38C-037 .. R oofing Est
Date
6 Line St.
Southampton, Ma. 01073 3/28/2011
('hone (413) 527 -4775
Fax (413) 527 -8461
Name / Address Job Location
N1CKY D'S 11 -13 Cedar St.
164 Northampton Street Northampton, Ma. 01060
Easthampton, MA 01027
Terms Rep
Due on receipt Chris
Description Total
Remove existing roofs. 9,800.00 1
Furnish & install 1/2" plywood over existing decking.
Furnish & install aluminum drip edge, pipe [lashings, chimney (lashings and step (lashings.
Furnish & install new lead counter (lashings.
Furnish & install CertainTeed Wintcrguard ice and water barrier along eaves and valleys.
Furnish & install synthetic underlayment.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
Furnish & install CertainTeed approved ridge vent.
Furnish & install modified bitumen roof system on flat section.
All exterior roofing related debris to be removed by R.C.1. Roofing.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $9,800.00
TERMS OF PAYMENT
5% Deposit
Balance upon c-implction Customer Signatur
Registration # 126235
Construction License # 074334 Date
Insured by Banas & i°ickert Ins.
(413) 527- 270(1
1u1.■,,,,ii. l S.:01 C) tv'12,1,15''dvl-1; no;
'IS I1SC; ' 1VI'V
)( ..
C11t1Si7l ld :n,f,C1
nil Z'c)1 :(101,w/)(14 i
-',' l :unilelIgi6a21 4)1
,,,ni ■<.,incn . ur i,n1rn11r , I : s
]/■V 1 S?i1:1 i71
l
'�'^- y! tf � _j(t ..? "'
J _ .`
•
1 1
•
., l T �� Common llllh of ,iVassachusclls
==� Department of industrial A ccidents
,1 {,� - Of of . 1/i es1
t 6 00 W Vash Street
'7 ;;� = Boston, `f,-1 02111
�.r -, -, " ' ' tY it' s'.tttuSS.gut
W orkcrs' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
_\1)j)licaNt Information Please Print Legibly
�` ( � r.
\:i;ill' (11 ;t�;;.t)r an ;t;tunvfndnnitutl) �_L.._ \_1Q�_ 1_.� \_\....,?
• \titirCSs
t, ,t,,; ' !.ii 5. u 1 hone : �!1�,� 2__:._.�1 -1
err ■:(■u :r,; rr,tplrrvcr"? Check the appropriate box: Type of project (required):
20 •7. D I ant a general contractor and 1
;H» .,�,, er "�r;.l 6. LL New construction
mpi; cc, (t+ ;l; and /or part- tints ?.• have hired the sub - contractors
Am n
,; r i,ruurieto or partner- listed on the attached sheet. 7. ❑ Kentodc lint
>i;;i, ;tn,1 iha: e no employees These sub - contractors have S. H Demolition
,,;r� (:,s inc itt atty ca )a cit em and have workers'
I ). E Building addition
�.) ,. hC!s ��Ifltl?. insurance
comp. Insurance.'
5. fl We are a corporation and its 10._ Electrical repairs or addition
. feu ., tlounckltvtier doing all work officers have exercised thei I I. Plumbing repairs or tidditiotis
n11 sc:. � No workers' comp. right of`excntptit >n per MG1. 12. f oofrepairs
;;, >ui -,n , c rc,;uu-ed.I ' c. 152, §I (4), and we have NO
employees. iNo workers' 13.❑ Other
comp. insurance required.)
,p, (, an; feel ;xt,c a i must also fill out the section below showing their workers' compensation policy information.
i in ;,nr,,,,ncrs „I,„ - ohntit this affidavit indicating they rue doing all work and then hire outside contractors must submit a new affidavit indicating such
, that :hc. :it« h, most attached an additional sheet showing the name or the sub - contractors and state whether or nut those entities havc
,;,;r:, l; ;i;,: •:r,it- cc havc employees, they must provide their workers' comp. policy number.
I on Nn rrnp ;.: r•r Mal i:i providing workers' compensation insuran for my employees. Below k the polio' and job site
'rli,rnrurion.
nr,:;, :r lit;t;; varNC: `✓� -�e- ` C L� Q c���0.\ �:�. -- `\ —
' ' .: " H ' :,Q.A61_C _ - 1 __5 ' 0 1__35--- C,►___ ___ __--- -_____ hxpinttiun Date: 1 0 5 ;2 0 1 4
- .• \tl,'.-•'s :' I t'1 3 _ Cc_a_o. -- Cit /State /1_1p: &N ,, � t la�0
vttach it cops of the workers' compensation policy declaration page (showing the policy number xnd expirxtlun date).
,l■,;c sc..,rt.• cnvcrae as required under Section 25A or IvIGL c. 152 can lead to the imposition of criminal penalties of a
H,: op to 5! . )00.00 tint /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and it tine
;;t to .S'it ,)O a Jut ai;ainst the violator. Be advised that a copy of this statement may he forwarded to the Office of
;testigati.t_ ,);'the Dl;A for insurance coverage verification. _
�l ,h, /ter,.'ht .. •rtil under th merlins a e' th
and penalties of perjury the information provided above is true and correct.
�
, ti;tturc_.; .r � _ - '{Z�t _____ ____
1 U /finial n" 0/111'. Do not writs' in this area, to he completed by c•itt' or tower official.
1l
PerrnitlLicense
SECTION 5 - CONSTRUCTION SERVICES
1 Lice nser �.onstruction Supervisor: Not Applicable 0
r
amc of Lice, C Nolder —— �Ul—�� -- �..[l..i -iS 1 _ �_ q � 1
License Number
- nQ, 5 . 5 0.>.�6, ice t~. I . . • • 5 — Q 3 — 12,
-'address Expiration Dale
( l 3) 5 7- Li7 25
„,,,,,,,,, .,-/f Telephone
, ____]
9 Registered Horne Improvement Contractor: Not Applicable ❑ I
ft, __
G_I._ of _ _ 126235
Comoan�l Na2ne Registration Number
H
�,�r' 5- 0m — liz
.:,cc„r„ Expiration Date
ncarn.p.IQ_n Ma • 0 1 673 Telephonc0J 3)52?' 4775
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 26C(6))
';-Yorkers Ccn .sensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
n the denial of the issuance of the building permit.
«., , Attached _ _ _ H.u, -i, ached Yes. _.. No r3
..
1 1. - 1-ionic Owner Exemption
e ;irrcnt exemption for "homeowners" was extended to include Owner - occupied OweUlnscs of one (I) or two(2) families
u .' 111 aiiu such homeowner to engage an individual for hire who does not possess a license, provided that the owner act;
1,_ ;upervisor. CMR 780, Sixth Edition Section 108.3.5.1.
U•ti nit ion of homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
) intended to he, a one or two fami dwelling, attached or detached structures accessory to such use and / or farm
,;.,,...,hire:;. A person who constructs more than one home in a two-year period shall not4t considered a houseman.
homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that beishe shall be
. for all such work performed under the building, permit.
.1ct,nt; Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work•lor which this permit is issued.
•v '. >o be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
pH. ;ccc or injuries not resulting in Death) of the Massachusetts General Laws Annotated, yoy may be liable for person(s)
i to perform work for you under this permit.
iindcrsiened "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
,tn,w p ;on Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws A •
I{ lilcownCr Signature a . " t.,a..C'.laec�- __- . -_. -_ _
. !). ; ,, ;;. .as ,
SEC 5. DESCRIPTION OF PROPOSED WORK Icheck all apllcable) --- -------- ' ' .
-- New house �—1 Addition
w u o
Replacement Windows Alteration(s) Roofing
Or Doors
s L� '
` Accessory 5| �—1 Demolition ( \ New Signs [[]] Decks [E] Siding (Di Other (01' ' —1
----------------/ - ^--------
,�n: p,oPescd ~\�i \ |
c��L�
—_ _
,..sting scomam _Ycs _ No Adding new bedroom Yes No
�
■vcoc� x^' Renovating unfinished basement Yes No
Plans Sheet
ea If Nev, house and or addition to existing houw|ng. complete t ��|wyv nQ�
. �
� Use One Family Two Family Other
. —
nvnn»o'�� 'own in each family unit: Number of Bathrooms
'�
amen ]araOc anachoU? � • •
Proposec Square footage of new construction Dimensions __ |
c w"mnc'r•
mococ �' rcvxoS7 Fireplaces or Woodstoves Number of each
Energy.:;` :`emaoonCompnanoc Masscheck Energy Compliance form attached?
' r 7 ype o|cnnu'xmoo
|� ;coo;::Innmmin 100 of wetlands? Yes No Is construction within 100 yr. floodplain Yes No
! . D=m ^/ c.isenento' cellar floor below finished grade
^ vvio Cv"mn,; conform tome Building and Zoning regulations? Yes No
! \
� .
Septic - a:� City Sewer Private well City water Supply
� ---- _-1
- ---- ---------
SECTION 7a OWNER AUTHORITION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
.-- --'—
1
U\ � �C�er�W��b�t
� �~� ` .
c,openy
� \ � �
xe,c�vo"*c^': -° • )��� /�� y�^[�" J~. , Ti ��
� o
a ; c on my � all matters ,�t�e to � authorized by mislv��ing permit application.
�
/ 2,—/(
DwrIat Date
\ �|
� \ ���� ��� �� � ` �7�� as .
the statements ac�|icahonavo(maondoo�ruhs.(ommbmu�n/my
��cn, here ��u^,v ".". . , "`== � �
on: belief . |
� |
Signed under the pains and penalties of pequr.
\
|
^
' Print Name
Se •+. ZONING AU Information must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be fillai in by
Building Department
-- — -- —
nti;t e
`: taCFS front i
Side I.:' ft. • I R:.
Rear I I
13 hiding ttcight . � I i
iN .1g. i liac Footage of i
(? ren Spa :e Footage %
c ; arca r-ctnus t kN , pavcd I
a Inel
Parking Snaces I i
Ii
Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DON'T KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW a YES O
IF YES: enter Book Page ;i ' and /or Document #
D Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C Do any signs exist on the property? YES O NO O
l
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:
F 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.
. 1
1 ft I S cntt ;
„...
*
(172.\c,..IAED
f REGEV IF.;]_
. i i ,,,,;„ t ,, ,,, 0 4 ■ . ■ ..,' , n
ti
gEpt OF StfilDiNG INSP City of Northampton Statt4r of 4' fi . • , ' ,
'•-• . ''', • 7.it',,, ', • f, ' , '', ' ; ,,
Building Department Curt f, C it,IA ';', i•1;, ,.1 . ',..!,•,' '''' — '. '
'' ' , :I , :ifi'i'; 5 :i, 1 • . ; i ---vc.... , ..
212 Main Street . , 4,
‘..,•%4i "e , !..
Room 100 Wetem • ! • . ,
Northampton MA 01060 ,
phone 4 13-587-1240 Fax 413-587-1272 01tiSV
Other S. - eP•-'0 • ' - . • .' - • , • ' i ; '
APP;.;CATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 ropertN
This section to be comploW by once
H-3 C.t_A.0, --.S \--- Map . Lot Unit.
AJ o rA-Vxca_ , r1V-e \ -6 ` 41 i tf‘"ka . Zone Overlay DlelsIct,
Elm St. District CB District
SECTION 2 • E OWNERSHIP/AUTHORIZED AGENT i
, .
2.1 Owner of Record:
I
P____•__C__ _\/___. _ --
)
N:iftle ' rrrit 3 Cymknt Malliry Address:
--) \V cA.S\-\e,t'N., ‘. \-c1,,e‘ ■I = (.5 l. 0 7 --)
I
; a tliaLnd,Ci Telep one
; Signature I
1 2.2 Authorized Agent:
. _
Mat in_e,,, • I e, - ah ii Confi rvi . _ .
a ' . • • • sa • •
,
Name (Print) Current Mailing .dress: 01 O
-------......_ ( 113) 521- 4715
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
;er- Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
4 - -tuildinc , )
' j .ft00Fi ri (a) Building Permit Fee .
Electricz1 (b) Estimated Total Coat of •
Construction from (6) J
_ -
3. Plumbing Building Permit Fee
i I
1
4. tilechaniczi (HVAC)
S. Fire Protection
- _ • ,)
5. Total = (1 - 2 4 3 + 4 + 5) i. '5?(D O. cs° Check Number
, .
This Section For Official Use Only ..1
Date
BOilding Pe ; i1 iVdmber _ Issued:
—,..
Signature:
Building CommisslonerAnspector of Buildings
—.
. —
•
11 CEDAR ST BP- 2011 -0820
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38C - 037 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 -0820
Project # JS- 2011- 001344
Est. Cost: $9800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 17249.76 Owner: DUPREY NICHOLAS DEAN & BETTY L
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 11 CEDAR ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775
SOUTHAMPTONMAO1073 ISSUED ON:4/12/2011 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 4/12/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner