17D-030 (3) , • ..
..., , i.i. Roofing, LLP
3 113 Holyoke Street
:.O. Box 309
Esti "a m ate Date
sthampton, MA 01027
Phone (413) 527 -4775 1/17/2005
Fax (413) 527 -8469
F. Name / Address Job Location
Lmi ly Todd 51 Straw Avenue
- I Straw Avenue Florence, MA
:lorence, MA 01062 586 -0421
Terms Rep
Estimate valid for 60 days Mike
Job Description Total
1 2move existing roofs. 5,775.00
Furnish & install 1/2" plywood over existing decking.
rurnish & install aluminum drip edge, pipe flashings and chimney flashings.
I' irnish & install ice & water barrier along eaves and valleys.
Furnish and install 15 lb. felt.
i arnish and install 30 year Tamko shingle.
I Furnish and install ridge vent.
1 A roofing related debris to be removed by R.C.I. Roofing.
\ll work will be performed according to manufacturers' specifications.
5 year R.C.1. workmanship warranty included.
3J year Tamko material warranty included.
1 .` 11 related permits will be obtained by R.C.I. Roofing.
SPECIAL ITEMS NEEDED
I Any carpentry work will be billed on a time & material basis.
Estimate includes main house and front porch only. Does not include flat roofs on side or back of house or
I do ached shed roof.
I
L
I E LOOK FORWARD TO DOING BUSINESS WITH YOU.
Total $5,775.00
(1 \1S OF PAYMENT
30% Upon delivery of materials 7 �
I% A Upon completion Customer Signature ` L I J 76jj
i •gistration # 126235
Construction License # 074334 Date 5 I 31 03
i 1..sured by Hackworth Insurance (413) 527 -9907
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F� E (.ib of a rti 1 ... T—. = � r 4 , eii,� - i ll Rtassachnsrtls 't ror �`� o- j� - DEPARTMENT OP DUILDNC INSPECTIONS 4 c r� -
212 Main Street Municipal Building
Northampton, Mass. 01060 ire s"
WORIOER'S COMTENSA`IION NSURANCE AFTIJ)AV1T
I _ �� eJi 5�, R C• � l>r"? ._
(liccv.s iperrnittec) 9
with a principal place of business residence at: • 0
51 B Hol at./ Eas+h tnn .MA O)D J7 (phoncio6 13).5;97 -4
C � ( t/ci ry /stalcda p )
do hereby certify, under the pains and penalties of perjury, that
(Vc I am an employer providing the following worker's cornoensaion coverage for my
employees wort ng on this job:
•
Q ► h f Alt/Jai vi 7i�
a 3IS1.3Iil -0411 10/s/ 05 _
( I J as clam-in= Compa (Policy Nu r) (a-ptruorn Date)
( ) I,am a sole proprietor, general contractor or homeowner (ciscie one) and have hired
the coon listed below wbo have the follotvinR worker's compen_anon policies: .
(Name of Contactor) (Insurance CoJnpanyiPolic- Num c) ( xplrii o? Dnlc)
— (Name of Contraeror) (Insurance ComoanviPoUcy Numccr) (Esoir.:tion Date) .
(Name of Contractor) (Insuranc: Company/Policy Nambet) (Expirtion Datc)
(Name of Contractor) • (Losutance Company/Policy Number) (Ex Date) .
(attach abditroc J bea ifnoonsury to asctudc infer z oa p -t iain to .1J oz•ccrac.or) •
•
( ) I am a sole proprietor and bave no one worldng for me. .
( ) I arn,a home owner performing all the work myself.
NOTE: plc-se be aware th w bomoo mem w =play prssooa to cam= :c+oo a- rcaair Woric on • clwallin of
cot more disc t =kJ in which the bowoowocr rcido or oa Lh6 Grmsocto a.ppurtcu: j7 ton- o w-c ax cos—filly oomick—oi a be
earploycs uode the taai:a's cccapcmcsst.ion AM (GL152,ssI(5)), application by • bomco4vc for c lie=c or peranit rszy csideonc the
IcgaJ n.a of ea enc*loyee coder dso Wortc ?s Coo pomatioa A.
1 uodcTtand th. n a u m d copy of tbuzoont racy be fore erd. to the oopertmcos ortodur ccoda
aid Aott' Moe or lnr w*.000 roc tb• '
oovcract vmf eIIioa and th1 (Jtae to secure loovcricc wader soction 25A of MOL 152 tan tad to the imposition of c imia i pcoAltio m
ooasiAiag of it f i n e of up b S 1.303.00 andk r of up to ooc year and civil pmaJ'.io is de form of • stop Work Otdnr and a
km o(S I00.00 a day apinst lac
ra dcp.rta•� ux only •
i
P CTITlJ I l`It1JD - � ,
Si gnal:Lit of LiccnsccfPcrmiucc Dtte .. - i c
N, 0 F ttoi SeRVICE$
8.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : j 1117.1i 5I € '771133
License Number
i ■ 'I - , s , ..• Os y3 r i. 7 5 - ,3 - O v'o
Address �� Expiration Date
113) .5Q 7- J1775
Signature
�3Kcl� e -` slriT�Y • raeRi - ,, . _ Not Applicable 0
R. Rnofi n 1 2 6 2 35
Company Name Registration Number
• o Main cni - Rt tiox .3n 5 - 6 - O.(o
Address Expiration Date
Eastha r ptnn, YIA 010g1 • Telephone (.913) 5a'7 -/ '175 E 0�0RS�C�O ION�N RANCE�AFFIDAVIT (M G L c' 152, § 25C(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 Lik No ❑
The current exemption for "homeowners" was extended to include Owner- occupied Dwellings 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 acts
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 considered a homeowner.
Such "homeowner" shall submit to the 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.
As acting Construction Supervisor your presence on the job site will be required 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 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.
The 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}.-an.iled
4 c
' e'er a' :r!....'k� 't� . ', c
New House 0 Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ► :
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ 1 Decks [ j Siding [ j Other [ j
Brief Description of Proposed Work: A %P.A►PC
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative 0 Renovating unfinished basement Yes No
Plans Attached Roll 0 • Sheet 0
; f I ' ew " h.®� <a:. ® d` ro""°n o eeistIn ho ng comrl `t°e�e ti CLowln :
a. Use of building : One Family • Two Family Other
b. Number of 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 Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
i. Is construction within .100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? _ Yes No .
I. Septic Tank City Sewer Private well City water Supply
6;1404 'yt�3za-
E O 'tz° .fJ ' ON BE .tG MP L "I ED NIEN ` i
_� ..- . T`q P APP II E , ILO GAR li i2
I , EM t 1 y Toad • , as Owner of the subject property
hereby authorize 1 1 I �7 l • / I 1! to act on
my behalf, in all matters relative to work authorized by this building permit appl cation.
Q fii.Q069r-1 4 - an - 0
Signature of Owner Date
I, 1 .k ' S ' I Q • • • ' .I , as Owner /Authorized Agent
hereby declare that the statements and information on the f. -going application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
�1 i "
Print Name
JI-ao -o5
Signature of Owner /Agent Date
Section 4.
- ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF INFORMATION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
•
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES ._
No
IF YES, describe size, type and location:
. - -
•
•
n
(. City of Northampton X .4,r° r
'_ ii," li_ 1 Tiding Department � � r �'t+ a"�gr' ° a
_ ? 12 Main Street -6
Room 100��� d '_
2 l 2005 Northampton, MA 01060�'�r� �Y�
phone 413-58 Fax 413-587-1 272�f_�
APPLICATION TO CONS-T; CT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
his secti"o 't• • e"co •I t d • `•ffac *°
1.1 Property Address: '. . ... - !,,r t �-' �
s
Si �O ✓ ► C'J . ' � � 3 � .,y n a "^s.S ,. '- y :1°,''.'.'-' 17 - & r.
V a a - ,stogy r „,,t4,'.“ ` aw t. r p 4. .4*n iv '
i.4 aro ?a :' !t^ .: ?
e , a - z,M- r r a” �' -1'.4j.0 S °C a 1 s
1 J Y " t#$ ", z , y .^"' .7 YN t yyq
rEl District �� - 4 2,, CB Dts r�ct '`�t F t"`
SECTION 2 - PROPERTY OWNERSHIP /AUTHO, IZ.ED A .
2.1 Owner of Record:
F,mil St tY \te. I FIoYP.nee.
Name (Print Current Kailing Addre s:
attU.Pk Teleph
PA 5 o - ON a
one
Signature
2.2 Authorized Agent:
Moak IDe /is le, - 13. C. I. f oo n9 RC I ox 309- E05tha pt- , .MA
Name (Print) Current Mailing Address: I 01 Qa,7
>— 1 i 4 1 1 3 5a - 'f q5
Signature Telephone _
SECTIOf 3 ES'i IMA'f ED CONSTR G TS
Item Estimated Cost (Dollars) to be Official Use Only
(+ completed by permit applicant
1. Building R0o7 i n9 41 5775.00 (a) Building Permit F ee'
2. Electrical (b) Estimated T
Construction, from(6) of
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
1 5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Al 5775.00 i Check Number
This Section For Official Use Only
Building' Permit Number: Date issued:
Signature:
Building Commissioner /Inspector'of Buildings Date
r
µ� ys
BP- 2005 -1017
GIS #: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit # BP- 2005 -1017
Project # JS- 2005 -1397
Est. Cost: $5775.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RCI ROOFING 126235
Lot Size(sq. ft.): 16335.00 Owner: TODD EMILY
Zoning: URB Applicant: RCI ROOFING
AT: 51 STRAW AVE
Applicant Address: Phone: Insurance:
P O BOX 309 (413) 527 -4775 Workers
Compensation
EASTHAMPTONMA01027 -0309 ISSUED ON:4/22/05 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 4/22/05 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo