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38B-298
R.C. • t . R oofing ,. 6 Line St. Southamton, Ma. 52 7- 47 77073 5 E st i mate Date Phone (43)7 -7 3/15/2010 Fax (413) 527 -8469 Name / Address Job Location Laura Facteau 43 Pine Island Lake 212 -214 South St. Westhampton, Ma. 01027 Northampton, Ma. 01060 (413) 529 -9833 Terms Rep Estimate valid for 30 days Dave Job Description Total Remove existing roofs. 8,800.00 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. 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 $2.50 per sq. ft. for wood decking replacement if needed. Add: $1,100.00 for Certainteed Landmark Woodscape 50 year premium shingle. A Certainteed Surestart Plus extended warranty (additional 5 years) will be included with fee ($440.00) absorbed by RCI Roofing if signed within 7 days. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $8,800.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration # 126235 Construction License # 074334 Date 3 /0 Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376 ?lice TDam.- monweailA al ✓iaoaaaeuewad Board of Building Regulations and Standards Construction Supervisor License ,.,. License;. CS 74334 E4 tIi •54'2010 Tr# 23520 Re kction .00 MARK T DELISLE 33 FIRST AVE EASTHAMPTON, MA 01027 Commissioner git4 6 ,o ar✓l z4 acadetla Board of Building Regulations and Standards A � Ci HOME IMPROVEMENT CONTRACTOR 11 -' Registration: 126235 Expiration: 5/6/2010 Tr# 266063 Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. EASTHAMPTON, MA 01027 Administrator The Commonwealth of Massachusetts • ;,� ---� Department of Industrial Accidents t tce i ations .. .._.� r Office o f investigations 4N . MP 600 Washington Street : ". • Boston, MA 02111 :s` e > www.ntass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant lnfortttation Please Print Leeibly Name (Business/Organization/Individual): R C T ( 00C `C1 \_\ L Address: �. YZ t?„ C ity /State!Zl�a: _,. -o. 1i Phone , _ L)11 A re you an employer? Check the appropriate box: Type of project (required): 1 . I am ., employer with 2.0 4 • ❑ i am a general contractor and I employees (fill and /or part - time).' have hired the sub- contractors 6. ❑ 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. fl Demolition workinu; for me in any capacity. employees and have workers' p 9. ❑ Building addition No v, orkers' comp. insurance comp. insurance.: ❑ We are a corporation 5. oration and its l0.0 Electrical repairs or additions I — I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions mysel 1. [No workers' comp. right of exemption per MGL 12.2 repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that cheeks box #1 must also till out the section below showing their workers' compensation policy information. lomeowners to submit this affidavit indicating they arc 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. lithe sub - contractors have employees, they must provide their workers' comp. policy number. 1 rrm an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Co,npany Name: l c,e, Q'fDQtG C\y k r ■ . Policy # or Self -ins. Lic. #: 5 p'■ AS ( Expiration Date: / 0 - 5 - Z 0 0 Job Site Address:2.,1 -Z14 City / State /Zip:,kor-Lk, ( . 010(00 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 x1.300.00 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 ccruJy under the ins and penalties of perjury that the information provided above is true and correct. Signature: _ -- Date; Phone #: ��t3) 5 ` �1 �ti S Official use only. Do not write in this area, to be completed by city or town official City;. Town: Permit/License # "Tssu�g Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6 Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder Mar '77 4 1334 License Number -L'‘ Cle 5 + 3 o a • 3 `• V . • • . 5 - 03 -10 Address _ Expiration Date ( L 4 13) 52 Lj7 ?5 .....i Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ f . C. I. 'Roo fi 126235 Company Name Registration Number pNa., .. ^7 7 /� Expiration Date El/IL:barn0bn, Ma. 01073 Telephon�y13)527 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 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 Afficavit Attached Yes No ❑ 11. — Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwelling.; of one (I) or two(2) families :ud 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 s. or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and / or farm aructures. 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. .\ acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work•for which this permit is issued. .•\lso be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to }implovecs 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, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature a .tar.hed _ • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) - New House I 1 Addition n Replacement Windows Alteration(s) n Roofing al Or Doors 0 Accessory Bldg. [ Demolition I 1 New Signs (0) Decks [C] Siding [DI Other (p) Brief Descrip on of Proposed I Work. _ a t} ,tarhe�J 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 balding One Family Two Family Other 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. Numbe' of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? Type of construction 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 budding 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 , as Owner of the sub I 1 .... ! • •C subject titer ) property R hereby authori..e Li ► ar - De, , e Qf 1 ► • ` n -1. t • R�Qf � i to act on my behalf, in all matters r lative to work authorized by thisuilding permit application. 9 t,t a Chad • y s ► Signature of Owner Date I • JIi "b e\ l S, k., as 2U ti10YL Ted aQ ept , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing 4lication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name 0 Signature of Owner /Agent Date Section 4. ZONING AU 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 1.. „ t Si4e i, F:ontai,c ' r I 1 - I - St:thacks Front 1 - I Side L:1 R:' L:(. R: i i 1- -__ ____� Rear L_ ©gilding Height i ` I3 dg. Square Footage I % f' I i 1 y Oren Space Footage % (Ln area minus bldg & paved I i # .3f Parking Spaces ' . I _.__ E P” . Fill: I. i (volume & Locations (. A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW o YES a l IF YES, date issued: I IF YES: Was the permit recorded at the Registry of Deeds? NO o DONT KNOW O YES 0 IF YES: enter Book ; Pagel i3 1 I and /or Document # ^!L ^ , B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW o YES o IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date issued: C. Do any signs exist on the property? YES O NO o IF YES, describe size, type and location: 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 o NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • City of Northampton Statusou ' t'', ti City Buliding Department Cu C , ; `, " r' s ' - :';',,1 APP 2 2010 t ..1.,,m,-;:y.1::,,, !, ,; , ` �� t o _ 0 212 Main Street R oom 1 00 v9t '° -t 1 f �t � 1 t __ Northampton, MA 01060 T i' k I phone'413 -5& -1240 Fax 413 -587 -1272 pl ) ' . ` Other • 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 j 2 t - 2. 14 SOrt.\ - �\--- Map • Lot Unit 00 r' \‘, (Nii e t.:" \ , \\- � Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: A - , .c),.v.fo� �C ck. C.,* t .G.v� 43 , „ =1-S \car- d v.....0... .t..... Name (Print) Current Mailing Addres : Signature Tele hone e [I Signature p (Li t 3) $ `1- y33 2.2 Authorized Agent: ~ • • ' r Name (Print) / Current Malting ddress: c. 0l3 ■ ' _ ('013)521 115 Signature Telephone • SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building �,o0f1 # � 1 0 (a) Building Permit Fee 2. Electrical f (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) '$ 8'' 0 0. 00 Check Number /,moo #`5 - This Section For Official Use Only / Date Building Permit Number: Issued: Signature: �- i Building Commisalonerllnspector of Buildings Date • t; � BP- 2010 -0965 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- 2010 -0965 Project # JS- 2010 - 001427 Est. Cost: $8800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 8232.84 Owner: FACTEAU PAUL A & LAURA A Zoning: URB(100)/ Applicant: RCI ROOFING AT: 214 SOUTH ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:4/29/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P & 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 4/29/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo