32C-113 C.I. Roofing
6 Line St. E D ate
Southampton, Ma. (1I 173 10/20:2011 J
Phone (413) 527 -4775
Fax (413) 527 -5400
Name / Address Job Location
Paul & Karen Hebert 59 Conz St.
59 Conz St. Northampton, Ma. (ii060
Northampton, Ma. (1104,11
1 erms Rep
Estimate valid for 3(I d;ivs Chris
Description Total
Furnish and install 1/2" fiberboard insulation. mechanically fastened over cxistwp lower Il;it 4.5001
roofs.
Furnish and install .00(1 reinforced rubber root system.
Furnish and install all related llashings.
Furnish and install .(132 aluminum drip edge.
All exterior roolm related debris to he removed by 12.0.1. Rooting.
All work to he performed according Io manufacturers' specifications.
5 year R.C.I. workmanship warranty included.
All related permits will he obtained by R.C.I. Roofing.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total l 4, 1111.100
, --' , it
TERMS OF PAYMENT �,
5% Deposit
Balance upon completion Customer Signature f
Registration # 120235
Construction License # (174334 -
; /1
Insured by lianas & Rickert Ins.
(413) 527 -270(1
t tIi
L 74334
,+v s(nctt i La. 00
MARK T DELISLE A'
33 FIRST AVEa
EASTHAMPTON, MA 01027, ±,
5/3/2012
2635/
OIticrul(lu, >umrr:All,,irs V IiusincasHr.�ulaliw,
HOME IMPROVEMENT CONTRACTOR
,j Registration: 126235
Expiration: 5/6/2012 Tr# 293949
Type: Partnership
R I. ROOFING
MARK DELISLE
6 LINE ST F�
SOUTHAMPTON, MA 01073 t
ry 7Whr,k 'w,ux:a* w,n '1' V2" I 2x}' ^rififi$a �s}a'cys�sr „>
AS A MASTER- UNRESTRICTED
MARK T DELISLE
33 FIRST AVE
EASTHAMPTON MA (1l02i -1811
13276 05/28/12 12455
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : M W h -- DP i i s led _ 17
License Number
5I PS Holyoke St.- E asth m pion Ma. o i o a.l 5- 03- ' 2
Address Expiration Date
C 13) 52/-
....o
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ft. C . I. / Roo f; n9 1.26235
Company Name Registration Number
51 B Holyoke Street - P.O. 1� oX Soy 5 - Ob -1 z
Address Expiration Date
Easthampton Ma. moan Telephon €413)527* 4775
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" w as extended to include Owner - occupied Dwellings olone ( I) 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 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.lbr 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 Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certilies and assumes responsibility liar compliance with the State Building Code. City of
Northampton Ordinances. State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature attached
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition I Replacement Windows Alteration(s) I I Roofing FY
Or Doors E
Accessory Bldg. I I Demolition I I New Signs [D] Decks [El Siding [D] Other [D]
Brief Wok Description of Proposed attached
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 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
I, aj ` E c "' ( y as Owner of the subject
property
hereby authorize JA l ar h "Del (S1 e Qf 1 1 • C. Roof,
to act on my behalf, in all matters relative to work authorized by this uilding permit application. 9
atta II -10 -11
Signature of Owner Date
I, J Deli sit, as aUt11OY a e.nt , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing viplication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
sh
Print Name
U -to-
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 toning
This column to be tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side I.: R: L: R:
Rear
Building I !eight
Bldg. Square Footage
Open Space Footage (I4)
(Lot area minus bldg & paved
parking)
it or Parking Spaces
Fill:
(volumet. I,)cation)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES O
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 O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 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 0 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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
i
, .
1
BEG BEG i Department use only
: City of Northampton Status of Permit:
Building Department Curb Cut /Driveway Permit
�" 212 Main Street Sewer /Septic Availability
Room 100 Water/Well Availability
oFB�° ECTo Northampton, MA 01060 Two Sets of Structural Plans
phone 413- 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: i This section to be completed by office
39 Cian S &' . Map Lot Unit
Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: 1
?o; "fl c-e r �� ear 4 59 Cortez )Uo 1t>n Ulo(oo
Name (Print) Cu rent Mailing Address:
d ��3 s$�
attache
Tele hone
Signature
2.2 Authorized Agent:
MaYik - q.C.z. : .SQutharnpton, .Ma-
Name (Print) Current Mailing Address: 010713.
('i13) 527- W775
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building Rocsi 4 � 00 f 0 o (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) $ ` 00 , 00 Check Number / eri
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
59 CONZ ST BP- 2012 -0492
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 113 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2012 -0492
Project # JS- 2012- 000823
Est. Cost: $4800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 12893.76 Owner: HEBERT PAUL E
Zoning: URC(100)/ Applicant: RCI ROOFING
AT: 59 CONZ ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:11/17/2011 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW RUBBER ROOF SYS
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 11/17/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner