35-027 • • • Roo fin g „p
6 Line St.
Southampton, 01073 E st i Date
Phone (4413) 3) 527 -7- 47775
Fax (413) 527 -8469 7/19/2010
Name / Address Job Location
Michael Klatski
1040 Ryan Road 1040 Ryan Rd.
Florence, MA 01062 Florence, Ma. 01062
(413) 570 -0842
Terms Rep
Estimate valid for 30 days Bob
Job Description Total
Remove existing back roofs only. 3,000.00
Furnish & install aluminum drip edge, pipe fleshings, chimney fleshings and step
flashings.
Furnish & install new lead counter flashings.
Furnish & install Certain' eed Wintergua, d ice & water barrier along eaves and
valleys.
Furnish & install synthetic underlayment over existing deck.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
Furnish & install CertainTeed approved ridge vent.
Furnish & install 1/2” fiberboard insulation on flat roof section.
Furnish & install .045 re- inforced rubber roof system, mechanically attached on flat
roof section.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work to be performed according to manufacturers' specifications.
5 -year RCI Roofing workmanship warranty included.
All related permits will be obtained by R.C.I. Roofing.
Add $2.50 per square foot for wood decking replacement if needed.
Furnish and install K -style gutters. 650.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $3,650.00
TERMS OF PAYMENT?
5% Deposit
Balance upon completion j��r` .�,
Registration # 126235 Customer Signature " �l�� -i
Construction License # 074334
Insured by Banes & Fickert Ins. Date 7 7 ( b
413- 527 -2700
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tit )••••• N 11c1),i)ti)wirl ut Puidli s r,
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License CS 74334
Restricted to. 00
MARK T DELISLE
33 FIRST AVE
EASTHAMPTON, MA 01027
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Linti 5/3/2012
, ,,,1111,,I,Icl Ti 26357
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of Consumer Affairs & Rusincss Itegulation
HOME IMPROVEMENT CONTRACTOR
Registration: 126235
Expiration: 5/6/2012 Tr# 293949
Type: Partnership
R C I ROOFING
MARK DELISLE
6 LINE ST
SOUTHAMPTON, MA 01073 t'inicrsecrviar)
.
+~ YiLe/`^nNn/nu) e0k� « , 1/0(�/ , 4Uy��[
' .:..4„,....., � �/ Muss
----'--' Department »//odu`7r/u/
O//��� «y/w,�� ' utiwuu
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600 Washington Street
« ��1‘' 4' 4' 4. /uu/^gui/diu
\\orke/`' Compensation |o:u rail cx Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
/7
``.mu(o^`".u`'`.p,"�.m.,�mu°m"u/: � \�) \
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�� ,c^-`_�. ��-�_-�___—__ ____ _, _ . __________
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________ __ _ __
A'e '■ "v a 1 employer? Check the. appropriate box: l�ypuo/prujvot(rcquirxd)�
�~ / ,� . oxyk.!n `,«h 1� �� / am a general contractor and | �
`� ' � ���_�_ �� 6 �� ��w �o/o�ruu� o
m` uxdi`'pon'tin`c).` have hi,edthe/vh'cwnouuon �� »
� j | ^m ^ ,.'!c proprietor or partner- listed on the cileLi sheet. 7. [l Remodeling
`»'y'"^| 0^'c :»unp\oy,c^ Fhcscsuh^u`o»uu»nhuc | X. El Demolition
■``'k:/ |^' me in ,x■ capacity. employees and have workers' 9� —_ Building addition ````'kcn wn�p insurance comp. insurance.: ^~
—� IV�lL| / ��d
,up,/`i| i _� We are a cn/pomum� and �u ( �� ocmcv repairs or uww
� rl L ( .w, .' homeowner doing all work officers have exercised their 11.1 | Plumbing repairs or uJdui.*:
x`: ,c\ Ni ` mn`p right u[ exemption per MU_ 1 2. repairs
^
c. 152 � and we have no
~~ '
m`",:,.' /u|mm!i ' `
|,; ( \ Other
employees. No workers' ��� - -__ - _ - __
_ _ _ __ _________ __________ insurance L _______
: ^"�^, n '/"^"''"^/: . ,u.,�'^ *I must also till out mcsection ^"lv°um°^`e their ..^mem*u/m,m^wi"on.ocxmiov/
'k^"""°"u`^ ' they ^n a�nu"x ~ur and mu`h.�v"o^eumv"�vmmvw=m" new An0u"..'°a.,"^"v,w^
� `■th:J0+210::i Ithil ,.'h''k mum attached ^uouutioo /uu"/ `o^vinuwuwww"/m^xm-e"o*^pv^ =uwwc°x oz, or ."xo^oc moa=" o~c
‘'ilipi'/=" m/" ,"^-c"otrou^w have employees, ow/must provide their workers' Comp. pxic/ ^,nue , .
~. ________ ____-____'______'__' --
/.//oux rxy,// . `zr that i/ providing .mv/krr/' compensation insurance /Or o!vemployees. Below i's the policy and /whsite
information.
Hm.m,:c t\`' Nomc: /\ p t. � \_-_ -- r ` ''' • _
'',/,c` ; ``. x //^'`^ i/c " � �LWg.._ _C�L1/4._ 51 _C):]_ 33 _ (or Expiration Date:
/.`> `u �(;.:�y ) 0 4 City[Stut*/Ii;.
■uxd`^u.|/! ..[ the workers' compensation policy declaration page (showing the policy number and expiration date
^Jvu/.'ux/c coverage u/ required under Section 25,A o(M6Lc. |fS2can lead to the rnpoSItiOil of ertiutnal penalties of
::u ..i' * \| `oo/m and/or one-year imprisonment, as well as civil penalties in the 6xno v[^ STOP WORK ORDER and a
.'/oyu��.0^.`x day u�xvm the violator. B: advised that u�oy! o[ this statement maybe b.pvopdod to the Office ot
(:vcuupuvo`or0`c 0A (or insurance coverage verification.
/ d«h'/'^,.///io' under /6 iv/ and fev^hies ofyerju/?'/hu//6e information provided ^b"'ebomeundcv,,ect.
_j�nUt���. � _ - ________ _____ _ -_{��Ci_-_��-'�^�=��|-�l_�_-____'_'____
'
\-_ ��
,bu . ------------ -------------'------------------------- ----'
___- ___ ___- '_____- __--___ - _- __
F ---
/ Official //^conly. D'' not write in this area, to he completed by city Or town official.
l\'`nc ___ ____yermi�Lioeuuuw__ __
(circle )�
of Health l Building Department l OtvJlvwo Clerk 4. Electrical inspector 9. Plumbing Inspector
laird r - - __ -
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ybvuc0:
__- _ _
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SECTION 8 - CONSTRUCTION SERVICES
'S.1 Licensed Construction Supervisor: Not Applicable ❑
Name or Lac., /:,o HoMar 1___LaY _A-__. l..t_e. 7_1 3
License Number
�1 30 .. ILO 11. • • 3-12.
address
Expiration Date
( 13/5Z1 li 7 7 5
Su;na;ure Telephone
8 Registered Home Improvement Contractor: Not Applicable 0
126235
Company Name Registration Number
' 5
���utCa t1 C Expiration Date
T • �.L3�.---- Telephon 1 3)527. 4175
SECTION t0- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 162, § 26C(6))
Jorkers Con :,)ensatton insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
,a the denial or the issuance of the building permit.
Signed ~flare- it Attached Yes No _ ❑
t t - Home Owner Exemption
cur rent exemption for 'homeowrtcrs was extended to include Owner - occupied Aweltlne3 of one ( I) or twta(2) families
to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
,upervisor. Ct'y1R 780, Sixth Edition Section 108.3.5,1,
)cII nition of Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
.,r is intended to he., a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
co res. ALcrson who constructs rnorthjn one borne in a two -year periodjh*lt not be considered a horrgeowoer.
h homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she [halal be
r-c;ponsiblc for all such work performed under the building permit.
acting Construction Supervisor your presence on the joh site will be rer.;;nred from time to time, during and upon
i:ttmpletion or the work - io which this permit is issued.
be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
.r;Soyees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you way be lltlbit for person(s)
hire to perform work for you under this permit.
■i,_ undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
\ \,rrthampton,C)rdinanccs, State and Local Zoning laws and State of Massachusetts General Laws Annotated.
Itnrneuwn Signature — _a.taCh
f .. , ‘..,:. s .�
.
' r -------- ---- -- —
! SECTION 5 DESCRIPTION OF PROPOSED WORK (check all applicable)
_ _-_-__-__ . __-__
�
w,r ovm L_] hon L_] Replacement Windows A|wp^doo(w) �—1 Roofing rr�
Or Doors
I-1 � � � « � .
__
Acc,S`n� �] eug Demolition F New Signs ([]) Decks {[] Siding [I:D| Other 10) •
- _____ ____ - __-___ '_'__ __- _______ ~ __ -
Lint: / DeSop�``n/ r 'npoucu \ _ (
��o� ____. �`y}�/- ______ _ __
, Alteration o/ wu*S bedroom Yes No Adding new bedroom _ Yes No
Attached wax./ovc Renovating unfinished basement ______Yoo No
: Hans Attache: Roll Sheet
s^ If New house and or addition tu existing houwinc.complete the following:
.. Use a/ x".:mo One p^w./),___ Two Family 0xc,__ _____ • _ .
; w"n`u^ � , vv'r^." each family unit _______� mcmoo,v�ovw'oom ~`
i c Is there a :,o'aSc attached? . '
!
o Proposed Square footage of new construction ____ ___.opnennmo
c mvmma'cuo/�a,
. Method n' ncvong _____ Fireplaces or Woodstoves Number of each
; Energy C..:s,rv000cCompliance _ masonxecx Energy Compli form
� T o/��nuw�'on
----- ----
Is coal,`.vno within 100 h of wetlands? _________ Yes No Is construction �
inn,/mn 100 y' floodplain Yes No
' Deptr of msumento,ccVa/ floor below finished grade __
^ vv`o ouhuii.g conform to the Building and Zoning regulations? _ Yes _ No
/ Septic T^'`~____ City Sewer Private well City water Supply
SECTION 7a OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
__
___
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I CSiv3 Y_N_VOA V\ ~ ____ ____ .w*{w^�ro(mewwu��
�openv
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nereby aomo'zo �� '=
• ' � a I • _ a Ile • ��
� o act on myb^na��n all matters r- ative to work authorized by this •uUd\ng permit application
\ J 13 Z
\\ \.
\��\��_ ��^' � �� t ______ _ . *» OrenenAuthonzed
a, -- xo/ ' xo ,t�mn -- anuinf"rnution on the foregoing alication are true arid accurate, to the best of my kn*4edge hereby
and belief
Signed underu� pains penalties of penury
L. �~ \
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pmm momo
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� � °-/ �~~- ~~~_ o c_ `/
O°n.`�AVon/ Date
__-.
Sep tion 4 . ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
1zisting Proposed Required by 'toning
I 1 his column to be f llcd in by
Ifuilding Department
I I H
L i:,,unaut. 1
s, ;hack Froni i
--
I
jiue i.. r: I.: I {:
I Rear
!13 hiding Iieight� -
II fig. Square I mirage 04
IT - ien Space Footage "/a
(; n aria inuus bldg & paved i
. r Parking Spaces
,i
A Has a Special Permit /Variance /Finding ever been issued for /ors the site?
NO 0 DONT KNOW O YES 0
F YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO C DONT KNOW 0 YES 0
IF YES: enter Book Page: ! and /or Document #1
6 Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained O , Date Issued:
■
i Do any signs exist on the property? YES NO Q
l
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 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 O NO 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Ar '""'1";',, - .i.• • • .
I . e.'' , ffich 4 . ,.. . . ,. ..,, , .1
.• .
City of Northampton St 'i ••.-.:' f‘... . .' • .
- •c' '' , i1: 1 19 , ",, '•. , ,
' : , . •, :: Bui,lpng Department
Curt C'' 1 ,,,' . ;:-.. ,*•• - • . •.., . . ,:.:
- __ , ,. • , k.: , ;N:4;,‘„,.,..? '•', 0' • - -;,•.--; • , , , -.
- - • .21'2-Main Street .erroo
mo-,..‘, • iy ,,, , , ,,
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Room 100 le . ,,
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AuG - 3 Ripthampton, MA 01060
T . - . k. 4 , .: .,.,. , . . . • S ' '
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• .: , , .,,,,,,*.:; 1-1.-:' 4'. " , .,, . „ ,. , „
. phone 413-587-1240 Fax 413 Pto
Other
• . , .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Proerty Address This section to be completed by office
/0 4 40 es 12-■,- . Map i Lot Unit, _
Zone Overlay District
i
Elm St. District CS Distsict _
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
-- --- -
2.1 Owner of Record:
..\0%..<1 9,,A.. Cl 0.--r vt ‘ e xAo
Name (Print) Current Mailing Address:
ataLthe. cl reVphion. 5 7 " - ° 34 Z
Signature
2,.,11‘ii.tgri;Vati
. C
' ' . • - is MI • r:i12
Name (Prifq) Current Mailing • rest:
0 I 013
( :4115
Signature Telephone
— .
SECTION2
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1 Building li nii .4 3 (0 5 0 .
0 D (a) Building Permit Fee
Electrical
---------- - — /
(b) Estimated Total Cost of
Construction from (8)
3. Plumbing Building Permit Fee
.
4. Mectianica; i-tVAC) k 4.3
5.-Fire'Protectlon
' ‘0
. 6. Total z (1 - 2 + 3 + 4 + 5) r. Check Number 0 • 0
This Section For Official Use Only
Date
Sodding Pen Number. Issued:
___-........---.....
Signature: —
aft
Building Cornmissioner/inspector of Buildings
------
•
, .
1040 RYAN RD BP- 2011 -0097
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:131ock 35 - 0271 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- 2011 -0097
Project # JS- 2011- 000179
Est. Cost: $3650.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING
Lot Size(sq. ft.): 10890.00 Owner: KLATSKY MICHAEL
Zoning: SR(100) //WSP II Applicant: RCI ROOFING
AT: 1040 RYAN RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775
SOUTHAMPTONMA01073 ISSUED ON:8/10/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: Strip and Reroof
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 8/10/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner