38B-080 Roofing
6 Line St.
Southampton, Ma. 01073 Estimate Date
Phone (413) 527-4775
Fax (413) 527 -8469 4/15/2010
Name / Address Job Location
Steve Berlin
179 South St. 179 South St.
Northampton, Ma. 01060 Northampton, Ma. 01060
(413) 586-5237
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 14,200.00
Furnish & install 1/2" plywood over existing decking.
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.
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.
5 -year RCI Roofing workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Add: A Certainteed Surestart Plus extended warranty (additional 5 years) will be
included with fee ($600.00) absorbed by RCI Roofing if signed within 7 days.
SPECIAL ITEMS NEEDED
Asbestos Removal 9,350.00
Hatteras Shingles Add: $1,800.00
Centennial Slate Shingles Add: $4,020.00
Carriage House shingles Add: $4,950.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $23,550.00
TERMS OF PAYMENT
5% Deposit
Balance upon completion Customer Signature
Registration # 126235
Construction License # 074334 Date /1 D
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
.10111:: ■11111.1110 600 Washington Street
• ='• = • Boston, MA 02111
ar www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information \ Please Print Legibly
Name ( Business /Organiration/lndividual): R Q, Q ,
00 , LAS
Address:_ `. ■ €.., .
City /State /Zip: #: 4!3' S '1 - Lt1
Are you an employer? Check the appropriate box: Type of project (required):
1. L 1 am a employer with 20 4. ❑ 1 am a general contractor and 1
employees (full and /or part-time).* have hired the sub - contractors 6. ❑ New construction
2. L 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
working for me in an y capacity. ca acit employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its MO Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work officers have exercised their 1 1. Plumbing repairs or additions
[No workers' self: ' com right of exemption per MGL
Y [ comp. 12.[i Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
} ltorneowners 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.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ( 4 u' k Cca,�+. a.\ \ T. n
Policy 4 or Self-ins. Lic. #: C.L. 5' Q'1 3S t Expiration Date: / 0 - a0 ] Q
Job Site Address: 119 Sm.AA -n. Sr City /State /Zip: Aio, to_ri,ticn {Ka. O (O )
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 ofa 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.
1 do hereby certify under the ins and penalties of perjury that the information provided above is true and correct.
Signature: Date: 1 9 -10
Phone #: (U 3) S ' � " 1 - L4'4`1S
Official use only. Do not write in this area, to be completed by city or town official
QV or Town: PermitfLicense #
Tsang Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable O Name of License Holder : Al21lcd '7'7133'+
License Number
4. • 1 5 -03 -10
Address - Expiration Date
Signature / / . Telephone
9. Registered Home Improvement Contractor: Not Applicable 0
fte .i'oofjr q R 126 235
Company Name • Registration Number
- ns ... - 5-06- I D
Aoares Expiration Date
• �f . •1 • • V - . • • Telephone& 3),52/-4/75
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 No ❑
11. — Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
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. or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
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 be 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
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, Statc and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature a .tarvted •
;,
•
•
Y 4 r f r
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House E] Addition [] Replacement Windows Alteration(s) D Roofing 0
Or Doors O
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks ,[D Siding (CO Other [0]'
Brief Descripton of Proposed C1 L h
Work: L (� Ar1
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
.6a. 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? ' ' 1.' " ' e
•
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. fioodpiain Yes No
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, ,5 ?:Ye Y i , as Owner of the subject •
property �{ '� Q
hereby authorize C J' 1al llf 1 SI a Of ft C. I . Rccf
to act on my behalf, in all matters r ative to work authorized by this uilding permit application. 9
�tt a0hpd z9 -r
Signatire'of Owner Date
4 . t - - - I • • ' , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing • .lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
aY ' .41 e,
Print Name
L i — z5 — /0
Signature of Owner/Agent Date •
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size I
Frontage
Setbacks Front
Side L: R: L . .' .. R:' . i 1 .._
Rear i 1 .._,..1
Building Height i ,
B'dg. Square Footage
O?en Space Footage % i
(Lot area minus bldg & paved ;
pa-king)
# of Parking Spaces }
Fill: I
,
(volume & Lpcation)
;
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:!
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES
IF YES: enter Book Page 1 and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued: __ ____
C. Do any signs exist on the property? YES Q NO O
IF YES, describe size, type and location: E
I
Ate.,..,......._ ,..._...,.,....... .... .............,.. ,..,
D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO O
IF YES, describe size, type and location: I
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q NO l
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
i 1 • , ... j
City of Northampton Statu�bf, .
Y {
Building Department Cut' C
\. 212 Main Street Sewer s'`" ` -
Room 100 Wat `
.� 3 N hampton, MA 01060 ,
phon 3- 587 -1240 Fax 413 - 587 -1272 plot/
as r'7*� ;g;. t .� ii
Other Spoc ;::; ; 7�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
T S a V`im S\- Map ' Lot Unit
A.)0 f ar\ 0.M p - t rl Zone Overlay District
Elm St. District , CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: C
11 �X7l
Name (Print) Current Mailing Address: p ` O i c
attae ed ( p,i) ss�
Telephone
Signature
2.2 Authorized Agent:
M M � r v
at 11P. ' 1P.� - �•t;.Z. Roof _ • - _ • • • _ • • sit .
Name (Print) J Current Mailing ' . dress: Q 1 613
�-L (f13) 521• Al/T5
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ftoofi 4 1 f i 2 0 a o (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection _
6. Total = (1 + 2 + 3 + 4 + 5) 1. It • Check Number S —
This Section For Official Use Only
Building Permit Number. Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
it
•
a t;
. �.
.. , T 'r - ,fi- BP- 2010 -0979
GIS # COMMONWEALTH OF MASSACHUSETTS
r w : 388 080 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- 2010 -0979
Project # JS- 2010- 001446
Est. Cost: $14200.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 161172.00 Owner: BERLIN - CHAVEZ STEVEN & REGINA CHAVEZ - BERLIN
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 179 SOUTH ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:5/4/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP,PLY & 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:
FeeTvpe: Date Paid: Amount:
Building 5/4/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo