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17B-013 T. „ 0 „.... Roofinor LU' 6 Line St. Southampton, Ma. 01073 Esti m a to Date Phone (413) 527 -4775 Fax (413) 527 -8469 10/23/2009 Name /Address Job Location John & Paula Benoit 384 Bridge Rd. 384 Bridge Rd. Florence, Ma. 01062 Florence, Ma. 01062 (413) 585-5845 Terms Rep Estimate valid for 30 days Mike Job Description Total Remove existing roofs. +-8.404,04..., Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings. Furnish & install new lead counter flashings. Y -CO Furnish & install CertainTeed Winterguard ice & water barrier along eaves and valleys. Furnish & install synthetic underlayment over existing deck. Furnish & install 30 year CertainTeed Woodscape Series shingle. Furnish & install CertainTeed approved ridge vent. Furnish & install 1/2" fiberboard insulation on flat roof section. Furnish & install .045 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. 5 -year RCI Roofing workmanship warranty included. 30 year CertainTeed material warranty included. All related permits will be obtained by R.C.I. Roofing. Add $2.50 per square foot for wood decking replacement if needed. Add: $750.00 for Certainteed Landmark Woodscape 50 year premium shingle. Add: $300.00 for Certainteed Surestart Plus extended warranty (included if signed estimate is returned within 7 days). WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total -S6r;49e:-e8 -- TERMS OF PAYMENT NS C' C/0 5% Deposit r" Balance upon completion Customer Signature e......Rti,_. , a,s_v... j' Registration # 126235 Cons ruc on .tccnse 4 074334 - Insured by Reynolds, Barnes & Hebb. Inc. 413 - 447 -7376 Date k k — a3 _09 -3---cc,evt r , liTi Board of Building Regulations and Standards Constructf Supervisor License 4 ti 1; Lic4ns CS 74334 i z ' s' (2o10 Tr# 23520 5` r i MARK T DELISLE ' 33 FIRST AVE C �- V.-- `---''' EASTHAMPTON, MA 01027 Commissioner s r I N ✓/1► e scc cueale4 c f �/ka4,4 3 *-� Board of Building Regulations and Standards o`- ;' HOME IMPROVEMENT CONTRACTOR ; ! A e Registration: 126235 I ' 4 4 , „� ° Expiration: 5/6 /2010 Tr# 266063 Type: Partnership R.C.I. ROOFING MARK DELISLE 51 B HOLYOKE ST. C:;---4,--4.1"--„._ EASTHAMPTON, MA 01027 Administrator \ The Commonwealth of Massachusetts Department of Industrial Accidents ,r }_ ' ' Office of Investigations 600 Washington Street WON 61•11116 ? Boston, MA 02111 7 k=ic... www.ittass.gov /die Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization /individual) : _. 1 - Q O �\„ ,\llt(reSs: j;; ,_ \,..., \'\ �. -- Ci tv;S tit lc1ip: Phone 1#• - i`1`1 A re you an employer? Check the appropriate box: Type of project (required): 1 ( 1 ant a employe -r with 2,O 4. ❑ I am a general contractor and I employees (lull and/or part - time).' have hired the sub - contractors 6. New construction 2. ❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub- contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' ❑ Building addition 9. [No workers' comp. insurance comp. insurance.: required. J C We are a corporation oration and its 10.❑ Electrical repairs or additions I i am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions ntvselii 1 No workers' com right of exemption per MGL I 2 comp. Roof repairs insurance required.]' c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other _— comp. insurance required.] 'Any applicant Mat checks box P S I must also fill out the section below showing their workers' compensation policy information. ' tlu k % lin submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractor s that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. if the sub-contractors have employees, they must provide their workers' comp. policy number. I flirt an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: as....e. Q',k,C...,\0 tt C.. Sx +,.A..A -- 1.- n S , _____ Policy P. or S 'It -ins. Lie. a: AVU1CCA, B Q \ 35 L Expiration Date: 1 0 - 5 - a 1 0 Job Site Address: 3`34 ,`', _ � hA City /State /Zip :`Y eAc.e chQ. A .. :attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to SI,300.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a ti of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification, I do hereby certify under the • ins and penalties of perjury that the information provided above is true and correct. ,gat ti re: _ �_ Date, ` 1 t ph. --,#: e,.`1- Ln 5 Official use only. Do not write in this area, to he completed by city or town official X ,aAr 'Down: Permit/License # n # " ttot j .. Authority (circle one): 1:01 ;' rd of Health 2. Building Department 3. City/'I'own Clerk 4. Electrical Inspector 5, Plumbing Inspector f� • 1 h er ' t Phone 4: - . a rt P erson: SECTION 8 CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ M p '/+ /� /'fir I"�� /��{ /'�.�+. Name 01 Listm *cf H4tdFr Kay ay k "belts 1L� / ? 1 3 3 License Number ' • • • 5 - o 3 -10 Andress Expiration Data ' 7 5 Signature Telephone 9. Recjistered Home improvement Contractor: Not Applicable ❑ R• a. I. / ROC) f 1 126235 Company Name Registration Number _..._..�, Expiration Date a arnp1Qn Mae 010773 Tetephon, 13)5 .27.4i75 SECTION 10• WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L, c. 162, § 26C(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 ❑ 1 1. - Home Owner Exemption ( he current exemption for "homeowners" was extended to include Owner - occupied Dwellings of one (I) 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 supervisor. CMR 780, Sixth Edjtiott Section 10$,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 or is intended to he, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm ,iructures. A person who constructs more ttkan one borne in a two-year period shall not be considered a honipowpir. ,ch homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsibic 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 `ompletion 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 !:mplovees 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. (he 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 at.3C? SECTION 5- DESCRIPTION OF PROPOSED WORK check all aDallcable) New House ; Addition Replacement Windows Alteration(s) n Roofing V Or Doors El . Accessory Bldg. l 1 Demolition I 1 New Signs (01 Decks 1 Siding [Oj Other (Dj ' Brief Descr ip; on of Proposed att ch iVork Iteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Flans Attached Roll - Sheet '� 6a. If New house and or addition to existing housing, complete the foll9W#ng a Use of budding One Family Two Family Other Number of rooms in each family unit. Number of Bathrooms Is there a garage attached? i , d Proposed Square footage of new construction. Dimensions Nurnbe' of stories? Method of heating? Fireplaces or Woodstoves Number of each g Energy Conservation Compliance. Masscheck Energy Compliance form attached? Type of construction Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No , Depth c4 basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulations? Yes No 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 1 Q 0...,._ 0,. C_P- Uti , as Owner of the subject property hereby authorise t M ?Y T, si P Qf • , I . Roof 1 n to act on my behalf, in all matters r6latiye to work authorized by this ui ding permit application. 9 Sip'nttiif;f Owner Dale k . .2S au t cx L 7eri each , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing acblication are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Ma Yk << s Print Name Signature of OwneriAgent 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 l. it Size ( H ( i f _ F, ontage Sutbacks Front i 1 Side L:i ' R: 1 L:i. _ R:I.._ .._' I _ I �__ _ 1 Rear I L-__-_I [wilding Height I , , y Bldg. Square Footage % ' Open Space Footage a/ (L,u area minus bldg (t. paved perking) # _31 Parking Spaces , _ 1 I 1 Fill: ( ! (volume t.pcation) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: 1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 •. DONT KNOW 0 YES 0 IF YES: enter Book Page 1 and /or Document a 1 B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 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: C. Do any signs exist on the property? YES O NO 0 IF YES, describe size, type and location: 1 J D. Are there any proposed changes to or additions of signs intended for the property 1 YES 0 NO 0 IF YES, describe size, type and Location: E Will the construction activity disturb (ci aring, grading, excavation, or filling) over 1 acre or is It part of a common plan that will disturb over 1 acre? YES NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. City of Northampton Building Department eer ���t�; 212 Main Street . Room 100 Northampton, MA 01060 P¢y • ¢ r •tQrr r '= phone 413 - 587 -1240 Fax 413- 587 -1272 t.r C . , a!♦ 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 { Map • Lot Unit ��� zone Overlay District Elm St. District CS District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2,1 Owner of Record: Name (Print) Current Mailing Addr. . : attzeheel Telephone Signature 2,2 Authorized Aoent: R r aY + 1 it 1P� 1 ,I. CX }Ti ea * _ s• • • • Name (Print) Current Matting "drew: 0 3 (x113)521- 4115 Signature Telephone SECTION 3 • ESTIMATED CON8TRUCT1ON COSTS i Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building QOOr) 4 �-' OCR . tom) (a) Building Permit Fee 2. Electrical J 7 (b) Estimated Total Cost of Construction from (6) 3, Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection $� 6. Totals (1 - 2 +3 +4 +5) ' , Sl R t;�C�. c " 0 Check Number 1`� r" - 35 This Section For Official Use Only Date Building Permit Number. Issued: Signature: _ Building Commissioner/Inspector of Buildings Data c ' Bit 1D f'' BP -2010 -0807 #: COMMONWEALTH OF MASSACHUSETTS p :$Pock: ,17B - 013 CITY OF NORTHAMPTON t: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS unit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Itegory: BUILDING PERMIT ,rmit # BP- 2010 -0807 •oiect # JS- 2010- 001189 st. Cost: $5800.00 ee: $35.00 PERMISSION IS HEREBY GRANTED TO: 'oust. Class: Contractor: License: Ise Group: RCI ROOFING 74334 .ot Size(sq. ft.): 9408.96 Owner: LASTOWSKI PAULA M ?oning: RR(100) //RI Applicant: RCI ROOFING AT: 384 BRIDGE RD Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON:3/16/2010 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 3/16/2010 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo