11A-074 (6) --R.C. 1, Roofing LLP
51B Holyoke Street
Box 303 Estimate
Easthampton, MA 01027 Date
Eas
Phone (413', 527-4775 10/24J2008
Fax (413) 527-8469
Name/Address Job Location
Tom Quinn Slate Section Only
57 Upland Road 57 Upland Road
Leeds, MA 01053 Leeds, MA
586-0283
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
Remove existing slate roof. 7,000.00
Furnish & install 1/2" plywood over existing decking.
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.
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 CertainTeed 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
Spring discount price.........$6,400.00
�1&y0
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total ,.
TERMS OF R: YMENT
5%Deposit
Balance upon completion Customer Signatur
Registration# 126235
Construction License#074334 Date f �_
Insured by Reynolds, Barnes&Hebb,Inc.413-447-7376
a Crxt17 Of Wart11alliptall
Q DEPARTMENT OP BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORICER'S COMPENSATTON INSURANCE AFIMAVrr
(li ccnscrJpermi ttcc)
v:r.:h a principal place of business/residence at:
(phone#`k1 BL52T- {??J
btrcct/c ty/staid�P)
do '�tercby certify under the pains and penalties of perJt.lry, that:
N i : f�m an employer providing the following worker's compensation coverage for my
enal)10%-ces worl�Dg on this job.
National Union F'iye.
Tn_s• CO. Of fltittsbu.�ra PA 1r~fC3b31?b8 10/05/09
Cnsurancc Company) (Policy Number) (Expiration Date)
l ; I �_,n a sole proprietor, general contractor or homeowner (circle one) and have hired
cont listed below who have the following worke>'s compensation policies:
of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(manic of Contractor) (Lusurance Company/policy Number) (Expiration Date)
(Name of Contractor) (In.sucance Compaay(Policy Number) (Expiration Date)
a� a; ;ionzi s5crt if ncccuary to incltwc infort UEM peztaiaing to all oodradon)
I am it sole proprietor and have no one worldng for me.
I am a home owner performing all the work myself.
NOTE:plc z=be aw-Arc that whilo 6omoowucra who eraplvY P w do�anrtmsaa,oonstsvctioo oT repair work on a dwelling of
rot more than thmo units in WWCh the bomoowncr mida or oa the Vnouads Tpurtm&d iberdo arc not gcoerdly 000sidered to be
c:arployc.s under the Work 's ooazpatico Act(GL152,ts l(S)),application by a homeowner for a lioc.n:se or prrmit may evidence tho
c1 ct ury of an employes under the Woriroes Cocnpomition AnL
I uaicl s d thst x copy of this uitcmeat may be forwarded to tbo Depnrwwot of In&L*ial Aecidea&Office of Im�for the
�v gc va Lcdioo and chit failure to s="covcrnga ttx d"suction 23A o!MOL 132=lead to 1k**%idea of ait W pe WCS
of e f oc'of up to S1,500.00 andlor imPsisoomcci of uP to one ytar end civil penslties in the form of a Stop Wore Onkr trod a
of s t oo.00 a day egbiust ma
For deWWx-W uao-Y
3j 13/03 permit Number
/ J&P4 i..at
Signahuc of LiMpermittee
r
FSECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: M w h INP-,i S ,e, r7 7 U 3'1j�
'
License Number
2$1�Q1uo e St.• Earth mnn Ma o�oa.� 5 - 103 - 10
Address �— Expiration Date
1
Signature Telephone `
9. Registered Home Improvement Contractor: Not Applicable ❑
-H.C. S. moo f nQ 12 6 235
Company Name ) Registration Number
5I B Aoluoke 5-All !D
Address
t1_ Expiration Date
Las kayo o}onT a. o i c a7 Telephon 1
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(S))
Workers kers Compensation Insurance affid vit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buil ing permit.
Signed Affidavit Attached Yes....... No...... ❑
t I. - Home Owner Exemption
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
s.or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
>tructures. 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 be/she 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.lor which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
mployces for injuries not resulting in Death)-of the Massachusetts General Laws Annotated,you may be liable for person(s)
ou 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
Nlorthampton Ordinances. State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature_____
f t
h
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition ❑ Replacement Windows Alterations) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [Cl] Decks [p Siding[01 Other[O]
Brief Work-
Qt of Proposed achPl1 t ���decf� " 1� )�
I 5 �
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 existinq housing complete the followinq
a. Use of building : One Family ✓o Two Family Other
b. Numbe 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?
I
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 AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
&u-Lnn as Owner of the subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
at_taehP.d 3l��109 _
Signature of Owner Date
1, Awh 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
3 3/0
Signature of Owner/Agent Date
f w
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
IAisting Proposed Required by Zoning
This column to be filled in by
Building Department
1,)t Size
F•ontagc
Stbacks Front
Side I.: R: I,: R:
Rcar
Building I leight
Bldg. Square Footage (/,
,J cn Space Footage
H of area minus hldg K paved
p:Aine)
of Parking, Spaces
Fill:
chime Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES Q
IF YES: enter Book Page and/or Document#`
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW Q YES
w
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES Q 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 0 NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Builc jng Department Curb Cut/Driveway Permit
�1
212 MaidStreet Sewer/Septic Availability
dom 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans '' <
phone 41.,3-587-1240 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 Property Address: ,, This section to be completed by office
57 (.lpland QcacL Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Cu rr cling Ain
a�.ta fed �-' n
I Telephone
Signature
2.2 Authorized Agent: D (�,�
VC Name Print l -Di ox 309 - East'-h met'an� a.
(Print) � Current Mailing Address: O1O^n
—� 013) 52#1- J411.5
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building ROOF 46-TV n0 1/ .0o (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) t✓ , Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
57 uPL�ICU BP-2009-0756
GIs#: COMMONWEALTH OF MASSACHUSETTS
x _ -T U74 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-2009-0756
Project# JS-2009-001125
Est. Cost: $6400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 20124.72 Owner: QUINN THOMAS F&AMY B
Zoning.URA(100)/ Applicant: RCI ROOFING
AT. 57 UPLAND RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMA01027-0309 ISSUED ON:311912009 0:00:00
TO PERFORM THE FOLLOWING WORK.STRIPRLY & 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 3/19/2009 0:00:00 $35.0013704
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo