The URL can be used to link to this page

25A-046 (59) 51 BATES ST BP-2019-1159 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block:25A-046 CITY OF NORTHAMPTON Lot--001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Cateeorv' ROOF BUILDING PERMIT Permit 9 BP-2019-1159 ProiecI# JS-2019-001879 Est.Cost: $2500.00 Fee: $109.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group- RCI ROOFING 074334 Lot Size(sa fl.): 71307.72 Owner: NORTHAMPTON MONTESSORI SOCIETY Zonine: GI(1011 Applicant: RCI ROOFING AT.- 51 BATES ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON.411912019 0:00:00 TO PERFORM THE FOLLOWING WORK.STRIP & SHINGLE ROOF - 32X15 AREA 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 li 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 Stimulate: FeeTYDe: Date Paid: Amount: Building 4/1920190:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Vecvionl] Cmnnlcrcisl Buddin Permit Nla G, 2000 HEQDepartment use only ity 0 Northampton Status of Permit urIdii gDepartment Curb CuVDrlvewayPermit APR1 8 2019 212 Main Street Sewer/Septic Availability oom 100 Weter/VJell Availability, il n mtha pton,, MA 01060 Two Sets of Structural Plans — Q 1Q �oragAl �'-587- 240 Fax 413-587-1272 P(gU51te Pla[ls.�, Ottheri9AedlfyN" APPLICATION TO CONSTRUCT,REPAIR,RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING l OTHER THAN A ONE OR TWO FAMILY DWELLINGgn _ SECTION 1 - SITE INFORMATION "W" I "9' // 1.1 Property Address: This section to be completed by office 5I �"�.es S+ Map dS/'q Lot Lot 0q(1Unil Noc+ w-r"Rfl#�Y1 MIA Zone Overlay District II r Elm St.District CB 31,odct SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: ""�� p QQ ,, I/ I{,_,,� Name(Prim) Mon}eF'S('6 �J166 (Js Ndf-rlwmP+on Curren)Mailing Address'. J51 i"615k CS aW, N0/4"T-wn e SQA a+lached Ielephone (4(3) 57(o y538 r re _ 2,2 Authorized Agent: loaK �C\ S1c - ICY V)001 'lnc' P (a l .rC S� Soy \\vwr pion, .ele/3 Name trim) Currmm Mailing Arl –/A� X413) ;52_l- ti 115 S{mature _eL Tslephnne —s-ECTION 3.ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant I. "'"ding�iooc-'J e, t50O (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee ,/ I TID l 4. Mechanical (HVAC) 5. Fire Prolection 6. Total = (1 + 2+ 3 + 4 + 5) q1 500.00 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature. Luiltling Commissioneglnspector of auildings Dale Vocsionl-7 Comnmtcol 13allding Permit Vhip G, 2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs 1-1 Additions ❑ Accessory Buil ding❑ li Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Rcofingy Change of Use❑ Other ❑ Brtel Description F_nler a hi el dcsci prion here. 01 Proposed Work: Qxt roO� ��Gs 0.'Sx".f�'-c o SECTION 5- USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly1-1A-1 ❑ A-2 ❑ A3 _ A-4 ❑ A5 ❑ D Business ❑ �— E Educational ❑ F Factory ❑ F-1 ❑ F.2 ❑ High Hazard ❑ - Instu nonal ❑ 1-1 ❑ 1 2 ❑ ISM Mercantile ❑ R Residential ❑ R-1 ❑ R'2 ❑ S Storage ❑ S-1 ❑ S-2 ❑ U Ultity ❑ Specify. - — M Mixed Use ❑ Specify. I_ S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDIOR CHANGE IN USE "Listing Use Group: Proposed Use Group. E)isting Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34J: SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION I Four Area per Floor (sl) isi 2 2„a 3m 4i Total Area (st) Total Proposed New Construction (sl) Intal Height (h) Total Height 11 I. Water Supply(M.G.L. C.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ Zone Posy em. — V.....n 1,9 Co Mind 13ul IdIng Panoil Mi,) Ii,2000 S. NORTHAMPTON ZOMN0 Fxi,arnlg Propusud Rupdred Lv (nnlug ,dx „ha need i , Itu ILII tUcha nnm L01 Slzf F.Uelil'C Selimcc, Florl Siy L—12:_ L.._If IEcnr Dulldllg Height king. Scuarc Fooutgc %. Opcn Space Foolagc tLx umn xld¢.tl pn ed mAlnul N of Parkin' S auUu CiI'. l. ck . . A. Has a Special Permit/Variance/Finding ever been issued for the site? NO O DON'T KNOW 0� YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: eater Book Page and/or Document 11 B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Cornmission? Needs to be obtained O Obtained O Date Issued: C Do any signs exist on the property? YES NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO IF YES, describe size, type and location: E. Will Phe construction activity disturb (clearing, grading, eI vation, or filling) over I acre or Is II part of a common plan that will disturb over I acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW Is required. VcrsioaL7 C... menial Building Parnell May 15, 2000 SE i CTION 9.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES- FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: _ Not Applicable 0 Name tRegistrang. Regisbalinn Number I Ezpirallon Dalc Siqnalure Telephone 9.: Registered Professional Engineer(s): Nerve Area of Responsibility noNess Regisballon Number 9pnaluro telephone Expimllon Dalc Nal e Area of Responsiblllty ( nboress Regisba lion Number Slgnelure Telepbooe Esprarcr Dale Name Area of Respan7bilrly nmress Re,in,ation Number 9ignawm Telepbooe Expiration Dale Name Area of HcsponsNilily Adtlmss Re,rarroorr. Nomber Yignalure Telephone Expiration Dele 9.:1 GG.caral Contractor j _ 1I�I r1Wtl/10 Not Applicable El Ccmoany Name. .1C."b nosnsibla pa1n charge o1 construction _ S 03 Addross Cy 13 54� -U77S .r Tecorone Vtc,ion 1 7 Cummcrcfal 13ullding Pormil May 15.2000 SEI CTION 10.STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O ISI SECTION 11 -OWNER AUTHORIZATION .TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I— I_ moo+e ap�_ r I as Owner or the confect property li hereby authorize_ Cl C. Z f10(A� act on my behalf,in all matters relative to work authorized by this building permit application. Sez O_V4, Zi, ON- l u 'aol9 5,,natare of owner Data ■ as Own.rLA_yu nyELzeQ Ag0ttLhe eby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Si_Ined under the pains and p (ties of perlitrv. aunt Name Yla K 1701 le OY -Ito -ate__ r__S,h.l 3nawie Eiceof OwnerlAgent Date PCTION 12-CONSTRUCTION SERVICES nsed Construction �Supervisor: �) O Not Applicable`l❑ NentO of License Holden n f 10.x11 ' '�Ws\f ' q,C� `GO�\ nct Lip L¢ense Number ,� ill tS el , Adtliesc E,,ru ,u Date L413)5-Z'I- LO-1 5 1Lgnalure Tetepnone SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c 152, § 25C(5)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this of idavil will result I"nIthe denial of the issuance of the building permit. J-fl geed Affidavit Attached Yes No tQN The Commonwealth of Massachusetts Department of Industrial Accidents *workers' 1 Congress Street,Suite 100 Bastion, MA 02114-2017www,mass,gov/dia Compensation Insurance Affidavit:Builders/Contracturs/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant If lin n ,s n er s Pri t L albly Name(Busin��es""s/Organization/Individuel): Lt C, K(YiH 11� LP Address: tD I YI P YOP+ City/State/Zip: Phone#: .5a - 05 Are you en employmP Check lh<epprupriate box: Type of project(required)' I.5�1 am a employer with/e mpluyea(fllandbrpamume)t 7, ❑Newconstruction 2,7 I am a sole pmpnetor m partnership and have no employees working for me in g, ❑Remodeling any cepacity.[No worker comp.insurance required.] 3. l am a homeowner doing all work workers' sureace required.] I Demolition ❑ 8• Y [No war Rin q ]t 4.❑tem a homeowner and will be hiring control..to canduat all work arm twill 10 Building addition property. rnaum that all emttact«edNer have w«kae'compensation wuranaor...Is 11, Electrical repairs or additions proprietors with no employees. 12,❑Plumbing repairs or additions 5❑I em a general contra hm and l have hired the a m-canheams listed rook eaactedshect. O Ulkoof repairs These sob contractors have employees and have workers'comp,insurance.) 6.❑We arc a corporation and its officers have exercised their right of exemption perMGL c. 14.[:)Other 152,§I(4),and we have no employees [No workers comp.Inaumnce aquircd.) "Any it,plicitto that checks has NI 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 outride contractors out subn it a new affdevit indicating such. tConnaclors that check this box moat attached an additional sheet showing the name of the sub corporations end state whether or not those entities have employaes If W sub-convectors have employee+,they mat provide their workers'comp,policy number. lana an employer that isproviding workers'compensation insurancefor my employees. Below is the policy and Job site information. --tf nn Insurance Company Name:�Q T M �(r4141 .-)-rl Sttrwi U Policy#or SeLMrk.Lie.#: V 1�� C)(1(p.(}d_�_ 'old I�a A Expiration Date: 10- 0,5 - 20 (G Job Site Address: 51 /ate$ S:-. City/Statx/zip:_4L Attach a copy of the workers' compensation policy declaration page(showing the policy number and a eplrali n dale). Failure to secure coverage as required under MOL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year Imprisonment,as well a 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. 7 do hereby cerelfy under the parrs d penalties ofperlury that the Information provided above Is true and correct irtnatum Date Oq n a. (V3) Sa-r- 4705 Oficial 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton Massachusetts * 3 DOF BUILDING INSPECTIONS 212 Main 212 Nein Street •Municipal Building Nps<IlaNpton, W 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, 554, I acknowledge that as a condition of the building parmit 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. The debris from construction work being performed at: 51 .'34-/2v+ _ (Please print house number and street name) Is to be disposed of at: U w-4 bior rrlinn Tf�nc Ar Far; W,J (Please pr n ame d location of facility) Or will be disposed of in a dumpster onsite rented or leased from: (AM Hr11 lino Ong KOPcrlrn (Company Na a and Address) Signature of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. RC.I. Roofing Estimate °ate 6 Line St. Southampton,Ma. 01073 3/19/2019 Phone(413)5274775 Fax(413)527-8469 Name/Address Job Location Montessori School of Northampton 51 Bates Street Northampton, MA 01060 Terms Rep Chris Description Total Remove existing roofs. Roof area 32'x 15' 2,500,00 Furnish&install aluminum drip edge,pipe fleshings,chimney flashings(if needed)and step flashings. Famish&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. Famish 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. ft,for wood decking replacement ifneeded. Total $2,500.00 TERMS OF PAYMENT 5%Deposit Customer Signature: - ,r Balance upon completion Registration k 126235 Date: Construction License R 074334 Insured by Banas&Fickert Ins. g Shin Ie Color Selection: (413)527-2700 A`R a CERTIFICATE OF LIABILITY INSURANCE �T 03119/19 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 INSURERISI,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. N the wrd wfe holder is an ADDITION INSURED,the poiloy ies)must have A O AL INSURED provisions or be endorsed. If SUBROGATION IS WANED,subJect to the terms and conditions of the pollcy,certain policies may require an endorsement. A statement on this c9mIfkate does sm confer rights W the camunwte holder in Esu olsach endomement(sl. PROOVLER E: Michael R.Banal Banes&Picked NE . 41}.g27.270R Aa NR: 413327.0849 Insurmum Agency X76rcss, mblilbonasirsuranceFOm 0 Main Street INSURERID AFFORDING COVERAGE NAICY Easthampton,MA 01027 INMJREn A: Admires lnsuranw Co. 24856 INSURED MBURER e: Safety Insurance CO. 39454 I=Roofing,LLP IXN ei Admiral lmuriesm,Co. 24856 6 Line Street INSURER D: Southampton,MA 01073 WSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CFATiFYTHATTHE POLICIES OF INSURANCE LISTED ,LOWHAVE SEEN MMOTOTHE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WDH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUWECTTOALLTHE TERMS, RIAT �r Ell EXCtUSiDNSAND CONINiIONS OF SUCH POLICIES.tEdATS SHOWN MAY HAVE BEEN REDUCER BY PAID CLAE4S LTR TWE OF INSURANCE POU:YNUMBER Nwo MW PMITE f{ wNMERC4L0ENERAI tMBWiY EADHM:r.URR£NCE S 1A00A00 CINMFX� CCUR AMAOEOPREMI Esc f SR,RRD MEDEAP $ 5,000 A X CA000020983-05 03104/19 03/04120 PERSONAL&AWINJURT S 11000,000 GENLAGOREWTE LIMITAPPLIE9 PER GENERALAGGFEGATE $ 2,000,000 Pau"©JJEC F-1— AROGUGiS.COMPIOP AOG S 2,000,000 i OTHER: ea B 1,000,000 AURIM06REtN9tJTt Ea MIYP.UTO BOOBY INJURY(Parpnm) $ DNIIED SCHEDULED X 5207761 OW30119 OW30118 6001LT INJURY(Px+weene S B AUTOS ONLY x AtJT03 Pw HIREa NONdNNW S x AUTOSONLY x AM ONLY f UYB(fELIALWB OCCUR EACH OCCURRENCE s 5,000,000 C ECC013 LIA9 cL&msuAnE X GX00000038643 03/04419 03/04/20 pc.ReoAm $ 5,000,000 DED x RETENTIONS 10,000 S WORKERS wMPENSA ON p ER AND EMPLOYERS'LIABILITY YIN PNYPROPRS:TORSWiTNERtEAECURYE❑ NIA Et EAG HACCIDENr f yFFuICCERRMEMEMBE "CLUDETI E.L.DISEASE-EAEMPLOYEE f pEb1:RIPTIOPERAT10Na Labw ELOISEASE-FOLN:YLatIT i DESCRIPnOX OFOPEMnON9l LOCATOHB/VEHICLES(ACORD 101.AddUcntl RmFML 8<IItluM,mW M AaFaRFC NAwn cpcA M rHNirq) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE�PRATION DATE THEREOF,NOTICE WILL c 00V pm�SDAANCE VWITIN THE POLICY PROVWONS.BE DELIVERED IN 15 ACORD CORPORATION. All rights reserved. ACORD 26(2 01 610 3) The ACORD name and logo are registered marks of ACORD A�oN CERTIFICATE OF LIABILITY INSURANCE 4A�-20e") 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, UTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate hold.,is an ADDITIONAL INSURED,the pdiey(les)must ba endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the -" cartMeaM holder In lieu of such endorsements. PRO01/CFJI iu, a Mlchad Banes BANAS& FICKERT INSURANCE AGENCY PHOxE 413 527-2700 F"x NO Ao L 9 banasinsurz n..c4m 63 MAIN ST Ix3MERa AFFORDOMCOMRAGE NAICa EASTHAMPTON MA 01027 HISYRERA: AIM MUTUAL INS CO 33758 Imusw element B: RCI ROOFING LLP IxeuREac: IWURER D: 6 LINE STREET INSURER E: SOUTHAMPTON MA 01073 Po amF: COVERAGES CERTIFICATE NUMBER: 3T958a REWSION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Was TYPEOFINSURANCE L pOIKYXWBERDynii CQp usims COMMFRCLLLOFNIMLNANLm' FACNOCCI1RRflICE f CLNMSMrOE ❑OCCUR S MFAFv S WA PERSpNLLAGYmnRY f GENLAGGREWTEUMITAPPUESPER GENER40iGCAEGATE $ POLICY❑IEP LOC PRODUCTS-COAR/OP$iGO f O HER a AUTONOBRELU9i11TY00MINNOSINGLEUMif —A— BODILY muRY(Nr Pawn) f p O.6a scNEDULEO NIA eoDRr mJURV IPnrWbMl f AUTO$ AVIOS NnEDAUT05 H�IX�WNED PROPERTY f i uNBRPyLA WO OCCUR FAW OCCURRENCE S FMCESSWa CIAIULADE WA AGGREGATE $ OED REIENRONf f MRXEMCOMPENSATION —To X71TWTMTER ANDEMPLOYFRaustru Y YIN A ONiFY�FMREMaExcluCowoETEcunvE WA NIA CoA VWC100802281T201 BA 10/052018 10/052019 EL.EACH ACCIDENT f 1,000,000 IMrndMeY me ELOISEASE-EAEMPI-0 E 1,000,000 DF,Wdamn.:.:a.I trisTONGFOPERATONSNA. ELDISEASE-POUCYIIMT af 1000,000 NIA OESCROTMINOFOPEMTIONa/LOLAIN)XB/VENKIEa IACORO101,AllltlonMR.m.:49eMG,4,mge.M.d,W Ilmongs.MrpulM) Workers'Compensation benefits will be Paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 O6 B,no authorimtlnn is given to pay claims for benefits to employees In steles other than Massachusetts K Me Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance Showa the policy in force on the date that this m Mcate wee Issued(unless the expiration date on the above antic,precedes the issue date of this caR llem.of insuranca). The status W this Coverage can be manitored daily by accessing the Proof Of Coverage-Coverage Verification Search hod at www.mass.gov4wd/wadrems mponsetioMnveaggabon51. CERTIFICATE HOLDER CANCELLATION �� SHOULD ANY OF RATION EATS THEREOF, N TILE BLL CBE DELIVERED IN THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELrvEREO IN Reference Copy ACCORDANCE WITH THE POLICY PROVISIONA Reference Copy AmmR®RIPmcMmATVE Reference Copy Daniel M.Cr y,CPCU,Vice President-Residual Mader-WCRIBMA ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD scat c5 ��ov1(1q A Orr on HOME IMPROVEMENT CONTRACTOR TYPE Partnership 1-83y'{ �� OSRic•o6I2020 . RCI ROOFING I t - i �iiiNtd{1 Commonwealth of Massachusells MARK T.DELISL� 1 � -•-^'e Dlvlslon of Professional L"nsure 6 LINE ST Board of BuHding Req,ulaiions and Standards SOUTHAMPTON,MA 01073' Ufldenuncrelary Con.`6f,Ctit6;�1A11'1a�,rVlsor t- CS-074334Mdl ,C ¢�) :. Fxplre. 05/03/2020 l RegisUatbn valid for vidUti Use MARK THOM'f{S only - fill p?l + ' hofore the axPimtlon date. If found return to: OEM 68 BRIGOS ST Office of Consumer Affair.and Business RegUletlon EASTHAMPTO 1A 014 SRS 5000 Washington Suaet-Suite 710 t. Boston,MA 0a11r e it f.j0�74 ��iII //'Gr/•'/'L commissioner WSW Not vaild without signature f�O�._,_ N .. MMOWh `LTH OFM � `AO (js a 4 • • �• HOME IMIYIi� VFX N 027TRAOTOR ' c� ,gvw � �g O dY3ido � ur 8HaETO 'm � w6R RSho l ti` < tnv §t r' z � lssvE �FOL€,oa�Nc5 f� w sOi,IRtyIshix+TtlNy ,01073 � R WN TBD 1 K T DELISLE �� \ g Acg+an nontf cd e 3 Exprnn°n SAS MIA HIG0624441 i< iF _ IS, 11/30/2019 1327VNI/281202 486498 OMMONWEH40 'd. FM g�� A .SMEE a� �., ORK� 8 ISSUES1 R-LLOW{ +1$ ` St i rE ey + 5• BWSINESSa oil u. ItRR,dFIN,G�L P i � � 60 Ott 0 4/0 912 018 J42�B�k:+9',Bt � � .