18C-008 1%LI Roofin
.,I,P
6 Line St.
Southampton, Ma. 01073 Estimate
•
Date
Phone (413) 527-4775
Fax (413) 527 -8469 10/26/2010
Name / Address Job Location
Eloise Leigh
272 Hatfield St. 272 Hatfield St.
Northampton, Ma. 01060 Northampton, Ma. 01060
(413) 586 -1648
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 8,900.00
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and
valleys.
Furnish and install synthetic underlayment over existing deck.
Furnish and install 30 year CertainTeed Woodscape 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.
30 year 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.
Add: $1,050.00 for Certainteed Landmark Woodscape 50 year premium shingle.
A Certainteed Surestart Plus extended warranty will be included with a fee of
($420.00) absorbed by RCI Roofing if signed within 7 days. This extended warranty
means that 20 of the 30 year warranty is covered for labor and material. The last 10
years of the 30 year Certainteed warranty would se overed f ter' only.
/ 4
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $8,900.00
'TERMS OF PAYMENT
5 Deposit
Balance upon completion
Registration s; 126235 Customer Signature -(PC{,,
Construction License # 074334
Insured by lianas & Fickert Ins. Date 424 / o20 1Q
413- 527 -270(1
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MARK T DEL1SLE
33 FIRST AVE . �
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EAST MA 0102;
mufti ul 7 uu. 1111 :1It all ..'7 Ilu>i ucs. i c;;ul:r lion
1 d , HOME IMPROVEMENT CONTRACTOR
1 `
Registration U;_'?',
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„id,'
? "`. Expiration: 5iil2p12 lra ' +3_ +•∎ir
Type. PartnelsHP
R C I ROOFING
MARK DELISLE
d t.INE ST _
5(_11,1 HAMPf(5N. N1A 010 1'uJ uc�
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The Commonwealth of Massachusetts
_ Department of Industrial Accidents
� � I r O
,,, ` c __ Office of Investigations
i . Sr 600 Washington Street
■ " _� , ,f Boston, MA 02111
_ � ^. `' w s' w. tnuss. guv /dia
\Vorkcrs' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant information Please Print Legibly
Name ( }3u;inc.+s /organization /Individual): _ C`\ °p c', A\S
.
Address: 1,m,._1.. _�_T_.
Ciry /tatc /1_,ip:?(M� v t o'z 3 Phone #: Li 11
. re you an employer? Check the appropriate box: Type of project r
7 I P 1 (required):
1 . l� i am ;t employer wi 2. O 4. El I am a general contractor and I
employees (full and /or part- time).'
have hired the sub contractors 6. (— New construction
2. Li 1 am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
work ling for me in any capacity. employees and have workers' q ❑ Building addition
[No workers' comp. insurance comp. insurance.'
j req u i rc iL) E P
5. We corporation and its 10.❑ Electrical repairs or additions
E e arc a cor
• 1 am ,, homeowner doing all work officers have exercised their II. Plumbing repairs or additions
mvseh. [No workers' comp. right of exemption per MGL
12.[Z repairs
insurance required.1 ' c. 152. § 1(4), and we have no
employees. [No workers' 1 3.❑ Other _______ _______
comp. insurance required.]
:Any applicant ;hat checks box u I must also fill out the section below showing their workers' compensation policy information.
h omeowners ■, ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that ,heck this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. lithe sub- contractors have employees, they must provide their workers' comp. policy number.
l am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
insurance Co :npany Nance: a.�` t?. Q` t .r Qw' o...A -' n . —
Polley ,; or Scit -ins. Lie. i/:A C -L{ 5? O', 35 to , Expiration Date: 1 0 - 5 - a ) 0
Jul Site Address: 2 a. e ce__A S V ., Cit /State /Zip: h r > L �,,, ► yAct otb(d)
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 S1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
investigations of the DIA for insurance coverage verification.
/ do hereby . drtijY under the . ins surd penalties of perjury that the information provided above is true and correct.
iignaturc, _ - -- - ...tt'..�
.r __ __ . _ Date: / I - 9 I 0
phor e ' #: (S,.13,i_ .5" - L `t `1, , . . _ .
f Official use only. Do not write in this urea, to be completed by city or town official.
1
City.or 'Town: Permit/License #
Issu!ng Authority (circle one):
F Board of Health 2. Building Department 3. City/ own Clerk 4. Electrical Inspector 5. Plumbing inspector
6.O
Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : N aY 1. - bei l s l e, L ? II 3 3
License Number
L.Lia.e, -. • . .r LI . • 5 - 03- 12
Address - Expiration Date
_ (i,3) 527- Li /75
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
_ . 1217235
Company•Name Registration Number
( L,i� _ sir 5 - 0b -12
Hoare aa Expiration Date
SosJaiirnptort , M. o 1673 TelephontOi 3).527 15
-
SECTION 10 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(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.
Signea Affidavit Attached Yes ' No ❑
11. — Home Owner Exemption
Th.; current exemption for "homeowners" was extended to include Owner- occupied Dwellines of one (1) or two(2) families
;md to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner act
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
is. ..)r is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
.,: . A erson who constructs more than one home in a two ear *eriod hall n • t • • • _ i • ,. .
Such -- homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will he required from time to time, during and upon
completion 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
In for injuries not resulting in Death) of the Massachusetts General Laws Annotated, You MAY be liabk for person(s)
you hire to perform work for you under this permit.
Th. undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature Ott aob c
• 1 I mo. r ; # % ..'0..)1 bus !
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
I I
I ,
New House [ Addition Replacement Windows Alteration(s) Roofing af
Or Doors ❑ . .
Accessory SIdg. LI Demolition 1 New Signs [0] Decks 1[] Siding [ED] Other [lam]'
Brief (,
Work: Descript on of Proposed a�taGh e11
'Wor
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 budding One Family _ Two Family Other .........
b. Number c` moms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposes Square footage of new construction. Dimensions
e. Number c stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Ccnservation 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
Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
1. 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 �
, as Owner of the subject
property
hereby authorize 1Je SL e Q • (3 . Roofl n9
to act on my behalf, in all matters relative to work authorized by this uilding permit application.
attached • j 1 - y-40
Signal** Owner Date
i
Jy T e � s P . a s a u tlioY i 7ei adult , as Owner /Authorized
Agent hereby ceclare that the statements and information on the foregoing adlication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
•
Print Name
Signature of Owner /Agent Date
.
Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column 10 be fihled in by
Building Department
_,
Lot � �i i| ` - - _)
-�� . . '
' � [ ----
F1 nn�ec � / /
Suhacks Front i
Side L' K: - ' !K: | | |. �
� �
Rear -- /
'
Bidding Height
■ --
B dg. Square Footage / � � 'A �� ! � i
O:)en Space Footage v6 . /
ux"�"m.=xmu &n�� / /
-2�ja)
i ' '
#.)[ Park � i^gSpucc^
U� T— h
' � | \i |
("o"m^ai�cuun ^
A. Has aSpecial Permit/Variance/Finding ever been issued for/on the site?
�� DONT 0 YES ��
NO \^� KNOW k~/ �_/
IF YES, date issued: | . .
IF YES: Was the permit recorded at the Registry of Deeds?
�� 0 ��
NO DON'T YES �-� ' �~� �_� -
| [ - - ---'
IF YES: enter Book . Page; and/or Document |
' -- .
�� ��
D. Does the site contain a brook, body of water or wetiands? NO �~ �� � DONTKNOVY �~� YES �~�y
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained y Obtained y�� Date Issued: � �~/ , ' ]
C. �� �� Do the property? YES �~� NO ��/
- ' - -- --- l
IF YES, describe size, type and location: !
`-- -- ------------------ /
D. Are there any proposed changes to or additions of signs intended for the property7 YES 0 NO 0
IF YES, describe size, type and location: 1
______ .
E Wll the construction activity disturb (clearing, ring, gradingexcavation, or filling) over 1 acre orioh part ofe common plan
that will disturb over 1 acre? YESK ) N(} K ]
�� ��
iF YES, then a Northampton Storm Water Management Permit from the DPW is required.
. ,
•
•
1 City of Northampton Statuzi
Building Department "� , +, r , , o- • •
2'12 Main Street ' .,,,al.....'''.,‘ ����
\ :- — - Room 100 W e r A' j , '�` .
Northampton, MA 01060 T d ek r. .'' "" $' ; J
phone 413- 587 -1240 Fax 413- 587 -1272 OIotit`itb ft'"" 060. .r ; -, ,
} Other S . ti a'A',',...4 • 't.• T !i
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property ddress: 0. ` d \\ This section to be completed by office
21 a k, c c_ S- Map ■ Lot Unit
/t) o i k-k \ \ r {1. . Zone Owriay District„_„_
•
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
C \ \C I - (t r \ A.
O ∎ s e , i" - /QC) C" \4. dt3r00
Name (Print) Current 4�) 1 � �»� �
ep one
Signature
2.2 Authorized Agent:
PlaY/k -- c) P. . I Ed - q.c,i. cZoofi nri ,. - -
Name (Print) Current MaU Ing • .. ress: 01 Ci.143
-e-- (J113) 521- At?75
Signature Telephone
•
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ,00fi na 4 s c 00 , 00 (a) Building Permit Fee
h cl ri l
J (b) Estimated Total Cost of
Construction from (6)
r-
3. Plumbing Building Permit Fee
4. MechanicaI (HVAC)
S:- Fire Protect on
6. Total = (1 + 2 + 3 + 4 + 5) $ S 1 9 00 , 00 Check Number / A ...
This Section For Official Use Only • Date
B Permit Number. Issued:
Signature: —
•
Building Commissioner/Inspector of Buildings Date .
a -S
p ■
x,;
t 1
•
• BP-2011-0441
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0441
Project # JS- 2011- 000719
Est. Cost: $8900.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 27834.84 Owner: LEIGH EARLE WARNER & ELOISE B
Zoning: RR(100) //RI/WP Applicant: RCI ROOFING
AT: 272 HATFIELD ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:11 /10/2010 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 11/10/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner