17C-129 (3) OWNER- CONTRACTOR AGREEMENT
Commonwealth of Massachusetts
Department of Housing and Community Development
This agreement made the 27` day of December, 2012, by and between Northampton Housing Authority, hereinafter called
the "Owner ", and R.C.1. Roofing, LLP, hereinafter called the "Contractor ".
Witnesseth, that the Owner and the Contractor, for the consideration hereinunder named, agree as follows:
Article 1. Scope of Work: The Contractor shall perform all Work required by the Contract Documents for roof at the
Forsander elderly housing development prepared by Bradley Architects., acting as, and referred to in the Contract
Documents as the "Architect ".
Article 2. Time of Completion: The Contractor shall commence work under this Contract on the date specified in the written
"Notice to Proceed" and shall bring the Work to Substantial Completion within 120 calendar days of said date. Damages for
delays in the performance of the Work shall be in accordance with Article 9 of the General Conditions of the Contract.
Article 3. Contract Suni: The Owner shall pay the Contractor, in current funds, for the performance of the Work, subject to
additions and deductions by Change Order, of the Contract Sum of: One - Hundred Sixty- Four - Thousand dollars
(5164,000.00).
Article 4. The Contract Documents: The following, together with this Agreement, form the Contract and all are as fully a part of
the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forms,
Conditions of the Contract, and Specifications as enumerated in the Table of Contents, the drawings as enumerated in the List of
Contract Drawings, DHCD publication known as the Construction Handbook, and all Modifications issued after execution of the
Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in
those Conditions.
Article 5. Reap Certification: Pursuant to M.G.L. c.62(c) §49(a), the individual signing this Contract on behalf of the
Contractor, hereby certifies, under the penalties of perjury, that to the best of their knowledge and belief the Contractor has
complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and
remitting child support.
Article 6. Worker Documentation Certification: In accordance with Executive Order 481 the undersigned further certifies
under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the
performance of this contract; that pursuant to federal requirements, the Contractor shall verify the immigration status of all workers
assigned to such contract without engaging in unlawful discrimination; and that it shall not knowingly or recklessly alter, falsify, or
accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these
terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, including but not
limited to monetary penalties,•withholding of payments, contract suspension or termination.
Article 7. Validation: This Contract will not be valid until signed by the Department of Housing & Community Development.
In Witness whereof, the Parties Hereto Have Caused This instrument to be executed Under Seal.
CONTRACTOR AWARDING AUTHORITY
R.C.I. 10OF ' . L• NORT .'MPTON HOUSING AUTHORITY
1
6 Line reet Southam )t MA 01073 By: % t w E -. r
Add ress / ignature, Tile & Seal
By: C#e 4 ; j' f '4g I ' Attest: r • 4g4 O��
'gnat and Sod
VIn accordance with M.C.L. 121B, and- Revisions thereto
Witness: ' A9 1 4vat. DEPARTMENT OF HOU I AND COMMUNITY,,.
DEVELy NT
/ . ndersecretary or Designee
Date: I l� (l
DI -ICD 51OOK -SIOM Owner - Contactor Agreement
..iea nonnno n...., 1 „r 1
LI\ Office of Consumer Affairs & Business Regulntion License or registration vain' tor Inarvlauf use only
before the expiration date, If found return to:
.ME IMPROVEMENT CONTRACTOR
C= Office of Consumer Affairs and Business Regulation
, °•egistratlon: 126235 Type:
'— " xpiration: 5/6/2014 Partnership 10 Park Plaza -Suite 5170
` =' , Boston, MA 02116
R.C.I. ROOFING '
MARK DELISLE ''"
6 LINE ST ,-.. _.
SOUTHAMPTON, MA 01073 Undersecretary Not valid without signature
•
COMMONWEALTH.OF MASSACHUSETTS Massachusetts - Departrnent of Public Safety
00.0 AliiWU4r Board of Building Regulations and Standards
SHEET METAL. WORKERS Construction Supern.isur c_fi. j, —
AS A MASTER- UNRESTRICT W License: CS- 074334
ISSUES THE AOOVE LICENSE TO: \ t j ` 4 t ; w `
MARK T DELISLE \ '1 '• `, ,i';' '.
MARK T DELISLE v 33 FIRST AV1 .`<'*' `�
c EASON
33 FIRST AVE \ I `, t. ,. h , -,'
EASTHAMPTON MA 01027- 1111)f �-_ ' �t�� n °� Expiration
c. Commissioner 05/03/2014
13276 05/28/1+ 15588, i .
t ,UCE 1SI O ;:liP8 0.0.AT ' , 10ERIAL:.NO ziz,
Fold, Then Detach Along All Perforations H
r1A 0o1 '3' 57 "j •
U a j artme o f l.a�Of = • ' •
O ccUpational?Salr }4y ondIdealth Administiatiori
g.0,* `T'. D•' cdt. A : e'.
has SSfctoessl(4torngtelod %a $ajgty ari:q Health.
Troia hig :06:13 s I try - ' ' • 4tn41 ctto 4*". &440 1. 1 �;
/A 1
frraine)` (Date)
The Commonwealth of Massachusetts
,,_ Department of Industrial Accidents
► =:,' /
�A ► . — Office of Investigations
600 Washington Street
e =IN= ` Boston, MA 02111
=iv v www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
\Tame ( Business /Organization/Individual): R (±, Q o0 c- , A� S
Address: C 1-.:, e✓ \--
- 2ity /State /Zip:S \- ,wn,\ik -0 .,-\ 1 M cc. of 0 3 • Phone #: (( /3) 541 ~C(1 `t5
.re you an employer? Check the• appropriate box: Type of project (required):
DI am a employer with 2,0 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part- time).* have hired the sub - contractors
[1] I am a sole proprietor or partner- listed ou the attached sheet. # ❑Remodeling
ship and have no employees _ These sub - contractors have 8. n Demolition
working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its , —
required.] officers have exercised their 10. _ Electrical repairs or additions
❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, § 1(4), and we have no 12. Roof repairs
insurance required.] t employees. [No workers' 13 • ❑ Other
comp. insurance required.]
ny applicant that checks box t 1 must also fill out the section below showing their workers' compensation policy information:
omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
mtractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information.
'm an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
rormation.
;urance Company Name: ,v 0..c , ,�r ,
licy # or Self -ins. Lic. #: \3 ' _ Cab & ??LI Oyu Expiration Date: I 0 • j _ f 3
b Site Address: 1 3 1411 ,~ �• City /State /Zip:Aiio(A-Vv .rmO-b A , , 0 t0c, 0
tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ilu_re to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
to 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
up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
io hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
mature: .�-
� ' i Date: 1 -1$ 1
tone #: 1 I3) .5"-e. .1 "4 1 `(5 .
Official use only. Do not write in this area, to be 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 #:
Initial Construction Control Document
� d To be submitted with the building permit application by a
,' Registered Design Professional
111 for work per the 8 th ed of the
=
Massachusetts State Building Code, 780 MR, Section 107.6.2
x x
Project Title: Roof Replacement, Forsander Apartments Date: 1 -15 -13
Property Address: 137 High Street, Northampton, MA
Project: Check (x) one or both as applicable: New construction X Existing Construction
Project description: Roof replacement on 8 residential buildings and 1 community building, including gutters and
downspouts, and some eave trim repair.
I, Donald S. Ferry, MA Registration Number: 9298 Expiration date: 8%31/2013, am a registered design professional, and
hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning':
X Entire Project Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. 1
understand and agree that I (or my designee) shall perform the necessary professional services and be present on the
construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a "wet" or - 6 "
electronic signature and seal:
Phone number: 413 - 448 -8253 Email: dferry @bradleyarchitectsinc.com '
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an 'x' project design plans, computations and specifications that you prepared or directly supervised. If `other' is chosen,
provide a description.
Version 10 09 2012
Version1.7 Commercial 13uilding Permit May 15, 201111
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, l - �� r �V�cvrv\ ` (� , as Owner of the subject property
hereby authorizee Vs., ; ` 5 \ — LT— 1 r V—` -.,;` to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
M c\ CA S\ C � - i�Op �l l Ltd as Owner(Autatizeci
A_geilt_ hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and p- • (ties of perjury.
Print Name
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: () Not Applicable C]
Name of License Holder : !0.c °ri \lam V ' s\ E 'Cl �. ` �_ e-CA) , ■ 0 1 �f' 1 (`{ I ( -A_
Z ` License Number 1
33 `_,% - - CJ't - �5 \�r�c�v�1Q1CJCl , j-A . Cj■ �� �'.a J�� � - ! `�
{
Address Expiration Date
—7'
Q a) 5 t- 0 - 1
Signature Telephone
SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 250(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 0
Version 1 .7 Commercial I3uilding Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable El
e.
_241E_
Name ( egistranl):
Registration Numb / er r
Address r to( L OflD0
C1 /� 1 C, v //
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
9.3 General Contractor
_ Not Applicable ❑
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version I.7 Commercial Building Permit May 15, 2000
8. NORTflAIVIPTON ZONING
Existing Proposed Required by Zoning
This column to be filled iii hr
liuildiIlg I)chanmrnl
Lot Size
Frontage
Setbacks Front
Sicic L: R: 1.: R:
Rear
Building Height
Bldg. Square Footage ok;
Open Space Footage `I
(Lot area minus bldg S paved
parking)
// of Parking Spaces
Dill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW O YES 0
IF YES: enter Book Page and /or Document 11
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW C) YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO C)
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing r Change of Use ❑ Other ❑
Brief Description Enter a brief clescription here.
Of Proposed Work: ikc Co <:S 0. v�.\ -kt_
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) 1 CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A -2 ❑ A -3 ._ __■r
a■P
A -4 ❑ A -5 ❑ 1
B Business ❑ _ ❑ - - - --
E Educational ❑ _ —❑
F Factory ❑ F - 1 ❑ F - 2 ❑ i ,„ 11111111111111111111111111111101111111•1111111111
H High Hazard ❑ --3A — L_}
1 Institutional ❑ 1 -1 ❑ I -2 ❑, ❑
M Mercantile ❑ 4— ■
R Residential ❑ R -1 ❑ R -2 ❑+ ❑
S Storage ❑ S -1 ❑ S -2 ❑' _ 1111111111111111111111111111111110 '
U Utility ❑ Specify:
—
M Mixed Use ❑ Specify: 1 -
S Special Use ❑ Specify: I I_e —_
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 5'
1
2 nd
2 nd
3 rd
3 (11
4 1h
4'
Total Area (sf) Total Proposed New Construction (sf)
Total Height (0)
Total Height 0
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone 111111111111111111i a 1 a [tidrspns 14y to nti —
r �.. Versionl.7 Commercial Building Permit May 15, 2000 _�
I - — :i - Pi N __ Department use only
2 3 2093 City of Northampton Status of Permit:
Building Department Curb Cut /Driveway Permit
212 Main Street Sewer /Septic Availability
DEFT. OF :.. `j Room 100
NORTHAMPTON. Mk. 01060
W ater/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify .
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
1 31 \42,�� s Map Lot Unit
et, 5c n,..r -� EJ.• .ecL \�c,� >,; >ev�\ t -,, -)Zone Overlay District
J Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT \ \
2.1 Owner of Record: A) ock.. i tY� {\ OCAu:j\ e1 Qu.N\r Z7 C1 Y
Name (Print) Current Mailing Address: 4 A o \ A s ;_,,� c":\--.
Signature . t' CA\ tom. (.n..0 Telephone (,...11: 4 -. 3 1
2.2 Authorized Agent:
C 1r4 C Y, S \tc, .. P C' 'l. ROOC\n3 -1 (0 1-,“1 ... 1.- - _a(+v.\-r\c zv *?\- 0 , roc,. 01.073
Name (Print) Current Mailing Address:
X1 t3) ?1- v`i`i5
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Zuilding q , I L' t f ° M 0 U (a) Building Permit Fee
2. Electrical _ (b) Estimated Total Cost of
_ Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) 1 G4 r 000 . 0 0 Check Number a� f i �' 3 eo QQ q Oq
This Section For Official Use Only _
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date __
File # BP- 2013 -0714
APPLICANT /CONTACT PERSON RCI ROOFING I r �,
ADDRESS/PHONE 6 LINE ST SOUTHAMPTON (413) 527 -4775 14
PROPERTY LOCATION 137 HIGH ST - FORSANDER APARTMENTS (s
MAP 17C PARCEL 129 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out / I/.3 3 1 j ) (
Fee Paid
Typeof Construction: REROOF
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 74334
3 sets of Plans / of Plan
THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN O ATION PRESENTED:
pproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
D- .. *ti • . relay
4011P gr.
Sign • -f Building 0 fi ial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
137 HIGH ST - FORSANDER APARTMENTS BP-2013-0714
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 129 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- 2013 -0714
Project # JS- 2013- 001194
Est. Cost: $164000.00
Fee: $984.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 125452.80 Owner: NORTHAMPTON CITY OF NORTHAMPTON HOUSING AUTHORITY
FORSANDER APARTMENTS
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 137 HIGH ST - FORSANDER APARTMENTS
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAM PTON MA01073 ISSUED ON:2/7/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:RE
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 2/7/2013 0:00:00 $984.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner