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23D-009 (5) BP-2001-0991 GIS#: COMMONWEALTH OF MASSACHUSETTS °g t CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:roofing BUILDING PERMIT Permit# BP-2001-0991 Project# JS-2001-1778 Est. Cost: $3800.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RCI ROOFING 126235 Lot Size(sq.ft.): 20081 .16 Owner: DUFFY WILLIAM G&SALLY A Zoning:URB Applicant: RCI ROOFING AT: 26 NONOTUCK ST Applicant Address: Phone: Insurance: P 0 BOX 309 (413) 527-4775 Workers Compensation EASTHAMPTONMA01027-0309 ISSUED ON:5/31/01 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. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: 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: Fee Type: Receipt No: Date Paid: Check No: Amount: Building 5/31/01 0:00:00 371 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo s ti :.. ..' pepartrnent.use.or` City of Northampton Status of Peiip .; Building Department Cu47C 212 Main Street 'Sewers'e. .>� Room 100 Waters ;:` ; _. Northampton, MA 01060 Two:.Se • . .n _ � ; phone 413-587-1240 Fax 413-587-1272 Plat/Site Ptans, £ : s = ss ,04 Other Spebify,.: F 3 s 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 / n 1C/c/s Map Lot Unit Zone Overlay District Elm St. District CB District SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: f(:4 0 P-fy d o i o Name(Print) Current Mailing Address: Telephone t / _ . 9 Signature I 2.2 Authorized Agent: c r I( S .1-- Name(Print) , �' Current Mailing Address: yY • 5.2 7 6/77r Signature Telephone SECTION 3- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6).: 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 +3 +4 + 5) —3 d 0 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date 6 y 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: SECTION 5-DESCRtPTION OIF,PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ] / Brief Description of Proposed Work: 5'f�6 p 511#nt5 �-ef i i' S� L k. (( /2 " v 'v Ltzoo .1 c /`r• S'i.1 f k Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll ❑ - Sheet❑ 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 SECTION 7a-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains nd penalties of perjury. Mark e1, 3 /e Print Name /, ,-y Signature of Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ` � Not Applicable ❑ Name of License Holder : 1 ' 0 C K \ e 1,+1 S e '' 7 'f 3 3 / rcc A L S �� /4 ,1 Z)-2-- Licens Nu be�r� v I Ex Address ira ion Date Expira — S-j- 7 — Signature Telephone 1 $ 11 k = ifl 1 3;(: .. rf.f Not Applicable ❑ (\ Company Name VVV� / Registra • n umber qc.) tins, n 44/C Address / Expi ation ate c /v)- ? Telephone S°`) 7 77S- SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.0.. 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 ❑ No ❑ f lm , t'j 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 -,ttnr-rr,T R� e-cti3;r,oti `—414;1<k' (rifi of 3oLtlja11t}3t0l1 1 n_„_____,• A E ,eZRSSnchncrue = 11-: f^. VA' DEPARTMENT OP 13UELDU'G INSPECTIONS est: ------ -' 212 Main Street • Municipal Building Northampton, Mass. 01060 r'V WORKER'S CO)CPENSA'T'ION LNSURANCE AFFU)AVTI.' (1i ccnsocJpertni ttee) with a principal place of business/resideriice al: e i 0 yri,, 24,, 4,, ,3J Y ii /l1 . O l 2 7 (p'honel i) SI7 (-17 7,S'" (straUci ty/statcrn p) do hereby certify, under the pains and penalties of perjury, that L.)/I :�n an employer providing the following worker's comrensaaon cove.-age for Inv employees wor ong on tins job. �I' b�c y r�u � o tVC! - ��s--- 3> z _, o (Lnsur-am coor-n\') (Policy Number) (Lxpirauon Date) ( ) I am a sole proprietor, general cootractor or homeowner (circ:e one) and have hired the contractors listed below who have the following workers conensation policies: (Name of Comm^ or) (ln urancc Cornoan•iPobc. N'uin'bc:) (1->_p(rouon Date)- (Name of Contractor) (Insurance ComoauyiPotica' Nutncrr) (Exointion Date) (Name of Contracto,) (I.LUUrancc Compa_oy/Policy Number) (Expiration Date) (Vane of Contractor) (tn_surance Comoany/Poticy Number) (L-xpuauon Date) (.aeth art-4i::«:al,`>cct If ncc�i.ry to inoJutk infoc min no pa-bunint to.1l coor^,..c-0 ) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plc--;be nwarc thsi wtuic hoancou,ni,vwo employ pc-tont to do r-.:.-t1-3 _,=M.,c, C rrpau work on.d',c1lin of not atocc th•n tr-o_toil,in which the twcneow cr maiden or on the c ouod,:ppurten.r_the-do r.2 ax 6e>.-:11y o idou ro be critployco ocean-the..o i;cfe c c Lion Act(GLt S2,s,i l(5)),npptieaiioo by R botneo•vcr fm t tics--ec pa-nit n_.y e.idcooe the legal et=au of to cen Ioyor under the Worlecei Compomalioo Ad I undc,Ytand that a copy of this ealemect tinny bo focanirti.d to the Dep.utux a of 1r A+.r,,d nmduso OiLioo of brrur+000 foe the oovcrxS(vcrjrciioo atd ttut L•iltsc to soaut'eovcrnsc under soetion 25A of MOL I 52 can lad to the i ilioa of crimioil peatliies 000iiroug of i fine of up to S 000.00 and/or itcowboacocat o f up to one year end civil pmRJtio in the form of n Stop Work Order nod■ flan of 5100.00 t day apron me ' For dcp•rk•=->1 u,c only Pc-rmit Number 1vL7 p.;_ Lo Signatnn:of LicuisecRecmiacc Thte ....__ R.C.I ROOFING MAIN x ESTIMATE EASTHAMPTON, MA 01027 (413)527- 4775 FAX (413)527-8469 Date: 5/15/01 Estimate To: BILL DUFFY Estimated By: MARK DELISLE Start Date: Job Location: 26 NONOTUCK NORTHAMPTON Job Phone: 584-2592 JOB DESCRIPTION REMOVE EXISTING ROOFS FURNISH & INSTALL 1/2" PLYWOOD OVER EXISTING DECKING FURNISH & INSTALL ALUMINUM DRIPEDGE AND ALL OTHER RELATED FLASHINGS FURNISH & INSTALL ICE & WATER g4RRTER ALONG EAVES AND VALLEYS FURNISH & INSTALL .L531).FELT FURNISH & INSTALL 25 YEAR SHINGLE. FURNISH & INS TAT,T, RIDGE VENT FURNISH & INSTALL NEW LEAD CHIMNEY FLASHTNc. ALL ROOFING RELATED DEBRIS TO BE REMOVED BY RCI ROOFING. R.C.I. WORKMANSHIP WARRANTY INCLUDED TAMKO MATERIAL WARRANTY INCLUDED SPECIAL ITEMS NEEDED Additional information pertaining to this Job Estimate TERMS OF PAYMENT 30%PRIOR TO START Total Estimated 70%UPON COMPLETION Job Cost $3,800.00 REGISTRATION#126235 FEDERAL I.D.#04 3418839 Authorized O CONSTRUCTION LICENSE#074334 Signature \ '„v �/�,i► �_ �..�✓ INSURED BY HACKWORTH INSURANCE(413)527-9907 ,5-. .17 ,1 `t ORIGINAL-ESTIMATOR COPY I