17C-120 (3) RC.1.1i :wofing Estimate Date
6 Line St.
Southampton, Ma. 01073 _ 3/31/2015
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Janet Bennett.
34 Sheffield Lane
Florence, MA 01062
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 13,800.00
Furnish & install aluminum drip edge,pipe flashings,chimney flashings (if needed)and step
flashings.
Furnish& install CertainTeed Winterguard 9 feet of ice&water barrier along eaves and 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.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.
Total $13,800.00
"PERMS OF PAYMENT f)
5%Deposit
Balance upon completion Customer Slgnat re .�►_ ,1_�yL�'_'
Registration# 126235 t
Construction License#074334 fat I
Insured by Banas&Fickert Ins.
(413)527-2700
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGI. c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: _ q C)j)e
The debris will be transported by: CoAlwle-�4--C.
The debris will be received by: V\,\p �A-cl
Building permit number:
Name of Permit
Applicant Lk-�6 ['Jc'
Date Signature of Permit Applicant
CERTIFICATE QF LIABILITY INSURANCE _ °��.'�7D4/2/'15
THIS CERTIFICATE I$ 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 13Y THE POLICIES
BELOW. THIS CER11FICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OIL PRODUCER,AND THE CERTIFICATE HOLDER,
IM POIRTANT; If the certcate holder is an ADDITIONAL INSURED, the po.licy(les) must 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
cerlificate holder In Iieu of such endorsement(s),
PRODUCER ^� NA : r Michael R. Banal
Ranas & Fickert: PHONE FAX
Insu�°once A�encsy L rxt): (813)_ 527-2700 rjg{C�ygl (413) 527-0849
63 M<Lin Street ADDRESS: rcb @banasin.surance.com
Easthampton, MA 01027 INSURBR(S)APFORDIWCOVERAGE _ NAICN
_._...,..�.__ (NSURERA:Admi.ral Insurance Co. �._ 24856
l,'tSURED INSURERS:SafQtV Insurance Co. 39454_
RCI 12ooi"ing, LLP 1NSURERC;Evanst:on Insurance Co. 35378
6 Line ,Street IN u ERO t r Insurancs Co. 24562
Southampton, MA 01.073 I SURERE: _
_ tNSURERF:
COVERAGES CERTIFICATE NUMBER; REVISION NUMBI:(R;
THIS IS TO CERTIFY THAT THC 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONCITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
_.__.__ _....__._..
irisR AbSL-317�� P`fYGG�.r� .....,P-� FXP
LTR TYPE OF INSURANCE POUCYNUMBER MMIDON tvlAfloD/YYYY _ LIMITS
A GENERALLIABILITY X CA000020963-01 3/4/15 3/4/16 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGETORENTED
E$tpe accutrenUL_ $ 50,000
CLAIMS-MADE CD OCCUR ME EXP(Anyone pe•sm_T $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
_ GENERALAGGREGATE� S 2,000,000
GEN'L AGGREGATE LIMIT APP LIES PER -PRODUCTS^CAMP/CPAGG S .2,000,000
POLICY X PR,COT 7 LOC _� $
B AUTOMOBILELIABIU7Y X 6207761 9/30/14 9130715 Eaacc�r rn I E IMF— 1,000,000
ANYAUTO BODILY INJURY(Per psZn) $
A1.L OWNED X SCHEDULED BODILY INJURY(Per wIdent) $
AIPOS AUTO$
N ED ROPEftRT7Y�AMA�E
X '$
X HIRED AUTOS AUTOS Peraccldenl
$
wBRSLLAUAe OCCUR X CUBW5757915 3/9/x.5 3/4/16 EACHOCOURRENCE $ 5,000,000
EXCESS LIAB ��CLAIMS-MADE AGGREGATE 5 5,000,000.
_ DE;D X RETENTION$ 10,000 _ $
WORKERS COMPENSATION WC0683905 10/5/14 10/5/15 W A7U• 0TH•
AND EMPLOYERS'LIABILITY ER
ANY PROPRIETOR/PART'NERIEXECUTTVE YIN N/A E.L.EACH ACCIDENr $ 1,000 000
OFFICERMEMBER EXCLUDEtt?
(Mandatory In NH) E,L.DIS MS> SEA EMPUJ E $ 11000,000
If yye^ d scribe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POUCYLPNr 1 1,000,000
CESCRIPTIONOFOPERATIONSI LOCATIONS IVEHICLES (ARach ACORD 101,Addl danalRarrarkeWAedule,if mote sFawe sregAred)
ROOFING C 014TRACTOR,
CERTI KATE:HOLDER ~�r CANCELLATION
SHOULD ANY OF THE ABO E 8 POLICIES SE CANCELLED BEPORE
THE EXPIRATION DATE N 'ICE WILT, 813 DELIVERED IN
****REFERE)NCE COPY**** ACCORDANCE WITH THE P L ISIO r'J
AUTHORIZED REPRESENTATIVE
0 1988.2010 ACORD CORPORATION, All rights reserved,
ACORD 25(2010105) 'rho ACORD name and logo are registered marks of ACORD
'hone, Fax: E Mall;
SECTION 8 -CONSTRUCTION SERVICES _-
8.1 Licensed Construction/�Supervisor: I Not Applicable 1
Name of License Holder LJ
License Number
Address Expiration Date
Signature Telephone
9. RegistereA Home improvvem�e�n,t Co.ntractor:, Not Applicable 3 blle li a 1 !�
Company Name Registration Number
Address �s-� Expiration Date
_�.Z09 Telephone
SECTION 10-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....... M/ No...... ❑
11. - Lorne Owner Exemption
The current exemption for"homeowners"was extended to include Owner-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, grovided that the owner acts
as su ervisor.CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.Aperson who constructs more than one home in a two-year period shall not be considered a homeowner.
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 permit.
As acting Construction Supervisor your presence on the job site will be required from 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 liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature__(I-Am 60d
SECTION 5-DESCRIPTIO OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑] Roofing
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs (0] Decks (C] Siding Other[O]
Brief Description of Proposed c�
Work:— — q p Q. a4, Pa.
Alteration of existing bedroom Yes No Adding new bedroom__,_Yes No
Attached Narrative Renovating unfinished basement _ Yes __No
Plans Attached Roll -Sheet
6a, If NEW houseeaand or addition to existing housing, com- Iete the following:
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?
d. Proposed Square footage of new construction. _Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves_ Number of each
g. Energy Conservation Compliance._ Masscheck Energy Compliance form attached?
h. Type of construction _
i. 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
Septic Tank_,r City Sewer _ Private well_ City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AG`ENT OR CON'rRACTOR APPLIES FOR BUILDING PERMIT
I, I&OL )t° f 1- , as Owner of the subject
property
hereby authorize �� P 1ST ( _�� .�� , f• I��4tn(`
to act on my behalf, in all matters relative to work authorized by this building permit aR ication.
ctr1� _
-4Lf- ><
Signature of Owner Date —
I, — `&K �,)(2LL'k CL"' l4)o'(t?_p,c 0Q n - as Owner/Authorized
Agent hereby declare that the statements and information on a foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pa�i'n�s, and penalties of perjury,
__R_LaCL�.� 4'
Print Name
Signature of Owner/Agent _ _ Date
t ' Departrn t use only`
1116ty of Northampton Status of Permit:
uilding Department curb Cut7DrivewaY
Per reit
212 Main Stree t Sewer/Septic Availability
Room 100 Water/Well Availability.
egetric,Plumbing&Gas Inspedl0fts , Y
Northampton,USA 01060 �; hampton, MA 01060 Two Sets of Structural,,Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans.
Other Specify
APPLICATION 'r0 CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
/? F This section to be compie'ted by office
3y C�hC�-f�t"/ l L i'► . Map. _.._ Lot Unit
F1 vro,,1 U A Zone _ _Overlay District
Elm St.District; . CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Tyr e rl'o aA et, MA oiy �-
Name(Print) Current Mailing Address:
Telephone
Signature
2,2 Authorized Agent:
—Ala.v r, _1h1 - Le .-I. K r�� L ICQ']
Name(Print) ', Current Mailing Address: �—
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant
1. Building , (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+41.5) f 3 ` ��. �"' Check Number
This Section For'Official Use Only
Building Permit Number: Date
Issued.
Signature:
Building Commissioner/Inspector of Buildings Date
34 SHEFFIELD LN BP-2016-0275
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 120 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-2016-0275
Project# JS-2016-000420
Est. Cost: $13800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 38115.00 Owner: BENNETT JANET
Zoning URB(100)// Applicant: RCI ROOFING
AT. 34 SHEFFIELD LN
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON.8/27/2015 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 8/27/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner