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17C-026 (10) BP-2023-1341 90 NORTH MAPLE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17C-026-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-1341 PERMISSION IS HEREBY GRANTED TO: Project# ROOF/SKYLIGHT 2023 Contractor: License: Est. Cost: 9900 MATTHEW CARRIER Const.Class: Exp.Date: VAN NAERSSEN KRISTOFFER J&KATRINA VAN Use Group: Owner: NAERSSEN KAZDA Lot Size (sq.ft.) Zoning: URB Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 09/26/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF/ REPLACE 2 SKYLIGHTS 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: Fees Paid: $80.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:9D037038-AB6F-4038-A0D2-5BDCFD884E5F Ai-).-` 'C , The Commonwealth of Massa.s uset 'OFF \' iD v ;, Board of Building Regulations a . St ds 416. (- F pALITY Massachusetts State Building Co.-, 0 Building Permit Application To Construct,Repair,Renovate" ' a Revi ed Mar 2011 One-or Two-Family Dwelling •r�10 o,/0Ns This Sec i n For Official Use Only Building Permit Number: el-03 • 19J Date Applied: I; , , , iu q16/a3 T.AiBuilding Official(Print Name) 1 Signatures Da SECTION 1:SITE INFORMATION 1.1 Property Address: 11.2 Assessors Map&Parcel Numbers 90 North Maple St. Florence 17C-026-001 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: <ristoffer Van Naerssen c/o Livewell Home Improvement Florence MAnlivcwcllhomcimprovcmcnt.corn Name(Print) City,State,ZIP 90 North Maple St. off ice@ 1'�pt�lnllhmbi �rvrvQ(1cti01� 1�-Ccin 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) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units_ I Other IQ/Specify: Roofing ___ Brief Description of Proposed Work2: strip and replace asphalt roof. Install 2 skylights SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I.Building $ 19,900.00 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 $ ifr go Suppression) Total All Fees: $//''�� Check No. 1,0 t4Check Amount: Cash Amount: 6.Total Project Cost: $ 9,900.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:9D037038-AB6F-4038-A0D2-5BDCFD884E5F 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 156 Northampton St., List CSL Type(see below) U No.and Street Type Description Easthampton, MA 01027 U Unrestricted(Buildings up to 35,000 Cu.ft.) p 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 stonemountainroofinglIc@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 Re istrant Name 156 Northampton St. stonemountainroofinglIc@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 with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes QI 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. Docusigned by: Kristoffer Van Naerssen d o Livewell Home Improvement nit, ( tm v. ..1 9/8/2023 Print Owner's Name(Electronic Signature) B7A7D092F667744CF... �M 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 'e" '~-" 9/1/2023 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:9D037038-AB6F-4038-A0D2-5BDCFD884E5F City of Northampton Massachusetts *• - Gs DEPARTMENT OF BUILDING INSPECTIONS ; i 3 212 Main Street • Municipal Building Jti OD Northampton, MA 01060 Ss . ‘^\` 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: 9/1/2023 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 y s ` 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: 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): 1111 I am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. n New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 7 Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.t required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.111 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'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: Travelers Policy#or Self-ins. Lic. #: 7PJUB6R27941623 Expiration Date: 02/17/2024 Job Site Address: "n NcrapLIZ_ (St City/State/Zip: �1Cdic Q.fl(Q L Vl'� 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 thethp pains and penalties of perjury that the information provided above is true and correct. Signature:*�i 6.44-ieti Date: CI tcRQ 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 3EICity/Town Clerk 4.0 Electrical Inspector 5E:Plumbing Inspector 6.0Other Contact Person: Phone#: • Commonwealth of Massachusetts c Division of Occupational Licensure Board of Building Re ulations and Standards Con tonTS�isor CS-117335 I plres:0610312026 MATTHEW(CRIER" r ,, 36 LYON HILE ROAD ,,t Z ' CHESTER Mit,01011 % f, ? ��' a.�� 'ram, ����Lit d.>>� Commissioner clabfG K '21/Emil'n THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Afffs aid Business Regulation 1000 Washingtc :Brat-Suite 710 Bosto►kMassachusetts02118 Home Im ro e. e ,fa's actor-i1epgistration "tz /`4. rR —,...,:yam = Type: LLC 'm �..= esfration: 206447 STONE MOUNTAIN ROOFING,LLC "" E p1'ation: 09/16/2024 36 LYON HILL RD .� .,�, CHESTER,MA 01011 ..,,.�-" .+„t Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid for Individual use only before the HOME IMPROVEMEN7"CONTRACTOR expiration date. If found return to: TYPEn-rc Office of Consumer Affairs and Business Regulation Registrattort ,. gxpiratlort 1000 Washington Street-Suite 710 20 6447'" , 0 911 5120 2 4 Boston,MA 0211E STONE MOUNTAIN ROOF—1.1 i LL a a- MATTHEW CARRIER 38 LYON HILL RD ,,.a.4.4' ` °ao'"' CHESTER,MA 01011 .� Undersecretary Not valid without signature ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `,/- 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,Eat): (NC,No): Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.corn 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 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000'000 CLAIMS-MADE n 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&ADVINJURY $ 1'000'000 2 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ , ,000 01 POLICY PRO- 2,000,000 JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ v B OWNED /� SCHEDULED 1020114776 02/18/2023 02/18/2024 BODILY INJURY(Per accident) $ AUTOS ONLY 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 PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN 100,000 C ONYFF PROPRIETOR/PARTNER/EXECUTIVEMEMBEE Y NIA 7PJUB6R27941623 02/17/2023 02/17/2024 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 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) 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 • Docut'gn Envelope ID:9D037038-AB6F-4038-A0D2-5BDCFD884E5F Stone Mountain Roofing LLC 156 Northampton St Easthampton, MA 01027 413-998-9010 stonemountainroofingllc@gmail.com STONE MEIIINTAIN www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT# 1187 LiveWell Home DATE 09/01/2023 Improvement office@livewellhomeimprov ement.com DESCRIPTION "' "" `" """ Job Location: 90 North Maple St. Florence, MA -This contract is for the sections highlighted in the diagram only. 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 new plywood where chimney was recently removed 4. Install two new Velux skylights (Skylight: Manual venting. Two factory installed solar"room darkening" blinds. VS C06 2004CS00) 5. Install six feet of ice and water shield on eaves and three feet in valleys/around all penetrations 6. Cover remaining roof with synthetic underlayment 7. Install new 8" aluminum drip edge on all eaves and rake edges 8. Install architectural shingles by CertainTeed(Landmark PRO) https://www.certainteed.com/residential-roofing/products/landmark-pro/ Color Choice: TBD 9. Install Shingle Vent 11 ridge vent on peak of roof(where applicable) http://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/shinglevent2 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 the installation process: do not walk or drive under active work, or on areas of potential roofing debris. Stone Mountain Roofing will obtain the MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 DocuSign Envelope ID:9D037038-AB6F-4038-A0D2-5BDCFD884E5F DESCRIPTION �,;,� building permit if necessary. Installations are weather permitting; inclement weather will cause scheduling delays. Total: Landmark PRO shingles=$9,900 Thank you for choosing Stone Mountain Roofing. A one-third deposit of$3,300 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. TOTAL $9,900.00 Accepted By °°`°S'9 by. Accepted Date 9/8/2023 (*well Ni441, (w,pvNtw,UAj B7A7D092F6674CF_. MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 2 / . DocuSign Envelope ID: 9D037038-AB6F-4038-A0D2-5BDCFD884E5F ! • i O / i j ' if r '1 ii . 1 - . 0 O I a � ! E _ N L ! AIL I um _ 7 l t . • 1 rI 0' • F.r DS IIlk r- ! I r , allakill i i 1 r r i 15,-0P i ' h1.11N.SETBAC/C I r 1 • t 1 j 611. Mil ,r . ! IN. � 0 I ,� r RACK 1 R . . I Q s i q .n / k'V NORTH MAPLE ST Site Plan Stale:1/16'-1•-0'