17B-013 (2) RC.I. Roofin g
6 Line St. Estimate Date
Southampton, Ma. 01073 8/23/2013
Phone(413)527-4775
Fax(413)527-8469
Name/Address Job Location
John & Paula Benoit i-i t vex--,
11 Fouth Ave. , • 01O6
Northampton, MA 01060 (413) 585-5845 3 tich.�
C�tGC(r) .. i
Terms Rep
• Estimate valid for 30 days Mike
Description Total
Remove existing roofs. 5,800.00
Furnish& install aluminum drip edge,pipe flashings, chimney flashings and step flashings.
Furnish&install CertainTeed Winterguard ice&water barrier along eaves and valleys.
Furnish& install synthetic underlayment over existing deck.
Furnish&install Lifetime CertainTeed Series shingle.
Furnish&install CertainTeed approved ridge vent.
Furnish&install 1/2" fiberboard insulation on flat roof section.
Furnish&install .060 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.
Lifetime CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
Add$2.50 per square foot for wood decking replacement if needed.
A Certainteed Surestart plus warranty will be included with a fee of$300.00 absorbed by RCI
Roofing if signed within 7 days.This extended warranty means that 25 years of the Lifetime
warranty is covered for labor and materials. The remaining years of the Certainteed warranty
would be covered for material only.
THANK YOU FOR YOUR BUSINESS.
Total $5,800.00
TERMS OF PAYMENT `.W..
5%Deposit \
Balance upon completion Customer Signature \ ` ` �
Registration# 126235
Construction License#074334
Insured by Banas&Fickert Ins. Date
(413)527-2700
Office of Consumer Affairs& Business Regulation License or registration vana tor rnulviuui use only
before the expiration date, If found return to:
�t •ME IMPROVEMENT CONTRACTOR p
a egistration: 126235 Type; Office of Consumer Affairs and Business Regulation
Yxpiration; 5/6!2014 Partnership 10 Park Plaza-Suite 5170
te, - Boston,MA 1)2116
R.C.I. ROOFING
MARK DELISLE
6 LINE ST /f '--�/ � �`----°-
SOUTHAMPTON, MA 01073 Undersecretary Not valid without signature
COMMONWEALTH OP MASSACHUSETTS 9 Massachusetts - Department of Public Safety
410000000W44(.40.0000:41,,
O, DOfrr Board of l3uilding Regulations and Standards
SHEET METAL WORKERS Con:aructiun Super'..isur `x
AS A MASTER-UNRESTRICT 'J
License: CS-0'14334 r�s
ISSUES THE ABOVE LICENSE TO: l`} 1 t<I S 1�r-/-''/...:, tY1-,, r
MARK T D ELIS .E r,�1�'f
MARK T DELISLE • E 33 FIRST Me pit "' ;_ . -,
_ EASTHAM*ONF 1t�( 0 t ..,
33 FIRST AVE cl. I
EASTHAMPTON MA 0 1 027- 1 8 j I ,4,,,. , i:
i`tatc,°, Expiration
13.276 05/28/14 ' 15588. I Commissioner 05/03/2014
Fold,Then Delach Along All Perforations H
•
UrS;.Departmeni of lalbor
Occupational Saloty nnd'Hoalth;Admiltisirettori
Ma4k T D'e i is 1e
has succie lcilly.eomfleteci a 10 hoilr Occupetional'Salety and:Heallh
Training coursein,
Cbnstrupttptl Safety&W f
eaith .,. ,
g
(Trtiiner), (Dale)
•
The Commonwealth of Massachusetts
Department of Industriai'Acciclents
1-7:- Office of Investigations
NOM
_.. _ 600 Washington Street
•
•
Boston, MA 02111
www.mass.gov/clia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurinbers
.pplicant Information Please Print Legibly
lame (Business/Organization/Individual): R L.,' :, Q. op(- (\.0
ddress: C.0 .
;ity/State/Zip: ,c k-\-, \ ,-o tea, o o-i 3 • Phone #: (y1:3) 5-41 -Y `(5
re you an employer? Check the appropriate box: Type of project (required):
am a employer with 2,0 4, ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time),* have hired the sub-contracto:-s
I am a sole proprietor or partner- listed ou the attached sheet. : Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9, ❑ Building addition
[No workers' comp. insurance 5, ❑ We are a corporation and its
_ required.] officers have exercised their 10,❑ Electrical repairs or additions
I am a homeowner doing all work right of exemption per MGL 11._ Plumbing repairs or additions
myself. [No workers' comp, c. 152, §1(4), and we have no 12.Ri<of repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13,_ Other
iy applicant that checks box 01 must also fill out the section below showing their workers' compensation policy information.'
D moo wnors who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
ntractors that check this box must attached an additional sheet showing the name of the sub-contn,ctors and their workers' comp.policy information.
m an employer that Is providing workers'compensation insurance for my employees. Below is the policy and job site
'ormation.
urance Company Name: 0..c- 'S - t t�t tiX ,
licy#or Self-ins. Lie, #: \Ai Olo't3Ici 0,5 C2\ Expiration Date: 10 . 5 . ( 3
Site Address: ,3 Li e)r% clr
\\ City/State/Zip: ��s �� A1Q
tach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
.e 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
up to $250.00 a day against the violator, Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
io hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
ature. .�
� " :Date; -7 - /3
tone#: �I '41-(41
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License rt
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 f#:
SECTION 8 •CONSTRUCTION SERVICES 1
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Rar .1) o t LS l e 1714334
License Number
s m , - 1: Ma. ()Ian__ 5 - 03 - 6
Address Expiration Date
Signature Telephone
9, Registered Home improvement Contractor: Not Applicable ❑
fi• . I. Roofs 126235
Company Name Registration Number
Hoorea�,,}}..�� Expiration Date
S tit-)arnFthn I Ma. 01 07_3 Teiephon(41 S:1527'4.?7"
SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.I..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 Qr. No ❑
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Uwner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner te.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 ,hat 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 attached
•
•
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition [] Replacement Windows Alteration(s) I l Roofing V
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [[ Siding[❑) Other[❑]
Brief Description of Proposed
at
'1-aehed
Work: 1.
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 I3E COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I' 1c:)\-‘'n €ti� -`D` �'N 0` , as Owner of the subject
property (�
hereby authorize V'►ar h P__ of •G.I. Roof;n 9
to act on my behalf, in all matters relative to work authorized by this building permit application.
attached q - q -(3
Signature of Owner Date
�NIaY k del sk as auk uit
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.
Vet sPrin
-'^ q -9 - 13
Signature of Owner/Agent Date
Section 4. ZONING AU 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 Frontage ' . _ .
Setbacks Front ! � � | \ ,t
Side 1_,:f j iRL! l L:1 i D1 / /
Side | /
�
i i � i \
Rear
--- --
Building Height ` ` � � ! |
Bldg. Square Footage | : { ' % | � ' ' �
Open Spate Footage ��
(ux��m/n�mo &v�v � ! | ! � | ! / .
parking)
#of9u�in8Spauc ' | . ' � �
- ) �� > -- �
Fill: /
� \
(vovmo&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 DON'T KNOW 0 YES 0
.
IF YES: enter Book Page! and/or Dncument#�
/ . /
B. Does the site contain a brook, body of water or wetands? 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 /—� Date Issued: i |
�_� �~/ , .
~�
�
C. Do any signs exist on the property? YES \.� NO �~�-\
/
- -'- — - - - — i
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 0
/
IF YES, describe size, type and location: I
E. Will the construction activity disturb(clearing,
n. orfiUing>over 1oo�m�hpa�nfa common �on
��will d|o�rbmer1e�e YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
���
Department use only
lj i, �(.� _.. _!' 1I 1` ity of Northampton Status of Permit:
l uiiding Department Curb Cut/Driveway Permit
I cFp 1 6 2013 ,''J 212 Main Street Sewer/Septic Availability
Room 100 WateriWell,Availability
°ec hampton, MA 01060 Two Sets of Structural Plans
Electric,Plumbing&GaF lns!pecti
Northampton,M:KWh ' •87-1240 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
3 84 6( cif, Map__ Lot Unit__
'C .O ft2r1.C., Zone Overlay District
•
Elm St. District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
o\n n C Cw `C� o, - 1 l C C-t.t^ 1 t Iasi e . -LIO -Vr.k4a sN ,Mk oi 0 c.0
Name(Print)�f Current Mailing Ad Address:
attached Telephone 5ILS.
p
Signature
2.2 Authorized Agent:
Mari Vii • ' leJ — q.C.i. wall__ .:a:..., -E._s all arnpton, ,Ma.
Name(Print) Current Mailing Address: 010 -_
- ---,_— (4!.i) 527- 4175
Signature Telephore
SECTION 3.-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building goof)n9 4 �5y L C� • CC (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) $ ,.5-73(X) . GO Check Number NIMII' 1161111111111111
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature: •
Building Commissioner/Inspector of Buildings Date
384 BRIDGE RD BP-2014-0323
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17B-013 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-2014-0323
Project# JS-2014-000557
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.): 9408.96 Owner: LASTOWSKI PAULA M C/O BENOIT PAULA M
Zoning: RI(100)/RR(100)/ Applicant: RCI ROOFING
AT: 384 BRIDGE RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527-4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON:9/17/2013 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 9/17/2013 0:00:00 $35.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner