37-043 ...„ 0 „ 4 „ ......... ,
RCI Roofing
6 Line St.
Southampton, Ma. 011073 E S t • m ate Date
Phone (413) 527 -4775 Fax (413) 527 -8469 10/20/2010
Name / Address Job Location
Peter Kakos
220 Rocky Hill Rd. 220 Rocky Hill Rd.
Florence, Ma. 01062 Florence, Ma. 01062
(413) 582 -7050
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Furnish & install aluminum drip edge. 5,700.00
Furnish & install 50 year Tamko Series shingles over existing main roof in Black
Walnut.
Furnish & install ridge vent.
Furnish & install pipe vent flashings and all other related flashings.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to be performed according to manufacturers' specifications.
50 -year Tamko material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Spring 2011
i
I
L E LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $5,700.00 1
TERMS OF PAYMENT
5'r, Ihlwsii /
13 u 1 t I e u p o n wni piciion '." / 7
Registration I; I 2623 Customer Signature
Consiruc! ion License tr 074334
Insurer by t3anas &. Fickcrt Ins. Date i y / ('='
413 ?2 7- 271
ALINsachu•lt - 1)�it;u tntr , +1 Public �;1fcl�
Buart) 101 tZc_ul tti,.it, anti'`tan1lar,I'
Construction SL.,.er _ „ :sc
License. CS 74334
Restricted to: 00
MARK T DELISLE,
33 FIRST AVE �*
EASTHAMPTON, MA 01027
Expiration. 5/3/2012
„nn,i n<•r Tr»: 26357
Office of Consumer Affairs & Business Regulation
i•
HOME IMPROVEMENT CONTRACTOR
Registration: 126235
Expiration: 5/6/2012 Tr# 293949
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
6 LINE ST
SOUTHAMPTON, MA 01073 Undersecretary
�' The Commonwealth of Massachusetts
air I Department of Industrial Accidents
- . i, Office of Investigations
=� , :. 600 Washington Street ;/ Boston, MA 02111
\— y�r
G a " YYYY WWW. tttass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name olusinessi r /individual):_ 1_ Q °p c, Y� \AS
City /State /lip: - Phone #: y �) S 1 - x-111 "`J
Are y ou an em ployer? Check the appropriate box: Type of project (required):
! • 1 am a employer with 2.0 4 . ❑ I am a general contractor and I
employees (full and /or part- time).'
have hired the sub- contractors G. [1] New construction
j 2.r 1 I am a sole proprietor or partner- listed on the attached sheet. 7. - 1 Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
p 9. U Building addition
No workers' comp. insurance comp. insurance.:
corporation and its O. E lectr i cal repairs or additions
officers have exercised their I I . Plumbing re
� 3 +. L tam�t homeowner doing all work g airs or additions p
mysel [ No workers' comp. right of exemption per MGL 12 oof repairs
insurance required.) t c. 152. §1(4), and we have no
employees. [No workers' 13.1 I Other
comp. insurance required.] '
' .Inv applicant t`ta, checks box #i must also till out the section below showing their workers' compensation policy information,
Iorneowners ∎, ho submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
•Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp, policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Co:npany Name: a.C,,e. Q' ty Cc.Sx,,.a..l\_ r1 . --
Policy # or Self -ins. Lie. #: AAA) Q,,, C..q, 5? 0-1 3s_ (, -_ _ Expiration Date: f 0 - 5' - aQ 0
Job Site Address: 22,6 6OCIN \•-i \ \\ X` City /State /Zip:c\ 0{-,c- t fvva .010(4. •
Attach a copy of the workers' con ) nsation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S I .500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S'250. a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
i do hereby certif v under the ins and penalties of perjury that the information provided above Ls true and correct.
Signature: --- - - - - -- -- Date: 3-a3-1 i
Phone #: (. -1_l3) Se.Z -X1.`1S
Official u,11! only. Do not write in this area, to be completed by city or town official
Citt3'or 'I'own: Permit/License #
1ssiting Authority (circle one):
1..Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6 O
Contact Person: Phone #:
•
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ •
Name of License Holder : M _ AY h "De 1 s i e. r7D4334
License Number
Address Expiration Date
Signature Telephone
....„.."
9. Registered Home Improvement Contractor: Not Applicable 0
fi. E. . 126235
Company Name • Registration Number
—1 I^:;, 5- 5 - oi - 12
Hoort Expiration Date
•. Is . is 9 • • i1 - , a $ Telephon(4 -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" 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 actt
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. .)r is intended to he, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
,t uctures. 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 he 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 persons)
you hire to perform work for you under this permit.
TTTh : 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.
i
Homeowner Signature att,aehd
' !R j ..,.„„„,,,,..,
,..•!t...,„,,;,..0,,,,...,_
. . '‘.,k
•
SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition [] Replacement Windows Alteration(s) Roofing 'y
Or Doors C7
O ns
;Accessory 51dg. � I Demolition . New Signs ( j Decks [C] Siding [t:31 Other [CA'
i
Brief Descript •on of Proposed ay,}.aChPli
`Work: `L
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 budding : One Family Two Family Other
5. Number c' rooms in each family unit: Number of Bathrooms
c. Is there a garage attached? •
d. Proposed Square footage of new construction. Dimensions
e. Numbe- c' stories?
:. 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
Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
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
?r. c 'C�� )
as Owner of the But
:Oct
•
hereby authorize Mar r T t ;RI � e of G. I . Roof, n
to act on my behalf, in all matters ative to work authorized by th ullding permit application. 9
Att. b the •3 2 3- I
Sighoft eof Owner Date
I, MY 2"Met k "MS,P aS a 1Z
Ut1inYPA aae. It , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing aIication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
MaYl l sit.
Print Name
73 -Z3 -1
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
I., it Sizc
Ft onlage 1
Setbacks Front i
Sick L: R: L:' R:'
Rear l I
B.tilding Height
B dg. Square Footage
I
r —
O )en Space Footage %
(l. n area minus bldg & paved ,
parking)
# .>f Parking Spaces — r
HI: I II
(vnlumc & 1 peatton)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES O
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: i and /or Document ft l
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained
0 Date Issued:
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 (3 NO O
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
City of Northampton "`
, S tatuli
�, 2� : uilding Department Cur 'C' t ;.
2 12 Main Street
•
R oom 100 W t
OFD - ci T if r o e t in
pE� , y► ort MA 01060 1��� ,
- phone 413 -587 -1240 Fax 413 -587 -1272 i?totlt3`ie + 4,4 , 41
Other 8' • rC�'s.� � " i,, ` f ��
APPLICATION 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 A ddress : t
220 i;00/,ti lyi r, 4). Map * Lot Unit
T �.bt�1L L J n Zone Owrtay District
Elm St. District CS District
SECTION 2 - ROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
r1
t'C- c t" \ Y\ c ZZC' i QCK Lill 47,A. � \Oft -r\tt, �U\ra• (�il�t+�2.
Name } (Print) Current MaHin Ad ss:
C 1 Telephone
Signature
2.2 Authorized Agent:
�P. le., - q.C.i. R c�f� iez, .; -. 59u a ,
Name (Print) Current Mailing ress: O ,3
-� �-.-- ( 521 - 4115
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building R j 0 0 CSC (a) Building Permit Fee
7 t
2. Electrical (b) Estimated Total Cost of •
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5 Fire'Protect
6. Total = (1 r 2 + 3 + 4 + 5) $ - 5 — 1 r L . � Check Number /76 7 O _ 3s
This Section For Official Use Only
Date
Boildintg Permit Number. Issued: •
Signature: —_
Building Commissioner/Inspector of Buildings Date
i ,
•
220 ROCKY HILL RD BP-2011-0777
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37 - 043 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- 2011 -0777
Project # JS- 2011- 001279
Est. Cost: $5700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 44866.80 Owner: KAKOS PETER J & LINDA L
Zoning: SR(100)/ Applicant: RCI ROOFING
AT: 220 ROCKY HILL RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMAO1073 ISSUED ON:3/29/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: ST RI P & 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 3/29/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner