23D-080 kc.
t.Ll'
6 Line St.
Southampton, Ma. 01073 ESti m at a Date
Phone (413) 527-4775 7/14/2010
Fax (413) 527 -8469
Name / Address Job Location
Anne Rosen
77 Warner St. 77 Warner St.
Florence, Ma. 01062 Florence, Ma. 01062
(413) 584 -0588
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 11,500.00
Furnish & install 1/2" plywood over the existing decking.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard 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 .045 re- inforced rubber roof system on flat roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
5 -year RCI Roofing workmanship warranty included.
All related permits will be obtained by R.C.I. Roofing.
Price for flat roof only: $2,400.00
Price for Shingle roof only: $9,100.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $11,500.00
TERMS OF PAYMENT
5% Deposit — j
Balance upon completion
Registration # 126235 Customer Signature "—'' /.
Construction License # 074334
Insured by Lianas & Fickert Ins. Date _ r
413- 527 - 270(1
0 il r..achu.clts - Uelrrrinunn. ..f Public �;rli{G
Su rid of Rui1r1i11 Rc_ulu(r■n' mid `i 1(lar',I'
(: ;t o :7up,..2 is,) r r ::,i
License: CS 74334
Restricted to: 00
MARK T DELISLE
33 FIRST AVE"
EASTHAMPTON, MA 01027 Fv 411H ' ,
�' Expiration: 5/3/2012
t "nurii..i,mcr Tr:?: 26357
. (o „,„i,o na '', lr/ �, f'. 74. r.,ez„ /« .,&:.
Office 0f Consumer affairs & Business tiegulatinn
. . HOME IMPROVEMENT CONTRACTOR
, ,,' Registration: 126235
'_'.` Expiration: 5/6/2012 Tr# 293949
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
6 LINE ST .. s',.-- .e .et j
SOUTHAMPTON, MA 01073 Undersecretary
I he Commonwealth of Ilassachuseils
Department of Industrial Accidents
, Office of investigations
Le 600 Wttshington Street
• tr Boston, MA 02111
is' wK'. MUSS. goL /tliu
\Voncetrs' Contht ttsation 1nsura ►ace Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information Please Print LeEibl'
Name
\tidress.
G il�: \Q phone ti:
:1 e vuu an employer? Check the appropriate box: Type of project (required):
i 2.0 4. E f am a general contractor and
f am a r.ni �luti <'r ���ith 6. New construction
entplo� (full and /or part - titre).• have hired the sub- contractors
1 I ant a sole proprietor or partner listed on the attached sheet. 7. U Remodeling
ship :rn:1 have no employees These sub- contractors have h. Demolition
work nig for me in any capacity. employees and have workers'
9.
insurance.; [7 Building addition
Ni ii irker comp, comp. insurance
5. We are a corporation and its O. Electrical repairs or additions
requir��i.)
U I ;tat ,t homeowner doing all work officers have exercised their I I.E Plumbing repairs or additions
arose!: j No workers' comp, right of exemption per MGL 12,[} oof repairs
insurance required.) ' C. 152, § I(4), and we have no
employees. [No workers' ! 3. (— Other �� -- —
comp. insurance required.)
checks box I l l must also IiU out thc section below showing their workers' compensation policy inhumation.
I<�nc�,«ncrs t. hu submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:t ��nrractors that check has hox must attached an additional sheet showing the name of the sub- contractors and state whether or not those entities have
ciao lo ees. It the sub - contractors have employees, they roust provide their workers' comp, policy number.
1 rrntt WI employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
in /onna
tisurauce c:t Narne:_Q.Q,,e. � Q �— — �`�`ti°� ` �
It : ,,f ;t it iris. I.ic. ;J : dC'1 '-) S _ - .- -- _.._-_-- - - - - -- Expiration Date: 1 0 - 5 - t y
h bite Adiltcss: "7 kA3o...( cver ,5\v -. _�� City /State /Iip �r gtr t <Yl�, ,,` 40�
:Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Fat(ure to sec.trc coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
l up tt, Si . and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a In
at‘ up to 5).51) HO a day against the violator. Be advised that a copy ofthis statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
/ i/o I:ereht aaartijY under the ins and penalties of perjury that the information provided above is true and correct.
(fit 3 = 5 — LCV 5 _ _____ _
(>fficial tt.,c only. Do not write in this area, to be completed by city or town official.
t or 'I o,t tt: Permit/License #
Its Authority (circle One:
n �• 2°
Ir. i rd of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6Q'thcr
Phone N:
SECTION 8 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Ap '77113 pllicable 0
Name of t is n -y
:;e Holder a -il .. t le, . - -- - -- ' j
License Number
/ CI *.. - "\ - 11D a Ma. nioi 55 - p3- / 2
Address Expiration Dale
Signature Telephone
......„.."
9, Registered Home Improvement Contractor: Not Applicable 0
. ' oo � 126235
Company Name ) Registration Number
.., , s�- 5- DL - !
r,00te M n 1� Expiration Date
sn-n �2Thr Ma . 0 ! OTL,3 Telephont61 3)5 47 75
SECTION 10 WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 25C(6))
Workers Cc.n oensation 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 Affirfawt Attached Yes g No 0
N. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Owotltnss of one ( or two(2) families
;u to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner actl
is iupervisor. 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, ;x is intended to he, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
.t,'iictures. A person who constructs more than one home in a two - year period shall not be considered a homeowner.
au,:h - homeowner - shall submit to the l3uilding Official, on a form acceptable to the Building Official, that boon shall be
responsible for all such work performed under the buildinE 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.
•1!`o be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
!:;r ployccs 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.
Th_ 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 31:La0.hed - -_ - -- -- -- - - -- --
1 .
1 , / ' 4 '
' ' i t _ ‘N,■ ' '.
t i !
't1
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition [ J Replacement Windows Alterations) I 1 Roofing
ff Or Doors C7 . .
I
Accessory Sldg L.� Demolition . New Signs (0] Decks (E) Siding iOJ Other (Q)
Sriet nJescnp; )n of Proposed ��
Work. ttach
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:
Use of bu ding One Family Two Family Other
Numbe c• rooms in each family unit Number of Bathrooms
Is there a arage attached?
d. Proposes Square footage of new construction. Dimensions
e. Numbe' ci stories?
Method di heating? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance Masscheck Energy Compliance form attached?
h Type of construction
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
Will building conform to the Building and Zoning regulations? Yes No
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
_non. , as Owner of the subject
property R (� T Roo } nereby authori:_e filar 1 el n11 e Qf I j • ` .1� -++ . t t •n
;o act on my behalf, in all matters rdlative to work authorized by thisbuilding permit application.
attt bchP.d _ o
j Sigtlf Owner Date
I. M AY L���S�- c �Ut o as nt , as Owner /Authorized
Agent hereby daclare that the statements and information on the foregoing a are true and accurate, to the best of my knowledge
and belief,
Signed under the pains and penalties of perjury.
Print Name
1 8 - 3 - 10
Signature'of Owner/Agent Date
Section 4. ZONING Ai/ Information must Be Completed. Permit Can Be Denied Due To Incomplete Information
Nxisting Proposed Required by Zoning
rhis column to be flied in by
Building Department
)/c
•
i � !
S.xhael•t, Front ' • •
Side L� R: K1
Rear ' i I
VJUdinXUei , 8h' .
)
B dg. Square Footage Y+
n)
(LA ^=" paved •
r'k'"u>
( |
x .t[ Parking Spaces
/ •
F]L ]|
u4e"^nL
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
7�
NO \�/ DON'T KNOYY \ YES \~/
iF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
�� �� YES ��
NO DONT \�� ` \^� \^�/
IF YES: enter Book Pa 1 and/or Document# -i
,^ L ' - _---_i
�� ��
G site �� Does the �rcnn�ain a �rouk. body u! water or wetlands? NO �,� DONT KNOW \�� YES �~�
IF Y[S, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtarned y Obtained
—� r �ate�usued�
\`� \.� , Issued:
C Do any signs exist on the property? YES 0 NO 0
- |
IF YES, describe size, type and location: '
—
D Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
---- ----------------------
IF YES, describe size, type and tocatton:
E Wtll the construction activity disturb , gradingexcavation, or filling) over 1 acre orhk part nfa common plan
that will disturb over 1 acre? YES[ ) NO � >
�� ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
r G
City of Northampton Sta iro!� ,t
Building Department Cufb C I
I UG pit; 212 Main Street ,,.�,,,n {1 s,.. ,
n
Room 100 W ''; `, •
�,.,... . ..IkIG M i :G tr M
phone 43 581240 M ax 413 12 2 � �'' ': .
i r, Northampton, -j .. �.., a
Ofieii� '.:i,41 y , ( ,.
Other S • e'zrc ,.,;.% ; , . i
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ON OR - TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property address: This section to be completed by office
—t
1'1 'Wo-�' ve..:f Map A ■ L Unit
cVa I I c\ . 0 C2t� Zone Ov District
Elm St- District C8 District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Records: ll ckortftfr (1'�lll cko �'( `1 `� 1 �)0.C't. _1 S \--. (\o .
Name (Print) Current Malting Address: r C t c.a..,.
_atta.Ch e LI
T elephone
Signature
2.2 Authorized Aaent:
py k 1) 9 1 e, - 1.e .I. f c f i Jp * _ L'► e
,5� k
c-, So 'An0 mr��- -
Name (Print) Current Malting Address: t T O ■ O`1.3
"Z (f13) 521- AP/15
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COST$
!tern Estimated Cost (Dollars) to be Offical Use Only
completed by permit applicant
1. Building l .4 ( a) Building Permit Fee
I.,,,F, I , ,
Soy o
2. Electrical J (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
SS 4. Mechanical (HVAC)
5. Fire' Protect ion ,
6. Total =(1 - 2 +3 +4 +5) t \,Soo - °C) Check Number /4 i)-._. , s gP ,20I( 0 I
r This Section For Official Use Only
Date
Bonding Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Bufdings Date
1 . r
1 s
mivARNER : " BP- 2011 -0115
GIS #: COMMONWEALTH OF MASSACHUSETTS
2 ,« 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 -0115
Project # JS- 2011- 000204
Est. Cost: $11500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 19514.88 Owner: ROSEN ANNE BRENNAN & JOEL E
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 77 WARNER ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775
SOUTHAMPTONMA01073 ISSUED ON:
TO PERFORM THE FOLLOWING WORK: Strip, Plywood & 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 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner