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23C-086
RC 1. Roofing 6 Line St. Southampton, Ma. 01073 Esti m Date Phone (413) 527-4775 Fax (413) 527 -8469 10/12/2010 Name / Address Job Location Jean Timko 76 Bliss St. 76 Bliss St. Florence, Ma. 01062 Florence, Ma. 01062 (413) 586-0813 Terms Rep Estimate valid for 30 days Dave Job Description Total Remove existing roofs. 5,900.00 Furnish & install aluminum drip edge, pipe fleshings, 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. 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: $700.00 for Certainteed Landmark Woodscape 50 year premium shingle. A Certainteed Surestart Plus extended warranty will be included with a fee of ($280.00) absorbed by RCI Roofing if signed within 7 days. This extended warranty means that 20 of the 30 year warranty is covered for labor and material. The last 10 years of the 30 year Certainteed warranty would be covered for material o ly. / / ri/44( cv _ /' • WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $5,900.00 TN;RMS OF PAYMENT s : Deposit Balance upon completion Registration # 126235 Customer Signature y ,/ /c Construction License # 074334 r Insured by Banas & Fickert Ins. Date 'y/ 7// 413..527 -270(1 (I, HI; I tri,, i,l ..I r'uiW ;111 , !.iu I.0 �tC en•,. %43_)4 •Ies1,∎∎ ∎rerl , OCT MARK T DELISLE 33 FIRST AVE : EASTHAMPTON, MA 01021 " ; ti :_6357 1111ir ul C un.unicr arl;r III IIc,s Rrgrilxliun HOME IMPROVEMENT CONTRACTOR t r Registration: 126235 qL+c, ExtIiration: 5/612012 Tra :r 1 yF o: Partnership R C . ROOFING MARK DELISLE S LINE S T 5 `;OUTHAMi'TON MA 51073 I�nrlrrsrireu�rr The C.'ommon wealth of Massachusetts s,►*� Department of Industrial Accidents •t l k,,,, Office of Investigations """ I _.. 600 Washington Street • .... ..... . Boston, MA 02111 r,`.s www.muss.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly R.,, Name (BilsinessrOrganimion /Individual): _ pp \_� ___ _ Address; '� C'i cy/ State'/ 1 , U a � __ Phone #: y( 11 5 Are you an employer? Check the appropriate box: Type of project (required): I .Q/1 am a employer with 2. O 4 . ❑ I am a general contractor and I employees (full and /or part - time).' have hired the sub contractors 6 . ❑ New construction 2. 7 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' y ❑ Building addition [No workers' comp, i nsurance comp. insurance.' required.] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions r officers have exercised their 1 1. Plumbing re 3. L� i am a homeowner doing all work f ❑ B airs or additions p myself. [No workers' com p' right of exemption per MGL i � 2 LYI r- �Roof repairs airs insurance required.] c. 152, §I(4), and we have no employees. [No workers' 13.❑ Other _ _^___ comp. insurance required.] ' :gym applicant htit checks box #1 must also fill out the :rection below showing their workers' compensation policy information. ` Itomeowncrs 's 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. lithe 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:_ L .. Q'tDQe.." - t;, C_c,. .1. nS . — Policy 4 or Self -ins. Lic. #: cCA ._5/ 0`1 � 3S t _ Expiration Date: J 0 - 5" - 2, - Job Site Address: _ ' ( &% S S'-' _. __. City / State /Zip t_ , m„L T M 01.4.4 L 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 $1.500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ins and penalties ofperjury that the information provided above is true and correct. si - - - - -- �� ''��= �.,..... _�__ — - D ate; l U -�� t —I 0 i'hone` # :''tL 3_' 51 U15 — - _._____ -__ ___ -_ Official use only. Do not write in this area, to be completed by city or town official ' Permit/License # Ai or To wn: -_ r,r;,,4 4 1ssg Authority (circle one): ' I "$hard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6 .Daher Phone #: . SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ t1�V,1 I /. Name of License Holder: �` {ZY) : k 15 ie. 17�33 � License Number kL\I'le, 5 kg \‘, . • . • 5-03-12 Address Expiration Date (4a3) 527- i_1 ?75 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ is • e•I ' d• 126235 Company Name Registration Number C� ;; n e_ 5- NI -12 �� — 7 � Expiration Date p Th - a : Q 1 /1 v Telephon& 3)5'4 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 - o ccupied L wellinn of one (1) or two(2) families anc to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts 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 helshe shall be responsible for all such work perf'rmed 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.f'or 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 llabk for person(s) you hire to perform work for you under this permit. Thr 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 __ aaleCi • • xt { SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House } Addition { Replacement Windows Alteration(s) D Roofing Ef Or Doors ❑ Accessory Bldg. n Demolition 0 j New Signs [❑] Decks . [(Z3 Siding [O[ Other [DJ' ' _. Brief Description of Proposed a�ta�h e11 Work: Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet .sa. If New house and or addition to existing housing, complete the following: a. Use of building : One Family Two Family Other j b. Number of rooms in each family unit:_ _„ , Number of Bathrooms I � i c. Is there a garage attached? ' ' f d. Proposed Square footage of new construction. Dimensions I e. Numbeff of stories? I f. Method of heating? Fireplaces or Woodstoves . Number of each I g. Energy Conservation Compliance. Masscheck Energy Compliance. form attached? h. Type of construction i. Is construction within 100 ft. of wetiands? _ 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 I , �� \ ' k CYN , as Owner of the subject property {� ke hereby authorize t sar ► - bG , i S 1 ()T t R to act on my behalf, in all matter r ative to work authorized by thuilding permit application. . ttrhe_d • / v - - a 1 — ‘. 0 Sign tUireAf Owner Date I, u • ; , ' I e ' 17_88 as l , as Owner /Authorized . Agent hereby declare that the statements and information on the foregoing awlication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Y k j I Print Na • 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 Lot Size Frontage . , I i I Setbacks Front 1 Side t.:' R: L:! 1 . R:: (____. Rear L ___ Building Height i B dg. Square Footage _ °' — Oren Space Footage % (L area minus bldg & paved parking) # , - if Parking Spaces 1 _ I I Fill: l l l _ �. (volume & L pcation) 1 - A. Has a Special Permit/Variance/Finding ever been issued for /on the site? NO 0 DONT KNOW O 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 1 and /or Document #i I 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 O , 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 O NO O IF YES, describe size, type and location: i -----= 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 ; acre? YES © NO IF YES, then a Northamp?on Storm Water Management Permit from the DPW is required. City of Northampton Statts or ''''',: ,1: . 2 F 10 Building Department Curb f C ,' °.4 n ' .4: I " n0 212 Main Street S I :�,' � ' ' Room 100 W a sNorthgmpton, MA 01060 T .f•'''.•,1,:`,.‘,:,..., � phone 4- 1-3 -1240 Fax 413-587-1272 F?lot%5 b ." � ; , _ � '..,+ .,r 1 r . .. ! 'i Other S.. rr+� . h t .,, + ,y Wm .t.. n . ' ;, . ._" .n .... + a . L___ 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 — 1(43 Q\ S � Map 1 Lot Unit Zone Overlay District, * ' Q) - C_t: , ;{lla. • . Elm St. Dlatnct CO & +ofict SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: II � 1 jj i\ C sa (�� ( > '� \ N` \V 1 (O b\ ■ JS . c��7 � 'C--t i \' ck..C)k- (a2- Name (Print) Current Mailing Add as: ; .3 ei e (L-t E , � , sx c,I - O' 1 13 Te lephone Signature 2.2 Au t h rued Agent: - Nan,e (Print) ./'. Current Mailing dress: o t, 0"1" ; ___ N-- (113) 521 4/15 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS t •, Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building 3Loofi I 5q 4 00 . C.0 (a) Building Permit Fee 2. Electrical J i 1 (b) Estimated Total Cost of Construction tfum :iii) _ __�_ 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5 , Fire Protection 6.. Total = (1 + 2 + 3 + 4 + 5 .. j 1 0 0 . ' Che ck Number /6d ' 3S 1 This Section For Official Use Only Date Bot'klingPerrnit Number. Issued: Sigiatirre: Building Commissioner /Inspector of Buildings Da %`/' ' ;is 76 BLISS ST BP- 2011 -0372 GIS #: COMMONWEALTH OF MASSACHUSETTS - 086 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- 2011 -0372 Project # JS- 2011- 000621 Est. Cost: $5900.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 17859.60 Owner: TIMKO EDWARD N & JEAN M Zoning: URA(100) //WSP Applicant: RCI ROOFING AT: 76 BLISS ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:10/25/2010 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 10/25/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner