30B-020 R .C. I. Roofing
6 Line St.
Phone (4113) 52 7- 47 77073 5 Estimate Date
Phone (43) 7 -7
Fax (413) 527 -8469 3/19/2010
Name I Address Job Location
IN -HOME HANDYMAN SERVICE David Stevens
903 Hampden Street 17 Norwood Ave.
Holyoke, MA 01040 Florence, MA 01062
413 - 297 -6629
Terms Rep
Due on receipt Bob
Job Description Total
Remove existing roofs on main house only. 5,000.00
Furnish & install 1/2" plywood over existing decking.
Furnish & install aluminum drip edge, pipe fleshings, chimney fleshings and step
fleshings.
Furnish & install new lead counter fleshings.
Furnish & install CertainTeed Winterguard ice & water barrier along eaves and
valleys.
Furnish and install synthetic underlayment.
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.
Without Plywood: $3,800.00
Labor & Materials: Bay Window and Bump Out 850.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $5,850.00
PERMS OF PAYMENT
5% Deposit
Balance upon completion Customer Signature J" 4
Registration N 126235
Construction License # 074334 Date 3/Z /�10
Insured by Reynolds, Barnes & Hebb, Inc. 413 -447 -7376
•
6 (1../16waciatutol4
ale ! Board of Building Regulations and Standards
.„ Construction Supervisor License
411 *
License CS 74334
f
Tr# 23520
;
MARK T DELISLE
33 FIRST AVE , •
EASTHAMPTON, MA 01027 Commissioner
_
e am4rumeveala ...A244aciscsosa3
Board of Building Regulations and Standards
9. lat 5 HOME IMPROVEMENT CONTRACTOR
,1
Tr 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
t
� :j � . Office of Investigations
V . 600 Washington Street
f TA •.=, ' Boston, MA 02111
www,mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print LeEibly
t
Name ( Business /Organization/Individual): X61 ; a i \,_ ?
Address: 4 L v E.. .
Cit State /Zip: Phone #: - L'ii
Arc you an employer ". Cheek the appropriate box: Type of project (required):
I . r ant ;t employer with 20 `l. ❑ I am a general contractor and 1
employees (full and /or part-time).*
have hired the sub contractors 6 . [j] New construction
t I am a sole proprietor or partner listed on the attached sheet. 7. Li Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' ❑Building addition
9. [No workers' comp. insurance comp. insurance.:
5. We are a oration and its 10.0 Electrical repairs or additions
cor
required.] _._, P
I f I I am a homeowner doing all work officers have exercised their I L O Plumbing repairs or additions
myself: No workers' con right of exemption per MGL �-,�
insurance required.]
r comp.
c. 152, §1(4), and we have no 12'r1 Roof'repairs
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,
Iiutncowneis v to 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.
i nsurance Company Name: et,,, .,.e. R'nDQC.. " i Q..es 3 .4,.0.\ n S
Policy t; or Surf' -ins. Lie. #:MWQ C L{ 5 p`\ 35 t Expiration Date: J0-5
Job Site Address: f S(1,:t 044'e, City /State /Zip: -;,,rr.rt.cc , . C`,,.hic"e.,
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 $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 carder the • ins and penalties of perjury that the information provided above is true and correct.
S i rapture: __ ___ Date:
Phone° #: ly l 3 ,� an - u -`l S
Official use only. Do not write in this area, to be completed by city or town offlciaL
#0 t + r Town: Permit/License #
t, g Authority (circle one):
Y rd of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
er _
G Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : MaYk___Tielis 1 l.,-__ 1 7 7 4 4 3 3 4
License Number 1111
‘'"").1-- ti, "
e 5 , 3o . • as • U . a •• 5 - -10
Address Expiration Date
� � �75
Signature Telephone �3) 527-
....
9. Registered Home Improvement Contractor: Not Applicable Cl
f • C /RoO91 J • 126235
Company Name Registration Number
--1 _l `l- .,..a 5 - DL -10
p+oarc„ Expiration Date
�
r
-earn pro n_, Ma . 01 CO 3 Telephone t1 ) 3) 5,?7 ! 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 Qr No 0
11. - Home Owner Exemption
He current exemption Ior "homeowners" was extended to include Owner- gccupied Dwellines of one (I) or two(2) families
;rrd 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 198,3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
s. or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and / or farm
..1; „ctures. A person who constructs more than one home in a two - year Period shalt 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 buildine 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•tbr which this permit is issued.
Also he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
linplovecs for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you mavye liable for person(s)
you hire to perform work for you under this permit.
l'he 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 .ta01v:A _— __.______
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ( Addition n Replacement Windows Alterations) n Rooting rilf
Or Doors CD •
Accessory Bldg. ] Demolition 1 . New Signs (O] Decks ICI Siding [DJ Other (D(
Brief Descriir, ai of Proposed att 2Gh�
Work L
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Pians Attached Roll - Sheet
6a. If New house and or addition to existing housing, complete the following:
a Use of b., ding One Family ` Two Family Other
n Number of rooms in each family unit: Number of Bathrooms
•
c. Is there a garage attached? f '
d Proposed Square footage of new construction. Dimensions
e. Numbe cf stories? _
Method of heating? Fireplaces or Woodstoves Number of each
g Energy Conservation Compliance. Masscheck Energy Compliance form attached?
r, Type of construction
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
e-sA,S , as Owner of the subject
property R n `� /�
hereby autnorize �aY 11e,1 �1 e Q� 1 ( � �* R��1�1 fl
to act on my behalf, in all matters rerlative to work authorized by this permit application.
_attache 31 - tt�
Si9►�t Owner 4 Dale �+
Y � �P.t i st e_ aS 2u t�or l7pi as �t , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing aliblication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
. 1 \ 4 - 1 1 5 1 L
Print Name
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
l. Sire II- '
I
F,ontagc i . ___
I
S.ibacks Front i I —I
Nide I 1
RCar i L__ - - - -I
Building Height 1 ,
i3;dg. Square Footage I % i I I I I I
();)en Spzi e Footage
(Let area minus WI; S pawl I I 1
tt t1 P Spaces _ I
Fill: Li I
. j & L4 aOun)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DONT KNOW O YES 0
IF YES, date issued:L
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW Q YES O
IF YES: enter Book Page I and /or Document #
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?
- - II
Needs to be obtained Obtained , Date Issued: 1
O O 1
C Do any signs exist on the property? YES O NO p
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
IF YES, describe size, type and location:
E Will the construction activity disturb (Gearing, grading, excavation, or filling) over I 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 horn the DPW is required.
City of Northampton iF r p a
Building Department �',; t ` •
212 Main Street
1 Room 100
o — 2 �� N rthampton, MA 01060
,pho e 413587 -1240 Fax 413- 587 -1272 '� '` ��, it
•
Otfler .'`�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
i
SECTION 1 - SITE INFORMATION
1.1 Property = address
This section to be completed by office
J� Map • Lot Unit
/ Zone Overlay District
Elm St. District CB District
I •
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
Qt�,,,� a .esje.�n5 t`_1 rw c e , r C
Name (Print) Current Mailing Address:
a tta eh e d Te ephone
Signature
j 2.Z Authorized Agent:.
��P 1 - fc fi • _ • • ...
Name (Print) Current Mailing .dress: o t O`1
�-..._ (fI3) 521 - 4115
Signature Telephone
SECTION 3 - ESTIMATED COMSTRQCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1 . Building Q C' 4 585 O ' 00 (a) Building Permit Fee
2 Electrical 1 l T (} (b) Estimated Total Coat of
Construction from (5)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection - S
6. Total =(1- 2 + +4 + 5) g , C)G r7
' Check Number Pc? _
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature: _
Building Commissioner /Inspector of Buildings Date
•
4
". K # BP- 2010 -0868
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- 2010 -0868
Project # JS- 2010- 001289
Est. Cost: $5850.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 24611.40 Owner: STEVENS DAVID R & DORI OSTERMILLER
Zoning: URB(100)/ Applicant: RCI ROOFING
AT: 17 NORWOOD AVE
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:4/7/2010 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:
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 4/7/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo