35-077 (3) RC ". Roofing
6 Line St.
Southampton, Ma. 01073 Estimate Date
Phone (413) 527-4775
Fax (413) 527 -8469 11/19/2009
Name I Address Job Location
Barbara Gomberg 842 Ryan Rd.
Michelle Solomon
4 Park Lane Florence, Ma. 01062
Mt. Vernon, NY 10552 (413) 320 -1284
Terms Rep
Estimate valid for 30 days Mike
Job Description Total
Remove existing roofs. 6,400.00
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 over existing deck.
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 RCI Roofing workmanship warranty included.
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 Woodscape 50 year premium shingle.
Add: $320.00 for Certainteed Surestart Plus extended warranty (included if signed
estimate is returned within 7 days).
Separate Price for Top Portion only: $3,000.00
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $6,400.00
TERMS OF PAYMENT I {
I
5% Deposit " t /
Balance upon completion Customer Signature
Registration # 126235 1 t �` /
Construction License # 074334 Date I I
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376
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/ c✓ee gP
✓fie TDornmancema`!�i o f ,./ a u . '
Board of Building Regulations and Standards
lir'
Constructipn, Supervisor License
\ Licettsei, CS 74334
C a ":"- , .. ` S (2010
# Tr# 23520
erricr` _0
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MARK T DELISLE ` ' C
33 FIRST AVE t ' :'. c'- J-:G-_ --'' -
EASTHAMPTON, MA 01027 Commissioner
glee govrtmo,uosa or../guaaciicraelt2
� - \ Board of Building Regulations and Standards
5 `' ;� HOME IMPROVEMENT CONTRACTOR
el ! I -' Registration: 126235
'''rt a Expiration: 5/6/2010 Tr# 266063
Type: Partnership
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST.
EASTHAMPTON, MA 01027 Administrator
The Commonwealth of Massachusetts
Department of Industrial Accidents
w r.= 5 Office of Investigations
", .r.. , 600 Washington Street
wi
� ro � r
" �'• •'-- Boston, MA 02111
• N www.rnass.gov /dia
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers
Applicant Information Please Print LeEibly
Name (Business /Organization /individual): R C2N
Address:__I L A e - ,
City /Stato /Zip: _,,. -o tAL. Phone #: - 11 j
Are / you an employer? Check the appropriate box: Type of project (required):
_
I . (�1 I am a employer with 2,0 4. ❑ I am a general contractor and I
employees (full and /or part- time).*
have hired the sub- contractors 6 . ❑ New construction
2. — 1 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodelin
ship and have no employees These sub - contractors have g. ❑ Demolition
working for me in any capacity. employees and have workers' q Building addition
[No workers' comp. insurance comp. insurance.
p
required.]
5. We are a corporation and its 10.0 Electrical repairs or additions
❑
officers have exercised t heir I . Plumbing re
3. n I am a homeowner doing all work g airs or additions p
myself, [No workers' comp. right of exemption per MGL 12.[�Roofrepairs
insurance required.] * c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
' Any applicant that checks box #1 must also till out the section below showing their workers' compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. I f the sub - contractors have employees, they must provide their workers' comp. policy number.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: ("N ,
Policy # or Self -ins. Lic. #: Mt,,k)Q„ C,L. 5 O`' 35 (, Expiration Date: j O - 2,
Job Site Address: a RkActa City/ State /Zip :4loce , Act_ t Nto C>tC}k,Z
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
tine 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 D1A for insurance coverage verification.
i do hereby certify under the ins and penalties of perjury that the information provided above is true and correct.
Signature: _ Date: 3 - \ - \
Phone - t .1
Official use only. Do not write in this area, to be completed by city or town official
dor Town: Permit/License #
L i g Authority (circle one):
0! oard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6 0dier
Contact Person: Phone #:
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
^] p . pp
Name of License Holder : M G r h "bel tS i V '77)4334
License Number
l..; ne 5- 'a CO - ... U. • I. 5 - O3 - !o
Address - 5� Expiration Date
(J4 j3) t 7 � r/75
Signature f�� Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
F E. I. / RDQ f i 126235
Company Name Registration Number
L:, ,4,,, Sir, 5-0b-1p
Haorc Expiration Date
arnpTh i, Ma . 01 67 3 Telephon,4-7l 3)52?- i#7 ?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 ii 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
is 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 con Idered a homeowner.
Such ' 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 he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
hmplovices 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 attached _ _____
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House Addition l ) Replacement Windows Alteration(s) n Roofing [yf
Or Doors .
Accessory Bldg. 1 Demolition I New Signs [D) Decks [Q Siding [DI Other [p)•
•
Brief Descript on of Proposed attaPL 1j
Work. L f 1 e
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
i 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. Numbe 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
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, �ca,��.x: �x,i7YI\C ( m C \- r-l l .� SlskCs A".r) (1 , as Owner of the subject
property yyy,,, � ` �
hereby authorize t ,MaY 11e1 l S, Q� • c . I . Rooftn
to act on my behalf, in all matters r ative to work authorized by th ur ding permit application.
attached 3- )1
Signature of Owner Date
I, • ► , - - • • 4. • I ,/ , 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.
Mak
Print Name
7 3 -1l �Iv
( 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 i
Frontage 1 I i 1
Setbacks Front
Side L:' R:1 ' L:i_ R:t
Rear L____...1
Building Height I 1
B;dg. Square Footage /o
Open Spade Footage
(Lot arcs minus bldg & paved
pa. - king)
# :)f Parking Spaces , . i I _ 1
Fill:
1 ,
(vo■ume & Location) - . - 1
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO Q DONT KNOW 0 YES 0
IF YES, date issued :
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW 0 YES 0
IF YES: enter Book . Pagel 1 and /or Document //[ J
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 0 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: [ _ 1
C. Do any signs exist on the property? YES O NO 0
IF YES, describe size, type and location: w
D. Are there any proposed changes to or additions of signs intended for the property ? YES a 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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
_
4 :40$;
1 City of Northampton g ; r tk ,i'' )
Y
Building Department Curb C ! ;.1 , ,
212 Main Street 4f ,
, I "' Room 100 i , , ' '�
F r
Northampton, MA 01060 E/.), :, 'r . . 2.
phone 413- 587 -1240 Fax 413 -587 -1272 11:4;;)1!1`, :ft. t. Y,. • .
VUICt s Gc a r ,
APPLICATf6N 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
'C„i a yc rl CIN'A Map . Lot Unit
- Ckp c e_Y .Cam, Zone Overlay District
Elm St. District CS District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: \ f 0 a QJ (I {`��� (C
/
Name �jCG.C -�(0. Go 3€ it'll i C Cl Ir (4'? Current Mailing A t, N. `� 3�C,r Cr
(Print) �.l t .) 32.a i Z RLi
a eh P d Teiee hone
Signature
2.2 Authorized Ascent: rr
.MaYk le+ - •.r. f 0t)fi " a ' -, . , • _ a • to • •
Name (Print) C. Current Mailing • •rasa: C>1 0`13
--7'' - _ ( - 4115
Signature Telephone
SECTION 3 • ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1t00f, 4 (4 COQ . 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) $ (z y QO . 00 _ Check Number /5 *3S
This Section For Official Use Only ,
Date
Building Permit Number. Issued:
Signature:
Building Commissioner /Inspector of Buildings Date ,
842 RYAN RD BP- 2010 -0806
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 077 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- 2010 -0806
Project # JS- 2010- 001188
Est. Cost: $6400.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 19906.92 Owner: GOMBERG BARBARA & MICHELLE SOLOMON
Zoning: SR(100) //WSP II Applicant: RCI ROOFING
AT: 842 RYAN RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:3/16/2010 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: 0/5: (/ 2 7(c)
/ „
l l�trt' 4
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
. 0e
Certificate of Occupangi ,�.,�, e Signature:
FeeType: Da e Paid: Amount:
Building 3/16/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo