36-266 R • Esti mate Date
Southampton. Ma. (11073 7/6/2011
Phone (413) 527 -4775
Fax (413) 527 -8460
Name / Address Job Location
Judy Steinberg 223 Maple Ridge Rd.
223 Maple Ridge Rd. Florence, MA 01060
Florence, MA 01060 586-0553
Terms Rep
Estimate valid for 20 days Chris
Description Total
Remove existing roofs. 26,500.00
Furnish & install aluminum drip edge, pipe Ilashings, chimney (lashings and step 'lashings.
Furnish & install new lead counter (lashings.
Furnish & install CertainTeed Winlerguard ice & water barrier along eaves and valleys.
Furnish and install synthetic underlayment over existing deck.
Furnish and install 30 year CertainTecd Woodscape Series shingle.
Furnish and install CertainTeed approved ridge vent.
All exterior roofing related debris to he removed by R.C.1. Roofing.
All work will he performed according to new OSHA 6/15/2011 standards
All work will be performed according to manufacturers' specifications.
30 year CertainTced material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Add $2.50 per sq. 6. for wood decking replacement i1 needed.
A CertainTeed Surestart plus extended warranty will be included with a fee of (51,200.00 )
absorbed by RC1 roofing if signed within 7 days . this extended warr means that a 20 of the
3)) year warranty is covered for labor and materials last 1(1 years of the 30 year Certain'Cced
warranty would be covered for material only.
Recover price $18,000 no Surestart warranty.
WE LOOK FORWARD TO DOING BUSINESS WITH YOU THIS SUMMER.
Total 526,500.0))
TFRMS OF PAYMENT
44, Deposit g
Balance upon completion Customer Si nature
Registration # 126235
Construction License # 674334
Date
Insured by lianas & Fickcrt Ins.
(413) 527 - 270(1
-1' 1 he Commonwealth of Massachusetts
Department of Industrial ,Accidents
�.�
�' m' Office of Investigations
i =" i:1 600 Washington Street
k Srzt : E. 7 r( Boston, MA 02111
4.. ` 7'
t,„.,.1
`Lf r WWW. mass.gov/iia
Workers' C0111 I n satiOit 111st/ranee Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant information Please Print Lejibly
!Nai11C utcss- Y)r ttion /lndividuul): �l 1,,\
Address: (/.., ` "-\ Y� e —
city'Stateui ): - A1 j
Lrc you sa employer? Check the appropriate box: Type of project (required):
: j 1 ant rt emplove.r with 2.0 `t. ❑ 1 am a general contractor and 1
employ eca ('lull and /or part lintel.'
have hired the soh contractors 6 . ❑ New construction
L] I am a sale proprietor or partner
listed on the attached sheet. 7. 11 Remodeling
ship ;ut ;i have no employees These sub - contractors have 8. ❑ Demolition
worki;o.1 Cor me in any capacity. employees and have workers' 9
11 Building addition
( No vcor kern comp. insurance comp. insurance.:
5. We are a corporation and its 10.0 Electrical repairs or additions
required . p
I L._i I ant a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
1 ntvseli. No workers' com right of exempti p er MG i, P
{ Roo f repairs
insurancc requn - odd r e. 152, §1(4), and we have no
employees. [No workers' 13.❑ (Other
comp. insurance required,) _____ —_--_ _
' 111;, applicant (hat checks tux 4 i must also till out the section below showing their workers' compensation policy inronnution.
iu;neu∎, to , 110 submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating suck
ouracu> th:u check this box H attached an additional sheet showing the name of the sub- contractors and state whether or not those entities have
employees. II" the sub - ntrxtctors have employees, they must pr their workers' comp. policy number.
I airy WI employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
in jornuation.
inst,rrnec Co:npany Nante:_ �.. Q C-C\- sti C..c.,,. • - 3:- J
lie rr of ti Il ins. I_ic. t ;:U( C _
Q3.5 _ Expiration Date: _ O 1 Q 0
ioh Site Addr::ss:Z 3 (Acs \.C. �. v . /2\ � & • City /State /dip \nCrfl- ?C ..e��
Attach 0 coley of the workers' compensation olicy declaration page (showing the policy number and expiration date).
allure 10 secure coverage as required under Section 25A of MGl_, c. 152 can lead to the imposition of criminal penalties of a
Hue up to S and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
or up to S'2Su 00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
Ittvcstigations of the DIA for insurance coverage verification.
4 / do hereby c crrtijv under thc and penalties of perjury that the informnation provided above is true and correct.
S. i _ _ _ _ _ - ----Date; __ — .7_ --_
Phone ti: (.t3_ -:1 Lk1 5 —_ ____----
f1
1 Official u.ic onfr. Do not write in this area, to be completed by city or town official.
Gtt ' or Town: Permit/License 14
Zss t`n`g Authority (circle one):
WBOard of Health 2. Building Department 3. Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
60,:ther
G:'c r Pierson: Phone #:
SECTION 9 - CONSTRUCTION SERVICES j
Licensed Construction Supervisor; Not Applicable C1 }
- e 1 I G, , , 111 r7 "7 I-11 3/y}try)
Holder M �Y - e. � l 1- -! l/ -- -- - -- - -- -_. _.- -- - -__ _--- - - - ---- 1__..l_ 1�.[_LL 1._ - -- --
License Number -- I
Address Expiration Date
-- - - - � - ' � 13) 5 Q _ _ _ _ _ _ ,nature Telephone
9. Registered Home Improvement Contractor: Not Applicable
Company Name Registration Number
I Expiration Date
`�, rc . :ao M -- — -
••+ 1�.Tti rn'�_Qn_ - 1 � • C teieprronee 1 3)527- 71.5
— — -- — - - ^v — t
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
\Yorkers Condensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will reautt
the denial of the issuance of the building permit.
Si„ned + "ic;�.it Attached Yes No -_ ❑
1 1. - Home Owner Exemption
current exemption for - homeowners - was intended to include Owner- occupied DwslllfEs of one (1) or twt)(2) families
try allow such homeowner to engage an individual for hire who does not possess a license, prbvidsd that the orf'ner Acta
super CiMR 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
.0 is intended to he, a one or tvvn lamily dwelling, attached or detached structures accessory to such use and/ or farm
awes. A person who constructs more than one home in a two-year period shall not be considered ,It hom44R•Dcr•
- homeowner - shall submit to the Building Official, on a form acceptable to the Building Official, that ho/ :he shim be
rc,I onsible for all such work performed under the building permit.
acting Construction Supervisor your presence on the job site will be required from tin to time, during and upon
,:r.npletion of the work.tor which this permit is issued.
be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
,:, for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you pt*Y bS ltabk for persona)
you hire to perform work for you under this permit.
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 att aahe�
,.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House li 1 Addition 1 1 Replacement Windows Alteration(s) Roofing 56
Or Doors I]
Accessory 51:1g P1 Demolition 1 1 New Signs [CD] Decks [E] Siding [pi Other (CA' -
Brief Descrip' )n of Proposed ai tanbP�
'Work l
Alteration of existing bedroom Yes — No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
Oa. If New house and or addition to existing housing, complete the following:
a Use of b HIding One Family Two Family Other
Number c • rooms in each family unit - Number of Bathrooms
Is there a Itarage attached? • -
i
d Proposec Square footage of new construction. Dimensions
e Numbe o: stories?
Method cf heating? Fireplaces or Woodstoves Number of each
q. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h Type of construction
Is construction within 100 ft. of wetlands? Yes - No. Is construction within 100 yr. floodpiain Yes No
Depth of basement or cellar floor below finished grade
K . Will budding 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
, as Owner of the subject
property
Q
hereby authori:'e Mar e.\ l S, P QT j ` 1 ei. I Roo1
to act on my behalf, in all matters r lative to work authorized by this u ding permit application. 9
a.ta che_d • 1 -4 s -
Si Owner Date
l • ' ` • • ' I . I ,o , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing - .•lication are true and accurate, to the best of my knowledge
and belief.
Signed under tie pains and penalties of perjury.
. °aY� 1! S
Print Name
Signature of Owner /Agent Date
`
Section 4.
.
.
ZON|NG Au information Must Be [omv�"u. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Kcqui�dbyZoning `
This column m,em|cuinx'
[--
Building Department � I �i
i.`: )\/z ` l. |
______
|i \
[xw��� '
1
Setbacks Front )
` /
'
Side I.: R L
�� � �K:| � | i |
/ i
Real
B i|di |{ ��� ' '
/ n& u ! | i ) `
8 dg. Square Footage �* �
� !
' I
, �
Vso Space F^ouGc m
x`i"m" =.""`wog &,"~a � � . �
_ua.'t:Iry ,
� i ■
x ,{ Px,king8nu�c ,
ST aces .
./
HI: ) {
\,�ume ,1/o"*=0 - � : |
A Has a Special Permit/Variance/Finding ever been issued for/on the site?
0 �� 0
NO \�/ DON7KNOYY \�� YES \~�
IF YES, date issued: |
IF YES: Was the permit recorded at the Registry of Deeds?
�� 0 ��
NO DONT YES \~� ' \`-/ �~�
| —
IF YES: enter Book . Page | and/or Docun�ent 4\ '
^- ------- '
B. Does the site contain a brook, body of water or wetlands? NO �~ �� � DONT KNOW �_ �� � YES �~ ��
�
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained y—� Obtained /�� Da�e\usuad�{ - |
x�� \�� ^ � i
C. Do any signs exis �� �on the YES ��� NO �~ ��
�
IF YES, describe size, type and location: �
_ ___ _______ ___________ ______
D. Are there any proposed changes to or additions 0! signs intended for the property ? YES 0 NO 0
_ '����
IF YES, describe size, type and tocation: |
� ��������� 1111
E Will the construction activity disturb ( ring. grading, vuhon, or filling) over 1 acre or is it pari 01 a common plan
that wfl disturb over 1 acre? YES[ l NO � l
�� ��
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
t
City of Northampton Sta'ttis of = - "''
SA ? 14411 a : uiIding Department Curb C �' '' ,
Main Street sewer � , , . v "° �' %' `,1
>ep� 212 Mi S • dF ` r'" R oom 100 Wit 43 I '„ °'� ' p
! t ,
�� Northampton, MA 01060 T c,.. '" `t , {
phone 413 -587 -1240 Fax 413 -587 -1272 PIoVSk r R
.,: i �rr. ( t 47 . , a `• #..-
--` Oilier SpOGl It l. t" : i t�dti � � a",�+r : i °! , it e : I i :. • �.„, ,
APPL CATION 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
2_.m M o e l f.. Qlic\q`tr. � .- . Map . Lot Unit
C, " � c `Nc �` J Zone Overlay District
Elm St. District Cli District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
��n.y �e .tN\csC.C Z2,3 fllc,..O. . ikac e%, . Cc\ bCc(4. t. tea,- Gk bt.>2_
Name (Prtlit) Current Mailing Address: J
a LL Ott •S8 ,, -o.SSa
Tel ephone
Signature
2.2 Authorized Agent:
N ayl � . � !e1 - f.e.z. f oofl 4. _ • - • _ ..... •
Name (Print) J Current Mailing • ddress: O 1 0`13
i--- �-----...-- (q13) 521. 4115
Signature Telephone
•
SECTION 3 - ESTIMATED CQNSTRUCTION COST$
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building }i,o0fl a Soo ." c: :: , (a) Building Permit Fee
2. Electrical 1 (b) Estimated Total Cost of
Conatrv.ion from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5 5:Fire
Total =
(1- $ o o 1 , 35
6. Total= (1 +2 +3 +4 +5) �(0 5 Check Number /4J P'
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature: _._
Building Commissioner/Inspector of Buildings Do
l
t� j
Y 3
223 MAPLE RIDGE RD BP- 2012 -0113
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 266 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: roofing BUILDING PERMIT
Permit # BP- 2012 -0113
Project # JS- 2012- 000170
Est. Cost: $26500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 129808.80 Owner: STEINBERG JUDITH G
Zoning: SR(100)/ Applicant: RCI ROOFING
AT: 223 MAPLE RIDGE RD
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMAO1073 ISSUED ON:7/29/2011 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 7/29/2011 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner