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23A-088 17 PLYMOUTH AVE BP-2017-1506 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-088 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-2017-1506 Project# JS-2017-002508 Est.Cost: $16400.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 10585.08 Owner: PHARMER WILLIAM S&DOROTHY K TRUSTEES Zoning: URB(1001/ Applicant: RCI ROOFING AT: 17 PLYMOUTH AVE Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAM PTONMA01073 ISSUED ON:6/13/2077 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF INCLUDING FRONT PORCH 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 6/23/20170:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ! lio'Optf rsght Use-ofro / \‘‘. City of Northampton tet of Pb7rltlt j' \ B Ilding Department Curb t;ut4pNrswPer, ¢ . Al2 Main Street aewollhspuc AuEroolinp„ N`le -' Room 100 Wator/W n Aiodirapllltyii Northampton, MA 01060 iTnab ears of Strwotunat Pians phone 413.587.1240 Fax 413-587.1272 IPI6USfte PI rns. , ' OIMar Jl' di' nc lOAr1ON TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMO ! H A ONE OR TWO FAMILY DWELLING ri— . 1 •SITE INFORMATION' be- II -jGO(O ,. (ri 5ddi ryp,$, TIM' by office i'7 I' Jiin'r0u tfr llyE. Map— /6114. Lai Lai U -_ Urii � M''' seotlua f0 be GOm rierevte€, MA Zan:a______.,.�._ CvolleyDtstrl¢a EI1n Et.District___ Ce-District__.._ aICN2PROPERTY OWNERSHIPIAUTHCI IZED.A ENT I -� _ C.me_f Reda() ybtzrL t 3 `l1( LaAke PliWi Ln. #ir ei> --a_ Current Mailing Aedres$1 / 70'33 y3LL. RffacAe _ Telephone :\.)(2;K 02Js,el2_ " 12 /' • C - G3 Lir» _13A- \ncr4lvtimp-}en IY,IA (i1C . 7_ nnti / Curtenn1 Malang Address.`` n tu, Telephone —_,, • Of, 3 • ESTIMATED-CONSTAUCTION COSTS 1 --_ � Estimated Cost (Dollars)to be Official Use Only completed by permit applicant. -J1L1P iij , 400. - (a) Banding Rome Fee - — o ma `- (EEDstImatod Total Cost of , _ ConstructionBorn,(6) =:-ming 'Sulldtng PerrnIt Pee. e M e r co'.(HVAC) 'maCion — '_I1 + 2 + 3+4 + 6) lio. 48,0, - Check Nunb'er & ? �� -_„__ TMa Section For'OHIt I.&,Use OIL_— Date ____ A lib Permit Nufl er',—_ issued, // AS /7 Building Commissioner/inspector of Buildings Oaie• .Iosi5- DES R N.LF.P$I -• r.. Os c, •ealga'$ Louse [] Addition ❑ ( Replacement Windows Alterationls} Roofing 21 Or Coors ❑ ssory Bldg, ❑ Demolition ❑ New Signs {p1 Decks[q Siding [CR Other Der t iorlon of Proposed t, :1 o of existing bedroom _Yes No Adding new bedroom_— Yes No ..'ra<i ea:raeze Renovating unfinished basemen! Yes No A :ached Roll •Sheet f New linewen apdtot'•aelteltojen i;,o,eixtsflingytaeu8titoch eiomrp7et$.it 11oY Ungi I use of building One Pettily Two Family Other ,ue oar of rooms In each family unit Number of Bathrooms___.__ s mere a garage attached? F'-onosel Seders 10otaye of new.construction, Dimensions ~ewer o'stories? _,___�_, 'sie?lou of healing? „ Fireplaces or Woodsloves Number of each fin eigt Conservation Compiieno©_ *Nlassoireolt Energy Compliance form attached? _____ T-pe of conseuction s oorsr.tollon within 100 ft of wetlands? Yes -_ No, is construction within 100 yr. floodplain _Yes_,,._No Demi+ of basement or cellar floor below finished grade ..r!_undang conform to the Budding and Zoning regulations? Yes_•„_No. s,o Tank City SewerPrivate well Oily water Supply j --ICN 7a OWNER AUTHORIZATION •TO OS COMPLETED WHEN +teRS AGENT OR CONTRACTOR APPLIES FOR dUiLDINE PBRr IS ___Lag /7MEbby yyP> 1RY�'�,Qf�VV� pp . dS Owner of the Sable-i toorree (V`Q[ u X3121ii CAC. (ST `, � Ct - T hv7t-4, ., nl behalf, in all mailers relative to work authorized by this building Permit aR, lodtion. Ow . ey t - /Q - / ci7 j of Owneer �� Dale ii€yi ��}d,¢14 _ f•\-ki1{?y47p3 lkt°V+ ,as CwnerfAakitnizad � I hereby declare that the statements and Information onite foregoing application are true and accurate, to the best of my knowledge :site' ar. under he pains and penaities of perjury, •:�1:fO1f11C1a ,��,. _�__......_ CY Wim_ 6, -- / 9 /7 dt,r0 of Owner/Agent _ Dale t' N 8 . CONSTRUCTION SERVICES( cchink_ g?sah(ccheptuflt'i Not Applicable ❑ •...demes Wedtll: f+ f � Z1{( P _-_ mber �.. t(/ � License Number S\Ti(3d1'�1U 'ni 4en IV n Ihlrt:''7 050 - 1 Expiration Dale Telephone isle rept,Flnrne ImpeovemeoACjentngdt „ri- - Not Applicable CI (no f ny,Name Registration Number ass Expiration Date i hnuaLitl \Ur') olapnone ILO))5 2'1'� n r --- (PON in.WORKERS' COMPENSATION INSURANCE AFFIDAVIT (N).G,L,c.Tet,Q 260”{4)) ,ers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this a flldevil vdll resun deo al of Lha issuance of the budding permit. _—_� zd Affidavit Attached Yes,,,. . @@� No...... ❑ - -,�_ ,_-„,,�,,,, 11. F3om? 1 (6113 z z r3,0r,m The,OW lent exemption for"homeowners”was extended to include,pwnygc^puled Dwelllnds of one(1) or lwo(2)families anal to allow ouch homeowner to engage an individual for hire who does not possess a license,provided that the owner sets s( stype for. C= '16 Sixth Edttign Section 108,3.51. Negation of Homeowneg, Person(s)who own a parcel of land on which he/she resides or intends to reside,ell which there u,or is intended to be,a one or two family dwelling, attached or detached structures accessory to such use and/or farm stexwres.A Doing who constructs more then one home lit a tw9•te Lfei•Iod Shall not be eonsidetred a homeowner, Sr_h"homeowner"shag submit to the Building Official,on a form acceptable to the Building Official,that itetshe shall be responstble for ani such ay orf performed under the bulldtlie permit, As acting construction Sgnervlsor your presence on the job site will be required from time to time, during and upon conviction of the work for which this permit s issued, AIs° be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers (0 5mpioyees for(n)uries not resulting in Death)of the Massachusetts General Laws Annotated,you may be lltLije for persons) you hire to perform work for you under this permit, Tie undersigned"homeowner" certifies and assumes responsibility for compliance with the State Building Code,City of N DIihampton Ordinances, State and Local Zoning Laws and State of Massachusetts Ceneral Laws Annotated. idomrawrer Signature— r fAc h.4,A -__ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of he provisions of MOL c 40, S54, ! acknowledge hat as a condition of the building permit all debris resulting from the construction sctivity governed by this Building Permit shall be, disposed of in a properly licensed solid waste disposal facility, as defined by MGL 0 111 , S 150A Address of the work. /2 PIyrnnufl FWD_ "/erLnee, The debris will be transported by: itiVIc- - D e'orir L. The debris wili be received by: CAI VhP / 4cJ*31UCTILQ � i�'/L-AI"O'rl HA - � I Building permit number; Name of Permit Ayant Date (G - i9 i7 Signature of Permit Applicant 'Kar, 7. 2017 10131A,M No. 0868 P, 1 A ORD CERTIFICATE OF LIABILITY INSURANCE DATE N.91191199,1 3/7/1' THE CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFICATE 00E5 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 certlflcale holder le an ADDITIONAL INSURED, Jho policyIi es) must be endorsed, I(SUBROGATION 15 WAIVED, subject to the ferns and condi Uons or Ws policy,certain policies may require an endorsement. A dateline lit ret this certificate doss not confer rights to the certificate holder in lieu of such end orsemenye), PROWLER COPOT HLQhael R. Banos Sanas & Fiokert PHONE Her (.113) 527-2700 wr pa. (e131 ssv-DCaP Insurance AgencyM A oi&ESB: Mb0 ba rtes insure rice,core 63 :chin street Easthampton, MA 01027 91.91/RTwm n9099941 COVERAGE uAlcn IL. _. . . .. .._ __ IREVREAA:Admiral Snauranoe CoCo, 24656 _ es WEO INSUPEAe;Safety Insurance Co, 13945S RCI Roofing, LLP msVREn D!Admira 1 Insurance Co, 24056 6 Line Stxeat Iewnwo,Star InSAIranoe Co, 24562 Southampton, MA 01073 liuBER e' INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOLIOY PERIOD INOFATHT. NO'RMTHSTANDWG ANY REQUIREMENT,TERM OR CONDITION CF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHCH THIS CERTFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TFE POLICIES DESORIBE0 HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSQVS AND CONDITION s of SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN RECUCED�{B�Y PAIpIDLI�C�yyLAIMppS.As0L LLIR TYPE OF INSURANCE HER eWJn POLIOIN. vER IA. g Ycen JPNANLYY7A WIZ • I ccN:n AL LIABILITY X CA000020963-03 3/4/17 3/4/10 EACH occunaeuce $ 1 ,000,000 X core:encwL OEIEIwu usultt PAPANSYADE s IFAEmn vrm o s 50, 000 OIf6Y9A1AOE Xi OCCUR MED E)9(AMera mem) 3 10,000 PER90taLe PDV INJURY $ 1 ,000,000 I GENERALAOGREDATE I1 2,000,000 `CEENN'LAGOREGA TTF LWT APR LIES PER PRODUCTS•WLAroP AOC; 3 2,OOO_QQQ POLICY 7 PR 7 LOc 3 • , ADTOk0SILE LIASIUTY I X 6207761 /30/16 9/20/17 Is1410s4PINUL1 1 3 1 ,000 ,000 PFY AUTO 190DILY INJURY Thr careen; 3 uL OWItU X, SCHEDULED a00ILY IHJURYP AUTOS AI)TDZ BrB%IEBnp $ X MATOAUTOS X 340,99F.0 Ole( YIQANNO9 F C Uw8PELLAJA9 _OCCUR X GX0000003O5-01 3/4/17 3/4/10 EACH OCCUR.ENCE g 5,000,000 EXCESS WAD CtAIMSMADB AcOrEQATE $ 5,000,000 DEO X RETENTION$ 10,400 , 3 _ D 1 WORKERS COMPENSATIQ1 WC0683405 10/5/16 10/5/17 T,USTAtID I 0Tq- I Pio EMPLOYERS'LIABILITY V!!! YIMIi¢ e19aPR W RIETOFNARTNEWEYECUINE1 •000, OOFFICER,lr En C9OLLAED7 ,NIA ELEACH aQOEEM 3000 cm ereO., NR) EL DISEASE•M ucLQYEE, 3 1,000,000 Dr8ORIPP.ON cc OPaPATIONS mLaW E.L.MS FAS{•PQLIOY LNP 3 1,000,000 rASORIPLON OFOPEPAnONs I Too/moss IVETT OLES (N,ah ACORD 101,At196Mel Reim*.WOMeulq II ep.tS hrevvita) ROOFING CONTRACTOR. • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THC ABOVE DESCPIBEO POLICIES BE CRNCbLLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W REFERGNCG COPY. ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPREEENTATNE © 1088.2010 ACORD CORPORATION, All rights reserved ACOR D 25 t2010/05) The AC ORD name and logo are registered marks of ACORD PCQne'. Fax E'Mall: • '' Massachusetts Department of Public Safety \ — ecti, 020M05111 V) Board of Building Regulations and Standards raa were ICS /P / o!Y License CS-074334 Ili F Offc fC Affairs&Bue,ncs R g 1 tlou Construction Supervisor _„:----=::61-_ Mace HOME IMPROVEMENT CONTRACTOR Registration 125235 Type, MARK T DELISLE /' Exp rat[ . 6!612018 Partnership 69 BRIGGS STREET 2 `1 ^, nie on EASTHAMPTON MA 010271 ' R.C.I.ROOFING MARK DELISLEn � Comms o� Expiration: 6 LINE ST :�^�� � "�"� Commissioner 05103I2018 SOUTHAMPTON, MA 01073 Undersecretary tic � �'t{O C'C e, -, i liaA �Nr'v ooN, o1 J•Mfil Ott rIA�9-aFO s , ' t ratirmovi;;4`�u14F1 n ;11-to";;;wW? ;1 . _z. 4, , 10 OFP 0 ESSIONA ' t SUR6=t FlOME IMPR ciVvl' N),y�C ONfRAOT OR 1 3 ''' '' s3j4{"AR�30A It C4•.Ttbb$ 2dC, 14,P 1 SHEE`JaargtTAL W0IRk9 S ;PO'it,IN 14! 11 �; V.-. IS6Wq $, rT33HE ti°o'LLOW IvNR11Ll C EN'S E{ SOIJ 11' 1 Ali ,OL093 - 1 Wi AI MAOTIEry WNIR6flR1CT El , H "+ Fi 'f�a1 Cfi a 4 31MMRICxI .DEI ISLE I -q REs a .,' � Id �,i �• '-norJ T{IC,0624941 /1 , M�/0'1/20'�vt tint .^14/30/2014 59 SRI GQ ft -% Jr .''y ul � ,.. 1uafl J fit ' .., 1t aTh9H a3 n sONE0 ``✓'" e>+-A „�,.,., .� *r , i'�AAM P6T 4, +.a?ia, 01027 17,9 .. I� * ' ' lir `.3? 2J8 I.. Y d, J ?, HUNOTttN b891 tlA l 1P ,1s. 000M ONW ALTM OEM 3eAO.H10SSET S 7..A ''''AilrilifilSION OFPRoFESSIONALLICENSURE. . ' ,.,�SHEETMtTAL WORk(fNS s=- e3 'l .3IS S UF -...`:'0:0'05,:):' . 6T,H2FC4.1.0WINC1.141 ENSE,A6 A �r7a} .1 . 1 0,y0,44,4 .541 .:0 E MAFOKT DELISLE T -',..t ROOFIN?,L,4R �� AI Ila 1 cay2 6 LINE S'1,f�E,'Et ,c e . rU x (..- 6 V EASTH'AMPI'ON MA 011073‘LA. v r N � t p y� § 77C, 601 ss 1O9IQa/20'2 e0 240C • NS6 NUM0 ft ¶.,.UPIR TION 1ATE . 6ER 4t NBNIBEft! The Commonwealth of Massachusetts pl �� Department of Industrial Accidents ]-1 - 1 Congress Street,Suite 100 _11= Boston, MA 02 114-2 01 7 XS www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information p Please Print Legibly Name(BusinessSOrgani:actio&lndividuai) er I fC Rp neei LL P Address: la Lina S1. City/State/Zip: .Spm ID dm/mem IV!-! 0/073 Phone #.- 69/3) ,5'3_'7 - 4/775— Are you an employer?Check the appruprinte boxy Type of project(required)', 2I am a employer with aZ-U employees(full and(or parttime)" 7, Q New construction 20 l am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity. No workers'compinsurance required.] 3am a'homeowner doing all work myself.(No workers'comp.insurance required.] 9. Demolition <.El l am a homeowner and will be hiringcontractors to conduct all work on mY ProPetry. 1 will 10 Building addition ensure that all contractors either have-workers compensation insurance or are sok 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions l am a general contractor and{have hired the sub-contractors listed en the attached sheet 13.0-Roof repairs Thesesubcontractors have employees and have workers'comp.insurance.: 6We are a corporation and its office/5 have exercised their right of exemption per 1001,c. 14.D Other 152,§Ifah and we have no employees.[No workers'comp,insurance required.] I'Any coplanar that checks box xl must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractors must submit a new affidavit in/teeing such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 run an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site information. n T Insurance Company Name; 0 71-21^ -72-) Net-47.7/7a, R✓7P0, �....... ._.Policy#or Self-ins. Lie. it: C. C&(3'/Oc - Expiration Date: /D -3" /7 Job Site Address: ./ 7 illy mmver44 AV€, _City/StatWZip; r/"fntelitt ern CItGLa.. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,540.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 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 under II airs ynd penalties of perjury that the information provided above is true and correct Signature: ,r Date: ' /9 `/7. Phone Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitiLlcense •# Issuing Authority(circle one): L Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#; RC.I. Roofing 6 Line St. Estimate Date Southampton, Ma. 01073 Phone(413)5274775 Fax(413)527-8469 Name/Address Job Location Dorothy Pharmer 17 Plymouth Ave. 344 Lamp Post La Florence, MA Hershey, PA 17033 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. Imdu4,w.rl +vmvF pwPeA. tell 12,600.00 Furnish&install aluminum drip edge,pipe flashings, chi`mney flashings(ifneoUed)and step flashings. Furnish M. install CertainTeed Winterguard ice&water barrier,6 feet along eaves and 3 feet in valleys. Furnish and install synthetic underlayment over existing deck. 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.L. Roofing. All Work will he performed according to manufacturers'specifications. Lifetime CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. Add$2.50 per sq.ft. for wood decking replacement if needed. Add $3,800.00 for garage.'"OV- • 7•tn&bua,w )tcs( OI¢U kick' pua8/ 044 ex(elUPa (0 ID. be,kte,Lakpeun,c1, , 4, a �of 1S'1(y 261"2 ,191 WE LOOK FORWARD TO DOING BUSINESS WITH I YOU. Total ( $Iu,do�o.00 gl/BRN4S-QZ PAYMENT )2 , (7o0 ..Z/0: Dep 3 y90 Customer Signature: Balance upon completion ��� Cte6�� K.( , +4/ Registration N 126235 IOvx��s Date: 6/042Ji7 Conslmction License#074334 Insured by Boas&Molten Ins B 6JP6.�- /d2{ £ o & ( 413)527-2700 e, Shingle Color Selection 1,LA+104`1'.0�