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25-022 (3) 141 RIVERBANK RD BP-2020-0555 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25 -022 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-2020-0555 Project# JS-2020-000957 Est.Cost: $9000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: RCI ROOFING 074334 Lot Size(sa.ft.): 5445.00 Owner. REARDON ANN C tonin . Applicant: RCI ROOFING AT. 141 RIVERBANK RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 _ Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:10/31/2019 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: FeeTvpe: Date Paid: Amount: Building 10/31/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Department use only City of North pto sof Permlt Building De rtm nt r t1t/flrlVewa `Kermit 212 Mai Stre t SCI Y � `•- �O Se !$,epfl Availability Roo 100,x, T ,Q� Wa rNve.Avallat�lhty Northampton, 9 T o Set of Structural Plans phone 413-587-1240 Fax 4 '80 ppc olSit Pian APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR D.EMbLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office j9 Iver balLk PJ Map Lot d yZ Unit Nor4llM I-0n I fn Iq Zone Overlay District Elm St,District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 OwnerofRecord: Name(Print) I VD r 2 Current Mailing Address: � )P (� ccs 99-3,3 Telephone- Signature 2.2 Authorized Agent: C Name(Print) C CO LIt1Q -,3 r)u±k t p-�m �Id� Current Mailing Address: 5Q-7 - LI 1� s Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION Cfbypermit Item EstimatedollarsElicant Official Use Only com feted a 1. Building P)04 0 _ (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of ----- Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total= (1 +2+ 3+4+5) — Check Number a This Section For Official Use only Building Permit Number: Date Issued: Signature: O Building Commissioner/Inspector of Buildings Date Spsoh @ rcl roo-jk'►,2 corn EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) SECTION 5-DESCRIPTION OF PROPOSED WORK check all a licable) New House EDAddition ❑ Replacement Windows Alteration(s) Roofin Or Doors E] g Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [❑ Siding [0) Other[01 Brief Description of Proposed ''II Work: S Q i tr7 �ed Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes Plans Attached Roll -Sheet —No fa. If New house andoraddition to existing housing, Com tete the followin a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain 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 7a-OWNER AUTHORIZATION -TO BE COMPLETEDWHEN �] OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Ann �Qf aj() property as Owner of the subject hereby authorizeca Ana I'1G to act on my behalf, in all matters relative to woo authorized by this building permit application. P ailoohod lC- a x019 Signature of Owner Date < ds I,P- I f 7r7rfzpd aa) !+ as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name l0 - a8 - ao1 Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: /fin Not Applicable ❑ Name of License Holder:_ Mar ar& Q I i,� IP — � License Number ri E AddOIGa GS - 03- a0 a 0 ress Expiration Date Signature Telephone 9. Registered Home Improvement Contractor Not Applicable ❑ P C= rS4InG LLP iac�a3s Company Name Registration Number Address `S-f' 10`13 CSSy5 aOQU Expiration Date T Telephone_4I,3-Say `I 7- � 4 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) Workers Compensation Insurance affidavit 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.,..... I( No...... ❑ RC.1. Roofing Date 6 Line St. Estimate Southampton,Ma.01073 10/15/2019 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Ann Reardon 141 Riverbank Rd Northampton, MA 01060 Terms Rep Estimate valid for 30 days Angci Description Total Remove existing roofs. 9,000.00 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 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.ft.for wood decking replacement if needed. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Tota I $9,000.00 TERMS OF PAYMENT 5%Deposit Customer Signature: Balance upon completion '1/L1% � Registration# 126235 Date: Construction License#074334 // Insured Banas&Fickert Ins. (413)52 7-7-2700 Shingle Color Selection: �ES c2 1JN SA rz� City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS a 212 Main Street • Municipal Building �7. Northampton, MA 01060 ass' •......• O� 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 four dwelling units....or to structures which are adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC, that entity must be registered. Type of Work: Est. Cost: DOD Address of Work: 1 U I 9 vio r h n f- 21 No 64a rn � MA Date of Permit Application: lh- Q7- ac)1� , 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: o - a • T. o LLP co35 Date Contractor Name U 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 � � w•• r4 DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building Northampton, MA 01060 mss•..,,,....,��� 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: Ll I K1Up �!�,r �=i1��iY� (Please print house number an street name) Is to be disposed of at: (ale5unctpr FCcri /� (Please pnntffiame a`}hd location of facility)Orwillwill be disposed of in a dumpster onsite rented or leased from: (Company Na a aCnrdyA — )rr ��, 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. The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 Congress Street, Suite 100 d Boston,MA 02114-2017 °V www mass.gov/dia «'orkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): 6 C, LLP Address: b Line. S+rpP+ _ City/State/Zip: �' Phone#: ,5a 7- 1)5 Are you an employer?Check the appropriate box: Type of project(required): I.5d1 am a employer with _employees(full and/or part-time).* 7. ❑New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 10❑ Building addition 4.F-1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�y'1!toof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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(tire outside contractors must 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. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T. /{�, Ir+uoi 13.S 11 p Policy#or Self-ins.Lic.#:_V W C 10 0(nn a a to V 7Q 617 A Expiration Date: /0- 0.5-d U aO Job Site Address: y R lvP rhan_L d City/State/Zip: Q IC)(po Attach a copy of the workers' compensation policy declaration page(showing the policy number and dxpiradon 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. I do hereby certify under the pains id penalties of perjury that the information provided above is true and correct. Signature: Date: 30 Phone#: L13) 5Q-7- 9795 OJJicial 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#: AC'"RI CERTIFICATE OF LIABILITY INSURANCE DATE(/07/1YYYY) 10/07/1 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 CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be 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 certificate holder in lieu of such endorsement(s). PRODUCER NAME: Michael R. Banas Banas&Fickert PH Banas Ext: 413-527-2700 A/C No): 413-527-0849 Insurance Agency 63 Main Street ADDRESS: mb banasinsurance.com Easthampton,MA 01027 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Admiral Insurance Co. 24856 INSURER B: Safety Insurance Co. 39454 RCI Roofing, LLP INSURER C: Admiral Insurance Co. 24856 6 Line Street Southampton,MA 01073 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION 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 OATH 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. N SR ADM SUER LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any oneperson) S 5,000 A X CA000020963-05 03/04/19 03/04/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 [g PRO- POLICY 7 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ea accident $ 1,000,000 OWNED SCHEDULED BODILY INJURY(Per person) $ B AUTOS ONLY X AUTOS X 6207761 09/30/19 09/30/20 BODILY INJURY(Per accident) $ X HIRED x NON-OVVNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S 5,000,000 O EXCESS LIAB CLAIMS-MADE X GX000000385.03 03/04/19 03/04/20 AGGREGATE 5 5,000,000 —TEDTX RETENTION$ 10,000 WORKERS COMPENSATIONS PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDE D9 ❑ N/A (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) ROOFING CONTRACTOR. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 11 1 AUTHORIZED REP 5 111tJIVE 15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD / , ® DATE(MMIDDIYYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 10/07/2019 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 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be 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 certificate holder in lieu of such endorsement(s). PRODUCER CONITIT NAMEA Michael Banas BANAS & FICKERT INSURANCE AGENCY IMC.PHONNo.E Extl@ (413 527-2700 (,C No: E-MAIL ADDRESS: mb@banasinsurance.com 63 MAIN ST INSURERS AFFORDING COVERAGE NAIC p EASTHAMPTON MA 01027 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: RCI ROOFING LLP INSURER C: INSURER D: 6 LINE STREET INSURER E: SOUTHAMPTON MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: 457722 REVISION 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. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD MM/D COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F-1OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ �/ $ WORKERS COMPENSATION /� STATUTE ETH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT S 1,000,000 A OFFICER/MEMBEREXCLUDED9 N/A NIA N/A VWC10060226472019A 10/05/2019 10/05/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sample ACCORDANCE WITH THE POLICY PROVISIONS. Sample AUTHORIZED REPRESENTATIVE Sample MA 01073 Daniel M.CrcI1•ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD SCA 1 0 20M•05117 Office of ConsumerAffairs &Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE.;,..Partnership ExRl 0510512020 RCI ROOFING, .,.R'�,:ji�L'L•'-�`�•� " MARK T.DELISL ti. . ,•;•: Commonwealth of Massachusett3 ' t� .� ..,'` ' rre" `� Division of Professional Licensure 8 LINE ST �%\�-�`•:��- Board of Building SOUTHAMPTON,M'A" 1Q7�i" g Reg�ulations and Standards Undersecretary Co n s,�rtt�,C't1rii�t$'t1 .rvls or --- CS•074334Oplres; 05/03/' Registration valid for Individual use only before the expiration date. If found return to; MARK THOMA�!'S D'E �l' �� w' ,N l .` •, :.yi;; Office of Consumer Affairs and Business Regulation 69 BRIGGS ST'�EE,7 Washington Street•Suite 710 Boston,MA 02118 EASTHAMPTO : At%.0�` `! Bost 115. Commissioner A&I Not valid without signature M SAC: HOME IMP59VtF P)RONTRACTOR �A ;. H.U'SE.7 <' t •"'''f ,,. ..!.t<t.i;,,f4; SHEET.M >t3A,L:•' ,. t �1c�t60F1- IN +':;; �'•( f::, tr;;:, ,�., S•, ;F7{:E,, WCSR R:. 80V4A � , � `\ 4,� ts, ISSUE , •: .F K. 5 r . OLtaO. t ,{ 010 " �,, t:' VVJN:G"L('Cf:NSE :•• ',;�•,,,,r , .J r•fik M K T•D'E'LIS-LISLE '�s,' Reglstratlori tl..... ..,'tf y� ffecti :fa,3$>>1�, '9;b'R1G' S.�t,• Explradon ;i' �:,. G•$;;:$, .•t..,:;,,,,°> ,:" HIC,0624741. .,<</u�F' a: 1. MA :p1, SIGNED /',i �' g=z1^': r tlof> 112 7 466498 COMMONWEALTH OF MASSACHUSETTS • • � , SHEET METAL WORKER$ ISSUESTH.E FOLLOWING'•LICENSE BUSINESS MARK T DELISLE RCI ROOFING t,:L'A EASTHAMPTON;`MA01073'" \rl'rt J 601 09/09/201 714002