25A-106 (19) 357 BRIDGE ST BP-2017-0667
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 25A- 106 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-2017-0667
Project# JS-2017-001090
Est.Cost: $8200.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
use Group: RCI ROOFING 74334
Lot Siae(sq.ft.): 35719.20 Owner: HUTCHINS FAMILY PARTNERSHIP
Zoning: SC(63)/URB(37)1 Applicant: RCI ROOFING
AT: 357 BRIDGE ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:11/16/2016 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 11/16/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
-- departriltzTt u4®ax6y
-- City of Northampton starts of Permit
)Building Department curb iheuorlwewey Permit )
212 Main Street Seatfeepdc'Availabnlly _
( Room 100 Wstem/Well Availability
Rl'JVI 1 A Northampton, MA 01060 Two Sets of StructuralPlains
phone 413..587.1240 Fax 413-587-1272 PIVASItePlajs l
Other Sloeofdy .
.__--A?PLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING J
F.CI'ION " SITE INFORMATION'.T [71" ) 7-007 _—_—
19roperN Add LpAa: Hila eeetlon to be completed,by office
35'7 13rfd Si Map Lot __unit
NC//bry p/Th, 12)A Zone_ _____ Overlay District ,
_ Elm St.DIstrIct___ CB District_
_.FC1ION 2 •PROPERTY OWNERSHIPIAUTHORIZED AGENT
' Ovner of Record:
p
5 w C�ien Zir-017 63 41¢272 S r as ik.>` 'may /I7/j cici 2.
?dn:; Current Malting Address'.
:�Pi1 -6CAA� _ mil/V2)2 17ez
Telephone
j
2. Ac-thorized AgeLl,
, i: (')O___ _ - IZ .C . I 'yh-Fin� (n LIna ..i. \noPh1no, rlrr4an fT4A (SIG:)
/-2.----
Currenl Melling Address
/ G1- % r n
agralure Telephone —�
"-ION 1 • ESTIMATED CONSTRUCTION COSTS
Estimated Cost(Dollars)to be Official Use Only
, _ cor•leted b •ermit e••licant ___ _
Id'rg It or (a) Buildmo Permit Fee
_ a , 00, —
LT - - _
cm(cal (p) Estlmat.d Total Cost of
_
Construction from(8)
_roping i Building Permit Fee
Mechanical(HVAC)
=ii e Protection
l=(1 + 2 +3 +4 .5) F8a �77�700. - Check Number q�}
9e
,_._ This Section For Official Use Only__Date
_ _
:a e .g Permit Numbed
issued ed',__,
Building Carnrn sl&nerflnspeolor of.Sulldings Date ____II
rill
;�DU
„ r'C Jam-DEBQRIPTION OF PROPOSED WORK(check ell abottoabig7
v; house Addition —
L] ❑ Or ement Windows Aiterat(on(s) E Roofing U
Or Doors ❑
cessory Bldg. C: Demolition L_ New Signs (C] Decks ICI Siding (0) Other ial
Description of Proposed
Seco
. et on of existing bedroom y_Yes No Adding new bedroom Yes No
clad Narrative Renovating unfinished basement Yes No
s ached Roll -Sheet
If New houtantl mha.ddYt'14n tahi weiee, tom fslete_N+ef4,jlewlmar.
.,se of :dues One Family Two Family Other ,.,,,
caher of moms n each family unit Number of Bathrooms
Is there a garage attached?
Fr000eed Square footage of new construction. Dimensions
ac
mer of stories?___,_
:le nod of healing? Fireplaces or Woodstoves_ Number of each___
Energy Conservation Compliance. Massoheck Energy Compliance form attached? _
-nae or construction
s conslruclion within 100 ft,of wetlands? Yes No, Is construction within 100 yr. floodplain_Yes__No
Deo”, of basement or cellar floor below finished grade
di, °wilding conform to the Building and Zoning regulations? Yes No
Septic Tarte City Sewer Private well Ctty water Supply
—_—
ovioN Is OWNER AUTFORIZATION -TO 8E COMPLETED WHEN
±JERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/til/CL S _—_,,,,,,,_ as Owner of the subject
eery
au—
au-bride I\Ct.rY, CY0\\Cw. O* C . T eb(51 1121
ny behalf, In aA matters relative to work authorized by this budding permit ag Iicailon.
.jt Cl P 2
-m.re of Owner Dale
t as Owner/Authonzed
ni e c 1aehattt _�,m tsinform�io ()WPM-
hereby -e lore(hat the statements and information one foregoing eppll¢alon are true and accurate,to the best of my knowledge
ed under the pains and penalties of perjury.
(5".
ria a kr ewnerlAgont Date
NNNNit
t,-thou 8 • CONS rRWCTIO.N SERVIQEO:
;coned ConstructionStineWitigef Not Applicable ❑
License Number
Ln , 1]. Ceor mfli(Y7` .— 0i -os " le
_ ce,
Expiration Dale
(L8.13) 5 al - '-1'19 5 __--
wit ie Telephone
t'.ef;Ldnre lrapno4gglentcmptraedef ���� Not Applicable ❑
_r1_1iW t4an ^ — Minn is _,._ L. bar
rs
ivpsit N — i Registration Number
I_r'12.2AH _._._ ____ c 5 ,- (1 - i&
Expiration Date 1
I
Salyrt _l..0a,19 (") Or/a TelephonegiciHinaadri'7r7c —j
.ON ip.WORKRS' COMPENSATION INSURAANCE AFFIDAVIT(MAI-c.1b2,§2d j¢)) I
E _ __
,rkers Compensation Insurance affidavit must be completed and submitted with Ole application. Rallure to provide this affidavit wide result
arias ci toe issuance of the building permit, ___� ,,,___
De,otv .Affidavit Allarhed Yes...,,,, C( No.,,... ❑ .,,,_.____
11. _Rome, Qwxter xe Pptio,
The current exemption for"homeowners"was extended to include Owner.owe tolet,Dwelllnes of one(I) or two(2)families
end to allow such homeowner to engage an individual foe hire who does not possess a license,provided (hauls.owner acts
as supervisor, Citt22.1780, $Ixth Editlpn Section 1083.5.1,
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or'blends to reside,on which there
is, or is intended to he, a one or two family dwelling,attached or detached rttruetures accessory to such use and/or farm
structures, A oorsogwho constructs twit e than one home in e two yg.flupilled shall not he considered a Ltumeceviter.
Such "homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
resppnslbte for alyquch work performed under the building permit,
As acting Cronstry_etton Supervisor your presence on theJob site wilt be required from time to time, during and upon
completion ofthe work for which this permit is issued,
A,so be advised that with reference to Chapter 152(Workers' Compensation) and Chapter t53 (Liability of Employers to
Rmpioyees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may he/tab t for persons)
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 Massaehwletis General Laws Annotated,
Homeowner Sigrin tore_ 2 a - Ar __ _
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
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 357 &irl9C i „
The debris will be transported by: CO IVV)Le- VO
The debris will be received by: C; A\P tiJ dl-44-C •
I / t
Building permit number:
Name of PermitAppUcant 2_6)-j �� <�� (���
Date Signature of Permit Applicant
/l - ? /C
The Commonwealth of Massachusetts
(— Department of Industrial Accidents
r t s 3 I Congress Street, Suite 100
'' e Boston,MA 02114-2017
'- --5, www.mass.gov/dia
1Vorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leg]bly
Name (BasinsstOrganizationandividual): R t. I g0o-fr/r41 LL P_�
Address: to Lint. LSV.
(24/State/Zip: Soufhatmphin, /'14 O/&73 Phone #:(',4/3) :5;27 - H773.--
Are you an employer?Check the appropriate box: Type of project(required):
Lglam a employer wah�U,_empioyees(fed and'or pan-nme7" 7, s New construction
2.01 am a sole proprietor r partnership and have no employees working for me in 8, Q Remodeling
any capacity [No workers'campinsurance required.]
3.slam a homeowner doing all work myself [No workers'comp. insurance required.]' 9. ❑ Demolition
10 Q Building addition
4 Q l am a homeowner and will be hieing contractors to conduct all work on my property I will
ensure that all contractors either haveworkers'compensation insurance or ON sole II.0 Electrical repairs or additions
proprietors with no employees 12.0 Plumbing repairs or additions
30 I am a genera(contractor and I have hired the cob-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance) 13.piper departs
6.0We are acorporation and us officers have exercised their right orocemption per MGic 14.0 Other
152.§I(4),and we have no employees.[No workers'compinsurance required.]
'Any applicant that cheeks box 41 must also Ni out the section below showing then workers'compensation policy information.
t Homeowners who submit this affidavit indicating they me doing all work and than hire outside contractors must submit a new affidav it indicating such.
[Contractors that check this box must attached an additional sheet showing the name of the sob-contractors and state whether or not those entities have
employees. If thecob-contractors have employees,they must provide their workers`comp policy member.
l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. -r
Insurance Company Name: sZ/2r �./n f4/Epiv1/r/5
Policy tit or Self-ins. Lie. 4: lIfC, O(of3'7`0.55 _,,,,_ Expiration Date: /O -., _ /7
it
Job Site Address; 3.57 /3/441/2-e 6'/. _City/state/Zip'. Hier indryykn 1174 0/C6 C
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, 525A 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 tl/Pains rdpenalties of perjury that the information provided above is true and correct.
Signature: '—'"""�'" �- Date. // ` (j "./6
Phone (
#'. 'uJ' ) 527- .y7Zs
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#
Ro g
b Line St.t, Estimate Date
Southampton,Ma.01073 1114/2016
Phone(413)527-4775
Fax(4131527-8469
Name/Address Job Location
Banas & Chen Realty 357 Bridge St.
63 Main Street Northampton, MA
Easthampton,MA 0 027
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 8,200.00
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 Premium shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to be removed by RCS. 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. Rooting.
Add$250 per sq. ft. for wood decking replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
To $8,209.00
TERMS OF PAYMENT Hi
5%Deposit Customer Sign' •
Balance upon completion
,Registration# 126235 If /6
Construction License ft 074334 Dare; 1 !
Insured by Banas&Fickert Ins.
(413)527-2700 Shingle Color Selection:
Oc±. 5. 2016 9: 50AM No, 0218 P. 1/2
A oc ? e CERTIFICATE OF LIABILITY INSURANCE mant.110'16
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS I
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTttORIZED
REPRESENTATIVE OR PRODUCER,ANO THE CERTIFICATE HOLDER,
IMPORTANT; It the certificate holder is an ADDfl1ONAL INSURED, the policy('Es) must bo endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions otthe policy,certain policies tray require an endorsement A statement on this certificate does not confer rights to Inc
certificate holder in Ileo of such endorsemenIs).
PROWOfR rcinnm"ct Michael R. Bangs
Sanas S Rickert PHONE Ira Am Nf.
., P (413) 527-2700 ;taro Nw, (412) 52'1-04699
Insurance Agency EMkL
-OBRESS: mblbanasinsurance,mom
63 Main Street INSUFEWSIAFEORDOla COVERAGE NAlce
tasttlampton, MA 01027 .' ILLSIIRFR A:ACO.d33ral Insurance C 24856
INSURm INSURER s:Safety Insursance Co. 39455
ACI Roofing, LLP G3uac c:Evanston ins%rance Cc, 35376
5 tine Street INSU-m D: : .r Insur_ co Co. 24562
Southampton, MA 01073 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OCHER DOCUMENT WITH RESPECT TO WHICH mit
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TI-C POLICIES CESCRIDED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS MO CONDITIONS OFSUOi DOGGIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
TYPE OKINSVRAN INSURANCE AWLsuck] Pd 4Y�E (MAMMY OWES
INS)) MO POLICY NUMBER IMMaR 1
A COME LLWauWT X CA400020963-01 3/6!16 3/4/17 BACH OCCURRENCE , 1,400,030 .,
DAMAGE
TRENTED COAERCA.GENERRLIWNTY RMESrEe
al 50,OOP
' CLAIMS-MADE I Xf OCCVR . MED DP(Any orc PC2m1 1D QOQ
_ _-,,,, PERSONAL MVIN.IURT I 1,0004000
GENERAL,AGGREGATE_ 2 000 r 0
CEN'LAGGAECATELaaTAPPUESPER PRacvcrs dtMPICP AGC 2,000.003_,
Popor X ..eccm LOC I
E AUTOMOBILE LIABILITY X 620776 , V30/16 9/30/zt COMBINEDSINGLE Om
(Eo aaimml Ir 7.,000,000
NITA= BOD0.Y MnRY(Rer parson). r6
ALLOY/AB SCHEDULED
AUTOS x NON-0 aooILV IN)pµv(par m.-07)))xs
NOWONNE6 PROPERTY cc,sI DAMAGE �
X rtRmnuros X AUTOS `Teraar m, 1 _,
` s
C1 uMSPZ I1.aL- _OCCUR X CUEW$757915 3/6/16 3/4/11I EACH OCCURRENCE S 5,000,000
EXCESS UAO CLAIMS-MROE rI AGGREGATE a 5,000 000
Dm X REEDIMON1 10,000 : I
$
D ixoxxERs coL+PENsnr,pN WC06834Q5 1aJB/15 lolElz> iTne Mau. o _.
ANO EmotpY£h5'uaeaitt �.......
ANY PROPRIE'IUWPARMEWEFECUTNE Y I NiA I E.L.EACH AC I%IYe M $ 1 000,000
OFACEPMI&IMINPNR 6E0.00E07 Y
nY e villa Eger EL.D`3E$E TA EMPLOYEES 1,000,00o ...1
OESCPIPtIONGK OPERATIOr Oilow EL.DISFASe-POLICY LIME,a 1,000,000
I. J
MSCAIIrnON OP OPEPAIONS)LOCATIONS/VEHICLE-9 {Attach ACORD IDL AMNan,I Re mark*Satmaltae if mama ryce YngNra)
ROOFING CONTRACTOR,
The General Liability policy includes an Additional Insured endorsement that provides
Additional Insured status to the certificate holder, only when there is a written contract that
requires such status, and only with regard to work performed on behalf of the named insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF WE ABOVE DESCRIBED POLICIES BE CAN ELLEO BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
***REFERENCE COPY*** ACCORDANCEWITn TMG POLICY PROVISIONS,
RUT "ENTREAT
ap 195e,4010 ACORD CORPORATION. Ail rights reserved,
ACORD 25(2010(06) The AGGRO Ma me and logo are registers a marks of ACORD
Phone! Gov- or Arz 3t Cr _o n an e,A.N.
•
•
scaegxom.emn C Massachusetts Department of Public Safety —
- - '®� Board of Building Regulations and Standards
yC (92e „a44/r%l > /urue141
-- License: CS-074334
rF Office of Conn Aff irs Ss BusinessRegulation :.o nshuction Supervisor
HOME IMPROVEMENT CONTRACTOR i {(
IV' h7s'l Registration 126235 Type. MARK T DELISLE "
69 BRIGGS STREET “‘ .......1)) 1
v Expvabon`- 61612016 Partnership EASTHAMPTON MA 01027
R C . ROOFING
MARK DELISLE ^ / /1 k
6 LINE ST _- _ -•/s oner Expiration'.
SOUTHAMPTON, MA 01073 Commissioner 05/0312018
w deisecretary
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er,0OMMONWEALTH-OF MASS 7 OHUSETTS.. ;., ';
.DIVISION OF PROFESSIONAL LICENSURE':
3,0PO of -
SHEET 40E11AL WORKERS-106 m
ISSUES TIDE FOLLOWING LICN$E AS A 0> ; ,
JdAR,KT DELISLE
-I Ra'1 ROOFING LLP I i),11 ) ,47,;,-
6 LINE STRT l , II
' EASTH4MPTON MA 01"073' rl`'0� -
601 =08109/2017 e 2406 11`-'1'
L NSENUMB 11 :EAPIR TION oATE :SERIALNUMBER'. .