Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
17D-032 (13)
BP-2024-0521 40 HATFIELD ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 17D-032-001 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-2024-0521 PERMISSION IS HEREBY GRANTED TO: Project# ROOF REPAIRS 2024 Contractor: License: Est. Cost: 14950 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date: 06/03/2026 Use Group: Owner: CS-MA LLC 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: 04/29/2024 TO PERFORM THE FOLLOWING WORK: EPDM REPAIRS AND GACO COATING 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: 1,14..2.. . Fees Paid: $105.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner DocuSign Envelope ID:D59F217E-8629-49F2-A100-180D43DA33D6 2 6 e Commonwealth of Massachusetts I�M' 202Q ,� Office of Public Safety and Inspections t' �, Massachusetts State Building Code(780 CMR) n"B P 't pplication for any Building other than a One-or Two-Family Dwelling • r�q PAC r'0 vry v (This Section For Official Use Only) Building Permit Number.jet''` I' Date Applied: Building Official: SECTION 1:LOCATION 40 Hatfield St.. Northampton 01060 No.and Street City/Town Zip Code Name of Building(if applicable) 17D-032-001 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 Building' Repair 0 Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other'pecify: Roofing Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes 0 No' Brief Description of Proposed Work EPDM repairs and Gaco coating 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) 0 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 0 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❑ S-2❑ U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION&CONSTRUCTION TYPE(Check as applicable) IA IB ❑ HA IIB ❑ ILIA IIIB ❑ IV O VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit i Debris Removal: Public 0 Check if outside Flood Zone CIIndicate municipal 0 A trench will not be Licensed Disposal Site 0 Private 0 or indentify Zone: or on site system CI re nnit i CI or trench or specify 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❑ 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:D59F217E-8629-49F2-A100-180D43DA33D6 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner CS-MA LLC P.O. BOX 966 WILBRAHAM MA 01095 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Michael Dupuis- contact 413 _733 _ 6631 mdupuis@cs-ma.us 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 411-998-9010 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? Yestr No 0 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE It Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 14,950.00 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor) el} 3.Plumbing $ ` I " 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ 14,950.00 (contact municipality)and write check number here 1444124 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 knowledge and understanding. Matthew Carrier �.i. Owner 413-998-9010 12/11/2023 Please print and sign name Title Telephone No. Date 156 Northampton St. asthampton MA 01027 stonemountainroofinglic@gmail.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: //�/C.._ y"21,'202 Name Date DocuSign Envelope ID:D59F217E-8629-49F2-A100-180D43DA33D6 City of Northampton M oa ,To `s.. .. 5 !� t L.; Massachusetts �e�5 sic; s ! R DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yJti cD� I Northampton, MA 01060 ssNh 37�10 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: o� "" Date: 12/11/2023 j j�oay The Commonwealth of Massachusetts Department of Industrial Accidents p=:d s Office of Investigations tita : Lafayette City Center r.r t 2 Avenue de Lafayette, Boston,MA 02111-1750 f'r 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 appropri ox: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. El New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.0 I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑ 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.] *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: Travelers Policy#or Self-ins. Lic. #: 7PJUB6R27941623 Expiration Date: 02/17/2025 Job Site Address: O r\Ctt fi Q S+. City/State/Zip: NbY4i' cr\1171 m Y� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature:G��'Ga L thi'•-rei4 Date: 9 Ic y &C6L1 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 21:Building Department 31:aity/Town Clerk -1.0 Electrical Inspector 5 Plumbing Inspector 6.0Other Contact Person: Phone #: l ® DATE(MM/DDCNYY) A�O 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(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. PHONE (413)586-0111 FAX No: (413)586-6481 L(AIC No,Extl: t ) Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC if 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 AWL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY)_ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ DAMAGE TO 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 X POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT $ 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 LIAR OCCUR EACH OCCURRENCE $ _ EXCESS LIAB _CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER v/N 500000 C ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A 7PJUB6R27941623 02/17/2024 02/17/2025 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 "A DocuSign Envelope ID:C3F8DBF1-4786-4A03-8C3B-95A95F5724F0� (Massachusetts Department of Industrial Accidents IT) ,, N= C. Office of Investigations M = 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. 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. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. LI Building addition 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 II.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' 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: National Specialty Insurance Company Policy#or Self-ins. Lic. #:NXT7EUNZ21-02-WC Expiration Date:07/18/2024 Job Site Address: LI O kc T\Q\L, (S\ . City/State/Zip: N)0A-VarciyttiN ff Pc 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 fme 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. ,— ocuSl ned by: Signature: /41// Date: \,)y el ` dCb2y Phone#: 41o0 �143E... 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 3.0City/Town Clerk 4.0 Electrical Inspector 50Plumbing Inspector 6.0Other Contact Person: Phone#: 71.1111111. AlC Rom CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 CONTACT NAME: Next First Insurance Agency,Inc. PHONE (855)222-5919 FAX PO BOX 60787 (AIC.No.Ext): LAIC,No): Palo Alto,CA 94306 ADDRLESS: support@nextinsurance.com ADDR INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: National Specialty Insurance Company 22608 INSURED INSURER B: PINGUINS CONSTRUCTION LLC 39 Serwan Ave INSURER C: 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. INSRL TYPE OF INSURANCE INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DO/YYYY)_ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- CT 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 OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000.00 OFFICER/MEMBEREXCLUDED? NIA X NXT7EUNZ21-02-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 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Chester,MA01011 u�.r❑ THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . AUTHORIZED REPRESENTATIVE 0§1111. ar.-?tr c25""— 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 PAIGU-1 OP ID: DA AWRP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/0812024 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 Nai€ACT Charles G.Marcus Agency,Inc. Charles G.Marcus Agency,Inc. PHONE 860-563-9353 I FAx 860-257-8404 842 Silas Deane Highway (A/C,No,EA): (A/C,No): P.O.Box 290756 ikss: Wethersfield,CT 06129-0756 Charles G.Marcus Agency,Inc. INSURER(S)AFFORDING COVERAGE NAIC/t_ INSURER A:MSA GROUP 14788 INSURED INSURER B: Pinguins Construction LLC 39 Serwan Avenue INSURER C: Willimantic,CT 06226 INSURER D: 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 LTR INS W R Vn IMM/DD/YYTYLIMM/Dr1/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X MPJ9003D 07/23/2023 07/23/2024 PREMISES(Ea RENTED $ 300,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT LOG PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY EeMNdEBntSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULEDO BODILY INJURY(Per accident) $ AUTOSRE� ONLY AUpTOS�t�/ p p ALTOS ONLY _ AUTOS ONLY (Per accident)AMAGE UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEO RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y t N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/M In NH)EXCLUDED? N I A If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 STONE MOUNTAIN ROOFING, LLC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 156 Northampton Street Easthampton, MA 01027 AUTHORIZED REPRESENTATIVE 4 __.3 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 9 Board of Building R ulations and Standards ' Cons on I rS ., isor -f. CS-117335 zr. `� pires:06/03l2026 MATTHEW CIRRIER ,..i %A 36 LYON HILL ROAD ,, CHESTER Mk,01011 %d 'J. tN Commissioner ♦ of• K. Dcmcfit&- THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Im ro e ent- .2. tractor-Re istration nt _.. }t Type: LLC ss 1 .egistration: 206447 STONE MOUNTAIN ROOFING,LLC *" •ration: 09/15/2024 36 LYON HILL RD —� ! CHESTER, -=' wf MA 01011 l t J Update Address and Return Card. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs 8 Business Regulation Registration valid for individual use only before the HOME IMPROVEMENT CONTRACTOR expiration date. If found return to: TYPEi`LCC Office of Consumer Affairs and Business Regulation Registration *. Expiration 1000 Washington Street -Suite 710 206447 _+>.09/15/2024 Boston,MA 02118 STONE MOUNTAIN ROOFING,•LLC, MATTHEW CARRIER 7- ;':: — i36 LYON HILL RD 3i� W. e"M^'' CHESTER,MA 01011 .r`s��-• -• •t'y', Undersecretary Not valid without signature DocuSign Envelope ID: D59F217E-8629-49F2-A100-180D43DA33D6 Stone Mountain Roofing LLC 156 Northampton St Easthampton,MA 01027 .A2L 413-998-9010 stonemountainroofmgllc@gmail.com STONE MOUNTAIN www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT# 1244 Construction Service DATE 12/11/2023 do Michael Dupuis 2420 Boston Rd. P.O. Box 966 Wilbraham, MA 01095 DESCRIPTION JOB LOCATION: 40 HATFIELD ST.,NORTHAMPTON MA 01060 1. Clean roofing surface using"GacoWash" concentrated cleaner or equivalent.Requires spraying product, agitating surface with a bristle brush,and washing off with water https://gaco.com/product/gacowash/ 2. Allow surface to dry 3. Make any necessary repairs to the EPDM rubber roof 4. Install one coat of GacoFlex "S42" onto the entire roofing. Requires rolling on the product COLOR: White(Please note,the GacoFlex"S42" is the high performing one coat system) https://gaco.com/product/gacoflex-s42/ 5. Install new clear acrylic dome on one of the existing skylight 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 delays. Total=$14,950 Expected Installation: Spring 2024.A$500 deposit will secure contract,permitting,material order, and priority scheduling. The balance of the one-third deposit, $4,400 will be due prior to installation. The balance shall be due upon completion,within 30 days of invoice. Accounts outstanding over 30 days subject to 2%finance charge monthly. TOTAL $14,950.00 DocuSigned bey /1: VAki� " tIAS Accepted Date 12/26/2023 AcceptedBy -F215D7335AB6458. cce.. p MA-CSL#117335 MA-HIC#206447 CT-HIC.0668321