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24D-045 .... 6 Line St, E s t i mate . Date Southampton, Ma. 01073 8/15/2012 Phone (413) 527 -4775 Fax (413) 527 -8469 Name / Address Job Location Joseph Callahan 18 Stoddard St. 18 Stoddard St. Northampton, Ma. 01060 Northampton, Ma. 01060 (413) 695 -4261 • Terms Rep Estimate valid for 30 days Dave Description Total Remove existing main roofs only. 5,800.00 Furnish & install aluminum drip edge, pipe tlashings, chimney tlashings and step tlashings. Furnish & install ice & water barrier along caves and valleys. Furnish and install synthetic underlayment over existing deck. Furnish and install 30 year IKO Series shingle. Furnish and install 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 IKO material warranty included. All related permits will be obtained by R.C.I. Rooting. Add S2,50 per sq. 11. for wood decking replacement if needed. WE 1,00K FORWARD TO DOING BUSINESS Wfl'l1 YOU. Total $5,800.00 TERMS OF PAYMENT 5 %. Deposit Balance upon completion Customer Sig — — - -- Registration it 126235 Construction License it 1)74334 Da c / —7 2 69/Z Insured by Banas & Fickeri fns. (413) 527-2700 � ,. Office of Consumer Affairs & Business Regulation License or registration vatic' tor IUUIVI lui use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - d Office of Consuter Affairs and Business Regulation �,_ „egistration: 126235 Type: Partnership :_ Y 10 Park Plaza -Suite 5170 xpiration: 5/6/2014 Boston, MA 02116 R.C.I. ROOFING MARK DELISLE .-..","--2'""':---'.:1`------.- 6 LINE ST ,� --5__— _ _ SOUTHAMPTON, MA 01073 Undersecretary Not valid without signature COMMONWEALTH OF MASSACHUSETTS Massachusetts - Department of Public Safety ASV ISIONOP'P4OFESSIONALLICENSURE- BOARD - M Board of Building Regulations and Standards Construction S wtturr e - SHEET METAL. WORKERS p � ' �'� AS A MASTER- UNRESTRICT ) i License: CS -074334 'i � ` . ISSUES THE ABOVE LICENSE TO: I 0� 1 i r `� 4 , 4-f;::,..' f i C�, ,. ix :r MARK T DELISLE /� ,,: tit MARK T DEL ISLE 33 FIRST AV1 , � *7� d EASTHAMP 'ONr tt r f p 33 FIRST AVE '° r Er • I ' y °- .w,KO''x 1 EASTHAMPTON MA 01 027 -181 i I ° 7,.G. - - 6 '.' j t ixt`� Expiration 13276 05/28/14 ` 15588. 1 Commissioner 05/03/2014 ° LICENSE NO „'EXPIfATION DA `SERIAL NO ,. Fold, Then Detach Along All Perforations H ® : ° 001 905783 4 U,S.= Dapariment of- Labor . Occupational and Health Administration Mask T. Delsle has suooessfully completed a 10 -hour occupational Safety : and °Health Training Course in C©nstruction.Safety & • r ' Ct-Lr C 1:11.. 4. 1/ 1.9/Q7 (trainer) (Date) The Commonwealth of Massachusetts Department of Industrial Accidents 1 Office of Investigations =:3eli 600 Washington Street _: :.= C .. , Boston, MA 02111 %iv v www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plurnbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): R (,`L ?O c, ns U_ S) Address: (.p 1:,(.e.... 5\-- City /State /Zip: „ -.o,s ∎ - (, MO— o■ 0 3 • Phone #: (S'3) ?...`1 Are you an employer? Check the appropriate box: Type of project (required): 1 1. am a employer with 2.0 4. ❑ I am a general contractor and I 6. [l New construction employees (full and/or part - time).* have hired the sub - contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub - contractors have 8. I i Demolition working for me in any capacity. workers' comp. insurance. 9. El Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.E Electrical repairs or additions 3. ❑ I am a homeowner doing all work right of exemption per MGL I l .n Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no 12. Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13.n Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information: r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information. f am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: `� ac- Z , ,,r2.n . C` Q_--, , Policy # or Self -ins. Lic. #: \ C, 0(0'I4 05 Expiration Date: 1 0 - 5 _ l 2, Job Site Address: 1 7- J\ -- t- ) -4 � c.-c - & S- City /State /Zip: )/o ✓t -La e , VVL,. o(o(, 0 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 pains and penalties of perjury that the information provided above is true and correct. Sis nature: ' Date: ` at -"( 2 Phone #: 5 T 41 `( S 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: p le. Not Applicable ❑0 Name of License Holder : f " 1 ar "Del s '77 3 34 • License Number 5)? 1{ok St.- Easthampton Ma. 5 - 03-14 Address 1 Expiration Date ( t3) 527• ��75 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ �. . �. 'Roof; nq 126235 Company Name J Registration Number 518 Holyoke Street - P. D• 'Box 309 5- 0 b - $. Address Expiration Date Easth ipion M. QIoa.7 TelephonE013)527. 4 ?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 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.taalleei • SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing rYf Or Doors E Accessory Bldg. ❑ Demolition ❑ New Signs [CI] Decks [Q Siding [0] Other [p] Brief Description of Proposed attache 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 I, �('� ;t` h 5 rr. as Owner of the subject property hereby authorize jvlarh T» isle of ' 1• V• +• • Roofi n to act on my behalf, in all matters relative to work authorized by this uilding permit application. 9 . 1'' - a0 — Signature of Owner Date J1y — 1)9.11 Si e. 3s aut1ioY a cn L , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing Raplication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. 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 DONT KNOW 0 YES Q 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 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 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 0 NO 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 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit: 7 Building Department Curb Cut /Driveway Permit I / AUG 24 t 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DE _ _ J Northampton, MA 01060 Two Sets of Structural Plans hJ Cl Tlp °AO�oso N bho e 413 - 587 -1240 Fax 413 - 587 -1272 Plat/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: \\ ` 1 St"��f Map Lot Unit /V C t"4- ZOk-r4-re C1 1 -- Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: `\ , \ l ' \ . \ c�4e.-f� �4' �R /1-4nciw \ - bni∎i`'\.‘x'b4e60 Name (Print) Cu ren Mailing ��t ;ilia? � c�s - yz � attached Telephone Signature 2.2 Authorized Agent: • _ I• • a .1 >t . - • _. Of • *• 11 Name (Print) V Current Mailing Address: 0101 3 (�# 13) 521- 41/5 1 �R Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building f ,00fi n q 4 J O 00 00 (a) Building Permit Fee 2. Electrical J (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) 5 Check Number a o(3 v This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner /Inspector of Buildings Date 18 STODDARD ST BP-2013-0211 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D - 045 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 -0211 Project # JS- 2013- 000343 Est. Cost: $5800.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 7100.28 Owner: CALLAHAN JOSEPH S & CYNTHIA L Zoning: URB(100)/ Applicant: RCI ROOFING AT: 18 STODDARD ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON :8/27/2012 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 8/27/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner