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43-002 (3) 472 WESTHAMPTON RD BP-2016-1550 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:BIuck:43 -002 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2016-1550 Project# JS-2016-002644 Est. Cost: $11100.00 Fee: $40-00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq. ft.): 149846.40 Owner: MIRRA ROBERT S&PATRICIA Zoning: Applicant: RCI ROOFING AT: 472 WESTHAMPTON RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAM PTON MA01073 ISSUED ON:6/28/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF 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. Certificate of Occupancy signature: FeeType: Date Paid: Amount: Building 6/28/2016 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner _____ _ —_ --� b$padrneAt use Orly City of Northampton 6faws of P§Fad 0 v Building Department Garb(Cote06veway Perrnit 7 Lai ` 1 212 Main Street 6ewaU3eptic AvBnabtnPy, CO I Room 100 VVaterNMell Auptte6iiIty Ti I\ N Northampton, MA 01060 TweSets ofStructural Plans G tI _ phone 413-587-1240 Fax 413-587-1272 Net/See Plans _ Other s_,eaity CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING =Co'ON 1 -S+TE INFORMATION'. � _ hts section to be completed by office t c'o,orW Address_ "i zdest-ha tit> 4 Map Lot Unit FIc/U'LCer stili 0/OG2- zone.__ ___ Overlay D lstnlct Elm St,District__ CE District - ON 2 • PROPERTY OWNERSHIP/AUTHORIZED AGENT S par of Record: Pa--/- Mirrrc. 4702 .1,0frA�XO( TlcrtxJr/ Mt/ (At.; A rq Current Melling Address X02 off l�C�l CI Ha-i___55 —oo07 see Telephone I .+tithorized Assent 7r( fl/O.110 e .0 . 7 e.o ir,1 �n LitTe -_ti%S- ;lNT, ke,.mr4n m c'SIO.;Y7 'n. / ,_e Current Melling Address! Telephone _ I TION 9 ESTIMATEDCONSTRUCTION COSTS 1 T Estimated Cost(Dollars)to be Official Use Only completed by oermit applicant a) 2-wcnc 6iN0Frnq r /1 , IOD ( Bwiding Permit Fee 1. 4.__. ..a yl (a)£stlmated Total Cost of Construction from (6) — "d'acing 8uiIclIng Permit:Fee zeohanioal(HVAC) a P-otect on =r1 +2 .3 +5+5) II , I00. — ] Check Number 0373$' I " 70 This Section ForCHlclal Use OWL__ • Aoing Permit Number'. Date .._ Issued:__.__.— Build ng Oommltslronerlfnspeoloo of Bailtlings Date Y5 - cva TION 5- DESCRIPTION OF PRtDROSED WORK(check all applloahle) -mss [: Addition ❑ Replacement WindowsAlteratlon(s) Roofing Or Doors Ell oessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks (❑ Siding ID) Other[Ell Tescnplion of Proposed -_ SPP C1_: n.< 41Qck of existing bedroom Yes No Adding new bedroom Yes No ecned Narrative Renovating unfinished basement Yes No s ACaohed Roll -Sheet If New Mouse and o!-add:Mon to.,exEstinq Nowa it completate fpllawimgr. :lee o'building:One Family Two Family Other >onter of rooms in each family unit Number of Bathrooms___.__ _ -.ern a garage attacned? oposed Sg uare footage of new-construction. Dimenulons_ 'lcv.cer of stories? wemoo of heating?_ Fireplaces or Woodstoves_ Number of each "orgy Conservation Compliance. Masscheok Energy Compliance form attached?__ o'construction wnslrucllon within 100 ftof wetlands? Yes No, Is construction within 100 yr. floodplain _Yes_No Jeulh of basement or cellar Ooor below finished grade ..I ruild'ng conform to the Building and Zoning regulations? Yes No. .nuc Tank City Sewer Private well City water Supply_ TION7e -OWNER AUTHORIZATION -TO BE COMPLETED WHEN :-.ERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Prr nA11,reyam �fin1ras Owner of the subject authorize -_I sn,�t Y� tar, IC`Q.. (14' R , C' . 7. . �l ' N'ij1(A ny behaf in all matters relative to work authorized by this building permit aR?illolntlon. Seer C cr,2 eon Owner Date r ( k \)2ISlo (LS nU-41(7ri7 rsc (FYI+. , asOwner/Authorized hereby declare that the statements and Information one foregoing application are true and accurate, to the best of my knowledge ,E ier ac under the pains and penalties of perjury. 11 (-)Irllsl e or OvmedAgonl Date 22_-_-.,22 :_'ON 5 CONSTRUCTION SERVICES li seised Construction Supervisor: Not Applicable ❑ ie or License Holder'i N1c"d, 7r1 H _ License Number r)v � (ICiS. � a.en celan � 1Y)� 1�1f1`7,� ___-- 05 -o -_IS y Explratlon Cele —_err 6H1 ) ;) art • 1`115 ,..rc Telephone -- Luis-area Horne lmpnauenient Erontracter Not Applicable ❑ _) (1 . 11, ?)(14i(13 -_- 1 au o any Name Registration Number 0 5- 0(e Ifie -reel Expiration Dale -_._itihCfOff _ -� n1C7'1 Telephone lur3),�.3L�1r75 Of ON 10.WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.O,L 0, 162, § 25C[6)) r, Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result denial of the issuance of the building permit, ec Pidayil Attached Yes,.,..,, E� No..,,,, ❑ 11. - F1c e OW/ler Ex&n r ion The anent exemption for"homeowners"was extended to include QWnen occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as sugCIylsor. CMR 780 Sixth Edition Section 108.3.51. Definition, of Homeowner; Person(s) who own a parcel of land on which he/she resides or intends to reside,on which there is, o' is intended to be, a one or two faro Ely dwelling, attached or detached structures accessory to such use and/or farm siructures. A person who constructs more than one home In a two-year Regjod shall not be considered a b mneotvner Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permits As acting Construction Supervisor your presence on the job site will be required broils time to time, during and upon completion of the work for which this permit is issued, Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting In Death) of the Massachusetts General Laws Annotated, you may be Mable for person(s) you hire to perform work for you under this permit The cnders,gned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of :ash aptpmu Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature kod __— The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant InformationPlease Print Legibly Name (Business/Organization/Individual): & L7 Ri)a4ntq L L.P Address: 4'' .Lane, Si. City/State/Zip;,,......5ou/horn >inn, MG) 0/093 Phone #: &13) 4 ? - H'7'75 Are you an employer?Check the appropriate box: Type of project(required): Eeam a employer with oZU employees true and/or pact-timed 7. Q New construction 2 am a sole proprietor or partnership and have no employees working Por me in $. Remodeling any capacity.[No workers'comp.insurance required] 3.d l am a homeowner doing all work myself[No workers'compinsurance required]' 9. ❑ Demolition 4.E i am a homeowner and will be hiring contractors to conduct au work on my property I will 10 ❑ Building addition ensure that alt contractorseither have workers'compensation insurancerr ateSOk I L([J Electrical repairs or additions proprietors with no employees. 12,E Plumbing repairs or additions 5.` I am a general contractor and l have hired the subeonunmrs listed on the attached sheet 13.2-12oof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.�Wearea corysa;ion and its o.i uera have excised their right oftee:eolian per MOL 2. 14. Other I S2,SIMSand we have no eine:toms. No workers'comp-insurance rnquired.I Any applicant that checks box SI must also fill ou: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. [Contactors that check this box must attached an additional sheet showing the name of the sub contractors and state whether or not hose entities have employees If the subcontractors have employees,they mutt provide their workers'comp.policy number. /am an employer that is providing workers'compensation insurance for my employees, Below is the policy and job site information. Insurance Company Name: Gra,- _. Policy#or Self-ins. Lie.#: IG 06,re31'0 _ Expiration Date: t0 • 5- /Las Job Site Address: 9.2 Gdi3hanxf7lah Intl _City/State/Zip: 50!?Y1cce O/C.C6a: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL.,c. 152,§25A is a criminal violation punishable by a tine 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 5250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify und2iipcsIsout penalties of perjury that the information provided above is true and correct. Sianaurre', `�, \ Dote', a2a7 - /Gr Phone u: (922 02.' - x/77.5 ._ Official use only. Do not write in this area,to he completed by city or town official, City or Town: Permit/License# Issuing Authority(circle one): t.Board of Health 2,Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 160k Address of the work: 7i e , eta _ Li /loam re 717/¢ The debris will be transported by: OD NSP e-4 CD 15 eo Sf, The debris will be received by: �v�u �� 'J��c� -NO 'SRA � Gl� ' Building permit number: -^ Name of Permit Appl cant ��_CT _aLyl ,,c\ Date (e Signature of Permit Applicant 9. '?Ulb IU', 20AIA Babas & fickerf Insurance Agency No. 7768 P. I/I ---, m ICOCERTIFICATE MALIABILITY INSURANCE 16 IA'' CERTIFICATE S ISSUED AMY( R OF RMATOONLLYMDCONFERSNO RCERTIFICATE HOLDERTDATE E IS :EFT-ICATE 1i DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED t EPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. -0FORTANT: If the certificate holder is All ADDITIONAL INSURED,The policylles) must he indorsed. If SUBROGATION IS WPIVED,subject to :tic terhMS and cenditimu of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the :ert.ficate holder in lieu of such endorsements), -`' °P NAMEA'.4r Michael R. Bangs TT;NTS 6 Fickert PHONE'--- (413) 51'/-CPae -,sueance A -1ANCEIL En(' (4131 527-2700 �rvgl _ f Iridin Street ADDRESS; StICB NSU 43I nr Grano e.,coin _ - 9tf amttOnr MA 01027 INaVRE Py$ AFFORDING COVERAGE, NP!C= ._ .—..._- INSURER A,Admiral_Insurance Co. 24856 "'IiNSURER a_Safety Insurance Co, 139454 NCI Roofing, LLP INSUREJrc-.Burlinetoq Insurance Co. 12362C 6 Line Street INSURER it,:Star Insurance Co _,.24562 Southampton, MA 01073 INSURER E INSURER F: : 9VERAGES CERTIFICATE NUMBER'. REVISION NUMBER: HIS IS TO CERTIFY THAT TUE POLICIES OF INSURANCE 1.1.515o BELOW HAVE BEEN ISSUED TO THE INSUPED NAMED ABOVE FOR THE POLICY PERIOD 'IDICATE'J. NDTIMTHsTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W TH RESPECT TO WHICH THIS 'e li ' vi crE,VIAY BE ISSUED OR MAY PERTAIN, TI IE INSURANCE AFFORDED BY TFE POLICIES DESCRIBED HEREIN IS SUBJECT10 ALL THE 1 ERMS. °x:-US ONE AND COROT:DNS OFSUGH POLICIES,LIMITS SHOWN MAY FAVE BEEN REDUCED BY PAID CLAIMS. )AWtsues '..'. ... ' POLICY EFF ' POLICY ENP ' TAPE INSURANCE "-- L--- INSRIMM - POUT(NUMBER Ietmoor eng i BiMiourn Y)I LILI NT$ CAMERAL UAaEITM X •CA000020963-02 3/4/161 3/4/19 EACH osuunnervcf IT 1 COO,OCC C OW.LR LA GE NF PAL I ARI I Tv DAMAGE TO RENTEDI PRFMISFs(F,ururrwe) S 50,030 • —I Cea POB i_X I U N ;occuR I.MNO EXP(Aronm Roeml :1 10 000 1 i ! PERSOPH1LLroVINJURY IS 1,000 ,000 ._J. ; OENMLADCNpcAIt Is 2,000,000 AGLREOATEpLNAT APP OF R PP R 1 j I PRODUCTS.mMP/OP AGn 1,s 2,000,000 POI TY I X lgei r 'LOC [ .LI FR1NcD SN(` rUMr �AonOEif LNewry X i 16207761 9/30/Ss9/30/16,16BFvre ' S 1,000.90Q yAV O i 1 I BODILY INJURY a er PBJorI I $ ATOS O X TUTOOU FD - 60UILY INJURYIP. rzwiarnl Y FAT Vi0$ X NOk O O . PROPERTY O A?\O __A. (Peru cc ituni) I eBRE4n uqs 161 3/9/1711AGe ICG CURRaucr, f 5,000,000 YIN 30/5/151 Le/5 16, EL --1... _J E[CCSB IAB • 9GlllR FAL _ mmMs•r+AUN Are a 5,000 000 oe_ X REINERT:NJ 10 ,000 lII I Is GETTERS sox EruATON TEC0683405... .__.. / I770514.11. 101r 1 F PLO R AABNR L EAOR.TORY AcolirLIMITS ER ANA P `Ring fPAFI'NeGE%ECUTITM — aME �NhI eecLwwP Y �IIu(gi 1 . .E EACH ADOI rrP NT a 1,000,000 nl 1 EA..FTs E EMPLOYEE 1 000,000 1' / e isHonu,sorva RATIONS Lit ', E94� _BLICY LIM ..I I ,i....._ rL.DISEASE•racy urnnls 1,OOR,Q00 l r . DN c CrfOPERATIONS I LOCATORS IEMwb VEHICLES ACORD ISA MU GE!RWEGET*Il MN E pace Is r[gJrN) .., VO CONTRACTOR, IERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAIS THEREOF, NOTICE WILL BE DEUVEREO IN ACCORDANCE WITH THE POLICY PROVISIONS. `************REFERENCE COPY*********k**`** AUTNORIZED REWE I CARVE cAt41;, 4S © �9 -01 ••RDORATION, AU rights reserved. ::ORD 25(2010/05) The ACORD name and logo are registered marks of ACOR ,.v- Fax: (413) 534-8344 E-Mail: ' m Massachusetts Department of Public Safety ucr, o zsasny„ LVf Board of Budding Regulations and Standards License CS-074334 e foul Ma, Were/Gr .,r rVConstruction Supe /mrfYoor Office ConsumerofAffairs&Business Regul clan rvis 2 HOME IMPROVEMENT CONTRACTOR MARK T DELISLE ! Registration 126235 Type 59 BRIGGS STREET i" ExpIratIon; 51872098 Partnership EASTHAMPTON MA 01027 R GIROO-ING MARK DEUSLE ry — n� CA__, Expiration'. G LINE ST . Commissioner 08103/2018 SOUTHAMPTON,MA 01073 Undersecretary . t t SOlett `.rn i to 37641144 PI "e 1011A yMO ,I NIWE'4GTo h4 p Ag C�US ��S-� HOME IMPRL'aVFly{N`L GpN tb.AGTUR s ' 8$JApD,OE eitC R bt33.tgC. 101,,P b41ERITM.Id.9TAL WOlRKERS / f , ISSUq,S TNHE POILLOMNI 4 I-CENSE ,.J 1 c AU4„A811A9 (Eft NNIR6 E7 RI CT E 0 , ' eOlJpHCA ct" ‘'t EACH 01073 I' �� t� MkNic 5E2ISLE VC 964 NO �tAl�fFOTVV'T1 ,2 i '6—. C 0624741 I i' &i/0112613 ,r111 1;/30/2014 59 ORI GOSH ST rdiL � yr. ,. `4A e,1°27,17 it3., G % r-0 /�mro sem- 2, 8} ��,,, 4° CO MONWgALIH OF f AOHUSETTS ?t P.i OtESSJ tMk LICENSURE SHEET METAL WOR4CF'MS ISSUES.THE FOLLOWING LICENSE AS A 3, teyt EUSINESkilt MARK T. EL1SLE (I I/ �' ROI RbOFLNG LLP ' S LINE STREET .I ep;a. EASTKAMPTON,MA 010‘76.'"c 1 601 09/09/2017 y 2408 L NSETNMU R -ENPP MON IAT SERIAL NUMBER RC.I. Ro Roofing 6 Line St. Estimate Date Southampton,Ma.01073 4/11/2016 Phone(413)527-4775 fax(413)527-8469 Name/Address Job Location Pat Mirra 472 Westhampton Rd. Florence, MA 01062 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 11,100,00 Furnish&install aluminum drip edge, pipe(lashings, chimney flashings(if needed) and step flashings, Furnish &install CertainTeed Winterguard ice&water barrier, 6 feet along eaves. Furnish and install synthetic underlayment over existing deck. Furnish & install zinc strip on front of house. Furnish and install Lifetime CertainTeed Landmark Series shingle. Furnish and install CertainTeed approved ridge vent. All exterior roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers'specifications. Lifetime CertainTeed material warranty included. All related permits will be obtained by R.C.I.Roofing. Add 52.50 per sq. ft. for wood decking replacement if needed. Add S 1500,00 for Landmark Pro Series shingle. Add 5300.00 for flat roof on shed dormer. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total sll,l0o,00 lI TERMS OF PAYMENT 5%Deposit Customer Signature: Balance upon completion Registration q 126235 Date: Construction License# 074334 —�' F '/am Insured by Banos&Fickert Ins. (413)527-2700 Shingle Color Selection: