44-106 i
387 ROCKY HILL RD BP- 2011 -0764
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map-Bloc 44 - 106 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP-2011-0764
Project# JS- 2011 - 001260
Est. Cost: $12300.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 65775.60 Owner: MALINOFSKY LEON W JR & TERESA HODEL MALINOFSKY
Zoning: SR(100) Applicant: RCI ROOFING
AT. 387 ROCKY HILL RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON :312412011 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 3/24/20110:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
RE � wED i ry of Northampton Stillh ofa
4 lot 11ding Department Curb`C �
2 12 Main Street
Room 100 �1!ViC
�� 1Np INS
oFeu Northampton, MA 01060.
phone 413- 587 -1240 Fax 413 - 587 -1272 010 tii�b"
Other�S
APPL.:CATION TO CO NSTRUC T, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING I
SECTION 1 - S,TE INFORMATIO
This section to be completed by office
Map Lot Unit,_,__ I
i
��pc �� L ��� • L \Olo Z' Zone Ove tay Distric
Elm St. District CB Dk trlct
SECTION 2 'ROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name (PnnQ Cuj_e to ng Address:
Telephone
L7 S - i g nature
2.2 Authorized Agent:
it I � r � • _ �
:gam (Print Current Mailing rots: 0 U`t.
I Sig nature Telephone
SEC 3 ESTIMATED CONSTRUCTION COSTS
Estimated Cost (Dollars) to be Official Use Only
comp leted by rmit applicant
(a) Building Permit Fee
Electnca; (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Rre Protect i o n
S. Total = (i -2+3+4+5) 2 00 Q o Check Number
This Section For Official Use Onl
i Date
SoElding'Pem Nu Issued:
Signature: - - --
BuIlding CommisalonerAnspector of SuAdings Dd* !
SE ction 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
1: 'sting Proposed Required by Zoning
This column to be filled in by
Building Department
S,;hacks Front
I ,
Side
Rear
' 13 ,ilding (ieight � - j
j !3 ;1g. Syuerc i�wtagc %
U' ,cn Space Footage %
L n arca minus hidg & paved
is kmi;?
i ;ukin14 S paces
�—
I
, ,iumc fi Ij)CdUDn
Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO O DONT KNOW O YES O
IF YES, date issued:;
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Paget I and /or Document N
_ _ I
I,. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O 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 0 NO O
IF YES, describe size, type and location: �!
D are there any proposed changes to or additions of signs intended for the property ? YES O NO O
IF YES, describe size, type and location: ?
E Will the construction activity disturb (Gearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable
New House Addition Replacement Windows t Alteration(s) Ei 7goofing
Or Doors ❑
Accessory Slag. 1 Demolition ❑ New Signs (0] Decks (❑ Siding (pj Other (C7}'
S,`ie' Descnl) )n of Proposed 'q t tov
i
�,teration o' u,istmg bedroom Yes No Adding new bedroom Yes No l
+ttac7ed Narr,!Iive Renovating unfinished basement Yes No
?tans Attached Roll - Sheet
oa. If Nevv ho use and or addition to existing housing, complete the following: r
use of iimq One Family Two Family Other
,Ljmner c rooms in each family unit Number of Bathrooms .�
;. ;here a arage attached?
d. Proposee Square footage of new construction. Dimensions
e. Numbe c' stories?
Methoc o: ')eating? Fireplaces or Woodstoves Number of each
Energy C. ,servation Compliance. Masscheck Energy Compliance form attached? i
Type of consti ,ction
I
:s constn:;,ior within i 00 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
Depth cat tasement or cellar floor below finished grade t
VJitl b,a;dir:y conform to the Building and Zoning regulations? Yes No.
Septic Tack _._ City Sewer Private well City water Supply
SECTION 7;) - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i
as Owner of the subject
propr.rty
hereby authori;:s •
to act or, my bE half, in all matters r4lative to work authorized by thislouil permit application.
attac�hPd 'Val - 11
;gnatui "of Owner Date
_ e� t �P �an au t�IpY'1 ao�' �']t .s Owner/Authorized
ger hereby c dare that the statemennforma tion on the foregoing aa�� lication are true and accurate, to the best of my knowbdge
and belief
Signed under tr.e pains and penalties of perjury.
Print Name f
1 Sign ature of Own ,r; . i, ent Date 11
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licenser, Construction Supervisor Not Applicable ❑
!Jame of Licon Hol M 4•
License Number
Address Expiration Date
1 Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable ❑
nQ 26
Company N ame Registration Number
ocrC„ Expiration Date
�;4yn Qn M a, Q L Q2 Telephon6J3 L7
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 26C(6))
',Norkers 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 Afficia Attached Yes... .. �z No..... O
11 - Home Owner Exemption
cur cnt exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (1) or two(2) families
to alio%- such homeowner to engage an individual for hire who does not possess a license, proylded that the owner acts
u t1Cr? i sor. CM 780 Sixth Edition Section 108.3.5.1.
)e5nition of Homeowner Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there
>. x i� intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
.arcs. A r)erson who constructs more than one home in a two -year period shall not be considered a homeowner
h homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he/she shaU be
rc for all such work performed under the buildinr*_ permit.
A; :acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
,:anpletion of the work.for which this permit is issued.
•v ,,o be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
!:r. ployces for injuries not resulting in Death) of the Massachusetts General Laws Annotated, You may be Ilabk for person(
hire to perform work for you under this permit.
undersigned " homeowncr" certifies and assumes responsibility for compliance with the State Building Code, City of
t'nampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws tated.
Homeowner Signature �C�e�
A P Common wealth of Massachusetts
—� Department of Industrial Accidents
i.-
Office of In vestigations
?� 600 Washington Street
Boston M, 02111
www.tttass.gov/dia
\� uncCrs Compensation Insurance Affidavit: Builders /Contractors /Electricians /Pluiiibers
, \pplical;t information Please Print Legibly
Phone
err sou tin rutployer'.' Check the apps opriate box: Type of project (required):
i ,tnt .::,ntl.h - with 2 4 • [] I am a general contractor and l
part - time).'
have hired the sub - contractors 6. [] New constniction
cnlplo, ccs Gull and /or I
,__� I ;tn: a >�,;e proprietor or partner listed on the attached sheet. 7. ❑Remodeling
slily , hl tic no employees These sub- contractors have g. E] Demolition
employees and have workers' t
��.lrkiu�, ftar me ill any capacity. ). [� Building addition
romp. insurance comp. insurance.-
5. 7 We are a corporation and its 10.0 Electrical repairs or additions
i
i and ., ?ltuneo�s ncr doing all work officers have exercised their 11.0 Plumbing repairs or additions
j No workers' comp. right of exemption per MGL 12.Fy Roof repairs
c. 152, §l(4), and we have no
employees. [No workers' 13.7 Other .___ ____
comp. insurance required.] J
' \n.Vil,l t' IX),'( a 1 must also fill out the section below showing their workers' compensation policy information.
i o suhmit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new aflidavit indicating such.
„r;, a.tt i� thai ; i,cck this N,,N must attached tai additional sheet showing the name of the sub - contractors and state whether or not those entities have
ph c_s. Ir thy soh- uuttractors have employees, they must provide their workers' comp. policy number.
,so =
t urrr « n etrploYer that is providing workers' compensation insurance for my employees. Below is the polio and job site
_J
rrJ��nrtution.
2J 4515. ------- �. .S?7__3�_ 1� - - -_ -- Expiration Date: / O -
City /State /Zip: lt %fvl� Gio Z
attach a ct,lt\ t,f the workers' compensation policy declaration page (showing the policy number and expiration date).
:lilac to :Celia ,a0VcNige its required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
I up I - x:00.00 and /or one - year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
�I t,il to UU a against the violator. Be advised that a copy of this statement may be forwarded to the Office of
I�,vestibat�.,ns ol'the DIA for insurance co verification.
! do lrereh under the ins and penalties of perjury that the information provider/ above is true and correct.
ate: �-
Phon
Ufficiu! lJ.w only. Uo riot write in this urea, to he c•ornpleted by city or town official.
City: °or 'I "wn: Permit/License
TsSU`tng Authority (circle one):
t3 „ilriinp Demirtment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
1 4 1�
rir ti7r � lc'l l)O
MARK i DEL(SLt_
33 FIRST AVE
EASTHAMPTON, MA 0102;
Olike ud l un.umrr Alkw' A� IL u.ni r, +> li r�;ulp lion
HOME IMPROVEMENT CONTRACTOR
Expiration: �b11(31� 1'a
., Ty }�c: Partnership
}ti �U I ROOFING
MANK DELISLE
o LINE ST
50UTt1AMf'T0N, YA 0 1073 1 nJrr,crrrlar�
i
Roc le Roofing
6 Line St.
Southampton, Ma. 01073 E st i m ate Date
Phone (413) 527 -4775
Fax (413) 527 -8469 10/26/2010
Name / Address Job Location
Terry Malinofsky
387 Rocky Hill Rd. 387 Rocky Hill Rd.
Florence, Ma. 01062 Florence, Ma. 01062
(413) 527 -9193
Terms Rep
Estimate valid for 30 days Dave
Job Description Total
Remove existing roofs. 12,300.00
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 synthetic underlayment 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.
30 year CertainTeed material warranty included.
All related permits :^.gill be obtained by R.C.I. Roofing.
Add $2.50 per sq. ft. for wood decking replacement if needed.
Add: $1,450.00 for Certainteed Landmark Woodscape 50 year premium shingle.
A Certainteed Surestart Plus extended warranty will be included with a fee of
($580.00) absorbed by RCI Roofing if signed within 7 days. This extended warranty
means that 20 of the 30 year warranty is covered for labor and material. The last 10
years of the 30 year Certainteed warranty would be covered for material only.
xNote* For spring 2011 installation.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $12,300.00
L
i'l?ItMSOI� PAYMENT
� "G I)clx �
13,ilancc ul>un cumplciiun
Kc islialinnit I'(i?�'? Customer Signature
Cowl lruc(io n I.icensc ft 074334
Insure! I). Kales,A Fickcri Ins. Date U z7 �d
4I.� -5?7 -2700