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78 TURKEY HILL RD BP-2017-0409 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:35 -269 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-2017-0409 Project# JS-2017-000680 Est.Cost:$16900.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq.ft.): 186828,84 Owner: PELLEGRINO JAMES R&CHARLENE Zoning: Applicant: RCI ROOFING AT: 78 TURKEY HILL RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:9/27/2016 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 9/27/2016 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File it BP-2017-0409 APPLICANT/CONTACT PERSON RCI ROOFING ADDRESS/PHONE 6 LINE ST SOUTHAMPTON (413)527-4775 PROPERTY LOCATION 78 TURKEY HILL RD MAP 35 PARCEL 269 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLIC..na12IM:15.. LIST �j ENCLOSEDlREQUIRED DATE ZONING FORM FILLED OUT 41 50 /j' Fee Paid Cie.—>s/ o2. 7 &V� W / Building Permit Filled out -- Fee Fee Paid Tyneof Construction: STRIP&SHINGLE ROOF New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 126235 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 11:1EIRMATION PRESENTED: Approved 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 Demolition Delay Signature fd B ding Ot 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. 3S z &9 i i -- Oep9rri6gAt usorly 41 City of Northampton iSta res of Pbfmd r& ullding Department Oyro( wVOrlveway Pdrm t " I /Y / rrp a5 212 Main Street SeweUEAPtiorAoglfab lltj _ - 3 2 Room 100 IWa4dr/Meali Avdrlabilrty j c32 Northampton, MA 01060 Two'Gets,of Struodural Plans oF phone 413-587-1240 Fax 413-587-1272 PIbu9lte-Plans oe 6 _ Other Slpeolfy. 'LIGATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOI-ISH A ONE OR TWO FAMILY DWELLING ,EC^1ON 1 -SITE INFORMATION': props l ryes, 111 aP�s'aetlon to�hs co.mplatetl by office 178 TLr.rk / /ll Rd Map � Lot __Unit 00 rote e, /4 Zone _ ______Overlay District Elm St.Dlstriot___ CD District_T ECT,O.N 2 .PROPERTY OWNERSHIP/AUTHORIZED AGENT ner of Recgrdi C1VfflL -Il . _ 78T u,t AU 170fence,/77Ap/cG2 U rVI) Current Mallin�gAddfess: SPQ t C"/� eco zf/3 a,o - /577 ✓a„a., X27 _ Telephony - -I mre ' A..hartzed gent: ri✓ I; n Di 11R le ____ C I KLIto (n Livve.- i1.}- :Al,cr4wr,mr4on CI\A () 0.:Y7. r (Pring „-- Current Mailing Address r '=re T._... Telephone J -CTION3 • ESTIMATED CONSTRUCTION COSTS Estimated Cost(Dollars) to be .Off oa:: tree Only _ completed by permit applicant- I 3 Ing ( 8o, gen P (e) Building Piprmil Foe �. 3 de 2a, (b) Estimated Total Cost of Cabskn0(1041 from (6) '.B ulltling Permitee ll eche nical(HVAC) 'e Proteolion ,(/ 1 'a1 =;1 +243 + 445) S /feyg00 - Cheek Number Jg�o2 `4 VII— _ Thla Sectlon For Offfcl,al Use Only-__ ..ruling Permit Number,,-_ ale Issued,__,__ Linalere Bulyding Coramlestonerllnspeoloo of Eulldings Rate _ J SgCTtQN G.DESCEEPTIOjy OF PROPOS-RE WORie fcheekall aiacileable1 Wow House E I Addltlort Replacement Windows AUe.rafion(s) r" Roofing LA Or Doors ❑ AccessoryBtdg. tI Demolition New Signs (MI Decks ( Siding (0) Other(C rt EfiieiDesstiphon of Proposed PV_ 41.k14r'(1k Anatolian of xisting bedroom Yes NO Adding new bedroom Yes NO Affected Narrative Renovating unfinished basement �Yes No Hans Attached Roll -Sheet I sm. If New hadusd=and eg alddlilpn tagevfisltipg ghgus akels.cnrrr elate ihte �N lowingc e. Use of building One Family Two Family Other thumper of rooms in each family unit: Number of Bathrooms c Is there a garage attached? _. Proposed Square footage of new construction. DiHen;ttons o. Number of stories? t Method of healing? _ Firep:aces or Woodetoves_ Number of each _ g Energy Conservation Compliance, Massoheok Energy Compliance form attached? r Type of construction I lecoastrudlonwithin 100 ftof wetlands? Yes --No_ Is construction within 100 yr. floodplain _Yes _No ! Depth of basement or co tar floor below finished grade evil Melding conform to the Building and Zoning regulations? YRS No Septic Tank City Sewer Private well City water Supply BECTON 7a••OWNER AUTHORIZATION 'TO 85 COMPLETER WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR rB811.171NO PERMIT _e_hadIsc (7211Sirt/IC _,,,,�_ , as ()wrist of the ecbjeot merest? /•, /1p hereby authorize _N\f .(_�� G)2liS1Q. )4- f l t elJ if( _,_ to acton my behalf, in all matters relative to work authorized by this building permit ap ostion. Signature of Owner Date I111111ae._____._._�_ —_ ��pp r 19,i(k,P MILS flu 4invf7 P6 C1( etc* _ __ as OwneriAuthoozed agent hereby declare that the statements and information onace foregoing application are true and accurate.to the best of my knowledge end oenef. Signed under the pains and penalties of perjury, 11fa.11 p_c'lii_.re til Name �3rgxaithe a'OwnerlAgent City of Nonhampton 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 MOL c 111 , S 150A. Address of the work: 7W %u_,ko dit/ ficyence, lh eic't» The debris will be transported by: Co t` iele,4-rC. CD \S ieo SAL The debris will be received by: fr\P/e4-€_. ( ')I j<L`LQ N�Iiti dC Nf��r Ft Building permit number: Name of Permit Appl'cant (L 2.6u6 /,,C\ c,c'f Date Signature of Permit Applicant The Commonwealth of Massachusetts Inca—dei Department of Inlustrial Accidents 11•`i 1 Congress Street, Suite 100 [ Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE FERMI i!INC AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Rel 8004,-; L L P Address: 6 Lin6, St City/State/Zip: SpuTh ip vn, M%1 0/073 Phone#: 54/3 .5;37 - At775 Are you an employer?Check the appropriate bax: Type of project(required)'. Yam oomph-vet with 2 O employees(foil and/or part-time)* 7. ❑New construction 2.0 l am a sole proprietor or partnership and have no employees working for me in R. E Remodeling any capacity.[No workers'comp.insurance required.] I am a homeowner doingall work myself No workers'comp.insurance required d uDemoliClon 3 a } Igenre ]' 3. I con a homeowner and will be hiring contractors to conduct all work on my property. i will I d Q Building addition enure that all contractors either have workers`compensation insurance or are sole 11,0 Electrical repairs or additions proprietors with no employees. 12,❑Plumbing repairs or additions Eam a general contractor and I have hired the sub-correctors listed on the attached sheer 2-Roof repairs -'i(hese sub-contractors have employees and have workers'comp insurance 6 We are a corporation and its officers have exercised their.dghwf exemption per MGI c. I14.0 Other u 152,a i(4).and we have no employees.{No workers'compinsurance req aired j Any applicant that checks box SI must also fill out the section below showing their workers'compensation policy information 'I homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit ndicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state.whether or not those entities have employees, If the sub-oontrc.tors have employees,they must provide their workers comppolicy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Sr Insurance Company Name: V 7( /' T/25'(?)07f)/4 _ _........_ .,— Policy for Self-ins.Lie.#: IVL �(i",f 3`{O5" Expiration Date: /0 Jr_ /co Job Site Address: MI IIU'4 AO/ .. ........._ .City/State/Zip: Rib/re {', Tf( aL,CGr23 Attach a copy of the workers' rompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e 152,§25A is a criminal violation punishable by a fine up to$:,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 ains a it penalties of perjury that the information provided above is true and correct. Sienattre'. .. Date: /' -ac2 '1 Phoneme (h`/'3) X027- 217 25 . Official 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): I, Board of Health 2.Building Department 3.City/Town Clerk S. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Mar. 9. 2015 10: 20AM Banas & Flcvert Hsu ranee Agency H©, 7768 P. 1/1 � AGO"RD. CERTIFICATE OF LIABILITY INSURANCE aF rt1m51moF.. HS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NORIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PO ED REPRW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND ME CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policyjies)must he endorsed. If SUBROGATION IS WAIVED,subject to the trms and conditions of tho policy,certain policies may require an endorsement. A gYaromant on this certitI le does not confer rights to to certificate holder in lieu of such endorsemennsl. •PRODUCERkE: MR ichael , Sanas —^ Hans d Eicken P" UE'--._ FAX Insurance Agency s.H- EA. (gT31 527-27 .. WSNM' (413) 52V-0549 ACRese mb£banaoannuranra ce.com 03 uain Street 11.R.9 thamnton, MA 01027 ,_.. .. INsuPEgs)ArFortolrc cOVERAnE nr.c= r_... ... .—.._... PAR RERA AdmiralIneeranco Ca 24956 CR UDR) INSURERe_Sa£ety Insurance Co. 139454 RCI Roofing/ LEP INsuflac 3urlinaton InsµranceQ, St__ _(us S Line Street IFSUaca a:Star, Insurance Co. ,.,(24562 Southampton, MA 01073 IRWREA E. �.......__._ _ _ Noun ER P: ._ .., COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CORSET LOT TI'IE POLICES OF INSURANCE USTFOBELOww HAVE BEEN ISSUED To THE)NS'RED NAMED ABOVE FOR THE POLICY PERIOD I 8IDR.AT-E NO1WTHSTANOIN^.;,ANY REQUIREMENT TERM OR CONDITCN OF ANY CONTRACT OR OTHER DOCUMENT WI Ut RESPECT'TO WHICH THIS (ORTFICATE MAY BE I$SUE0 OR Y R2F1 ADC, THE INSURANCE Y i > GENERAL UAaIUTY IOLI MR ...S.SHOWNY IA'Y I- TED3 ED BYPAID CLAIMS. HEREIN Ii SUBJECT 10 ALL MR TERMS. CLus OSTM for iNsu CONDITIONS OF SAUCNIPO LitIlen LIMI_S OWN &M ER ORDED Brv' POLICY RFD P DCY MCP 1 UNITS _... It. -Tat POLICY EFF POLICY MCP A X •CA000020963-02 O KW 1 awn Occu uetnee I 1 L000,000 X,CCMERcm.GENE PAn I I$fl ` Fay SR.:unurv,ay i-a 50,000 SIARRMADElit.,090.uk I l I LILO ExP(Ary CmPn (n) '4 10 OCG_ __,.__ IPERSOFNL&AtVINJURY IS 1 ,0001000 1 I GENERAL AOOReJA I: ; s _. . _ I_,. 2.000 009 DE,N.A Re ATE UNIT MPIF PPR I !PRrOltts n1Pmv DDI.$ 2,000,000 POI ir. i'RU. . X 3CT e_ e0 _ auTOtAOsits LlARutt i 9Pso/la 9/3o/Ino i}NmiNtnswFl;t,t(rdrz & ' Y. � iS2079&1 1€? ) a y COO,OOC ANY AUTO BODILY INJURY OR/PPomn 1 E ALL UVREDNTOS X SCHEDCISO 1 11 =60011.Y INJI/Rt(PmalrlGrni) b NON.OWNEo 1 ,PROPERTY DMTAW"4a 1s•• VHIREDAUTOS f -AUTOS ,(Pa I C ll X F 1076336 FAN,nrc,RRCNCr. " s 5,000,000 Ex aR3RE4A UPa q 3/9/0.6 3/9/191 �EYCESS LIPs DTAIMSNAOLI I AGGREGATE a 8,000000 CEO X RPYENnONa 10,900 1I F ,ORREffi OWPEN4ATIOH Lo/5/1;91 VVC SLFL'J- 18 r L WC0683405 ,g Ha AND EMPLOYERS'FLUMER TCRY tiMtl'$ ER _ . IRPROPRRIOIVmv(rwERRXEcunT tel EE;E.L EACACCRV10 e 1,000,000.. haf£PMEM Nt1 EXCLWEO'1 Ti,N/A I P"RLYRR Nil e}„ olsEAgE-1.9.58Pyoyer s 70,000,00C stw n. lPDx . a'ugPEunnoNsal w I DiDI DISEASE 'is 1,000,000 _.L____ i _. I .. ..,.....___ ` I£6OMPRON Or OPORRONS/LOCATIONS/VEHICLES WIRD PCOPO 101,A W Innel Re CV Co.901100l110.1f Owra EfA4P It NO TRI) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF ME A60 VF DR SCRIBED POLICIES SE CANCELLED SEEORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I ACCORDANCE WON TME POLICY PROVISIONS, *"*****"""'REFERENCE COPY "**k*** " 1 Aor:+os¢sD RF4B.1 WIVE1101111/4 I l9 19.:-2010 -�RD CORPORATION. All rights reserved. %CORD 25(1010106) The AC ORD name and logo are registered marks of ACOR. hone, Fax; (413) 534-8344 E-Mail: T Massachusetts Department of Peelle Safety Et& 0 20M.W H it P Board of Banding Regulations and Standards a �.nuld°f0/fir . /usJGr License: CS-074334 F, Office of Consumer Affairs&Business Regulation i6nshuctlmn ,^3upervisol Wil 'ii ? HOME IMPROVEMENT CONTRACTOR u Tei Registration: 126235 Type _ MARKT DEUSLE �f Expiration: 8162018 Patlnershlp E86S STREET iAi 1. I EASTHATHAMPTON MA 01027' R C . ROOFING MSAS CELISLE 6LINEST M SOUTHAMPTON, MA 01073 Com> sioer051(13/201s 6 — Expiration', undersecretary rairSolagAltiffifigite Ni% . iALss, 1-1-'11'oA .1 oASAh SSTS; r 22- 22 2,a ( t i - �4cOFP O ESN HOMIP 12012 pvagg�,,tI r,y0 ON.021F,f TUR o,ra .43SA:S1303 It cltttb&11Nc2,1,1, tHS E12. IISTAL w01R'KEERS .4 871 ru IS9IDS TWE EOIL L.0'2012lCE LltE YES. sOt `h- 3yF S� 4 tA.,0 202E A;y A 7YAST° 12WS Je a 1 ft = , 7 "^0 r- ` I 2(l MAf�P( 'i' DEUSLE I I =nI -".i0.1Re6 Pt31 � rl 'F'EC"NE 7.,.r�. EPR "" \\] to, 133C 0624'741 1 21/01/16,(]<<;2,,(F, '11/30/2014 59 812FGOb`7SI" 1 nru I 'aa°' R • r. -�� J `I3rIE� i'' �... .. '9�611'IJA�M1•�N ,IaPA 01027 1139 .. _. IH�i,�.l�,+a G�fq/28 16 2184 )3 . ...7 , . u A • 'Juni coii `coMMoNwEALTH OF MAesAdHUSETTS^ az C entB ASS10NAt_L10ENSORE`ax SYIESIMETAL WORK,SR6S . ISSUES Tk1E FOLLOWING LICENSE AS A 3 SU3NESS .,> s ,,,;-;,:di'-,::, r �IAtKT DELISLE � I RCJI ROOP1N1,LPi i�t I ) „ 6 LINE S7ft_ Y '''• 6 EASTHA44PTQN MA 01`0'722( °1 o� I 601 ;`� ,' 109720171 i' 2406 NSENNMB"R .ENPIR BON ,ATE ;SERIALDIBMBEB RC.1. Roofing Line St. Estimated _ Date Southampton, Ma.01073 8/3!!2016 Phone(413)527-4775 Fax(413)527-8469 Name t Address Job Location Charlene Pelligrino 78 Turkey Hill Rd. Florence, NSA 01062 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 16,900.00 Furnish& install aluminum drip edge, pipe flashings, chimney flashings(if needed)and step fleshings. Furnish&install GAF approved ice&water barrier.6 feet along eaves and 3 feet in valleys. Furnish and install synthetic underlayment over existing deck. Furnish and install Lifetime GAF Timberline shingle. Furnish and install GAF approved ridge vent. Replace 30'of rake board. All exterior roofing related debris to be removed by R.C.1.Roofing. All work will be performed according to manufacturers'specifications. Lifetime GAF material warranty included. All related pernits will be obtained by R.C.I. Roofing. Add$2100.00 to furnish and install new gutter system. Add$2.50 per sq. ft.for wood decking replacement if needed, WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total s16,9oo100 TERMS OF PAYMENT 5%Deposit Customer Signature12;4/14 ��y Balance upon completion l !4ZL...12_ fi� AL/71 " 2— Registration R 126235 Date; 1/d Construction License f 074334 Insured by Bangs&Fickert Ins. �" � _ (413)527.2700 Shingle Color Selection, HD -E( 6freli