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23D-203 Roofing 6 Line St. P hone a (413) 52 7- 47 77073 5 Esti m Date P hone (413) 7 -7 Fax (413) 527 -8469 4/13/2010 Name / Address Job Location Diane Kleber 110 Maplewood Terr. 110 Maplewood Terr. Florence, Ma. 01062 Florence, Ma. 01062 (413) 230 -8413 Terms Rep Estimate valid for 30 days Dave Job Description Total Remove existing roofs. 10,500.00 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. --- 1,1S11 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: $1,350.00 for Certainteed Landmark Woodscape 50 year premium shingle. A Certainteed Surestart Plus extended warranty (additional 5 years) will be included with fee ($540.00) absorbed by RCI Roofing if signed within 7 days. 1 / 4 10" 0 s kr -- a • ( (k1 Sv S 4 - u � - ' 4 ' c t) u.. f C O n? u.. j WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $10,500.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature _ "4 Registration # 126235 Construction License # 074334 Date 51,D j' Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376 / ••:. 'I;IN Iles; lf• I), i,.it ,'iil• HI ••l I'uSiiii '.ill is • 41 11 J ii,,,Ild uuI liuililill ■! 1i, _ .roil '1.in1li1 L 1,.. e•I I S,' ■ ,., 74334 RestflCted to. 00 a y MARK T DELISLE 33 FIRST AVE ' " 'zt EASTHAMPTON, MA 01027 ;., kI , li,+ti,■i■ 5312012 ■ ,, ,, „.i„•, T,:: 26357 l;.. r•<J..,,,,,.,,.: • 1'4,, ,;,,,i;,,.,.•e7:: mice of t'uusnmei ■hair V ISu.iura ltc{,ulaliuu 11 r HOME IMPROVEMENT CONTRACTOR i-, Registration: 126235 . . Expiration: 5/6/2012 Tr#t 253949 Type: Partnership R C I ROOFING MARK DELISLE 6 LINE ST ..'_S SOU THAMP TON, MA 01073 t nulcrsccrclan • . The (omman u)Ltalth of I l assac usetts "`_„, Department of Industrial Accidents i Offfce of Investigations , � ,� � � 600 Washington Street %,, _ , , Boston, MA 02111 ti � '‘1,,$.., — WJ H'. /1J1JSS.1.,'ol' %(gill \\�(IrkcIS' Ctrtnlrcnsatiuu hiti u rance Affidavit: Builders / Contractors /Electricians /Plumbers \Irlriicant In forma IIOtt Please Print Le>;ibly Namc tii,,,ric >s.d)r� –/A ioniindivRiti ti): L c) (— . �\._2 \Llcires* `- It∎,,titatc, lip- +.3 i Phon : � S!',7 - L 1 5 — :Lrc vuu an employer? Check the ;tppropriate box: 7 hype of project (required): : "� I am , mplo� e.r with 20 4 . I am a general contractor and 1 emplo ties (fun and/or part - tinge).' have hired the soh contractors (. [ New constntction ,_j 1 ;ern :1 sold proprietor or partner- listed on the attached sheet. 7. [ i Remodeling slip ;tied have no employees These sub - contractors have 8. ❑ Demolition workin�� lot me in an> capacity employees and have workers' y Lii Building addition N .∎.okeas` comp. insurance comp, insurance.; re(iuiR:dl, j 5. 1 ) We are a corporation and its I 0.( Electrical repairs or additions j 1 am .+ homeowner doing all work officers have exercised their 1 I. fl Plumbing repairs or additions rage!; lNar workers` comp. right of exemption per MG1_ 12. ViZool tepairs nlura,cc r equi red. 1 ` c. 15'2, §I (4), and we have no employees. No workers' I 3.L_ Other comp. insurance required. 1n. .u,p,heow L,11 checks bo.N al must also till out the section below showing their workers compensation policy information. i liiuic,,dvrnCrs „ t,, , MINIM this affidavit indicating they arc doing, all work and then hire outside contractors mutt submit a new affidavit indicating such . t. ,uuractors tha::i,eck this sox must attached an additional street showing the name of the sub - contractors and state whether or not those cntities have cinl,l,,vccs if U,c sub - contractors have employees, they must provide their workers' comp. policy number, / ain cur employer e'r that it providing worker.' compensation in.suranc•c for Illy employees. Below is the policy and job site in /i■rrrtation. :l;tlr;ltl.:t' L'o.11pan∎ ;N'iillte:_ V' ._..rNt.C" $ �A4o�\ \ . �.� i'„ic■ , r �d it 1, .ic '', . ' -- C�`� 5.3-Q2-1 3E_‘., - - - -- t:xprr;tllon utttc._[0 a_a ■ 0 Jh,h iitc .•\did,, : - jam- ©b ' - . cr. City /Shale /Zip: 4t SVS11.0GJ Attach a copy of the workers' compensation policy declaration page (showing the policy number a nd expiration date). i :t,lure to sec Are coverage as required under Section 25i1 of MGL c. 152 can lead to the imposition of criminal penalties of a title op to SI.� )0J)0 and /or one -year imprisonment, as ■veil as civil penalties in the !brat of a STOP WORK ORDER and a lip tip to ''?�ti 00 ;t day against the violator. Be advised that a copy of this statement may be forwarded to the Office of !r,vestigations of the DI A for insurance coverage verification. / phi /rcreht• c i.rtijrr under the ins and penalties of perjury that the information provided above is true and correct. ta)titti r _ _ _ i'hone 4: cj{t3..i._,S l_ - - 5 _ ___�_ _ Ufficia/,r,c only. Do not write in this area, to he completed by cite' or town official. i Gl Itor '1,,wu: — __ Permit/License q t Tssu'itig authority' (circle one): 1,f ?oard of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector G.�,© -- — ` . Phone it: • SECTION 8 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable 0 Ndm@ of LicPn;;o Homer "Delis ea r77J-1,334 License Number Address Expiration Date )3) 57- 11(175 Signauue Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 sty f nci L 2 Company Name O Registration ti A D�J� ( - emommipoolftftwaraftuorar----..... 5-0L-I0 � cc �{ i1, -��'r� t� l lLrll►C Expiration Date ,Toni jagm.J o . 3 Telephone:6i 3)527 "T 75 SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6)) '. Ocn Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will resutt n the denial c the issuance of the building permit. Signed Affinz:v t Attached Yes No 0 1 - Honie Owner Exemption he current exemption for "homeowners" was extended to include Owner - occupied Dwtilines of one (1) or two(2) families to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner actl ;ts supervisor. CM R 780, Sixth Edition Section 108.3.5.1. ne inition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there in is intended to he, a one or two family dwelling, attached or detached structures accessory to such use and / or farm ,:;tures. A person who constructs more than one home in a two - scar period shall not be considered a hoigeywogr. a:;,;h - homeowner" shall submit to the Building Oflicial, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the buildinz permit. :tcting Construction Supervisor your presence on the job site will he required from time to time, during and upon ,npietion of the work•for which this permit is issued. he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to ,:r plovers for injuries not resulting in Death) of the Massachusetts General Laws Annotated, YOU m*v be tlab{tti for person(s) hire to perform work for you under this permit. undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of r,,rthaiup ;on Ordinances, State and Loeal Zoning Laws and State of Massachusetts General Laws Annotated. • Homeowner Signature __a4.a0.7 ►Gd i r / tit, • i SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable) ` New House , Addition [J Replacement Windows Alteratlon(a) 1 1 Roofing Eyi t . New Signs Or Doors Cl 1 r O �! Accessory 51:1g , � Demolition g ( ) Decks i0 Skiing (0) Other (p)' • Sne! Descr;; );, of Propose ■ ��� � 3 �� ezi — Vc rk Alteration of east ng 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:iding One Family Two Family Other ' c Number c rooms in each family unit: Number of Bathrooms Is there a ;arage attached? 1. f d Proposed. Square footage of new construction. Dimensions e. Number c' stories? Method o: neat ngn Fireplaces or Woodsloves _ Number of each Energy C,:nservahon Compliance Masscheck Energy Compliance form attached? Type of construction . Is constru;.tion within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No Depth r t 3sement or cellar floor below finished grade k Will bui ding conform to the Building and Zoning regulations? Yes No . Septic Tar:c City Sewer Private well City water Supply SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT . S:S\ 0. 2`Q._._ \ ( , as Owner of the subject property . ' Y T • R Roo i hereby authon:_e l l ads L S, e_ of R ° c. -+ T � . Fi n :o act on my b half. in all matters r ative to work authorized by this uilding permit application. 9 AU_ g c hP.d a( -k Sig't1#1f[liQ Owner Date u , I I ' • • I ,. , as Owner /Authorized Agent hereby daclare that the statements and information on the foregoing ...lication are true and accurate, to the best of my knowledge and belief. Signed under tie pains and penalties of perjury. M Oi li 5 Print Name E ac, 40 Signature of Ownar/Agent Date Section 4. ZONING all Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information —_— Existing A iroposed Required by 'Zoning This column to be filed in by Building Department I,. S;te. ' t i'tonta QC I Setbacks Front Side i,:; R: I.:" R:' Rear I3 ,ilding Fleight [3 J. Square Footage 0 ?en Space Footage it. ,t ;uta minus Bldg & paved t,a k m C ) ( Parking, Spaces , f: !i , j , i Humc&lpcarionl A Has a Special Permit /Variance /Finding ever been issued for /on the site? NO O DONT KNOW 0 YES 0 IF YES, date issued:; IF YES: Was the permit recorded at the Registry of Deeds? NO 0 . DONT KNOW O YES 0 IF YES: enter Book Page; ' and /or Document #1 6. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained 0 , 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: E 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 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. rr a , • City of Northampton .` Building Department CurbC I " l "/ dl' 1! 4\:',' 2_010 212 Main Street r , • • Room 100 r� Northampton, MA 01060�ri ' " phone 41 3 -587 -1240 Fax 413- 587 -1272 Plots e g i Other SpeC t; �{ k. . ' A e, APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1 1.1 Property :_ddress. This section to be completed by office 1 c o \te,‘, C1Ct, � �tC' . Map ' Lot Unix Np { . o s \- '� Zone Overlay District ` Elm Si District CB Dietrict SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Q‘-_ ( VC V ► ltd mail\ r..,..)o Ttt . �clb✓ .,a�gl -+5 Name (Print) Current Malting Add ss• ptdrap ttae e d r�.� -230- Telephone Signature _ j 2.2 Authorized Agent: r Name (Print) J Current Mailing •dress: O ` 0'13 ('413) 521. 4115 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS ;tern Estimated Cost (Dollars) to be Official Use Only completed by permit applicant - 1 Building i , ,oO r l 1 © 5 a � (a) Building Permit Fee 2. Electrical J 7 + (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) 1 (l � op , Q 6 Check Number 4d This Section For Official Use Only Date Boilding Permit Number. Issued: I - Signature: Building Commissioner/Inspector of Butidings Date 4 : IV110 c A. *A BP- 2010 -1084 GIS #: COMMONWEALTH OF MASSACHUSETTS titmomock: 23 - 203 s 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 -1084 Project # JS- 2010- 001591 Est. Cost: $10500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 12022.56 Owner: KLEBER RODNEY E & DIANE L Zoning: URB(100)/ Applicant: RCI ROOFING AT: 110 MAPLEWOOD TER Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAM PTON MA01073 ISSUED ON: 5/28/2010 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 5/28/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo