29-118 (2) RC i. Roofino
LU'
6 Line St.
Southampton, Ma. 01073 EStifliate Date
Phone (413) 527 -4775
Fax (413) 527 -8469 8/13/2009
Name / Address Job Location
Megan Davis
82 Forrest Glenn Dr. 82 Forrest Glenn Dr.
Florence, Ma. 01062 Florence, Ma. 01062
(413) 727 -8008
Terms Rep
Estimate valid for 30 days Bob
Job Description Total
Remove existing roofs.
6,000.00
Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice & water barriefa • from eaves.
Furnish and install synthetic underlayment over existing dec"7
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: $800.00 for Certainteed Woodscape 50 year premium shingle.
Add: $320.00 for Certainteed Surestart Plus extended warranty (included if signed
estimate is returned within 7 days).
Add $2.50 per sq. ft. for wood decking replacement if needed.
Lao & Ma ri I�urni and in tall 5" K -style gutters. 500.00
i
(744-04
WE LOOK FORWARD TO DOING BUSINESS WITH YOU. TOtaI G ,S OO .0 0
o X24 4
TERMS OF PAYMENT / 5% Deposit
Balance upon completion Customer Signature ,
Registration # 126235
Construction License # 074334 Date (3 o . ( Q
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376
1
•
J.e -anononweaith of,A
Board of Building Regulations and Standards
Construction Supervisor License
License CS 74334
EXP�i 5/3 /2010 Tr# 23520
Re ll 0
MARK T DELISLE
33 FIRST AVE
EASTHAMPTON, MA 01027 Commissioner
Board of Building Regulations and Standards
_ !1�►. HOME IMPROVEMENT CONTRACTOR
Registration: 126235
Expiration: 5/6 /2010 Tr# 266063 i •
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
r 600 Washington Street
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors/Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization /Individual): IR Q., (2,0 ,
Address: L ■ .
City /State /Zip: _ . n 11_ CJ Phone #0/3) 341 - &Ai - 1 5
Are you an employer? Check the appropriate box: Type of project (required):
1.1 , I 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. n 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'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.+
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.M Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13. ❑ Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
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: T n 5 .
Policy # or Self -ins. Lic. #:/4} C,L{ 58 0`1 35 tp Expiration Date: / 0 - � ap 1 0
Job Site Address: g Z. • City/State/Zip:-0, oce Ce (Y GL. CA673
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: j • o9
Phone #: (4 (3)
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 ❑ •
Name of License Holder : May Del ; s p (77
License Number
CO .. a. U • . I 5 - 03 • io
Address - Expiration Date
( 521-
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
ft c. I. 1�. oofi 126235
Company Name • Registration Number
- - - '. - 5-0b- 10
Aaareab Expiration Date
ISO lYnptOr1 M. 0161 Telephone& ?75
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 sett
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 a .t.aalleCI •
•
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Ei Addition [] Replacement Windows Alteration(s) ❑ Roofing
Or Doors ED . .
Accessory Bldg. ❑ Demolition ❑ . New Signs [0] Decks •[ , • Siding [oli Other[t7]'
Brief Description of Proposed
Work: a Ltanheli
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?
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
I, M. CS-C■ - Dc lti , as Owner of the subject
property hereby authorize t MO% — Dei C1 QT r it el. t. R&
to act on my behalf, in all matters r ative to work authorized by this uilding permit application. 9
a ,tac.hed ( 0 -1 7 - o5
SigliitEtWof Owner Date
I, 4. s t- - - a e ' a - I .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.
1443;
Print Name pp
•
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 -
Frontage 1 1 1 • •• •• I 1" ---- ------
Sctbacks Front , ,
,
r
_ .
Side L:i 1 R:1 1 Li .-., __1 R:1_ ..1 r _ 1
i ------ 1
Rear i 1 , _ _ ,
I 1 =
,
Building Height 1 J I____ .1 I 1
Bldg. Square Footage 1 : E % I 1 1 I 1
... __
Open Space Footage %
(Lot area minus bldg & paved , : i I I : I: I . _
parking)
# of Parking Spaces
1 1 I 1
Fill:
IF
(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:L 1 • - .
„ ...
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 ... DONT KNOW 0 YES 0
IF YES: enter Book 1 Page and/or Document /4 1
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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 0 , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: { •1
. .
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 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 pad 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.
1 - ,,,, i-- 44, ""Q: •
...r. .4; A. t..l.
L a artmeft / '
� ' ', . - -' City of Northampton Statt of Ise n ` ' i' A t ��
- Bu�ij itig Department Curb Cut/D r rr c ,
2 c 1�� 212 Main Street S8w8r5eptid` �� t 0 r 0
y
C;C\ Ro 100 U1iafeiN eII AVa • ` y E 3 ` 1 �'� ,( `
d` am , MA 01060 'ttivets of Man
Nhohe 4 -1240 Fax 413- 587 -1272 'Plotlthte Puri '° r
Other'Specify .S -
-APP TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR IN A° FAN`, v ' FLLP "' j
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be C . plete y ,k.
p C r Gl UrtA Or . Map • Lot - -- - -- -
lor.. Zone Overlay L ti
Elm St. District CL Disc.
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: Q
'NB C-� Q:) k S c (C SAc p
�� CL A C." ` i
( Mailing Name t.aelted Temp 13� --tz-t OO G
Signature -
2.2 Authorized Agent:
MaYk Vie. ' le, - f.C.z. f{oofin .� L; &-. S A u Q: ' h _
Name (Pri J Current Mailin ddress: ' of 0 -3
t —•.._ - ( 521- 41 ?5_ i
Signature Telephone 1
i
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use On;,
completed by permit applicant
1. Building 1300F) 4 i 5. O0.00 (a) Building Permit Fee 1
2. Electrical (b) Estimated otal Cost of
Constructicri from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection ` -' —
6. Total = (1 + 2 + 3 + 4 + 5) $ 67 , 50 0 . 00 Check Number 7( 7 ,53-->
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings
t° Vii~ DR BP- 2010 -0474
Gls #: COMMONWEALTH OF MASSACHUSETTS
A ,Bl l9 -11$" s 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 -0474
Project # JS- 2010 - 000655
Est. Cost: $6500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 1 1935.44 Owner: DAVIS MEGAN
Zoning: URA(100) / /WSP H Applicant: RCI ROOFING
AT: 82 FOREST GLEN DR
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:10/29/2009 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 10/29/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo