp.insurance'quated]' 9. ❑Demolition 4.a l am a homeowner and will be him ewivadctora to residua all work on m y10 Building addition hiring }parperty. I will erasure that all co/amours either have workers'compensation insurance or are Sole I I.a Electrical repairs or additions proprietors wide no employees. 12.0 Plumbing repairs or additions 50 I am a general contractor and I has c hired the subcontractors listed on the Washed sheet. 13 oof repairs These subcontractors have employees and have workers'comp insurance.: P 6.0 We are a corporation and its officers have exercised their right of exemption per MCiL c. 14.0 Other 152.§1(4).and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks boa al most also fill out die section below stow ing their workers'compensation policy infurmatwwt. Homeowners who submit this afuidkasrt indicating they are doing all work and then hire outside contractors meta submit a new affidavit indicating such. :Contractors that check this hex must attached an additional sheet showing the name of the sub-eontractars and state whether or not those entities have employees. If elk sub-contractors has.areiloyees.they must preside their workers'.xrmp.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: "V)er V"U-TU€.1 - -k re- IpS,,reth oe `` — Policy#or Self-ins.Lic.#: W C.a,'-315 - 6 I 61 7 LI- in13 Expiration Date: 6f j J O)U 4 lob Site Address: oa Ci e 0 r (C._e ( t 5I-- City/State/Zip: No r k4takvilO f o/l l Pt 4 Attach a copy of the siorker^s'compensation policy declaration page(showing the policy number and expi�r((tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 thee pains and penalties of perjury that the information provided oh)t•e i' I tie and co cf. Si mature: o l,% Date: f 7 u ay t� �2 Phone#: M,k% — I1 — 947D Official use only. Do not write in this area,to be completed by city or town official ('its or Toros: Permit/License ft Issuing Authority (circle one): 1. Board of Health 2. Building Department 3.('lty(Tawn Clerk 4. Electrical Inspector 5. Plumbin:, I uspecttir 6.Other Contact Person: Phone#: City of Northampton �oaYtiMN`o� 5\5,..."", SAC Massachusetts ��, ;•- 'e 14 DEPARTMENT OF BUILDING INSPECTIONS• 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: rher Location of Facility: C a-Ce11 , ,s-e 5 6Z tl al11' 51' 66/y0/-4 The debris will be transported by: 0, S, /we / ,b9 'y 41SJ "I(I Name of Hauler: L2 S f17e/aI , Hof iy Signature of Applicant: l' ` Date: l y `3 i-�� USMETAL-01 LAURA AMMO DATE MM/DD/YYYY) �— CERTIFICATE OF LIABILITY INSURANCE E(MM/D23 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 co,N o,Eat):(413)594-5984 FAx 413 592-8499 97 Center Street ( lac,No):( ) Chicopee,MA 01013 E-MAIL laura@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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS -LTR INSD,WVD IMMIDDIYYYYI (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PBP2910552 6/1/2023 6/1/2024 D AMAGEES(TOEaRENTED occurr ence) $ 500,000 PREM IS 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 Xi PRO- X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: _ $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO BAP2483772 6/1/2023 6/1/2024 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY , AUTOS ONLY (Per accident) $ _ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PBP2910552 6/1/2023 6/1/2024 AGGREGATE $ 1,000,000 _ DED X RETENTION$ 0 _ $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WC2-31S-616974-013 6/1/2023 6/1/2024 500,000 ANY PROPRIETOR/PXCLUDE/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ OFFICER/MEMBERt EXCLUDED? (Mandatory E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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.The Workers Compensation Policy Includes the following 3A States:MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affacr0and Business Regulation 1000 Washingtoj} rt- Suite 710 Bostork--Massacf tts-02118 Home Imp '— coregistration ,..) .....fr . r 1 \,Type: Corporation U.S.METAL ROOFING DISTRIBUTORS,INC. '( _ e ation: 34740 740 HIGH ST.SUITE 2 `-' Exxpikation: 01/18l2024 HOLYOKE,MA 01040 ,� ,I : Y $' s, Update Address and Return Card. • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPE:Corporation Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 134740 01/18/2024 Boston,MA 02118 I.S.METAL ROOFING DISTRIBUTORS,INC. :EITH REHBEIN .: L 1� 4- 4' ---- 40 HIGH ST.SUITE 2 era.g.a004: IOLYOKE,MA 01040 Undersecretary Not valid without signature r. / 1 , nil `. : =�,U.S. METAL ROOFING(� D I S T R I B U T O R S , I N C . GA,\ .` t� 740 HighiStreet•Suite 2•Holyoke,MA 01040 c •T ' 1- 0 r•1'l,.I...Iat„rP.\ii V-536-i5474•Fax A413-533-8 4 ro r,t _ .•,-.-,-Z-e,:-,,,,,--,,--„, is rMzIx&Aski ` � 2.74.-v 3s = L'Illi. z. ,5.„, .`,. ,, _ \s_,. `, install new E St,aMnding me m chanically locked system,24 gauge as listed below. 1. t . • III0 1 rtndlw rer*amitieMOes B.M en sue mete]tot 33 Wm SPECIAL INSTRU S/ ;AMENtTS l� E? ' S `a /-�i°,AC'Sai ,/ f • S •J14r � �' 5/:STi/gyp Ckf f/t���JX iCk 1,41,/ L/"/Sh// // ' FASCIA: `1, �J,1g1/i/er 1%, H/i/'r ,a e ark. ,/ 1} PLYw000: 1 re ) 'rA��(/-r /r? , ,,/L. i/iv-/r�i/e/' LN//Pe RIP/REMOVE: r ,./J /Od r/1 Me/'-s* S ft 1- fl/4 /&/ OTHER: ,1),, a i ". 1,e1/7 4- d 1,,(. /-rr !,/il/ to✓er HOUSE: �/C c� -.f/L''�C/t /`/tit-(d/_ LS r7i/- of OM!CVO/. (n/L !till PORCH: - "+'7.-,( Q!ul- J/*e L///f�)/2cy �4, L 7 U'u 6. ADDITION: - -ijr1e/t 56t4e //'77 c.Q4t/L1 r -/4/7I I Aj�//`o'(/f/�" GARAGE: —, I '•'La-(( gP4,/rt s. 74,,, Q/J �QLC- /�. ._. GOFERS: 138 _500,00 DOWNSPOUTS - {( +%;i6Z2 ' �/�adk 9�1//(1�. /r7S/W7/Cie I/%J.� REPAIR: 4. I". `Ito-,tt'a 76•Z l/C/C! ,zr /h n .i/ 10 I ,( ' ..s.fi,,�xJ-/-e i-d //75 a//��• iglu.G✓/./77/5414 9ISeelfCoi` 7he• /�h 3/t h ivof: �1 / /ys.ve6.// fe "T�'/',� .0 a I/'rao n'e e,E• war- A eC s, /`e---�=2,! ti/�t f e� . .2.rb /Ye w/l/ he ip,0 eon f. the /° /re. 5-Lk,. fee/ a//•/act /0.-ea./s_ S.�Y7/i/e/7c "/�y� 7k,j..--ie G),l/ C'c!vv .the /72/274ih0/s2/'•df 21/2' _/Pef._i.._67e/ r" .�. ch:7ecfacrr/ S4i✓�9/Ps lei!//7" /n6/,PO1_ _ .0-?ciOd0,CIO '---27 'S -51-" ec' - (her /ieyarr� q-€/a, s of ffi.S Contractor will begin work on or about \ (date).Barring delay caused by circumstances beyond Contractors control,the work will be completed by (date). All roofing panels are custom tabricat on-site with state-of-the-art rollforming equipment. 'As with any rollform steel panels,a certain amount of waviness or oil canning may become evident at certain times of the day when sunlight hits them.This is standard in the mdoetry and does,not affect the integrity of the metal.Thu'hall not 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 wan finishing on interior or exterior. The contractor does further agree with the owner that(a)he will begin work within a reasonable time aver the execution thereof,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 materialy and labor-complete in accordance with above specifications for the sum of: , Payment to £bllow i f //te2c r( 5('/Z rI roc J__7 f e H�n rl 3dlars(S 3 1 3<�(� Ui ) • as rJMP ' Merit.a CaMncloio..ru.nel R.eunrn 3 D %(s 11,' '/ )tan signing Contract: U S.METAL ROOFING DISTRIBUTORS,INC. seem Marta 2I+ x(S__�7//_&ti a PO, 740 High Street,Suite 2,Holyoke,MA 01040 L� �� Prone /�7.//"._ 1-a00-232.0399 aA J %K Gt!)upon 1/2 job completion; nev.v.eon No. / o MA•134740 CT�fM54ti /O %(f }worn be mace tamvnN)pm completion Mere a //eY+S'. work under this mA�i i, - � µ_ Naeoe:Na agreement ter wine improvement contracting work twit rpW•down WWI enema n late re depots)a more than am-t ird of are total contract puce or the total. by a--- .•,�-er7a_w �,ff ' dolmas or ptymer s Merl ate contractor rrl4st mak•,n Wwn i ,to order and/or own./nare /�a(� C I11/.L obfon dawn/a t oralf Wei'materials andlgwpn•^l.etr tey°rt-+rn Iri is mitt! ,1 4 j 11 To tie be e gg Ot ) Accep ance of Proposal I have reaQ both sides d this document anc ccept the prices,specifications and conditions stated. I understand that,upon signing.this pro$eal barn i es 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 tthe third business day atter the date of this transaction.Cancellation must be done In writing.See accompanying cancellation. DO NOT GNTHIS CONTRACT IF THERE ARE ANY BLANK SPACES SlOnatln .y'�'/,,!', 4^attr 9 • — Date i W IMPORTANT INFORMATION ON BACK 1