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36-292 (5) 74 SOVEREIGN WAY BP-2020-0891 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 36-292 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-2020-0891 Proiect# JS-2020-001516 Est.Cost: $10900.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O.Const. Class: Contractor: License: Use Group: RCI ROOFING 074334 Lot Size(sg. ft.): 60504.84 Owner: LYONS DANIEL&MARLENE Zoning: Applicant. RCI ROOFING AT. 74 SOVEREIGN WAY Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:2/5/2020 0.00.00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF ON FRONT AND .TURRENT SECTIONS 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 sitnature: FeeType: Date Paid: Amount: Building 2/5/2020 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner r , Department useorily - City of Nofthamptot Z.c Status`of Permit Building ( epar�ment ur , DnvewayfPermlt Y<_ 4'A,', 212 Main St'reepe� ewer epfic Availability '1. Room 160 ` 4 ate") QII AuaIlakility Northamptono, 1060 20?0 TVf'I its of StrPlans.- �' ;HN phone 413-587-1240-.F � �far 272 Plo S Plans rn,cpr,rr Ot 0 Specify APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOV� R..-DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be compi ed by office 01 q V Sbv 2(P-►�n ul a.y Map _ Lot Unit F-16few-1 MIA Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (Y1r.r ler�Q 4- � `-I Sov Ir , n wat'4 Flortnce, Name(Print) Current Mailing Ad ss: IL 6fl SS Sip Q �Ct ChQ Telephone Signature 2.2 Authorized Agent: C (o LI'nQ 5-� . Sou- k (wcA&) n)H 0I013 Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b permit applicant 1. Building ,� . (a)Building Permit Fee U 2, Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Parmit Fee 4. Mechanical (HVAC) 4106 5. Fire Protection 6. Total= (1 +2+3+4+5) o Check Number Me This Section For Official Use Only lBuilding Permit Number: Date Signature: ZD Building Commissioner/Inspector of Buildings Date S+hon�pson @ Irci roo F�►�� ,.corn EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) ` �:. t � i i _ ,. . .. ,�,,.. ^� _ .. ,F .� � � � t .. i f ' i; �• ' • f. �,. .. ;VY.-, j:l �. ' � a r,' � f ` � �: � t; _ _ � i � s � S i -_ � �.� _. '. ! -. � i 3 �: < � - � _ _ �j, S= � - �.. _ _ .. ..J _ � .. '. r1 L _ - i _ t. t� - ... _ _ _. i _�' ' . _ - _. .. j ,_'.. .. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement Windows Alteration(s) Roofing Or Doors ❑ ff Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding [O] Other[O] Brief Description of Proposed I I Work: S e L oA)C iod Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes _No Plans Attached Roll -Sheet sa. If New house and or addition to existing housing, complete the following: 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 COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, I 1 1����11P. + boj'\ LU cm' as Owner of the subject property I herebv authorize to act on my behalf,in all matters relative to wo authorized by this building permit application. Signature of Owner Date I, /I I L�(�C I,)p,I�J I� — (� (L(t�,�Dr I ZPd as Owner/Authorized Agent hereby declare that the statements and information on the foa oing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. f Print Name Z' �' _ U1aoZJ0 Signature of Owner/Agent Date a i -_� �" .— ,.:. i c' ` `. �r,r _ - u ,_, _ �. : � i t �� �� - � i^ �'.� j �'.. ;.. °„ �� �:�� t - _ � %..r .. r:,� `7 .$ l r j�� �3 �' . , . . %f .�.�� ... I �rs^ •s „��� SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Muir K (1-I 1-vs le- C S — 0 /n y IS C.1 License Number rl E OIGa 05 - 03- dQ ay Address Expiration Date Signature Telephone 9. Registered Home lmnrovement Contractor: Not Applicable ❑ Pi C-1 LtnG LL-P (0,3 L3,5 Company Name Registration Number a L i n e 3+ - 010`13 Os - 05 - a 0 a U Address ( Expiration Date �Yl(➢��1�E�` (UfObk.n t . C 0 11 Telephone 413-Ja7-` ?9,S 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....... Is� No...... ❑ t t RC.1. Roofing Date 6Line St. Estimate Southampton,Ma.01073 1/24/2020 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Marlene& Dan Lyons 74 Sovereign Way Northampton, MA G4-9ff utv6z Terms Rep Estimate valid for 45 days Angel Description Total Remove existing roofs from front and turret sections 10,900.00 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. Total $10,900.00 TERMS OF PAYMENT 5%Deposit Customer Signature: p/� Balance upon completion ".�J l( Registration# 126235 Construction License#074334 Date: + U—Zv Insured by Banas&Fickert Ins. (413)527-2700 Shingle Color Selection: „� . �. .... .. .. ... -- . . ._ r,, .�� 1• J:A�k:1"'1'l,KL,�”. el ..,i.�. �-�l.� �t,1p��,�i;� •f, .. ._ �f � '�i.;: W � . ,.. ., ..yt. ... � .. ._ ...., 'r; _13i�',v:..te�,: e:!`� .;C•'.Zi�t '.gt.�...�� ;rS . .:' .' , . a.. .. �'�" City of Northampton Massachusetts IJ DEPARTMENT OF BUILDING INSPECTZON3 ^ 212 Main Street • Municipal Buil4ing Jsk ,Ob Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor�aw Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")rgulates the registration of contractors and subcontractors performing improvements or renovations on detached on 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 ar 9 adjacent to such residence or building"be done by registered contractors. Note:If the homeowner has contracted with a corporation or LLC,th t entity must be registered. Type of Work: KoAl 11 Q Est. Cost: IO qCC� Address of Work: r]LJ 5pupyQ t Gh �Jrw Gr l 1CF . YYl 1� Date of Permit Application: ()I - 31 - SOU ab 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 INTOONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOM 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 THEESPONSIBILITES 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: 01 �311a0a0 6 .C . I. &n04na LLP Dae 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 i/�; Massachusetts ib , wi r DEPARTMENT OF BUILDING INSPECTIONS .M w 212 Main Street •Municipal Building r Northampton, MA 01060 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: �� reign WoA . Flurewr,, W11- (Please print ho e numb and street na e) Is to be disposed of at: +prn &cuc.linn -7-run,s-�Pr FCcri h' (Please print ame`a d location of facility) Or will be disposed of in a dumpster onsite rented or leased from: U CL Lj l rI U G41(1 &C L,Cjr r14 (Company Na0e 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. , -.^�Y.4ef- '`i' '.i`..:i f.i•.e Y t r •a ;. `f. \ The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 109 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Cont�actors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly n• Name (Business/Organization/Individual): c I n4 . LLQ Address: City/State/Zip: 1)1 Phone#: 5D7-_ 05 Are you an employer?Check the appropriate box: Type of protect(required): I.[j�I am a employer with/5employees(full and/or part-time)." 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for me is 8• EJ Remodeling any capacity.[No workers'comp,insurance required.] 9. ❑Demolition 3.[31 am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 [J Building addition 4.O I am a homeowner and will be hiring contractors to conduct all work on my property. I will i ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[;?fZoof repairs These sub-contractors have employees and have workers'comp.insurance., 6.FJ 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 hire outside contractors must submit a new affidavit indicating such. tContractors 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 ane an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ffi4tal �Ia5(I OTA LC. Policy#or Self-ins.Lic.#: y W C n o(J 0a a to V 7.16) 9 A Expiration Date: /U- 0 5-IQ U dG Job Site Address: 9Y &\iPre1qJJity/State/Zip:RoaYleo.iM)A QM Attach a copy of the workers' Anpensatpolicy declaration page(shows g the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal vi¢lation 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 Offic�of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains d penalties of peJut v that the information provided above is true and correct. Si nature: \ Date: 1 3l Phone#: N:0 5Q7- 4795 Official 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 i Contact Person: Phone#: AC�® DATE(MM/DD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 10/07/2o1s 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 CONTACT NAME: Michael Banas BANAS & FICKERT INSURANCE AGENCY PHONE , (413 527-2700 Fa No: E-MAIL C�3 ADDRESS: mb@banasinsurance.com 63 MAIN ST INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER 8: RCI ROOFING LLP INSURERC: INSURER D: _ 6 LINE STREET INSURERE: SOUTHAMPTON MA 01073 1 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. ILTR NSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMID YILICY EFF DDIYYYYI (POLI D1 EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE F-1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILEUABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WOR KERS COMPENSATION X I SPER TATUTE ETH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? WA WA 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$ 1,000,000 N/A DESCRIPTION OF OPERATIONS I 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.Cr4y,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 � 1: DATE ,a ►R�J CERTIFICATE OF LIABILITY INSURANCE (MMIDDIYYYY) �-� 10/07/19 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 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 CUNTACI NAME: Michael R. Banas Banas&Fickert AICNNo Ext): 413-527-2700 AAic No): 413-527-0849 Insurance AgencyE-MAIL 63 Main Street ADDRESS: mb@banasinsurance.com Easthampton, MA 01 027 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Admiral Insurance Co. 24856 INSURED INSURER B: Safety Insurance Co. 39454 RCI Roofing, LLP INSURER c: Admiral Insurance Co. 24856 6 Line Street INSURER D: Southampton, MA 01073 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 REQI IIREMFNT,TFRM 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 AL)UL SU13R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA(3b 10 RENT= CLAIMS-MADE 19 OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any oneperson) $ 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 POLICY IX JECT PRO- ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED Ix SCHEDULED X 6207761 09/30/19 09/30/20 BODILY INJURY(Per accident $ AUTOS ONLY AUTOS )xHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE X GX000000385-03 03/04/19 03/04/20 AGGREGATE $ 5,000,000 DED I x RETENTION$ 10,000 1 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under __DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I 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 S NTKIVE ,915 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SCA i 41 20M-05M Office of ConsumerAffalrA&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:,Partnership 12�ti 05/05r 2020 ' C; -ic 4T•!`E RCI ROOFINU111 x•; , }y ,•iia �x�', .__. ' MARKT.DELISL s X41 , �` Commonwealth of Massachusell3 S LI E 5T } -'.Ys U � 1 DIVlslon of Professional Licensure SOUTHAMPTON,MA tl0? � Board of Building Regulations and Standards Undersecretary Consr�i� tidi�I11}>�rvisor — CS _ •:074334w SXplres:05/03/2020 Registration valid for individual use only before the expiration date. If found return 4o: MARK THOM;S DEllJrS ; N-V + ' Office of Consumer Affairs and Business Regulation 69 BRIGGS . 1000 Washington Street•Suite 710 EA8THAMPT0R A,O.��`0'2`l,,. >a0 Boston,MA 02118 e�"C.)ISSif:IL�1�� /d�lifa,Ix •rs�t� �,' C 0 MIsSI0ner Not valid without signature �— DO:MMO �ILT'M $ @H. NWEM ' ? s USE7T8 _ • O,R:. o W HOME IMP3O�V1�!! N�r))CONTRACTOR a ISS SHEET`jY =TIAL WSR�CRS� 11� {k .;Pi3•l'L'0•U1/1NG ('GE°NSE C1 T,6 �SI,�(, s,01073 � k�,�� �• 1 •ry..�' .in.,..n, ( i [3�''.�3iF'.'a.� R•�/Nv) S�TR �g� J.C••fiE�C ... :+W fi i' 3 I M KTfbE'LIS LEs `' rs i , i Regietradori#, -/`ri'� ffccti b`{�'G,{ Expiration XA k i � Sc YJ� HIC,0624741 it+U� ,:� $;� `�•. f1/30/2019A A 1: •27�o SIGNEDiI AQs i ' rr sK: C ____•� ,�_, ,. � s��xh" �.,<�`�6128/�'020 �� ?::.' 13276� �r &F, 486498 '. --• ._ ,uu,(�h;n �'$fiY r.. „ r „viz Nir.1`,ri',• .. 1 l ' .C7MMONWWI. IMy.OFrM �v ;Uu`�1 t,;l • ..• �z';•'�fi�>' SNE �B �%IOI� bt y Ulan • '� ; . Y�&,,4. 'IS :U:E3Y ti.RcILO,1V..I. iR s r§, > BUINES }, �' t•� .tkl.�• t •� kf r k Y p , f '6 f;RigkpIN'4 L, F' f�l' tr'1;A` E'T1'f �1Cl Pclty',�N i •n: ,�i X�1 r '•"!�(s.GSL a�f ' . a ,•xr ox 4� X601, v • Y '0'910'912019 ' 34''2236 , / r _� i .. ,.. r,..1•,r:11••r':t:�1rtii I�.,�I�.Y..il;'., M,Y,tl: ,. �..... ... i .