24C-119 (3) 0b/1272@09 09:33 4135855754 BERRIEN LAW PAGE 01 /W.
RC . Roofn
MP
518 Holyoke Street
P.O. Box 309 EStI m ate Easthampton, MA 01E27 Date
Phone (413) 527 -4775 5/18/2009
Fax (413) 527 -8469 ._ .
Name I Address Job Location _
Dan Berrien g Fifth Avenue
14 Elizabeth Street Northampton, MA
Northampton, MA 01060 01060
617 -792 -4606
Terms Rep
Estimate valid for 20 days Rich
Jab Description Total
Remove existing roofs. 9,400.00
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter fleshings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and
valleys.
Furnish and install synthetic underlayment.
•
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.
MI 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 $800.00 for Landmark- Woodscape Premium shingle. .
Add $160.00 for Certainteed Surestart Plus 5 -Star extended warranty.*
*InclAed if estimate is signed and returned within seven days of remittance.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total
TERMS OF PAYMENT
5% Deposit •
Helene up;:in completion Customer Signal ure
Regi.tredon ;t 126235 �� '
Construction License 4 074334 Date • /a. ot
insured by Reynold% Barnes & 1Ncbb, Intl, 313 -447 -7376
Page 1
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 74334
Expiratitnl: 5/3/2010 Tr# 23520
41100''' Restrketion; 00
MARK T DELISLE
33 FIRST AVE
EASTHAMPTON, MA 01027 Commissioner
'
gize ganvinoitweaa of,Armacitaleat
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
WAIN
Registration: 126235
Expiration: 5/6/2010
Tr# 266063
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST.
EASTHAMPTON, MA 01027 Administrator
Almommir
, ` a CrxtR cif Northampton *
1
c� -�n
� i�sj ~� d JIssssdtttsetts'
:vi 1
•
e F . ''' 1111
OF BUILDD.G INSPECTIONS i I
G
. 212 Main Street • Municipal Building �'
Northampton, Mass. 01060 L " r• `+
WO RICER' S COMPENSATION INSURANCE AFFIDAVIT
I, _____A_Mark. lTe h s e of ft. c'.i. Roof;
(licenser/permitter)
wi:h a principal place of business/residence at:
,
s - ‘ , „.„.A,, 6_4. • - . 0 l013 (hone #(413) 5.?•
' - city/staieinp)
do hereby certify, under the pains and penalties of perjury, that:
(J1I am an employer providing the following worker's compensation coverage for my
employees working on this job:
x.)Q.c.:.O( o.\ w oh tf\ t"e.
I t S . co . 0 C CI NNkS �, Ws �) c 3 (.311 V$ t o - 5 - o
ra
- (Insurance Company) (Policy Number) (Expiration Date)
.
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(auach additional shoat if noccs:uy to include information pertaining to all oserractora)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself'.
NOTE; plwsc be aware that wbiIo iaco:woo a who employ penont to do maintenance, comtructimor tapir wait as a dwellio$ of
of mote than throo units in which the homeoaacr resides or on the grounds appurtenant thereto are not gosecatty oomidded to be
tmployt:r under the wocioa's compeusatian Ad (GLI $2 ss 1(5)), apptiettioo by a homeowner fora lice or permit may wideaoe turn
lagai crams of an employer uadarthe Wod ec'i Coaopeonalion Act.
I understand t a copy of this t t1My be fonvordad to lb* Depsmood of l Ow Ofeworlout000ktho
C OWXVO vrti wilco sod that allot% to warm comp under section 25A. of MOL 151 as Indio tistimpoeidatofatimied poodle
g of a Sae of up to S I,S00.00 and/or imprisonment of tip to one year sod eivil penalties is the than of a Stop On* re
Work Ord a '
sno of S 100.00 a day against rue. '
\ d cpat permit Number `1 -�3 oq Lot
. . ,, ,,'v j Signature of Liosee/Permittte Late
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: O Not Applicable ❑
•
Name of License Holder : M pY h Te 1 ` i s V • A • .3
License Number
*11 •: - • .,II•. V • • - _ 5 -03 -
Address Expiration Date
( 13) 52/ -11? ?5
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ft t. ' Rb*finq 126235
Company -Name Registration Number
•
1-• _ 5 — 06 — 1 D
Addr -ss Expiration Date
S } I ri MA , ioa3 Telephonk 113)521.4 / r1 ?5
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 IS No ❑
11. - Home Owner' Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families
and 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 he/she shall be
responsible for all such work performed under the buildin¢ 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.for 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 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 attanhed •
•
•
•
•
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors E7
Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks [q Siding [D] Other [0]
Brief Description of Proposed � } }a�he�
Work: ( L
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. Number 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
j. 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
, as Owner of the subject
property -{�
hereby authorize V "` T t L s a c T �! ft Q • ej..1.. Roofn
to act on my behalf, in all matters r lative to work authorized by thislouilding permit application.
att�chP,d �, -13 -v9
Signature of Owner Date
I, . May k �e1; S� � aS aU Lf1QY��e4 a�e 1. , 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.
Math
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
Lot Size
Frontage
Setbacks Front
Side L: R: L:
Rear
Building I leight
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO cp DON'T KNOW 0 YES Q
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 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:
C. Do any signs exist on the property? YES 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 Q NO 0
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 0 NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
;96 3 3 r E �''1 4
City of Northampton Status of Perm
Building Department �
9 p Curb C ut!Dt
212 Main Street Sewer/ Septi#�Availir
Room 100 1Nate7Well Availabil�
Northampton, MA 01060 Two Sets ofStruutur l�l
phone 413 - 587 -1240 Fax 413- 587 -1272 Plot/Bite i fans 7
Other Specify,;
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
�. cm./ Map • Lot Unit
/Jo< L ki■AD. • C:io(DC Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current ss
Mailin Addre
3. 0.��ca L TC► _4) 1`f z 4l
Te ephone
Signature
2.2 Authorized Agent:
ne. - c�� ,a m in o
Name (Print) Current Mailing Address: k,-13
(Lit )S -7 - 1
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building n � C j 0O 00
(a) Building Permit Fee
00�� �q - 1
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) -II 9 ,4 00 < t 0 Check Number
This Section For Official Use Only
•
Building Permit Number: Date
Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
8 FIFTH AVE BP- 2010 -0054
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 119 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit # BP- 2010 -0054
Project # JS- 2009 - 001387
Est. Cost: $9400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING
Lot Size(sq. ft.): 6969.60 Owner: COFFEY DONALD J & EDNA K & ROBERT H & DONALD P & KEVIN F &
THOMAS F
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 8 FIFTH AVE
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527 -4775
EASTHAMPTONMAO1027 - 0309 ISSUED ON:7/16/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP AND RE SHINGLE
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 7/16/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo