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29-305 (6) RC.1. RDate 6 Line St. Estimate Southampton,Ma. 01073 10/16/2015 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Donald Lafleche 398 Acrebrook Dr. Florence, MA 01062 Terms Rep Estimate valid for 20 days Chris Description Total Remove existing roofs. ,3r9{�6-6fI Furnish & install aluminum drip edge,pipe flashings, chimney flashings(if needed) and step flashings, /� Furnish& 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. l �„ All exterior roofing related debris to be removed by R.C.I. Roofing. �7 >i 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. / WE LOOK FORWARD TO DOING BUSINESS WITH YOU. TOtaI --�4 99fl 60 TERMS OF PAYMENT 5%Deposit Customer Signature: Balance upon completion `pL/ Registration# 126235 Date: f 5" Construction License#074334 Insured by Banas&Fickeil Ins. Shingle Color Selection: ,, (413)527-2700 C,ScI�U v1 Cj 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 IicE,nsed solid waste disposal facility, as defined by MGL c 111 , S 150A, Address of the work: Ac rehrroL The debris will be transported by: 3D The debris will be received by; C� +���� ���Er. i; o( Building permit number: -- Name-, of Permit A pp Hcant Date Signature of Permit Applicant AC(pRD® CERTIFICATE OF LIABILITY INSURANCE DATE(I6WDDTM) THJS CERTIFICATE II> ISSUED AS A MATT R.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORVIFD BY THE POLICIES BELOW, THIS CERVIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE: ISSUING INSIURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, 11 the If the certifoftil hoide)'is rt ADDITIONAL INS quire n poorseme tttA,be endorsed. If SUBROGATIONt lt>WAIVEED, subject tD the terms and conditions of the policy,certaGT policies may require an endorsement, A statement on this certificate does.not confer rights to the FInsui�anco. to holder in 11E1u of such elxiorsementa�_ R �TAT —' s & Fia:kert- h1E Micyhael R. Ranas _ PFfO FAX A<�en(,y 43, ) 527-2700 ��I ; (} 413) 527 0849 ooRES mb @banasin3uzance,COm iampton, MA 01027 jNSURERIS)AFFOROltt3COVERAGE _ NAIC/I .—........ INSURERA;AdMira3. Insurance Co, 24856 I r�UREO INSURERS;SafGt:y InsuranceCo_,_ 39454�� RCT lne 6';tre LLP iNSURERC;Eyanston InSurwn-qe Co, 35378 6 Line £ftreet — Southampton, MA 0 .073 Is ERD' t r Insurance Co. 24562 I NSURER E; �^ INSURER F: _ COVERAGES r C13RTIFIOATE NUMBER; REVISION NUMBI R: THIS IS TO CERTIFY THAT THI?POLICIES OF INSURANCE:LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ANgVE FOR THE POLICY PERIOD I INDICATED, NOTWITHSTANDING ANY REEQUIREMEENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RtES FIE CT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, LAR GENERAL LIA81urrI INSURANCE POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, _ sa'X L _ _ ,�= DC_^C{TIONS OF SUC_�i Ab0'L�SO� P..C,GO(_E.. ......�� _ �- N R POUGYNUMBER M /DON MMIDO/YYYY LINITS _ X CA000020963�-01 3/4/15 3/4/16 EACHOCCURRENCE $ 1 0 00 000 X COMMERCIALGENERALLIABUTY DAM10E TO RENTED -� CLAIMS�IAOE [�OCCUR E$(�e oxurrence) $ 50 000 MEDEXP(AvyOpppersm) $ ­­101 000 1 -- ---- PERSONAL&ADVINJURY $ 1,000,000 -- --- GENERAL AGGREGATE`_ $ 2 000 000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMPIOPAGO S 2 000 000 ni" X PRO L0C �` $ AUTOMOBILELIABIVY }{ 620%761 9/30/14 9/30/11 Eaacc� IMT� 1 000 000 adYAUTO BODILY INJURY(PwrAuon) S At A01 08 0 X AUTOSULEO BODILY INJURY(Per w1denl) $ X HIRED AUTOS X NON-OWNED .E — AUTOS cEcRdPer P l S r UPABR£LLALIAB''—T''_OCCUR X CI1BV15757915 r $ — L 3/4/15 w 3/4/16 EACH OCCURRENCE $ 5,000,000 EXCESSLIAe _(L CLAIMS•MADE AGGREGATE $ 5,000,000 OED X RETENTIDI4$ 10 000 _ -- $ AND EMPLOYERS' r WC0683405 10/5/14 10/5/15 WOSTATU• 10'H. ~' ,I AND EMPLOYERS'UAaIU'IY YIN 8Y OPCEMENBER EXCLUDE(I?ECUTNE ^�y NIA E.L.EACH ACCIDENT 1 000,000 (Mandatory In NH) f yyos doscribounder E MSE-EA EMPUO $ 1,000,000 DES RIPTION OF OPEMTIO Sbelow E,L DISEASE-POUCYLPAST } 1 ,000,000 'f SCRIPTION OF'OPERATIONS)LOCATIONS f VEHICLES (Attach ACORD 197,Addltlonal Ronmrks Schedule,If more spaoo Ia roqu red) ;00E'ING CONTRACTOR, ERTIFICATEE HOLDEf2 _ -----�� CANCELLATION r SHOULD ANY OF THE ASO I. B POLICIES BE CANOELLED BEFORE THE EXPIRATION DATE N ')CE WILL BE DELIVERED IN _ *** *RE =E (:OPY*,t** ACCORDANCE WITH T)1E P L ISto AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION, All rights reserved ;ORD 25(2010/05) 'rho ACORD name and logo are registered marks(if ACORD ne, Pax: !:-Mall; r SECTION 8 -CONSTRUCTION SERVICES —y- 8.1 Licensed Construction Supervisor; Not Applicable ❑ Name of License Holder;� > , �;�p License Number o !_ 4o I-) M 0 I o,7'� _--_� 0 5 °y t0 Address '��— —T— Expiration Date Signature Telephone 9, Registered Home.Improvement 0,6n1ractdr:; Not Applicable ❑ Company Name — Registration Number Address Expiration Date Telephone L�` 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 Ye;s....... Cf No...... ❑ 11. - Horne Owl1tr. Exgrn tio.n. The current exemption for"homeowners"was extended to include O�yner•'occirpied Dwell%nEs of one(1) or two(2) families and to attow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CIVIR 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,A erson who constructs more than one home in a two-deer mod shall not be considered a homeowner. Such"homeowner" shall siibmit 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__ C10 Lod �__ SECTION 5-DESCRIPTION OF PROPOSED WORK (check all applicable) New House Addition Replacement Windows Alterations) Roofing�— Or Doors ❑ Accessory Bldg, Demolition New Signs (CMl Decks Siding [CO) Other[oj Brief Description of Proposed � 1 C A --— 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 house and cxi.ad`di'-i.o-n;to ex sting,housing, gornalete thefoliowina: 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. 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 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 OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ( n(z l as Owner of the subject property —"' hereby authorize rA o,, Q (A-. 6 (? , I 4,A-jr) to act on my behalf, in all matters relative to work authorized by this building permit aptlication. Signature of Owner Date_ 1, Mai- — j-�►�--��--- 1' c�1T as Owner/Authorized Agent hereby declare that the statements and information on e foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 'rint Name IC signature of Owner/Agent _ Date ----- Department us'e only SCE ( ity of Northampton 'Stattrs of Permit: ' I E uilding Department Curb CiiAZoriveway Per,M­ n 6 "��� 212 Main Street Seweri, pUcAualability`. Room 100 1Natofovoll Availability o hampton, MA 01060 Two Sets:of StructuraiPlans . DEPT.OrBUiTi^+ta a Y ?W13. 87-1240 Fax 413-587-1272 Pic, ite Pfans Other Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOI-1.3H A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION:—�1 1.1 Property Address: This sectiars to be completed by office 39?ACrcb irk_ br• Map --- Cot Unit rinrano;r, till -- Zone Overlay District—�• Elm St.District,__._ C3 Dlstrict,_• i SECTION 2 - PROPERTY OWNERS FIIP/AUTHORIZED AGENT 2.1 Owner of Record: — �n���l�a' LA 9�Ac rehrv(7G_)r. FC t-94,L c,, /)7/4 arc& ;7- Name(Print) Current Mailing Address: S 7(fi <fTlk C/i r S� - - --- Telephone Signature 2.2 Authorized Agent: — �1!_`°.JS C� -1- Name;Print) ^✓ Current Mailing Address:: Signature L-09 IS _ Telephone `--- i—SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item — Estimated Cost (Dollars)to be Official Use Only �__ _com feted by ermit applicant 7c)0, (a) Building-PE;rmtFee — 2. Electrical (b):Estimated Total Cost of r Constru.etion from(6) 3. Plumbing Building Perrnit.Fee _ 4. Mechanical(HVAC) 5 Fire Protection 6 Total = (1 + 2 +3 +4 + 5)___,_f q-�rr, Check NUrriber This Section For Official Use Only. Building Permit Number:_ Date Issued: Signature: Building Commissitmerllnspector of Buildings Date 398 ACREBROOK DR BP-2016-0567 GIs#: COMMONWEALTH OF MASSACHUSETTS Man:Block:29-305 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-2016-0567 Project# JS-2016-000951 Est. Cost: $4700.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq.ft.): 11499.84 Owner: LAFLECHE DONALD P&KAREN J zoning: Applicant. RCI ROOFING AT. 398 ACREBROOK DR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON.1012612015 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 10/26/2015 0:00:00 $40.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner