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17A-266 (3) 86 OAK ST BP-2019-0014 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-266 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# BP-2019-0014 Proiect# JS-2019-000018 Est.Cost:$6800.00 Fee:$40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: UseGrouo: RCI ROOFING 126235 Lot Size(sa.ft.): 20211.84 Owner: LOUX DOUGLAS B&KERRY E zoning.: URB(100) Applicant: RCI ROOFING AT. 86 OAK ST ApplicantAddress: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:71512018 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: FeeType: Date Paid: Amount: Building 7/5/20180:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner ty of Northampton S,taema awPk(dNlt RECEIVED 8IdingDepartment nyib=(SwgAw�w�dPerlt � - 212 Main Street s§uunlu$apphs A4n'All$dM1t)I — RDOM 100 iva'a�s�dYNu.mllrA.vaatw�ahty JUN 28 2018 No he Don, MA 01060 Tiro beds>c(9&waownaq=Plans. phone 13. 87-1240 Fax 413-587.1272 IRldd4�tlezPtams 1,2_ gErvar S.IopArla;e r�r�-eFe�mne+nsree*wws— - --- No r CT, ALTER, REPAIR, RENOVATE OR DEM01.1811 A ONE OR TWO FAMILY DWELLING _CI ION 1 SITE INFORMATION: T }hill Se¢A wp to,ba ¢Otti1PC yOgIU I.1 P,rrputv,Ad IjyL; S(o Oak S+. Ma P' Le,e._ __umu Flo reme', Mp 2'm'ar - © ealny'o'ralntsr__, Elm s.n olalrraf �e-Dle.tstct-,_ 2:ECTION 2 • PROPERTY OWN ER�drHIP'IAWTHOFNZEO A5ENT ��alAs i K err8o Oak S /aru�e came(P Inq ICurrent Mailing Addlesa; 'SreQ,__Q` 2C�LLG2 __ Telephone 3ign3lure 2 AO[norl2Bd o—rity' Ptr . , - ,liLr _i%� L�iO19s L� 7. ;eme tannp /•�,� Ourre�nImelln\gAddress; ;cCTOI,j3 fisIfAMOP Estimated Coal(Dollars)to be �^ Ofllclal Wee.Only com leted b arm[( a Iloanb fhrikxng ,� - (a) EulldIrrg PUrmil foe Electrical - (b)Eslfrom strup4 Totmost of CtlflaMllf161A on).18I r lrlmnbing :BUliding Permlf Fae "0 CO I Arrchandal(HVAC) Fire Proleo(dr, toter + 2 +8+ 4 +6� �/o�'D - Check Number _ �_-. —_ ThIsr S.otlon For'OHlclai Use Only '�Lllldlng Permit Number:�-_�_ Br+11'ding. 'ommin'sf¢pe$In&pealor.g6B,ulltlings. Dara 96"GTION 6 ®5 mRIPTION DF �AJ_TOSHD-VJ'DRK Ich 'k Bit II ' blap' New House [] Addition ❑ Re placement Wlntlows Alteration(a) ❑ Roofing— �7 Of Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs fpf Do, fQ aiding pj Otherl0l Brief Descriplion of Proposed Alterslion of existing bedroom—_Yes,_No Adding new bedroom _Yes No Anached No'relive Renovating unfinished basomenl Yes - No Plane Attached Roll - Shea( -- --- sa,lf New hoiuA . t rrurvad'dllblibnYe;eiFs!Yhna 11o•IB�e'Ntg r�.mlpl:e4akd,�iug[pr a ,,h' '. r a. Use of building:One Fnmlly—,—_ Two Family Other—_--_, b. Number of rooms in each family unlC Number of Balhroomn__--- I c Is Ihar[harp. a garage allaohed?—,— I d. Proposed Square footage of new construction. Dlmeneiono e. Number of stories? f Method of heating?—_,— Fireplaces or Woodstoves— Number of each c. Energy Conservation Compliance. Masscheck Energy Compliance form attached? - ' h. Type of conslruotlon_�— Is construction within 100 it of wetlands?—Yes --No. Is construction within 100 yr, floodplaln__Yes No I Depth of basement or collar floor below finished grade i< WIII buildln9 conform to the Building and Zoning regulations? Yes No Septic Tank_-- City Sewer_ Private well_ City watery Supply___ SECTION 7aOWNER AUTHORIZ'ATION,-TO BE C OMPLET.EOWHEN -- - -- OWNERS 'AGENT URCQlNTIiNv0'M APP4IES FOR•BU1DINO PERMIT L as Owner of the subject properly / _1 d (� � 'ueieby authorize �, tdyr Cl P. �-�" �r Y IihYli-,p-(� io act on my behalf, in all manors reiadive to work authorized by this building permit aRNTot len. i Signature of Owner Dale ---_ lY-u'1(1Yi7 P(� OOPn as OwnerlAumorized nyenl hereby declare Ihel the slafemants and information on a foregoing applioallon are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury, --- Print Name Signature 1Ovg Agonl _-� Date -- C'ION e C6N3'I&WCTI O:N S:E RV'AC E9' I.icepsetl Co rucllon��6((�1�tRerv�l�i y� Not Applili/cable O rLLlco so o14Qf'�Ily g�1C�P ___ _1.'J. License Number �ln� � bLsYrrlol� YID 91Ir7� _—__— e lreas Expiration Gale =_�`��_—� �sl l�) ) art • 4`lrl .. naw,e Telephone `ec�sfere Wu9•g #g ��o-nane�Obr 1p -- Not Applicable O rti?e ny.Clla � Registration Number Iresa Expiration Dale 'TION 10 WORKERV OCIMPENSATICIA INSUBrANOE AFFIOAVIT(,M'.0 L o, ?F2, $.260,(())) frers Componsallon Insurance aifldavit must be completed and submitted with thle application. I:allure to provide Ihls allidavll will result ne dental of the Issuance of the bulldlnq permit, sed Alhclawi Alla)hed Yes....... Lc( No...... ❑ 11 � I..'IDI iF QyliD'Y:?`.T4�'XS(:rlrt4ltS�SZgIZ)i The ourrent exemptlon for"homeowners"was extended to Inolude mer occupiedDwellines of one(1) or Iwo(2)families anl to allow suoh homeowner to engage an Individual for hire who does not possess a lioense, provided that the owner Reis ms su e vlso , C�;,R 7811,sixth Edition Segtlo t 1p8 J 5 1 D¢Nrlt{glt orgeoavneq; Person (s) who own a parcel of land on which he/she resides or Intends to reside,on which there Is, n Is Intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm slrup0.rres.A uersgyLyq_a s ucts more than site home lu a hvo �egLge29,od shall not be considered Rjmneo ser. Such"homeowner°shall sdbmlt to the Building Official,on a form acceptable to the Building Offiolal thate e s all c rMonsib-I fot,qork performed under the hulldlno oevrntL As acting ons rn�c It on Sttoervlsor your presence on the Job site will he mqulred fiom time to time, during and upon complellon of the 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 Fmployess for Injuries not resulting In Death)of the Massachusetts Ceneral Laws Annotated, for persons) YOU hire to perform work for you under this permit The undersigned "homeowner" cerifiea and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and Stale of Massachusetts Ceneral Laws Annotaled. Homeowner Slgaahu•e_ ¢CA 1 4) 20M0511 ICommonweallh of Massachusells " G�'ieauynaasawerrVgs°Q./y'rrvuralw• Iry;�l Olvlalon of Professional Licensure r OHO E IMPROVEMENT &CONTRACTOR Regula Ilan \'W Board of Building Re vlallona and 5landerds HOMEIMPRO.VEMENT CONTRACTOR Cons`IpcS{> rfl$8' rvisor Refilelrellom. 126236 Type; ExplrellD�jlct /(2y SAX- Padnsmhlp CS•074334 Egplres 06/0W20201 `r a ts R.C.IROOFING YY C,N 110�� r ei Y FYS� e MARK THOMAS DE Q 1 b 4 69 BRIGGS STIIjjEET 7 1 MARK DELISLE ¢ YlJ t'la EASTHAMPTO0 6LINE ST bl Y 3. c.� x1.,., If)/4X.1.1011� I �� ,e� -•. SOUTHAMPTON,MA 01b73 Undev¢ecrelnry ^ D r1 Commisslonor �` I-Flc' ;5 current- e�cp. s-s-e-D' �fw� �. �°-� spy • OQ' `¢C MMO•—W A H'bL ' p..,'._..MA`S`7e� 'l7HL SETT, HOMEIMPRQVPrMIoe'�•GONTRACTOR ° ° • • • a R C t R'ODiFiNO 4LP �sy3,Tfxe �t �O '- F a SHEEIy(ft19L WbRKFSF, gr"y 61'INP+I ST C yy IS9IJES F E FOLLOWINV irA'SE c +. 'SOU01073 TOTED r c AprK T DELI SLE IGG HIC 0624741 12/0112017 11/30/2018 r EASTs fv1A 01 � '� n 02 , T01V 1327&!, � "sy _�.--- $s /28/3020 1 468489 v , . . '^ � 'I�.OMMONW.S H'SOF,MGTS 16G?HU'SE. ¢S, � " ' iV7ARK� ISSUES'' FOLIaOWJk, BUSINES ,�,� `T KriroELfSL 74 IRp MIN,GL P g4 0 �Fs'' A.VVV % 8 EAB. N, M °O 910912011 34'2236 p,YiA � 'r• . of 11 ../ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia VWVorkers' Compensualon Insurance Affidavit: Builders/ConU-actois/Electricians/Plumbers. TO BE RILED WITHTHE PERMITTING AUTHORITY, Applicant Information _ _ _ Ple so or int L rd Nettle (Business/OrgenizatioNIndividuel): LL12 Address: ,L/n41 City/State/Zip:�1Vwn bn MA 0/6/73 Phone#: a/3) ,5 7 - 1-1'77S Are you on employer?Check the opproprlate box: Type of project(required): .. LQ 1 am s employer with r 4) employees(full end/or pert time).' 7. []New construction 2 l am a sole protractor pannersup and have no employees working for mein 8. []Remodeling any capacity.(No workers'comp. insurance required.] i❑1 am a homeowner doing all work myself,(No workers'comp. Insurance required.)t 9. ❑Demolition 4.❑l am a homeowner and will be hiringcontractors to conduct all work on 10 ❑ Building addition y property. will ensure that ail contrecwrseitherhave workeri compensation insurance or are sole IL❑ Electrical repairs or additions proprietors with no employees. 12,[]Plumbing repairs or additions 5.❑I am a general contractor and l have hired lire sub-conlmotors listed on the attached shed. 17 QROOPrepalr9 These sub contractors have employees And have workers'comp.insurance.) 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.❑Other 152,F 1(4),and we have no employees.(No workers'comp.insurance required.] Any applicant that checks box AI must also fill out the section below showing their workers'compensation policy information. [Homeowners who submll this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. [Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees, If the submontreclors have employees,they most provide their workers'comp,policy nonber, I am an employer that Is providing workers'compensation insurance for my employees. Below Is the policy andjob site information. Insurance Company Name: t4d T.m IYlu1y2.�Zi1$t[/Q✓IP'C Cj, Policy#or Self-ins,Lic, #', /A,//,l/1'.-/(,'/J-(p 0,2�A/oc{'7-a0/7F(- Expiration Date', /0 Job Site Address', 9LI&A tSf City/State/Zip', LILMri,MN o/oi 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 ofthe DIA for insurance coverage verification. I do hereby certify under therein s it penutrips oftnalury that the Information p�ovided above is true and correct. Signal too Ff — - Date' / - 2/-/� Phone (31/3 ) v57- s/77S Offlcial use only, Do not write in this area,to be completed by city a•town offldal City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2.Building Department 3, City/Town Cleric 4, Electrical Inspector 5.Plumbing Inspector 6,Other Contact Pei sort: Phone#: Apr. 4, 2018 10:50AM No, 2462 P. 0 r� � OATk{MM10amttYl ACORb CERTIFICATE OF LIABILITY INSURANCE o41o4na THISCERTIFICATE1S ISSUEDASAMATTER NINFORMATIONONLYANDCDNR ALTER RIGHTS UPON THE CERTIFICATEHOLDER,ES CERTIFICATE DOES NOATE OF RNOR OESN NOT AMEND,EXTEND ACONORALTERTHECO HEISSUAPFORDIR SYTHE THORI E BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CON571TUTEA CONTRACT BETWEEN THEISSUING INSURER(5),AUTt10RREO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMO TANG I!"' CcrtMcato nolGeHs an ADDITIONAL INSURED,the poi cy(IN)MOS;pave ADDITIONAL INSURED provision of be¢,,dosed. If SUBROGATION IS WAIVED,SUJ*0t totho forme and conditions of the polity,certain pollcles may require an endorsement may statement on Ni.CortlAcate does not confer r: hts to the certificate IMA—in ileo If such anderaement(s. PRooucen nam Michael R.Sanee Vanes R Flckett " . 413427-2700 cy,413.527-0848 _ MSurance Agency eoo� mb banaDmSvdno..COm 63 Main Street 10URFEW AIFOROINO OGVU"OE NAICI Easthampton,MA 01027 txsUeert A: Admiral lnsUrance CO. 24855 INSURED INSURCRII; Safety Innuranoo Co. 19454 RCI Rooting,LLP INSURER s: Admhal insurance CO. 24856 6 Una Street INSURER o: SouthemptOn,MA 01073 INgRel 01 INSURER£: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THi51 TO CERTIFYTNAT THE POLICIES OF INSURANCE LIST£D9ELOYJHAVE BEEN 15SUEDTOTHE INSUR ONAMEDASOVE FOR THE POLICYPERIO0 NOICAreO. NDTMin5T o"C Nq ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO VO-0OH THIS CERTIFICATE MAY DE ISSUED OR MAY PERTAIN,THE MSURANCEAPFORDEO BYTME POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSlONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWM MAY HAVE BEEN RSOVCED BY PAID CLAMS. 1 R TYVfi OF M9UMNGe POLICY UMBER D EFIIA0061m LIMIre X COMMERCIALDENEPALUA9ILITY EACH OCCURRENC S 11000,01 CLAjmS of O OCCUR S 9 S 50 B( MPO E%P dery 8 10,0( A - X GA000020953.04 03104115 03!04119 PERSON 6ACv WJURt s 1000,01 E 'LAOORECAT5LIgqMOoIYAPQMSPER GENERA PORE T6 5 2000,01 PPUPY�JEGT Lit LOG PROOUCTYCOMPIOPA S 2,0000! OTHER; 1 91 n u gUiOMOBILC LIABILITY E 1000,0! A AUTO 900S.YINJURY(Pxpnwni b ^ OWNEV SICJHaoutED X 5207701 OWD117 09/3O11B atlmtnwupv lPv+:eeenq s B HIRED ONLY x N4NNNMOD AUTOS PRAY x AUToSONL,r S UMBRBLL'U"A OCCUR BACK C R£ CE S 5.000.0t C EXCESS JAB CIAIM VADE X GXOD000038"2 WWI 03104119 ARofut ATE s 5,000 Ot DEO X RE NTIONS 10-0006R AND 4MILOPMPENSAI N ANDEMPLOYERSLIAAIINY B.L EA HA IDEM S Oh'FICEOPJM .LV[flOA e-AXLU�E�7ECIITIVO Y� NIA L.045 9c•EA 425PWYEg 2 1Mtne+R°ry RNH) rp661MMUMe .OI POLICYLIMIT 0 tYyr DCSCRIPTIONOF OP PIONS denw 065CryP1{ON or 'BRATIPN$ILOOAPANSIVEHICi.i9 yiPPRG Rot,ACaleedMRamYn Schoid+.m+Ya+aMM+d it ma..'Pi<Pi+reaRtul} ROOFING CONTRACTOR CERTFICAT HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED£POLICIES BE CAR56tNED BEFORE THE EXPIRATION DATE THEREOF, RBFEFSNCE COPY, ACCORDANCEWITH THE POLICY PROVISIONS. AurtomzEO Rev s 1 r S �— ISA RD CORPORATION. All rights regalve AOORD 26 I201W031 The ACORO name and logo are registered marks of ACORO ;ERTIFICATE OF LIABILITY INSURANCE AS A MAT 1wlanor� TER 4F 1NFORMAT7DN pNLY AND CONFERS Np RIGHTS LYON THE CERTFFtOATE HOLDER. THIS OF INSURANCE DOES NOTLCON8 No, WE A ID, OR ALTER THE COVERAGE AFrO JCER,AND THE CERTIFICATE HOLDER, E EEN THE IgSUING INSUURER,$),AVTHO"D t hPtdtY is an ADDIT In the EZONAL INSURED,the pot kypeet muse be eed,ndpgIf SU ROGATION IS WAWED,subject to Ch nEOIsetYll((y O ielBE mPy Yegpim qn enE0noes nG A El8ttm8nt On lhia CerllfiCd(P IMF,92 GOnlq/ryptt#;P kt4C q Ino 6 Bauch 1878.3 1133)52]-9288 e 11131 SST-pe89 r . A,1.M Mutualh#Wefi:P Campan a It 873 C@R7IRIGAff NUMBER; West 74A7 7XE POLICIES OF INSURANCE 4fSTEd BELOW ryAVF SEE! ISSUED TREVISION NUMBER:Tra INPUAEC NNA40 ABOVE FOR THE POUC"PERIW 11TANOING ANY RECi6RMfkX,, mKVAIR THE OR CQYIXFON 0, ANY CDNifuCT OR @OTHSN uORAINi vsl H RESPECT tb WpICN Wql JONWAI.Iin) OR ONS Or EUCfrYppyUpES.L MI7S SHOWN MAY RANCE AFFORDED 9E�N OUCED ICIES PAIDOO Na t EO NERgiN Is SUBJECT T A4L Tile TERMS. JF wsy"Nue Eq "uIonwart MiY9 1N EACH OIxunapfG6 ; a4MADE []ODDVA MBP6AP Wyam Pe,.ml s PF��A`tbAP/fNfiMY P OW6(NL AGGR6Wtfi ; ;;WelNiiM'Pl1e8P6A: cAL6JGt5.WMNPppdd S Y i &LEW.&DTY 5 ',MTC PDD6Yiuu1 y(PN Pswt 3 ON u 6v"NEOV4QP MollyItYAMT IRmucefmp S OE 0 "o-5 -.Ay o1FOM1 5 S S IIAfI{AIUB OCCItR EACNOGG�RRENDB 5 :SSSUAB CWMSH.a➢6 F:+CAG$tT6 S I Rfi6A'fkSN S i I@&P+E�EtCB$R N x o 2w%9w'CtR"ty NIA VW0-100.6022947.2017A 1OM017 1015/2016 £x.eAeNnodo6NT r Jt�PO em,AMee,O�+lw� e.t.PiEtnsE•EA c�wLo+� s NP6`pROOEGIiO 56 SLDISFA66.PWYT:,YAIT s �.QQ.g e 9e applies to A'amplo Dot ot&{ufiat.tCpAP4Pt.MQ:MnelAtht�bhAMule.Umontpitaiefa4ekf6} mye applies M MAA empioyteE Doty errs over"by the wort erc comp.N.Con policy, ATEHOLDER CANCELLATION ;Dvereye THDtADANYCRTHEABOVE DESOF NOTICE WILL EE DELIVERED REDtl IN ACOR4cN� ION DATE TH Tfi6P31�JG/Y✓^Ft4y/uyA�/,W/I^L]LB/ED�fi(UVE/RJ}E6 in AURWN2e4fl6PREPFHYA'M1vk �.�""""""'J\ `-�w�. 5588-2E5 R 0. TION. As ng 's l8S8h2d, ^SAS) The ACQRG..a and logo am rtgistemd an9dul of ACORD City of Northampton 212 Main Street,Northampton, MA 01060 Solid Waste 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. Address of the work: 26 (ilk �SY 22e-e ,n Ml,�- The debris will be transported by: ffa &I i�d Q2uac(i _ The debris will be received by: ltlesMrn R , c1ii4 %ays��crl Building permit number: Name of Permit Applicant Date Signature of Permit Applicant ►, Sk C.I. Roofing Estimate t °ate hempton,Ma. 01073 6/6/2018 ne(413)5774775 x(4)3)527-&469 Vame 1 Address Joh Location erry Loux 5 Oak St. lorenue, MA 01062 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roof. 6,800.00 Furnish and install 1/2" fiberboard insulation,mechanically fastened. Furnish and install.060 reinforced rubber roof system. Furnish and install shingles at flat roof tie-in. Furnish and install all related flashings. Furnish and install.032 aluminum drip edge. All exterior roofing related debris to be removed by R.C.I.Roofing. Ali work to be performed according to manu£acrurers'speci ications. 5 year R.C.I. workmanship warranty included. All related permits will be obtained by R.C.I.Roofing. Add for skylight replacement;$900.00/per. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $6,500.00 TERMS OF PAYMENT 5%Deposit Customer Signature: Balance upon completion Registration N 126235 Conuctiou License k 074334 Dare. m Insured by Banes&Fickert Ins. (413)527.2700 Shingle Color Selection: {'n D SC 'Y