36-292 (4) 74 SOVEREIGN WAY BP-2017-0308
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map- Block:36-292 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Cateaorv: BUILDING PERMIT
Permit# BP-2017-0308
Project# JS-2017-000512
Est. Cost: $7800.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RCI ROOFING 774334
Lot Size(sq. ft.): 60504.84 Owner: Marlene&Daniel Lyons
Zonine: Applicant: RCI ROOFING
AT: 74 SOVEREIGN WAY
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775
SOUTHAMPTON MA01073 ISSUED ON:9/8/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: Strip roof and install underlayment, drip edge and
Certainteed lifetime Landmark series asphalt roofing
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 9/8/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
RECENED
DOISortriient use.only
7 rD46 Ity of Northampton 1Slatus of PA'rmrt
�3uilding Department Curb(:1•V06)/eway Permit
owroF BIJIW m ,� 2 2 Main Street Sewer/8eptle Availability.
NDBTNAMFTON,M n°Ns Room 100 Water3Me&IAytdiratilllty
na.c�
to ampton, MA 01060 Two Sets,of;Structural Plans
phone 413687-1240 Fax 413-687-1272 Islkhafte Flare --. .
.. - __ Other 3pe41fy
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOI-IEH A ONE OR TWO FAMILY DWELLING
EC 'ION 1 -SITE INFORMATION.
'Oro e Address This section to be completed by office
P ny S
7y Savereiyn (fiat/ Map �_`--� Lat --Unit
AIOV/fiam,a/ ,) MA/ 0/C6 0 Zona _Overlay DtstrIot__.
Elm at.Distilct___ CB District_.
'..=.G', ON 2 .PROPERTY OWNERSHIP/AUTHORIZED-.AGENT
+._,Owner of Record ------
(bantA)= Tar(ene, Lyen2 79 Sot/ere/in lJad,/ /arfha �o �a/o�oi
.'pdm; Current Malting Address,
Set a Cf't2.] — /=38ao
_ Telephone
At tror zed Agent:
yr; Yle1 _1. C . T. �nnFin� (n S'txr �bv an iY,IA CILC�Y7_
Current Mailing Address,
X1(15
Telephone --_�
3LCT_ON 3 • ESTIMATED CONSTRUCTION COSTS
Estimated Cost(Dollars)to be Official Use Only
com.leted b oermit a olicant
(a) EuJtling Permll Fee
7800.
Eiecncei (b) Estimated Total Cost of
Construction from (6)
:umbing Building Permit Fee
echanical(HVAC) l
- .e Protection _
CUI = (; + 2 +9 + 4 +•0)_� 'J80O- Check Number
mo ..-1
/
This Sutton For Offictal Use Only__
r ::ng Permit Number',: _ Date
//�� !f Issued.
e lure'. // Y =�� -- O / '�
Building Commisslonernnspeo!or of•BulldIngs Date
DESCRIPT•jONV.OF ?RGP9SED WORK idheok all apellealelel
.. House [ Addition Replacement Windowsv AlteratIon(s) U ReofIng
Or Doors ❑
:essory Bldg_ [1 Demolition E New Signs (07 Cooks ti❑ SMing(D) Other iDI
h_escnol on of Proposed /�
_ __SeeL'.—S. ai,L1'24 — COI? -----
-alio of existing bedroom Yes No Adding new bedroom Yes Nn
oohoo Narrative Renovating unfinished basement --Yes No
s Attached Roll -Sheet
t(
NEW housf: at1ticaa+.a gltWloLa taeaxisabata hPUlBinp, cntrLth'd'ete' 1+ s fgJlaw mQl
Use of bali3ng:One Family—T Two Family_ Other
a:5,9: of rooms'in each family unit: Number of Bathrooms__—
a 'nere a garage attached')
%r000sed Square footage of new construction, Dlmentiionn— ,...___...
vamber of stories?
`lelood of hoMing? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance Massoheok Energy Compliance form attached?
Type of construction
it nor ciruotion within 100 ftof wetlands? Yes No, Is construction within 100 yr floodplain _Yes No
Dcath of easement Or cellar floor below finished grade
mu minding conform to the Building and Zoning regulations? Yas_--, NO
sa;e Tank__ City Sewer Private well City orator Supply
^
tiCstOY?a -OWNER AUTHORIZATION •TOS COMPLETED,WHEN
;NEES AGENT OR CONTRACTOR APPLIES FOR BUIGP1NG PERMIT
Mai(mi.... fie/ ,_s �''���--._ as Owner of the subject
,eeyreuthorize EL.(SC_�i. 2.StCkr. (3+ �i C . t, f tc_LC
,_, on my behalf, in all matters relative to work authorized by this building permit aR Ilcetion.
in c ck d
Hanre of Owner Date _j— .9.
reb IS l)2(Iitt _ as, el and information ofelni Qato .a __ , as OwnerfAuihorized
n rah declare that the statements and information enure foregoing application are true and accurate,to the best of my knowledge
r•s.under the pains and penalties of perjury.
tbasoatt44. arm'
,_ n^:
W«a;OaAgen�� ---, Dae _ -„2-!1”/lO -
ripe 8 •CONSTRUCTION SERVIC.ES
incensed Conbtructlon�gu oe,Lviso(I ��-� Not Applioabte C
_..... Elcanee r tless:_.1Y to C1 v teAiSill _ lLi -)t-L
_ _ —license umber
I Lae' � C ` Fq.31.-1
S i` t 05 -OS ` {0_..—.__
Expiration Date
i. _ - (8St ) 5 art ' Li _ _
Telephone
ieristonpdNomalmorovemeat C'antraGiQT, H NotApplloable O
IE r 11 II191
-3(p_iv, Name Registration Number
HMO Q8§', —_ _.— � 05 - 0(0 — S ___ __
:::?ess I Expiration Date
yT .(11.-Tl._r'CL1L� OItY13 •relephuneiyC�, ,5;1rL'4f'1'"LS
---
CT ION 10-WORtKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c,162,3 28H{R)j
.mens Compensation Insurance affidavit must be completed and submitted with ilia application.Failure to provide this affidavit will issue
he der e•of the issuance of the building Permit, -----
)ed Affidavit Attached Yes_...._ 2< No ❑ _—_,—
11, - Rear Ownter Exeanotzo)
The current exemption for"homeowners"was extended to include Ow ep n,oenipled Dwellings of one(1) or two(2)fatniLies
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner nets
as supervise CVIR 780x Sixth Edition Section 108,3.5.1.
Dofintt{p?i of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which these
Is, cr is intended to be, a one or two family dwelling,attached or detached sh uctures accessory to such use and/or farm
struotures,A Verson who constructs more than one home in a two-y-car=jog shall not he 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 fon all such work performed under the bulldinw permit,
As acting Construction Sm,ervisor your presence on the job site will be required from lime 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;o
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you Inny be Iigjil;for person(s)
you hire to perform work for you under this permit,
The undersigned"honteewnei'"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,
liomeowner Signature 0,-Vgi'A rjncd
Ciry 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
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A,
Address of the work: 74 Sew(ter ! )a Noe/AAA/010r, 02n
Tm3 debris will be transported by: Coi � e,p D ) 5: - s
The debris will be received by: Cly r'p let��'_. /'H
I
Building permit number: --, _
CI— 7 s Nc < < P
Name of Permit Applicant
Date ? vii—/6. Signature of Permit Aopiicant
lam 9. 2016 1N : 20AM Banas & Flokert Insurance Agency No. 7768 6. 1/I
'----.1 4DATE mw.mM...YI I
ORd CERTIFICATE OF LIABILITY INSURANCE 3/9T16I
----
'HS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
:ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES •
BELOW. THIS CERTIFICATE OF INSURANCE GOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS), AUTHORIZED
-9EPRESENTATVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an AUDITIONAL INSURED, the pollcynes) must he endorsed, If SUBROGATION IS WAIVED,subject to
'.he terns and conditions of the policy,certain policies may require an endorsement, A statatnant on this certificate does not confer rights to the
Lettlfcate holder in lieu of such endorsement(s).
OR1/GEN NAM'EC1 Michael R. Banas
arra 6 Fiokert PHONE'��-""' fA4 D(Igq
•n., ranee Agency -lam. Eal. (413) 527-2700 1 TIC,X (4Ea1 ssT-
,3 Va1R Street EAIAIL
ADDRESS: mb@banaainsurance.,Com _
las th amp;:on, MA 01027 1NsuREWs)APPORoINc COVERAGE n-�<n __
INSURED A!Admiral Insurance Co 24956
'R`L' INSLIREAs r Safe tY Insurance Co. 13945;
RCI Roofing, LLPRoe/RumBurlington Insurance Co I22620
6 Line Street
IW"URSRO:Star Insurance Co _..24562
Southampton, MA 01073
INSURER E:
..... .... .. 1
INSURER F: I
OVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
-CS '.5 TO CERTIFY TIWT TI1E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED'IO THE INStf12ED NAMED ABOVE FOR THE POLICY PERIOD
NIXCATEO. NOTW,THSTANOING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WFH RESPECT TO WHICH THIS
DERFIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY TEE POLICIES DESOZIBED HEREIN IS SUBJECT"IO ALL THE TERMS
EXCLUSIONS ANDCOND'TIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
2 "'lAcc L6UBR - "' ' POLICY EFF ' POLICY ESPI'
TYPE OP INSURANCE
PORI MAD POLICY NUMBER IMMIW/YYYYII(MMlaa'Y1YI UMTS
GENERAL LIABILITY I X •CA000020963-02 I 3/4/161 3/9/17 aaery occufumrvce 1e 10,00,000
3.3:1 ca entwLQNEPA111ARIUTr DAMAGE TO E�—" I
PREMISES(Ca uawrvn m) ii 50,000
I moi, euenvOADE IX.I;OOP j 1 Mkt/PAP ANN_+PRET) Ir 10 000
•'
1 PCRSONAL&MV INJURY IS 1,000,300
,_ I
1 i GENERALAG(ML)Aft __IA, 2,000,000
•
,LAcfaEGAATTE LIMIT APrR IIFS PER PRODUCTS•CnMorOPAanls 2,000,000
PfITCY I ),' Ar LAI nM.liNCO SINC r L rR_._ S
TOMO II4 LIPRIVTY - X 16207761 a/3o/Ss� 9/30/16 .MPro lcemt 1.000,000..
I AVM I BODILYINJVRY LI CAROM '>
) SCMEDU n F
ITCS x AVTUS BODILY INJURYNM/ r,nrl $ ._._.
NOWNeO M
• . PROPERTY ONOC @
X rRED AUTOS X AUTOS 1 (Poe FFE FEN
2.
oE0 X RE IENT�ONS 0.000 F61076336i
EYeasLlAs ...,_-.. EO/E/SB['I 10/3/16!�� CnoeY LweEN04 i D,000, ___
MURELLA LIAB OCCUR X 1 3/4/161 3/9/17 F p
nu
CLAIMSMAUL1 AGGREGATE a 5/,000X000
1 �1
WARNERS COMPENSATIONWI SLAV IUM R.
1 EMPLOYERS'LIABILITY rIRI �'WC0683905X ,T n 1MRE • ER
'
ARV Po]'HILIOIOPANINEREXEOUTVrc F NIAI
IN H •
EL.EACMCGdr .s 1,000 . 000
:,/FL
GMof r ELIEGCNIFT NB OF oPEPnnonsualo 1.....,..j_.__ I
ELDISEASE•EA eM,P.60a rgE 1 000,033
Ender
CL.01SEA E•POLICY LIMIT i 000,000
ECG PT10N OE OPERATORS ILDCAI1ONS/VEM CIES {APNEA ACOREI 101,AO/11E011M RBI1W%9 E011e0L11B.If mit 6tYcc is fe4,i my)
TOEING CONTRACTOR.
ERTIFICATE HOLDER CANCELLATION
SHOULD ANY QF THE ABOVE DESCRIBED POLICIES aE CPNOELLE0 REFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
"*""*"'REFERENCE COPY********"*"'"
I
AUTNOR¢EO RE PRETATVE L
, _ 4 11_
@ 19::.2010 • •RD CORPORATION. All rights reserved.
::ORD 25(2010/05) The AC ORD name and logo are registered marks of ACOR•
.v_ Fax: (413) 534-8344 E-Mail:
0 201,1C011
P Massachusetts Department of Public Safety
=tea
`®/ Board of Building Regulations and Standards
i+ ea(G',,/ 't � c7 License: CS-074334
Office of Consume! Affairs&Buess Ry I tb n Construction Supervisor
j3 HOME IMPROVEMENT CONTRACTOR y
941.�
1Registration 26235 Type MARK T DELISLE
� j
59 BRIGGS STREET l,"W',r1)
Expvatlom': 5/62018 Partnership EASTHAMPTON MA 01027
R.C.IROOFING
MARK DELISLE - M
6 LINE ST Commissioner' 05/03)2018
SOUTHAMPTON MA 01073 Undersecretary.
IMP ryry W, 4.�H oa Mk9ASau�uSE1s
� ' iet'W ' S'r; "NE4;f�r ' �t (tdCQ1t1�Aj4(HJF� I a
HCM'' 114EE PVE/3.1 yN O,NCON 14.ACTUA t, „BOARD C'¢
ltCt1t�Ob>3'itNG1y4,Y S EE1l: M6FAL WOR&RS ,
� 'LINIAf1I tS %' IaSWIi St T,y,E P06LOWING-NI LENSF ,
S0k" (> H'X' �xi fa 01073 A�� I AMASTER WMR"$&1RI0Th0 , r
V rllt �� 3hIARIC .'I' OEII SLE g ' � (
IRe e .: 1 E -' EXPIPES IN .3 UI w
H1C 0624947 I` '
r 2/61/101 .
`t 1/..30/2014 IGaS ST , ' ' wn .
W ' 9ASfi APT0N ,�A 01027- 1739 ,)sicrvgpi
I
, ' 112,Q16v4<'T eei im ,t 1d„',': 2185
^fi UNOAiE OK7a 11 l. n)irl.1}/,
•-'19 OoMmONWEALTH:OF MAMSACHUSE:T.T5.,
t' /DIVISION,OP PROFESSIONAL L10ENSOREr:A '.
,9.0A'F,i9+4f--. .. -.
SHEET METAL WORKER ,.
ISSUESJHS.FOLLCWING.LIOEWSE AS A ,
°' BUSINSSEr
MARKT DELISLE
(�
RUYRooF,NGLtp
6LINE Sr,( ET t � `
' EAST
„HAMPTON MA 010a�1 , rt`
9'
601 ✓0910S/2017 4 2406 r
'g
L ' NSENUMB R- ,ENPIR 4ION r ATE. .SERIA4NUMSER
The Commonwealth of Massachusetts
! _—AG Department of Industrial Accidents
,� s 1 Congress Street,Suite 100
yP4ik Boston, MA 02114-20.17
t. www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE PILED WITH 11W PERMITTING AUTHORITY.
Applicant Information ,r� Please Print Leeiblt
Name(Business/Organizatiodlndividual): r\C I Roo ce 4,7q Li_P -_
Address: &., brit- St- /
City/State/Zip:,,..- Thin, M/4 0/073 Phone#: 013) ,:5`37 - A/775
Are you an employer?Check the appropriate box:
Type of project(required):
Loam a employer with cs2-0 _employees(hill antic:pad-time).• 7. 0 New construction
3.1:I am a sole proprietor or partnership and have no employees working for me in S. ❑ Remodeling
any capacity.[No workers'comp.insurance required.]
3.Q I am a homeowner doing all work myself.[No workers'comp. insurance required.]' Demolikion
4 0 I am a homeowner and will be hiring contractors to conduct all work on my property. twit IOQBuilding addition
ensure brat all contractors either have workers'compensation insurance or are sole I 1.0 Electrical repairs or additions
proprietors with no employees. 12.E Plumbing repairs or additions
5.E I am a genera:contractor and I have hired the sub-contractors listed on the attached sheet. ) 12'Roaf repairs
These sub-contractors have employees and have workers'comp.insurances
60 We are a corporation and its offtcers}ave exercised their right decoction per!AUL C. 14-0 Other
152,O(4),and we have no employees.[No workers'comp.insurance required.]
'Any applicant hat checks box l/I must also fill out the section below showing their workers'compensation policy information
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
:Contractors that check this box must attached an additional sheet showmc the name of the subcontractorsand state whether or no those entities have
employeeslithe sub-contractors have employees,they must provide their workers'comppolicy number
I am an employer that is providing workers'compensation Insurance for ng employees. Below is the policy and Job site
information. < L
Insurance Company Name: &tar -72) 2. y i•
Policy k or Self-ins, Lie.k: /l,/C o(af 3 -`i Expiration Date:""// /0 ' -/6,
Job Site Address: 1 5 VeVP./4r9 I/pt./ City/State/Zip: /o0/Mu4r.P ,./44/7- 4' /64'0
Attach a copy of the workers' pony ensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCL c. 152,§25A is a criminal violation punishable by a fine 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 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 t alai tr rd penalties of perjury that he informatIon provided above is true and correct
Signature; \_ Date: 2 -a.9'/6
Phones: (4/3,) ,5`027- y77c
1
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):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone
RROOF g
6 Lute St.t. Estimate Date
Southampton, Ma. 01073 8/16/2016
Phone.(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Marlene Lyons
74 Sovereign Way
Northampton,MA 01060
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 7,800.00
Furnish& install aluminum drip edge, pipe fleshings,chimney fleshings Of 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 Certainfeed Landmark Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by R.C.S. Roofing.
All work will be performed according to manufacturers'specifications.
Lifetime CortainTeed material warranty included.
All related permits will he obtained by R.C.I. Roofing.
Add 52.50 per sq. fl. for wood decking replacement if needed.
Estimate is for Back Main, only.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total 57,800.00
TERMS OP PAYMENT p
5% fr�Deposit Customer Signature: /1� / IL
Balance upon completion ✓�
Registration 4126235 (y'#.141q/
`( f(
Construction Licensea 074334 Date_ 8 ^1�t -JQ
Insured by Nanas&Picker!Ins. Shingle Color Selection: / iN�
(4I3>sn-too C�.- oil ��f°°IU