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17D-060 (10) BP-2023-0721 20 GARFIELD AVE COMMONWEALTH OF M SSACHUSETTS Map:Block:Lot: 17D-060-001 CITY OF NORTHA PTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGI TERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARA TY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2023-0721 PERMISSION IS HEREBY GRANTED TO: Project# ROOF 2023 Contractor: License: Est. Cost: 9200 JONATHON RIGALI 108346 Const.Class: Exp.Date: 05/01/202 Use Group: Owner: DRIS OLL MARY H Lot Size (sq.ft.) Zoning: URB Applicant: RIGAL ROOFING EXTERIORS CONSTRUCTION Applicant Address Phone: Insurance: 241 WEST HARTFORD AVE 656ZUB-OW38670 UXBRIDGE, MA 01569 ISSUED ON: 06/05/2023 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: i . Tt, . Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax (413)587-1272 Office of the Building Commissiiner The Commonwealth of Massachusetts / V ,5'(.1 W Board of Building Regulations and Standards,. IPALITY Massachusetts State Building Code, 780 CMR-.o'/,. USE' yq. Din Building Permit Application To Construct,Repair, Renovate Or Detlt�aff A R ised'liar 2011 One-or Two-Family Dwelling 'gVn,N'nio This Section For Official Use Only Buildin Permit Number: /3 f7'"o4 5A 7 i Date Applied: \\\ Ev►ns (Z-3-5 //�� L- 5-2623 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro er Ad ess: „I ` 1.2 Assessors Map& Parcel Numbers -O 6ef-Firlo� CAN_ _� lOfev1(L- 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record:\ pp ((__II .1.w N�)'16\ ,ix 5c 1\. 2O 6.d 7f,t-►(it A0-e- Vi U-' Name(Pint) City,State,ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0----Owner-Occupied 0 Repairs(s) 0 Alteration(s) Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work': 54 r;t? r, caJA.4 did-ki .Dfts4.1( 141-"v Se') -(tac r 4ft.-tnr‘'kG",c vot I 5Se.iv ' f 1' Srw.✓1Stce `� f✓',,e,y 3./ 4-u,•lw c-- u.Aq Lr r — - , Ql tyC_ ,�_t _ i -. - S76 La-t Al n e m" SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ of eel, ��- 1. Building Permit Fee: $ Indicate how fee is determined: i 0 Standard City/Town Application Fee 2. Electrical $ 0 0 Total Project Costa (Item 6)x multiplier x 3. Plumbing $ O 2. Other Fees: $ 4. Mechanical (HVAC) $ 2) List: 5. Mechanical (Fire $ d Suppression) Total All F e $ — 40 Check NoL1L' Check Amount: 6.Total Project Cost: $ 4l2c0, 0 Paid in Full 0 Outstanding Balance Due: ferrecxl revyThr j 0 0 ri 01.ii eG ,,vAoa . cam SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) — 41nau.` J2 ense u 3ber x , License Number Expi on ate Name of CSL Holde List CSL Type(see below) V elf G.J.f‘, v`"2--_ No.and Street Type Description / ^ Unrestricted(Buildings up to 35,000 cu.IL) V K ID!cel5e, 4 OI(1tc 1 R ; Restricted 1&2 Family Dwelling City/Town,Statef&EIP ` M Masonry RC Roofing Covering WS Window and Siding r' SF Solid Fuel Burning Appliances Jo v v1 pd.1.pti�• I _Insulation Telephone Emailess D Demolition 5.2 Registered Home Improvemenit-Contractor(HIC) t t f 7G r'.ot� (ie k'e. HIC Ie gist a�Number Expir n Date x HIC pang Name or HI egit Nadipe Za L rS}^ �'iT� — Jo &4,i— No.and Street Email dress 'W'- p l'1cG( 4l3 ?-I -8'25' • City/Town ate,ZIP Telephone SECTION 6: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 ❑ No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I ereby attest under the pains and penalties of perjury that all of the information contained in this application is , e and a ate to the best of my knowledge and understanding. Ehi7 Print Owner's or Au o zed nt's N: a(E ectrom 'gnatur Date NOTES: 1. An Owner who obtains a btu .. ,ermit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Numberof bedrooms Number of bathrooms Numbr of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts l` l!g�!t Department of Industrial Accidents =nt,_= 1 Congress Street,Suite 100 _ 1-j= '� Boston, ALA 02114-2017 ,;��,.� www.mas s.gov/dia %Yorkers'Compensation Insurance Affidavit:Builderslfontractor±u'Electricians/Piun►hers. '1 O INE F ILl!)W'ITll"[IIE PER'111'ITING AUTHORITY. Applicant Information 1 Please Print Leeihly Name tlousinessOrganiatiimllndividual): /E,,e> 4.1..54-4,C;-w� I Address: �-k(( !n)es,)-- l cox_ City/State/Zip:1Of.4jn yy4 of 541 Phone#: 4O3 ( /7 Arc yea an employer?[Aetlt the appropriate box. 1 Type t Type project(required): . I am a erect'''.LT with enrplo}c.s(full:nrd'or part-tirnc).' 7. D New construction -'; I am a molt proprietor or punne ship and have nu ctnpluy,era w urkinr:^ Cur me is S. D Remodeling my Capacity.[No workers'comp.insurance required] 9. ❑Demolition 30 I am a hart u ner doing all work myself.INar outliers.comp.'roman.reyuucal.l' 10 El Building addition 4.Q I am a honrarwn r and will be hiring c.I1tracturs to conduct all work on my property_ I w'ill CTeMlie that ill corwaerun either have vsori.ers.compensation insurance or arc yule ii Electrical repairs or additions prupricturs with nu cTrrplutirca. 12.0 Plumbing repairs or additions 5 am a gCTreral contractor and I have hind the sub-contractors listed on the:uiached sheet_ 13 f repairs These sub-contracwrs have employees and have workers'comp.insurance.; 6.0 we are a corporation and its officers have exo cised their right of exemption per MGL e_ 14.[3 Other 02.§1(4).and we have nu employees.[No workers'comp_insurance required] *Any apphcant that checks box PI mini also fill out the section below showing their workers compeasatioa policy information. +Ilurnuwiw s who submit this affidavit irnlicating they are doing all work and then hire outside contrarian auk admit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet shone ins the name of the suI.-coutracturlsod stale whether or out those entities hair eTnploices, if the sub-euntracuxs have ellipluye-s,they must prueredc their workers carp_pullicy number_ I am an employer that is providing workers"compensation insurance for my employees. Below Ls the policy and job site information. Insurance Company Name: A-(- A r v/v.-rGx" crA s w-rrvc l.L_ (c vymi — Pokey#or Self- Lie.#: 5 ZiiR ~oki3 ' --' -.23 Expiration Date: Z 6p/Zy lob Site Address: 2e 6a/ ��_ CityrStatr&'Zip: I kt 4 z - /)/�1 J- 6440 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 D1A for insurance coverage verification. I do hereby c• tiff under he pain.and penalties o"p erhor-t that the informratrrw)r:rrnid I above is true and correct_ !i Signature: \ 7 ])ate 5/. )- Phone» �r: ' 7 Zlr "8l • Officio . 'on! Do not write in this area,to be completed by city or town ofciaL City.or Town: Permit/l.icense# issuing Authority(circle one): I. Board of health 2. Building Department 3.Cityl'iown Clerk 4. Electrical Inspector 5. Plumbing Inspector G.Other t ontact Person: Phone If: A RD® CERTIFICATE OF LIABILITY INSURANCE DATEiMWDDlYYYYi 05/31/2023 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 CONTACT Gregg Parker Robert A Parker Insurance&Financial Services ac°,"r o,Eat): (508)234 3439 Nc,Nol: (508)234-2778 174 Church Street ADD I S: gparker@rapins.com INSURERS)AFFORDING COVERAGE NAIL* Whitinsville _ MA 01588 INSURER : Nautilus Insurance INSURED INSURER B; Green Mountain Ins Co Inc 20680 Rigali Exterior Construction Inc. INSURER C: Ace American Insurance Company 0 241 Hartford Ave West INSURER D: INSURER E: Uxbridge MA 01569 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 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 NED SU p POLICY NUMBER (MMILDI CY EFF POLICY EXP LTR D Y) (MMIDDIYYYY) UMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMACLAIMS-MADE X OCCUR PREMISES E T(Ea ocwEcD nce) $ 50,000 MED EXP(Any one person) $ 5,000 A NN1507795 02/072023 02/07/2024 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY n LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SNGLE LIMIT $ 1000000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OVTNED SCHEDULED 20049933 02/062 ccci 023 02/062024 BODILY INJURY(Per adert) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ _AUTOS ONLY _AUTOS ONLY (Per accident) UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS LIAB •CLAIMS-MADE AN1277447 02/07/2023 02/072024 AGGREGATE $ 1,000,000 DED RETENTION $ $ _ WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY C OANY FFICER/MEMBERfEXCLUDm?�cUTiVE YfN N/A 6S62UB-0W38670-7-23 02/082023 02/08/2024 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory lnNH) E.L.DISFASE-EA EMPLOYEE $ 1,000,000 If yas,tlesa'ibe antler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS f VEHCLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 Fax: Email: O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/22/2023 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 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 CONIACE NAME: Certificate Department A-Costa Insurance Agency Inc (AiC NE Ext): 508-875-3488 wc,No): 508-875-9388 EDARIL 1 Franklin Cmns ADDRESS: coI@a-caatains.com INSURER(S)AFFORDING COVERAGE NAIC S Framingham MA 01702 INSURER A: Pllgrlm7nsurance Company INSURED INSURER B: ACE American Insurance Company 22667 OVER THE TOP CONSTRUCTION INC INSURER C: 15 LAWRENCE ST 2 ND FLR INSURER D: INSURER E: MILFORD MA 01757 INSURERF: 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 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 --OF INSURANCE ADDL SUBR _ POLICY EFF POLICY EXP TYPE - - _ -- LTR INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES(EaEoccurrence) $ _ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JEa LOC PRODUCTS-COMP/OP AGG $ OTHER: $ COMBINED SINGLE LIMI AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ 100,000 _ - A ALL OWNED X SCHEDULED AUTOS CSC00001012968 1/14/2023 1/14/2024 BODILY INJURY(Per accident) $ 300,000 AUTOS - NON-OWNED PROPERTY DAMAGE _ HIRED AUTOS _AUTOS (Per acddent) $ 250,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERT AND EMPLOYERS'LIABILITY - Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICER/MEMBER EXCLUDED? N N/A 6562UB6R46837A22 6/24/2022 6/24/2023 - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. RIGALI EXTERIOR CONSTRUCTION INC. 241 Hartford Ave W AUTHORIZED REPRESENTATIVE Uxbridge MA 01569-1177 R ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD City of Northampton 'Z`rrJ sus sic r Massachusetts �a?' - `"f< fir DEPARTMENT OF BUILDING INSPECTIONS y `, 212 Main Street •• Municipal Building y`.,_ �.1. � -0: Northampton, MA 01060 -SYh..s CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility: ) \U C,., c�e -C___ l So )k . d-r.A s l The debris will be transported by: Name of Hauler: c Jec,_ C 04-4-‘r?).--• 7 Signature of Applicant: Date: .51 b-7j , la Commonwealth of Massachusetts lip, Division of Occupational Licensure Board of Building Re ula_tions and Standards Cons ion isor CS-108346 r� spires: 05/0'�12024 t JONATHAN IGAL1 241 WEST HA TTFO- a . t,.., ,' UXBRIDGE M 01569 -ft. • '��jL I I ,t3�� Lt d`l • /sOSrre%ae►ga'a IP n I1 Pi 7—T! . 6 V V,,O11OI*al J 1 AS 11(.1 ;Jf�t c.0 I . v `..'$iLuRu' s. I. J THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration - fr rA _-v __, Type: LLC RIGALI ROOFING AND EXTERIORS LLC. T r Registtatlon: 1766 00 241 WEST HARTFORD AVE 1 _'"� Expiration: 05/71/2024 UXBRIDGE,MA 01568 41� ENO Update Address and Return Caro. THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affairs&Business Regulation Registration valid not Individual use only before Me HOME IMPROVEMENT CONTRACTOR expiration date.It tound return to: TYPE:EEC Office of Consumer Affairs and Business Regulation Beglatf h100 Emanative 1000 Washington Street•Suite 710 178670 05/11 I2024 Boston,MA 02110 RIGALI ROOFING AND EXTERIORS LLC. JONATHAN RIGALI 241 WEST HARTFORO AVE 1 _p(v,, UXBRIDGE.MA 01569 Undersecretary Not valid without signature