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17C-181 Roofing 6 Line St. Southampton, Ma. 01073 Este m ate Date Phone (413) 527 -4775 Fax (413) 527 -8469 7/20/2009 Name / Address Job Location Gerry Giguere 22 Plymouth Ave. 22 Plymouth Ave. Florence, Ma. 01062 Florence, Ma. 01062 (413) 586 -6994 Terms Rep Estimate valid for 30 days Rich Job Description Total Remove existing roofs. 10 000.00 Furnish & install 1/2" plywood over the existing decking. Furnish & install aluminum drip edge and related fleshings. Furnish & install CertainTeed Winterguard ice and water barrier along eaves and valleys. Furnish & install synthetic underlayment. Furnish & install CertainTeed Landmark - Woodscape Premium Series shingle. Furnish & install 4 box vents. f • All exterior roofing related debris to be removed by R.C.I. . Roofing. .rc wafer c'w"r fortA red 5 -year RCI Roofing workmanship warranty included. -,' year CertainTeed material warranty included. r) All related permits will be obtained by R.C.I. Roofing. Add: $135.00 for Certainteed Surestart plus extended warranty (included if signed estimate is returned within 7 days). NN/VNN CHANGE ORDER NNNNN July 23, 2009 > Increased price of RIP & REDECK W /Rubber Roof from $9,500.00 to $10,000.00. Changed description of RIP & REDECK W /Rubber Roof. ( +$500.00) Total change to estimate +$500.00 N N NNN N N N NNN N N N N N N N N N N N NNN WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $10,000.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature 5J Registration # 126235 Construction License # 074334 Date 1/21 l Insured by Reynolds, Barnes & Hebb, Inc. 413 - 447 -7376 1 . fit ' i Board of Building Regulations and Standards l Construction Supervisor License tea 1 License: CS 74334 i I 1 t Eat€. '5/3/2010 Tr# 23520 Reatr, iot1, 00 MARK T DELISLE 33 FIRST AVE �-.G..- — EASTHAMPTON, MA 01027 Commissioner y/' hie €amvnxaluveah of,/iicatiacituesel4 B oard of Building Regulations and Standards mil— Si HOME IMPROVEMENT CONTRACTOR _ Registration: , 126235 , (_E 4-----1777 Expiration: 5/6/2010 Tr# 266063 Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. .. .,...,,_ EASTHAMPTON, MA 01027 Administrator • 4'cPrp . � Z ti r t Crx� >xf Northampton ii, ���s� .ry`,1. �`' 6 ,Itasseelloectts' ij 1T V r DEPARTMENT OP BUILDING INSPECTIONS i 1 t . . 212 Main Street • Municipal Building Northampton, Macs. 01060 2 u m WORKER'S COMPENSATION INSURANCE AFFIDAVIT I, - • • • a• 1,4 (iiccnscefpermiuet) with a principal place of business/residence at: • • e _ • - t - ' • ..IP vet a- 12 ....e • _._ . 0 t 0 (phOneitta45 2 • .•. city /staivap) do hereby certify, under the pains and penalties of perjury, that: (41I am an employer providing the following worker's compensation coverage for my employees working on this job: )J o..\lk ono.\ U..h.OA c■ re. ZalS. to. oG Q Amu , Q k mlc_3L3fV� 10- - (insurance Co mpaay) v (Policy Number) (Expiration Date) () i. 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 Number) (Expiration Date) (Name of Contractor) • ' (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contactor) (Insurance Company/Policy Number) (Expiration Date) (ratacit additioasl shoed if nocesury to iorlode infamstioc pertaining to all coobec en) ( ) 1 am a sole proprietor and have no one w orking for me. ( ) 1 am a home owner performing all the work myself. • • NOTE: please be ammo III vtbi10 bomeowaera Woo eaoploy penes to do ms ntanne , oxsautdonor repairool C as 1 of to: moo Una thtoo mitt in vdricb that homeoaoac resides or am du grounds eppuctionetthardo on Dot Faulk aoacidetedta bs =ploy= s under tha wakes c o w p e n s . t i c * Act (G1.1S2.T31(5)). applieatioa by a bomaoaoet f o r a lioynuo or permit may widewdle ie22.i sterna dui employee uod.ttbe Wockee's Compematioa Me. • s' , • 1 uDdc•••4 tt3st a copy gilds Waned any bo forwardrd to tho Depa►ti000t otIodetstrist Midst/ Woo ethos* alb eo'�a Lso cciHcasioa sad tot tai Routes muses s to us s mater section SA c(MGL IS'� CU �,dto that imposat debit podia . , .a ooasisti.•tg of a fine of up to SI.SOO.00 snd/or imprisonment alb? to one year and civl peaslties is tbt Oars ets 8$op *MOON ■1 a , firs 0(5100.00 a dry against roc. x t flpg5'.>44!!: . ' For depseeDtd+Jtaaadlt ti S- of Lto=sce/Permittee Date e SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ j�. • Name of License Holder : M aY k "Del I S 1 + I l p i 1744 3 3 ' License Number ,. ��z: � . — -10 Address - Expiration Date Signature Telephone • f 9. Registered Home Improvement Contractor: Not Applicable ❑ 8,E. T. 'Roof; f; 121,235 Company Name • Registration Number , 5 - L6 -10 Haoreb� - t1 Expiration Date , &t.11 prom Ma , 0) 6` - / 3 Telephonkil 3)521- 4175 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 ❑ 11. - 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 actq 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 he/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.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 Dcath) of the Massachusetts General Laws Annotated, you MAY be liable for person(s) vou 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. H omeowner Signature atta • • , ,s • thA • • SECTION 5- DESCRIPTION OF PROPOSED WORK (check ail applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing cd. 1 Or Doors ❑ • • Accessory Bldg. ❑ Demolition ❑ . New Signs (D] Decks Siding [a Other KM' ' ' Brief Description of Proposed a ltaehP11 Work: 1 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: 1 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 cf 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 constru :tion 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 . 1. 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 1 1, r� C ► � `� - , ae Owner of the subject property • tt • • • �I hereby authorize L. : a a• 1 0 • i to act on my behalf, in all matters r- ative to work authorized by this •ui ding permit application. . ovine, Date . • I, it . i 11 " - . *is - • . • .1 , 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. - , S'.. , '• °under the pains and penalties of perjury. { te r'.:.: aJ, � .- Alt, P 0 tO • S "� ,. 4.+,ONner /A Date ;, : ' ' .. r 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 Lot Size 1 1 I _.._._. __ i Frontage 1 I 1 1 Setbacks Front , l Side L:I i R : I i L I.._T__. _J R:C._ ._.._1 . Rear i .__. __.? Building Height 1 B;dg. Square Footage i i Open Space Footage % (Lot area minus bldg &paved # i ..._ _ 1 I .... - ... -.-_— parking) # of Parking Spaces 1 1 1 1 [- 11 Fill: ' (volume & Location) I . A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: 1 . IF YES: Was the permit recorded at the Registry of Deeds? NO 0 •: DONT KNOW 0 YES 0 IF YES: enter Book ? ' Pagel J and /or Document # [ ~ ___ -1 B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained © , Date Issued: L l C. Do any signs exist on the property? YES © 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 O NO O IF YES, describe size, type and Location: J E. Will the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acre or Is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. ax ps a� qt / ■ City of Northampton Ste Building Department CurbCt l e, , 212 Main Street T ,�, '? , Room 100 Northampton, MA 01060 phone 413- 587 -1240 Fax 413-587-1272 a ° 4 Oiher APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH -A'ONE OR FAMILY DWELLING SECTION 1 -SITE INFORMATION Apr, — r L J 1.1 Property Address: �QQ This section to be Completed by office 'tYwAk Map Lot Unit 'ckb C� -*(1C _�. Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT • 2.1 Owner of Record; le) st C t C 'l..l t' cc ON a. Name (Print) Current Mailing Addre• attaellp d Telephone `�` -�� IP9 `i Signature - 2.2 Authorized Agent: Mayk 71 e ' 1e - ft.C.z. goof; ,� L:.re�.;� . sc upm� -on Name (Print) Current Mailing Address: t ' 01 6.1. j (1I3) 521. 1115 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building qoofiyi 4 /L (CO „C (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of . Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) (`C3�� `� Fire Protection 6. /��� D 4.3C 6. Total = (1 + 2 + 3 + 4 + 5) / t ` Check Number This Section For Official Use Only • Date Building Permit Number. • Issued: Signature: • • Building Commissloner /Inspector of Buildings Date • f 1 4 AvE BP- 2010 -0149 GIS #: COMMONWEALTH OF MASSACHUSETTS 4 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- 2010 -0149 Project # JS- 2010- 000179 Est. Cost: $10000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 8363.52 Owner: GIGUERE GERALD H & PENELOPE AN SMITH - GIGUERE Zoning: URB(100)/ Applicant: RCI ROOFING AT: 22 PLYMOUTH AVE Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:8/7/2009 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 8/7/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo