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11C-073 (2) • .. RC.I. Roof Date 6 Line Estima Southampton, Ma. 01073 6/28/2011 Phone (413) 527 - 4775 Fax (413) 527-8469 Name / Address Job Location John Tatar() 114 Florence Rt#- Si 114 Florence Ref' / Leeds, Ma. 01053 Leeds, Ma. 01053 (413) 586 -3967 Terms Rep Estimate valid for 30 days Dave Description Total Remove existing, roofs. 9,600.00 Furnish & install aluminum drip edge, pipe llashings, chimney 'lashings and step 'lashings. Furnish & install new lead counter 'lashings. Furnish & install CertainTeed Winterguard ice & water harrier along eaves and valleys. Furnish and install synthetic underlayment over existing deck. Furnish and install 30 year CertainTeed Woodscape Series shingle. Furnish and install Certain'Feed approved ridge vent. All exterior roofing related debris to he removed by R.C.I. Rooting. All work will he performed according to manufacturers' specifications. All work will he performed according to new OSHA 6/15/2011 standards. 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 it needed. Add: $1,050.00 for Certainteed Landmark Woodscape 50 year premium shingle. A Certainteed Surestart Plus extended warranty will he included with a fee of ($420.00) a bsorbed by RCt Roofing if signed within 7 days. This extended warranty means that 20 of the 30 year warranty is covered for labor and material. The last 10 years of the 30 year Certainteed warranty would he covered for material only. WE LOOK FORWARD To DOING BUSINESS WITH YOU. Total $9,600.00 TERMS OF PAYMENT 5% Deposit , j .✓ Balance upon completion Customer Signature 'u(r`�f�;/ Registration 4 126235 Construction License 4 074334 Date / Insured by Bangs & Fickert Ins.I (413)527 -2700 • , 1,.., • The Commonwealth of Massachusetts r^ ,- f Department of Industrial Accidents 1 ''� Office of Investigations e 1 600 Washington Street k / Boston, MA 02111 4" f ^�1`-� } W W W. /n aS %. g o v/ I i a Wo► (_:oinpensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legi N(imc (}itL,in,,,,, )rgarti /individual): _._�, 9 �1 Lam _ -- � Address: ( \,..,_\ , ,A \- its /S(ittc,/11 t? t.� \Qn _ Rtd`Za _ PI- Rine .., -Li�i1S \rr 1'ou ;ti) ell) ploytr . Check the appropriate box: Type of project (required): L,` I it'll a employer with 2 ,(D _ - 4 . ❑ I am a general contractor and 1 -_ hive hired the sub -contractors G. Li New construction e.mplovices (full and /or part - tine).' ❑l ama sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have S. ❑ Demolition working for me in any ac capity. employees and have workers' capacity. ❑ Building addition (No v■,irkers' comp, insurance comp. insurance.: required.' ❑ We are a corporation W oration and its i0.ri Electrical repairs or additions ri I am .t homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions ntiscl;'. (No workers' comp. right of exemption per MCA. 12. VR oofrepairs tnsur „Hai required. I ' c. 152, § 1(4), and we have no employees. Ho workers' 1 3.E1 Other comp. insurance required.) ______________ ' i.y applicant ih,it check, box 4 I must also ill) out the section below showing their workers' compensation policy information. 1 tontcossnets s ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 't. ontructon that check this fox must attached an additional sheet showing the name o! the sub - contractors and state whether or not those entities have employees. I1'the sub- contractors have employees, they must provide their workers' comp. policy number, / trot an employer that is providing workers' compensation insurance for my employees. Below is the policy and Joh site in /urn /t. n;urance t.'o :npanv Name: Q,.t Q Cif c��Cu. v, o.A Ni_+ n � _______ i'oh∎.'v ss or S(11 -111s. Lie. 4 1AJUlC _� �_Q 3S Expiration Dater O — Q i '. _ Job Site ( Addtcss. IN CtOC"r_ , S� . _ -- Cit /State /Zi „ _ „ - �0.• 0105. — - t -- Attach a co p\' of the workers' compensation policy declaration page (showing the policy number and expiration date). i .tilttre to sec—,ire coverage as required under Section 25A of MGL. c. 152 can lead to the imposition of criminal penalties of a Line up to Si 'i00.00 and /or one -year imprisonment, as tivell as civil penalties in the form of STOP WORK ORDER and a fine of up to ';;25U 00 tt 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. _ 1 rio hereby cc•rt {/v te nder the ins and penalties of perjury that the information provided above is true and correct. Sign ire; 1 -- - U ( 1 ____—_— 1 e+: c_<- LC ` S — — — – —_ Official use only. Do not write in this area, to he completed by city or gown official C►tysor Town: Permit/License # 1ssuig Authority (circle one): L'IlVarti of Health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector f. (Oili r,,,,thrt Person: Phone #: . SECTION 8_ CONSTRUCTION SERVICES ii1 Licenser'. Construction Supervisor: Not Applicable amo, of Lice o Holder 1 1 -.C] .t1 -� - e 77_U_3 .L-7 _11l License Number - - -- ?.� N * a . 01 .. IA • 03 - 12. Address _ Expiration Date —^ — �cna!ur� Telephone Registered Home Improvement Contractor: Not Applicable 0 - - -- __ 1 26235 Company Name Registration Number ocr�„ Expiration Date . a_t__c_L0 1 relepriori -Ii_3)5,2 -'T 4175 SECTION 1D- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) 1 Vorkers Cc,n,;;ensation 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 Affvcta� tit Attached Yes No ❑ 11. - Home Owner Exemption current exemption for "homeowners was extended to include Owner- occupied Pwellint:s of one (1) or two(2) families 1 allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner ac(U as supervisor. CM R 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which hclshc resides or intends to reside, on which there )r is intended ',o bc, a one or two fancily dwelling, attached or detached structures accessory to such use and/ or fame ,,;,,dare~. A person who constructs more than one home in a two -year period shall not be considered a homeowner. s,,:ch homeowner shall submit to the luilding Official, on a form acceptable to the Building Official, that )te/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 •;. °,pletion of the work•for which this permit is issued. I o, be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to plo' ees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you MAY be lljbk for person(*) ,r,lr hire to perform work for you under this permit. lit.; 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 ..........h�„'(�__ t'$ Ych e • , . • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House l Addition Replacement Windows Alteration(s) n Roofing PK Or Doors Accessory Bldg. i - 1 Demolition 1 1 . New Signs [O] Decks [E Siding ID) Other [0]' I Brief Description of Proposed e Iork: attaell Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet sa. If New house and or addition to existing housing, complete the following: Use of b aiding One Family — Two Family Other Number c rooms in each family unit. Number of Bathrooms Is there a garage attached? d. Proposec Square footage of new construction. Dimensions e. Numbe c' stones? Method of heating? Fireplaces or Woodstoves Number of each Energy Conservation Compliance. Masscheck Energy Compliance form attached? Type of co, struction Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No • 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 \ 0 , ss Owner of the subject property Q �• hereby authori ::e 1 X L�, S l e_ Q\ r 1 j c). L.. RQQ 1 1 � act on my be: half, in all matters r tative to work authorized by this uing permit application. Sig'natlli'eOf Owner Date • , • • 0 • ' 4 • .0 , as Owner /Authorized Agent hereby d 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. taY k l 1 51 ea 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 F onta�C 1 1 I Setbacks Front ■ Side I.. R: I,:' R: Rear L ' 13.,ilding height 1 r . dg. Square Footage I °4. ■ 2�en Space Footage 0/ 1. , t arca minus bldg & paved I a king) ■ )f Parking Spaces Fill: �, lv._.lume & 1.oCaUOn) ;, I A Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T 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 #1 ■ E. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW a YES C IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: 1 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 Q NO 0 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 Q NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Y �•n i S 2 SOH REC 1 � .... ". a -�. . 3 r � r : Ot , - . ", x ,: City of Northampton Sititt4 t; 25 ION Building Department , Curd C •, ti ►� } w„ 212 Main Street „ 4 ,10',, " & , ' z '° DEPT. OF BUILDING iNSPECmoNC ail' „� ' NORTHAMPTON MA' �' Room 100 W r , t Iri, i +,a' 1, Northampton, MA 01060 'N e11 , �4 a q • , , d� i pr phone 413 -587 -1240 Fax 413 - 587 -1272 Piot/SI{ ��wifx ,krn" t•',, , •' � y +�4^f T T � �� :'R P .��5� Other`s r s9�x � � \ , : .,... APP'L'CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION . This section to be completed by office 1.1 Property ;address: lVA F \ot SC' , Map 1 Lot Unit LE.- .S , �... Zone Ov.riay District Elm St. District Ce Oistitt SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT - 2.1 Owner of Record: �a�r,n _ \ o■_ _Li 11 Ck ()(e__n(e \ aS I 'Ma. Oto53 Name (Print) Current Mailing Address: ` Telephone ' - - ��1'� �{�'� � { , Signature 2.2 Authorized Agent: ma i v • .I. c e► ♦II !/ • ti i '5e.' �' Name (P t) Current Mailing . ddresa: O l 0` --- ( 52'1- 4115 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTq Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant . 1. Building 00 Fi r l) 0 o (a) Building Permit Fee j 2. Electrical J (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical ;HVAC) 5Fire 'Protection �� � 5-- A-3 5-- 6. Total = (1 2 +3 +4 +5) ,$CI ,(e©0 "o Check Number / This Section For Official Use Only l _ Date Bolding' Permit Number. Issued:, Signature: ""�"..'.'" Bultdtng CommisstonerItnsgeator of Buildings Ds* , '46,, , • • 114 FLORENCE ST BP- 2012 -0099 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11C - 073 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: roofing BUILDING PERMIT Permit # BP-2012-0099 Project # JS- 2012 - 000154 Est. Cost: $9600.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 20734.56 Owner: TATARO JOHN M & DEBORAH A Zoning: URA(100)/ Applicant: RCI ROOFING AT: 114 FLORENCE ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAM PTONMA01073 ISSUED ON: 7/29/2011 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 7/29/2011 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner