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31B-073 (3) . • . • • i Roofing 6 Line St. Southampton, Ma. 01073 Estimate Date Phone (413) 527 -4775 Fax (413) 527 -8469 5/13/2010 Name / Address Job Location Zeke Rozell 151 North St. 38 Summer St. Westfield, Ma. 01085 Northampton, Ma. 01060 (413) 210 -0300 Terms Rep Estimate valid for 30 days Dave Job Description Total Remove existing roofs. 11,300.00 Furnish & install 1/2" plywood over existing decking. Furnish & install aluminum drip edge, pipe flashings, chimney flashings and step flashings. Furnish & install new lead counter flashings. Furnish & install ice & water barrier along eaves and valleys. Furnish and install synthetic underlayment. Furnish and install 50 year shingle. Furnish and install ridge vent. All exterior roofing related debris to be removed by R.C.I. Roofing. All work will be performed according to manufacturers' specifications. 50 year material warranty included. All related permits will be obtained by R.C.I. Roofing. WE LOOK FORWARD TO DOING BUSINESS WITH YOU. Total $11 ,300.00 TERMS OF PAYMENT 5% Deposit f "� Balance upon completion z/ 7 Registration # 126235 Customer Signature - - - Construction License # 074334 f Insured by Banas & Fickert Ins. Date c/ ! 413 -527 -2700 - Ni.t....ftliti..c■IN Dc/i,ii iinciii ,,I l'iikli■ ss,ilci \ \,,,_ 13n.tctl ill Itinliiiii:.! License CS 74334 Restricted to. 00 . . MARK T DELISLE 33 FIRST AVE EASTHAMPTON, MA 01027 `I , Lyildlimi 5/3/2012 --- i "imei.,1".•1 Tr 26357 . 7;ie (y,,,, I , / '• l(,,,,,/t,,,,,,/,',J, ()nice of Consumer Affairs S. Business Regulation HOME IMPROVEMENT CONTRACTOR 4,1.t Registration: 126235 Expir ation: 5/6/2012 Tr# 293949 r, . r„ ■ Type: Partnership R.0 I. ROOFING MARK DELISLE 6 LINE ST SOUTHAMPTON, MA 01073 Imtlerserretary The C . . o mmon wealth of Massachusetts Department of Industrial Accidents 1 . t Office of Investigations � �r . � • r 600 Washington Street =� ' �1 Boston, 1/1/1 02111 , 't�" `-5`: w w w. mass.gov/dia Workers' Compensation insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant information Please Print Legibly N 03nstncss Orpniiation /individual):, __.% Q 0C L \- Address: \,,,,_\ , , , 1 . __ _ Lit\,'Stinc/ il): _._, »•. ,..,__-- _•__V•a___.____�__ Phone #: e, - LA1`l5 :\.rc you an employer? Check the appropriate box: .l Type of project (required): 1. 1 ,tin a employer with 2.0 4 . 1 am a general contractor and I emphr;ees (mull and /or part - time)." have hired the sub contractors 6 . n New construction ' L__] i am a sole proprietor or partner- listed on the attached sheet. 7. 1 Remodeling ship anti have no employees gees These sub - contractors have 8. 1 F } [] Demolition working for me in any ca p )acity employees and have workers' insinsurance.: t9. 1 Building addition 1No cc,rrkcrs' comp. insurance comp. � We are a corporation required. i 5 poration and its 10.0 Electrical repairs or additions t I . i am ;t homeowner doing all work officers have exercised her 1 I .❑ Plumbing repairs or additions 111 Sel i No yvorkers' comp. right of exemption per MCA. 12, S311 oof repairs insurwtce required.] ` C. 152, §1(4), and we have no employees. No workers' i 5.❑ Other — i ____ - _ —_— comp. insurance required.] \n■ ;rpplicatu is :ha checks box u1 must also till out the section below showing their workers' compensation fwlicy information. i hmx:owncr ho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. - t_ ontraitors that .heck this ixox Hurst attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. it the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site rrr%ornrution. insurance (:tr:npan■ Nante:_ace. Y-ctvt t"\ 1., _C,_c.a -\ .�- n f'rrlrt. x r err tic it‘-ins. Lie. o: ALw ..._ LLA. '' Q '' . ,5--1, Expiration Date: / 0 - S - a 0 1 0 fob sit Addr $ skiL mrne-r ■\-- Cit /State/Zip.,kr- + t -tu g 41660 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to sec.tre coverage as required under Section 25A or MGL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1 ,X00.00 and /or one -year imprisonment, as well as civil penalties in the iorm of a STOP WORK ORDER and a fine or 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. / do hereby c crtijv under the ins and penalties of perjury that the information provided above is true and correct. ti ), ----- — -- _— Date: ~1 l'hon' i (_ 2 )' .. ) ,57_,.`1 - LA-1-1 s I Official use only. 1)o nor write in this area, to he completed by city or town official. Cittor '1'cr' n: Permit/License q iss uln'g Authority (circle one): 1'agoard of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector . 6,OLhcr f..1i' .., o..r.,)n: Phone a: SECTION 8 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: Not Applicable ❑ Name of Licen:;e Holder Yk , N fi e. '77L1 334 License Number • ti " O a • s.h s -• u . • • 5-03-10 Address _ Expiration Date (413)5�� -x'175 Signature , Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ • 126235 Company Name Registration Number - - .. ) -s 5-06 -10 HGOreaa Expiration Date &Lli ptorl Ma . 0 167 3 Telephoni41 3)527.41 5 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 i :n the denial of the issuance of the building permit Signed Affidavit Attached Yes No ❑ 11. - Home Owner Exemption the current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families ;end to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts. ;is 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 :s. .)r is intended to hc, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm \tr, c1ures. A person who constructs more than one home in a two -year period shall not be considered a howeovtpep. 5, :,:h - homeowner - shall submit to thc 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. .\> acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of thc work,for which this permit is issued. - \':.o he advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to !:a ployecs for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you Rtav be liable for person(s) you hire to perform work for you under this permit. Th„ 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 attached __ __ l ,' • e q 'S • " .l t,„ „: . 1 \ Oat . .r1:•h SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ( Addition Replacement Windows Alteration(s) n Roofing [3 Or Doors El Accessory Bldg. 1 1 Demolition 1 1 . New Signs [0] Decks [Q Siding [01 Other (Oi' Brief Descrii — ;)n of Proposed 2 a h J \Mork } L 1� e- 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 budding : One Family Two Family Other o. Number c• rooms in each family unit: Number of Bathrooms o. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Numbe' c' stories? f. Method of neating? 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. floodptain Yes No ;. Depth of basement or cellar floor below finished grade k. Will bui,ding 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 C( f e •e >u Aoi * , as Omer of the subject property ft; (1 T Ro n hereby authorize l J ' M lar �el l S1 t pc `1 +� . ,o act on my behalf, in all matters r ative to work authorized by this uilding permit application. g attached • co Signafif('e'of Owner Date . • I. Ala y k e1 i s1 e. -as a u t inY'i 7 Pi4 aQ aft , as Owner /Authorized Agent hereby daclare that the statements and information on the foregoing alication are true and accurate, to the best of my knowledge and belief. l Signed under the pains and penalties of perjury. Ma 11Sle- Print Name Signature of Owner /Agent Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Dented Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by (wilding Department , 1. Size I I ()Wage 1 I I Setbacks Front I Side 1.: R l.' R, i Rear I _ I fLilding height r B dg. Square Footage % . :- • . ' 0 )en Space Footage (LA area 1n+nus bldg & paved pa,kine) i 4 .)r Parking Spaces HI: (vnlurnc & I hcalion) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW 0 YES O IF YES, date issued :I IF YES: Was the permit recorded at the Registry of Deeds? NO O . DONT KNOW 0 YES 0 IF YES: enter Book Page; ! and /or Document N 1 I B. 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 O NO O IF YES, describe size, type and location: J D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 0 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 O NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 1 1 . 17771 117.7":. " 7 "* . 7 * *: 7 *** ' ' .,,t . , t •• . CIty of Northampton Statuioth 1, .., • ' .. , , . ' .' ' lere '0.'" • •• ,s, • . .,, . E3uilding Department Curt C w . - z 1 :. , '".. - . ..'' . 212 Maul Street S r -...__ .• 7 ' 14 . 1‘, ' '''''''''Pr *: ' " ' 4 T : •: • ? ' ,'?` , '' ' . Ilig 2 7 MO Room 100 WIltt , ! c ., (: A -, . - • : . . a ' .,...‘'' ii: '/' 1 .! ,-,ii`t-i,, .. 'II` - , - ' ''" - — • Nortnarnpton, MA 01060 1 .w.F.'q, 0 .',„7,7 - 4;o:# 1 .*41 , :A ; --`, .' . : ... .• . - ph oneA13-*7-1240 Fax 413-587-1272 Plot/thii• • ' t- -' • t: • ',"■ o :" no I" "re ' ell ' I i ' 'el! t . '‘ •; .ei %-1', •• • , _ -1 Other'SpeOl 4iik:M! , ` ^ ' zi. ,,'., . ::. ', • 1 • • • ;' ' '.,. - t43;. io.'• .,..." APP, :CATION TO CONSTRUCT, ALTER, REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION This section to be completed by office 1,1 Property Address 3 V Sex 3' . Map i Lot Unit ' /Q0 c•-\2\-‘,Q_ct‘i\-ibf\ Zone Overlay District Elm Si. Dlatrici_____ CB INetskt l SECTION 2 - - OWNERSHIP/AUTHORIZED AGENT - - ----- -- ---- ' - ' 1 Owner of "•ii:ecord: .-.../"' ( 14 S v...Ni yvtic Cil . - iNkcA Ike .L ) 1\ALx Mg Name (Print) urrent Mailing Address: ■fte....c.i 1 41 : Z 1 0 T 03_0_0._ , 2 tta c lephone Signature _ 2.2 Authorized AtIent: . . - .Ma-k_..1 - ,,TA• ll • „Lcos IN II . Name (Print) , • .. a • III II • \ ..."" , Current Maigng • ■dress: 0 ■ 613 (413) 521- 4/15 .-- Signature Telephone • SECT1ON 3 - E$T1MATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only , completed by permit applicant ___ 1 Building ) 0 , F. (a) BuPermit Fee U I 4 I 3oo.ao 1 ---- --. Electrical (b) Estimated Total Coat of Construction from (6) 3. Plumbing Building Permit Fee 4. mecharlica ,:HVAC) 5. Fire Protect (d n 6. Total %, (1 - 2 4 3 + 4 + 5) Check Number 7 /35 This Section For Official Use Only Date Building Perm!: Number. -- issued' • Signature: Building Commissioner/Inspector of BuAdings Dots . . 4`,1,' 38 SUMMER ST BP- 2010 -1086 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 31B - 073 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- 2010 -1086 Protect # JS -2010- 001593 Est. Cost: Fee: $35.( PERMISSION IS HEREBY GRANTED TO: Const. Class Contractor: License: Use Group: RCI ROOFING 74334 Lot Size(sq. ft): 13895.64 Owner: LAVELLE TERRENCE M & ALINE R TRUSTEES Zonin¢_.URC(10Q)/ Applicant: RCI ROOFING AT: 38 SUMMER ST Applicant Address: Phone: Insurance: 6 LINE ST (413) 527 -4775 Workers Compensation SOUTHAMPTONMA01073 ISSUED ON :5/28/2010 0 :00 :00 TO PERFORM THE FOLLOWING WORK:STRIP,PLY & 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: Ok 8=-117- to cw,&_ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL T S. x ,/ . ...--- uaz. A t Certificate of Occupancy - _ ilinature: FeeType: Date Pail. Amount Building 5/28/2010 0:00 :00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo