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18C-108
RC I. Roofing 6 Line St. Phone (413) 527-4775 4775 71073 Estimate Date Phone 413)7 - Fax (413) 527 -8469 10/12/2009 Name / Address Job Location McSherri, Mary c/o Ward Trust 71 Gleason St. PO Box 523 Northampton, Ma. 01060 Bloomfield Hills, MI 48303 - 9523 (413) 364 -7973 Terms Rep Estimate valid for 30 days Bob Job Description Total Remove existing roofs on Front and Back only. 6,100.00 Furnish & install 1/2" plywood over existing decking. Furnish & install aluminum drip edge, pipe flashings, chimney fleshings and step flashings. Furnish & install new lead counter flashings. Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys. Furnish and install synthetic underlayment. 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 -year RCI Roofing workmanship warranty included. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. t)t WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $6,100.00 TERMS OF PAYMENT 5% Deposit L / Balance upon completion Customer Signature / ; v>� CL.'� lc j Registration # 126235 Construction License # 074334 Date (( �U ' 2 - 67 Insured by Reynolds, Barnes & Hebb. Inc. 413- 447 -7376 a • 0 GTE iontmoouvealtA or✓llaaaacfIaslla Board of Building Regulations and Standards Constructipn Supervisor License Licenee� CS 74334 s w (22010 Tr# 23520 • MARK T DELISLE 33 FIRST AVE -_ • EASTHAMPTON, MA 01027 Commissioner t j • ,per T,e - 6 7 om of,/lictweicluaaft Board of Building Regulations and Standards al HOME IMPROVEMENT CONTRACTOR � _ _ " Registration : 126235 i .,; Expiration: = 5/6/2010 Tr# 266063 1 • ;Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. ��..?..4 EASTHAMPTON, MA 01027 Administrator • ,r, • .�� ti �x . • i a aril nut tort Ilk ; aj(! - la i r. ,..„, 4 ;� D EPARTMENT OF BUILDING INSPECTIONS . a I 212 Main Street • • Municipal Building . .,,,< Northampton, Mass. 01060 I,sr ,0 WORKER'S COMPENSATION INSURANCE AFFIDAVIT i, - • • • • • 1,4 (Iicensedpermiaec) with a principal place of business/residence at: - • " , , •_ ...4 ot0 �,3_,.(p h o ne # 4 .1 13) 5a7•q? ?5 . • . city /stateinp) do hereby certify, under the pains and penalties of perjury, that: W I am an employer providing the following worker's compensation coverage for my employees working on this job: IJa. - ono.\ ■►A:csn fn re. Z.-t\ S . Co . oC Qik•SCo xek 1 Wts vj c 3 te,sn vs 1 o - 5 . a 9 ( Insuuance Company) (Policy Number) (Expusti'on 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: (Flame of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) ' (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Exprradon Date) , (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (rush additional shed if ssoccsuty to include information pertaining to all oowetars) ( ) I am a sole proprietor and have no one w orking for me. () I am a home owner performing all the work myself. . • . NOTE: please be aware that vitae homeowners who employ perms to do eaaiotaowaoe, eoetsouaiecroesagairw & at Levalt of . not room than thtroo units is which the homeowner resides or ca the grounds apputteoaetdueto ate not gamey oeoeidendto be =ploy= under the waiaaes oompeasation Act (GLAS?,ssl(S)), application by a homoowmet fora Goyim permit mty attested* ' e. z1 status of an employer nodreibe Wo Compensation Act. I am4e ressssd that a dopy of this st stameet nay be forwarded to the Depetmeot of lodnt4id MAO' Oflieo of tsa l o i lla faxgc vx paioo aid that failure to s comp oak realoa tiA•f M0L 1St ere hadto tbtr tmpadded (CAW Soft , , coediting of dame of up to $1,5110.00 sea impsisa of tip to one yen. sad civil pc:ssides in the Slop !stair nad a . fir of 5100.00 a day against me. . . t ,O'Ag5';/44!!: • for depeemMattl naaae4► • . Pexanit MOW , ' ,,,, . li r ; r v = $IIc1t32TC OfY+ICmSCe/PCrID1t�C �� I C SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: p Not Applicable 0 • Name of License Holder: KAY - Del is1e. / `I33"! {, �. License Number .• 4a ii . 5 -p3 -10 Address _ Expiration Date Signature /. Telephone • ,./ 9. Registered Home Improvement Contractor: Not Applicable 0 fi. e'.I. ROO 126235 Company Name Registration Number Ace re } t1 E xpiration Date `E0 � , arnpto�, , Ma, 01673 Telephon�Nl3)521. SECTION 1C- 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 Dwellines of one (1) or two(2) families : d to allow such homeowner to engage an individual for hire who does not possess a license, provided thgt the owner aeti 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 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" 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 attached • . ,,, •,, , ti,,,(),k14 I , SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition El Replacement Windows Alterations) ❑ Roofing [36 Or Doors I] . • Accessory Bldg. Cl Demolition El . New Signs [D] ecs ,[D. Siding (Dl Other [C]J ' • , Dk Brief Description of Proposed a l h Work: L (� tpl i 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: 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? ` ,..).0.. •r 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, cY\O. 0k CS\r■ V _ (-4 , as Owner of the subject property 3 kc.i. ,[ � hereby authorize t Nat' -1 e l (r i S , O Roo i n to act on my behalf, in all matters rr ative to work authorized by thwlding permit application. 9 . Sig'it3t freof Owner Date I, V . 1 1 - - - • • 4 ' de • I .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. • Signed under the pains and penalties of perjury. ' k Wed ___ Print Name I 2- - Z -gig Signature of Owner /Agent Date I t t t 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 _ _..,, ._ ... : __..... - ..___.. ,� Frontage 1 II 1 r ___________, Setbacks Front I . Side L:i i R :i L:._ ,...� R:� .� El l__ Rear i I . Building Height V ,,. L _.I 1 1 Bldg. Square Footage F . , % Open Space Footage (Lot area minus bldg & paved i i s ._. 1 I i 1 L pa-king) # of Parking Spaces L 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: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 ., DONT KNOW 0 YES O IF YES: enter Book ? Page[ 1 and /or Document #r_ 1 B. Does the site contain a brook, body of water or wetlands? NO © 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: I C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and location: I D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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 O NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. S x I tef J I y w 1 . . 3 i f I I City of Northam ton State f . 0' ' # xW Building Department Curb C fi ; ^' _ `= i 212 Main Street Sewerj p t� . ' R % ° , ;' .., ", t Room 100 1 atBf�W .� I ' t t.a $ r � r s ` Northarrspton, MA 01060 i re ,� , r : phone 413- 587 -1240 Fax 413- 587 -1272 Hoti e - 1 tan w 1 i�� e � � x , Other >' ° v b 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 I: ! office t G \ 1 - S\. Map • Lot Unit__ J.a4 C" � i R 11 • Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Prin Current Mailin Addres : attaeIled N.,, ,,�kA � � , r te, . 143 c‘.53 �S ?3 Telephone Signature - cy ( ').) 3 GLt -1 113 2.2 Authorized Agent: , aY� �ea . le-' - .C.Z. oQ�i n l: ng d w� r n Name (Print} 9 Current Maili dress: - - `� ( 13) 52h - X715 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Roofirii 4 j1 O U r ©© (a) Building Permit Fe 2. Electrical (L7 l (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) ; ©a Check Number • .0/ 45 This Section For Official Use Only Date Building Permit Number. Issued: Signature: Building Commissioner /Inspector of Buildings Date 1 I I y BP- 2010 -0626 GIS #: COMMONWEALTH OF MASSACHUSETTS 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 -0626 Project # JS- 2010 - 000912 Est. Cost: $6100.00 Fee: $55.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 7143.84 Owner: WARD MARY MCSHERRY Zoning URB(100)/ Applicant: RCI ROOFING AT: 71 GLEASON RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:12/28/2009 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE FRONT & REAR 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 12/28/2009 0:00:00 $55.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo