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12-034 RC.1.00�RoofingDate 6 Line St. Estimate Southampton,Ma. 01073 5/8/2014 Phone(413)527-4775 Fax(413)527-8469 Name/Address Job Location Jim Viola 208 North Farms Rd. 208 North Farms Rd. Florence, MA 01062 Florence, MA 01062 Terms Rep Estimate valid for 30 days Chris Description Total Remove existing roofs. 16,700.00 Furnish& install aluminum drip edge,pipe flashings, chimney flashings and step flashings. Furnish& install CertainTeed Winterguard ice&water barrier along eaves and valleys. Furnish and install synthetic underlayment over existing deck. Furnish and install Lifetime CertainTeed Landmark 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. Lifetime 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. A Certainteed Surestart plus warranty will be included with a fee of$760.00 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. Customer is responsible for securing interior items and any attic debris fi-om roof removal. Total $16,700.00 TERMS OF PAYMENT 5%Deposit Balance upon completion Customer Signature Registration 9 126235 Construction License#074334 Date Insured by Banas&Fickert Ins. (413)527-2700 Office of Consumer Affairs& Business Regulation License or registration vaua for inuivium use umy DME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: T26235 Type: Office of Consumer Affairs and Business Regulation 0qegistration: xpiration; 5/6/2016 Partnership 10 Park Plaza-Suite 5170 Boston,MA 02116 R.C.I, ROOFING MARK DELISLE 6 LINE ST SOUTHAMPTON,MA MA 01073 Undersecretary Not valid without signature y �.C)IUIM©NWEAL�1�-I'OF MASSACHUSETTS � Massachusetts - Department of Public Safet ° "'' • o :o e o Board of Building Regulations and Standards SHEET METAL. WORKERS Cunsrruction supern'isur AS A MASTER-UNRESTR9CT ;'J ! License CS-074334 ,€ ISSUES THE ABOVE LICENSE TO. MARK T DELI)LE MARK T DELISLE 33 FIRST Avie EASTHAMA ON# 071 0 ' 33- -FIRST AVE EASTHAMPTON MA 01027- 181 Commissioner Expiration 13276 05/28/16 15588, 1 05/03/2014 e o m e Fold.Then Detach A16ng All Perforations OSMIA 0 0 13& T8. U S`D4parlment Oh1;aE>pr OccupahonahSafety Ind Meaith Atl ministration Man'k T. llal; s1e: J188 8u099sslQIiy;c0m0idt0d a 1N,)6u.r Qccupatlonal:Salety and-Meal(F Treining.C)ourse in' CbnstNot jori,$ fe &:Wealth (rrtiiner) (Date) The Commonwealth of Massachusetts Departtent of Industrial`Accidents Office of Investigations d 600 Washington Street ` Boston, MA 02111 mm,mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians[Plumbers .pplicant Information Please Print Le ibl Iame (Business/Organization/Individual): L,` �d0�-�� 0,0..E tddress: ;ity/State/Zip: ,��-�, �� , tea, o�0-7 3 Phone #: (q3) 4-1 -CO T5 re you an employer? Cbeck the appropriate box: Type of project (required): _9'11 am a employer with Z 0 4. ❑ I am a general contractor and I I 6, ❑ New construction employees (full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed ou the attached sheet. $ ❑ Remodeling I 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 11,7 Plumbing repairs or additions myself [No workers' comp, c. 152, §1(4), and we have no 12, Roof repairs insurance required.] t employees. [No workers' 13.7 Other comp, insurance required,] Ji iy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: :)meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit utdicating such, ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' comp,policy information. rn an employer that Is providing workers'compensation insurance for my employees. Below is the policy and.job site 'ormatiom urance Company Name: licy#or Self ins. Lic, #;� QlA?)q o S Expiration Date: I O • S - Site Address: Oq ,y rk- �"ac\S f_,, City/State/Zip;c�tx MA 0 t o(,Z 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 ve.stigations of the DIA for insurance coverage verification, to hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct: gnature: 5- 1 (4 -114 Date' tone Official use only, Do not write In this area, to be completed by city or town official, City or Town: Permit/License # 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 #: SECTION 8 -CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable O Mel e � (n Name of license Holder: M zy'k i q 3 3 4 License Number �.Lne_ `L_3 M 5A Address Expiration Date 5 2q- Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable O Roo s nQ b 35 C mo pany Name Registration Number Expiration Date �,�!U.'L.C7 am O on —MA. o I Q�� Telephon SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§26C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result rn the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... 4Z No...... 0 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-gets sus 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 shaD be responsible for all such worl:performed under the building nermit. 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. .,\Iso 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 2#,taehPd 1 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) : — New House Addition Replacement Windows Alteration(s) Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [p] Other(0] Brief Description of Proposed }. (?17 t Work: d 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 fallowing° 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 BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I' W VA " .t cAo' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this"building permit application, at.t a ched S 1 I I - III Signature of Owner Date I' as zut6y'rfeJ Ziqitnt as Owner/Authorized Agent hereby declare that the statements and information on the foregoing and belief. Jblication are true and accurate, to the best of my knowledge Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date Section 4, ZONING AU Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Propos�d- Required by Zoning This column to be filled in by Building Depamnerit Lot Size Frontage Setbacks Front Side U Rear Building Height Bldg. Square Footage % .Open Space Footage % (Lot area rninus bldg&paved #of Parking Spaces A. Has aSpecial Permit/Yahanco/Finding ever been issuedfor/un the site? ` NO 0 DON'T KNOW 0 YES 0 ' > |F YES, date isaued:| / ' IF YES: Was the permit recorded at the Registry ofDeeds? NO ~ DONTKNOY 0 YES 0 IF YES: enter Bnok � Pagp}| ( and/or Document #� ' � | ! B Does �h� site contain a brook, body of NO /r-� DON7 KNOW �-� YES /-� B. ' *�� -� «+-� IF YES, has permit been or need to be obtained from the Conservation Commission? Needs tnbeobtained /�� Obtained y~� , Date Issued: `—^ `~/ � C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe type location: ! ' ' ' i D. Are there any proposed changes toor additions of signs intended for the property 7 YES ��~� NO �~�� IF YES, describe size type and location: ' ' � | | E Will the construction activity disturb(clearing,gradingexcavation, nrfiUing)over 1 acre mis it part ofo common plan that will disturb over 1acre? YES �^_,3 NO �x_x 1 IF YES,then a Northampton Storm Water Management Permit from the DPVVia required. Department use only U IJ� II City of Northampton 'Status of Permit: Building Department 'Curb Cut/Driveway Permit FMAY 15 2 014 212 Main Street 'Sewer/Septic Availability Room 100 Waterfflell Availabilit, El�ctric, Plumbing&Gas Inspections Northampton, MA 01060 Two Sets of Structural Plans MA 1,11.06Q FTTVrr1:413-587-1240 FaX413-587-1272 Plot/Site Plans [Other Specify_ L APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 11 PropertV Address: This section to be completed by office A)C)C-� Map Lot Unit A Zone Ove rlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/ALITHORIZED AGENT 2.1 Owner of Record: (,/V\ Q�0, 0 0 Of rx(-e— kk,% 0 Z.. Name(Print) Current Mailing Address: (91_ I 3,Lt j,? _�') 5,,g q att-ache-A Telephone Signature 2.2 Authorized Agent: M;Ivh .1 0.1�Aj P, - J?Cofi nrl L iag-siz Name(Print) Current Mailing Address: 0101-8 , ;� - J4 115 ( q 13) 5 21 Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (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) 0 a Check Number 03 This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 208 NORTH FARMS RD BP-2014-1206 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 12-034 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category: ROOF BUILDING PERMIT Permit# BP-2014-1206 Project# JS-2014-002041 Est.Cost: $16700.00 Fee:$35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft.): 106155.72 Owner: VIOLA JAMES&NANCY WHALEN-VIOLA Zoning: Applicant: RCI ROOFING AT. 208 NORTH FARMS RD Applicant Address: Phone: Insurance: 6 LINE ST (413)527-4775 Workers Compensation SOUTHAMPTON MAO 1073 ISSUED ON.511612014 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 Sivature: FeeType• Date Paid: Amount: Building 5/16/2014 0:00:00 $35.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner