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13-094 (6) 24 STONEWALL DR BP-2022-0011 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -094 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTR AC I ORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2022-0011 Project# JS-2022-000014 Est.Cost: $9300.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 074334 Lot Size(sq.ft.): 16988.40 Owner: RUDNITSKY ALAN N &SUSAN K Zoning: Applicant: RCI ROOFING AT: 24 STONEWALL DR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527-4775 Workers Compensation SO UTHAM PTO N MA01073 ISSUED ON:7/6/2021 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. I • • � l I Certificate of Occupancy signatu ;" • FeeType: Date Paid: Amount: Building 7/6/2021 0:00:00 $40.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner The Commonwealth of Massa usett 0� FOR Board of Building Regulations d Sta dards`Jl/� IPALITY Massachusetts State Building Cod , R `c0 s. .� ti o� /�'� Building Permit Application To Construct,Repair,R 6>„, , Demo i8fya evised ar 2011 One-or Two-Family Dwelling g4i.o�'ti�,� This Section For Official Use Only o� 29sA'c Building Permit Number::R? "// Date Applied: n'°so otis 4u„kia,5 /��� 7.2-2oz j Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 24 Stonewall Drive, Northampton 13 094 1.1 a Is this an accepted street?yes x 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: Alan&Susan Rudnitsky Northampton MA 01060 Name(Print) City,State,ZIP 24 Stonewall Drive 413-584-2516 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) l Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: remove existing roof and install new shingle roof SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Botkli g Roofing $ 9,300 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check Nog y 27 Check Amount: v Cash Amount: 6.Total Project Cost: $ 9,300 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-074334 05/03/2022 Mark Delisle License Number Expiration Date Name of CSL Holder U List CSL Type(see below) 32 Old County Road No.and Street Type Description Southampton MA 01073 U Unrestricted(Buildings up to 35,000 cu.tt.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonr y RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-527-4775 mdelisle@rci-roofing.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 126235 • 06/17/2022 RCI Roofing LLP HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 6 Line Street mdelisle@rci-roofing.com No.and Street Email address Southampton MA 01073 413-527-4775 City/Town, State,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 lax 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 RCI Roofing LLP to act on my behalf,in all matters relative to work authorized by this building permit application. see attached O 1, - 2 g-2.t 2( Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains a d penalties of perjury that all of the information contained in this application is true and accurate to t of knowledge and understanding. RCI Roofing LLP O10-30-Zozl Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit 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 Number of bedrooms Number of bathrooms Number 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 Department of Industrial Accidents Office of Investigations Lafayette City Center 2 Avenue de Lafayette, Boston,MA 02111-1750 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): RCI Roofing LLP Address:6 Line Street City/State/Zip:Southampton MA 01073 Phone #:413-527-4775 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 13 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors �' New❑ construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in anycapacity. employees and have workers' P tY 9. Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.H I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.© Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other 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. $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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Insurance Co Policy#or Self-ins. Lic. #:VWC10060226472020A Expiration Date:10/05/2021 Job Site Address: 24 Stonewall Drive City/State/Zip: Northampton MA 01060 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 and altie perjury that the information provided above is true and correct. Signature: Date: (2( 30— ZoZ Phone#: 413-527-4775 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(check one): 1❑Board of Health 20 Building Department 31:City/Town Clerk 4.❑Electrical Inspector 50Plumbing Inspector 6.DOther Contact Person: Phone#: Roofing 6 Line St. Estimate Date Southampton,Ma. 01073 6/16/2021 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Sue Rudnitsky 24 Stone Wall Dr. Northampton, Ma. 01060 Terms Rep Estimate valid for 30 days Description Total Remove existing roofs. 9,300.00 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 $3.00 per sq. ft. for wood decking replacement if needed. AIM Zi/iiP/ 6 t&/4 '&-Z6-�9 • WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $9,300.00 TERMS OF PAYMENT 5%Deposit Customer Si re: Balance upon completion Registration# 126235 Construction License#074334 Date: V6f j219 2dz, Insured by Banas&Fickert Ins. Shingle Color Selection:7114/WIC /J(413)527-2700 Of}L (�e4Z • Commonwealth of Massachusetts V ir Division of Professional Licensure Board of Building Regulations and Standards ConstrateflUYiiNiefvlor '1F-;imoiiiomweirdiiiiC rife, Office of Consumer Affairs&Bus'ness Regulation CS-074334 Expires:05103/2022 HOME IMPROVEMENT CONTRACTOR TYPE:Partnershic MARK THOMAS DELISLE Re9i$tration 32 OLD COUNTY RD • 144:- 126235 1772022 SOUTHAMPTON MA 01073 RCI ROOFING,LLP kit '7.17 4.1 „LI MARK T.DELISLE -"Commissioner duije Ll&ritir‘ LINE ST SOUTHAMPTON,MA 01073 Undersooretar), • " Construction Supervisor Unrestricted -Buildings of any use group which contain less than 36.000 cubic feet(991 cubic meters) of enclosed Registration valid for individual use oroy. space, before the expiration date. if found return to; Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite Tit; Boston,MA 02115 Failure to possess a current edition of the Massachusetts Not valid without signature State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl - • • MMONWE ALT I-1 OFMASSACJSTS!. yaTt4 Cr'r„e4p/T1 irorr--47 rt13Y, b 'AHD SHEET METAL WORKERiri ISSUE:THE FOLLOWING uct..JQP e. STATE OF CONNECTICUT \\\\, `;,,,:14,6-45(IFPARTALENT OF CONS ER PROTECTION riieliRRKOTOOFEINLGISLLLE Uill p, HOME IMPROVEMENT.CONTRACTOR 6 LINE•.STREET \ R C I ROOFING LIT ' EASTHAMPTON;MA 01073 6 LINE ST 6: SOUT I IAMPTON,MA.01073 cram-111117J • 0,• HIC.0624741 ' _J1/-24.2.0 11/30/2021 ACC DATE(MM/DD/YYYY) ��.. CERTIFICATE OF LIABILITY INSURANCE 10/09/2020 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 Banes BANAS & FICKERT INSURANCE AGENCY (A/cc,No.Ext): (413)527-2700 FAX (A/C,No): E-MAIL ADDRESS: so@banasinsurance.com 63 MAIN ST INSURER(S)AFFORDING COVERAGE NAIC# EASTHAMPTON MA 01027 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: RCI ROOFING LLP INSURERC: INSURER D: 6 LINE STREET INSURER E: SOUTHAMPTON MA 01073 INSURER F: COVERAGES CERTIFICATE NUMBER: 583626 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. INSRL TYPE OF INSURANCE NSD ADDL SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS IMMIDD/YYYYI (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED 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: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A NIA N/A VWC10060226472020A 10/05/2020 10/05/2021 (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 I 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/Iwd/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 Reference Copy ACCORDANCE WITH THE POLICY PROVISIONS. Reference Copy AUTHORIZED REPRESENTATIVE Reference Copy MA 01027 " Daniel M.Crowley,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 DATE(MM/DD/YYYY) A C •RL CERTIFICATE OF LIABILITY INSURANCE 03/09/21 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 CONIACI NAME: Michael R.Banas Banas&Fickert PHONE 413-527-2700 FAX (A/C,No,Extl: (AIC,No): 413-527-0849 Insurance Agency E-MAIL 63 Main Street ADDRESS: mb@banasinsurance.com Easthampton,MA 01027 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 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 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 -AUUL3ULIR EFF LTR TYPE OF INSURANCE INSD•WVD POLICY NUMBER -(MM/DY/YYYYUMM/DC D DT ) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 A X CA000020963-07 03/04/21 03/04/22 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JE 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 AWNED X SCHEDULED X 6207761 09/30/20 09/30/21 BODILY INJURY Per accident $AUTOS ONLY AUTOS ( ) X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE X GX000000385-05 03/04/21 03/04/22 AGGREGATE $ 5,000,000 DED X RETENTION 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/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 """`Reference Copy "" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REP S IVE I - .. 9 15 ACORD CORPORATION. All rights reserved ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD