32C-196 (2) 10/05/2009 12 14135958132 SERVICENET PAGE 02/02
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Roofing
6 Line St.
Southampton, Ma, 01073 EStI m ate Date
Phone (413) 527 -4775
10/1;2009
Fax (413) 527-8469
Name /Address Job Location
SERVICE NET
Tom Gross 121 Williams St.
129 King Street Northampton, Ma. 01060
Northampton, MA 01060 (413) 575-0437
-- ---
_ - Terms Rep
Due on receipt Chris
Job Description Tate!
Remove existing roofs. __■■ 9,800.00
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 RC1 Roofing workmanship included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.S. Roofing.
SPECIAL ITEMS NEEDED
I
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total w � — $9,800.00
TERMS OF PAYMENT
5 %Deposit �7
Balance upon completion Customer Signature % __ . j J r01v /yeege
Registration # 126235
Construction License 4 074334 Date 1Q' = s e y
insured by Reynolds, &fres & Hebb, Inc, 413.447-7371, — �— --
. . . -
. .
Olt Board of Building Regulations and Standards
Constru "luveallA Supervisor
161411"4"" aa '
iv License?: CS 74334
4Piratibin : 5/ Tr# 23520 .'
R‘rictioli 06 :
MARK T DELISLE
33 FIRST AVE , eT... - ....Z...._ __----
EASTHAMPTON, MA 01027 Commissioner ,
1
, ,
gite eammtanuseaa ort/PlawachadeM
Board of Building Regulations and Standards
% 11 f I HOME IMPROVEMENT CONTRACTOR
( Wfilal 1
• Q t11..Y4 Registration: 126235 i
-,--, Expiration: 5/6/2010 Tr# 266063 I .
....
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST.
EASTHAMPTON, MA 01027 Administrator
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� '� '` DEPARTMENT OP BUILDING INSPECTIONS .i I •
212 Main Street 'Municipal Building r
Northampton, Mass. 01060 /rue'
WORTEER'S COMPENSATION INSURANCE AFFIDAVIT
I, ______JA„ark. - • t r • II f, 41
(licensedpermittec)
with a principal place of business/residence at:
f '
- k - ' , .. .. •_ .... th .. 0 t013 (hone# j - • 11 5 5'
.. - city /sta1e/np)
do hereby certify, under the pains and penalties of perjury, that:
(.. am an employer providing the following worker's compensation coverage for my
employees working on this job:
No.. +oc10.\ \I."; OA c■ e.
axns . CO . oC 1 7 , s i t 1 � t A W C 3 1,331 - 1 O S 1 o ' 5.09
(Insurance Company) (Policy Number) (Expiration Date)
() I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) ' • (Insurance Company/Policy Number) (Expiration Date)
•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date),
(Name of Contactor) (Insurance Company/Policy Number) (Expiration Date)
(ash additional shod if necessary to include iafocsaatioa pertaining to all 000icaetois)
( ) I am a sole proprietor and have no one w orking for me.
( ) I am a home owner performing all the work myself. , '
. NOM. *au beawar doe Aide bccocowacts vkao anploy peaces to do teeitdcaaacc, ozedsuctioctormseirffotkee time* of
ao:
no than throe shits la whicittlte bonbowoarresides oc as the pouods apputteoaatthndo ate xot geserallycoaidetd '
oxploy= undo the wottees compcatstim Mt (GL1$2f2 l($)). appliatioo by a boaenwroir for a tiogsae cr permit may aviation tin
1 cga1 trans of an employes. under the Wockses Coaopeoaation Mt.
I uodwt.a4 t h a t a D o p y a t t h i s oatmeal m a y be Wr oardd tote Dcputn000t ofleduatrW Moidesttt Mee of rwa haft
oavaasc vai&atioo tad that failure to scans comp under section 2SA of t.(OL ISl Ism ktdto die logo plea daWrl . •
cowl: in of a •$ae of up to S I,500.00 t a /or iao oaeacat of tip year one y and chi petuM b the e Was eta Stop Welk trod a '
fu:o of S100.00 a day against lac.
Fordapittmaattitweatp j '
do...41
�� , tom r,n,a 1t
signature of Li /?ermittee ,
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: T p Not Applicable ❑
•
Name of License Holder : aY V e� ! e. T ` " i 3 3
License Number
. . 11 5 10
Address - Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
fte . I. / R h° n9 126235
Company Name • Registration Number
!. 5_ 5-0b- 10
Aaareaa Expiration Date
I STO L,It` ±am ptort Ma. 0167,3 TelephonfOi 31521- 4775
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 Dwelllines 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 attaCheCA •
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House n Addition ❑ Replacement Windows Alterations) ❑ Roofing ii
1 Or Doors Cl .
Accessory Bldg. ❑ Demolition ❑ , New Signs [0] Decks . [[1 . Siding [Dj Other (C7]'
Brief Descripton of Proposed >� a h
Work: a {? Pl
` 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:
I a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms j
c. Is there a garage attached? /..r
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d. Proposed Square footage of new construction. Dimensions
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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
;. 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, c\I \ `� JU C..t'' , as Owner of the subject
! property 4
hereby authorize LJV1 Y - bet S 1 P ii • c. I . Rocif;n9 R&if;n
to act on my behalf, in all matters r Q ative to work authorized by this uilding permit application. .
Ott wh.d Jo -6-09
Si Sigh Owner Date
I,
y . 1 $ - - - f e ' • . / . I , as Owner /Authorized
. Agent hereby declare that the statements and information on the foregoing . s ' lication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
___„?1 •
PlaY li 1 e, . ,
Print Name .
/o - x -0 9
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 r ii•
Frontage _
Setbacks Front I ( r _.
Side L:1 1 R: 1 L:[ 1 R:I _ .. _J L ----- 1 L
Rear 1 ti [.:__ ._ [
Building Height ! . _i L__.„,1 I.. i
Bldg. Square Footage I , % ......
Open Space Footage
(Lot area minus bldg & paved f i 1...... j I . + t �___... __
parking)
# of Parking Spaces 1. 1 -
Fill:
l ' i (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:C I " .
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 . DONT KNOW 0 YES 0
IF YES: enter Book 1 ' 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?
Needs to be obtained O Obtained Q , Date Issued: f
C. Do any signs exist on the property? YES O NO O
IF YES, describe size, type and location: [ —1
•
D. Are there any proposed, changes to or additions of signs intended for the property ? YES O NO V
IF YES, describe size, type and location: 1
E. Will the construction activity disturb (clearing, grading, excavation, or filling) overt acre or Is it part of 11 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.
f� 4
City of Northampton Status of Pei
Building Department Curb C,t Drl�f'bl?��t.
212 Main Street sewerisept
Room 100 V�ater/Welh �
Northampton, MA 01060 'fVvaet of utafPlas'.0
n , �
phone 413- 587 -1240 Fax 413- 587 -1272 `P4tigite i'iai�
Omer Sr cify'�
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLI' ; A ONE OR 1 ; C FAMIL
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This section to
a, a. Map • Lot —
/00 r qvr‘i Yl { -. Zone Over,; <<Ict
Elm St. District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record;
Sts C iJ e I al o
Name (Print) Current Add Ot64, O
attaeecl
w/3 5-15 5 - 40431
1
T elephone
Signature -
2.2 Authorized Agent:
Name ( Print> 9 Current Mailing Ado ,s: 0 \ 0'-(
14131521 _L±11-15
3
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Officia, 'Jse
completed by permit applicant
1. Building Qoofi 4 1 0° O O (a) Building F lit Fee i
2. Electrical (b) Estimate tal Cost ()
Construct from (6)
3. Plumbing Building Pen .t Fee
4. Mechanical (HVAC)
5. Fire Protection _
6. Total= (1,2+3+4+5) $ 00 .00 Check Numb
This Section For Official Use OnI
Date
Building Permit Number. Issued:
Signature: •
Building Commissioner /Inspector of Buildings r ,te
•
•
•
al, WIfAM.S1t BP
GIs #: COMMONWEALTH OF MASSACHUSETTS
.411001c -196 ' CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP- 2010 -0418
Project # JS- 2010 - 000570
Est. Cost: $9800.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 11325.60 Owner: SERVICNET INC
Zoning: URC(100)/ Applicant: RCI ROOFING
AT: 121 WILLIAMS ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 - 4775 Workers Compensation
SOUTHAM PTONMA01073 ISSUED ON:10/19/2009 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 10/19/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo