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22D-068 (8) BP-2024-0295 96 FLORENCE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 22D-068-001 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-2024-0295 PERMISSION IS HEREBY GRANTED TO: Project# ROOF/SKYLIGHTS 2024 Contractor: License: Est.Cost: 16300 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date: 06/03/2026 Use Group: Owner: WILMER,KRISTEN R. LOKENSGARD, ERIK H. Lot Size (sq.ft.) Zoning: WSP Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 36 LYON HILL RD (413)998-9010 7PJUB6R27941623 CHESTER,MA 01011 ISSUED ON: 03/19/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REFOOF, REPLACE2 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: old444 4.v44 Fees Paid: $80.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:8AC7304E-B18F-411E-A1AF-4FED6536FD22 / 6 f14? The Commonwealth of Massac settc I B �''� Board of Building Regulations and Standat•ds (719(9.0 O FOR ��Q MU�CIPALITY I� Massachusetts State Building Code, 780 CMRA• ,,, '41/ U ��� Building Permit Application To Construct,Repair,Renovate OrDeirtts�-a,. evised, Mar 2011 One-or Two-Family Dwelling .\°7 Q/0, • This Section For Official Use Only Building Permit Number: !/l'07 4-Ac Date Applied: LoU i 5 IA a.Sb OMCAL C' 11-4iti 3 jt9 f Lt-I Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 96 Florence Rd. Florence 22D-068-001 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 CI Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Kristen Wilmer Florence, MA 01062 Name(Print) City,State,ZIP 96 Florence Rd. 828-284-4137 kristen@wildskyfarm.com 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) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other /Specify: Roofing Brief Description of Proposed Work2: Spring 2024. Strip and replace asphalt roof. Replace 2 existing skylights SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 16,300.00 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Feesr, 4(g 0 Check Not 3G1 Check Amount: Cash Amount: 6.Total Project Cost: $ 16,300.00 ❑Paid in Full 0 Outstanding Balance Due: DocuSign Envelope ID:8AC7304E-B18F-411E-AIAF-4FED6536FD22 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 List CSL Type(see below) 156 Northampton St., No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) , Easthampton, MA 01027 _ 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 stonemountainroofingllc@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 Registrant Name 156 Northampton St. stonemountainroofingllc@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 . 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. �o�. 9/28/2023 Kristen Wilmer � 21 Print Owner's Name(Bl�ti 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 t the best of my knowledge and understanding. 3 j 1�I2( Z' Matthew Carrier /1 9/28/2023 ' AuthorizedAgent's Name Electronic Si ature) Date Print Owner's or ut ( 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"maybe substituted for"Total Project Cost" DocuSign Envelope ID:8AC7304E-B18F-411E-A1AF-4FED6536FD22 City of Northampton ?°aYn�Mpr°�.. SAS ,�._.s,c r Massachusetts �? - '<<. (411, '•I DEPARTMENT OF BUILDING INSPECTIONS y; i 4 +S.a;: ' 212 Main Street • Municipal Building uti. Northampton, MA 01060 rsN - ��o 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: 9/28/2023 31 1212C2L 11,1 Art • DocuSign Envelope ID:C3F8DBF1-4786-4A03-8C3B-95A95F5724F0' ' f Massachusetts Department of Industrial Accidents r Office of Investigations c h 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): 1.0 I am a employer with 18 4. 0 I am a general contractor and I 6. 0 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. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance.: 9. Building addition required.] 5. 0 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. ✓�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. #: NXT7EUNZ2I-02-WC Expiration Date:07/18/2024 Job Site Address: q(.p 'Ft C1)(0."C4 Q d City/State/Zip: 0 r6)0_ 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. ,— oc ione f by: Si• to V� Date: 3 I I o� , Qoati Phone#: 41 open 1143E ... 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:City/Town Clerk 4.0 Electrical Inspector 5Ellumbing Inspector 6.0Other Contact Person: Phone#: A� ® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/18/2023 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 CONTACTNAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 1 FAX PO BOX 60787 (A/C.No.Est): (A/C,No): E-PAIL Palo Alto,CA 94306 ADDREss: support@nextinsurance.com INSURER(S)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 D: 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. INSRP TYPE OF INSURANCE AINSD DDL SWVD- POLICY NUMBER (MUBR M/DDIYYYY) (Y EFF MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO-JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINEDtSINGLE LIMIT $ (EaANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION x PER H- TUTE ER AND EMPLOYERS'LIABILITY Y/N A ANYPROPRIETOR/PARTNER/EXECUTIVE ri OFFICER/MEMBEREXCLUDED? N/A X NXT7EUNZ2I-02-WC 07/18/2023 07/18/2024 E.L.EACH ACCIDENT $1,000,000.00 (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 $1,000,000.00 , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The Certificate Holder is STONE MOUNTAIN ROOFING LLC.A Waiver of Subrogation applies in favor of this Certificate Holder on the following policies:Workers Compensation. All Certificate Holder privileges apply only if required by written agreement between the Certificate Holder and the insured,and are subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION STONE MOUNTAIN ROOFING LLC LIVE CERTIFICATE 36 Lyon Hill Rd air` �y 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Chester,MA01011 h*r �5 r THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'r ,_'-`1' ACCORDANCE WITH THE POLICY PROVISIONS. 4..A AUTHORIZED REPRESENTATIVE"1:1wc+ti I Click or scan to view ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents �n tom— Office of Investigations Lafayette City Center Tau: t 2 Avenue de Lafayette, Boston,MA 02111-1750 ww».mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Stone Mountain Roofing LLC Address: 156 Northampton St. City/State/Zip: Easthampton, MA 01027 Phone #:413-998-9010 Are you an employer? Check the appropria a box: Type of project(required): 1.0 I am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction listed on the attached sheet. 7. 0 Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. Building addition required.] 5. 0 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 12.0 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors 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: Qb F CYQnCQ Q(-) _City/State/Zip: F l uQ il( C 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 certify under the painsand penalties of perjury that the information provided above is true and correct. Signature:G/Caieto eaMie4, Date: al I a0a%-i 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): 10Board of Health 20 Building Department 3tlCity/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: I ® DATE(MM/OD/YYYY) A�D 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 pollcy(les)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. (pL/CNIJ E>nl: (413)586-0111 FAX No): (413)586-6481 Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.Com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# 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. INSRLICY EXP LT TYPE OF INSURANCE ADOL WVDUBR POLICY NUMBER MMIDDPOLICYIYYYY) (M EFF MIDDIYWY LIMITS LTR INSD WVD ( ) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGE 1 O RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A CGL0159193 02/18/2024 02/18/2025 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO 2 0000X POLICY JECT LOC - 0 , OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ g 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 $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ,DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 500,000 C ANY CER/MEMBPROPRIETOR/PARTNER/EXECUTIVE Y N/A 7PJUB6R27941623 02/17/2024 02/17/2025 E.L.EACH ACCIDENT $ (Mandatory In NH) EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory in NH) 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 Ill Y--.^4 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD t Commonwealth of Massachusetts i� Division of Occupational Licensure Board of Building Regulations and Standards Cons IOnrS (Visor s. CS-117335 r• - ' spires 06/03/2026 MATTHEW WRIER ' �4 -, r'` 36 LYON HILk ROAD ',:4 7. z � CHESTER M4tj01011 eft° =r- ...� s 4 - Commissioner cla y f. Y raeo— THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affai arlq Business Regulation 1000 Washingtt ; rw t,-Suite 710 Bostort;_Massachuset 118 Home Im.ro e e t= rac - e istration t _ 4`�' _ ; Type: LLC STONE MOUNTAIN ROOFING,LLC , ,egi5t ation: 206447 36 LYON HILL RD 4 --.. E pj'ation: 09/15/2024 CHESTER,MA 01011 !�' ��/ T - " Cl -7_7-1, 1110 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:ICC. , Office of Consumer Affairs and Business Regulation Registration Expiration 1000 Washington Street -Suite 710 6447`" 09/15/2024 Boston,MA 02118 STONE MOUNTAIN ROOFI I L z MATTHEW CARRIER . a`x_-,'µ; /ti36 LYON HILL RD . `, *� pwi�. CHESTER,MA 01011 �.�»T«lc.i�rr�.r.k Undersecretary Not valid without signature DocuSign Envelope ID:8AC7304E-B18F-411E-A1 AF-4FED6536FD22 Stone Mountain Roofing LLC 156 Northampton St Easthampton, MA 01027 413-998-9010 stonemountainroofingllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ R O O F I N G rmXr Contract ADDRESS CONTRACT# 1211 Kristen Wilmer DATE 09/28/2023 96 Florence Rd. Florence,MA 01062 kristen@wildskyfarm.com 828-284-4137 DESCRIPTION 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 six feet of ice and water shield on eaves and three feet in valleys/around all penetrations. Install ice and water shield entirely on the section where there are existing skylights 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 PRO) https://www.certainteed.com/residential-roofmg/products/landmark-pro/ Color Choice: MAX DEFINITION 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. 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/ 9. Remove existing skylights and replace with(2)new fixed, non-venting Velux skylights *Stone Mountain Roofing is not responsible for any necessary interior trim work* 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 MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321 r 11. DocuSign Envelope ID:8AC7304E-B18F-411E-A1AF-4FED6536FD22 DESCRIPTION r 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 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. Landmark PRO shingles=$13,900 Velux Fixed skylight(2)x$1,200 each=$2,400 TOTAL= $16,300 Thank you for choosing Stone Mountain Roofing. Expected Installation: Spring 2024. A$500 deposit will secure contract,permitting, material order, and priority scheduling. The balance of the one-third deposit, $4,900 will be due prior to installation. 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 $16,300.00 Accepted By D°cuSigned y Accepted Date 9/28/2023 V -J 3F072D3483034C3.. MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321