10D-010 BP- 2010 -0148
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- 2010 -0148
Project # JS- 2010- 000178
Est. Cost: $5500.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor. License:
Use Group: RCI ROOFING 74334
Lot Size(sq. ft.): 9583.20 Owner: CALLAHAN FREDRICK D & CHERYL A
Zoning: URB(100) //WP Applicant: RCI ROOFING
AT: 129 WATER ST
Applicant Address: Phone: Insurance:
6 LINE ST (413) 527 -4775 Workers Compensation
SOUTHAMPTONMA01073 ISSUED ON. 81712009 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 8/7/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
City of Northampton
Building Department
212 Main Street
Room 100 V1f 11'' Y1 tt
Northampton, MA 01060
phone 413 - 587 -1240 Fax 413 - 587 -1272 F�lot
Other `5
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 complebd by office
9 � 0.�eX' � � . "' - ; MaP Lot UrA
7
` Zone OwrMy tKs
S
Elm St. Dwwdt ce
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
C�'e-rI k 4 pO k j q (,- Ck-A' -r r S
Names (Print) Current Mal" Address:
t 4 11 �l - 53 cD (l 0 FjS
Telephone
Signature
2.2 Authorized Aaent:
Mayk v
1
Name (Print) �,— Current Mafpnp Add ress:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
com leted by rmit applicant
1. Building ,) f j Q ® e) o (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of .
Construction from 6
3. Plumbing Building Permit Fee
4.:MWianical (WAC)
5 ti 4 ,fttection
6. Total = (1 + 2 + 3 + 4 + 5) ° Check Number _
This Section For Official Use On
?Permit Number. �
Building CommMIcir er/inspector of Buildings ( x 777
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 DepeRment
Lot Size
Frontage I
Setbacks Front -
Side L: . R:1
L: R
Rear
Building Height
Bldg. Square Footage
Olen Space Footage r
(Lot area minus bldg & paved 1
pa,-king)_
# of Parking Spaces I F___A
Fill:
volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOWii 0 YES 0
IF YES, date issued:_.. _ l
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW . 0 ( YES, 0
IF YES: enter Book " _._.,,..___ ....� Page___ and /or Document #L
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued: C �
C. Do any signs exist on the property? YES 0 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 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 0 NO O
IF YES, then a Northampton Storm Water Management Permit from the DPW Is required.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all aimlicable)
I New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs (01 Docks 10 Sidling (01 OdwrIC *
Brief Description of Proposed
Work: a
i Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
` Plans Attached Roll - Sheet
.sa. If New house and or addition to existing housing, complete the followina:
i a. Use of bu !ding : One Family Two Family Other
b. Number o� 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 Ccnservation Compliance. Masscheck Energy Complianee.form attached?
h. Type of construction
I i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yea No
j. Depth of basement or cellar floor below finished grade
k. Will buildirg conform to the Building and Zoning regulations? Yes No.
1. Septic Tan''k City Sewer Private melt City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I as Owner of the subjed
grope �
hereby authorize R oo f ; na
to act on my behalf, in all matters relative to work authorized by thistuilding permit application.
0
Sig f Ownar Date
M zyk sliv- as Ownerdut wined
Agent hereby declare that the statements and information on the foregoing a0lication are true and accurate, to the best of my knoWilimi e
and belief.
Sigriiunder the pains and penalties of perjury.
Pri
S'�Iaf Owner /Agent Date
y y ' F Yt {
4
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable O
b
Name of License Holder Y !l - bei , S 1 e' 1 124 3 3 `r
License Number
Ma. n tQ`t7� .5 -103 - 10
Address Expiration Date
Signature Telephone
9. Registered Home Improvement Contractor: Not Applicable O
126235
Company Name �+� Registration Number
' r3 V ' MPCn ` ' — I 1 D
Aooreaa Expiration Date
Telephon •
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 26C(6))
Workers Com .oensation insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will re"
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... ie No...... O
11. - Home Owner Exemption
The current exemption for "hoMcowncrs" was extended to include Owner - occupied Dwellimn 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 nets
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
structures. A person who constructs more than one home in a two -year period shall not be copsidered a hom2w w
such •homeowner" shall submit to the Building Official, on a form acceptable to the Building Official that he/she shalt be
responsible fbr all such work performed under the building permit.
.as acting Construction Supervisor your presence on the job site will be from time to time, during and upon
completion 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
Employees for iniuries not resulting in Death) of the Massachusetts General Laws Annotated, vop mar ba cable fat permi(s)
you hire to perform work for you under this permit. a
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
\Iorthampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
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DEPARTMENT OF BUILDIKG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mar. 01060
WORICER'S COMPENSATION INSURANCE AFFIDAVIT
(liceascelpermitttx)
wit a principal place of business/residence at:
•^ia'p'tl .01a-. Ol0"�3 (phone# 1 J
- city /staidnp�
do �:erc;by certify, under the pains and penalties of perswy, that:
(�I am an employer providing the following worker's compensation coverage for my
employees workng on this job:
ms s. co. bG q,'�tom,
(lnslu-ance Comgauy) (Polity Number) (.*mtfn Dada)
a sole proprietor, general contractor or homeowner (circle one) and have hind
ttr contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Comipany/Poliey Number) Mkp Dde)
(Name of Contractor) - (insurance Company/Policy Number) (Expt ldaDO)
(Dame of Contractor) (Insurance Company/Policy Number)
(Name of Contractor) (insurance Company/Policy Number) MOM= DO)
( h zdditioaal sled if aeomuy to izr t iofacmadoo pat %Wft to *a ooedas(oet)
O I am a sole proprietor and have no oat working for me.
O I am a home owner performing all the work myself
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Board of Building Regulations and Standards
Constructs "pn Supervisor License
Lice's CS 74334
10 Tr# 23520
MARK T DELISLE�1`""'�
33 FIRST AVE
EASTHAMPTON, MA 01027 Commissioner
Ire �� �monu�� o�,/�aeaaa�see� •
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration\,126235
Expiration. ' 510/2010 Tr# 266063
{ ' Pi6ership
i
R.C.I. ROOFING
MARK DELISLE
51 B HOLYOKE ST.
EASTHAMPTON, MA 01027 Administrator
i
1i �=
R o
ofingLLP
51B Holyoke Street
P.O. Box ton Estimate Date
Easthampton, MA 01027
Phone(413)527 -4775 4/14/2009
Fax (413) 527 -8469
Name / Address Job Location
Cheryl Fox 129 Water Street
129 Water Street Leeds, MA
Leeds, MA 01053 586 -4085
Terms Rep
Estimate valid for 20 days
a
Job Description Total
ESTIMATE DOES NOT INCLUDE ADDITION ROOF. 5,800.00
Remove existing roofs. to"
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.
Furnish and install rubber membrane roof on low- sloped portion in rear of house.
All exterior roofing related debris to be removed by R.C.I. Roofing.
All work will be performed according to manufacturers' specifications.
5 -year R.C.I. Roofing workmanship warranty included.
30 year CertainTeed material warranty included.
All related permits will be obtained by R.C.I. Roofing.
Certainteed 5 -Star SureStart extended warranty ......... Add $120.00
SPECIAL ITEMS NEEDED
Add $2.50 per sq. ft. for wood decking replacement if needed.
THE OWNER HAS THE
BUSINESS RIGHT
DAT OF SIGNING. CONTRACT WITHIN (3) Total $5,800.00
3 00 et ct
TERMS OF PAYMENT
5% Deposit
Balance upon completion Customer Signature
Registration # 126235
Construction License # 074334 I
Insured by Reynolds, Barnes & Hebb, Inc. 413- 447 -7376 Date 02 02 - T