36-172 (5) 723 FLORENCE RD BP-2017-1028
GIST: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:36- 172 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-2017-1028
Project# JS-2017-001771
Est. Cost: $7300.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 14461.92 Owner: SINGH AMRIK&GURMEI S BADWAL
Zon_ne: Applicant: RCI ROOFING
AT: 723 FLORENCE RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:3/16/2017 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF - CERTAIN TEED
LANDMARK SERIES SHINGLE
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 3/16/2017 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
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Pwlief £5+$01919 uoldwe'.{poN }O 8119)
tiru40$hle%w.Paci Cd
_O i iOk 5-DESCRIPTION OF PROPOSED WORK fcheokall Aimee-able}
.w House [_ iAddition C Replacement Windows AUerat(on{s} n Roofing
Or Doors E
pessary BIda. '_J I Demolition ❑ Newfllgns (C] Decks (Q Stding (Clj Other E5
fpw;n or Proposed
-te-arof exsting bedroom _Yes No Adddng new bedroom Nes _ No
aches Narrauve Renovating unfinished basoment Yes No
-ens Attached Roll -Sheet
da if New house and rap addidlonrn)EX{6fillmg0h.oU&8plq.C4mplate'bhmeir.
'_'se of bu iding One Family _ Two Family Other
-neer et rooms m each family unh: Number of Bathrooms____,___
's 'ree a garage o'.tached?
Pr000sed Square foolage of new construction. Dimentdone.
'vomber er stories?
Id eutod of heating?_ .__ Fireplaces or Woodstoves_ Number o' each
-,ergs Conservation Compliance. Masscheok Energy Compliance form attached? _
-rs of consttaot on —_
s one=Ir(iction within 100 ft of wetlands? Yes ,No- Is construction within 100 yr. floodplain_Yes No
Je,rth of basement or collar hoot below finished grade
;r;in oci'.dinc cor16orm to the Building and Zoning regulations? Yes
-epim Tann_ City Sewer . Private well Gay water Supply,,,__,
SECTION Te •OWNER AUTHORIZATION -TO BE COMPLETED WHEN
re;:.NERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
___.-,...._ Y �1/1 �_ .� as Owner of the subject
oaody
t o '.aorire I v 1 x t Pv 1 .O'� zyi T ap
_ 2:111 my ochaif. in all matters relative to to work authorized by this budding permit kation r,41 — Dale �3 % /7
-e of Owner
I --__—
i
{ ,;A j>, rI I(:;t1R\p OA /.t{F-14H'tyt?Pr` ft( en-4-- _ ___ as Owner/Authoring
ant ne:'eby declare that the statements and information mine foregoing appP.Oation are true and accurate, to the best of my knowledge
relief
reed under the pains and penalties of penury.
- /7 _
shire et Owner/Agent Dale
1 ON 8 -CONSTRUCTION SERVICES
gnsed Construction Su nerVii.9.1i Not Appllii}cable ❑
qj=snaa Hq$1zr3-$x_ _ I"- _- r1L - f�
license Number
Expiration Dale
Telephone -- j
set
Lstered Hoag inipnetrentt-0ntrattbr, - Not Applioabte 0 w.
G RCil iaGt._ n d ''ala—
Tang Name J Registration Number
6. Liv_c_5+- --_ OrY - clic - Ifi
Expiration Date
Saul//nalpitra4na. C)1 U'1Telephone LjPil' )),S L't9'ij
to WORKERS'COMPENSATION INSURANCE AFFIDAVIT(MCL.0,152,§ 25O(31
Compensation Insurance affidavit must ba completed and submitted with this application. Failure to provide this affidavit will result
no penial of the Issuance of the building permit
^cr, >aiaadn Attached Yea.,,„ ,. 51
1. CR,mzn!f d.Seri ,Wirall41.0-1111
The cucent exemption for 'homeowners”was extended to include Pigs ervoce},Inled Dwellings of one(I) or two(2) families
and to ahow such homeowner to engage an individual for hire who does not poisess a license,provided that the owner Rots
assuper tsor. CIL11273O, Sixth Edition Section,108,3.5,1
Defcdtigp of Homeowner1 Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is;.Mended to be,s one or two family dwelling,attached or detached ntructu;'es accessory to such use and;or farm
strucnlres.A person who constructs more than one home In a(5'o-der ppgind 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 shallhe
respgnsf,fl le for all sigh work performed under the building neYmtL
As acting Construction Sunervisa8 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
Empioyces for injuries not resulting In Death)of the Massachusetts General Laws Annotated, you may be livable for permits)
you hire to perform work for you under this permit,
The;order igned"homeowner"certifies and assumes responsibiliny for compliance with the State Building Code,City of
Northampton Crdinances,State and Local Coning Laws and State of.Massachusetts General Laws Annotated.
llomenwner Signature (A* 'Alp hod _--__.... _...
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 150k
Address of the work: 7z3 i/ertnc'c kerl NY/Lan/dm
The debris will be transported by: C,53 n 1P t D S .E20sP
The debris will be received by: em MP/eA-e. Op(uoiuQ
Building permit number: T_
Name of Permit cant (L - 2-oui (N./ C/ e
Date 3 _,o / /7 Signature of Permit Applicant
Mat, 7. 2017 10 : 31AM No. 0868 P. I
A�----104.3,,,,t,,,,,v;
RL7 CERTIFICATE OF LIABILITY INSURANCE _
3/7/19
I THS CERTIFICATE IS 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 BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder Is en ADDITIONAL INSURED, Mo policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the tense and Conditions of the policy,certain policies may regtdre an endorsement. A Statement on tins certificate does not confer rights to The
certificate holder in lieu of such endorsenlerfls).
PROCOC ER ... CONTACT
bfa.
NABS: ahael R F}anae
Hanan b Wickert P NE Aal
c.i.54; 1413) 527-0049
Insurance Agency - t'4 s, (413) asins'ura we Na,
Mises; BtbQbanasinsurance.cora
63 Main Street INSU'EMSI AFPQ?PIrn COVERAGE RAW tl
&aethamptanl MA 01027 manes A:Achnira1 Snaurance Coy 24056
IreuvED IP5URCRaj8afety Znay grace Co. 39454
RC2 Roofing, LLP 1N9IRENc-Admtra. Insurance Co. 24856
6 Line Street IN51nM D:St- . Ii.= . n.•- 4 .2 .............
Southampton, MA 01073 .10(23.03.;
IMYIRM P:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY TRIM TMG POLICES OF IHS:RANCE LUMED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FYJICY PER100
INDICATED. NOTWITHSTANDING ANY REOUIREMEINT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WRH RESPECT TO I. THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY WE POLICIES DESCRIBED HEREN IS SUBJECT TO ALL THE TERMS,
_,I{EXCLUROHS AND CONCITIQNSOFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEENREtAJeED BY PpAJD1CLAIMS.
ItfN TYPE OF INSUNPNCfl lW
JNwL 9R NW PUUC.I'MIABER -
/.=3"1 =C�" UMTS _ I
A GENraALUAmurr x CA000020263-03 374417 314/10.RICH OCCURRENCE 1 100 001
DAAMOE TO RENT 0
X NWMEA1:WLGEtEPALLi N1LIT1 1F1Fmv 11 tyyLTJ'TenOn) I 50,000
CLAws+.uuE X Or4Ve MED EXP Nato,pang I 10,000._
PERSONAL a MV INJURY 1,000,000
OENERALADOREOATE 2.000,000
G:NLAOGRFCATELNITAcaL�WSPER PRODURE-COMP/31N00 2 900 QQQ__
PL11CY A feRi I( LOC y
B NITOMOBILBLIABIUTY X 6207761 9/30/16 9/30/17 Lahti .'l001sINOL4Leal1
1,000,000
ANY AU10 0001LY INJURY(EW Prem)
ALL UNE 0v Wort INNAY Per exkeng
X
AUTOS W OIWED PROP£ Y OMNZE
AUTOS
X nIRECAUN3 X AUTO Es:e:aa�n
o UMERELLA LIN _OCCUR X GX0000003B5-01 3/4/17 3/4/10 EACH OCCURRENCE 3 5,000,000
EXCESSLIAO CLAIMS-MADE AGG EOAT1 3 5,000,000
I DED X fl ummox; 54.000 na 5(AtL:4 Tr.
s
D YARKESSCONP€NSATON WC0603405 10/5/16 10/5/17
4NOEUPLOYEAS'U>eItITY YIN ?lflIt
ANY rRCPRIETOR MTNERLEXEPIRVE EL.EACH ACP I£Nr_ F 1.000.000
cc FGERMEMDEREXCLwwwv y NIA
sale nry 10�(n_) c.L DISEASe,,UA,666.6”EE9 1,000,000
IIDESOR:PTION c OPERATIONS Not/. E.L.Disease.POLICY Lynn s 1,000,0010
1
t*SCRIP1ON OFUPERA90Ne I LOCA ONS NEM CLEs (Moth ACORO 101,Adieao.I Re,mNn kh4dule,II mve SOU H re Need)
ROOFING CONTRACTOR.
CERTIFICATE HOLDER CANCELLATION
PHOULD ANY OF THE ABOVE nhSORIBED POLICIES BE CANCELLED BEr Oer
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W
REFERENCE COPY. ACCORDANCE WITH THE POLICY PROVISIONS.
AUTn'WU:e°REPR€£ENTAMNE
I
0)19883010 ACORD CORPORATION. All rights reserved.
ACORD 251201O/0E) The ACORD name and logo ore registered marks of ACORD
Phone: Fart &Main
__ _
�` 2 Massachusetts BDepartment of Public Safety —
aaa <s zolnmsn,' ''�i Board ofBuilding Regulations and Standards
/� 1e�r�V if -
- - License CS-074334 1p ,
1:oi1$t1'UCt(On Supervisor
Office ofC u Affairs&Bug nes Regalnnon
W(fi HOME IMPROVEMENT CONTRACTOR MARK T DELISLE cyE r
Jf Registration 126235 Type. 89 BRIGGS STREET r
�'ryt Expiration; ,.162418 Parinecship EASTHAMPTON MA 01027 "'f
R G.1 ROOFING
MARC DELISLE esel„µ CA`,:, Expiration:
6 UNE Si - t' ---- Commissioner 05103/2018
SOURHAMP"ON, MA 01073 Emit'secretnry_
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141 0604741". r 4001•Azd..?;NArt••� 'S'A/3Q/2014 55 BRIGQ'S' �" , KA
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•
OMMONWEALTH OF M•$S 'OHtiSET .:4.-e. .:'.
iDl(IISION.OFL ROFESSlONALttCENsUn •
5$EETTMETAL W01 %<.4Re
ISSUES Thi FOLLOWING Li4' �1S$ASA
BUSINESS t
M7l ,,J DELISLE (
74 gGt RCTOFINR3 Gt8>. ; �� i, „yfl �' .
6 LINE $tMET n` ( '� rr Acso'/ . Tx
EASTH4MPTON, MA 01073
Jia � ,
601 .. 09109/2447 .,01 2406.
L - SERBMII R'c...ENPIRTION AT - .SERIALNUMBER'
The Commonwealth of Massachusetts
1 i? Department of Industrial Accidents
_ 1 Congress Street, Suite 100
^-111= : Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information �/ Please Print Legibly
Name(Business/Organization/ludividual): R C 1 R(ip-4,-,7 LL
Address: �' .L,»Z.- St .-..- /
City/State/Zip; . tofhairufnn N'/I 0/073 Phone #: (M3) ...�37 - -1-/775—
Art you an employer?Cheek the appropriate box:
iI 1 Type of project(required):
am a employer Wit,, -2O employees(felt and+or pars-tone)' 7. i]New construction
2.❑1 em a sole proprietor or partnership and have no employees working for me in S. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9.3.❑I am a homeowner doingall work myself No workers'Corp.insurance re ❑ Demolition
5 6 p required
4 ❑lam a Immeowmer and will he birrg contractors to conduct all work on my property I will 10❑Building addition
ensure that all contractors either base workers'compensation insurance or are sole I1.❑ Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
i.❑I am a general contractor and huve hired the suhuontractors I fisted on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance) 13,14.rt❑�'Roof repairs
b.9 we are a orporationand its ofPeershave exercised their right ofexemption per MG>a Mee
152,E I(4),and we have no employees.[No workers'comp.Insurance required]
'Any applicant hat checks box ul must also fill out the section below showing their workers'compensation policy information.
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 showing the name of the subcontractors and state whether or not those entities have
employees If to subcontractors have employees,they must provide their workers'comp policy number.
1 an an employer that is providing workers'compensation insurance for my employees. Below is the policy and job ssite
information.
Insurance Company Name: t,.); (Y �f �lt✓n/IPO. ............
Policy a or Self-ins. Lie.N', Ili G /7(A?3A/0c Expiration Date: /M 5-
/7..,,
Job Site Address: 7.2-3 /„��('YBMC£- Rd City/State/Zip: (✓eteeDdtxp/zn, NIA arono
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, §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.
t do hereby certify under tl<-aims d penalties of perjury that the information provided above is true and correct
tC'' y
$'gnaiure: \ Date: /0 " /7 _
Phone k: ('f/3� ,5"a7— y775—
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License4
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk S. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone k:
RC.I. Roofing
6 Line St. Estimate Date
Southampton, Ma.01073 2/28/2017
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Amrik Singh 723 Florence Rd.
213 Grove St. Northampton, MA
Northampton, MA 01060
Terms Rep
Estimate valid for 30 days Chris
Description Total
Remove existing roofs. 3x700.00
Furnish& install aluminum drip edge,pipe flashings, chimney flashings(if needed)and step 7 30D
flashings.
Furnish& install CertainTeed Winterguard ice&water barrier,6 feet along eaves.
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 52.50 per sq. ft. for wood decking replacement if needed.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU. 73 0 ,,a1
Total 52,20 BO
TERMS OF PAYMENT ° C
5%Deposit Customer Signatures f Tri
Balance upon completion
Registration d 126235 r
Construction License g 074334 Dete'. 2 0 �-
Insured by Bans rckHamIvs.
013)527-2700 Shingle Color Selection: 0/AIX:do ��C SID
4/ G(