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25A-150
RCI. Roofin ...._.__..„:.......... LIT 6 Line St. I Southampton, 7 - 01073 I � St I mate Fax (413) ro Date Phone (413) 527 4775 1 10/26/2010 1.3) 527 -8469 Name / Address Job Location Dave Munska 32 Strong St. 44 -46 Woodbine Ave. Southampton, Ma. 01073 Northampton, Ma. 01060 (413) 527-9014 I Terms Rep Estimate valid for 30 days Dave Job Description Total Remove existing roofs (not including porch). 9,500.00 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. All exterior roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers' specifications. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. Add $2.50 per so. ft. for wood decking replacement if needed. Add: $1,150.00 for Certainteed Landmark Woodscape 50 year premium shingle. A Certainteed Surestart Plus extended warranty will be included with a fee of ($460.00) absorbed by RCI Roofing if signed within 7 days. This extended warranty means that 20 of the 30 year warranty is covered for labor and material. The last 10 years of the 30 year Certainteed warranty would be covered for material only. South Side Only: $6,000.00 *Note* Manufacturers warranty and Surestart Plus warranty applies to entire house only. An RCI Roofing 5 year workmanship warranty for south side. L _ I WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $9,500.00 TERMS OF PAYMENT q 5 %, Deposit Balance upon completion Registration # "126235 Customer Signature C.„,_,l.� , Construction License # 074334 Insured by Batas & Fickert Ins. Date /1Z // p 413- 527 -27(l0 I I)', p.ii iiti it( ,,I l'iihit■ •,il( L ??‘,... Iii),ii tl .11 BiiiIiliii.2 1 .iiiil ,, I.111■1,ii II Lft.etist ,.:.s 74334 Restra.ted to. 00 MARK T DELISLE 33 FIRST AVE EASTHAMPTON, MA 01027 c- :! , --....... _,, __. Li k or ,I■t,r1 5 - - - ---" 26357 . (',...., /11 1 , ,•I e f . ''■ //if; I/ , ( fc I, . :, .1, .‘, ()Hive of l. onminici .kitairs ..C. litisowss Itegolittion HOME IMPROVEMENT CONTRACTOR 6 l' Registration: 126235 Expiration: 5/6/2012 Tr# 293949 Type: Partnership R CI. ROOFING MARK DELISLE 6 DNE ST SOUTHAMPTON, MA 01073 1 ildvcsecretar■ The Commonwealth of Massachusetts = *=.„, Department of Industrial Accidents r - Office of Investigations �=- 600 Washington Street =`� • Boston, MA 02111 r, 7 1�V www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 0e - a \—\,S Address:_ �,. ■ City /State. /I.ip: � { oto`t� Phone #:( J J - ��`Z5 - Are you an employer? Check the appropriate box: Type of project (required): am a employer with 20 4. ❑ I am a general contractor and I employees (full and/or part- time). * have hired the sub contractors 6. ❑ New construction 2. n I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling r ship and have no employees These sub - contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: 9. Building addition required.] 5. corporation are a co ration and its 10.0 Electrical repairs or additions ❑ officers have exercised their I I. Plumbing repairs ! am a homeowner doing all work g airs or additions p myselr . [No workers' comp. right of exemption per MGL I2.(�Roofrepairs insurance required.]' c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other comp, insurance required.] Any applicant that checks box # I must also fill out the section below showing their workers' compensation policy information. Homeowners oho 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: a.C.e. k n S , Policy # or Self -ins. Lie. # :} t Cpl _5$ 0`1 35 ( , Expiration Date: 1 0 - 5 �O 1 0 Job Site Address: -N -t. Ue . )0c1.0∎A. .J cube. City /State/Zip:a(,Pe {Lyvv c1 'Ma. 010,13 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 line 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 $20.00 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; / 2 • ° ( 0 Phone LS�1 — L:rt S Official use only. Do not write in this area, to be completed by city or town officiaL 4;< or Town: Permit/License # TSSUiiig Authority (circle one): 1 Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6 dtier of tact Person: Phone #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 • Name of License Holder : MaYX� p e ,ISl e . r7 1 433'' License Number 11 - 0 a.a . . 11 5 -03 -12 Address Expiration Date ( 3) 52/- 41 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 R. L . •Ro i r of � 126235 Company Name Registration Number _ r 5 - ti 12 ` Aaore -� c Expirat Date > � YnpThn MA. 0103 Telephon�y1 3)54.4? ?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 ❑ • i 1. — 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 act' 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. 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 attanhed • h .. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all aoolicable) l New House ❑ Addition [] Replacement Windows Alteration(s) ❑ Roofing I Or Doors [l . . Accessory Bldg. ❑ Demolition ❑ . New Signs [Cl] Decks,[[] . , . Siding (Di Other (Or Brief Description of Proposed ^y,� P` � Work: d t n 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? ' ' 1 d. Proposed Square footage of new construction. Dimensions I e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each I 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 I `l I �\] e. �(1� ��c..`\ OL , as Owner of the subject • property ^� �! Q r hereby authorize J . U' \ ! Si Of IZ • c,,T. . ROO 1 1 n to act on my behalf, in all matters r ative to work authorized by this uing permit application. 9 . att06ed • 1 z - 3 — i o Sig'nd'"ftl e`of Owner Date I, ,May l 1J A l Sl F_ 'AS 'all t inY l7,P I ao 1. , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing aOlication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 14"aYli I ,gl Print Nam Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed This Requi red co lumn by to be Zoning filled in by Building Department Lot Size Frontage Setbacks Front i � Side L:' R:' L :i _. R:: 1 Rear I_._ _. Building Height j i _._i B'dg. Square Footage % - O3en Space Footage % (Lot area minus bldg & paved , ! pa-k ing) # ;uf Parking Spaces Fill: I i I (volume & l.pcation) 1 . 1 I 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: 1 . IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES O IF YES: enter Book ' Page' f and /or Document it 1 B. Does the site contain a brook, body of water or wetlands? NO © DON'T 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 O , Date Issued: 1 ^ ^� C. Do any signs exist on the property? YES O NO 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: I__�______ ._. 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. City of Northampton Sta is ', : i \ Building Department Cur /, x: ;, -, c.o 212`, Main Street } A � ° ' , i Room 100 W r 4 Northampton, MA 01060 r p k phone 413 - 587 -1240 Fax 413 - 587 -1272 iilot% 1tb '*:'•,.3.'. .r,, { _ ri T• Other'S • � 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 y y-y(P W pc, 4. b% e.. Q:JN_- Map ' Lot Unit ,IV © rF 'mq } C1 Zone Overlay District • Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: c e)..l e- 1 RZ ■S `S\-• -acs ...0..wn0-t.r, , r∎,t,... 01,4573 Name (Print) C rrent Ma TrI Telephone Signature 2.2 Authorized Agent: Malik n1, • — q.e.i. R oQfi , - - -. • _ Name (Print) J Current Mailing • ddress: 01 613. 'e■--___ ( 527 • A17 ?5 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building f ,00fi 4 q 6 ( ® o o (a) Building Permit Fee 2. Electrical J (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) $ g,SOO as Check Number /7 g r 5 This Section For Official Use Only Date Bgitding Permit Number. Issued: Signature: Building Commissioner/Inspector of Buildings Dale , B P- 2011 -0529 yyZZ k . GIs #: COMMONWEALTH OF MASSACHUSETTS 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-2011-0529 Project # JS- 2011- 000869 Est. Cost: $9500.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 4617.36 Owner: MUNSKA STELLA G & THOMAS J JR DAVID J & JAMES K Zoning: URB(100)/ Applicant: RCI ROOFING AT: 46 WOODBINE AVE Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 - 4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:12/8/2010 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 12/8/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner