25C-021 Roofing
6 Line St.
Southampton, Ma. 01073 Esti m Date
Phone (413) 527-4775 4/15/2010
Fax (413) 527 -8469
Name / Address Job Location
Edith Matusek
132 Russell St. 194 North St.
Hadley, Ma. 01035 Northampton, Ma. 01060
(413) 584-1745
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 10,500.00
Furnish & install aluminum drip edge, pipe fleshings, chimney fleshings and step
fleshings.
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.
Add $2.50 per sq. ft. for wood decking replacement if needed.
Add: $1,100.00 for Certainteed Landmark Woodscape 50 year premium shingle.
A Certainteed Surestart Plus extended warranty (additional 5 years) will be included
with fee ($440.00) absorbed by RCI Roofing if signed within 7 days.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $1 0,500.00
TERMS OF PAYMENT
5% Deposit _
Balance upon completion Customer Signature , GC. �
Registration # 126235 9 /f�.1 7
Construction License # 074334 Date /6 — U
Insured by Reynolds, Barnes & Hebb, Inc. 413 -447 -7376
firk I
Board of Building Regulations and Standards
Constructip?!L �'n a mmwiui Supervisor Li �cense
lz!a�" a
��� �ro Licenses CS 74334
E4p1rati�n 5/(2010 Tr# 23520 3
- � �
.., OfigiV cf 00'
• MARK T DELISLE
33 FIRST AVE
Cj f —� --
EASTHAMPTON, MA 01027 Commissioner ,
f � ✓he 6 m/m.a ravea/J o1,/i6z4aadsivae�a
--\ Board of Building Regulations and Standards
it • 0 HOME IMPROVEMENT CONTRACTOR
t !I Registration: 126235
" ti .6 ' Expiration: 5/6/2010 Tr# 266063
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST. C._.a-24"....►.,_
EASTHAMPTON, MA 01027 Administrator
• The Commonwealth of Massachusetts
r- af�' Dep of Industrial Accidents
t r--� Office of Investigations
=~ M 600 Washington Street
' r -' ' Boston, MA 02111
t-,--- � `' � K'K'K'. /11aSS.'Oi/(Il(!
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant information Please Print Legibly
Nittlme (liiisincssi( )rganinuionilndividual): R e., - T____ C \ oQ, 1� ��•.?
;ydtll.ess: o
Li t tity,11.ip: .• -..,, _o 14- ` Phone #: 4 - `l 15
Are ■r,u an employer? Check the appropriate box: Type of project ( required);
i .1 ant ;, employ e.r with 20 4. I am a general contractor and l
employees t full and /or part- time)."
have hired the sub- contractors 6. [] New construction
Lb] 1 :tni a sole proprietor or partner- listed on the attached sheet. 7. [1 Remodeling
ship and have no employees These sub- contractors have g, [ 1 Demolition
working for me in any capacity employees and have workers' 9.
insurance.:
r Building addition
No t%,,rker s' comp. insurance comp.
5. We are a corporation and its 5. I OE Electrical repairs or additions
acquired. ❑ rn
I 1 I ant a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions
rrtt sel:. j No workers' comp. right of per MGL 12.[�oof repairs
insur :::ice required.] r c. 152, §1(4), and we have no
employees. (No workers' 13. O ther
comp. insurance required.]
' .1rn applie:uit unit checks box u I must also till out the section below showing their workers' compensation policy information.
i,,nrctt\,ncia ,, Ito submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
•t Contractors than check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. IC the sub - co have employees, they must provide their workers' comp. policy number.
/ am an empiorer that is providing workers' compensation insurance for my employees. Below is the policy and job site
in jnrmation.
insurance Lo:npany Name: as'.,,e.. 4 c..., Qs Sty ( N.A. .-- r\'` . . — —
Policy i; or Syll -ins. I.ic. ;#: g. ___ , 5' 0`1..35 (, Expiration Date: / 0 - 5 - 2,0 l 0
Job Site Add; ess:1 - t 4 jO Ck--\r‘ S\ City /State /Zip; Apr A t • 0iO4.00
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
F:,ilure to ,ecure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
line. up to S I, (.)0 .0() and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to $2$O lO a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DI■ for insurance coverage verification.
1 do hereby L -r(ife under the tins and penalties of perjury that the information provided above Ls true and correct.
Signature: .. _- .` Date;
('hone #: (-L3 ,- ` LLI 5
1
Official u.t'e wz/r. Do not write in this area, to he completed by city or town official.
City or Town:
n: Permit/License #
ung
Xss Authority (circle one):
L 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 ❑
N.r„)e 01 Lic )sv Holder / — `�.lL+ _�_____�__�__�._ p [ pl [ l 33 q-
License Number
.L e _ v c.. o• • • . 5 — 0 3- is
A ddress Expiration Date
C_ '175
Si gnature Telephone
Register d Home Improvement Contractor: Not Applicable ❑
. .� 1262
ompany Name Registration Number
� S'
,� 5-06 - 10
'�cc„. Expiration Date
1 ` { am • - . • • 3 Telephony J 3 , 527.4775
•
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
n the denial of the issuance of the building permit.
Signed Afficavit Attached Yes. No ❑
1 1. - Home Owner Exemption
Hie current exemption For "homeowners" was extended to include Owner - occupied Uwellin>rs 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 sett
supervisor. CMR 780, Sixth Edition Section 198.3.5.1.
D efin ition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
or is intended to he, a one or two Family dwelling, attached or detached structures accessory to such use and / or farm
.t. uetures. A person who constructs more than one home in a two -vear period shall not be considered a homeowner.
-,lch "homeowner shall submit to the Building Official, on a form acceptable to the I3ui(ding O(Tcial, that he/she shall be
r•sltonsible for all such work performed under the building permit.
acting Construction Supervisor your presence on the job site will he required from time to time, during and upon
.:,,mpietion oldie work•ior which this permit is issued.
Also he advised that with reference to Chapter (52 (Workers' Compensation) and Chapter 153 (Liability of Employers to
mplovees for injuries not resulting in Death) of the Massachusetts General haws Annotated, you may be llabk for person(s)
hire to perform work for you under this permit.
flu:. undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
v'.irthampt0n Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
lomcuwn cr Signature a l.,tac "o�,hed
SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition [ [ Replacement Windows Alteration(s) F 1 Roofing PK
Or Doors ❑ •
Accessory Bldg. 1 Demolition U . New Signs (0] Decks (q Siding 101 Other [0]• -
Line` Descrtd on of Proposed �
�}.�
w ork L ezi
,Iteration of existing bedroom Yes _ No Adding new bedroom Yes No
:+ttached Narrative Renovating unfinished basement Yes No
Mans Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following.
• a Use of J� One Family Two Family Other
Numbe, ci rooms in each family unit_ Number of Bathrooms
•
Is there a garage attached?
d Proposed Square footage of new construction. Dimensions
Numbe cf stories?
Methoc of neaung? Fireplaces or Woodstoves Number of each
Energy Conservation Compliance. Masscheck Energy Compliance form attached?
Type of construction
Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
, Depth cif basement or cellar floor below finished grade
wili buiding 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
'�� �� , as Owner of the subject
property p (�
j hereby authori, :e Aar �L�l �1, ` Q i (' l { R
OOfl n —
:o act on my behalf. in all matters r lative to work authorized by this uilding permit application.
tt_,]te-hP,d a - - z — i c>
Signature of wrier Date
- a 0 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.
Print Name
I Signature of Owner /Agent Date
Section 4. ZONING All information Must Be Completed. Permit Can Be Denied Due To Incomplete intormtalon
Existing Proix>scd Required by Zoning
This column to he filled in by
Building Department
L Size i 1 1 i i 1
F: t,ntage , I l
St:thacks Front i
Side L:' R:' , l.: R: =. l
Rear I__ -_._. i
I3.1ilding Height
i - i 1_ i
LB;dg. Square Footage
O:,cn Space Footage
(1.a1 area minus bldg .0 paved i . 1
,f Parkins; Spaces 1 . ' ■
Fi,i: f
cwl ime S: l4rcatron) I.
Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:+ i .
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 . DONT KNOW 0 YES 0
IF YES: enter Book ; Page I and /or Document q
I
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 0 Obtained Date Issued:
C Do any signs exist on the property? YES 0 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 (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.
City of Northampton Sty
Building Department Curti G ` � 1 s r �
P,P +z 2 o 212 Main Street
11!a, t1
Room 100
• Northampton, MA 01060 T *� :'
phone 413- 587-1240 Fax 413 -587 -1272 Pig
Other S.
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1 .1 Pr Address
This section to be completed by office
194 operty !►•9 t o r k-\,` ` Map • Lot Unit
Ll
100'i V\cLiAQ fl Zone Overlay District
Elm St. District C8 District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Name (Print) Current Mailing Address:
__atta_checi Telephone
Signature
2.2 Authorized Agent:
Mark - i?oofi
Name (Print) J Current Mailing • •rest: o‘ 0%13
-� �--,.— (f13) 521- 4115
Signature Telephone
-
SECTION 3 • ESTIMATED CONSTRUCTiQN COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
I . Building Q ,4 to ' oc� , co (a) Building Permit Fee
2 Electrical JJ �� (b) Estimated Total Cost of
Constriction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 - 2 +3 +4 +5) $ 10, ti j00 . 00 Check Number _ �—
This Section For Official Use Only
Date
Building Peanut Number. issued:
Signature.
Building Commissioner /Inspector of Buildings Date
•
4`T" BP-2010-0968
GIS #: COMMONWEALTH OF MASSACHUSETTS
021 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 -0968
Project # JS- 2010- 001430
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.): 6229.08 Owner: MATUSEK JACOB G & EDITH M TRUSTEES
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 194 NORTH ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:4/29/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: STRI P & 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 4/29/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo