37-015 (3) •
RC.1. Roofing, LLP
51B Holyoke Street
P.O.Box 309 U
Easthampton, MA 01027
Estu m a t e Date
Phone(413)527-4775 5/2/2007
Fax(413)527-8469
Name/Address Job Location
Ingrid& Bill Tobin 669 Florence Road
669 Florence Road Florence, MA
Florence, MA 01062 584-3293
Terms Rep
Estimate valid for 60 days Bob
Job Description Total
Remove existing roofs. 6,300.00
Furnish&install aluminum drip edge,pipe flashings,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 Cor-A-Vent ridge vent.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers'specifications.
15 year 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 replacement if needed.
544c- f/ nCJ
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN(3)THREE
BUSINESS DAYS OF DATE OF SIGNING. Total $6,300.00
TERMS OF PAYMENT
5%Deposit
Balance upon completion Customer Signature Al
Registration# 126235 _
Construction License#074334
Date ��3
Insured by Reynolds,Barnes&Hebb,Inc.413-447-7376 0
r .
B �Y tit �Zi of N tE1amptrtt _*=;,_
1
' � B
9�4; PI assschnsctts' =_•� _
"""„:„„ DEPARTMENT OF BUILDING INSPECTIONS • _ - `_
212 Main Street ' Municipal Building \:::;---=--_--; $.'"
Northampton, Mass. 01060 Is '
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
______„„Mart
_ 7erhsle of it.G.Y. Roof i n
(Lcenset/permittec)
with a principal place of business/residence at:
•
I B Ho)yoke St./Eastham 1'Q 1n .Ma. o.►oa7 (phone#Q1 i3)5J7 ??
-� 5
ticity/statc/ap)
io hereby certify, under the pains and penalties of perjury, that:
1‘I am an employer providing the following worker's compensation coverage for my
employees working on this job:
tmerican }PornAssurance We 13 9b6x{15 10
(Insurance Company) (Policy Number) ira on 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 Conractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach addition-xi sheet if necessary to include information pertaining to all contractors)
( ) I a a sole proprietor and have no one w
m working for me.
( ) I am a home owner performing all the work myself
NOTE:please be aware that while homeowners who employ person to do rani�r— tcs coastruc too or repair work on a dwelling of
not more than throe units is which the homeowner resides or on the grounds appurtenant thereto are cot generally 000sicierod to be
employe:s under the worker's compensation Ad(GLI52,ss 1(5)),application by a homeowner for a license or permit may evidence the
legit ctah,II of an employer under the Worcees Compensation Act.
I understand that a copy of this wtrmart cnay be fotwnrd+d to the Department of Industrial Accidents'Offioe of Imtusttoe fort the
coverage vcrificatioo and that failure to seatre coverage under section 25A of MOL I52 can lead to the imposition deeming pc a1lie
ea:misting of alone of up to S 1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
Eno of S100.00 a day against me.
•
EtNumber Lot# ....____-. \ .
.. ,.. Signature of Liceosec/permittee Late
ii
•
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑j�
Name of License Holder : V l aY I��Deli si n/ / `f j 33 J.
License Number
Stree.. - Tasfillarnpron, Na. 0i02.7 5 - 0 3 - 0 8
Address
Expiration Date
( 13) 5a'1• x1?75
Signature Telephone
4-11 .al�.�i��
i �ir ' _' Not
Applicable ❑
R oof i n✓ ) �6 2.35 Com an Names
Registration Number
518 Nol\olte. Street. - P.D. Box 3b/ 5- Ob - 08
Address M ^ �r Expiration Date
)Easthampton, Ma. No 27 Telephon�Il3) 5a'f-11175
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 ❑
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
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 a t-tar hec
s '
SECTION 5 DESCR1PTIONtOF PROPQSED WORK1(checkiall applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s)❑ Roofing V
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: I • Ma/
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attachea Roll 0 . Sheet 0
5i:ilfiNMErdat-Wiffdr6Mdil ition".to existing:ho rsing,tacompletee tffelf611o' :
a. Use of bui ding : 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. Mascheck 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'AUTHORIZATI,ON -TO BE COMPLETED WHEN
OWNERS AGENT"OR CO'NTRACTOR APPLIES FOR BUILDING PERMIT
I, \t∎ lb am ` I Oh'm , as Owner of the subject property
hereby authorize .Mark Del'Isle. a R•C•Z. Roofin to act on
my behalf, in all matters relative to work authorized by this building permit application.J
attached 41I 3)0/
Signature of Owner Dat
I,
Mary " elisle. QS authoYrz.e.cl a ent , as Owner/Authorized Agent
hereby declare that the statements and information on the foregoin application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
sle.
Print Name
013/0i
Signature of Owner/Agent Date
4 Oft.
4
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parka)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES—
No
IF YES, describe size, type and location:
r 7 ;;
City of Northampton -
Building Department
212 Main Street
Room 100
Northampton, MA 01060 T
phone 413-587-1240 Fax 413-587-1272 l' i.v1 ::; . _
APPLICATION TO CONSTRUCT, ALTERr Rplq ATE pft I 4€MbLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION i..
1.1 Property Address: � ��
�
10109 Fiorenee cacJ
X11'00 •
Zone b ;7;', � t® 3 € ` � 7
Elm St. District .;CB Di tract
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
11 lam Jingr 1 10151 n 100 Florence f?Danl / Florence_
Name(Print) Curr 'lira d e 1
attache_el
Telephone
Signature
2.2 Authorized Agent:
MarkI el i sl- - R. C.I. Roof;n9 P.o. Box 309 - Easthamrto�, 1v a
Name(Print) Current Mailing Address: O'Gal
('413) 5V- 4(115
Sig ature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building Roof i n9 4 b3oo.o0 (a) Building Permit Fee
2. Electrical (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) 41 4)300.00 Check Number ,/41344.
This Section For Official Use Only
Building Permit',Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP-2007-1220
Gs#: COMMONWEALTH OF MASSACHUSETTS
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-2007-1220
Project# JS-2007-001947
Est. Cost: $6300.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq.ft.): 40859.28 Owner: TOBIN INGRID F&WILLIAM FX
Zoning: SR Applicant: RCI ROOFING
AT: 669 FLORENCE RD
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775 Workers
Compensation
EASTHAMPTONMAO1027-0309 ISSUED ON:6/15/2007 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 6/15/2007 0:00:00 $25.0010442
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo