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BP-2024-1423 640 KENNEDY RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 04-010-001 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-2024-1423 PERMISSION IS HEREBY GRANTED TO: Project# ROOF/SKYLIGHT 2024 Contractor: License: Est. Cost: 19600 MATTHEW CARRIER CSL117335 Const.Class: Exp.Date: 06/03/2026 HUNTER,STANLEY A. III&JUANITA M. Use Group: Owner: FORSYTHE Lot Size(sq.ft.) Zoning: WSP Applicant: STONE MOUNTAIN ROOFING LLC Applicant Address Phone: Insurance: 156 NORTHAMPTON ST (413)998-9010 7PJUB6R27941623 EASTHAMPTON, MA 01027 ISSUED ON: 10/28/2024 TO PERFORM THE FOLLOWING WORK: STRIP AND REROOF AND REPLACE SKYLIGHT 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: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS.Signature: 6/2- Fees Paid: S120.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner Docusign Envelope ID:80DDA1 B5-2A78-4D0C-A887-26C7688E6AAB C r r 1-1 \� OCT 2 The Commonwealth of Massachuse s .1. 8 cO4 Board of Building Regulations and Sta ds�F'r QF OR Tri Massachusetts State BuildingCode,780 C e`�;HA a ?, MUN CUS IP ITY Building Permit Application To Construct,Repair,Renovate Or Demobs 1'viied M r 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 00.1 `�• '% Date Applied: // f/Rtftp _j�2 �-2-8-Ly Building Official(Print Name) ature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 640 Kennedy Rd. 04 -010-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: — Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Juanita Forsythe & Stanley Hunter Leeds, MA 01053 Name(Print) City,State,ZIP 640 Kennedy Rd. 203-536-8754 HunterSA3@gmail.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) ❑ Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other ietpecify: Roofing Brief Description of Proposed Work2Remove&replace asphalt roofing(excluding garage&low slope section) Skylights: Of 3 existing, remove 1 and roof over. Replace 2 with VELUX fixed. (see attachment for U-factor.) SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 19,600.00 1. Building Permit Fee:$ Indicate how fee is determined: 0 Standard City/Town Application Fee 2. Electrical $ 0 Total Project Cost3(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5.Mechanical (Fire Total All Fees:Suppression) I_ t Check No. ai Check Amoun . GO Cash Amount: 6.Total Project Cost: $ 19,600.00 0 Paid in Full ❑Outstandine Balance Due: Docusign Envelope ID:80DDA1B5-2A78-4D0C-A887-26C7688E6AAB 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) U 156 Northampton St., No.and Street Type Description Easthampton. MA 01027 U Unrestricted(Buildings up to 35,000 cu.ft.) p R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-998-9010 stonemountainroofingllc@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 206447 09/15/2026 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 ❑ 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 FocuSbriedStanley Hunter a,, 10/22/2024 Print Owner's Name(Electronic Signature) Date 844C4A60C2249A... 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. Matthew Carrier /0 434 e) 474 Print Owner's or Authorized Agent's Name(Elec nic Si nature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. `Total Project Square Footage"may be substituted for"Total Project Cost" Docusign Envelope ID:80DDA1B5-2A78-4D0C-A887-26C7688E6AAB City of Northampton f Massachusetts mow: ((.J�• * c L � w• L ` 1. ; ' DEPARTMENT OF BUILDING INSPECTIONS o J„ �'.." ;r 212 Main Street • Municipal Building v`,,. \��L�, Northampton, MA 01060 sv�y `^JP 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: io/a 3/ao3� Docusign Envelope ID:80DDA1B5-2A78-4DOC-A887-26C7688E6AAB VS/VSENSS Tested Performance Information Glass Description Laminated Impact White- Snowload Laminated i89 ina (VELUX Glazing Code) (04) (06) Lam (08�ted (10) (89) Thermal Performance (All listed thermal performance values are NFRC certified) U-Factor(W/m2K) 2.44 2.33 2.44 2.38 2.16 SHGC 0.23 0.23 0.23 0.23 0.22 VT 0.53 0.53 0.47 0.52 0.52 UV Protection% 99.9 99.9 99.9 99.9 99.9 (300-380 nm) Fading Protection% Krochmann Damage Function 83.1 84.6 88.4 83.2 8`0.1 (300-600 nm) Acoustical Ratings STC 33 n.r. 33 n.r. 33 (Sound Transmission Class) ( OITC 28 n.r. 28 n.r. 28 (Outdoor-Indoor Transmission Class) Certified Air Infiltration/Exfiltration Lls/m2 0.30 0.03 0.30 0.10 1 0.30 Certified Water Resistance Pa 720 720 720 720 720 Certified Structural Performance(Pa) Performance Grade or DP in accordance with AAMANVDMA/CSA 101/I.S.2/A440-17 Tested Size Negative Design Pressure -Uplift (Hurricane) S06 3120 3216 3120 3840 3120 M08 5040 3216 5040 7200 5040 C06 n.r. n.r. n.r. 7200 n.r. Tested Size Positive Design Pressure -Download(Snowload) S06 14400 9600 14400 38304 14400 M08 19176 11040 19176 55062 19176 C06 n.r. n.r. n.r. 62244 n.r. Fall Protection Testing Results Tested Size Testing is 91Kg sandbag dropped from indicated height to middle of glass without glass breakage. 218.4 kgf-m 218.4 kgf-m" 218.4 kgf-m' 218.4 kgf-m' S06 (2.4m drop) (2.4m drop) (2.4m drop) n'r (2.4m drop) M08 n.r. n.r. n.r. n.r. n.r. Wind-Borne Debris Impact Ratings for Impact(06) Glazing Cycle Pressure Maximum Wind Florida Product High Velocity Tested Size (KPa) Missile Level Zone Approval Hurricane Zone S06 +/-2.39 C 3 Yes No M08 +/-2.39 C 3 Yes No µ 04 glass: Tempered with LoE 366 over clear laminated heat strengthened (0.030"interlayer) 06 glass:Tempered with LoE 366 over clear laminated heat strengthened(0.090"interlayer) 08 glass:Same as 04,with white interlayer 10 glass:Tempered with LoE 366 over clear laminated tempered(0.030"interlayer) 89 glass: Same as 04,with i89 coating on interior laminated surface •Indicates that the Laminated glass(04)test report should also cover this indicated glazing as it is equal to or stronger than the Laminated glazing n.r.=No report 3/23/2023 The Commonwealth of Massachusetts ts Department of Industrial Accidents "` IV fr Office of Investigations r0Lafayette City Center ,:. % 2 Avenue de Lafayette, Boston, MA 02111-1750 up s www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg bly 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. g I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction 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 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 3.0 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.Q 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 arc 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 ant 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: 640 Kennedy Rd., City/State/Zip: Leeds, MA 01053 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:OfaZtezo 6.4.44:€4, Date: 10/23/2024 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 2❑Building Department 31:City/Town Clerk 4.0 Electrical Inspector 51'lumbing Inspector 6.0Other Contact Person: Phone#: ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM'DDrVV VYIo,;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. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Eat): (A/c.No) Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC a Northampton MA 01060 INSURER A: Berkley Specialty Insurance Co INSURED INSURER B: Arbella Protection 41360 Slone Mountain Roofing LLC INSURER c: WCAR-Travelers 156 Northampton Stroot 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 RUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR INVD POLICY NUMBER (MMIDDIYYYY) (MM/DD!YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S 1.000,000 DAMAGE IOREP4iLD 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any ono person) S 5.000 A CGL0159193 02/18/2024 02/18/2025 PERSONAL&ADV INJURY 5 1.000,000 GEN1 AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 5 2.000,000 X POLICY n JPECO- LOC PRODUCTS-COMP/OP AGG 5 2'000.000 OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) '5 B - OWNED X SCHEDULED 1020114776 02/18/2024 02/18/2025 BODILY INJURY(Per accdent) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY _ AUTOS ONLY (Per accident) PIP-Basic S 8,000 UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ ~— EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER vIN 500,000 C ANY Y N/A 7PJUB6R27941623 02/17/2024 02/17/2025 E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 II 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 Illl. .D r� '1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ®r Division of Occupational Licensure Board of Building Re utations and Standards Cons font. �`. Srvisor .p CS-117335 6pires:06/03/2026 MATTHEW CARRIER 36 LYON HILL ROAD CHESTER Mit01011 - S.` sift )t.re,t:1.3* vf Commissioner d, G, K. W&, THE COMMONWEALTH OF MASSACHUSETTS _ Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: LLC Registration: 206447 STONE MOUNTAIN ROOFING,LLC Expiration: 09/15/2026 156 NORTHAMPTON ST. EASTHAMPTON,MA 01027 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:LLC Office of Consumer Affairs and Business Regulation Registrat&n Expiration 1000 Washington Street •Suite 710 206447 00/15/2026 Boston,MA 02118 STONE MOUNTAIN ROOFING.LLC MATTHEW CARRIER 156 NORTHAMPTON ST, v `^ EASTHAMPTON,MA 01027 Undersecretary of valid without signature Docusign Envelope ID:A7F9F71B-33F0-495F 9460-2513B849A9E8 1 f Massachusetts Department of Industrial Accidents _; 1__ � Office of Investigations • Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 L' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SRJ Construction LLC Address: 201 Union St. City/State/Zip: Manchester CT 06042 Phone #:413-693-5543 Are you an employer? Check the appropriate box: Type of project(required): I.❑✓ I am a employer with 18 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [] Demolition workingfor me in anycapacity. employees and have workers' P tY $ 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 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no q ] employees. [No workers' 13.❑✓ Other Roofing 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. 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: Liberty Mutual Insurance Policy#or Self-ins. Lic. #:06-15628-24240-342341 Expiration Date:08/28/2025 Job Site Address: 640 Kennedy Rd. Leeds, MA 01053 City/State/Zip: 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. �nature:I l Date: 10/23/2024 Phone#: 4IE�E45E... Official use only. Do not write in this area, to he completed by cite or town official. City or Town: Permit/License # Issuing Authority (check one): 1❑Board of I lcalth 2❑Building Department 30City/Town Clerk 4.0 Electrical Inspector 5E'Iumbing Inspector 6.0Other Contact Person: Phone #: ACGRa CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDDIYYYY) 09/24/2024 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 ERICA LUCERO _ NAME: LUCERO INSURANCE AGENCY PHONE 203-220-2622 FAX _{A/C.NO._EXU: (NC,No): 836 FOXON RD E-MAIL ELUCERO4@FARMERSAGENT.COM EAST HAVEN CT 06513 INSURER(S)AFFORDING COVERAGE NAIC INSURER A: ATLANTIC CASUALTY INSURANCE CO INSURED INSURER B: LIBERTY MUTUAL INS SRJ CONSTRUCTION LLC • INSURER C: 201 UNION ST INSURER O: MANCHESTER CT 06042 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 SUBR POUCY EFF POUCY EXP UNITS LTR INSD WVD POUCY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE l/`1 OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 A L261008944-0 08/29/2024 08/29/2025 PERSONAL s ADV INJURY $ 1,000,000 GENT..AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 X POLICY( PERQ LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY IPer person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _- AUTOS ONLY (Per accident) S UMBRELLA(JAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE Y(— N/A WCS-33S-B25T69-014 08/28/2024 Q$/28/2Q25 E.L.EACH ACCIDENT $ 500,000 OFFICEB (Mandatory inBEREXCLUDED9 I I500 QQQ (Mandatory NH) E.L.DISEASE-EA EMPLOYEE $ 11 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 It 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 Stone Mountain Roofing LLC. ACCORDANCE WITH THE POLICY PROVISIONS. 156 Northampton St.Easthampton,MA 01027 AUTHORIZED REPRESENTATIVE ERICA LUCERO 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:80DDA1 B5-2A78-4D0C-A887-26C7688E6AAB Stone Mountain Roofing LLC 156 Northampton St Easthampton, MA 01027 jak4L +14139989010 STONE MOUNTAIN stonemountainroofingllc@gmail.com www.stonemountainroofingllc.com/ ROOFING Contract ADDRESS CONTRACT# 1450 Juanita Forsythe& Stanley DATE 10/22/2024 Hunter 640 Kennedy Rd. Leeds, MA 01053 413-530-4368 (J) 203-536-8754(S) jmfghil1331 @gmail.coln HunterSA3®gmail.com DESCRIPTION -This project excludes the low slope section located on the right side of the house. -This project excludes the detached garage. -Please see UPDATED Diagram 10.22.24 for solar sections. NOTE: Contract is divided into 2 phases: Phase 1 - Solar Sections-Fall 2024 Phase 2 -Remainder of Roof- Spring 2025 PHASE 1 -FALL 2024- SOLAR SECTIONS ONLY (See UPDATED diagram 10.22.24) 1. Remove the existing roofing shingles 2. Inspect the existing copper flashing on the chimneys. Make the determination whether to remove and replace with new lead flashing. 3. Inspect the existing plywood for any rot or deterioration. Any new plywood will be$75 per sheet installed. (Wood prices subject to change) 4. Install six feet of ice and water shield on eaves and three feet around all penetrations 5. Cover remaining roof with synthetic underlayment 6. Install new 8" aluminum drip edge on all eaves and rake edges 7. Install architectural shingles by CertainTeed(Landmark) http://www.certainteed.com/residential-roofing/products/landmark/ COLOR CHOICE: Pewterwood Includes CertainTeed Lifetime Limited Warranty(Transferable) with 10 year SureStart period. MA-CSL#117335 MA-H1C#206447 CT-H1C.0668321 Docusign Envelope ID:80DDA1 B5-2A78-4D0C-A887-26C7688E6AAB DESCRIPTION https://certainteed.widen.net/content/srzv 1 kjewe/pdf/surestart-warranty-brochure-00-02-203-NA-EN- 2301.pdf?u=nwk4fd 8. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) h t tp://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/shinglevent2 9. Complete any other necessary flashings, including new LIFETIME pipe boots. https://lifetimetool.com/product/ultimate-pipe-flashing-shingle-kynar-coated/ 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. Either party may cancel this contract for any reason,up until the time of firm scheduling,with a full refund of deposit(less any permitting fees paid, or manufacturer product restocking fees). Total Cost for Phase 1: Landmark shingles=$9,550 PHASE 2 - SPRING 2025 - REMAINDER OF ROOF (Sec UPDATED Diagram 10/22/24) 1. Remove the existing roofing shingles 2. SKYLIGHTS: a. Remove one(of three) skylights and infill with new wood b. Replace the remaining two skylights with new VELUX fixed non-venting units. 3. Inspect the existing plywood for any rot or deterioration. Any new plywood will be$75 per sheet installed. (Wood prices subject to change) 4. Install six feet of ice and water shield on eaves and three feet around all penetrations 5. Cover remaining roof with synthetic underlayment 6. Install new 8" aluminum drip edge on all eaves and rake edges 7. Install architectural shingles by CertainTeed(Landmark) http://www.certainteed.com/residential-roofing/products/landmark/ COLOR CHOICE: Pewterwood Includes CertainTeed Lifetime Limited Warranty(Transferable)with 10 year SureStart period. https://certainteed.widen.net/content/srzv 1 kjewe/pdf/surestart-warranty-brochure-00-02-203-NA-EN- 2301.pdf?u=nwk4fd 8. Install Shingle Vent 11 ridge vent on peaks of roof(where applicable) http://www.airvent.com/index.php/products/exhaust-vents/ridge-vents/shinglevent2 9. Complete any necessary flashings including new LIFETIME pipe boots. https://lifetimetool.com/product/ultimate-pipe-flashing-shingle-kynar-coated/ 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:80DDA1B5-2A78-4DOC-A887-26C7688E6AAB DESCRIPTION delays. Either party may cancel this contract for any reason, up until the time of firm scheduling, with a full refund of deposit(less any permitting fees paid, or manufacturer product restocking fees). Cost Summary for Phase 2 Remainder of Roof: Landmark shingles=$7,250 (2)VELUX fixed skylights @ 1,400 each =$2,800 TOTAL PHASE 2: $10,050 PROJECT SUMMARY: Phase 1 -Fall 2024 Solar Sections=$9,550 Phase 2 - Spring 2025 Remainder of Roof w/2 Skylights=$10,050 TOTAL PROJECT COST= $19,600 For Fall 2024, a deposit of$2,900 will secure contract,permitting,material order, and priority scheduling. The balance of Phase 1 shall be due after completion,within 10 days of invoice date. Outstanding balances over 30 days subject to 2%finance charge monthly. For Spring 2025, a deposit of$3,350 will be due prior to scheduling& installation of Phase 2. The balance of Phase 2 shall be due after completion, within 10 days of invoice date. Outstanding balances over 30 days subject to 2% finance charge monthly. Thank you for choosing Stone Mountain Roofing. TOTAL $19,600.00 Accepted By p-°OOUSignedby: Accepted Date 10/22/2024 '-4844C4A60C2249A... 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