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24D-243
• Roofing 51B Holyoke Street P.O. Box 309 Estimate Date Easthampton, MA 01027 Phone (413) 527 -4775 6/16/2009 Fax (413) 527 -8469 Name I Address Job Location SUNSET PROPERTY MANAGEMENT ATTN: David LaMotte 67 Crescent St. P.O. Box 2415 Northampton, Ma. 01060 Amherst, MA 01004 Terms Rep Due on receipt Rich Job Description Total Remove existing roofs. 5,900.00 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. SPECIAL ITEMS NEEDED Add $2.50 per sq. ft. for wood decking replacement if needed. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $5,900.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration # 126235 Construction License # 074334 Date Insured by Reynolds, Barnes & Hebb. Inc. 413- 447 -7376 TT• - • - e eammaluvealig of.AtairSaduitida Board of Building Regulations and Standards Construction Supervisor License LioenteN CS 74334 5/30, 10 Tr# 23520 ' frkcifcsif; ) • MARK T DELISLE " `- 33 FIRST AVE EASTHAMPTON, MA 01027 Commissioner A.e eponmanweeza ort../Kerciaacisaietla Board of Building Regulations and Standards if/ HOME IMPROVEMENT CONTRACTOR T Registration:. 126235 Expiration: 5/6/2010 Tr# 266063 Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. EASTHAMPTON, MA 01027 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1: _ 600 Washington Street ' • • • Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information Please Print Legibly n Name ( Business /Organization/Individual): oft Address: L ■ A � . City /State /Zip: • n LL. , 0 go Phone #:( q f 3 ) .5 1- 4115 Are you an employer? Check the appropriate box: Type of project (required): 1. jI am a employer with 2.0 4. ❑ I am a general contractor and I employees (full and /or part-time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ 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' comp. insurance. 9. El Building addition [No workers' comp. insurance p• required.] ' 5. r] We are a corporation and its 10.0 Electrical repairs or additions 3. n 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.RlRoof 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 #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S • Policy # or Self -ins. Lic. #: AMC_ CLl 5'$ d'1 35 (, Expiration Date: / 0 - 0 0 Job Site Address: ( 1 City /State /Zip: N tctk Aka-. 6lt>l ,b 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 fine 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: t t Phone #: c4,L3 ` j ?-,1 - 11 ,1,`15 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ M 1 O '77,4334 Name of License Holder : M aY k - be1 L S l License Number 5 -03 Address - Expiration Date 52? - Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ �. . . /R bfin9 126235 Company Name • Registration Number Haoreaa � Expiration Date , S tilt/ am pion Ma . 01 3 Telephone& 3)527.4f ?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 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 actt 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 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.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 atta06ed 44. • ,,„ - . y C •F. -,,. s t to; 10(41E14, SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House E Addition El Replacement Windows Alteration(s) ❑ Roofing Ilf Or Doors l] . Accessory Bldg. El Demolition ❑ . New Signs [0] . Decks , [D , Siding [p] Other [pj' Brief Description of Proposed Work: C L t ./ 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 b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? • • • s.. ' " •' 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 . 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 O { I, ` Lo,. �� i rpe ti.Ctc. -� , as Owner of the subject property �/( Q hereby authorize t Mar aY Deli �i, e QC �! fj • 1 j .1. Roof; Rcci to act on my behalf, in all matters r ative to work authorized by this uilding permit application. . . i'• ,0 Sigtstitse'of Owner Date I. J4a Y P11 SI e �_ aS au tVI>nY r 7P� a©r nt , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing Olication are true and accurate, to the best of my knowledge and belief. • Signed under the pains and penalties of perjury. MAYii . Print 'Name /1v(YQ`i 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 [ . .._ I ( __, ( :,_ _ _ _. g _ Frontage �) - _.. . 1 Setbacks Front ; Side L:( R : I 1 L:1 _ __f R:I __.v [j ,, j Rear I _ _ ..__' • C l Building Height ' B;dg. Square Footage Open Space Footage (Lot area minus bldg & paved t i I ._ 1 I I 1 ( 1:11 parking) # of Parking Spaces 1 - 1 L - --I 1----1 Fill: , (volume & Location) 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 O IF YES: enter Book I . Page{ l and /or Document #1- - 1 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 O Obtained © , Date issued: f l 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 1 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 O . IF YES, then a Northampton Storm Water Management Permit from the DPW is required. :V r . • , , a t� r l •r nehtuse f1�1; �� ' City of Northampton Stetu °of Pe _ ' , 4' ° i . Building Department Curb C uvori ve,' y ► t it' k . f ' ` x �6 S �' 212 Main Street SevvecSepti�ta�� : s Room 100 ' : 6 r `° 1 - ' # r `� J; ` Nert�aifipton, MA 01060 'fw¢' ets`bt��t u ` s* ' °` ` -,, t v t ., phdne`4l3- 587 -1240 Fax 413- 587 -1272 phut .01E. t � � r , ''-``t Ot S pecify - iu APPLI TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO rA: DWEL_i, SECTION 1 - SITE INFORMATION 1.1 Property Address: `` This section to be co.i plett. ,J• ( ' n- `Y S� . Map �� D. Lot ` A) rna MR\--D.n 1 f • 3O11 Zone Overlay ... *ri Elm St. District Cb gib.,. SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 1 2.1 Owner of Record; Ste— Qct C Ma no 4 C v>tix a1,� p O ' �1. _41, - a.rtA\ _a... 606Z Name (Print) Curre t Mailing A �dr s: - 6 '— attached �� 3 zzz Telephone Signature - 2.2 Authorized Agent: MaYk�e �e, - t�.C.z. Ro d i n : ; - .: _. S,QkA ,as., � ,_ Name (Print) 9 Current Mailing ddress: 0 O l3 - e . - - - - ( !3) 521- 41/5 I Signature Telephone } SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use ON; completed by permit applicant 1. Building Roofi 4 59 oo • O 13 (a) Building Pei nit 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) $ - 5 j CE 0 . t) 0 Check Number �7�I .... This Section For Official Use Only Date Building Permit Number. • Issued: z Signature: • • Building Commissioner /Inspector of Buildings Datt: } t ? OtAX, ST BP- 2010 -0512 GIS #: COMMONWEALTH OF MASSACHUSETTS Mapalock: 24D - 243 f 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 -0512 Project # JS- 2010 - 000716 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.): Owner: SUNSET PROPERTY MANAGEMENT Zoning: URC Applicant: RCI ROOFING AT: 67 CRESCENT ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:11/9/2009 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 11/9/2009 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo