29-204 (3) 1\. . Roofin
6 Line St.
Southampton, Ma. 01073 Esti mate Date
Phone (413) 527 -4775
Fax (413) 527 -8469 4/5/2010
Name / Address Job Location
Mike Tobin
27 Beattie Dr. 27 Beattie Dr.
Florence, Ma. 01062 Florence, Ma. 01062
(413) 584 -7069
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 7,700.00
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: $1,000.00 for Certainteed Landmark Woodscape 50 year premium shingle.
A Certainteed Surestart Plus extended warranty (additional 5 years) will be included
with fee ($400.00) absorbed by RCI Roofing if signed within 7 days.
* RECOVER PRICE *: $5,000.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $7,700.00
TERMS OF PAYMENT 1
5% Deposit t
13alance upon completion Customer Signature � (v {/f / \ 4\ ��
Registration
�,istration # 1262 35
Construction License # 074334 Date '0
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376
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L■ 74,534
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MARK T DELISLE
33 FIRST AVE
EASTHAMPTON MA O1027
x.�
26357
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1)11i1 ' r rl l uu+uuu Itu1iue>. Rc;2ulaliuu
` �� HOME IMPROVEMENT CONTRACTOR
}t � Reyislrotion:
Expiration: 5rb /.212 T r#
Type: Partnership
R C I ROOFING
MARK DELISLE
6 LINE ST
5C)UTHAMPTON, MA 01073 I Mk, .errOil r r
. ,,\ , The Commonwealth of Massachusetts
_„=. Department of Industrial Accidents
Office of Investigations
=. L.'
600 Washington Street
IMO SO
� =� Boston, MA 02111
7 f
;s www. muss.gov /diu
WorLers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
O Naine ( HuNine ,sJUrganiuttiun!)ndividual): s ,,,S
,Address:,____ \,,,.,„■ A £'. .
City /State /Zip: „ _... .. 1,►. Phone #: - LA 77
ire you II II employer? Check the appropriate box: Type of project (required):
i . i am a employer with 2,0 4 • Q 1 am a general contractor and l
employees (cull and /or part- time).'
have hired the sub - contractors 6. El New construction
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. (J Remodeling
ship and have no employees These sub - contractors have 8, ❑ Demolition
working for me in an capacity. employees and have workers'
- p Y 4. ❑ Building addition
[No workers' comp. insurance comp. insurance.•
_ required ] 5. E We are a corporation and its 10.❑ Electrical repairs or additions
3. _ 1 rn a homeowner doing all wore
officers have exercised their 11.❑ Plumbing repairs or additions
mysel 1. [No workers' comp. right of exemption per MGL
I 2.2lioof repairs
insurance required.] r c. 152, § 1(4), and we have no
employees. [No workers' 13.❑ Other. _._
comp. insurance required.]
_':\ny applicant th checks box 41 must also 1111 out the section below showing their workers' compensation policy information.
tionrcowners ■'ho 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. lithe sub-contractors have ernployees, 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
in formation.
Insurance Coynpany Name: a..C„ .. R, C.-,-\ i, C._e... o�A . n S . _
Loft, 4 or tight -ins. t_ic. 14: AJ, C LL 5 5? V`1 3S ( Expiration Date: j O - 5' - 0
Job Site Address: Z1 es Z. �r City/ State /Zipc(t t',, ,_. 0I 0(
: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
line up to S I , ;00.00 andlor one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
()Cup 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 Rio hereby r4 under thepains and penalties of perjury that the information provided above is true and correct.
`i Olature; - -- ____ _ Date: 1- "1 1 1— l b
Phone #:: ( (3) .5a. - Lk. In5 _._____.__ _____._.___- ____.___
Official u.tc only. Do not write in this area, to be completed by city or town official.
nor 'Town: Permit/License #
.� Authority (circle one):
,,
�e B'"oard of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector S. Plumbing Inspector
6YOt2i'er
Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
•
Nam of Licen,.e Holder :_ � del 1 S 1 e '17;4333+
License Number
()ton 5 -Q -12
Address - Expiration Date
- ?5
Siglature — /� Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
' _1. " in9 126235
Company Name Registration Number
Ha4rtba Expiration Date
nr l v t a . 01673 7 3 Telephon61 3)52 ?' J 775
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Ccmoensation 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 Exem tp ion
"1'hc current exemption for "homeowners" was extended to include Owner - occupied Dwelltnes of one (1) or two(2) families
an, to allow such homeowner to engage an individual for hire who docs 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. ;4r is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
,;ti°ctures. A person who constructs more than one home in a two - year period shall not be considered It homeowner.
- '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 he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Em.ployecs 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.
Thz 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 at„.tat-.hed
•
•
•
• - i ,. .,r.
{ SECTION 5• DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition n Replacement Windows Alteration(s) ❑ Roofing Ce
Or Doors ❑
Accessory Bldg. [1 Demolition ❑ . New Signs [D] Decks . [E] Siding (D) Other (t7)'
Brief Descript.on of Proposed 4.
VVcrk.: L n Pl
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 budding : One Family Two Family Other
b. Number o' rooms i;; each family unit: i 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 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. floodpiain Yes No
;. Depth of 'easement 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
F
S EC TI 0 N 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L , as Owner of the subject
p; cperty j'� •
hereby authorize L,MaY 1 J t° s e o � • � j. ROOfI n 9
to act on my behalf, in all matters relative to work authorized by this ui ding permit application.
att. rhea — -tom
Sig'natureof Owner —' ^— Date
• • ' 4 • / . , as Owner/Authorized
. I Agent hereby declare that the statements and information on the foregoing : O .lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
s lis l • ed
Print Name
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 ' )
Fwontav i 1 1
Sk :tbacks Front
1
Side L:' R: L:' R:' l l
Rear l._.__._
B.iilding Ileight
1
B'dg. Square Footage %
O?en Space Footage
(L: arca minus bldg & paved
•
1
# ,')f Parking Spaces
F; II: l
(volume & location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DONT KNOW 0 YES o
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Pagel and /or Document
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton Ste {{
��"'� 21z� Main Street Department CurD C �, ' r ;
0 ,%Room 100 Wa k '.:,„,•,, , ,
I �' No�hamptc�, MA 01060 ,k F rk:1 �� ,.
'phone 413 -587 -1240 Fax 413 - 587 -1272 Plot%Stii; $_ + .,` .r,, , ::
Other s • «r, C` ; . " `"
APPICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address.
G..
This section to be completed by office
1 Q e.r-).. 1-I e.. `-‘) C Map • Lot _ Unit
- 0.0 Zone Overlay District
Elm SL Dlstrtct CB DNtrict
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
'(`n't ‘ t i \ ' e . ----c b p i e 21 0_,'c - e . Z f . - C e p ,
Name (Print) Current Melling Address:
_a a ch e c I Telephone - •
Signature
22 22 .Autho Agent'
Ai, .- CC _
Name (Print) 7 Current Mailing ..Tess: 01 0`13,
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee r9 2. Electrical (b) Estimated Total Cost of
Construction from (61
3. Plumbing Building Permit Fee
4. Mechanica' (HVAC)
5:- Fire Protection
6, Total - 2 +3 +4 +5) ,"( 00 ,c')C) Check Number , fi(p ,
This Section For Official Use Only •
Date
BoI1dingPermit Number. Issued:
Signature: _
Building Commissioner/Inspector of Buildings Dele
X1'4 •
BP- 2011 -0464
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 -0464
Project # JS- 2011- 000746
Est. Cost: $7700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 10018.80 Owner: TOBIN MICHAEL V & KATHLEEN G
Zoning: URA(100) //WSP Applicant: RCI ROOFING
AT: 27 BEATTIE DR
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:11/16/2010 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 11/16/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner