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32A-239 03/27/2000 21: 4135299775 DENESE @ NORTH RIVER PAGE 01 • .# 0.....°111.16..44.114 7 14 " .4 0+ ' I R.C. • Ro o i mL g LLP , !3 6 Line St. Southampton, Ma. 01073 Proposa Date Phone (41.3) 527 -4775 7/27/2009 Fax (413) 527 -8469 - Name/Address Job Location CONSTRUCT ASSOCIATES i ATTN: Roble 2 Pomeroy Terrace ConOmin(ums 36 Service Center Road t Northampton, Ma. 01069 Northampton, MA 01060 T erms -+�°— Rep I Due on receipt j Chris _ �— Job Description Total Remove existing roofs. , 54,900.00 Furnish and install ice & wat r barrier along eaves and valleys. I.: Furnish and install synthetic underlayment. II Furnish and install 16oz cop er drip edge. 1 Furnish and install 30 year ertainteed shingle. I Furnish and install Certainte d approved ridge vent. I, Furnish and install 20oz cop er valleys. Furnish and install 20oz cop er snow belt on upper dormer area copper '! seams will be soldered toge her. Ii Furnish and install .040 bro ze aluminum standing seam roof to ail apron 'jl areas. III Furnish 20oz copper for win ow caps. All work to be performed according to manufacturers' specifications. All exterior roofing related debris to be removed by R.C.I. Roofing. I 5 -year R.C.I. workmanship arranty Included. Ail related permits will be o tained by R.C.I. Roofing. II Add: $3,000.00 for 50 year remium shingle. i Add: $4,000.00 for flat roof . 'I� I ii _ WE LOOK FORWARD TO DO[NG BUSINESS WITH YOU. Total j l $54,900.00 TERMS OF PAYMENT ill 50% Deposit upon delivery of maberiais. II ' Balance upon completion �(� Registration #t 126235 Customer Signature Construction License it 074334 ! li i Insured by Reynolds, Barnes & H b, Inc. Date `.\ 413- 447 -7376 I l i4 g%e eammootwe tai or,gaaeaa+eue d Board of Building Regulations and Standards illilk Constructi9n Supervisor License , IF i , - At, Lic*nn CS 74334 c ' S .'- * (2010 Tr# ii :ti / 1 `j c 1 =j MARK T DELISLE . ° '' / 33 FIRST AVE `� "_'W'''`" . 0".7"—Z...- - � - �EASTHAMPTON, MA 01027 Commissione • __ €ommoouueah Or ✓llaoaad atri • Board of Building Regulations and Standards T * ,j e t 6 HOME IMP CONTRACTOR _ ! 1 6 0 Registration:\ 126235 ' , ` ..,,;1 E ration ;:. /2010 Tr# 266063 1 j $ Partnership R.C.I. ROOFING' \ , �, i 1, ` . i MARK DELISLE 41. : f r 51 B HOLYOKE ST \ f ; C4� ; EASTHAMPTON, MA 01027 Administrator a r. ? `;� � 1. • a t ' ra t i`., L 6 7 4 t r ep F '�*'^;t. .r ,.._� A . � # cr Nl+ 1" 3 � �► , ,� 6 assechnsctts' Ail """ DEP ARTMENT OP BUI LDING INS PECTIONS S. . Ei • . 212 Main Street • Municipal Building "' Northampton, Mass. 01060 e'` WORKER'S COMPENSATION INSURANCE AFFIDAVIT • -__, ____ - . - • 1 !1 (Iicenset/permiuee) • ., a principal place of business/residence at • 5i 3 Ho t.' Fastham 1b .Ma. 0,,l Oar/ • (phone #��i i3 ) 52? -4115 s treet/ ty /state/rip) c o hereby certify, under the pains and penalties of perjury, that: ', � am an employer providing the following worker's compensation coverage for my e worming on this job: National Union F1 Ye, TnS• CO. of fittsI -u c PA VNIC3631 ?bg 10/05/09 (Insurance urance Company) .J' (Policy Number) (Expiration Date) ,) 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Narnc of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (r.uach additional sheet if neocssuy to indude infocrostioo pertaining to all contractors) ( ) I am a sole proprietor and have no one w orking for me. ( ) 1 am a home owner performing all the work myself. e NOTE: please be aware that whilo homeowner who employ persons to do mamtcasa* , construction or repair wort: on a dwelling of not mocc than throe units in which the homeowner sides oc oa the grounds appurtenant thereto are not generally oomidered to be auployc. -s under the wocicea ..cccapcnsatica Act (GL152.s 1(S)), application by a bomcowaer fora llama or permit may evidence the It-pi ct_rals of as employer under tha Wodcoet Compoosation Act I uaicritsad that z Dopy of this azitemmt. may be forwarded to the Dopettwo:4 of Industrial AOCidmt>' OISoe of Ileums lit to cov=sc ycrificstioo azui that failure to wane covasgo trader section 23A of MCI 151 on WIG t ofd pe131Mes ooesisti.-•S of a fine of up to S t,S =Vac d Jor imp¢u� o of up to Doe year and eivt7 penalties is the form of a Stop Wank Order and a ' ,' :Ina GC :S[04.00 a day against roc.. For departmtdal tine a* Permit Number ` � ; Signaiinze of Lia�usee/Permittet Lane Map I.Ot ; AI.. • Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , I, le Ci`r S , as Owner of the subject property 1 P PertY 16041 hereby autho ize +L• C. . �'1Q I to J act on my behalf, in all matters relative to work authorized by this building permit application. tt.ache•fl 1 - - i I Signature of Owner Date IIIIIIIIIIIB I, J'1 i;Y [1 1)e 1S e-- / 1? Re.I.10017 QCn , as Owner /Authorized, thereby declare that the statements and information on the ) foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. L_MattK isleJ ,,,,_ , „,_ _ __ _ Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder . at 1] C1i S e.. �,,,.,_ �/ J/L License Number 31_$ H 01jolie fra - Easibampfion Ma. 01o2 ?E j 05-03 - 10 • Address Expiration Date � 4 1 x 7- 75 .$ Signature Telephone ' . SECTION 13 - 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 cf the issuance of the building permit. Signed Affidavit Attached Yes • No 0 Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): _. _ _.___ I Registration Number _._ Address i Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): I • _.__. E i Name Area of Responsibility Address Registration Number j]( F Signature Telephone Expiration Date Name Area of Responsibility l Address Registration Number 1 Signature Telephone Expiration Date Name Area of Responsibility 1. Address Registration Number Signature Telephone Expiration Date ______ __ ____ 1 i Name Area of Responsibility . 1 1 .._..... L. r Address Registration Number . I., . r : . _ :I __ 1 Signature Telephone Expiration Date 9.3 General Contractor Not Applicable 0 Company Name: Responsible In Charge of Construction I Address • Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department L ot Size I Frontage Setbacks Front Side L: R:' L: R•= i. Rear Building Height i Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved of Parking Spaces Fill: (, & Location) �.. 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 0 IF YES: enter Book Page I and /or Document # B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES fO IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © ,Date Issued: C. Do any signs exist on the property? YES Q NO 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: 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 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing Change of Use ❑ Other ❑ Brief Description Enter a brief description here. I Of Proposed Work: , SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B I ❑ B Business ❑ 2A I ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 0 F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1-2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 0 R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B ❑ U Utility ❑ Specify: i M Mixed Use , [2 , Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN Existing Use Group: Proposed Use Group: 1 Existing Hazard Index 780 CMR 34): I Proposed Hazard Index 780 CMR 34): ; l SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1 si 2 23 1 I mi . i r4,,kt Total Area (sf) Total Proposed New Construction (sf� i .,y b Total Height (ft) i __ ___ __. i 4* r Total Height ft n l .... Jig: . .. 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private E] Zone! 1 Outside Flood Zone❑ Municipal ❑ On site disposal system❑ • , Version 1.7 Commercial Buildin& Permit May 15, 2000 City of Northampton Status;of P@ �� q, , Q Building a partment Curb Cu • 4X 2:12 Ma'n Street Seweti /Se. D; ° 4 c,)3 ' R 100 1Nalteri VVe , � `' " ' _ _ = No 4 mpton, MA 01060 Tw '.. - , f t -� �� , ,_ ' ` ` ,. phone -413- 587 -1240 Fax 413- 587 -1272 Plot/ite Ptar5 l t � � ti Other Specify ,_: / > t 14 y.. APPLICATTO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 1.1 '4 QQ r- 'e-, \ -\- `e___ - rZ,C;c Map Lot Unit 3 `i V-/ • "' y ` t Y Zone Overlay District i z_-- v._._..._ Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: oleic, � La abed Telephone ( � -- 57:71. - 9 I Signature a 2.2 Authorized Agent /Eastilamptn,. _ _ ayl<'Delis E 1 gO of Bog • N ame (Print) Current Mailing Address: J„_ ,- (+13) 521•177 _. . 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 ! 2. Electrical (b) Estimated Total Cost of I Construction from (6) ! ., 3. Plumbing 1 t Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection (_ ...,_. 6. Total = (1 + 2 + 3 + 4 + 5) a ,5 / UCH L c Check Number /��� a-1 This Section For Official Use Only Building Permit Number Date Issued Signature: B'ldiig Commissioner /Inspector of Buildings Date • • 2FO;`iKR BP-2010-0324 GIS #: COMMONWEALTH OF MASSACHUSETTS 32A . 239. F CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0324 Project # JS- 2010 - 000433 Est. Cost: $54900.00 Fee: $275.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): Owner: WROBLESKI HELEN Zoning: Applicant: RCI ROOFING AT: 2 POMEROY TERR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:9/24/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: STRI P, 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: FeeType: Date Paid: Amount: Building 9/24/2009 0:00:00 $275.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo