31B-073 (3) . •
.
• • i Roofing
6 Line St.
Southampton, Ma. 01073 Estimate Date
Phone (413) 527 -4775
Fax (413) 527 -8469 5/13/2010
Name / Address Job Location
Zeke Rozell
151 North St. 38 Summer St.
Westfield, Ma. 01085 Northampton, Ma. 01060
(413) 210 -0300
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 11,300.00
Furnish & install 1/2" plywood over existing decking.
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install ice & water barrier along eaves and valleys.
Furnish and install synthetic underlayment.
Furnish and install 50 year shingle.
Furnish and install ridge vent.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers' specifications.
50 year material warranty included.
All related permits will be obtained by R.C.I. Roofing.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $11 ,300.00
TERMS OF PAYMENT
5% Deposit f "�
Balance upon completion z/ 7
Registration # 126235 Customer Signature - - -
Construction License # 074334 f
Insured by Banas & Fickert Ins. Date c/ !
413 -527 -2700
- Ni.t....ftliti..c■IN Dc/i,ii iinciii ,,I l'iikli■ ss,ilci \
\,,,_ 13n.tctl ill Itinliiiii:.!
License CS 74334
Restricted to. 00
. .
MARK T DELISLE
33 FIRST AVE
EASTHAMPTON, MA 01027 `I ,
Lyildlimi 5/3/2012
---
i "imei.,1".•1 Tr 26357
. 7;ie (y,,,, I , / '• l(,,,,,/t,,,,,,/,',J,
()nice of Consumer Affairs S. Business Regulation
HOME IMPROVEMENT CONTRACTOR
4,1.t
Registration: 126235
Expir ation: 5/6/2012 Tr# 293949
r, . r„ ■
Type: Partnership
R.0 I. ROOFING
MARK DELISLE
6 LINE ST
SOUTHAMPTON, MA 01073 Imtlerserretary
The C
. . o mmon wealth of Massachusetts
Department of Industrial Accidents
1 . t Office of Investigations
� �r . � • r 600 Washington Street
=� ' �1 Boston, 1/1/1 02111
, 't�" `-5`: w w w. mass.gov/dia
Workers' Compensation insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant information Please Print Legibly
N 03nstncss Orpniiation /individual):, __.% Q 0C L \-
Address: \,,,,_\ , , , 1 . __
_
Lit\,'Stinc/ il): _._, »•. ,..,__-- _•__V•a___.____�__ Phone #: e, - LA1`l5
:\.rc you an employer? Check the appropriate box: .l
Type of project (required):
1. 1 ,tin a employer with 2.0 4 . 1 am a general contractor and I
emphr;ees (mull and /or part - time)."
have hired the sub contractors 6 . n New construction
' L__] i am a sole proprietor or partner- listed on the attached sheet. 7. 1 Remodeling
ship anti have no employees gees These sub - contractors have 8.
1 F } [] Demolition
working for me in any ca p )acity employees and have workers'
insinsurance.: t9. 1 Building addition
1No cc,rrkcrs' comp. insurance comp.
� We are a corporation required. i 5 poration and its 10.0 Electrical repairs or additions
t
I . i am ;t homeowner doing all work officers have exercised her 1 I .❑ Plumbing repairs or additions
111 Sel i No yvorkers' comp. right of exemption per MCA. 12, S311 oof repairs
insurwtce required.] ` C. 152, §1(4), and we have no
employees. No workers' i 5.❑ Other — i ____ - _
—_— comp. insurance required.]
\n■ ;rpplicatu is :ha checks box u1 must also till out the section below showing their workers' compensation fwlicy information.
i hmx:owncr ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
- t_ ontraitors that .heck this ixox Hurst attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. it 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
rrr%ornrution.
insurance (:tr:npan■ Nante:_ace. Y-ctvt t"\ 1., _C,_c.a -\ .�- n
f'rrlrt. x r err tic it‘-ins. Lie. o: ALw ..._ LLA. '' Q '' . ,5--1, Expiration Date: / 0 - S - a 0 1 0
fob sit Addr $ skiL mrne-r
■\-- Cit /State/Zip.,kr- + t -tu g 41660
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to sec.tre coverage as required under Section 25A or MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1 ,X00.00 and /or one -year imprisonment, as well as civil penalties in the iorm of a STOP WORK ORDER and a fine
or 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.
/ do hereby c crtijv under the ins and penalties of perjury that the information provided above is true and correct.
ti
), ----- — -- _— Date: ~1
l'hon' i (_ 2 )' .. ) ,57_,.`1 - LA-1-1 s
I
Official use only. 1)o nor write in this area, to he completed by city or town official.
Cittor '1'cr' n: Permit/License q
iss uln'g Authority (circle one):
1'agoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
.
6,OLhcr
f..1i' .., o..r.,)n: Phone a:
SECTION 8 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: Not Applicable ❑
Name of Licen:;e Holder Yk ,
N fi e. '77L1 334
License Number
• ti " O a • s.h s -• u . • • 5-03-10
Address _ Expiration Date
(413)5�� -x'175
Signature , Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
• 126235
Company Name Registration Number
- - .. ) -s 5-06 -10
HGOreaa Expiration Date
&Lli ptorl Ma . 0 167 3 Telephoni41 3)527.41 5
SECTION 10 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
i :n 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
;end to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts.
;is 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
:s. .)r is intended to hc, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
\tr, c1ures. A person who constructs more than one home in a two -year period shall not be considered a howeovtpep.
5, :,:h - homeowner - shall submit to thc 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.
.\> acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of thc work,for which this permit is issued.
- \':.o he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
!:a ployecs for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you Rtav 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 attached __ __
l ,' • e q 'S
• " .l t,„ „: . 1 \ Oat
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ( Addition Replacement Windows Alteration(s) n Roofing [3
Or Doors El
Accessory Bldg. 1 1 Demolition 1 1 . New Signs [0] Decks [Q Siding [01 Other (Oi'
Brief Descrii — ;)n of Proposed 2 a h J
\Mork } L 1� e-
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 budding : One Family Two Family Other
o. Number c• rooms in each family unit: Number of Bathrooms
o. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Numbe' c' stories?
f. Method of neating? Fireplaces or Woodstoves Number of each
q. 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. floodptain Yes No
;. Depth of basement or cellar floor below finished grade
k. Will bui,ding 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
C( f e •e >u Aoi * , as Omer of the subject
property ft; (1 T Ro n
hereby authorize l J ' M lar �el l S1 t pc `1 +� .
,o act on my behalf, in all matters r ative to work authorized by this uilding permit application. g
attached • co
Signafif('e'of Owner Date
. •
I. Ala y k e1 i s1 e. -as a u t inY'i 7 Pi4 aQ aft , as Owner /Authorized
Agent hereby daclare that the statements and information on the foregoing alication are true and accurate, to the best of my knowledge
and belief.
l Signed under the pains and penalties of perjury.
Ma 11Sle-
Print Name
Signature of Owner /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Dented Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
(wilding Department
,
1. Size I
I ()Wage 1 I I
Setbacks Front I
Side 1.: R l.' R, i
Rear I _ I
fLilding height r
B dg. Square Footage % . :- • . '
0 )en Space Footage
(LA area 1n+nus bldg & paved
pa,kine)
i
4 .)r Parking Spaces
HI:
(vnlurnc & I hcalion)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES O
IF YES, date issued :I
IF YES: Was the permit recorded at the Registry of Deeds?
NO O . DONT KNOW 0 YES 0
IF YES: enter Book Page; ! and /or Document N 1 I
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: J
D. Are there any proposed changes to or additions of signs intended for the property ? YES O 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 O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
1
1 . 17771 117.7":. " 7 "* . 7 * *: 7 ***
' ' .,,t . , t •• .
CIty of Northampton Statuioth 1, .., • ' .. ,
, . ' .' ' lere '0.'" • •• ,s, • . .,, .
E3uilding Department Curt C w . - z 1 :. , '".. - . ..'' .
212 Maul Street S r -...__ .• 7 ' 14 . 1‘, ' '''''''''Pr *: ' " ' 4
T : •: • ? ' ,'?` , '' ' .
Ilig 2 7 MO Room 100
WIltt , ! c ., (: A -, . - • : . . a
' .,...‘'' ii: '/' 1 .! ,-,ii`t-i,, .. 'II` - , - ' ''" - — •
Nortnarnpton, MA 01060
1 .w.F.'q, 0 .',„7,7 - 4;o:# 1 .*41 , :A ; --`, .' . : ... .• . -
ph oneA13-*7-1240 Fax 413-587-1272 Plot/thii• • ' t- -' • t:
• ',"■ o :" no I" "re ' ell ' I i ' 'el! t . '‘ •; .ei %-1', •• • ,
_ -1
Other'SpeOl 4iik:M! , ` ^ ' zi. ,,'., . ::. ', • 1 • • • ;'
' '.,. - t43;. io.'• .,..."
APP, :CATION TO CONSTRUCT, ALTER, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
This section to be completed by office
1,1 Property Address
3 V Sex 3' . Map i Lot Unit
' /Q0 c•-\2\-‘,Q_ct‘i\-ibf\ Zone Overlay District
Elm Si. Dlatrici_____ CB INetskt
l SECTION 2 - - OWNERSHIP/AUTHORIZED AGENT
- - ----- -- ----
'
- ' 1 Owner of "•ii:ecord:
.-.../"'
( 14 S v...Ni yvtic Cil . - iNkcA Ike .L ) 1\ALx Mg
Name (Print) urrent Mailing Address:
■fte....c.i 1 41 : Z 1 0 T 03_0_0._
, 2 tta c lephone
Signature _
2.2 Authorized AtIent:
. .
-
.Ma-k_..1 - ,,TA• ll •
„Lcos
IN II .
Name (Print) , • .. a • III II •
\ ...""
, Current Maigng • ■dress: 0 ■ 613
(413) 521- 4/15
.--
Signature Telephone
•
SECT1ON 3 - E$T1MATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
, completed by permit applicant
___
1 Building ) 0 , F. (a) BuPermit Fee
U I 4 I 3oo.ao 1
---- --.
Electrical (b) Estimated Total Coat of
Construction from (6)
3. Plumbing Building Permit Fee
4. mecharlica ,:HVAC)
5. Fire Protect (d n
6. Total %, (1 - 2 4 3 + 4 + 5) Check Number 7 /35
This Section For Official Use Only
Date
Building Perm!: Number. -- issued'
•
Signature:
Building Commissioner/Inspector of BuAdings Dots
. .
4`,1,'
38 SUMMER ST BP- 2010 -1086
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31B - 073 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 -1086
Protect # JS -2010- 001593
Est. Cost:
Fee: $35.( PERMISSION IS HEREBY GRANTED TO:
Const. Class Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft): 13895.64 Owner: LAVELLE TERRENCE M & ALINE R TRUSTEES
Zonin¢_.URC(10Q)/ Applicant: RCI ROOFING
AT: 38 SUMMER ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON :5/28/2010 0 :00 :00
TO PERFORM THE FOLLOWING WORK:STRIP,PLY & 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: Ok 8=-117- to cw,&_
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL T S. x ,/
. ...---
uaz. A t
Certificate of Occupancy - _ ilinature:
FeeType: Date Pail. 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