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29-367 (6) 61 AUSTIN CIR BP-2017-1507 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:29-367 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-2017-1507 Project# JS-2017-002510 Est.Cost: $4800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 16030.08 Owner: MATTHEWS DENNIS R&SUSAN M Zoning: Applicant: RCI ROOFING AT: 61 AUSTIN CIR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAM PTONMA01073 ISSUED ON:6/23/2017 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 if 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 6/23/2017 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner G79paci feTst t4`e-crn!rY Silty of Northampton SYbtve DPP&ffDU t: I Building Department Curb(ruw07 ‘pw'Peraltlt ' � ��et, 212 Main Street SewePares aeemaneediey. . �,_ Room 100 lwate / !IFudlrandtly Northampton, MA 01060 7wa ,of Smeownel Flan: phone 413.587.1240 Fax 413-587-1272 PIoUQhe Plans. I \ JtherS e&(Y• . k?PLICATION TO CONSTRUCT, ALTER, REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING .Re'S(P) 1 .SITE)INPCAMATION &" (0-f '50 { -roper-try A,ytldreD,g' ^ 'Mibi section to be oOmpplleted by office lot Austin eir. Map .-- Lot Alti ..,.,-Unit nor ma, MA Zone_.r- -Overlay"DTatelmt_ ____ Elm St.Dlatriat___.._�. , QB-Distefot_.._ STPEN 2 •PROPERTY OWNE.RSHIRFAUTHORISED AGENT I :;aver of RecgId: beon',S ffhfbtg /o.. si i Ocr' Neotn,, /Yl" Drolc e rRrinp Curren)Mellin Address' 4i3 -53 - 44,3g, ,...�._cQE'. AQC>''tId _ Taleghone — — A-..Pnorizcd AaeaL %'1,i' ✓ K. OU I't5[o- . c C , T Apahr �u Lino _,`.- .cAtxtrLlvvvn'r}av1 fYaA OIGt-l'l. . ring �,�- Current Mailing Address: __,,, Telephone _ _me.- 'N 3 r ESTIMATED CORSTRUCTI N COSTS _ Estimated Cost(Dollars)lobe Official Use Only cor•leted b •ermit a.•Ifcanl - d (a)Building Rl:rmll Fee P_ib.C_. h1PD0_ ' Hommel i (7T)Estimated Total Cost of __ Con9tne5+10]rt.from e) .rating -'.Eutiding Permit Fee .incha nloal(HVAC) e e ProIecli0n /_ __ —__ 'o'a =(1 + 2 '3 + 4 + 5) $ Yaeo _. Check Number - T! r' � _. This Section Por Offt tai Use Only__ ._. —.�. Date ire Permit Number'. _ - •� issued' ,—..,�.__ 1 air 1� - t 1 ���"//� Basing Fng Commiesloneril➢specie[of-Bxlidinas Date QP E PgePFepPOSEO WOMH (c$ck all appllfipblr). • House c: Addition ❑ Replacement Windows Alteraiion(s} Roofing El Or Doors © e se arty Bldg. E2 Demolition C New Signs (C:11 Deeku [❑ Siding (CI Other(DI �___ GeeCriplldn of Proposed aflcn of existing bedroom Yes, No Adding new bedroom _Yes No I one Nar aus Renavaiirvo unfinished basement __,•Yes __No s Attached Roil Sheet --- f Neer hraust: arra 0Weaiddfi ,F,en to,exisdinn lehowspmn .00'rnptgttlitt`Lailoi^ l:ihej; Use of bi,dlding One Family TWO Family Other _, nrte�her of rooms In each family unit: Number of Bathrooms___,_,,,__ ft n a garage attached? a c 1•sed Spuate footage of new construction. DIment lon Ember of stories' ,_,i Aaiood of heating? ,,,, Fireplaces or Woodstoves,•_ Number of each Energy Conservation Compliance, _ Masschech Energy Compliance form attached?_ Tate of conetr etion ,�_� is construction within 100 ftof wetlands? __ Yes _—No, Is conatructRin within 100 yr. floodplain _Yes__No ceotn of basement or solar floor below finished grade has molding conform to the Building and Zoning regulations? Yes___,_Ne. s n:ic"ane__ City Sewer Private well City water Supply,__,,, ;Toy 7a ..OWNER AUTHORIZATION •TO.BE COMPLETED WHEN r1ERS AGENT OR CONTRACTOR AP PLIES FOR BUILDING PERMIT LePrieP E1,t/A/Z125 ,as Owner of the sot-Reef ✓oily ▪ he Ire N\fiS_Y1 O,C` I s . -- iry neraif, in all matters relative to work authorized by(his building permit aRlllcation, : ,A3LICILect. olarE or Owner Date (0e--/ —/7 i_{ly%f y_ fc.Po,NP _ Q. (3 0410,A-70i (sj••C ip-4- _,as Owner/Authorized hereby declare that the statements and information ondte foregoing app�ioallon are true and accurate, to the best of my knowledge co her ,d Lacer the pains and penalties of perjury. canna „ 6_ -/? _ T or 0_vrvrlAml Dalt 9 • CONSTRUCTION SERVICES' -. `ed Censtrg^ticnlbssrvippg: Not Applicable O0 orbdracji L3f ! ', )� ( `''. l )(), I�Ip __..._ _lLa.L.L b License Number v r Y 1l R..1Y1YT'101C i nnC�i y,_�,.._ C)5 ' 'O S _l LII mg= { Expiration Dale / Telephone c isgetod Horne JrNonovdiuent Qgntttaatbrry. Not Applicable ❑ �J nosy Name Registration Number ass Expiration Expiration Dale 014-dl V,dn C 1 3 Telephone ?41'55),5alo ION 10.WORKERS'' C,OMP,ENSATION INSURANCE AFFIDAVIT(1,14©,L,0,15,21§25CM rs Compensation Insurance affidavit must be completed and submitted with Ihla application. Failure to provide this affidavit will result denial el the Issuance of the bulldog perma. ac Affidavit Attarhed Yea,...,., 11 - F1mm1.'e ,Aer EX eraptan The ourrent exemption for"homeowners"was extended to include Qwnrn jeci.ipied Dwellings of one(1) or two(2)bindles and to allow such homeowner to engage an individual for hire who does not possess a license,provided thatibe owner acts as supervisor, CIyJR 78O,, Sixth Edttign Section 103,3,5,3 DepnPion of Houneownot,, Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there s,0) it intended to be,a one or two family dwelling,attached or detached ntructures accessory to such use and/or farm suacwres,4 ret sag who constructs more than one home kt a two-deg; period shall rcpt be considered a hmneowiier. Such"homeowner" shall submit to the Building Official,on a foam acceptable to the Building Official,that he/glee shall be responsible for aU$uch work performed under the building pe holy As acting Co nstru (ton Attervlsor your presence on the Job site will be required from lime to time,during and upon owI-lotion of 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 maybe 0ngle 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 Norhampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated, Homeowner Signature ,r,.—rS ekuPd City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit .n accordance of the provisions of MOL c 40, 554, 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. &, 4.5 fir) fir _&'icrnCl /heti e/tr ..)- Tho. debris will be transported by: 02 I4(e-lt--Q-• � -Cep L. The debris will be received by: C,a Nv(u �e4 �O�wt > W Nt14:110L- -GtI l k: f3uilaing permit number: Name of Permit Ap cant ILO: 2..oc c;�f Jc\ Date lv -/y-i(-7 Signature of Permit Applicant Mar. 7. 2017 10:31AM No. 0868 P. 1 ACC:We CERTIFICATE OF LIABILITY INSURANCE DATEN'a'D°""I �.---".• 3/7/1' THIS 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 I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is on ADDITIONAL INSURED, Ma pollcyI es) must he endorsed. If SUBROGATION IS WAIVED, subject to the terms and coneltIons of the policy,certain policies may require an endorsement. A statement on thl 6 certificate does not confer rights to the certificate holder in lieu of such enEdorsement(s,, pno W CEA CONTACT NAME! Michael R, Banos I Banca 6 Fickert PHONE Ivaco. (413) 527-2700 qua: (4151 s37-oaP9 Insurance Agency ASI its: mbUbanas insurance.coca 63 Main Street ^easthampton, E4A 01027 mumps)AProRDIN3 COVERAGE HAwn IGSUREA A I ACID)irA1 Snsuzence Co, 24056 _ !',GIMES INsvRERe;Sa£ety Insurance Co. 39454 RCI Roofing, LLP IImmuEne:Admiral Insurance Co. 24856 6 Line Street 1111"t";nE11r IFLO1DIatoe Co ,24562 Southampton, MA 01073 !RUREne. ROAMER P, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER, I 7 HIS Is TO CERTIFY TWT THE POLICES OF INSURANCE USTED BELOW HAVE BEEN less IED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IH THIS CERTFICATENMAYOBE ISSUED OR MAY PTANDNG ANY OERTAWE HETERM NSURANCE AFFORDED BY TI£ POI.ICGE$ DESC IBEDOCUMENT EREIN IS SUBJECT RESPECT ALLD THE TERMS EXCLUSIONS AND CONDTIONSOF SUCH POLIrC�'�IENT�SS..LIMITS SHOWN MAY HAVE BEEN REDAJ UCED BY PMD CLAIMS. ULTS TYPE OF INSURANCE A ST=Hi you FER MMO0,ro ma o• E UMTS A GENERAL LIABILITY X CA000020963-03 3/4/17 3/4/16 smif OCCURRENCE $ 1,000,000 ® CLYRAERCIALGEIEPAL LIABILITY PAJMGES Ir' CO RENTED E DAMAGE lfRNTED ) 50, 000 I CLAPA*MADE IX 0<ruR neo D"'(Aw o a penal) $ 10 ,000 , PERSONAL AAQV INJURY s 1,000,000 GENERAL AGGREGATE 4 2,000,000/� • I CEVLAOGREWTE L PATtPP LIES ER PRODUCTS'WIN?P AGO $ 2,ys�QQQ . POLICY P'Q Lee $ D NITOMOBILE LIABILITY X 6207761 9/30/36 9/30/17 e ,' ' s 1 000 000 ANY AUTO Go0II.Y INJURY(Per perm)) $ ALL MTTEE x SCHEDULED BOGY INJURY(Per&c)denll $ ALTS AUTOS X nREDAUTOE X q!T BjRD Pwet)=DAYAGE s $ O • UGH PELLA LIAS Oxon X GX000000305-01 3/4/11 3/4/10 EACH OCCURRENCE 9 81000,000 EXCESSLIAO CLAIMS.MADF. POO ft GATE E 5,000,000 DED X RET IONS le see f TOSSERS CCMPENGATION 10/5/16 10/5/17 ■OTN. 0 4100603405 ANOFROFRIEnv LiDELLIMThE v rrN ' OFFY MAENEroR P.AOLLLEDEO%EGIINE y I IIIA - Et EIGHACgLEM $ 1 .000.O00 )InemeMry In HHI E L mews•EA EMPLOYEE,T 1,000,000 I e.owame vn ID�sCRIPnory oPPnA*Tors wmw EL,DISEASE•poucr OF f 1 000 OOC LPSCPIP1 OH OF OPERATONS I LO AnoNa/VEHICLES (Mich AGGRO 10I,AdSS4,,tl Penn*,SCh.euIe,imam emu IS regvreU) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVEREO EN R rzn NCE COPY, ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORISED PEPRESEN1ATNE I © 1988.2010 ACORD CORPORATION, All rights reserved ACOR D26(2010/05) The AC ORD name and lag 0 are reulsle redme rke of ACORD Phone' Fax: E•Mall: ' Massachusetts Department of Public Safety — 2. ;nu, t; mtum t�I Board of Building Regulations and Standards '�c 'funny? au/'of,0i/� 4etiette License: CS-074334 _ Construction Supervisor dR, °MufCons Affairs&Business Rgtatten t'`�y �' ; HOME IMPROVEMENT CONTRACTORMa 6$ RKBR GQ ELISLE 11,-4211r62 Registration 126235 ship 09STHA S STREET 2 ,v� in .t,,,,,,-,-J-0., Expiration, eintp,=18 Partnership EASTHAMPTON MA 01027 ' P C:.POOPING MARK DELISLE 6 UNE ST ;fit vt.., t--- i Co�sioner 0603120015 . SOUTHAMPTON, MA 01073 link]secretn ry. 49 '11 1' ��ry 1. rte !; H: K 6 —Tf6,f�!I . iQ11°11' Y+rt �y 1fa�A' t(�/�ll( ' SY.. ^�. ar iliiiMQde#N,S� g 040.'iro 4frix. )4), OPP o ESSION' , r i' ti. -47 HOME noii v ygAi .claN RA.CTOR 7/au �a 46oARAo, A7n b i1I'v, }.Y SN5fl03h1Mi�`TAL *01NiN2iS„ 'ill ,Y/,t(N 4 al, N 1S$�mf,s ThE, fOUCZW4i Aei`bENS(^ , soU" 4'-Yt�,Q E.,, f A 0L07a I - PAW�A' afAAVTEt[Y r NI161T,P F CfO �IT /�1ARlfel 6ELISL6 , �, y , Rs It 'E1 t t' .1, ..i ExPIRCS ,if b t,t 4 h ttii H[G,0624147 1 ,2,/0'142 0, i,1t,ii ,.^"*1/30/2014 $9 BRI `Obi' ST' " t� A LY r lN (! f oN D ,2' , , �..,...,.,.,. " 4i MP7i» A oio27 i73r: 71 , !;i ,x °'.,a? ltimo, i21.a) 042 O�OPyM�ONQW„PA{�LT�R C r Sy1.42s� USnEYuT�+ ” !©CUESTQG4 p FOAL LICENSUir a sHEBf MstAL wOsk7 a `r I$SU S, '3{p POLLmW[NC Lit/USE/A.8 A w d it , tt ;".t , 1 ausivESS H�4 .0 t iiaku DELISLE (11 I. 11 „ 3raR oEi % a Vit ; i B LINE sItet f° ” .y= A., 2, til ' EASY$) PTON MA eto,7rtt '+ t � �. 607 1 T'ai16910912013 ,f 2408 o-". t a NSRNRMR•R ¢SPIR ItlU I ME.: ,SERMI NRMRER: • The Commonwealth of Massachusetts 1 ,-' Department of Industrial Accidents _ _ 1 Congress Street,Suite 100 '__?„NBoston, MA 02114-2017 „' www.mass.gou/dia Workers' Compensation Insurance Affidavit: Builders/Contraotars/Electriclans/Plumbers, TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant bdormation �j pp Please print Legibly Name(BusiensstOrganizafionindheiduaty R C 1 R 04 9 LLP Address: 6 Lin. Q_St. ... ,_ City/State/Zip: .Sou#arniaton, 444 o/&73 Phone#: &13) .512'7 - 4[775` _ Are you nn employer^Cheek the appropriate box: Type of project(required)', 1 ✓ am a employer with o2-U employees Mitt aM/or pan.nme)” 7. D New construction 2 1 am a sole proprietor or partnership and have no employees working for me In 8. ❑Remodeling any capacity.No workers'comp.insurance required] 3 l am a homeowner doing all work myself'.{No workers'comp.insurance required.]' 9' ❑Demolition 4.E]l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 [' Building addition ensure that all contractors ether have workers'compensation insurance or are sole II.❑Electrical repairs or additions proprietors with no employees. 12.❑ Plumbing repairs or additions S0 I am a general contractor and l have hired the sub-contractors listed on the attached shut 13.[{'Roof rej>airs These stab-contractors have employees and have workers'comp-insurance) 6We are a corporation and its officers have exercised their right of exemption per MGL c I4.❑Other i 52,slim.and we have no employees,No workers'comp.insurance required.) ors 'Any applicant that checks box 81 must also fill out the section below showing their workers'compensation policy information. h Homeowners who submit this affidavit indicating they art doing all work and then hire outside contractors most submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. It the sub-eontraetors have employees,they must provide then workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees, Below is the policy and job,site information. (" Insurance Company Name: (5;12/';Jh8Le✓4nAt .... Policy%orSelf-ins. Lie. g: (if v O tnf 3 5OS . Expiration Date:. /O -Jr' /7 Job Site Address._ (o/ Girg5rbnu Cu- . City/State/Zip: Boren & /N9- L'lO6w:2 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$1,50090 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 DR for insurance coverage verification. 1 do hereby certify under tains of perjury that the information provided above is true and correct, Signature: ...-- s"'� Date: Gr -/1 / 7 Phoue f: (IR) .5027 - 775 __...., w. Official use only. Do not write in this area,to be completed by city or town official - City or Town: _Permit/License N Issuing Authority(circle one): 1,Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector A Plumbing Inspector 6. Other Contact Person; Phone#; RC.I. Roofing Estimate Date 6 Line St. Southampton,Ma. 01073 6/1/2017 Phone(413)527-4775 Fax(413)527.8469 Name/Address Job Location Dennis Matthews 61 Austin Cir. Florence, MA 01062 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 4,800.00 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. 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 $2.50 per sq.fl. for wood decking replacement if needed. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $4,800.00 TERMS OF PAYMENT 5%Deposit Customer Signature: Valance upon completion Registration g 126235 Construction License R 074334 Date: / )ey 7 -7 Insured by Banes&Fickert Ins. (413)527-2700 Shingle Color Selection: ti