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38D-003 . . R Date 6 Line St. Estimate Southampton, Ma. 01073 4/6/2011 Phone (413) 527 -4775 Fax (413) 527 -8469 Name / Address Job Location Nick Duprey 298 300 South st 164 Northampton Street Northampton, MA 01060 Easthampton, MA 01027 Terms Rep Due on receipt Chris Description Total Remove existing roofs. 9,600.00 level front main roof by sistering rafters and installing new plywood. 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- inforced 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 RCl Roofing workmanship warranty included. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. SPECIAL ITEMS NEEDED Acid $2.50 per square foot for wood decking replacement if needed. Total $9,600.00 TERMS OF PAYMENT Balance u c upon completion Balnce p Customer Signature / Registration 4 126235 Construction License 4 074334 Date Insured by t3anas & Fickert lns. (413) 527-2700 1 �1n,ll i ' 11 1 'i f'111 rC Ii _.Ki r 0 t r UELISLC_. t°,4? ‘7.377 „L; 33 FIRST AVE ,, a u EAST} HAMPTUrJ MA 010" • Ulllii "1 ( ti II Hirt AIl;it, A 111,.1;14., !le;;ul+elienr ';' HOME IMF'R)VEMENI CONTRACTOR s y ` ' : Rowstratlolr 1 '6,'a.` us ; Expirations /6/2012 Ira 1ie`".tir Type. f'artncrsh(p k C f ROOF INO tvlARK OELISL l ti LINE SI .... __ _ `-,.) 1r-i;v;ir •,i,!Ii073 t nilirsriich.,,, • :` 1 h e C ommon v alih oJ Massachusetts �-,-- � �� Department oJIndusirraI ,, 7' 7 4 * : ,h - i i. '' Office of Investigations i , _ , , 600 Was Street t,� - ��� , , ,/ Boston, MA 02111 \Y,^ `1 WW 4'. //JUJU. go /dia W nrkcrs' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plurnbcrs Applicant iut'ornaation Please Print Legibly r . N'awe ,, 11u.,; to .s;t)r /Individurtl). a QC 1 - -- \.,S ∎, ,• „t, ;iii tut r:' check the appropriate box: "hype of project (required): - ;t,n ,t :upit„ct , .,th 2,C7 . J i tun a genend contractor and I .•tttplo ec. (Dull andior part- lithe).' have hired the sub contractors 6. [11 New construction - listed on the attached sheet. 7. ❑ Remodeling _ j ! ;tin a so proprietor or partner - ;hip :, nave no employees These sub- contractors have ta. 0 Demolition t��tt:t for ,,le its any capacity. employees and have worke 9 U Building addition 1N0 , r k:: � comp. insurance comp. insurance,. rec)w,. ' 1 5. 1 We are a corporation and its 1 0.E Electrical repairs or additions ___1 1 a,n a i„ nteawner doing all work officers have exercised their I I. Plumbing repairs or addition; tnyselt. jNo workers' comp. right of exemption per MGL I 2. [y Roofrepairs in.trr;tricc t uired.f ' c. 152, §1(4), and we have no employees. 1No workers' 13.❑ Other comp. insurance required.] ' , ;,.,,; ,:hcck.< Uo ■ a I [Min also till out the section below showing their workers' compensation tx,licy information. io;uc;;,,„ciN „ h„ submit rht. at fidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . :nt(t;tl. I) , l,.,; unr,■ ibis t'■iLt must atutchcd all additional sheet showing the name u( the sub- contractors and state whether or not those entities have ,.n,;,;, „ccs i; :t ;, ,„i,- „,nu have employees, they trust provide their workers' cutup, policy number. ;; t„ un cttt rt er that is providing workers' compensation insurance for rrrt' employees. Below is the policy and job site col /u'mutito/t. {(�� pp �} \ : ..; r.ti ` .ti (. . 1;11iIII\ NdInC:_ V` -1r�” \ C..C- K c...,..„....,......\ �,.• _.�._ .. - ^ ,i �__ — _ ___.- ---- __- ---- --- -- - --.._ -. - :: , ` ' i. %+ N-th1S CA. 5_3 _ - -- 4'1 3___(.. - -- -_,_ ___ - - - - -- Expiration Date: 1 0 - 5 - 2. l 4 >tic d..! :..... q 00_ -_: �\— City/ State /Zip:penrA-LxviAcid� 0t0W A tt:tcit it cow „f the workers' compensation policy declaration page (showing the policy number and expiration date). ,.:it lore to scc.ire coverage as required under Section 25A of MGM c. 152 can lead to the imposition of criminal penalties of a I:n,: up to SI .:'00.(0 ancf,'or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine tip to ;`?ail Im it clan against the violator. fie advised that a copy of this statement may be forwarded to the Office of ti vestigatit,n:: of the DiA for insurance coverage verification. 11 (11' /zt'reht , /ir under tine yaina and penalties of perjury thus the information provided above is true and correct. >i gnat trt - , % '� 7 Of/ic'ial a c ,ur /10 not write in this area, to he completed by city or town official. ritv To, Permit/License # SECTION 8 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Nam of LiCcn.:o Holder _ _ � � Gl - k - 11)e. 1 � � � -�� 17 4 1 3 3 4 1 License Number . 0' _`C -• • ar a. u . • • •' 5 - 03 - 12 -.ddress / j' �1 ra � R /7 Expiration Date — — 1, q i 1 J ! n ] l - " ( t 5_ Signature Telephone �, V Z-- ' Registered Home improvement Contractor: Not Applicable 0 .� . 126235 c ompany Na r.! C �� Registration Number - t ._ 4: s\ -. ,._ _____ -- 5 - of- I2 ,-� C<< -» — t nC Expiration Date & tlarn��Ma , 0 1 0 T 3 Telephon"�1 3) 5,27. [ n/5 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25G(6)) \\r''orkers Cam; ensat on Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result n he :.enal of the issuance of the building permit Signec Affic :: „ Attached Yes- _. r2" No ❑ 1 t. - Home Owner Exemption et;rrcn■ exemption for - horpeowners" was extended to include Owner- occupied Oweillnzs of one (1) or two(2) families to a iow such homeowner to engage an individual for hire who does not possess a license, provlds4 that the owner aetl .!r ;upervisor. 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 ,.. r is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm ..ctures. A person who constructs more than one home in a two - year period shalt not 4e considered a howcowocr. homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be - >Lnsiblc for all such work performed under the building, permit. .feting Construction Supervisor your presence on the job site will be required from time to time, during and upon ,_,,. ,p!ction of the work.tbr which this permit is issued. :_,> ; - ,c advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to _r nit) v ccs fnr injuries not resulting in Death) of the Massachusetts General Laws Annotated, you MAY be llabk for person(s) ;ire ti; perform work for you under this permit. ,;; "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of \ :,n;tinptun Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. !lnntcowncr Signature at, a ___ — ------ __ -_ -- `� t 4 +7-+::11,t ' SECTION 5. DESCRIPTION OF PROPOSED WORK (check all applicable) i � New House u I Addition Replacement Windows Alteratlon(s) 7 Roofing Or Doors ❑ , Accessory f,, Demolition l New Signs fCI1) Decks i❑ Siding (0) Other [C ' pct Deso l Proposed attach&A ..J;eration or e.ust!ng bedroom Yes No Adding new bedroom Yes No : Narrriiive Renovating unfinished basement Yes No =Tans Attached Rol! - Sheet Ca. If New house and or addition to existing housing, complete the following: Use of budding One Family Two Family Other ._ Number c* rooms in each family unit: Number of Bathrooms Is ;here a ;arage attached? ; . Propose. `square footage of new construction. — Dimensions Numbe c' stores') • Method . 7:eat!ng? Fireplaces or Woodstoves Number of each Energy :iseniat!on Compliance. Masscheck Energy Compliance.form attached? • . Type or construction is ccns,ru.a on within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth of casement or cellar floor below finished grade Will bur,ding conform to the Building and Zoning regulations? Yes No . Septic Tan.; City Sewer Private well City water Supply _ .J SECTION ;'a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT h_ `k...k R ( , as Owner of the subject property I r,ereby autr.ori::. �)'l dY - DG11 S1 P Qf - c f.. RoofI n - o oct on m: malf . in all matters r lative to work authorized by thi u!lding permit application. 9 , aLt ac hed • LI i a - i 1 — _� Sig'nattiI pf Ownar Date i, ' , as Owner /Authorized ___,_,KZ • Agent hereby acla that the statements and information on the foregoing .:.lication are true and accurate, to the best of my knowiedge ,nd belief. Signed under the pains and penalties of perjury. S'al/k s1'e, Print Name -! 4 i I S:..Diem;. ZONING 1 alt information Must Be Completed. Permit Can Be Denied Due To Incomplete Information + Existing Proposed Required by Zoning 1 i This column to be filled in by Building Department Ii. I i— -- — . ,lntat;c II S,thacks Front i Side I.:' R:' I. IC Rear --__ I. _ _ ( I 1 11 ,ilaing Height I r_ , 0 ;is.:,. Square Footage %, 1 () )(.‘.:1 Space Footage 0 4, c . a area minus bldg ,� pavCd a 'k im,l ;! 0 Parkins Spaces I — � ,,lunw,:. ,c , 1 4 — l A Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 F YES, date issued IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document it B Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O 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 IF YES, describe size, type and location B are there any proposed changes to or additions of signs intended for the property ? YES © NO 0 - ______-] IF YES, describe size, type and location 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 Q F YES. then a Northampton Storm Water Management Permit from the DPW is required. it+ colt 4 1 4 t -, tAAltl titA4Ro N. ;.4 1:i4 ., ittt 4' 1 n ' , 4 t• 4 .‘ , . ' RECEIVED City of Northampton .14,, b , . 1 2 alli Building Department A APR I ! 212 Main Street i , ,Abiuutii , r, C14.rt). t; .....,./." ,p 1:4 1,: ti ,ti,, ' " :. ;■!':: . ,:. "- .i lf ,::'` r4vr ipse.' Room 100 : DEPT. Of BUILDING INSPECTION1 ' yy , _,,.. .'lv :,?...i. NOR1HAMPTON.HA01000 grthampton, MA 01060 . ''''n-ri-.. '''''' " ' ' . phone 413-587-1240 Fax 413-587-1272 ' ' • • ..o,'' . ', ,,itiy 'TY" ,I - ■ ' ' ' A ','', ' I ' 4,. *,. , * . * * , . ..,t, °t APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION Proper, This section to be completed by office ' ...icirets Lot Unit, A/ el oiNf \-t, Zone Overlay District Elm St District CB District SECTION 2 • 7 )ROPERTY OWNERSHIP/AUTHORIZED AGENT :------- - 2.1 Owner t" Record: , A.) t (__\/ --■..... p c - Ni..., /Print) Current Mailing Add t __Q,V4-An.O. AA 4/7 \ —e.vel I • C'4 ‘ ,: te l attach_t.d Telephone 1 S'ignature cLi ..t\tatu e_d Agent: I . . Mak:D*1 e - .0 .L Ccofi ni . _ • . . . Ss • •• • •C ' Name (Print) .."04 Current Mailing ..ress: 01 CS ( .521- /TS -11griature Telephone --- SECTION 3 - E.' STIMATED CONSTRUCTION COSTS : ;t, • Estimated Cost (Dollars) to be Official Use Only , completed by permit applicant 1. building o F ri 4 C c, 00 . 0 0 (a) Building Permit Fee —.; 2. Electrical (b) Estimated Total Cost of • i Construction from (6) -4 3. Plumbing Building Permit Fe. .t, Mechanical HVAC) 5.•vire'Protection S. Total = ( 1 - 2 + 3 + 4 + 5) $ k, Co 0( . ei (' Check Number ) 7 2/ 035 , - This Section For Official Use Only Date Building Per..nt; Number Issued: .. ----- --- , SignBture: Building Commissioner/Inspector of Buildings Date ..._ . . ,..._._ 298 SOUTH ST BP- 2011 -0821 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38D - 003 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 -0821 Project # JS- 2011- 001345 Est. Cost: $9600.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 6577.56 Owner: DUPREY NICHOLAS Zoning: URB(100)/ Applicant: RCI ROOFING AT: 298 SOUTH ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 SOUTHAMPTONMA01073 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 Siznature: 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