29-598 28 STONE RIDGE DR BP-2019-1054
Gls s: COMMONWEALTH OF MASSACHUSETTS
MV.Block: 29-598 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 s BP-2019-1054
Projects JS-2019-001720
Est Cost$13400.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO.
Const.Class: Contractor., License:
Use Group: RCI ROOFING 074334
Lot Slze(sg. ft.): 81021.60 Owner., DECKER ALBERT R&JANET L
Zoning: Applicant. RCI ROOFING
AT. 28 STONE RIDGE DR
ApplicantAddress: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON312712019 0:00:00
TO PERFORM THE FOLLOWING WORK:STRI P & 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 Occuoancv signature:
FeeTvpe: Date Paid: Amount:
Building 3/27/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
2d0F
City of Northampton , +
- Building Department
' 212 Main Street r m
Room 100
Northampton, MA 010130
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION I -SITE INFORMATION ECEIVED 6P—f(i , 106-V
1.1 Property Address: This section to bexomplet tlby office
a B S}orle Ki die Or. MAR 2 6 2019 M P Lot 5� Unit
Florence Mi no Overlay District
DEPT.OF f.� DYF InKP�QiorJS
DCPTNa on r L Tae $idol:, CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED.AGENT
2.1 Owner of Record:
:ana+ -- AI Lir ker k An nrFln✓Pnrr rno
Name.(Print) Current Mailing Added::—
SR4-
�
�o 04riched Telephone
Signature
2.2 culthortzed Agent.
Inr 1k"I, — ALL fn Lynn S+ Q41-,i MA I
Namo(Pring Current Mailing Adtlr ss:
Signature Telephone
SEGTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit aDDlicant
1. BuildingObr�n 1 0p (a)Building Permit Fee
2. Eilectric.1 (b)Estimated Total Cost of
Construction from fi
3. Plumbing Building Permit Fee /
4. Mechanical(HVAC) l
5. Fire Protection
6. Total=(1 +2+3+4+5) 13 400 Check Number
This Sectlon For Official Use Only
Date
Building Permit Number: .Issued:
Signature: 3"Z7- 20)17
Building Commisslonepinspeclor of Buildings Date
S4I .jompson De r6i roi Cl,
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New(louse Addition ❑ Replacement Windows Alteration(s) Roofing Eir
Or Doors ❑
Acceosory Bldg. ❑ Demolition ❑ New Signs [oi Decks [❑ Siding iol Other[01
Brief Description of Proposed 11 1
Work: See. OAQCheri
Alteration of existing bedroom____Yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement _Yes No
Plans Attached Roll -Sheet
Ba.If New'dhoftiiiatidPbr3rid8itl6n�'tbfe-21§tlihoesind�rbombiete�theJoilomnfl:
a. Use of building: One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
C. Is there a garage attached?
J, Proposed Square footage of new construction. Dimensions
e. Number of stories?
L Method of healing? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance farm attached?
In. 'Type of construction
1. Is construction within 100 ft.of wetlands?_Yes _No. Is construction within 100 yr. floodplain_Yes_No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes_No.
I, Septic Tank_ City Sewer_ Private well_ City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OW1VERS A
AGENT OR CONTRACTORAPPLIES FOR BUILDING PERMIT
(
1CLlf -i- `F � In1PPxef , as Owner of the subject
property p n -r y� n
hereby authorize (l l." L
to act on my behalf,in all matters relative to we authorized by this building permit application.
Sea tf}prhod n�-as- 19
Signature of Owner Date
as Owner/Authorized
Agent hereby declare that the statements and Information on the foteAcing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
1
Print Name
03 -as-I9
Signature of Owner/Agent Data
SECTION 8-CONSTRUCTION SERVICES
6.1 Licensed Construction Supervisor: Not Applicable 13Name of License Holder: M(I r K M I,)le C S - O'/ y 3 ct
License Number
99' rl Ea ot qnp4nn (nA1 05 - 03- a0a6
Address Expiration Dale
Signature Telephone
9. Registered HomILImprovelgib t a t f Not Applicable ❑
CI- RCQ� nC LLP hd(od35
Com envanv Names Registration Number
LnP t �, �4lnrnneln YYIYa (71013 ()S - o - a0a0
Adtlress Expiration Date
Telephone 413-.Saj -Y'1l
SEC1110N 18-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O:L,c.152,1 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....... 51' No...... ❑
RCI-go��o�fink EtitDate
Southampton,Ms.01073 7/23/2018
Phone(413)527-4775
Fas(413)527-8469
Name/Address Job Location
Al Decker
28 Stone Ridge Dr.
Florence, MA 01062
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 13,400.00
Furnish&install aluminum drip edge,pipe flashings,chimney flashings(if needed)and step
flashings.
Fumish&install CertainTeed Winterguard ice&water barrier,6 feet along eaves and 3 feet in
valleys.
Furnish and install synthetic underlayment over existing deck.
Fumish and install Lifetime CertainTeed Landmark Series shingle.
Fumish 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$2.50 per sq. ft. for wood decking replacement if needed.
Estimate includes sumoom.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $13,400.00
TERMS OF PAYMENT
5%Deposit Customer Sit=
Balance upon completion
Registration b 126235 Date: (a
Construction License W 074334 U&Iaa xi
Insured by Banes&Fickert Ins. Shingle Color Selection:
(413)527-2700
City of Northampton
Massachusetts
�4
DBPARI NT OF BUILDING INSPECTIONS
212 Main Street a Municipal Building . Cy
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the-reconstruction, alteration, renovation, repair,modernization, conversion,
improvement,removal,demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be
done by registered contractors. -
Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered.
Type of Work: Rocr ln0 Est. Cost: 1111, U00
Address of Work: '�7' siWEB KAnn n( � Fltlferco DOO
Date of Permit Application: O - 0 S - 15
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
_Building not owner-occupied
_Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT. SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
op, -a5 -19 RCI / nONnf LLP r�1a135
Date Contractor Name t HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts (i)
DEPARTMENT OF EDZDDZci INSPECTIONS313 Hain 8th p .n, Mi BuildingNorlhpGon, NA OU60
Debris Disposal Affidavit
In accordance of the provisions of MGL c 40, 554, 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 150A.
The debris from construction work being performed at
AlS+ :n) r D�ltn on )
(Please print house nu er and street name)
Is to be disposed of at:
W1 S-Fa✓n ..ri��G�� Tiync{P� Fri �iJ.a
(Pleas�ntyiame location of facility)
Or will be disposed of in a dumps✓Iter onsite rented or leased from:
� )Cp lift � IiYla �nf� 'e—.! C�l nfs
(Company Na a and Address)
Signature of Permit Applicant or Owner Date
If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
�\ The Commonwealth of Massachusetts
Tw,rkers'
Department ofIndustrialAccidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Compensation Insurance Affidavit:Builders/Contractors/ElectriciansIplumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant If li Please Print Leeibly
Name (Busines�� �s/Organizationgndividual):� ' 7(, 0
_ kor,h Q_ ( P
Address: W// cell, S+rpe -
City/State/Zip: Q1Q`)3 Phone#: 5D7- q205
Are you an mutterer?Check the approprbte box: Type of project(required):
L5�lamecmployuwith/5cmployecionimNorparrtime).» 7, ❑New construction
2MIamesolepeoprie1ororpottnuship and have no employers working forme in S. ❑Remodeling
any capacity.[No wmkeri camp.insurance required.]
3.Ql am a homeowner doing dl work myself[Nm workeri comp.insurance required.]s 1 ❑D Building
ion
4.❑l am a homeowner and will behirin communicate conduct all work on Iwill ]0❑Building addition
g con y property.
worm that ab connacmra wither have workeen'resupenrectiona inwrenw or we sole IL[]Electrical repairs or additions
proprietors wim no employem. 12.❑Plumbing repairs or additions
5.711 em a genual connacmr end I have hired the sub-consmcto,,bittern the anached sheet. 13.[Rkoof repairs
These sub-conuacmrs have employees end have workers'camp.insumare.t
irM W e wo a corporation and its oRcers have exercised their right of exemption per MGL c. 14.Q Other
152,§I(4),end we have no employees.[No woram'comp.macrame oquired.l
*Any applicant that checks box#1 must also fill out the section below showing their workers'competuation policy infarmetion.
I Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractors must submit a new affidavit indicating such.
IC.mmat ra that check this box at atta lculan additional sheet slowing the name of the subcontracmrs and state whether armor those entities have
_employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
Iam an employer that is providing workers'compensation iamearrcefor my employees. Below is thepolicy andjob site
information. /�
Insurance Company Name: T. m ��:Trisimapt0 L(1
Policy#or Self-ins.Lie.#'. 0_1R0 aaee y 73618 A Expiration Date: /G- 0 5-a0 12
Job Site Address: ag SAO RP �. f�no X002 City/State/Zip: F�(tf2 ") 610108.
Attach a copy of the workers'compen Hon pocky declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL Q. 152, §25A is a criminal violation punishable by a fine up to$1,500.00
and/or ane-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 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 cipenalaes ofperjury that the information provided above is true and correct
sz m /,' fit C4 a5 (9
Cq
Phan # [i) 5Q7- 4015
Offacial 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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
scnr � sam.asrn
�cs offCC�onsumaAHalt &Busin.asilegulAtIon
HOME IMPROVEMENT CONTRACTOR
TYPE:Partnershlo
Exol,e an
1 fi_E y 05/05/2020
RCI ROOFING
]Z
4
Commonwealth of Maseachusell2 "
MARK T.DELISL DIVISIon of Prolesslonal Llcenaura
6 LINE ST S:;:__'_ ) ° Board of Building Re ulallcns and Slandards
SOUTHAMPTON,MA 01071 Undersecretary Cone`IµGtlt�i�'ISl}�rvlsor
CS.074334E'�plres, 05103/2020
Registration valld for Individual use only
before the expiration data, If found return to: MARK TH0 AS DELI
office of Consumer Affairs and Business Regulation 60 BRIGGS STEEP 11t�
1000 Washington Street•SUIte 710 EASTHAMPTO �q OSXw V. ,�� i, '
Boston,MA 011 �4' /JX1e,'S':PJ C1U .:,rC ,e� � ::,:
Commissioner V"� moi•
Not valid without signature
&�MMONWE TH..O.F,M"' TT.S,-rs
HOMEIMPgp, ONTRACTOR tea 99 ®
/ &P 3HEE EID �(2�Ws'
c2= . .�'�� . . ISS'U FOLLOtri9N BE"'
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HIC.0624741 �r ui 2 �.g � � 11/30/2019 EAST
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09/09/201.9 34223fi �s&§3"'I I,:
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IA�SPGDn� "FRTIF/CATEOFLIABILITY INSU
1rILAlE15ISSUEOgSAMATT R.4NCE �-
CERTIFICATEDOESNOTAfPI ER OFINFORMA710N ONLYANDCONFERSNO RIGHTS UPON THE CERnFicgre HDLDER.rHIs
B��Owr{f p/1 �1 ,uxm���Y�R NEGATIVELYAMEND,EXTEND ORALTER THE COVERAGE AFFORDEDBYTHOU.— Ie3
/ TATIVIS OR1PRODUC R,AND TCEDOES NOT CONSTITUTEA CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT: It the card ts holder is an ADDITIONAL INSURED,the pW1490e5)must haveADDITIONgL INSURED provisions or b eendomed.
If SUBROGATION IS WANED,subject to the farms and conditions of the policy,certain policies may require an Endorsement A statement on
I
certificate does not confer rights to the certificate holder In lieu of such endomement(a).
PRODUCER
NAME; Michael R.Banes
Banal S Flckert Pxoxe . 013-527-2700 xo: 413-527-0849
Insurance Agency
63 Main Street ADOkbie, mbAbanaslnsurance.com
Easthampton,MA 01027 INaoR s1A 11UNNoCOVERAGE NAIOP
IxsuRERA: Admiral lnsurence Co. 24856
INSURED INSURER B: BeFaly I115UIen:Co. 39454
RCI RooOng,LLP IxauRER C: Atlmirallmurenca Co. 20666
fi Line Street uLwREao:
Southampton,MA 01073
INSURER E:
NSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTVATHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFNY CONTRACT OR OTHER DOCUMENTWTH 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,
UCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
LTR TYPEOFINSUMNCE HRO D I PIX NUMBER mmmornIIMMMKMI LIMITS
X COMMERWLOENEMLLMWUT/ EACH OCCURRENCE $ 1,000,000
ClAIM5MA0E l OCCUR PREMISES Ee wove 5 50,000
MED EXP f 111
A x CA000020963.05 03104/19 03104/20 PERSONAL S ADV IN URY s 1,000,000
GENLAGOREWTE UMRAPPUES PER GENERALAGGREGATE $ 2,000,0DD
POLICY JECT LOL PRODUCTS-COI AGO S 2,000,000
!ER'. $
AUTOMOBILE LMMUT! Ee ectlbnl COIRUNETrIffanM f 1.000.000
gxyq�p BODILY INJURY IPerp,�,) f
B OVWED x scHEDULED x fi207T61 09/30/18 09/30119 BODILY INJURY IPRr Meexnl f
MJIDSONLY AUTOS
HIRED NONOWNED S
x AUTOS ONLY x AUTOS ONLY Par Fctl 1
S
UMBRELLA DAB OLOUEACH OCCURRENCE s SAOOAOO
C UCEss UAB CUIM:n DE X (1)(000000385-03 03/04/19 03104/20 AGGREGATE f 5,000,000
DEO OM RFTEMIONS 10,000 f
WOWEERSCONPENMTOH eTANTE E
ANDEMPLOYBULUMUTY
Y
ANYPETORMTNERECUTNE❑ NIA EL EACH ACCIDENT
OFFCEFUMEMBERE%LLUDED? i
INu,tlMaryln NN) EL DISEASE-EAEMPLOYEE f
DEGLRIPTION OF OPFMTIONG MIw/ EL DIEEAEE-POLICY LIMIT f
DESCRIPTION OF OPEMMMSI LOCATONSIYEWCLES IAC0R01a1,ACdtlaIW gxnvhS asNMUM,may b ftluHW H mon FprP Y rpaRW)
ROOFING CONTRACTOR.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE UPIRUNTION DATE THEREOF,NOTICE WILL
C 0PY
AUTHORIZED ACCORDANCE WITH THE PO CY PROVISIONS BE DELIVERED IN
UP
15 ACOFID CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
C�RTIFICATE OF LIABILITY INSURANCE ° ` srzDts
I °" "'
TflCA(S IS ISSUED o3 t
AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING KSURER(SI, AUTHORIZED
TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
+tha CBrtIECBto hold,,is au APO NONAL INSURED,the pciky(lesl must be endoreed if SUBROGATION IS WAIVED,sublect to
FIDnB ofucn endore,m na It P olicM may require an endonem M A Wtament on this urNflcate does am corder r13Ms to tha
A MjCH,N ear,as _
_RT INSURANCE AGENCY 413 527.27W F
ENMI a nssirreumnGe.eom
INSMR a ARORWXDCDVEPAGE MNCf
MA 01027 IxsWnaa: AIM MUNAL IN3 C0 33758
> FYfuaEa E:
nRFRO: —
W�_
r REY1310N NUMBER:
T prpr BEEN ISSUED TO THE INSURED NNAED ABOVE FOR THE POIJCY PERIOD
INWN, `NY CONTRACT OR OTHER DOCUMENT NMT,RESPECT TO WHICH THIS
UE r THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL"fHE TERMS,
r V CEO BY PAID OWNS.
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