29-471 (2) we
RC. I
. Roofing,,,,,
51B Holyoke Street
P.O. Box 309
Phone ( 13) 7- 75 Estimate
Date
Phone (413) 527-4775 9/8/2008
Fax (413) 527-8469
Name/Address Job Location
Ellen Darabi 306 Ryan Road
Mary Jane Lane Florence, MA
Florence, MA 01062 413-320-3511
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
Remove existing roofs. 11,600.00
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 15 lb. felt 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-Star CerainTeed Surestart Plus extended material and workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add $2.50 per sq. ft. for wood decking replacement if needed.
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3) $11 ,600.00
THREE BUSINESS DAYS OF DATE OF SIGNING. Total
TERMS OF PAYMENT
5%Deposit
Balance upon completion Customer Slgnatu
Registration# 126235
Construction License#074334 Date vi -2 a
Insured by ReNnolds.Barnes&Hebb, Inc.413-447-7376
a ti CHt of 'Wart 11aillptell
;. �a�a+trhaaett.
y Q DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
W ORICER'S COMTENSATION INSURANCE A PIDAVTT
1T
R00fi V),n
(liccnscrJpermittec)
a principal place of business/residence at:
51_3 }j0 (phone#
strrct/c ty/statdap)
dc hereby certify, under the pains and penalties of penury, that.
(� I am an employer providing the following worker's compensation coverage for my
enn )lovices working on this job:
Nati O'naI U rLLb n Fi Ye.
'Ir1s. Co. of f'ittsbuYQ PA )NC3b31gb9 10/05/04
C nsurancc Company) Y (policy Number) (Expiration Date)
O I <-,-n a sole proprietor, general contractor or homeowner (circle one) and have hired
t:-.0 contractors listed below who have the following worker's compensation policies:
(N Lmc of Contractor) Onsurancc Compauy/Policy Number) (Facpim6on Date)
(Name of Contractor) (Insurance Company/PoUcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Compauy[PaUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/policy Number) (Expiration Date)
tore Sdction�i
shlxe if ncccsury to inc}ude iaf"Mutioa pertsiaing to all ooarncton)
; ) I am a sole proprietor and have no one woddng for me.
I am a home owner performing all the work myself.
NO:-E:plc a.=be aware that while hoazowom who employ pcnom to do m&jdcn nn onsmictioa or repair worse on a dwelling of
::oc rnoc c than thrl units is which the homoowocr reside or ou the grounds rppudcnad therdo arc not gc>cra.11y oomrWered to be
cxtptoyc:z under the works m c=*=s ica Act(GL152,=1(5)),application by a homeowner for a license or permit may evil the
:chi rtatuc of an employer undo the WorkW z Compomation ArL
I uz-,: t— ad that.x copy of this ctitcmmt nay be forwarded to the Deputmoos of Lndastrial Aocideo&OlSoo of tors-n-for the
-v«mg-Ya-,Ecziioo and that fa'1wc to ce=coverage tmdcr s0W0a 25A of MQL 132 can lad to lk i ca of ww iw peadtia
`0m of a fine of up to S1,500-00 tnNor impmonmcni of up to one ymr and cio pealwcs is the form of a stop wait otda and a '
3=of 1 00.00 a day Lgninst tae.
For ao only er
Lot#
µ Signature of Lia zsc6permitim Date
SECTION 8 -CONSTRUCTION SERVICES
` 8.1 Licensed Construction Supervisor: C Not Applicable
� ❑ ,r j�
Name of License Holder: M —b 1 7 e. 17q ,33"1 ,3 3"►
License Number
St - Faglh mnton Ma. oic all - - 10
Address i —I- Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
8. C. 1. 'Roh f- na 126235
Company Name i Registration Number
51 A Adwoke Areet - P D. x 309 - - /0
Address i Expiration Date
Easl6amolan , Ma. c i 0 a-7 Telephon /
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 buil ng permit.
Signed Affidavit Attached Yes....... No...... ❑
11. - Home Owner Exemption
T:Ic current cXcmption for•'homcoNyncrs"vvas extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to alloyv 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)v%ho oN�n 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.
SAch"homco��ner"shall submit to the Building Official.on a lin-m acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor dour presence on the job site will be required from time to time,during and upon
completion of the work.lbr which this permit is issued.
[so be adyiscd that with relcrence to Chaptcr 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees For injuries not resulting in Dcath)ofthe Massachusetts General Laws Annotated,you may be liable for person(s)
N ou hire to perform vyork IM N ou under this permit.
I'nc till dersiincd"homcovvncr"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
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing FYI
Or Doors I:3
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [C] Siding [O] Other[[:1]
Brief Description of Proposed
Work:
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?
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. floodplain Yes No
j. Depth cf basement or cellar floor below finished grade
k. Will bui ding conform to the Building and Zoning regulations? Yes No .
I. Septic ank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, E I Ian , ) a r a ] as Owner of the subject
property
ihereby authorize ' inn
to act on my behalf, in all matters relative to work authorized by this uilding permit application.
attaehPd ii- �9- o�'
Signature of Owner Date
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.
Print Name
11 -f9-03
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
F;xisting Proposed Required by'Zoning
This column to be filled in by
Building Department
l.ot Si/c
Frontace
Scthacks Front
Sidc I.: IZ: L: R:
Rear
13'iJldino I leight
131dg. Square Footage %
Open Space Footage 6.
(Lot urea minus hide K PM'al
f..rkm�l
uCParking Spaces
F.II:
(c;lumc K I.pcation)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DON'T KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES 0
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained O Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO Q
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 O NO 0
IF YES.then a Northampton Storm Water Management Permit from the DPW is required.
City of Northampton Status of Permit: Department use only
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
/pbone_4,13-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Propertyy Address: This
-� This section to be completed by office
306
an i�-C�a� Map Lot Unit
`J Zone Overlay District
Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
llexn Mara i -
Name(Print) urrreent aili Address:
at. a e A Telephone
Signature
2.2 Authorized Agent:
mak P.�. fix 3�9 - Eas�h metc�n�Ma
Name(Print) Current Mailing Address: 01021
�— �'�!3) 5�1- -4??5 �[
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
1. Building RC)OF, ' �1 I oo.00 (a) Building Permit Fee
2_ Electrical (b) Estimated Total Cost of
— ectnc—al Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6 Total = (1 +2 + 3 +4 +5) (0009 Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
k,3 Aft RD " BP-2009-0545
GIs#: COMMONWEALTH OF MASSACHUSETTS
a QIogk:29.473 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-2009-0545
Project# JS-2009-000766
Est. Cost: $11600.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 50965.20 Owner: DARABI ELLEN
Zoning:URA(100 //v SP Applicant: RCI ROOFING
AT: 306 RYAN RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.1112012008 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 11/20/2008 0:00:00 $35.0013225
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
ow