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