38C-004 • Roofing
6 Line St.
Southampton, Ma. 01073
P.O. Box 309 Est m ate Date
Easthampton, MA 01027
Phone (413) 527 -4775 6/22/2009
Fax (413) 527 -8469
Name / Address Job Location
Jessica Gifford
166 Grove St. 166 Grove St.
Northampton, Ma. 01060 Northampton, Ma. 01060
(413) 341-3394
Terms Rep
Rich
Job Description Total
EXCLUDES REAR ADDITION AND CARPORT 8,800.00
Remove existing roofs.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and
valleys.
Furnish & install synthetic underlayment over existing deck.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
Furnish & install CertainTeed approved ridge vent.
Furnish & install 1/2" fiberboard insulation on flat roof section.
Furnish & install .045 re- enforced rubber roof system, mechanically attached on flat
roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to 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.
SPECIAL ITEMS NEEDED
Add $2.50 per square foot for wood decking replacement if needed.
Add $1,500.00 for CertainTeed Surestart Plus extendegl warranty (included if signed
estimate is rett.Arned within 7 days) s; w; ` — 7 citzs
WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $8,800.00
TERMS OF PAYMENT
5 %Deposit
Balance upon completion Customer Signature
Registration # 126235 /
Construction License # 074334 Date c9 '
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376
gfie fommumureahi of' Oaactivaea3
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 74334
1, •
Etk• 513/2010 Tr# 23520
Re .t 11;_ 00
•
MARK T DELISLE
33 FIRST AVE G — �--3
EASTHAMPTON, MA 01027 Commissioner
Bite Ve ammzaruveaax or.,/ ac`uuse '
Board of Building Regulations and Standards
_ -- HOME IMPROVEMENT CONTRACTOR
=_ Registration: 126235
Ne
Expiration: 5/6/2010 Tr# 266063
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST. c�4,...A
EASTHAMPTON, MA 01027 Administrator
• , , C.s.itR oaf Northampton ,,
rn
�Y�� X18 JRassacknutts' r
�•W i DEPARTMENT OF BUILDING INSPECTIONS �: 1 1 .
212 Main Street 'Municipal Building <-
Northampton, Mass. 01060 'olio
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
-L, ______Lmark _ - . • i •• 0,4
(licensedpermittcc)
with a principal place of business/residence at:
- 1 . - ` • _.� ....4 • .. O lO1A (phone #(J113) 1 527.4775
. • - c!ty /statenip)
do yereby certify, under the pains and penalties of perjury, that:
(vii am an employer providing the following worker's compensation coverage for my
employees working on this job:
lJ o.. o coo.\ \ ..h ■ • o1\ c`■ re.
ZnS. CO aC Q SQ,A,� co �
, \kJ0 31.3\1 Vi to-S-01
- (Insurance Company) (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) (Insurance Company/Policy Number) ( Expuntion Date)
(Name of Contractor) ' ' Inca Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) ( Expiradon Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(r uath Aciditiocal shod. if z occ wy to iochude information pertaining to all oottx o s)
•
( ) 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 thatvvbilo homeowu=ta veto tacky pas= to do am hoe, osastrvotiocrot wok a ttiM Maui at •
o: room than tfno units is which the bomeowoer r e s i d e s c c oo t h e g r o u n d s sppuneoaed thereto on sot 6 fl1 Nodded bM
coy er s ceder tho waiters compeacasim Act (G1.3.57,14 (5)), application by a bonsoowsir for a Comae or permit reh evidence alts
! csai status of an a ploy.e uodac the Worker's CoaoQamation A.
•
s
I u p d a r a t s a d tat a on of this stat.maat may bit hemu dad to the Deputises( otlodatrW Mciar r Cmas etta aver MIN
oovaxso vcri@a at flare sad flare to sours comes under sack ZSAaf b40L lS't cm lotto for impod80d dalad . .
co:dis�tg of a • ele bf up to 51,500.00 orbs of tip to ace year and civil penalties io the fosoa of a Step Wads ad a ' a ,
fira 0( 5100.00 a d y agiiast tt>c. ".
' For aspmemad+l •
......001.40.....#41< P rtinitNUMbdr ,,.a„ . ;i
, Loll
Sit efLitxnscxlpermitttx Date ---- . ..�.•+• , •'
1
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: MaYh1)PlIsl e, e n 4334 •
License Number
c
• �" m — *I •. a.* ..• . • 1 5-03-10
Address Expiration Date
Signature ./// Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
R. ft.I.1finq . • 126235
Company Name • Registration Number
,,�„� 5 — i06 -10
Aooreaa Expiration Date
SoilitaYnX310 - 1 M. 0 1613 Telephon(013)527•;KZ
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 Q' No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellines 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 act'
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, States and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature a lt.aCilej •
• � t
•
•
•
SECTION 5- DESCRIPTION OF PROPOSED WORK [check all applicable)
New House ❑ Addition 1:1 Replacement Windows Alteration(s) Roofing C
Or Doors ❑ . •
Accessory Bldg. ❑ Demolition ❑ New Signs [Dl Decks .[[] Siding [D] Other [ol'
Brief Descript ;on of Proposed a ` a h
Work: t (_' {rJ
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
f •i ,
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 I, ' S.� CC (D 1 "V r"--;c 1 , as Owner of the subject
property
• • •
hereby authorize L : • 1 • i / I/
to act on my behalf, in all matters r- ative to work authorized by this •uilding permit application.
a tt a the d
Sig'n4itfie'of Owner Date
I, Y • - - I* ' • .41 .1 as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing . • • Iication are true and accurate, to the beat of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature'of Owner /Agent Date •
•
Section 4. ZONING AU 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__..__. 1
Frontage I I 1 I 1 .____ _ 1
Setbacks Front
Side L:I ; R. 1 L ._ ..I R:1 __ .... [ __ I __.. 1
Rear I
Building Height I j •I 1_1
Bldg. Square Footage a 1 %
Open Space Footage %
(Lot area minus bldg & paved } ( i i i 1
parking)
# of Parking Spaces —�� L - --
Fill: .._.. .
(v &Location) - .,.... _- _ .., _., ., . _ • __ . .. _.._.. •. , ..._ ,..__. _ _..._....,_._____._.._.._.
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 O YES 0
IF YES: enter Book . ._ .I , Page[ I and /or Document #C
B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained 0 , Date Issued: [
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location:
1
•
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:
E. Will the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acre or Is it part of a common pig
• that will disturb over 1 acre? YES O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
a
w
r fit.
City of Northampton St 11 e3,
Building Department Curb b C °t
212 Main Street
Room 100 6? ', a
Northampton, MA 01060
phone 413- 587 -1240 Fax 413- 587 -1272 pip
1 f;
o f
OtherS.
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 by office
` �. �Y_ �' � I� .. Unit
lc� C –
" Map Lot
Zone Overlay District.
Elm fit. Dlstrikt , CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record;
,•••• (i c f : C -)t /
Name (Print) Current Mailing Address:
a taehpd ion»
Tete hone
Signature
2.2 Authorized Agent:
M aYik 1e - , .C.s. �oofin J - • . - . • _ . . ,..t►
Name (Print} Current Mailing • ddress: 0.1.3
�-.�- (113) 52'7- 4115
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant _
1. Building Q o afi yiej 4 b b (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) $ Check Number /V97 I _ $36
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /inspector of Buildings Date
•
t •
= BP- 2010 -0147
GIS #: COMMONWEALTH OF MASSACHUSETTS
4X, 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 -0147
Project # JS- 2010- 000177
Est. Cost: $8800.00
Fee: $175.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 074334
Lot Size(sq. ft.): 36503.28 Owner: GIFFORD JESSICA
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 166 GROVE ST
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 (EXCLUDES REAR
ADDITION /CARPORT)
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 $175.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo