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29-167 RC.I. Roofin 6 Line St. Estimate Date Southampton, Ma. 01073 6/25/2012 Phone (413) 527 -4775 Fax (413) 527 -8469 Name / Address Job Location Mary Shannon 106 Briarwood St. 106 Briarwood St. Florence, Ma. 01062 Florence, Ma. 01062 (413) 584 -1868 Terms Rep Estimate valid for 30 days Dave Description Total Remove existing roofs. 6,800.00 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 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 sq. ft. for wood decking replacement if needed. Add: $800.00 for CertainTeed Landmark 50 year premium shingle. A CertainTeed Surestart Plus extended warranty will be included with a fee of $320.00 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 $6,800.00 TERMS OF PAYMENT 5% Deposit Balance upon completion Customer Signature i," Registration # 126235 Construction License # 074334 Insured by Banas & Fickert Ins. Date 6/2-. (413) 527-2700 �. Office of Consumer Affairs & Business Regulation License or registration vana for inarviuui use wily —_ _ • MEIMPROVEMENTCONTRACTOR before the expiration date. If found return to: =� =' �� � � egistration: 1.26235 Type: Office of Consumer Affairs and Business Regulation °" xpiration; 5/6/2014 Partnership 10 Park Plaza -Suite 5170 Boston, MA 02116 R.C.I. ROOFING MARK DELISLE • 6 LINE ST `, C'--------- SOUTHAMPTON, MA 01073 Undersecretary Not valid without signature COMMONWEAL MASSACHUSETTS - Massachusetts - Department of Public Safety pi: 1019N‘tFPROFESSIONAL ,i:10ENSUI3E 1),OAOp.0r / Board of Building Regulations and Standards SHEET METAL WORKERS Cunstructiun Superlisur AS A MASTER- UNRESTRICT-1D 1 License: CS- 074334 r ISSUES THE ABOVE LICENSE TO'. ! a � ��c } r S �� L r .; MARK T DELItS'LE r. MARK T DEL ISLE N 33 FIRST AV£ * - V EASTHAMI#ON ` V,i 0� 1 7 ;s, 33 FIRST AVE i°( ( • • EASTHAMPTON MA 01027 -1S I _;4. -- it�: Expiration Commissioner 13276 05/28/14 ' 15588. 05/03/2014 ILLO No , ..EXRLRAtiQN DATE `SERIAL No Fold, Then Detach Along All Perforations H O . A " 0 3 0 5783 0 U.S.- Department of-Labor Occupationaf.Safety and Health Administration Ir1avrk T. Delisle has successfully completed a 10-hour Occupational Safety and Health Training. Course in Construction Safety Health r ;' ee-kt C )f -e t. 1 / (Trainer) (Date) SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applic ❑0 Name of License Holder : M y Y h - Deis le 7 3 34 License Number 51 F Hoi St.- Easthampton Ma. 010 al/ 5 - �I Address 1 Expiration Date ( 5p?- L1 '7 75 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ • S. 'Roo f i n 124 235 Company Name Registration Number • • 1 • 1 • • . - .. •. •• CS • Address t� C Expiration Date EasthArnpton Ma . O { O a rl Telephon�y1 47 ?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 `g 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 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 - 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.aCkej • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House [] Addition ❑ Replacement Windows Alteration(s) n Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [❑ Siding [❑] Other [❑] Brief Description of Proposed attaehe Work: (_ 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,o- C >QAim' , as Owner of the subject property -'{-' • hereby authorize (1ar 17e1 sI e Q� • 0. 1, . hoof; n to act on my behalf, in all matters relative to work authorized by this uilding permit application. 9 a tt ached -�. t 2_ Signature of Owner Date • I, j4y k T \ ► s 1 e. as 2U t 1QY t led aqe.nt , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing adDlication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. .Mark elissted 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 Lot Size Frontage Setbacks Front Side L:- R: L: R:` Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg & paved parking) # of Parking Spaces Fill: (volume & Location) 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: . IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book Page ' and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES 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 0 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 I 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. Department use only City of Northampton Status of Permit: Building Department Curb Cut /Driveway Permit I 1 JUL -- 2 2012 i 12 Main Street Sewer /Septic Availability 3 Room 100 Water/Well Availability DE, 3 -4 Northampton, MA 01060 Two Sets of Structural Plans NORTHAM-- ,,in010 ° l one 13- 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 This section to be completed by office 1.1 Property Address: Cr 10 (,p 6f 1 ac WCX) S\ Map Lot Unit , V.)(- cv-tcc, Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 1 0. �\ s A 1 ( <^ \o,r Wool 5S_ Cloeentt• nna. blob Name (Print;) Current ng Address: ress: attached LIB s - t $(03 Telephone Signature 2.2 Authorized Agent: MaY� � e k� — q.C.z. Roof; I-19 _( 1 e,5i�_SQ arnpron, Na. Name (Print) Current Mailing Address: O1 rt V 1-- (J-113) 52/ - 4 775 11 VV Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building Qoofi / _ Q r ©0 , QU (a) Building Permit Fee 2. Electrical JJ �� 'f l V (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) $ (Q 0 0 , OCR Check Number do ,`Z . [ d $ 5 `j This Section For Official Use Only �J Date Building Permit Number: Issued: Signature: Building Commissioner /Inspector of Buildings Date 106 BRIERWOOD DR BP- 2013 -0007 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 29 - 167 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- 2013 -0007 Project # JS- 2013- 000009 Est. Cost: $6800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 10018.80 Owner: SHANNON BYRAM R JR & MARY LYNN Zoning: Applicant: RCI ROOFING AT: 106 BRIERWOOD DR Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMAO1073 ISSUED ON: 7/3/2012 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 7/3/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner