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24A-108
RC.I. Roofing 6 Line St. Estimate Date Southampton, Ma. 01073 6/8/2012 Phone (413) 527 -4775 Fax (413) 527 -8469 Name / Address Job Location Mary Savarese 36 Prospect Ave. 36 Prospect Ave. Northampton, Ma. 01060 Northampton, Ma. 01060 (917) 744 -0373 Terms Rep Estimate valid for 30 days Dave Description Total Remove existing roofs. 11,200.00 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. (o Furnish and install synthetic underlayment over existing deck. Furnish and install 30 year CertainTeed 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 $3,500.00 for wood decking replacement if needed. Add: $1,100.00 for CertainTeed Landmark 50 year premium shingle. A CertainTeed Surestart Plus extended warranty will be included with a fee of $440.00 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. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $11,200.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature Registration # 126235 Construction License # 074334 Date / 6 p l Insured by Banas & Fickert Ins. (413) 527-2700 - r. The Commonwealth of Massachusetts *� Department of Irrdustrial.Atccidents � =� .. 1 � . Office ffice of Investigations 600 Washington Street _M .� , € � � � ` Boston, MA 02111 't z ir ;s�•' • w►t'rt'.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly ( ): � Name Business /Or (Business/Organization/Individual): t Address: L.:, > : City /State /Lip:_, . `t ,,,,,„.i\-: ` ti — — Phony. #: i' ' ' - -- Are you an employer? Check the appropriate box: Type of project (required): _ 4. I I am a general contractor and 1 I. RI am a employer with _'� 6. Li New construction employees (full and /or part-time).* have hired the sob contractors 7. I� � eu 2.1 1 I am a sole proprietor on die tttaelicQ sheet. r or partner- ii ship and have no employees "These sub - contractors have S. P1 Demolition working for me in any capacity. workers' comp. insurance. q Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its • required.] officers have exercised their 10.( Electrical repairs or additions 3. r 1 am a homeowner doing all work right of exemption per MGL 11 ( 1 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.[''I ' Roof repairs insurance required.] t employees. [No workers' j 1 3. [ Other comp. insurance required.] ' applicant that checks box #11 must also fill out the section below showing their workers' compensation }wlicv information. I Homeowners who submit this affidavit indicating they s e doing all work and then hire outside contractors Hurst submit a new affidavit indica: i ng such 'Contractors that check this box must attached an additional sheet showing the n of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Beloit' is the policy and job site information. . 6 Insurance Company Name: : \ � _ i Expiration Date: 1 -- i Policy # or Self ins. Lic. #: . ; T, 1 2, Job Site Address: 3( Cv -0%9 c_Ne 0.4 e..,.., _-- - - -_.— --- - - -_ -- City /St< to /Zip:A,b � (,, i _ e . tAcA Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiraLion date). Failure to secure coverage as required under Section 25A of N1GL 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 he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: — -- — rate- -_.. .) - 1 Phone #: i -, ! .) - 52.1 - cl _i - 1 "S - - Official use only. Do not write in this area, to be completed by city or town official. 1 City or Town: Permit/License # 1 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 : aYA s 1 e _ ___ 17 License Number 516 Ho1yoe St.- E a Sth m Dton 1 Ma. ()wag 5- a 3 - 1 Et Address Expiration Date ..i L4 13) 5 27- r1'75 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ ft.i.'fo0f;r9 126235 Company Name Registration Number 51 B ) oluot a Street. - P 0. Box 309 5- Oh- 1 ' Address ^ rt Expiration Date Easthampton/ Ma • o i o a ( Telephon,4y13)527• 4 775 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) t'unilies and to allow such homeowner to engage an individual for hire wilo does not possess a license. provided that the owner acts 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 -vear period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a limit 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 joh site will be required from time to time, during and upon completion of the work -tor which this permit is issued. Also he advised that with reference to Chapter 152 (Workers (.:ompensation) 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 Lags and State of Massachusetts General Laws Annotated. nti Homeowner Signature ,�,tac�+L c • 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 Site Frontage Setbacks Front Side 1.: R: 1.: R: Rear 13uilding I (eight Bldg. Square Footage Open Spare Footage 0 (Lot areu minus bldg K laved parkine) 4 of Parking Spaces Fill: (volume& (.)cation) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW O YES O IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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 0 NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House 7 Addition [— Replacement Windows Alteration(s) I I Roofing ri Or Doors ❑ Accessory Bldg. 1 Demolition 1 1 New Signs [D] Decks [C] Siding ID] Other [0] Brief Description of Proposed Work attaehe> 1 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 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 1, c SO. `J b,` e S'e. , as Owner of the subject property hereby authorize lPlar, De, 1 s e of • C. x • Roof) n9 to act on my behalf, in all matters relative to work authorized by th uilding permit application. attached �- +z -►� Signature of Owner Date j"ly Tt sit aS Ziit1101 ae , 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. Vet Si e. Prin Signature of Owner /Agent Date ---- -. Department use only RECEVED ' City of Northampton Status of Permit: Building Department Curb Cut/DrivewayPermit JUN ' 4 2012 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability �r,.,�� n�,; aaresu orthampton, MA 01060 Two Sets of Structural Plans �pTone" - 587 - 1240 Fax 413 587 - 1272 Plot/Site Plans Other Specify 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 s3( Pc,ospe.c C \J Map Lot Unit N mR " Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: ( N \ ,.\J &e€ ' e.. � � c o f corqu Name (Print) Cu r nt Mailing Ad ess: att�aehed 4y -� Telephone Signature 2.2 Authorized Agent: .N1a0k 71 e 1e, - Q.C.Z. oofinc _(Q Li neS-E: Southampton ,Ma.. Name (Print) J Current Mailing Address: 01013, � - (113) 521- 4115 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Roof ' n it 1 ,?..00• ©o (a) Building Permit Fee 2. Electrical (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) $ 1 \ Z 00 . O © Check Number c)20 3 S This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Cornniissioner /Inspector of Buildings Date 36 PROSPECT AVE BP- 2012 -1119 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24A - 108 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit # BP- 2012 -1119 Project # JS- 2012- 001918 Est. Cost: $11200.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 9888.12 Owner: SAVARESE MARY L & JEAN B Zoning: URA(100)/ Applicant: RCI ROOFING AT: 36 PROSPECT AVE Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMAO1073 ISSUED ON:6/14/2012 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 6/14/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner