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23C-059
T. ___._.------..,„.. It . • Roofing ? L L �rY c -} Oak 6 Line St. Th i P hone a 4 7- 77073 Estimate D ate ' � Phone (413) 527 4775 rrt Fax (413) 527 -8469 , 4/200• P 'f 10 � 3 a fr,l), /6--.) Name I Address Job Location / . y<r 02 i Robin Silva • �,r� 181 Willow St. 181 Willow St. Florence, Ma. 01062 Florence, Ma. 01062 (413) 586 -1436 Terms Rep Estimate valid for 30 days Bob Job Description Total • Remove existing roofs. 4,000.00 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 and install synthetic underlayment over existing deck. 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. Add $2.50 per sq. ft. for wood decking replacement if needed. Add: $200.00 for Certainteed Surestart Plus extended warranty (included if signed estimate is returned within 7 days). Add: $500.00 for Certainteed Landmark Woodscape 50 year Premium shingle. e a - -°/ = t' . _ r ' 7 24_. _.: re t U WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $4,000.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature � Registration # 126235 Construction License # 074334 Date r Insured by Reynolds, Barnes & Ilebb. inc. 413- 447 -7376 gite - pow, of.. Board of Building Regulations and Standards li Constructfpt , Supervisor License , g V S Licettde'\ CS 74334 ' ? =1- 2p10 Tr# 23520 : , MARK T DELISLE 33 FIRST AVE :•;' ;,', -� ..-, ii EASTHAMPTON, MA 01027 Commissioner ____ ..." Jib Pon of ../1� a Board of Building Regulations and Standards Dui HOME IMPROVEMENT CONTRACTOR E r'1 iA !I Registration: 126235 i "•... Expiration: 5/6/2010 Tr# 266063 Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. (___...4....42-0-... EASTHAMPTON, MA 01027 Administrator • The Commonwealth of Massachusetts Department of Industrial Accidents n Y, _,,,,•.•- Office of Investigations 600 Washington Street ok �: � - - : Boston, MA 02111 w /dia Workers' Compensation insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant information Please Print Legibly Name (Business /Organization /individual): © . • s \X., Address:_, S , City /State /Zip: ,,. • • , u Phone #: - t-1`fl Are you an employer? Check the appropriate box: Type of project (required): i . 2 am a employer with 20 4. ❑ i am a general contractor and I 6. El New construction employees (full and/or part - time).* have hired the sub - contractors 2. 7 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub - contractors have ship and have no employees 8. [3 Demolition working for me in any capacity. employees and have workers' 9. [] Building addition [No workers' comp. insurance comp. insurance. ❑ We are a corporation required.] 5. oration and its 10.E3 Electrical repairs or additions 3. 7 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.212.00f repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] ' Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. INomeowners ho submit this affidavit indicating they are 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 Company Name: .'C'L R'fbQC.X" , Policy # or Self -ins. Lie. #:NUJC c 5? 0`1 3s Expiration Date: / 0 - - 0 Job Site Address:1'S Wt \1pt 5\' City /State /Zipm- tyu_.e. Mc+. c' ocz. Attach a copy of the workers' compensation 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 tine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ins and penalties of perjury that the information provided above Is true and correct. Signature: Date: Phone .5-1 -L-C1 Official use only. Do not write in this area, to be completed by city or town official. Cttor Town Permit/License # ng Authority (circle one): 1F )hoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6 Cher •C`on`tact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: 1 le1 Not Applicable ❑ Name of t,lonnse Holder : M aY k - Del �s '771 License Number L.111a_5. a •. 3.. ti. 11. • 1 5 -03 Jo Address . Expiration Date l� Lj (1 75 Signature Telephone 52'7- ......X.' 9. Registered Home Improvement Contractor: Not Applicable ❑ fi. a . I. Roo 1 126235 Company Name Registration Number tiooru. tt�� t1 �f�1 Expiration Date • • ' . •t • • • V . • • Telephone& 3)527. T ! 15 — SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(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 Qr No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families ; rd to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts :s 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 tructures. A person who constructs more than one home in a two -veer 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 worl4 performed under the buitdine permit. , 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 !mployees 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 a.taohed r , SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable) New House ] Addition fl] Replacement Windows Alteration(s) El Roofing EIK Or Doors C) . Accessory Bldg. Demolition . New Signs [❑] Decks [C] Siding [0] Other [p]' . Brief Descripton of Proposed attarhp1j iVork 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 c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Numbe- 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 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 Nrk �, \J as Owner of the subject property i • r Q n T } r hereby authorize li (3Y 1Je s e o f ! j• L. -++. Roof; 1 n to act on my behalf, in all matters r lative to work authorized by this ur ding permit application. 9 att�phP,d - 1- to Signattue of Dwner Date I, • • ' ' I • / ,A , 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. Mari li sle - Print Name 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 L,it Size I. 1 i I • Frontage i I � 1 (. _. Setbacks Front i Side L:i K:' La„_. R: I _.___1 L___._ -__I Kear I L _ i Building Height ; l - Bldg. Square Footage I j . 1 � Open Space Footage % (l.•t area minus bid & paved 1 i __, par(ing) ■ ,)f Parking Spaces I__.._ l Fill: I, �l_ svoIume & Lpcation) 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: 1 . . IF YES: Was the permit recorded at the Registry of Deeds? NO 0 .. DONT KNOW 0 YES 0 IF YES: enter Book - Page 1 a /or Document R1 j B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ,Date Issued: !~ ` 1 C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: I l 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 (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. �, . it}i _ G' of Northampton Ste ^ 1 : i . :. l ! r li lb Department Curti C ,, , a , 212 Main Street `, 1. ,, � ) Room 100 ` `. • I l,..F� ' MAR 1 5[010 r, . 1 Northampton, MA 01060Y. x r ` phone 4.113 -587 -1240 Fax 413 -587 -1272 Piq ;ter . ■ Other $. iyi 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 Address 1 g { L \ \\ p Sr Map • Lot Unit ,c\,b4."'cnC --C Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: fk Obi h ► \U C'. i $ l u,)‘10, c.,J S\ 4,o r Name (Print) Current Mailing Address: attached (y13) 5-3(.,- )43(.0 Telephone Signature 2.2 Authorized Anent: 14 • • v SO Name (Print) / Current Mailing •dress: ` r. - --- __ (413) 521- 4115 O 0`1.3 . Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building R _ 00 0 , oo (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) 41 U Oco. 0° Check Number /5(4c9— 0335 This Section For Official Use Only Date Building Permit Number. Issued: Signature: _ Building Commissioner/Inspector of Buildings Date ;if.: ' .. ST BP- 2010 -0804 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 -0804 Project # JS- 2010 - 001186 Est. Cost: $4000.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): Owner: SILVA ROBIN B Zoning: URA Applicant: RCI ROOFING AT: 181 WILLOW ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:3/16/2010 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 3/16/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo