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23D-091 (7) BP-2023-1344 171 FEDERAL ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23D-091-001 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-2023-1344 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 7600 JASON SMEGAL CS-093889 Const.Class: Exp.Date:02/24/2024 Use Group: Owner: MCDERMOTT MARY Lot Size (sq.ft.) Zoning: URB Applicant: J SMEGAL CONTRACTING LLC Applicant Address Phone: Insurance: 622 HANCOCK RD 413-655-7663 6S6OUB-6R311297 PITTSFIELD, MA 01201 ISSUED ON: 09/26/2023 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: t t � Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED & The Commonwealth of Massachusetts 1 it ,R Board of Building Regulations and standards S P ? 5 navy, M'JNIF PALITY -. QR \ Massachusetts State Building Code,780 CMRUtE C Building Permit Application To Construct,Repair,Renovate-Or-Der lish..a —gevised Mar 2011 One-or Two-Family Dwelling =arc ri oa,s This Secti_oy For Official Use Only ___`- Building Permit Number: j+SO-d-3 -I Y Date Applied: i,,,,AL Building Official(Print Name) Signature Da SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 171 Federal Street 1.1a 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 Y Side Ya s R ar Y: . i1/4) Required ed Required Provi d Required Provided 1.6 Water up ly:(M.G.L c.40,§54) 1.7 Flo d ne formation: 1.8 Sewa e Disposal System: Zone: s Outside Flood Zone? Public❑ Private 0 Check if yes❑ Municipal CIOn site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Mary McDermott Northampton,MA 01062 Name(Print) City,State,ZIP 171 Federal Street 413-230-7727 marymcdermottlayahoo.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 0 Existing Building 17 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition 0 Demolition ❑ Accessory Bldg.0 Number of Units Other o '.ecify:roof replacement Brief Description of Proposed Work':***See Contract*** SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $7,600.00 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ CIStandard City/Town Application Fee 0 Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Feel: Check No.%Wm Check Amount: Cash Amount: 6.Total Project Cost: $7,600.00 0 Paid in Full 0 Outstanding Balance Due: ( I ( (' SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 093889 02.24.2024 Jason Smegal License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 622 Hancock Road No.and Street Type Description Pittsfield,MA 01201 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC RoofingCovering WS • and Siding SF Solid Fuel Burning Appliances 413-655-7663 office(a)jsmegalroofing.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 200030 11.03.2024 J Smegal Contracting,LLC HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 622 Hancock Road officena,jsinegalroofing.com No.and Street Email address Pittsfield,MA 01201 413-655-7663 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 El 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 to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION Set Contra C. 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. 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" City of Northampton r>>� t_ Massachusetts /,,� p n_ ie• -i DEPARTMENT OF BUILDING INSPECTIONS x 212 Main Street a Municipal Building v �. it }b Northampton, MA 01060 nlp,v a; ''' 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: Co set 1a N oGTe Hcunacitinaril. Location of Facility: I4 YV 1 ilow Cree c Rood Lenox. HA The debris will be transported by: Name of Hauler: o.\4►SOn sego I • Signature of Applicant: Date: Ci'2.1 •23 The Commonwealth of Massachusetts IDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 " www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):J Smegal Contracting, LLC Address:622 Hancock Road City/State/Zip:Pittsfield, MA 01201 Phone #:413-655-7663 Are you an employer? Check the appropriate box: Type of project(required): LEI❑✓ I am a employer with 7 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9. ❑ Building addition 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.] *Any applicant that checks box#1 must also till 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. Contractors 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:The Hartford Policy#or Self-ins. Lic. #:6S60UB-6R3 1 1 29-7-23 Expiration Date:03-21-2024 Job Site Address: t"1t Federal si • City/State/Zip: Worthamp}on NA0 1 to(p0 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: q. 21. 23 Phone#:413-655-7663 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: roketr . y4t4,00 • KLAUS ROOFING Gutter, I LOW SLOPE SYSTEMS Shutter b'J Smegal Contracting, LLC ORDER AND CONTRACT //� r ?Name: ' `Q/ 1/tit �e�/��'2�c;� Date: 7-4- 3 Street: ! ti° CP �t Town: >� // l�� � ( � o a�"ti'ts21b/1 State: I agree to furnish all materials and labor necessary for the work (specified below) on premises located at a-!'rD✓e Specifications Contractor agrees to remove eyisting layer(s) 1 of roofing down to wood decking on •e4ti l4t.*-( . New roofing will consist of using a two-layer Polyglass Elastoflex low slope roofing system in color: black. We will install a base sheet,then drip edge with primer. We will then install cap sheet. We will install new aluminum vent pipe boots as well as flashing to be installed as needed, where needed to ensure a watertight seal. New aluminum drip edge in color:4 will be installed. ?g.D 1 00 -.") If any rotted/bad sheathing is found it will be replaced at an Additional Cost of$iirlever sheet. (INITIALS) l►kc,L) C..g 10 ptveocs c s/y``Jcwc) r - c/@ 1 o v ip e r' ( )C Price includes all permits needed as well as siding debris removal from property. The undersigned property owners agree upon completion of specified work to pay the sum of $ 7 tP OOcontract price $ 3 cS OO deposit Final Balance $ 3c!?00 not including an extra cost occurred during roofing install. This contract constitutes the entire understanding of the parties, and no other understand, collateral or otherwise. Shall be binding unless in writing signed by both parties. At any time before work is actually started on the above-mentioned premises by us, we hereby reserve the right to reject this contract and, in such case, your advance payment will be returned. IN WITNESS WHEREOF the undersigned have here unto subscribe their names the day and the year first above written. HOMEOWNER SIGN HERE: 1$C9eAfiLDt 7 4 S Contractor:Jason Smegal,Owner CSL#093889 HIC#200030 Not responsible for damaged caused by ice dams/ice backup,or for leaks caused by satellite dishes or install. Includes 5-year workmanship labor warranty. Elastoflex products come with a 15-year material warranty.Solar panel install voids all labor warranties.*All standard chimney flashings to be LEAD* 449 Pittsfield Road Suite#201 Lenox,MA 01240 ACORL CERTIFICATE OF LIABILITY INSURANCE DATE 9/21/202 "' 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 NAME: Emily Volentine Bell Scott Insurance PHONE FAX Roofer's Choice Insurance IA/c.No.Extl: 972-938-9676 (A/C,No):877-937-7521 PO Box 2567 ADDRESS: coi@rooferschoiceinsurance.com Waxahachie TX 75168 INSURER(S)AFFORDING COVERAGE NAICO INSURER A:Summit Specialty Insurance Company 16889 INSURED JSMEGAL-01 INSURER B J. Smegal Contracting, LLC 622 Hancock Rd. INSURER C: Pittsfield MA 01201 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:236473064 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 SUBR POLICY EFF POLICY EXP LIMBS LTR INSD MD_ POLICY NUMBER (MM/DO/YYYY) (MM/DD/YYYY) _ A X COMMERCIAL GENERAL LIABILITY SCGL004000004600 4/1/2023 4/1/2024 EACH OCCURRENCE $1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY x ofLOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILEUABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ $ UMBRELLALIAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-WADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER I !OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) RE:171 Federal Street CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Department of Building Inspections 212 Main Street AUTHORIZED REPRESENTATIVE Northampton MA 01060 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD JSMEGAL-01 KKNIGHTS ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/21/2023 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 Kim Knights NAME; MountainOne Insurance Agency,Inc. PHONE FAX 85 Main Street,Suite 100 (NC,No,Ext):(413)418-4470 (A/C,No): North Adams,MA 01247 ADDRESS;Kim.Knights@mountainone.com INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:State Auto Property&Casualty 25127 INSURED INSURER B:The Hartford-ARWC J Smegal Contracting LLC INSURER C: 622 Hancock Road INSURER D: Pittsfield,MA 01201 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMM/DD/YYYY) IMM/DD/YYYY) _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES lEa occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY j UT f I LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 JEa accident) $ _ ANY AUTO BAP2484307 4/1/2023 4/1/2024 BODILY INJURY(Per person) $ OWNED v SCHEDULED AUTOSE ONLY AUTOSN EE BODILY INJURY(Per accident) $ X AUTOS ONLY X NOB-OWNED ONNLYY (Per accident)'DAMAGE $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB ,CLAIMS-MADE AGGREGATE $ DED RETENTION$ _ $ B WORKERS COMPENSATION "y PER STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 6S60UB6R31129723 3/21/2023 3/21/2024 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OMand RJMEn NHj EXCLUDED? N N/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 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) JOb: 171 Federal Street. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE POLICY PROVISIONS. Department of Building Inspections 212 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i�ir Commonwealth at Massachusetts ; Division of Occupational Licensure Board of Building ReJgulationsr. and Standards tl Const ton Sffrvisor CS-093889 6cpires:02/24/2024 JASON W S EGAL f 622 HANOCROAD PITTSFIELD MA 01201 1 i% )Ltb,(l 1• Commissioner cSai /. 'U1 v u(;/a, 2/27/23, 10:22 AM Scan_20230227.jpg • • • THE COMMONWEALTH OF MASSACHUSETTS • Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registrationpiration 200030 11/03/2024 J SMEGAL CONTRACTING LLC JASON SMEGAL 622 HANCOCK ROAD y ,,,,,,K �. /oCGln.6i' PITTSFIELD,MA 01201 Undersecretary 1/1 https://mail.google.com/mail/u/1/?ogbl#inbox?projector=1