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23B-047-002 (3)
BP-2024-0513 593 ELM ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-047-002 CITY OF NORTHAMPTON Permit: Agricultural All Bldgs PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2024-0513 PERMISSION IS HEREBY GRANTED TO: Project# roof 2024 Contractor: License: Est.Cost: 9900 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date: 06/03/2026 CHILDREN'S ADVOCACY CENTER OF Use Group: Owner: HAMPSHIRE COUNTY INC. Lot Size (sq.ft.) Zoning: SC Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 04/26/2024 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: 72_ Fees Paid: S100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:35C8DEBF-D815-4205-BB45-1 E506923DA58 2 5- The Commonwealth of MassachuS tf -._•� Office of Public Safety and Inspections ' "'r Massachusetts State Building Code(780 CMR) 44 Building Permit Application for any Building other than a One-or Two-Family` (This Section For Official Use Only) Building Permit Number:,.9"'6!3 Date Applied: Building Official: SECTION 1:LOCATION 593 Elm St. Northampton 01060 No.and Street City/Town Zip Code Name of Building(if applicable) 23B-047-002 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing BuildingV Repair❑ Alteration 0 Addition❑ Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other Qpecify: Roofing Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No Sic— Is an Independent Structural Engineering Peer Review required? Yes 0 No 1 Brief Description of Proposed Work Strip and replace asphalt roofing SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) CI Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.ft.)and Total Height(ft) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 0 IB D HA CI IIBC MA IIB0 IV VA 0 VBD SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal Site 0 Public❑ Check if outside Flood Zone❑ Indicate municipal❑ required 0 or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed 0 Railroad right-of-wa Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicably Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0 SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: DocuSign Envelope ID:35C8DEBF-D815-4205-BB45-1E506923DA58 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Children's Advocacy Center of Hampshire County 593 Elm St., Northampton MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: c/o Kara McElhone 413.570.5989 - kmcelhone@cachampshire.org Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Matthew Carrier 41 1-998-9010 stonemountainroofingllc@gmail.com CS-117335 Name(Registrant) Telephone No. e-mail address Registration Number 156 Northampton St.. Easthampton MA 01027 U 09/15/2024 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Stone Mountain Roofing LLC Company Name Matthew Carrier HIC: 206447 Name of Person Responsible for Construction License No. and Type if Applicable 156 Northampton St.. Easthampton _MA 01027 Street Address City/Town State Zip 413=998-9010 413-214-9525 stonemountainroofingllc@gmail.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the 4suance of the building permit. Is a signed Affidavit submitted with this application? Yes No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 9,900.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ L c. 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 9,900.00 (contact municipality)and write check number here I /u SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 - °" �,"'" Owner 413-998-9010 3/22/2024 Please print and sign name Title Telephone No. Date 156 Northampton St. Easthampton MA 01027 stonemountainroofingllc@gmail.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: y- 26-202- Name Date DocuSign Envelope ID:35C8DEBF-D815-4205-BB45-1E506923DA58 City of Northampton -44\•"� Massachusetts �� '' + DEPARTMENT OF BUILDING INSPECTIONS r `. 212 Main Street • Municipal Building Northampton, MA 01060 ssbh T7‘^\` 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, Northampton MA The debris will be transported by: Name of Hauler: Aaron's 24/7 Towing & Roll Off Services Inc Signature of Applicant: Date: 3/22/2024 The Commonwealth of Massachusetts Department of Industrial Accidents IT;)w= 14.= w Office of Investigations =ail- _ Lafayette City Center walla 1. `; 2 Avenue de Lafayette, Boston,MA 02111-1750 wwN.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.❑ I am a employer with 4. I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.El 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:02/17/2025 Job Site Address: 59 3 CAM City/State/Zip: No( 1"61 0f1 C1I n 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 certifyyy�� under the pains and penalties of perjury that the information provided above is true and correct. Signature:Gka- 644s:el, Date: 1f I Iq I aca 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): 1❑Board of Health 20 Building Department 30City/Town Clerk 4.❑Electrical Inspector 5 Plumbing Inspector 6.0Other Contact Person: Phone #: C ® A € DATE(MM/DDM'YY) /i CERTIFICATE OF LIABILITY INSURANCE 01/23/2024 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,No Eat): (413)586-0111 �A No):Ax (413)586-6481 Webber&Grinnell Division E-MAIL mlastowskikwebberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURER A: Berkley Specialty Insurance Co INSURED INSURER B: Arbella Protection 41360 Stone Mountain Roofing LLC INSURER c: WCAR-Travelers 156 Northampton Street INSURER D: INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 2025 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 LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) _(MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ��x1� DAMAGE I O REN I ED 100,000 CLAIMS-MADE t" OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A CGL0159193 02/18/2024 02/18/2025 PERSONAL aADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 7PRODPOLICY n jRa 1-7LOC UCTS-COMP/OPAGG $ 2,000,000 I OTHER: _ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 1020114776 02/18/2024 02/18/2025 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 5 —r EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ _ $ WORKERS COMPENSATION PPER OTH ATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? n N/A 7PJUB6R27941623 02/17/2024 02/17/2025 (Mandatory In NH) 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/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 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ■ DocuSign Envelope ID:C3F8DBF1-4786-4A03-8C3B-95A95F5724F0" f Massachusetts Department of Industrial Accidents Office of Investigations `1 Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): PINGUINS CONSTRUCTION LLC Address:39 Serwan Ave City/State/Zip:Willimantic, CT 06226 Phone#:413-799-0210 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 18 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 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.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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' 13.0 Other comp. insurance required.] *Any 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: National Specialty Insurance Company Policy#or Self-ins. Lic. #:NXT7EUNZ21-02-WC Expiration Date:07/18/2024 Job Site Address: J C1& E t T' St: City/State/Zip:J\)CYk m rn 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 certifil under the pains and penalties of perjury that the information provided above is true and correct. , — ocuSi ned bv: Signature: C Date: k_61 143E Phone#: 41 03=Ig1°-C9�' 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): 10Board of Health 20 Building Department 31:1City/Town Clerk 4.0 Electrical Inspector S0Plumbing Inspector 61:1Other Contact Person: Phone#: f 1 ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) i�� o�i)s/zoz3 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: Next First Insurance Agency,Inc. PHONE (855)222-5919 FAX PO Box 60787 (A/C.No.Ext): (A/C.No): Palo Alto,CA 94306 E-MAIL ADDRESS: support@nextinsurance.com INSURERS)AFFORDING COVERAGE NAIC# INSURER A: National Specialty Insurance Company 22608 INSURED INSURER B: PINGUINS CONSTRUCTION LLC INSURER C 39 Serwan Ave Willimantic,CT 06226 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:648092494 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 LIMITS LTRINSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $DAMAGE TO CLAIMS-MADE OCCUR PREMISES(EaENTED occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEQ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY 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) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE ERA A ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBER EXCLUDED? n N/A X NXT7EUNZ2I-02-WC 07/18/2023 07/18/2024 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The Certificate Holder is STONE MOUNTAIN ROOFING LLC.A Waiver of Subrogation applies in favor of this Certificate Holder on the following policies:Workers Compensation. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION STONE MOUNTAIN ROOFING LLC LIVE CERTIFICATE 36 Lyon Hill Rd J,� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Chester,MA 01011 1:' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN rry '� . ACCORDANCE WITH THE POLICY PROVISIONS. . ti ` *'•1:-- {={ AUTHORIZED REPRESENTATIVE a,.,,_. ,_,_ Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r , '4 PAIGU-1 OP ID: DA ,acoRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) oa/os/zoza 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 860-563-9353 Charles G.Marcus Agency,Inc. Charles G.Marcus Agency,Inc. PHONE 860-563-9353 FAX 860-257-8404 842 Silas Deane Highway (A/C,No,Ext): (A/C,No): P.O.Box 290756 Mass: Wethersfield,CT 06129-0756 Charles G.Marcus Agency,Inc. INSURER(S)AFFORDING COVERAGE _ NAIC K INSURER A:MSA GROUP 14788 INSURED INSURER B: Pinguins Construction LLC 39 Serwan Avenue INSURER C: Willimantic,CT 06226 INSURER O: - — 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 INsn wvn IMM/DD/YYYYI IMM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X MPJ9003D 07/23/2023 07/23/2024 DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) $ 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 PE87 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY (Ea acccident)SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ — OWNED SCHEDULED _ AUTOS�Ep ONLY AUTOS W BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS ONLY (Perr aEc dent)D AMAGE �— $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION STATUTEPER ER H AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETgORR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ Mandatory in NH)EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 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) Stone Mountain Roofing,LLC.is listed as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN STONE MOUNTAIN ROOFING, LLC. ACCORDANCE WITH THE POLICY PROVISIONS. 156 Northampton Street Easthampton,MA 01027 AUTHORIZED REPRESENTATIVE C)v54e4Ak___,2 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Division of Occupational Licensure ' ` Board of Building Re ulations and Standards Cons ions jrvis0r .f CS-117335 r spires:06/03/2026 MATTHEW 4RRIER ° .., 36 LYON HIL -ROAD ,,g... . , -' 31' CHESTER Mk01011 ke.4 Commissioner (SCA f. & " THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affatetha Business Regulation 1000 Washingtrurt-Suite 710 Boston,_Mas`sachusetis--02118 Home Im.ro ertjent.;N. - 0-:"e istration i type: LLC STONE MOUNTAIN ROOFING LLC :V non: 096447 36 LYON HILL RD —M • E anon: 09/15/2024 CHESTER,MA 01011 .. et ��. � 'ke41Aq — ti4*.! I♦ Update Address and Return Card. • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affajru s Business Regulation Registration valid for Individual use only before the HOME IMPROVEMENTCONTRACTOR expiration date. If found return to: TOE.I.T4 Office of Consumer Affairs and Business Regulation Registration Exbirattop 1000 Washington Street -Suite 710 2444 .�g/1 Boston,MA 02118 STONE MOUNTAIN R7DOFIt L .`-ram MATTHEW CARRIER ,'.R� /J /M Oy,�� 36 LYON HILL RD '. - , - „e0„..ea, ..e./.k' Il CHESTER MA 01011 ;:;a:s.„ Undersecretary Not valid without signature 4 rpocuSign Envelope ID:35C8DEBF-D815-4205-BB45-1E506923DA58 Stone Mountain Roofing LLC 156 Northampton St *./**7) Easthampton, MA 01027 413-998-9010y"� stonemountainroofmgllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ R 0 OFING Contract ADDRESS CONTRACT# 1311 Children's Advocacy Center DATE 03/22/2024 of Hampshire County do Kara McElhone 593 Elm St. Northampton,MA 01060 .ze ,.,{�x s ti z s � 1 DESCRIPTION � � 4. 1. Remove the existing roofing materials 2. Inspect the existing plywood for any rot or deterioration. Any new plywood will be $60 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) http://www.certainteed.com/residential-roofmg/products/landmark/ Color Choice: Cobblestone Gray 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. Install new Mule Hide rolled roofing on low slope section 9. Complete all necessary flashings including new LIFETIME pipe boots and base flashing around the chimneys https://lifetimetool.com/product/ultimate-pipe-flashing-shingle-kynar-coated/ Includes CertainTeed Lifetime Limited Warranty(Transferable)with 10 year SureStart period. hops://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 necessary building permit. Installations are weather permitting; inclement weather will cause scheduling MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 DocuSign Envelope ID:35C8DEBF-D815-4205-BB45-1 E506923DA58 DESCRIPTION delays. Either party may cancel this contract for any reason,up until the time of firm scheduling and/or the second deposit,with a full refund of deposit less any permit fees paid. Total: Landmark 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. Warranty confirmation shall be provided upon final payment. Installation and manufacturer warranties are not in effect until Paid In Full. TOTAL $9,900.00 Accepted By °ocoS'9°edbY: Accepted Date 3/22/2024 64'a NLLa oln t- 04877B4A64B2489 • MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321