42-012 (2) ,R.
RCT
. 1. Roofing LI,P
51B Holyoke Street
P.O. Box 309 EStimate
Easthampton, MA 01027 Date
Phone (413) 527-4775 10/24/2008
Fax (413) 527-8469
Name/Address Job Location
Kathy Duteau 288 West Farms Road
288 West Farms Road Florence, MA
Florence, MA 01062 585-0625
l
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
Remove existing roofs. 8,500.00
Furnish & install aluminum drip edge, pipe fleshings, 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 15 lb. felt 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-Star CerainTeed Surestart Plus extended material and workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add $2.50 per sq. ft. for wood decking replacement if needed.
ADD 1,200.00 for Lifetime Shingle.
I ' ,
Spring discount price $8,000.00
64 86X.CD
i THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total 487500.06
TERMS OF PAYMENT
5%Deposit
Balance upon completion • A /
Customer Signature Livid r /
Registration# 126235 - �L .� �1�
Construction License#074334 Date
Insured by Reynolds.Barnes&Hebb.Inc.413-447-7376
4-t tU M p� ,
(' „ *,n•
Northampton _
1. h , 19
, Alasaachnsrtta' _:
c;.1 DEPARTMENT OP BUILDING INSPECTIONS n =s —=
212 Main Street ' Municipal Building
' `
Northampton, Mass. 01060 rte'
WORKER'S COMPENSATION INSURANCE AN'IADAV1T
i, -Y-art 1'Deh s e e of 1 C.I. q.00fill
(licenscdpermittce)
wan a principal place of business/residence at:
513 )4c) kesSt.1E2stham ton J'ta. 016a.7 (phone#k1413)527- 1775
istrcct/ci ty/stair]n p)
dc hereby certify, under the pains and penalties of petj uy, that:
(V/ I r m an employer providing the following wor'ker's compensation coverage for my
e<nolavees working on this job:
National Union Fire-
"Ins. Co. of fl►ttsbuyc PA wczb3i7bg Io/o5/o9
- (Insurance ura nce Company) J' (Policy Number) (Expiration Date)
( ‘) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractor s listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compa ry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
‘,..;arhi-3,-iitiocul sxct if necciwv to include information pertaining to all contractors)
) Ins a sole proprietor and have no one working for me.
) I am a home owner performing all the work myself.
NOTE:plc.ac be aware that while homeowners who employ persons to do maintmance,construction or repair work on a dwelling of
:.nt mocc than three units in which the homeowner resides or on the grounds appurtenant thereto are not generally oomidcrcd to be
employc,-s nrides the woximes compensation Act(GL152,ss 1(5)),application by a homeowner for a license cc permit may evidence the
'.cal u a of an employ«under the Wor4.oec CompaCnation Ad..
I uric-stand that>copy of thin cutrmmt may be focwerded to the Departmcot of 4.121111 AI Aoadu'Moe of braunnoo for the
nvrzagc vcrificslioo and that failure to coact covcras tender soction 2$A of MOL 152 can lamed to tbs.impositioa of criminal penalties
COmit:-^g of t floe.of up to S1,500.00 and/or imprisonment of up to one year and eivtt1 penalties in the form of a Stop Wort Order and a :
flat of:100.00 a day against tne.
■ Permit Ntlmbex Lot 0
::, .; Signature of Liccuscr/Permittee Late'
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
JameofLicense Holder: a�1� De1►Slei TN"l33-1 •
License Number
518 l{oI�oke St- E_asthampion Ma. o loaf/ 5 - 03- 10
Address Expiration Date
(4 13) 52/- Ai/75.
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
lam' oof1 - 126235
Company Name • Registration Number
Si B)4olyoke Street - P O. oX 3O'j 5-011- 10
Address t� t1 n Expiration Date
/! • • • Y . . • Telephon�4/1 3)527'J '7 t
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 build/g permit.
Signed Affidavit Attached Yes No ❑
11. - Home Owner Exemption
The current exemption fbr"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.
)efinition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
s.or is intended to he.a one or two family dwelling,attached or detached structures accessory to such use and/or farm
;tructures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
'uch-homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/ste shall he
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
!-:mplovees 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 youundei'this permit.
'Hie undersigned "homeowner' certifies and assumes responsibility for compliance with the State Building Code,City of
vorthampton Ordinances.State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature_3 .tached •
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House I I Addition ❑ Replacement Windows Alteration(s) n Roofing ai
Or Doors 0
Accessory Bldg. 1 I Demolition I I New Signs [O] Decks [❑ Siding[O] Other[0]
Description of Proposed ad�
Wor k: tached - ^ �� S i-1_11)R es
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. 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 cons'ruction 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
l -Kat. i.] te°a ct , as Owner of the subject
property •
hereby authorize aY h 17e1 l s1 e of !1 Q
•e,.I. Roof i n
to act on my behalf, in all matters relative to work authorized by thisbuilding permit application. 9
att behed - t 3-09
Signature of Owner Date
I,j112 J4y1 U e 1 i e_ -as au j&1 agent , as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing alication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
S�IaY� Islam
Print Name
��-- 3- 13-09
Signature of Owner/Agent Date
t w
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
I, )t SIZC
ontage
S..tbacks Front
Side I.; R: L: R:
Rear
Building I leight `--
_
Bldg. Square Footage
Open Space Footage %,
(I of area minus bldg&paned
parkme)
of Parking SpLtees
Fill:
plume.K I.peationl
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW Q YES Q
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T 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 .Q. ; DONT KNOW Q YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES Q NO Q
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES Q 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 Q NO Q
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
212 Main Street Sewer/Septic Availability
\ I 'Roorri100 Water/Well Availability
Northa'mpxo6,, MA 01060 . , ,
Two Sets of Structural Plans
phone 413587-1240 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
1.1 Property Address:
This section to be completed by office
.238 West Farms foacl. Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Kathleen '1 uteav a88l WesiFarrs Coad Forejzr .
Name(Print) Current il{pg Ad o eers 5
attached Telephone
Signature
2.2 Authorized Agent:
MaYlk De 16 - q.C.i. i{oof;n P.O.L3ox 309 - F:astliampton, Ma.
Name(Print) Current Mailing Address: OIOa7
(q13) 521• 4/(/,5 I
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building f oof1 JJJ 4 000. 00 (a) Building Permit Fee(b) — _
2. Electrical C7lJ Estimated Total Cost of
Construction from(6)
3. Flumbin Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 +2 +3+4+5) $ 8ow.00 Check Number ..--
This Section For Official Use Only 111
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
1 T
4 1 'RD BP-2009-0757
GIS#: COMMONWEALTH OF MASSACHUSETTS
M* B1oe4:42"µ6t2 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-2009-0757
Project# JS-2009-001126
Est.Cost: $8000.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 34978.68 Owner: DUTEAU JAMES&KATHLEEN
Zoning: SR(100)//WSP II Applicant: RCI ROOFING
AT: 288 WEST FARMS RD
Applicant Address: Phone: Insurance:
P 0 BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMAO1027-0309 ISSUED ON:3/19/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:ST RI P & 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 3/19/2009 0:00:00 $35.0013704
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo