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25A-118 (5) 16 SHERMAN AVE COMMONWEALTH OF MASSACHUSETTS BP-2021-1781 Map:Block:Lot:25A-118- 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-2021-1781 PERMISSION IS HEREBY GRANTED TO: Project# Contractor: License: Est.Cost: 33511 Const.Class: Exp.Date: CAMPBELL GREGORY JAMES and CAPELLA Use Group: Owner: NERINE SHERWOOD Lot Size (sq.ft.) Zoning: URB Applicant: EAST COAST METAL ROOFING Applicant Address Phone: Insurance: 701 TREASURE ISLAND 4016361895 WEBSTER, MA 01570 ISSUED ON:08/24/2021 TO PERFORM THE FOLLOWING WORK: STRIP&SHINGLE 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: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: 110 iv • .52 Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED e C mmonwealth of Massachusetts AUG 2 3 Bo d of uildingRegulations and Standards FOR �021Ma ach setts State Building Code, 780 CMR MUNICIPALITY USE EPr° • pile tion To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 OR A 11P I°N.MA o 06o"S ne-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 39'.1 J ./7(1 ate Ap lied: ____ Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers go Sturman Ave • 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 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 ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ra q o Catert1012.1t Noritia.rA 'ov% t MA Ot0100 Name(Print)i City,State,ZIP tlo StiQecv av Ave Lit a'to 61694 iele'3'13t!np av1.co No.and Street Telephone Email'lddress SECTION 3:DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) ' Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': Ir;c r T :"tsioXUet atna c,9aler s1n't.IO; 1nsAall Re< ,(k_ ,t '.15 S/s}cwA. SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ 0 Standard 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 Fees: $ Check No.3 %?Check Amount: 4D Cash Amount: 6.Total Project Cost: $ 33 5- 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C` .c L— '©` S ) a. A 'G k leak 1 S k• License Number Ex irati n Date Name of CSL Holder List CSL Type(see below) ge Edeet ma live No.and S e Type Description [ rQ/1SioYl R I 6990s U Unrestricted(Buildings up to 35,000 Cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances !�/0/636 /8Q5"" X4ttlarteeenieoasf rK.idro 'r►f I Insulation Telephone Email address .Cam D Demolition 5.2 Registered Home Improvement Contractor(HIC) I1 gii y)., q as East 6 IJle?a/ 2Oo7`' HIC Registrationf Number xpir ion Date HIC Company�� Name or HIC Registr tame 70/ /r'te.SLJrC Alamos Rol No.and Street Email address tijddiferi /MA ois7o 0/6,34 ap95- 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 flev 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 E4sl Go4s1/Odd/ go44 to act on my behalf,in all matters relative to work authorized by this building permit application.4rep, (�i k )PrO er Name(Electronic ic 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. 7L1 Lie lara S /Q/ZOO/ 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 6 (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. Othex 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 atHaMp\ 0 •S ... Si�Massachusetts S g _ << 4 If-( "‘ w DEPARTMENT OF BUILDING INSPECTIONS h A,` 'r`.' -, :< 212 Main Street • Municipal Building yvs-. c. �' Northampton, MA 01060 �s'Nfy 3'3"' 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: Pi' i-iykn-6 n Zc) im krouut, MI? D/SB I The debris will be transported by: Name of Hauler: E. L. f/arucy i .Sons Signature of Applicant Date: F�/94o•L/ The Commonwealth of Massachusetts Department of Industrial Accidents ;.= � 1 Office of Investigations t = i'== 600 Washington Street • _ Boston,MA 02111 ' �-•�.1�'` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): East Coast Metal Roofing Address: 701 Treasure Island Rd City/State/Zip: Webster, MA 01570 Phone#: 508-341-8339 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 listed on the attached sheet. 7. ElRemodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in anycapacity. employees and have workers' P h' 9. ❑Building addition [No workers' comp. insurance comp.insurance.$ 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 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.21 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. tContractors 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: Beacon Mutual Insurance Policy#or Self-ins.Lic. #:0000076113 Expiration Date:3/16/2022 // Job Site Address: / ' Sf fyisiaa A✓! City/State/Zip:NOr{�1 to?7tn,/l1,1t 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. l do hereb der a pains and penalties of perjuly that the information provided above is true and correct. Signature: Date: 8' /9 o9do2/ Phone#:508-341-83 9 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#: AC`ORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOPYYY) �.� 04/07/2021 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 Kevin Pires NAME: Platinum Insurance Agency,Inc. lalce.N.E,�t); (401)272-5900 ONE FAX No): (401)272-5901 1990 Pawtucket Avenue ADDRESS: kpires@platinumins.com East Providence,RI 02914 INSURER(S)AFFORDING COVERAGE NAIC# Phone (401)272-5900 Fax (401)272-5901 INSURER A: Western World Insurance Company INSURED INSURER B: RGSW,LLC. INSURER C: 41 Edgewood Avenue INSURER D: Beacon Mutual Insurance Company INSURER E: Cranston RI 02905 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 ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) ❑ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000.00 GE TO ❑ CLAIMS-MADE Q OCCUR PREMISES(Ea o"ccurrence) $ 50,000.00 ❑ MED EXP(Any one person) $ 5,000.00 A ❑ Y NPP8745464 04/05/2021 04/05/2022 PERSONAL 8 ADV INJURY $ 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000.00 El POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000.00 JECT ❑ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ❑ ANY AUTO BODILY INJURY(Per person) $ OWNED ElA SCHEDULED BODILY INJURY(Per accident) $ ❑ AUTOS ONLY AUTOS ElHIRED El NON-OWNEDPer PE RTY DAMAGE AUTOS ONLY AUTOS ONLY ❑ ident) ❑ $ ❑ UMBRELLA LIAB ❑OCCUR EACH OCCURRENCE $ ❑ EXCESS LIAB ❑CLAIMS-MADE AGGREGATE $ ❑ DED ❑ RETENTION$ $ WORKERS COMPENSATION P©PER ATUTE ❑E µ R AND EMPLOYERS'LIABILITY Y/N D OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE—ANY y N/A 0000076113 03/16/2021 03/16/2022 E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE East Coast Metal Roofing,Inc. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 254 Sutton Avenue Oxford,MA 01540 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03)QF The ACORD name and logo are registered marks of ACORD r - Commonwealth of Massachusetts ' Division of Professional Licensure Board of Building Regulations and Standards Construct jo Sup ► iSor Specialty 4.4 CSSL-101285 Expires: 02/11 /2022 NICK TERLETSKIY 41 EDGEWOOD AVENUE CRANSTON RI 02905 ' Q 47 1" -t0 Commissioner r Construction Supervisor Specialty Restricted to: CSSL-RF - Roofing Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call (617) 727-3200 or visit www.mass.gov/dpl Ke3v72,y1�.21e%4? G�6/ ad ` Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, MGhusetts 02118 Home Improveme• -o,tractor Registration Type: Corporation r' r Registration: 184472 EAST COAST METAL ROOFING,LLC i. Expiration: 01/19/2022 701 TREASURE ISLAND RD WEBSTER,MA 01570 I 70- 1 1 sy s v`O� MP sca t 0 zo t-0snr - Update Address and Return Card. s — . e g7in,V70/ 1V../ga kk74541e.al Office of Consumer Affairs&Business Regulation . HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TY. . orporation i before the expiration date. If found return to: r Expiration r Office of Consumer Affairs and Business Regulation 01/19/2022 1000 Washington Street-Suite 710 EAST COAST Fl ,LLC Boston,MA 02118 PAULLECHIARA .µQ J 701 TREASURE IS - ,�..et'aG.4 " i WEBSTER,MA 01570- i Not valid wl ut signature Undersecretary i DocuSign Envelope ID:AEC86A8A-FFBB-4B9F-99BC-0820659AEF46 East Coast Metal Roofing,LLC. At H, 11.U H J I 254 Sutton Ave,Oxford,MA 01540 METALROOFING Tel:844-611-3267 e a stco a stm eta l ro ofi ng.co m REQUIRED PERMITS Registered Home Improvement Contractor MA#184472 Registered Home Improvement Contractor CT#HIC.0644642 Rhode Island Registration #40663 Homeowner Information Name: Gregory Campbell Address: 16 Sherman Ave. City: Northampton, MA Zip: 01060 Phone: 413-270-2654 Required Permits: The following building permits are required and will be secured by the contractor as the homeowner's agent and I/We as Owners of the subject property, hereby authorize East Coast Metal Roofing, LLC.to act on my/our behalf,. in all matters relative to work authorized by the building permit application: AZ\- 8/3/2021 Owner's ignature Date Owner's Signature Date Owners who secure their own permits will be excluded from the Guaranty Fund provision of the MGL Chapter 142A This permit notice forms a part of the Purchase and Installation Contract of the same date. DocuSign Envelope ID AECB6A8A-FFBB-4B9F-99BC-0820659AEF46 EAST COAST EAST COAST METAL ROOFING,LLC 254 Sutton Ave,Oxford,MA 01540 METAL ROOFING Customer Contact 1-844-611-3267 Visit our website at:EastCoastMetalRoofing.com NAME Gregory Campbell ("Purchaser) JOB ADDRESS 16 Sherman Ave. (-Premises") CITY/TOWN Northampton, MA ZIP CODE 01060 MAILING ADDRESS Same ZIP CODE HOME PHONE E-MAIL Gcgc73730ginai1.cow CONTACT NAME Greg/ Capella WORK 413-588-2130 CELL 413-270-2654 The Purchaser is the registered owner of the Premises and hereby contracts with East Coast Metal Roofing LLC.(the"Contractor")authorizing the Contractor to furnish all necessary materials and labor to install,construct and place the improvements according to the following specifications, terms and conditions(the'Specifications")on or at the Premises: PROFILE:_x SHINGLE/ SLATE/_PVC COLOR Charcoal grey Strip & dispose llayer asphalt & underlayments. Install 1/2" Home Improvement Contractor Regni184472 Plywood entire home. Ice & water 3'up all eves and valleys breathable underlayments rest of Home. Build cricket behind chimney. Take down satellite & di spose.add snowguards as marked Reboot 1 vent pipe 14" & 1 gooseneck.install permalock roofing system on entire home install 6" gutters in classic white including downspouts. collar 1 chimney. Install ridge vent ADDITIONAL SPECIFICATIONS S120- per sheet for plywood install if needed $70- per square for extra layer strip, clean up, disposal YES NO ROOFING MATERIAL YES NO ROOFING MATERIAL X Rubber/PVC Low Slope Roofing Color X — Supply adequate electrical power X Outlet Location:Back deck Flash Skylights# X Flash Vents# 184" 1 gooseneck x Work with the Contractor to fix damage uncovered — — during installation at a cost agreed to by the parties. X Ridge Vent 40' Plywood for rot repair min charge$2.50 sq ft X Respect the work site. In the interests of everyone's X — Underlayment ice&wate r synthetic safety,Purchaser will not use or borrow Contractor's equipment or tools and will not access or interfere with X — Snowguards#11 +/- the project during installation.Skilled professionals ROOF REMOVAL should be hired for any work that requires access to or traversing your roof. X Strip existing roof(#of layers 1 ) LOCATION FOR DELIVERY X — Haul away roof debris and pay refuse fees. Driveway X — Supply 1/2"plywood Start Date* 6-12 weeks or sooner, weather permitting *Protects may be delayed due to inventory supply issues from certain manufacturers. LOCATION FOR BIN: Driveway Substantial Completion Date**1-2 weeks or sooner **Unless arcurestances are beyond the Contractors control. THIS CONTRACT INCLUDES THE ALUMINUM SHINGLE COMPANY UFETIME LIMITED WARRANTY,50 YEAR TRANSFERABLE,NON-PRORATED FOR MATERIALS MANUFACTURED BY THE ALUMINUM SHINGLE COMPANY,PLUS LIFETIME LIMITED WORKMANSHIP WARRANTY PROVIDED BY EAST COAST METAL ROOFING CERTIFIED INSTALLERS. SPECIAL INSTRUCTIONS Contract Price$ 33, 11.00 -_-._ Sales Tax$Included Financing Requested YES X NO_OAC Dividendl5yr Total Contract Price $ 33.511.00 Interest Rate O%to26.99% Less 1/3 Down Payment $16.755.50 .00 Payment not to exceed$365.90 Progress Payment $0 Total Balance on Completion $ 16,755.50 MAKE ALL CHECKS PAYABLE TO:EAST COAST METAL ROOFING,LLC. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office of branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. IN WITNESS WHEREOF,the Purchaser and Contractor have hereunto signed their names at the Premises,this 3 day Of August 2021 EAST COAST METAL ROOFING LLC. Do not sign this contract if there are any blank spaces. Per: Purchaser:IMP Signature C: Signature Print NameBrandon •utty Signature THANK YOU FOR YOUR BUSINESS This is not a credit transaction. If financing is arranged,the Purchaser agrees to agn and provide all necessary documents required by any lender, immediately on request In order to complete the financing AH surplus material is the property of the Contractor See reverse of contract for additional terms and conditions.