17C-239 Roofing,.,,
51B Holyoke Street
P.O. Box 309 Estimate
Easthampton, MA 01027 Date
Phone (413) 527-4775 3/18/2009
Fax (413) 527-8469
Name/Adcress Job Location
Ron White 117 North Main Street
117 North Main Street Florence, MA
Florence, MA 01062 Home: 586-8946
Cell: 537-0640
Terms Rep
Estimate valid for 20 days Rich
Job Description Total
ESTIMATE IS FOR HOUSE AND GARAGE. 14,500.00
Remove existing roofs.
IFurnish & install 1/2" plywood over the existing decking.
Furnish & install aluminum drip edge, pipe (lashings, chimney flashings and step flashings.
Furnish & install new lead counter flashings.
Furnish & install CertainTeed Winterguard ice and water barrier along eaves and valleys.
Furnish & install synthetic underlayment.
Furnish & install 30 year CertainTeed Woodscape Series shingle.
1 Furnish & install CertainTeed approved ridge vent.
Furnish & install .045 re-inforced rubber roof system on flat roof section.
j All exterior roofing related debris to be removed by R.C.I. Roofing.
5-Star CertainTeed 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.
I
I
i
1
i
I
THE OWNER HAS THE RIGHT TO CANCEL THE CONTRACT WITHIN (3)
THREE BUSINESS DAYS OF DATE OF SIGNING. Total $14,500.00
I F,RMS 01= PAYMENT
I ;110 Deposit `
Balance upon completion Customer Signature
4 Registration r, 126235
Construction License 4 074334 Date
Insured by Revnolds. Barnes& Hebb, Inc.413-447-7376
ttnM PTO /(
2 L\
Df
Wart 11allip tail
J w iH
c� DEPARTMENT OF BUILDrNG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WOPUCER'S COMPENSATION INSURANCE AFFIDAVIT
_S-Mark led*i S 1 e of R C T R
(licenscrJpermittcc>
V,r,:h a principal place of business/residence at:
Jt- (phone# -Ji#7 7!5
strrctic ty/stalrJrip)
c /her(Jby cer-tiry, under the pains and penalties of perjury, that:
1 ism an employer providing the following worke's compensation coverage for my
el:Inlov ees word ng on ties job:
Natio'n2l UniAn Fite-
CO. Of f'ittsburg PA WC3631768 10/05/09
CZ-Trance Company) (Policy Number) (Expiration Date)
� ) I r--n a sole proprietor, general contractor or homeowner (circle one) and have hired
L .e con'i-actors listed below who have the fokwing worker's compensation policies:
of Contractor) (Insurance Company/PoUcy Number) (Expiradon Date)
(N=C of Contractor) (Insurraucc Comparry/PoGcy Number) (ExpiradonDate)
(Name of Contractor) (Insurance CompanylPoky Number) (Expiration Date)
(Name of Contractor) (Insurance Company(Policy Number) (Expiration Date)
ud additional sheet if nrcusary to include information pertaining to all ooarndon)
a sole proprietor and have no one worlting for me.
I am a home owner performing all the work myself.
NOTE:plc-se be aware that w iUo homeowom who emplay pc==to do R,.i,•�masuvaioa or rcpair work on a dwelring of `
nt mccc than throo units in wb3ch the homoowocr r midcs or on the grounds appurtetrnod thetdo are not Cco ri4 ooa kkred to be
c:tployc:3 under the wor're,muVcas4ca Act(GL152,r-1(5)1,appticadon by a homcowna for a bcente or permit may evidence the
cS;A ctatua of an omployee under tho Workoea Compomation Act_
I uaiC, u d that x copy of this rtatcmcnt may be forwnrdod to the D"rtmcot of lMu hial Ao6den&Moe of lmrxanoe fordo
'�;ovcragc vc it C iioo and that failure to coatrc oovangv trader soaion 25A of MOL 151 can lad to tk itttpoaitioa of aWW penai$a
'Omit:.-tg of a f oc of up to:1,500.00 and/or imprtsoamc�of up to one yur and dQ ptaatties in the fa-of a stop Work order and a
t of�100.00 a day a&.inst mw
For dT=W= l taco only
Permit Number
P7-0 )&p# Lot N
r t Signature of LicmZMTJ crmittec
OP . .It
SECTION 8 -CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: �Q1 Not Applicable ❑
Name of License Holder: i -t(S e� - 1-7g ,334
License Number
5)
Munhe- St- Easth me T lon . Ma. o ona - - - 10
.ddress — Expiration Date
1
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
- U- 1. Rf)6w 126235
Company Name J Registration Number
519 1duoke St irmt - P D• Bax_ 309 - 10
Address J
} ^ n Expiration Date If -Eastharn oldrA . a. o i Q e`.7 Telephon
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 deniai of the issuance of the build g permit.
Signed Affidavit Attached Yes....... 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 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
tnrctures. 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.lbr which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
l mployees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
�.ou hire to perform work for you under this Hermit.
ti he undersigned"homeowner"certilies and assumes responsibility for compliance with the State Building Code,City of
\orthampton Ordinances.State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
A
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House Addition Replacement Windows Alterations) E7ftofing
` Or Doors M
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [E] Siding[p] Other[0]
Brief Description of Proposed _
Work. XVI) 1562,010
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?
I h. Type of construction
I
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 bui ding conform to the Building and Zoning regulations? Yes No .
I. Septic--ank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN _T
OWNERS AGENT O !N R CONTRACTOR APPLIES FOR BUILDING PERMIT
'Ronald- !UL e, as Owner of the subject
property
•
hereby authorize Boof;na
to act on my behalf, in all matters relative to work authorized by this building permit application.
a .tae�e_d _1- 17-bq
Signature of Owner Date ONE
I, Nzyk Me'(sly.. a5 autr y rrrA -aQent as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing ai6blication are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
�,�lnl •
Print Name
X1 .17-aq
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
I.)t Size
Frontage
Setbacks Front
Side L:_— _ R: L: R:
Rear
Building Height
Bldg. Square Footage 'No
Open Space Footage %
(lot area minus bldg R paved
pa;rkine)
€of Parking Spaces
Fill:
0 olumc&Lpcation)
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 O DON'T KNOW O YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q. DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q Date Issued:
C. Do any signs exist on the property? YES Q NO 0
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 Q
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 0 NO 0
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
Room 100 Water/Well Availability `
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
r—
SECTION 1 -SITE INFORMATION
1.1 Propertj Address. This section to be completed by office
117 Xodk Maain 6tyieet Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
'Ronald l�] fie. �7 I�o.� a�n tSt. I F�bYeC1,G�
Name(Print) Current ailing Ad ress
e Telephone
Signature
2.2 Authorized Agent:
M;1 162 Roofina U,&131)9 - East j mnton, a.
Name(Print) Current Mailing Address: 0107
�-� ( 113) 527- 775
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building oOr+ 500.00 (a) Building Permit Fee
2. Electricai J VlJ (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) 1 00, Check Number 131 3S
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
117 NORTH MAIN ST BP-2009-0866
GIs#: 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-2009-0866
Project# JS-2009-001269
Est. Cost: $14500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING
Lot Size(sq. 1): 8363.52 Owner: WHITE RONALD G&ELIZABETH A
Zoning.URB(100)/ Applicant: RCI ROOFING
AT. 117 NORTH MAIN ST
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527-4775
EASTHAMPTONMA01027-0309 ISSUED ON:412412009 0:00:00
TO PERFORM THE FOLLOWING WORK:ROOFI N
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 4/24/2009 0:00:00 $35.0013842
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo