23C-009 (2) 54A LANDY AVE BP-2019-1339
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23C-009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category: ROOF BUILDING PERMIT
permit ft BP-20131339
Project# JS-2019-002160
Est.Cost. $13200.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: RCI ROOFING 074334
Lot Sme(sa. h.): 20995.92 Owner: GOODWIN-BOYD KATHLEEN A&GP
Zoning: URB(100)/ Applicant: RCI ROOFING
AT. 54A LAN DY AVE
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON 5/24/2019 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE ROOF ON OLDER SECTIONS
- NEWER ADDITION NOT INCLUDED
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: OB: 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 Occuoancv Signature:
FeeTvpe: Date Paid: Amount:
Building 5/24/20190:00:00 $40.00
212 Main Street,Phone(413)587-1240,In:(413)587-1272
Louis Hasbrouck-Building Commissioner
City of ortLtri xr. Pkv*tr, i
�. , Buildin De
212 ain2 3 2019R m Northam on,
phone 413-587-1
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO
FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooertv Address: This section to beaompl ted by office
5y A LO-dy Rye Map � � Lot (.PT Unit
Florence Miq 0104D;. Zoma Overlay oistricl
_ =EI n SC District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Racerd:
611 11ePn 6 Into�l�.�'y5�r� 54 A lanAi (lye GlnreGro rnR OIG(od
Name(Print) St Teurr t Melling Add s:
l��BN
�)no n�+nrhoc^)
Telephone
Signature _
2.2 Authorized Anent:
C (n L)n e SJ 4> 44,N.mpian rn e OI O'7 �
Nam.(Print Current Malling Adtlr ss'.
�41:.',) 5Q7-4'115
SignnlureTelephone
SEfTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by peooit aDDlicant
1. Building (a)Building Permit Fee
OpFln d 0 .
2. Eil.vicai (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Tota1=(1 +2+3+4+5) QOO. 00 Check Number
This Section For Official Use Only
Date
Building Permit Num r: Issued:
Signature: 5 Z,5-2019
Building Commissioner/Inspector of Buildings Date
S-` hemnson @ rciroI .com
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
1
SECTION 5-DESCRIPTION OF.PROPOSED WORK(check all applicable)
New Nouse Addition ❑ Replacement Windows Alteratlon(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Dacka (❑ Siding[0] Other[❑j
Brief Description of Proposed 1111 ,,
Work: See tta(`hlI
Alteration of existing bedroom___—yes_No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes __No
Plans Attached Roll -Sheet
ea.If NewaM1oU§ ard:uraadifltlt+ltbtsitlsElnbtlSouslDst: c`O nCflete tFae folfowlDa.
a. Use of building:One Family Two Family Other
b. Number of rooms in each family[mit:__._ Number of Bathrooms__
c. Is there a garage attached?
it Proposed Square footage of new construction. Dimensions
e. Number of stories?
f Method of heating? Fireplaces or Woodsloves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. 'rype of construction
I. Is construction within 100 ft. of wetlands?_Yes _No. Is construction within 100 yr. Ooodplaln_Yes_No
j. Depth of basement or cellar floor below finished grade
k, Will building conform to the Building and Zoning regulations? Yes,No.
I. Septic Tank_ City Sewer_ Private well_ City water Supply_
SECTION To-OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR Bp UILDING P
� AERMIT
_ ; �POYy l'IOI�\l rlh '- rd as Owner of the subject
property ✓l __//��
hereby authorize r alYYYIYIO
to act on my behalf,in all matters relative to wo authorized by this building permit application.
�o r �4nrhod US - ao- Iq
Signature of Owner Date
_/Ila rK I1e s IP — /1 S uteri od =Dta
as Owner/Authorized
Agent hereby declare that the statements and Information on the fthe best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of OwneriA enl
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed ConstructionS�upe"Isor: Not Applicable Elry/�
Nem.of Llcene.N.Id.r: II InY foli5le- CS - O7ys3y
License Number
,5� ri r+an ml� 0103-7 05 - 03- a0 a 0
Atld=ss T Expirallon Date
N1315a�- 4��5
Signature Telephone
9.Registered NOIIIe%IrcrpWyemeht ContYertw: Not Applicable ❑
P) C Z RCOA'n[ LLP lalod35
Company NameU IRegistration Number
( n �-Ine St a)t_+1-kava, kin 100A 010`13 IDS - 05 - a0a0
Aodre:� �— Expiration Date
Telephone 413'Ja7-Y'/'IS
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.O.L c 152, §25C(e))
Workers Compensation Insurance affldavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the Issuance of the building permit.
Signed Affidavit Attached Yes....... F( No...... ❑
RC.I. Roofing Estimate Date
6 Line St.
Southampton,Ma.01073 5/9/2019
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
Kathleen Goodwin-Boyd
54a Lonely Ave
Florence, MA 01062
Terms Rep
Estimate valid for 45 days Chris
Description Total
Remove existing roofs on older sections(newer addition not included). 13,200,00
Furnish& install aluminum drip edge,pipe flashings,chimney flashings(if needed)and step
Bushings.
Furnish&install CertainTeed W interguard 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 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.
Add$1500 per skylight to replace �/�s fll yl _
Add$5 per linear sq.ft to replace gutters&downpouts
Add$10 per linear sq.ft. for fascia board replacement
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $13,zoo.00
TERMS OF PAYMENT
5%Deposit Customer Signature: .
Balance upon completion
Registration M 126235 Date:
Construction License R 074334 � /
Insured by Banas&Ficken Ins. L L/.(Z L�� 0,6/
(413)527-2700 Shingle Color Selection:
LLt ceae-e ea9}S, -
City of Northampton
Massachusetts
DEPAETNENT OF BUILDING INSPECTIONS 2
212 Main Strut • Munlnipal Building
Northampton, MA 01060
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and
subcontractors performing improvements or renovations on detached one to four family homes.Prior to
performing work on such homes, a contractor must be registered as a Home Improvement Contractor("HIC").
M.G.L.Chapter 142A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing
at least one but not more than lour dwelling units....or to structures which are adjacent to such residence or building"be
done by roistered contractors.
Note:If the homeowner hd.
as contracted with a corporation or LLC,that entity must be registered.
Type of Work: A 041✓f0 Est. Cost 1'3. -CO. Oh
Address of Works,/ A l nn/jy� GIO✓Of1L � fhA
Date of Permit Application: n5- a 0-(q
I hereby certify that:
Registration is not required for the following reason(s):
_Work excluded by law(explain):
_Job under$1,000.00
_Owner obtaining own permit(explain):
Building not owner-occupied
Other(specify):
OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED
CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT
ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND
UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK
PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION.
Signed under the penalties of perjury:
I hereby apply for a building permit as the agent of the owner:
Ob- ao -i9 la(a135
Date ConVactor Name HIC Registration No.
OR:
Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property:
Date Owner Name and Signature
City of Northampton
Massachusetts �„e✓ �.: :`6
i
DEPARTMENT OF BUILDING INSPECTIONS v )
213 Main Street .Municipal Building
Northampton, MA 01060 �e
Debris 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.
The debris from construction work being performed at
54 A Lnn l Ago Flora✓ce mq
(Please print house n ber an street name)
Is to be disposed of at:
(AID (Please prin L.
d TonFiliA Ii
Or will be disposed of in a dumpster onsite rented or leased from:
() llnrr .nl Qorrrlrna
(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.
a\ The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
VWiavkers'Compansaflon
Boston, MA 02114-2017
www.mass.gov/dia
Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant If m t' n Please Print Legibly
Name (Business/OrgmizatioMndividual): h C I LLP
Address: (0 ] t ti P +top j- O �
City/State/Zip: SoU+ri_MP:J�n.M A 01093 Phone#: 5D7- 05
Are you en employer?Check the appropriate box: Type of project(required):
L�l am e smployerwilh__/5_employeca(full and/or part-time)." 7. []New construction
2.[]lemasole propriUonmpennasbip mWl�avem employees working foroxin 8. Remodeling
any capacity.IN.workers'comp,insurance required.]
)al am a hameowner daingall wosk myself IN.wmkers .]
comp.no, ..cerequwdI 9. []Demolition
4.[]I am a homeowner end will be hiring comortora to conduct all work on my property. twill
11][]Building addition
cosine that all contractors deur have woskaicomperuation insurance or are sole I1,0 Electrical repairs or additions
prapristors with no employees.
12.Q Plumbing repairs or additions
5.Q I em a general convector it I have hired the sub-contractors listed on the attached sheet.
rinse arm-notcrs havecmlava and lva warkas'.W..wmance.s 13. out repairs
mm
6.[]Wc ate.em, montaninsomccre have acraked their nigh.fexemption per MGL c 14.QOther
152,41(4),andwe have no employees.IN.workers'wrap,monarce required.]
"Any applicant that checks box 41 at also Micas the section below showing their workers'compensation policy information.
t Hmomocas who submit this affidavit indicating they are doing rill work and then hire outside contractors at submit a new affidavit indicating such.
IContrectors that check this has moa reached rin additional sheet showing income of the sub-contractors and stele whether or not hose entities have
_employees. if the aub-wnaec mar have employees,they must provide their workers'comp,policynumber.
I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information. —r n
Insurance Company Name: T /{1 m r!hn7l _Lrt 0,104 0 6)
Policy Nor Self-ins.Lia M: Vr/C I ODin/t QaL t1JQQJFtA Expiration Date: /G' O$-,=1O /4
Job Site Address: City/State/Zip:�IhJ'P Yl(R 1V1p QlCtaa
Attach a copy of the workers' core ensation 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.
/do hereby certify under the painsndpenalties ofperjury that the information provided above is true and correct
Sienahrre� Dare 05 a0 19
Phone N� /13) 5a7- 4775 - - -
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 5.Plumbing Inspector
6.Other
Contact Person: Phone N:
AC)& CERTIFICATE OF LIABILITY INSURANCE ATA o;;191"s")
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 CONSTRUTEA CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTA T. 0 the cerfificaft holler a an ADDITIONAL INSURED,Me policy(les)must have ADDITIONAL INSURED provisions or a endorsed.
If SUBROGATION 13 WAIVED,subject to the Mans and conditions of the policy,certain policies may require an endorsement A 9ta0ement on
this certificate dose not confer rights to the mrNlcate holder In lieu of such endomement(s).
PRODUCER N E, MichaelR Banal
Game&Fickert HIoxE . 613-627-2700 uc xo: U3d2]-0849
PAS
Insurance Agency A kw: m2Imnasinsumnce.c0m
63 Main Street
Easthampton.MA 01027 IXSU eAFFORDINGCMEMGE XAIC/
INSURER A: Admiral Insurance Co. 21856
INSURED INSURERS: Safety lnsunnte Co. 39054
RCI Roofing,LLP INSURERC: Admiral Insurance Co. 20856
6 Lim Street INSURER D:
Southampton,MA 01073
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITLSTANDINOANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENTWITH RESPECT TO PMICH THIS
CERTIFICATE MAY BE ISSUED OR MY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSIR
LTR TWE OFINSUFAI INS41P NAM POLICYNUMSER MMIDDIYYYY) I.DNYYD UMTS
1W. EIRMIGESIBRAILUARIMIT EACH OCCURRENCE S 1,000,000
CIAIMEAMDE ❑X OCCUR PRIFUSESIES REA 50,000
MED CUP s 6,000
A X CA000020MMS 03104MO 03IOa120 PERSOIWLSADYINIURY B 1,000,000
GEWLAGGREWTE LWITAPPUES PER: GENERALAGGREGVTE $ 2,000,000
POLICY O jELTT EILCL PRODUCTS-OOMPNPAGO S 2,000,000
ZEN: S
AViOYDdLE W&LILY Ef%y0M1 S 1r000,0O0
NIYAUTO BODILYINJURYIPwpnm) S
B SCHEDULED
AUTOS
AUTOS oXLr X 62D7761 09I3DMB 013M9 BODILY INJURY(PIN ) $
x WRED x NON-OANEDS
AUTOS ONLY AUTOS ONLY Par
AAAU� S
UYBREl1A WB pCCUR EACH OCCURRENCE $ 6,000,000
C EXCESS DAB oc":CLUMAUE, % G%000000386-03 03/04/19 03/04/20 AGGREGATE 1 6,000,000
DED x RETEMION4 10,000 s
MRNERE COSENS"Anon BTATl1IE Efl
AND EMPLO VLIABILITY YIN
ANY PROPRIETORPORTNEWEXECUINE❑ NIA EL EACH ACCIDENT S
OFFICERMEMBER EXCLUDED➢
UA_NAAyln Nm E DISEASE-EA EMPLOYES
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DEBCRIPTONOFOPERATONS. E DISEASE-POLICY LIUT s
DESCRIPTION OF OPERATIONS I LOCATIONS YEWCLES(ACdO tM,AndwW Ror-na SchMWR may W aYwMd M mon wu Y r Inxu
ROOFING CONTRACTOR.
CERTIFICATE HOLDER CANCELLATION
THE EXPASHOULD NCEOATH THEEREOF,NOTICE
WILLBOF THEABOVE DESCRIBED E3BEOANOELLED BEFORE
C®� A
THE EOELIVEREDIN
115 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
nco oiz CERTIFICATE OF LIABILITY INSURANCE
0&1912019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND, IMEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTIRORRED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: N the certi0cate holder ie an ADDITIONAL INSURED,the p.HcAlas)must be Endorsed. If SUBROGATION IS WAIVED,eubl.d w
the tonne and conditions W the policy,certain policies may requirean Endorsement A statement on this certificate does not eonfEr rights to Me
.tatl0caM holder In If..of such endorsement a.
P.C. CONTACT Michael Banns
BANAS 8 FICKERT INSURANCE AGENCY •"M'! 813 527-voo W.N,;
L a el ban. Inaulenca.wm
63 MAIN ST INSUMBSAPPOMMXOCOYMAGE xucE
EASTHAMPTON MA 01027 INSURERA: AIMMUTUALINSCO 33750
Xaunw
NEVMERa:
RCI ROOFING LLP IxauMEMc:
W.URERw
6 LINE STREET INAII.A.:
S0UTHAMPT0N MA 01073
COVERAGES CERTIFICATE NUMBER: 379588 REVISION NUMBER:
THIS 13 TO CERTIFY THAT THE POLICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING PNY 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,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWMS.
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dem.far bewfit.W employee.In states Mer than Massachusetts if Na insured hire.,or has hired Nose employee.mWdB of Massechues0s.
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CERTIFICATE HOLDER CANCELLATION
SHO�� ME EXPIRATION
DAM THEREOF, N TICS SLL BE DELIVERED
IN
w THE E%PIRATIOX DATE THEREOF, NOTICE WILL BE DEWEREp IN
Reference Copy ■■V_ ACCOIaDAXCEWRH THEPODDY PRGN610N3.
Reference Copy
AVTMORIEFDRIPREaMrAIIVE
Reference Copy 3—(1�-LPX
Daniel M.Crq*y,CPCU,Vice President—Residual Market—WCRIBMA
01988-2014 ACORD CORPORATION. All rights reserved.
AC0RD 25(2014/01) The ACORD name and logo are registered mart W ACORD
srat z aorncsn> '
9/ceW11iurume.ARMaws ReB tion
HOME IMPROVEMENT CONTRACTOR
TYPE:Partnetahlp
B Expiration
120236 l 05/0572020
RC1 ROOFING,1 N ji
�
F,A COmmonweallh of Massachusetts "
fiAARKT DEL{SC 'kit t J( � ,,.n�,,� Olvixf-n of PrafessOnai Licansure
6 LINE ST /,/ � $ _ Board of Building Re ulallons and Stafltlards
SOUTHAMPTON,
�°
Undersecretary Cons tµCt3tlr allO>�s and r
__., . CS•074334 r �4 B&Plres 0510312020
Regiatratipn vaild for individual so only p
before the expiration date. if found return to: MARK THOMA60Eii]�t� ^.
Offics ofConsumer Affairs and Business Regulation 6B gR10066T EE7
1000 Washington Street-suits 710 EA@THAMPTO �A p�,p,f
Boston,MA 0� _ _ +O1f51X5i.10yt110
` Commisslonar l/r"'
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