29-535 . Roofing, LLP
51B Holyoke Street
P.O.Box 309
Easthampton, MA 01027 m ate Date
s t i
Phone(413)527-4775 10/26/2005
Fax (413)527-8469
Name/Address Job Location
Michael Liu 14 Indian Hill
14 Indian Hill
I ` Florence, MA
Florence, MA 01062 Home: 585-9124
Work: 582-7000
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
i Remove existing roofs.
5,300.00
Furnish& install aluminum drip edge,pipe tashings and chimney flashings.
Furnish& install new lead counter fleshings.
Furnish& install ice&water barrier along eaves and valleys.
Furnish and install 15 lb. felt over existing deck.
Furnish and install 30 year Tamko Heritage Series shingle.
Furnish and install Cor-A-Vent ridge vent.
All roofing related debris to be removed by R.C.I.Roofing.
All work will be performed according to manufacturers'specifications.
5 year R.C.I.workmanship warranty included.
30 year Tamko 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 replacement if needed.
ADD......$3,000.00......To remove old plywood and replace with new 1/2" CDX plywood.
WE LOOK FORWARD TO DOING BUSINESS WITI I YOU.
Total $5,300.00
TERMS OF PAYMENT
30%Upon delivery of materials
70%Upon completion Customer Signature
Registration# 126235
Construction License#074334 Date
Insured by Hackworth Insurance(413)527-9907
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DEPARTMENT OF BUILDTNZG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
S 1-e of t.-T R00fil nj-
(1ic cnseclpermittec)
,with principal place of business/residence at:
strut/
;6p)
do do hereby certify, under the pains and penalties of pegury, that:
(� 1 am an employer providing the following worker's compensation coverage for my
emp owes working on this job:
Am�r`t�an�In `1 Grpun X81 bb l 0 10 Ob
Gnsu=cc Company) �~ (Policy Number) (Expiration Date)
O 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:
;Name of Contractor) (Insurancc Company/Policy Numba) (Expiration Date)
;Name of Contractor) (Insurance CompanylPolicy Number) (Expiration Date)
(Name of Contractor) (Insurance CompanytPolicy Number) (Expiration Date)
CNa.me of Contractor) (Insurance Company/Policy Numbcs) (E)piration Date)
(atUZ.'Aditional rjxct if neocsssry to inhale information pertaiaing to all O0d Mdors)
( I am a sole proprietor and have no one worSisng for me.
( ) I am a home owner performing all the work myself.
NOTE:please be awatti that whilo homeowner wbo employ pasoos w do mainteaanoe.ootntsudion or repair woes:oo a dwelling of
not mocc than throo units in which the homeowner reside or oa the pounds VV denant th=w are not gmaslly coorWercd to be
uadcr the wo k&l coapccsatloa Act(GL1 application by a homeowna for a Gocme a per3l3 may-id--tho
Ieg. ctawAo£anompl oyer under thoWorltoesCoospenujioaAd
1 unirsiand that a copy of this aatemmt may ba forwarded to the Dopartmoot of IndaL+trial Acd4w&Offios of lawraoa for dw
co`cz�vaiLcatioo and that failure to w=oovetagv tmda soaioa 25A of MGL 152 cu lad to the of a;O"PM W46
of&&a of up to S1,500.00 vNor 46otltn41 of up 14 one yev W dvil pmtH ej le the ram at 9W Wok Order and a
fi>x of�109.00 a day ttpinA nc
For Mm ue
onY
r c umbe
Lot
r S'Part c of Liamsseepermittee
AL
SECTION 8'-.CONSTRUCTION SERVICES
8.1 Licensed Constructions Supervisor: Not Applicable ❑J,(
Name of License Holder :yl�t Y 1)e.1 i.5 e. ! 1 ?33 -I
License Number
51 - OE 61mornn Na. n1ov 5 -n - Ob
Address Expiration Date
(!q13) 5V- 4?75
Signature Telephone
Reg mg arofement Cont Not Applicable ❑
R-0- 1- �£i 12.6 235
Com any Name Registration Number
5113 kkbAe. Strut - P.I). BDA 301 5. O b - 0 L _
Address J Expiration Date
Telephon
q5
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...... ❑
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 hle/shg shall be
responsible for all such work performed under the building permit.
As 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.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Delth),ofthe 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. taehe�
SECTIONS DESCRIPTIONkOF PROPOSED WORKz(ch al[apalicablg)
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
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❑
, If4New house and o ddition to existing housing,:complefie�h' fi 06.0" .:
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. Mascheck 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 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`AUTHORIZAI ION -TO BE COMPLETED WHEN
OWNERS AGENT'OR�CONT0CTOR'gPPLIES FOR BUILDING PERMIT
I, c /Y1 iC6 Il.l U as Owner of the subject property
hereby authorize ayk Defisle- Q o riq to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, Mark DelWt. as -utAnil anent as Owner/Authorized Agent
hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
NzykPrint Name ;ell
- 06
Signature of Owner/Agent Date
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces. .-, t
,;w
Fill: .
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES—
No
IF YES, describe size, type and location:
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587.1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION
,This secti'° ico" ��
1.1 Property Address:
IO CEXIL'P Zone `' Ode r ayes t
J
Elm St. District • CB.D�stiict ,, ,
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
JM10-6ae-1 L u �{i -Ind 1 an 11 F I L)CE e, N a .
Name(Print) Current` ajling Ad ress:
Telephoned
Signature
2.2 Authorized Agent:
Marh` el isle le - R. .I. Roofing px 3CZ9 - Easthaynotw Ma_
Name(Print) Current Mailing Address: O` R
0131 527- qg75 f
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
L com leted b ermit a licant
1. Building RODI In �30���� (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) 3 V , Check Number o J�
This Section For Official Use Onl
Building Permit Number: Date Issued:
r
Signature:'
Building Commissioner/Inspector of Buildings Date,;;
4WHILL BP-2006-0793
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map Block: 29-535 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0793
Project# JS-2006-1211
Est.Cost: $5300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 10628.64 Owner: LIU MICHAEL Y&
Zoning_UFA Applicant. RCI ROOFING
AT: 14 INDIAN HILL
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON.2/9/2006 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 2/9/2006 0:00:00 $25.008256
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo